HeartSuite 6.20 HL7 Interface Specification · 2011-06-21 · Tech Note: HeartSuite 6.20 HL7 Interface Specification Proprietary and Confidential | 85000-1004A Page 5 of 57 4. HL7

85000-1004A

HeartSuite 6.20HL7 Interface SpecificationTable of Contents1. Purpose....................................................................................................................................................................................... 3

2. Scope .......................................................................................................................................................................................... 3

3. General Information / Reference Documents .......................................................................................................................... 33.1. Key Operational Issues ............................................................................................................................................. 3

3.1.1. Use of Unique Patient Identifier............................................................................................................. 33.1.2. Use of Visit Number............................................................................................................................... 33.1.3. Use of HL7 Order Messages ................................................................................................................. 4

3.2. Applicable Standards ................................................................................................................................................ 43.3. Definitions ................................................................................................................................................................. 4

4. HL7 Interface Description.......................................................................................................................................................... 54.1. HIS Requirements..................................................................................................................................................... 64.2. Data Flow .................................................................................................................................................................. 7

5. Application Specific HL7 Message Processing ...................................................................................................................... 75.1. HeartSuite ................................................................................................................................................................. 7

5.1.1. ADT ....................................................................................................................................................... 75.1.2. ORM ...................................................................................................................................................... 75.1.3. ORU....................................................................................................................................................... 7

5.2. HeartSuite Hemodynamics ....................................................................................................................................... 85.2.1. ADT ....................................................................................................................................................... 85.2.2. ORM ...................................................................................................................................................... 8

5.3. EchoIMS.................................................................................................................................................................... 85.3.1. ORM ...................................................................................................................................................... 85.3.2. ADT ....................................................................................................................................................... 85.3.3. ORU....................................................................................................................................................... 8

6. RadSuite and HIS HL7 Messaging Specifics ........................................................................................................................... 96.1. HL7 Message Processing Requirements.................................................................................................................. 96.2. Transport and Minimal Lower Level Processing Requirements................................................................................ 96.3. Segment and Field Requirements............................................................................................................................. 9

6.3.1. Common Message Header (MSH) Segment....................................................................................... 106.3.2. ADTÂ01 - Admit Patient..................................................................................................................... 106.3.3. ADTÂ02 - Transfer Patient................................................................................................................. 136.3.4. ADTÂ03 - Discharge patient .............................................................................................................. 14

Confidentiality Statement

© 2008 Emageon Inc. 1200 Corporate Drive, Suite 200, Birmingham, AL 35242 | Support: 800-383-1046.The information contained herein is confidential and is the sole property of Emageon Inc. None of the information may be reproduced, copied, and/or re-distributed electronically, manually, or otherwise to any person without advance written permission from Emageon, except as may be expressly authorized bycontracts or other agreements between Emageon and its customer. Emageon is a registered trademark and Enterprise Visual Medical System (EVMS) is atrademark of Emageon Inc. Other trademarks or service marks referred to herein are the property of their respective owners.

TechPropri

6.3.5. ADTÂ04 - Register patient ................................................................................................................. 156.3.6. ADTÂ06 - Outpatient to Inpatient....................................................................................................... 186.3.7. ADTÂ07 - Inpatient to Outpatient....................................................................................................... 196.3.8. ADTÂ08 - Update Patient Information ............................................................................................... 216.3.9. ADTÂ11 - Cancel Admit..................................................................................................................... 246.3.10. ADTÂ13 - Cancel Discharge.............................................................................................................. 256.3.11. ADTÂ40 - Merge Patient.................................................................................................................... 266.3.12. ORMÔ01 - 'New Order'...................................................................................................................... 286.3.13. ORMÔ01 - 'Cancel Order'.................................................................................................................. 336.3.14. ORMÔ01 - 'Change Order' ................................................................................................................ 376.3.15. ORU^R01 - Advanced Visualization Radiology Reports and HeartSuite Hemodynamics Laboratory Re-sults 406.3.16. ORU^R01 - Unsolicited Result HeartSuite and EchoIMS Reporting ................................................... 426.3.17. MDM^T02 - HeartSuite Hemodynamics Case / Physician Report....................................................... 466.3.18. ORU^R01 HeartSuite Hemodynamics Case / Physician Report ......................................................... 48

6.4. HL7 Message Acknowledgments............................................................................................................................ 506.4.1. Acknowledgement from RadSuite ....................................................................................................... 50

6.5. Pre-Filtering............................................................................................................................................................. 50

7. Appendix A - Sample ORU Messages .................................................................................................................................... 517.1. ORU^R01 HeartSuite Message Sample (single OBX)............................................................................................ 517.2. ORU^R01 Pediatric Echo Message ........................................................................................................................ 53

Note: HeartSuite 6.20 HL7 Interface Specificationetary and Confidential | 85000-1004A Page 2 of 57

1. PurposeTo ensure the definition of a HL7 implementation, protocol, and communication between the Hospital Information System (HIS) and Emageon Standard HL7 Interface (henceforward Emageon HL7 Interface) are documented.

This specification applies only to HeartSuite 6.10 systems.

2. ScopeApplies to the Emageon HL7 Interface.

3. General Information / Reference DocumentsThis document contains specific details of the Emageon HL7 Interface. These specifications shall be construed as the data set and implementation of the Emageon HL7 Interface produced by Emageon in order to implement inbound and outbound HL7 messaging. This interface is a component of HeartSuite and used for communicating patient and medical information with a Hospital's Information System.

Some of the benefits realized by use of this interface include:• Automatic pre-fetch of archived images for scheduled patients.• Reduce or eliminate redundant physician/technician manual entry of patient data.• Means for a hospital information system to receive clinical results information.• Capture a rich set of patient data in HeartSuite for numerous applications.• Helps in providing a centralized point for maintaining patient demographics within the department.• Modality worklists for managing site workflow.

Because the software architecture of the Emageon HL7 Interface allows for configuration changes to meet site-specific requirements, it can be adapted to an institution's existing HL7 communications protocol and messaging structure if changes are not feasible on the institution's interface engine and/or HIS components. Having a flexible design that allows for site specific configurations, the Emageon HL7 Interface provides several advantages for HeartSuite customers:

• Specify what HL7 fields are required and optional.• Allows for site-to-site variation regarding what information is contained in various fields.• Minimizes time required to establish an integrated system with the hospital information system.• Message structure can be uniquely tailored for each site.

Customization and configuration of the Emageon HL7 Interface is available. Customization and configuration require a site specification to be co-written and agreed to by Emageon and the institution requesting customization. Development work for configuring the Interface and any unique HIS requirement-driven development will not begin until there is agreement of the site specification by both parties. Further questions on the customization process should be directed to your Emageon Account Representative.

3.1. Key Operational Issues

3.1.1. Use of Unique Patient Identifier

HeartSuite requires the population of a unique patient identifier for each patient; typically this identifier is in the PID-3 field as defined in the HL7 Standard. When dealing with multiple sites or institutions, especially when existing hospitals have formed into one entity, issues such as duplicate patient identifiers may arise if each site issues its own identifiers for patients. In these situations, typically a Master Patient Index (MPI) is implemented by the combined institutions to resolve conflicts such as duplicate patient identifiers.

3.1.2. Use of Visit Number

When considering ACC reporting requirements (e.g.,patient admission date) and HL7 result messaging requirements of various hospital information systems, capturing visit details for a patient on HeartSuite may be important. In order for HeartSuite to capture and properly associate visit information, a unique visit identifier (sometimes referred to as the episode number) for a given patient must be included in the HL7 messages

Tech Note: HeartSuite 6.20 HL7 Interface SpecificationProprietary and Confidential | 85000-1004A Page 3 of 57

sent to HeartSuite. When utilizing HL7 order messages, it is acceptable for HeartSuite to receive multiple HL7 order messages that include the same visit identifier for a patient having multiple studies scheduled within the clinical domain during a single visit.

3.1.3. Use of HL7 Order Messages

The HeartSuite system benefits by the use of HL7 order messages. One advantage for utilizing order messages is that the message itself can be used as a filter for the Institution's network of HL7 systems. That is, typically an order message is only sent to the department or lab system that can 'fill' the order. For example, a Cardiology order for an ultrasound test will not be sent to a Radiology department's server for fulfillment. The HL7 order message is sent only to the Cardiology server - thus eliminating unnecessary processing of that message by any other department's server. Reception of an HL7 order message yields improved departmental workflow and pre-fetching any archived studies for the patient.

Lack of an order message could have numerous disadvantages and may inhibit the expected functionality and use of the system with respect to the clinical user's workflow. Decisions to implement the HL7 interface without an Order Message input should be jointly reviewed with the clinical staff, the Emageon Account Manager (sales person) and Emageon Project Management to ensure that the user’s expectations are properly set.

3.2. Applicable Standards

The Emageon HL7 Interface is guided by the requirements of the following specifications and standards:

ANSI/HL7/V2.3.1-1999 HL7 Standard Version 2.3.1

3.3. Definitions

HL7 Health Level 7

HIS Hospital Information System (including an interface engine, where applicable)


4. HL7 Interface DescriptionThe following diagram shows the general flow of HIS and Emageon HL7 Interface messages.

As shown in the above diagram, the HIS communicates with the RadSuite HL7 Interface to send inbound ADT and Order messages. The RadSuite HL7 Interface in turn forwards all messages to HeartSuite, which then forwards appropriate messages to HeartSuite Hemodynamics and EchoIMS. Note that forwarding of messages to HeartSuite, HeartSuite Hemodynamics, and EchoIMS is transparent to the HIS.

Both HeartSuite and EchoIMS directly communicate with the HIS to send outbound Reports messages. HeartSuite Hemodynamics does not communicate directly with HIS to send outbound Reports. Hemodynamics sends data to HeartSuite to pre-populate the reports which are then sent to HIS by HeartSuite HL7 Interface.

For inbound messages, the RadSuite HL7 Interface waits for a connection initiated by the HIS. When the HIS is required to send a message, it requests a connection to the Emageon HL7 Interface if there is no existing connection. Upon acceptance of the requested connection, the HIS transfers the message data and keeps the connection open until an acknowledgement from the Emageon HL7 Interface is received. After this message transfer and acknowledgement cycle, the HIS can keep the connection open for further message transfers, or disconnect from the Emageon HL7 Interface until another message transfer is required. At that time, another request for connection by the HIS is required and the same sequence of events is executed.

For outbound messaging, the HeartSuiteHL7 Interface client will attempt to connect to the HIS when data is available for transfer to the HIS (e.g. a HeartSuite based Clinical Report has been confirmed by a physician). After the result message is sent, the HeartSuite HL7 Interface client will wait a configurable amount of time for an acknowledgement to be returned. If an acknowledgement is not returned, the HeartSuite HL7 Interface will attempt to resend the result message again after a configured amount time. The HeartSuite HL7 Interface will attempt to send a result message until it receives an acknowledgement message, unless configured to not receive an acknowledgement, or until the maximum number of retry attempts is reached. The number of attempts can be configured.

HIS HeartSuite

HeartSuiteHemodynamics

EchoIMS

ADT and order

Reports

Forwarded HL7 messages

Forwarded HL7 messages

Pediatric echo reports

RadSuite


The Emageon HL7 Interface supports the following HL7 messages:

Component Key:• RS: RadSuite• HSV: HeartSuite (Includes the VERICIS application.)• HSH: HeartSuite Hemodynamics• E: EchoIMS

Supported message segments for each message are listed in the table entitled Supported Message Types and Segments. Details of each message type, associated segments and fields are addressed below in the section Segment and Field Requirements. It is possible for the Emageon HL7 Interface to process different and additional message types. Please consult your Account Representative for information regarding the Emageon HL7 Interface customization, configuration, and testing services.

It is desirable the sending application filter out ADT messages not relevant to HeartSuite.

4.1. HIS Requirements

The Emageon HL7 Interface expects the following capabilities from the HIS:• The physical network layer is Ethernet.• The HIS will send HL7 messages via TCP/IP.• The HL7 messages sent by the HIS follow the MLLP standard.

HL7 MessageSupported Applications

RS HSV HSH E

ADTÂ01 - admit patient. X X

ADTÂ02 - transfer patient. X

ADTÂ03 - discharge patient. X X

ADTÂ04 - register patient. X X

ADTÂ06 - outpatient to inpatient. X

ADTÂ07 - inpatient to outpatient. X

ADTÂ08 - update patient information. X X X X

ADTÂ11 - cancel admit. X X

ADTÂ13 - cancel discharge. X

ADTÂ40 - merge patient information. X X X X

ORMÔ01 - new ('NW') order. X X X X

ORMÔ01 - cancel ('CA') order. X X X X

ORMÔ01 - status update ('SC') or ('XO'). X

ORU^R01 - radiology report - EVMS X

ORU^R01 - laboratory results - HS Hemo X


• The HIS will connect to configurable port at an IP Address (designated at system installation time) to send HL7 formatted ADT and ORM messages. The IP Address is determined by the Hospital's Network and/or IS Depts.

• The HIS accepts an acknowledgement message with the HL7 ACK message type in response to the ADT and ORM messages sent to HeartSuite.

• The HIS will buffer messages in the event that the connection to the HeartSuite HIS Interface goes down. The buffered messages are sent once the connection has been re-established.

• The HIS will listen on a port at specific IP Address to receive unsolicited HL7 ORU (result) messages from the HeartSuite HL7 Interface Client application.

• The HIS will send acknowledgement messages with the HL7 ACK message type in response to the ORU messages sent from the HeartSuite HL7 Interface.

4.2. Data Flow

The Emageon HL7 Interface is capable of handling data flow that is unsolicited and bi-directional. As a server, the Emageon HL7 Interface accepts unsolicited HL7 ORM and HL7 ADT messages sent by the HIS. The Emageon HL7 Interface, in turn, replies with an HL7 acknowledgment message of type ACK. As a client, the HeartSuite HL7 Interface sends unsolicited HL7 ORU messages (event R01) to the HIS with the expectation of an HL7 acknowledgement message of type ACK returned from the HIS.

5. Application Specific HL7 Message Processing

5.1. HeartSuite

5.1.1. ADT

When HeartSuite receives an A01, A02, A04, A06, A07 messages, the patient and visit information is created (if not previously existing); otherwise the appropriate patient and visit information is updated.

When HeartSuite receives A03, A08, A11, and A13 messages, the appropriate patient and visit information is updated (if previously existing), however HeartSuite does not create patient and visit records from these messages if patient and visit records do not previously exist.

5.1.2. ORM

When HeartSuite receives a New Order (NW) message, patient and visit records are created (if not previously existing), and a scheduled Order is created. A pre-fetch of prior studies is also triggered at the reception of the New Order message.

When HeartSuite receives a Cancel Order (CA), the scheduled order is deleted from HeartSuite, unless the study has been started or is completed. Note that patient, visit, and order records are not created in HeartSuite if these do not previously exist.

When the status of a Study is changed from an initial value to a different value that is not scheduled (S), then HeartSuite will send out a Status Change (SC) message to the HIS if the system has the HL7 Outbound option installed.. Also if a Study becomes associated to an Order and that Order has a status other than scheduled (S), then a Status Change (SC) message is sent out if HL7 Outbound is available.

5.1.3. ORU

When the confirming physician confirms a report in VERICIS Clinical Reporting, a ORU^R01 message is sent to HIS. When the confirming physician makes amendments to the report, the amended report is resent.

An ORU^R01 message can be split into multiple messages. This allows systems that have restrictions on the number of OBX segments allowed in a message, or has limitation on the amount of bytes sent in a message, to function appropriately. If a report exceeds the number of OBX segment or the number of bytes restriction, a DSC segment is inserted at the end of the report and the remaining part of the report is sent in the next HL7 message.

NOTE: For HeartSuite to be able to return visit related information (i.e. PV1 segment), an order is required, either sent through HL7 Interface or user-created in HeartSuite.

The available report types that are available will depend on the server and application. For example, HeartSuite Hemodynamics can send back Case Reports or Physician Reports. HeartSuite can only send back a Physician Report, but allows for multiple report types.


5.2. HeartSuite Hemodynamics

PhysioLog supports the use of either ORM or ADT input. The preferred method is to use ORM input.

5.2.1. ADT

The ADT input method to HeartSuite Hemodynamics should only be used with a filtered ADT feed. An unfiltered ADT feed may result in a case queue that is unreasonably large and therefore ignored by the clinical user.

When HeartSuite Hemodynamics receives an A01 or A04 message, the Interface stores the applicable patient demographics. HeartSuite Hemodynamics provides a user interface called the HIS Patient Select screen to view all resident ADT patient records. When the user selects the appropriate patient, HeartSuite Hemodynamics inserts the patient in the Case Queue with all applicable demographics populated. HeartSuite can be configured to send an A01 to HeartSuite Hemodynamics when it receives an ORM.

HeartSuite Hemodynamics utilizes the A03 or A11 message to delete the patient from the database HIS tables and, if the cath procedure has not taken place, from the HeartSuite Hemodynamics Case Queue. Cancel Order Messages are processed in the same manner.

The A08 message can be processed anytime before the case is performed and the patient demographics will be updated.

The A40 message is used to merge the Patient ID after the admit and/or order messages have been received, but before the case is performed. This message can only be processed prior to receiving the A03 or A11 message.

5.2.2. ORM

The preferred alternative to manual patient selection is the New Order message (NW) from the HIS. If the HIS sends an Order message to HeartSuite Hemodynamics prior to a cath procedure, HeartSuite Hemodynamics automatically creates a Scheduled Study with all applicable demographics populated. Note however, that the queued case may not be visible if the date is future.

The case queue will only accept the first order presented for a given visit. Multiple orders for a visit will be ignored.

The ability to cancel a case utilizing the Cancel Order message (CA) is also provided. If the cath procedure has not taken place, the case will be deleted from the HeartSuite Hemodynamics Scheduled Studies.

5.3. EchoIMS

5.3.1. ORM

EchoIMS requires an Order message before any other messages for a patient can be processed. When an New Order message (NW) is received, EchoIMS creates patient and visit records (if not previously existing), otherwise the patient and visit information is updated. EchoIMS then creates a scheduled Order.

When a Cancel Order (CA) message is received, EchoIMS cancels the order, provided that the study has not been starter or completed.

5.3.2. ADT

If a patient and visit information previously exists in EchoIMS (i.e. created through an Order message), the Interface processes the A08 message and updates the appropriate patient and visit information. If an order message for the patient has never been received, the ADT messages for the patient will be ignored.

When EchoIMS receives A40 message, the patient identified as the source patient is merged to the destination patient.

5.3.3. ORU

When the confirming physician signs the report in EchoIMS, a ORU^R01 message is sent to HIS. When the confirming physician creates an addendum to the report, the amended report is resent.


6. RadSuite and HIS HL7 Messaging Specifics

6.1. HL7 Message Processing Requirements

The Emageon HL7 Interface transfers and processes HL7 messages with the following conditions:• Original Acknowledgement rules apply.• Non-deferred reply is used.• Segments are not continued across messages.• Messages are not batched.

Messages transferred between Emageon HL7 Interface and the HIS are sent individually (segments do not span more than one HL7 message), and are acknowledged individually. The Emageon HL7 Interface acknowledges a message immediately after it has parsed the message for validity. See the section HL7 Message Acknowledgments for more details.

6.2. Transport and Minimal Lower Level Processing Requirements

The transfer protocol is TCP/IP socket based communications. The data protocol is HL7 MLLP, that is, each HL7 message is preceded and succeeded by the respective start and end block characters.

An HL7 message transferred between Emageon HL7 Interface and the HIS is done via TCP/IP socket based communications with the message in the following form: <SB><HL7 Data><EB><CR> where:

<SB> (Start Block) is ACSII VT, 11, \x0B

<HL7 Data> (data) consists of MSH segment<CR>PID segment<CR>...other segs...<CR>

<EB> (End Block) is ASCII FS, 28, \x1C

<CR> (carriage return) is ASCII CR, 13, \x0D

6.3. Segment and Field Requirements

The Emageon HL7 Interface will accept, parse, and process the (MLLP based) HL7 messages defined in the following tables.

1. The column headers indicate the supported applications:• RS: RadSuite• HSV: HeartSuite (Includes the VERICIS application.)• HSH: HeartSuite Hemodynamics• E: EchoIMS

2. The content of the column indicates the requirement for the item:• R: Required. If required data is not provided, the message is not processed.• O: Optional.• Gray: Grayed columns are not available in the message segment for the application.• Blank: Not applicable to message and application. Data included here will be ignored.

3. When fields that have been previously populated are subsequently designated to have NULL values, two double quotation marks are required to exist in the field. If the double quotation marks are not provided in the HL7 messages, the data will not be removed from the system.


6.3.1. Common Message Header (MSH) Segment

6.3.2. ADTÂ01 - Admit Patient

Segment Field Description NotesSupported Applications

RS HSV HSH E

MSH MSH-1 Field Separator '|' R R R R

MSH-2 Encoding Characters '^~\&' R R R R

MSH-3 Sending Application R R R R

MSH-4 Sending Facility Identifier R R R R

MSH-5 Receiving Application R R R R

MSH-6 Recieving Facility R

MSH-7 Date/Time of Message R R R R

MSH-9 Message type R R R R

MSH-10 Message control ID HIS generated; unique identifier. R R R R

MSH-11 Processing ID 'P' R R R R

MSH-12 Version ID R R R R

MSH-15 Accept ACK Type O


RS HSV HSH E

PID PID-3.1 Patient Identifier List - ID R R

PID-5.1 Patient name - family name R R

PID-5.2 Patient name - given name O R

PID-5.3 Patient name - middle name O

PID-5.4 Patient name - suffix O

PID-7 Patient date of birth O O

PID-8 Patient sex O O

PID-10 Race O O

PID-11 Patient Address O O

PID-13.1 Phone Number - Home O O

PID-14.1 Phone Number - Office O O


PID-18 Patient Acct. Number O O

PID-19 Social Security Number O O


RS HSV HSH E

PV1 PV1-2 Patient Class O

PV1-3.1 POC/Nursing Unit O

PV1-3.2 Assigned Patient Location - Room O O

PV1-3.3 Assigned Patient Location - Bed O

PV1-4 Admission Type O

PV1-7.1 Attending Physician - ID O O

PV1-7.2 Attending Physician - Family Name O O

PV1-7.3 Attending Physician - Given Name O O

PV1-7.4 Attending Physician - MIddle O

PV1-7.7 Attending Physician - Degree O

PV1-8.1 Referring Physician - ID O O

PV1-8.2 Referring Physician - Family Name O O

PV1-8.3 Referring Physician - Given Name O O

PV1-8.4 Referring Physician - Middle O

PV1-8.7 Referring Physician - Degree O

PV1-9.1 Consulting Physician -ID O

PV1-9.2 Consulting Physician - Family Name O

PV1-9.3 Consulting Physician - Given Name O

PV1-9.4 Consulting Physician - Middle O

PV1-17.1 Admitting Physician -ID O

PV1-17.2 Admitting Physician - Family Name O

PV1-17.3 Admitting Physician - Given Name O

PV1-17.4 Admitting Physician - Middle O


RS HSV HSH E


PV1-19 Visit Number The visit number is unique to the patient for each visit.

R O

PV1-44 Admit Date/Time HeartSuite saves only the date portion.

R O


RS HSV HSH E

NK1 NK1-2.1 Name - Family Name O

NK1-2.2 Name - Given Name O

NK1-5.1 Phone Number O

NK1-30.1 Contact Person’s Name - Family Name

O

NK1-30.2 Contact Person’s Name - Given Name

O

NK1-31.1 Contact Person’s Telephone Number

O


RS HSV HSH E

IN1 IN1-2.2 Insurance Plan ID O O

IN2-8 Insurance Company Name O O


RS HSV HSH E

IN2 IN2-6 Medical Health Insurance Card Number

O

IN2-8 Medicaid Case Number O


RS HSV HSH E


6.3.3. ADTÂ02 - Transfer Patient


RS HSV HSH E

PID PID-3 Patient Identifier List R

PID-5.1 Patient Name - Family Name R

PID-5.2 Patient Name - Given Name R

PID-5.3 Patient Name - Middle Name R

PID-5.4 Patient Name - Suffix R

PID-7 Date/Time of Birth R

PID-8 Sex R

PID-10 Race R

PID-11 Patient Address R

PID-13 Phone Number - Home R

PID-14 Phone Number - Office R

PID-18 Patient Acct. Number R

PID-19 Social Security Number R


RS HSV HSH E



PV1-3.2 Room O

PV1-3.3 Bed O


PV1-7.1 Attending Physician - ID O

PV1-7.2 Attending Physician - Family Name O

PV1-7.3 Attending Physician - Given Name O

PV1-7.4 Attending Physician - Middle O

PV1-8.1 Referring Physician - ID O

PV1-8.2 Referring Physician - Family Name O

PV1-8.3 Referring Physician - Given Name O


6.3.4. ADTÂ03 - Discharge patient


PV1-9.1 Consulting Physician - ID O




PV1-17.1 Admitting Physician - ID O





R

PV1- 44 Admit Date/Time HeartSuite stores only the date portion.

O

PV1- 45 Discharge Date/Time HeartSuite stores only the date portion.

O


RS HSV HSH E

IN1 IN1-2 Insurance Plan ID O

IN1-4 Insurance Company Name O


RS HSV HSH E

PID PID-3 Patient Identifier List - ID R R

PID-5.1 Patient name - Family Name R R

PID-5.2 Patient name - Given Name R

PID-7 Date/Time of Birth O

PID-8 Sex O

PID-10 Race O

PID-11 Patient Address O


RS HSV HSH E


6.3.5. ADTÂ04 - Register patient

PID-13.1 Phone Number - Home O

PID-14.1 Phone Number - Office O

PID-18 Patient Acct. Number O

PID-19 Social Security Number O


RS HSV HSH E

PV1 PV1-2 Patient class O

PV1-3.2 Assigned Patient Location - Room O










R O


R


RS HSV HSH E


PID-5.1 Patient Name - Family Name R R

PID-5.2 Patient Name - Given Name O R

PID-5.3 Patient Name - Middle Name O

PID-5.4 Patient Name - Suffix O


RS HSV HSH E


PID-7 Date/Time of Birth O O

PID-8 Sex O O

PID-10 Race O O




PID-18 Patient Acct. Number O O



RS HSV HSH E






PV1-7.1 Attending Physician - ID O O

PV1-7.2 Attending Physician - Family Name O O




PV1-8.1 Referring Physician - ID O O










RS HSV HSH E







R O


O O


O


RS HSV HSH E





O


O


O


RS HSV HSH E


IN2-8 Insurance Company Name O O


RS HSV HSH E


6.3.6. ADTÂ06 - Outpatient to Inpatient


RS HSV HSH E


O



RS HSV HSH E

PID PID-3.1 Patient Identifier List - ID R


PID-5.2 Patient Name - Given Name O




PID-8 Sex O

PID-10 Race O






RS HSV HSH E










6.3.7. ADTÂ07 - Inpatient to Outpatient















R


O


O


RS HSV HSH E

IN1 IN1-2.2 Insurance Plan ID O



RS HSV HSH E





RS HSV HSH E





PID-8 Sex O

PID-10 Race O






RS HSV HSH E




















RS HSV HSH E


6.3.8. ADTÂ08 - Update Patient Information





R


O


O


RS HSV HSH E




RS HSV HSH E

PID PID-3.1 Patient Identifier List - ID R R R R

PID-3.4 Patient Identifier List - Assigning Authority

O

PID-4.1 Alternate Patient ID O

PID-5.1 Patient Name - Family Name R R R R

PID-5.2 Patient Name - Given Name R R R R

PID-5.3 Patient Name - Middle Name O O O

PID-5.4 Patient Name - Suffix O O O

PID-6 Mother’s Maiden Name O

PID-7 Date/Time of Birth R O O O

PID-8 Sex O O O O

PID-10 Race O O O O

PID-11 Patient Address O O O O


RS HSV HSH E


PID-13 Phone Number - Home O O O

PID-14 Phone Number - Office O O O

PID-18.1 Patient Acct. Number - ID O O O O

PID-18.4 Patient Acct. Number - Assigning Authority

O

PID-19 Social Security Number O O O

PID-26 Citizenship O

PID-27 Veterans Military Status O


RS HSV HSH E





O


O


O


RS HSV HSH E

PV1 PV1-2 Patient Class O O

PV1-3.1 POC/Nursing Unit O O O

PV1-3.2 Assigned Patient Location - Room O O O O

PV1-3.3 Assigned Patient Location - Bed O O

PV1-3.5 Location Status O O O

PV1-4 Admission Type O O

PV1-7.1 Attending Physician - ID O O O

PV1-7.2 Attending Physician - Family Name O O O


RS HSV HSH E





PV1-8.1 Referring Physician - ID O O O

PV1-8.2 Referring Physician - Family Name O O O O

PV1-8.3 Referring Physician - Given Name O O O

PV1-8.4 Referring Physician - Middle O O


PV1-9.1 Consulting Physician - ID O O

PV1-9.2 Consulting Physician - Family Name O O



PV1-10 Hospital Service Code O O

PV1-15 Ambulatory Status O

PV1-16 VIP Indicator O






R O R


O O O


O O


RS HSV HSH E

PV2 PV2-3 Admit Reason O


RS HSV HSH E


6.3.9. ADTÂ11 - Cancel Admit


RS HSV HSH E

OBX OBX-3 Observation Identifier O

OBX-5 Observation Value O

OBX-6 Units O


RS HSV HSH E

AL1 AL1-3 Allergen Code/Menmonic/Description

O


RS HSV HSH E


IN1-4.1 Insurance Company Name O O


RS HSV HSH E


O



RS HSV HSH E



PID-5.2 Patient Name - Given Name O R



PID-7 Date/Time of Birth O O

PID-8 Sex O O


6.3.10. ADTÂ13 - Cancel Discharge

PID-10 Race O




PID-18 Patient Acct. Numbe O



RS HSV HSH E

PV1 PV1-3.2 Assigned Patient Location - Room O










R O


RS HSV HSH E







RS HSV HSH E


6.3.11. ADTÂ40 - Merge Patient


PID-8 Sex O


RS HSV HSH E

PV1 PV1-19 Visit Number The visit number is unique to the patient for each visit.

R

Segment PV1 Segment Description Notes

Supported Applications

RS HSV HSH E


IN1-4.1 Insurance Company Name O


RS HSV HSH E



O




PID-5.3 Patient Name - Middle Name O O

PID-5.4 Patient Name - Suffix O O


PID-7 Date/Time of Birth R O O

PID-8 Sex O O O

PID-10 Race O O O

PID-11 Patient Address O O O

PID-13 Phone Number - Home O O


RS HSV HSH E


PID-14 Phone Number - Office O O

PID-18.1 Patient Acct. Number - ID O O O


O





RS HSV HSH E

PV1 PV1-3 Assigned Patient Location O






O


RS HSV HSH E

MRG MRG-1.1 Prior Patient Identifier List - ID R R R R


RS HSV HSH E


6.3.12. ORMÔ01 - 'New Order'


RS HSV HSH E



O




PID-5.3 Patient Name - Middle Name O O O

PID-5.4 Patient Name - Suffix O O O


PID-7 Date/Time of Birth R O O O

PID-8 Sex O O O O

PID-10 Race O O O O

PID-11 Patient Address O O O O

PID-13 Phone Number - Home O O O

PID-14 Phone Number - Office O O O

PID-18.1 Patient Acct. Number - ID O O O O


O

PID-19 Social Security Number O O O




RS HSV HSH E

PV1 PV1-2 Patient Class O O

PV1-3.1 POC/Nursing Unit O O O

PV1-3.2 Assigned Patient Location - Room O O O O

PV1-3.3 Assigned Patient Location - Bed O O

PV1-3.5 Location Status O O O


PV1-4 Admission Type For EchoIMS, must be one of “Adult”, “Fetal”, or “Pediatric”

O R

PV1-7.1 Attending Physician - ID O O O

PV1-7.2 Attending Physician - Family Name O O O

PV1-7.3 Attending Physician - Given Name O O O

PV1-7.4 Attending Physician - Middle O O


PV1-8.1 Referring Physician - ID O O O

PV1-8.2 Referring Physician - Family Name O O O O

PV1-8.3 Referring Physician - Given Name O O O O

PV1-8.4 Referring Physician - Middle O O O


PV1-9.1 Consulting Physician - ID O O

PV1-9.2 Consulting Physician - Family Name O O

PV1-9.3 Consulting Physician - Given Name O O

PV1-9.4 Consulting Physician - Middle O O

PV1-10 Hospital Service Code



PV1-17.1 Admitting Physician - ID O O

PV1-17.2 Admitting Physician - Family Name O O

PV1-17.3 Admitting Physician - Given Name O O



R O R


O O O


O O


RS HSV HSH E



RS HSV HSH E



RS HSV HSH E

IN1 IN1-2 Insurance Plan ID O



RS HSV HSH E

ORC1 ORC-1 Order Control “NW” R R R R

ORC-5 Order Status RadSuite: Default is INCOMPLETE; send CM for COMPLETE

O

ORC-7.4 Start Date Time This is interpreted as the scheduled date.

R


RS HSV HSH E

OBR OBR-3.1 Filler Order Number RadSuite: Unique across the entire system. The length must be 16 characters or less.

HeartSuite: Unique for a patient. The order number cannot repeat for the same patient, but more tha one patient can have the same order number.

This field will be mapped to OBR-2 (Placer Order Number) on HeartSuite for use by it and all the other downstream systems.

R R R R

OBR-4.1 Universal Service ID - ID R R R R

OBR-4.2 Universal Service ID - Text R R R R

OBR-4.3 Universal Service ID - Coding System

O

OBR-4.4 Universal Service ID - Alt. ID O


OBR-4.5 Universal Service ID - Alt. Text O

OBR-4.6 Universal Service ID - Alt. Coding System

O

OBR-6 Requested Date & Time HeartSuite stores only the date portion

R R

OBR-15.5 Specimen Source O

OBR-16.1 Ordering Physician - ID O O O O

OBR-16.2 Ordering Physician - Family Name O O O O

OBR-16.3 Ordering Physician - Given Name O O O O

OBR-16.4 Ordering Physician - Middle O O O

OBR-16.5 Ordering Physician - Degree O

OBR-18 Placer Field 1 O

OBR-19 Placer Filed 2 O

OBR-20 Filler Field 1 O

OBR-24 Diagnostic Service Section ID - Modality

This will be mapped to OBR-18 (Placer Field 1) on HeartSuite for use by it and all other downstream systems.

For requirements, consider the following:

Refer to HL7 table 0074 for reference.

Best if “US” or “XA” for use by HeartSuite.

Best if DICOM Modality values are used for RadSuite.

Must be CTH for HeartSuite Hemodynamics.

R R R R

OBR-27.4 Quantity/Timing - Start Date/Time YYYYMMDDhhmmss R

OBR-27.6 Quantity/Timing - Priority STAT, HIGH, MEDIUM, LOW, ROUTINE

O

OBR-31 Reason for Study Maximum text allowed is 256 characters.

O O O


RS HSV HSH E



RS HSV HSH E

SCH SCH-11.4 Appointment Timing Quantity O


RS HSV HSH E

ZDS ZDS-1 Study Instance ID O


6.3.13. ORMÔ01 - 'Cancel Order'


RS HSV HSH E



O







PID-7 Date/Time of Birth R O

PID-8 Sex O O

PID-10 Race O O


PID-13 Phone Number - Home O

PID-14 Phone Number - Office O

PID-18.1 Patient Acct. Number - ID O O


O





RS HSV HSH E

PV1 PV1-3.1 POC/Nursing Unit O



PV1-4 Admission Type For EchoIMS, must be one of “Adult”, “Fetal”, or “Pediatric”

O R














R O R


O


RS HSV HSH E



RS HSV HSH E

ORC ORC-1 Order Control “CA” R R R R


O


RS HSV HSH E



RS HSV HSH E


HeartSuite: Unique for a patient. The order number cannot repeat for the same patient, but more tha one patient can have the same order number.

This field will be mapped to OBR-2 (Placer Order Number) on HeartSuite for use by it and all the other downstream systems.

R R R R

OBR-4.1 Universal Service ID - ID R R O R

OBR-4.2 Procedure Description R R O R


O




O

OBR-6 Requested Date & Time HeartSuite stores only the date portion

R R


OBR-16.1 Ordering Physician - ID O

OBR-16.2 Ordering Physician - Family Name O O

OBR-16.3 Ordering Physician - Given Name O O

OBR-16.4 Ordering Physician - Middle O

OBR-16.5 Ordering Physician - Degree O












R R



O


O


RS HSV HSH E



RS HSV HSH E


6.3.14. ORMÔ01 - 'Change Order'


RS HSV HSH E



O


PID-5 Patient Name R


PID-7 Date/Time of Birth R

PID-8 Sex O

PID-10 Race O


PID-18.1 Patient Acct. Number - ID O


O




RS HSV HSH E

PV1 PV1-3 Assigned Patient Location O

PV1-8 Referring Physician O




RS HSV HSH E




RS HSV HSH E

ORC ORC-1 Order Control “SC” or “XO” R


O


RS HSV HSH E


R

OBR-4.1 Universal Service ID - ID R

OBR-4.2 Procedure Description R


O




O


OBR-16 Ordering Physician O












R



O


O


RS HSV HSH E



RS HSV HSH E


6.3.15. ORU^R01 - Advanced Visualization Radiology Reports and HeartSuite Hemodynamics Laboratory Results


RS HSV HSH E



O

PID-4 Alternate Patient ID O


PID-5.2 Patient Name - Given Name R R

PID-6 Mother’s Maiden Name O O

PID-7 Date/Time of Birth R O

PID-8 Sex O O

PID-10 Race O





RS HSV HSH E

OBR OBR-3.1 Filler Order Number R

OBR-4.1 Universal Service ID - ID R

OBR-4.2 Procedure Description R


O

OBR-7 Content Date/Time HeartSuite: If this value is not present than each OBX-14 must have a value.

R R


R

OBR-25 Results Status Partial, Complete O


OBR-27 Quantity/Timing - Priority STAT, HIGH, MEDIUM, LOW, ROUTINE

R



O

OBR-32 Principal Result Interpreter O


RS HSV HSH E

OBX OBX-1 Set ID O

OBX-2 Value Type O

OBX-3.1 Observation Identifier - ID O R

OBX-3.2 Observation Identifier - Text O O

OBX-3.3 Observation Identifier - Name of Coding System

O O

OBX-5 Observation Value RadSuite: Report Text

HeartSuite Hemodynamics: Study Lab Table

R R

OBX-6.1 Units - Identifier O

OBX-7 Referenced Range O

OBX-8 Abnormal Flag O

OBX-11 Observation Result Status O

OBX-14 Date/Time of Observation R

OBX-15.1 Producer’s ID - Identifier O

OBX-15.2 Prodcuer’s ID - Text O

OBX-16.1 Responsible Observer - ID O

OBX-16.2 Responsible Obeserver - Family Name

O

OBX-16.3 Responsible Observer - Given Name

O

OBX-17.1 Observation Method - ID O

OBX-17.2 Observation Method - Text O


RS HSV HSH E


6.3.16. ORU^R01 - Unsolicited Result HeartSuite and EchoIMS Reporting


RS HSV HSH E

PID PID-3 Medical Record number R R

PID-5.1 Patient Last Name R R

PID-5.2 Patient First Name R R

PID-5.3 Patient Middle Name O O

PID-7 Date of Birth O O

PID-8 Sex O O

PID-18 Patient Account Number O O


RS HSV HSH E

PV1 PV1-2 Patient class O O

PV1-3.1 POC/Nursing Unit O O

PV1-3.2 Room O O

PV1-7.1 Attending Physician ID O O

PV1-7.2 Attending Physician Last Name O O

PV1-8.1 Referring Physician ID O O

PV1-8.2 Referring Physician Last Name O O

PV1-9.1 Consulting Physician ID O O

PV1-9.2 Consulting Physician Last Name O O

PV1-17.1 Admitting Physician ID O O

PV1-17.2 Admitting Physician Last Name O O


R R



RS HSV HSH E

OBR OBR-2 Placer Order Number Provided in Order message R R

OBR-3 Filler Number For HeartSuite this is the unique identifier of this report. For EchoIMS, this is the identifier of the report amended. See OBR-21 also.

O O

OBR-4.1 Charge (Procedure) Code, Universal Service ID

Provided in Order message R R

OBR-4.2 Procedure Description Provided in Order message R R

OBR-6 Requested Date/Time Requested Date of the procedure from the order message.

R

OBR-7 Observation Date/Time Date/Time of the first confirmed report. Even in amended reports, this will contain the date/time of the first confirmed report.

R R

OBR-16.1 Ordering Physician ID Exists if provided in Order message O O

OBR-16.2 Ordering Physician Last Name Exists if provided in Order message O O

OBR-16.3 Ordering Physician First Name O O

OBR-16.4 Ordering Physician Middle Name O O

OBR-21 Filler Field 2 For HeartSuite this is the unique identifier of the reports (i.e. if an amendment is done this value remains the same). For EchoIMS, this is the unique identifier of this specific report. See OBR-3 also.

O O

OBR-24 Diagnostic Service Sector ID O

OBR-25 Status/Correction Flag Used to determine whether or not it is the first time the result has been uploaded.

If the result message is a subsequent result, then this field will have value of 'C', otherwise for HeartSuite it is empty signaling the first time the result has been uploaded and for EchoIMS has value of 'F' signaling the initial report.

R R

OBR-32.1.1 Prin. Results Interpreter ID Confirming Phys ID R R

OBR-32.1.2 Prin. Results Interpreter last name Last Name of Confirming Physician R R


OBR-32.1.3 Prin. Results Interpreter first name First name of Confirming Physician R R

OBR-32.1.4 Prin. Results Interpreter middle name/initial

Middle initial/name of Confirming Physician

R R

OBR-34.1.1 Technician ID ID of Sonographer O

OBR-34.1.2 Technician Last Name Last Name of Sonographer O

OBR-34.1.3 Technician First Name First name of Sonographer O

OBR-34.1.4 Technician Middle Middle name/initial of Sonographer O


RS HSV HSH E


The OBX segment encapsulates the entire text of the report signed by the Confirming Physician. For HeartSuite, three options are supported: (1) one OBX segment containing the whole report; (2) one OBX per line; (3) configurable number of bytes per OBX segment. For EchoIMS (pediatric echo), only the option of one OBX segment per line is available.

The DSC segment is used when a report is message is broken into multiple ORU^R01 messages. Both HeartSuite and EchoIMS support systems that have restrictions in the number of OBX per ORU^R01 message. In addition HeartSuite also supports systems that have restriction in the number of bytes sent per ORU^R01 message.


RS HSV HSH E

OBX OBX-2 Value Type 'TX' R R

OBX-5 Observation Data Report data:

'^' is used to indicate where carriage returns are in the report body if the option selected is one OBX segment to encapsulate the entire report (HeartSuite only).

Note: Special characters defined by HL7 that may be in the body of the text report are converted to the defined HL7 version 2.3 escape sequences.

The following are used:| mapped to \F\^ mapped to \S\& mapped to \T\~ mapped to \R\\ mapped to \E\

R R

OBX-11 Observation Status For HeartSuite reports this will always have a value of 'F' for EchoIMS this will have an initial value of 'F', otherwise, if the report is an amendment this will have a value of 'C'.

R R


RS HSV HSH E

DSC DSC-1 Continuation Pointer R R


6.3.17. MDM^T02 - HeartSuite Hemodynamics Case / Physician Report

NOTE: The HeartSuite Hemodynamics HL7 Interface supports either ORU^R01 or MDM^T02, but not both, for a given implementation.


RS HSV HSH E

PID PID-5.1 Patient Name - Family Name R

PID-5.2 Patient Name - Given Name R

PID-7 Date/Time of Birth Date format: YYYYMMDDHHMMSS.

O

PID-8 Sex O

PID-11.1 Patient Address - Street Address O

PID-11.3 Patient Address - City O

PID-11.4 Patient Address - State or Province O

PID-11.5 Patient Address - Zip or Postal code O


PID-14.1 Phone Number - Business O

PID-18.1 Patient Account Number O



RS HSV HSH E

PV1 PV1-3.2 Assigned Patient Location - Room R

PV1-7.1 Attending doctor - ID Number R

PV1-7.2 Attending doctor - Family Name O

PV1-7.3 Attending doctor - Given Name O

PV1-8.1 Referring doctor - ID number O

PV1-8.2 Referring doctor - family name The name is stored in LN, FN format in the database.

O

PV1-8.3 Referring doctor - given name The name is stored in LN, FN format in the database.

O

PV1-19.1 Visit Number O

PV1-44 Admit Date/Time Date format: YYYYMMDDHHMMSS.

O


The OBX segment encapsulates the entire text of the verified report. HeartSuite Hemodynamics HL7 Interface supports three options: (1) one OBX segment containing the whole report; (2) one OBX segment per line; (3) configurable number of bytes per OBX segment.


RS HSV HSH E

TXA TXA-1 Set ID-TXA 1 R

TXA-2 Document Type CR = Case ReportPR = Physician Report

R

TXA-3 Document Content Presentation FT = Formatted text R

TXA-4 Activity Date/Time O

TXA-5 Primary Activity Provider Code/Name

O

TXA-12 Unique Document Number O

TXA-14 Placer Order Number O

TXA-17 Document Completion Status AU = Authenticated R

TXA-22-1 Authentication Person, Time Stamp - ID number

O

TXA-22.2 Authentication Person, Time Stamp - Family Name

O

TXA-22.3 Authentication Person, Time Stamp - Given Name

O

TXA-22.15 Authentication Person, Time Stamp - Date/Time Action Performed

O


RS HSV HSH E

OBX OBX-1 Set ID O

OBX-2 Value Type Value is set to "TX R

OBX-5 Observation Data R

OBX-11 Observation Status Value is set to "F R


6.3.18. ORU^R01 HeartSuite Hemodynamics Case / Physician Report

For MSH, PID, PV1, and OBX segments definition, refer to MDM^T02 - HeartSuite Hemodynamics Case / Physician Report on page 46.

NOTE: The HeartSuite Hemodynamics HL7 Interface supports either ORU^R01 or MDM^T02, but not both, for a given implementation.


RS HSV HSH E

OBR OBR-2.1 Placer Order Number O

OBR-4.1 Universal Service ID - Identifier O

OBR-4.2 Universal Service ID - Text O

OBR-6 Requested Date & Time Scheduled date for cathDate format: YYYYMMDDHHMMSS.

O

OBR-7 Observation Date & Time Date cath was performed Date format:YYYYMMDDHHMMSS

R

OBR-16.1 Ordering Doctor - ID O

OBR-16.2 Ordering Doctor - Family Name O

OBR-16.3 Ordering Doctor - Given Name O

OBR-22 Report Results/Status Change Date Date format:YYYYMMDDHHMMSS

This is the date the report is verified/confirmed

R

OBR-25 Status/Correction Flag Used to determine whether or not it is the first time the result has been uploaded.

If the result message is a subsequent result, then this field will have value of 'C', otherwise it is empty signaling the first time the result has been uploaded.

R

OBR-27.4 Quantity Timing - Start Date/Time Scheduled date for cath

Date format:YYYYMMDDHHMMSS.

O

OBR-32.1.1 Principal Results Interpreter - ID Practitioner who confirmed the report. For Case report this is the Attending Doctor.

R

OBR-32.1.2 Principal Results Interpreter - Family Name

R

OBR-32.1.3 Principal Results Interpreter - Given Name

R


The DSC segment is used when a report message is broken into multiple ORU^R01 messages in support of a HIS that may restrict the number of OBX per ORU^R01 message.


RS HSV HSH E

DSC DSC-1 Continuation Pointer O


6.4. HL7 Message Acknowledgments

6.4.1. Acknowledgement from RadSuite

The acknowledgment message returned from RadSuite HL7 Interface consists of the MSH and MSA segments. The message type returned for all acknowledgements is ACK. MSA-1 will be AA. The Emageon HL7 Interface echoes the originating message's message control ID in MSA-2. If an unsupported message is received, an Acknowledgement message having type 'ACK', code “AA” is returned with “Message type not supported.” in the Text Message field MSA-3. The ERR segment is not used.

6.5. Pre-Filtering

If possible, the HIS or interface engine should filter out certain HL7 messages to minimize the number of messages the Emageon HL7 Interface has to receive, process, and ultimately discard because the message was an unsupported message type.

MSH Segment Description Notes

MSH-1 Field Separator '|'

MSH-2 Encoding Characters '^~\&'

MSH-3 Sending Application

MSH-7 Date/Time of Message Date from MSH-7 of incoming message

MSH-9 Message type 'ACK'

MSH-10 Message control ID Unique identifier to relate response to initial message.

MSH-11 Processing ID 'P'

MSH-12 Version ID

MSA-1 Acknowledgement Code Described above.

MSA-2 Message Control ID ID taken from Message Control ID field (MSH-10) of incoming message.

MSA-3 Text Message Text string further identifying acknowledgement message.


7. Appendix A - Sample ORU Messages

7.1. ORU^R01 HeartSuite Message Sample (single OBX)MSH|^~\&|VERICIS||||20021210135248||ORU^R01|6|P|2.3|||||||| PID|||08890||JONES^JOHN^D^||19970528|M|||444 LONE ROAD^^HOUSTON^TX^45455|||||||70047188||||||||||||| PV1||I|MED||||203695^SMITHÊDWARD^J||||||||||||000000109190|||||||||||||||||||||||||||||||||| OBR||00040||HIS00000^test procedure|||20021209104316|||||||||203695^SMITHÊDWARD||||||||||||||||1234^Smith^Sarah^H|||||||||||| OBX|1|TX|||Emageon^123 ABC Drive, Anytown, WI 12345^Phone: (800) 123-1234 Fax: (262) 123-1234^www.emageon.com^^Cardiac Cath Lab Procedure^Comprehensive Report^December 9, 2002^^ ---------------------------------------------------------------------------^^Patient: JONES, JOHN ^Patient ID: 08890^MR#:^Gender: M^Race:^DOB: May 28, 1957ÂGE: 45 years^Pt. status:^Room:^^ ---------------------------------------------------------------------------^^Study^Study Date: December 10, 2002^Study ID: SID_11101089Âccess. Num:^Height: 72 in ( 182.9 cm )^Location:^Weight: 230 lb ( 104.5 kg )^BSA: 2.26 m\S\2^ ---------------------------------------------------------------------------^^STUDY CONCLUSIONS^^SUMMARY^- There is mild to moderate biventricular heart failure.^- The left ventricle was small and demonstrated moderate hypertrophy, mural^ thrombus, diaphragmatic calcification, posterobasal calcification, and^ lateral calcification.^- The pulmonic leaflets exhibited mild thickening, moderately decreased^ excursion, and moderate valve calcification. The pulmonary valve annulus^ was dilated. There was moderate to severe pulmonic stenosis. There was^ moderate pulmonic insufficiency.^- There was no angiographic evidence for coronary artery disease.^- Left external iliac: There was a diffuse stenosis at the site of a prior^ angioplasty distal to the graft anastomosis. There was a probable^ moderate-sized thrombus. The lesion is a likely culprit for the patient's^ intermittent claudication. It was amenable to angioplasty and an^ intervention was performed. Distal to the lesion, the vessel has poor^ collateral vascular supply and has poor distal runoff. The lesion is a^ fair target for graft. Left common femoral: at a site without prior^ intervention. The lesion is a likely culprit for the patient's leg^ ulcers. Distal to the lesion, the vessel has poor distal runoff.^- This is the end of my report. This individual is in excellent condition.^^COMPARISONS^Ângiography demonstrates mild restenosis of the right renal artery since the^previously cited comparison study. This lesion underwent on November 20, 2002.Ângiography demonstrates no restenosis of the right common carotid artery since^the study of November 13, 2002. This lesion underwent on November 12, 2002.^^RECOMMENDATIONS^^There is no evidence of obstruction to explain the reported symptoms; the stress^test appears to be a false positive. The patient's chest discomfort does notâppear due to obstructive coronary artery disease. The medication(s) dalteparin,^losartan, and nitroprusside should be discontinued. The patient may resume all^previous activities in 1 days. Based on the conclusions of this study, a cardiac^surgery consult should be obtained for coronary endarterectomy, repair of theâortic root with reimplantation of the coronaries, mitral valve annuloplasty,âortic valve replacement, and aortic valve repair.^^ ---------------------------------------------------------------------------^ÎNDICATIONS AND HISTORY^ÎNDICATIONS^- Coronary: unstable angina, CCS class III, with onset one to seven days prior^ to admission. The patient was status post thrombolysis with concurrent^ aspirin administration and required the administration of vasopressors.^ ST elevation began November 12, 200213:01.^- Coronary: suspected coronary artery disease, significant (50% or greater)^ coronary lesion in a major coronary artery, recurrent coronary stenosis^ (50% or greater) at site of previous transcatheter coronary intervention,^ suspect recurrent coronary stenosis at site of previous transcatheter^ coronary intervention, suspect in-stent coronary stenosis, ischemic heart^ disease, and abnormal stress test.^- Cardiac: arrhythmia, suspect pericardial constriction, pulmonic valve^ disease, transplant heart disease, and initial research study.^- Cerebrovascular: prior CVA, prior TIA, carotid bruit, carotid artery disease^ by Doppler, prior endarterectomy, and suspect in-stent restenosis^- Renal: malignant HTN, history of flash pulmonary edema, azotemia with ACE^ inhibitors or A2 blockers, and abnormal MR angiogram^- Lower extremity: suspect in-stent restenosis involving the right lower^ extremity.^^CLINICAL PRESENTATION^The patient arrived at the cath lab 15 min after reaching the facility and 30^min after symptom onset with an acute myocardial infarction.^^HISTORY^There was a prior diagnosis of NYHA class II congestive heart failure. There isâ history of ventricular arrhythmia. The patient had chronic lung disease (on^home oxygen). There was no history of family history of coronary artery disease,^renal failure, or cerebrovascular disease.^^ ---------------------------------------------------------------------------^^PROCEDURAL DETAILS^^BACKGROUND INFORMATION^- Cardiac catheterization performed emergently.^- Coronary intervention performed urgently.^- The patient required intra-aortic balloon placement before leaving the lab.^- No cardiopulmonary support was required at commencement of procedure.^- This is a text box that was entiered in as free form text by the engineering^ looking at this report.^- Oxygen was administered at 1 L/min during the procedure.^- General anesthesia administered by Anesthesiology. Pre-procedural sedation^ given: 3 mg of IV diazepam, 9 mg of IV midazolam, and 4 mg of IV^ morphine.^- Anticoagulant (enoxaparin, heparin 400 units IV) was administered.^- Aspirin ( 648 mg PO) was given more than 2 hours before the intervention.^- An antithrombotic agent, bivalirudin Euthromyesin was administered after the^ lab visit.^^ ---------------------------------------------------------------------------^^HEMODYNAMICS^ÎMPRESSIONS^- There is mild to moderate biventricular heart failure.^- Following administration of adenosine, the overall pulmonary hemodynamic^ response was fair, with mild increase in cardiac output, marked increase^ in pulmonary artery pressure, mild increase in arterial saturation, mild^ reduction in exercise tolerance, and no change in dyspnea.^^ ---------------------------------------------------------------------------^^CARDIOVASCULAR STRUCTURES^^VENTRICULOGRAPHY^^The left ventricle was small and demonstrated moderate hypertrophy, mural^thrombus, diaphragmatic calcification, posterobasal calcification, and lateral^calcification.^^VALVES^^Pulmonic valve: The pulmonic leaflets exhibited mild thickening, moderately^decreased excursion, and moderate valve calcification. The pulmonary valveânnulus was dilated. There was moderate to severe pulmonic stenosis. There was^moderate pulmonic insufficiency.^^ ---------------------------------------------------------------------------^^CORONARY AND GRAFT ANGIOGRAPHY: DETAILED FINDINGS^^LEFT MAIN CORONARY ARTERY:^Left main: Normal. Angiography showed severe diffuse disease.^^LEFT ANTERIOR DESCENDING AND BRANCHES:^LAD: Normal. Angiography showed severe diffuse disease.^^LEFT CIRCUMFLEX AND BRANCHES:^Circumflex: Normal. Angiography showed severe diffuse disease.^^RIGHT CORONARY AND BRANCHES:^RCA: Normal. Angiography showed severe diffuse disease.^ÎMPRESSIONS:^There was no angiographic evidence for coronary artery disease.^^ ---------------------------------------------------------------------------^^PERIPHERAL ANGIOGRAPHY^^LEFT ILIAC:^- Left external iliac: Normal. The vessel was partially occluded, very small,^ mildly calcified, moderately tortuous, and mildly ectatic. Angiography^ showed moderately reduced antegrade flow and a single discrete lesion.^ The vessel was supplied by a diseased bypass graft. There was a diffuse^ stenosis at the site of a prior angioplasty distal to the graft^ anastomosis. There was a probable moderate-sized thrombus. The lesion is^ a likely culprit for the patient's intermittent claudication. It was^ amenable to angioplasty and an intervention was performed. Distal to the^ lesion, the vessel has poor collateral vascular supply and has poor^ distal runoff. The lesion is a fair target for graft.^^LEFT FEMORAL/


POPLITEAL:^- Left common femoral: at a site without prior intervention. The lesion is a^ likely culprit for the patient's leg ulcers. Distal to the lesion, the^ vessel has poor distal runoff.^^RIGHT TIBIAL/PERONEAL:^- Right anterior tibial: The lesion is moderately calcified. The trans-stenosis^ pressure gradient was 7 mmHg (peak resting), 4 mmHg (mean resting), 3^ mmHg (peak post-adenosine), and 6 mmHg (mean post-adenosine). The^ reference vessel diameter was 5 mm. Stenosis was assessed by quantitative^ angiography (QA). Distal to the lesion, angiography showed small to^ medium-sized vessel, minor luminal irregularities, and calcification.^^ ---------------------------------------------------------------------------^^PULMONARY ANGIOGRAPHY^- The pulmonary artery was mildly dilated. The mid pulmonary artery was^ calculated to be 4 cm in diameter. There was no evidence for pulmonary^ artery thrombus.^^ ---------------------------------------------------------------------------^^VASCULAR INTERVENTIONS^^FIRST LESION^^First lesion Summary: The residual lesion was tubular and concentric. There wasâ small filling defect consistent with thrombus. Before the intervention there^was TIMI 1 flow. Following the procedure, the intervention site exhibited TIMI 2^flow and a final resting gradient of 6 mmHg. This was an ACC/AHA type C "high^risk" lesion for intervention. The minimum luminal diameter was 1 mm (initial)ând 3.5 mm (final).^^Second lesion summary: The residual lesion was diffuse. There was a moderate^filling defect consistent with thrombus. Following the procedure, theîntervention site exhibited TIMI 3 flow and a final resting gradient of 1 mmHg.^This was an ACC/AHA type B "moderate risk" lesion for intervention. The minimum^luminal diameter was 1 mm (initial) and 0.75 mm (final).^^Fourth lesion intervention detail:^^Setup: Prior to the intervention, a 6 mmHg mean resting gradient was measuredâcross this lesion. A 6 Fr guiding catheter was used to intubate the vessel. The^lesion was crossed with a 0.014 in high torque intermediate wire. A 0.014 in^high torque intermediate wire was placed to protect the side branch. A 0.014 in^J tip wire was placed as a "buddy" wire. A therapeutic ACT was maintained^throughout the procedure.^^ ---------------------------------------------------------------------------^^Prepared and signed by^Sarah Smith MD^Confirmed December 9, 2002 10:43:16||||||F|||||||


7.2. ORU^R01 Pediatric Echo Message

MSH|^~\&|ECHOIMS|ECHOIMS|ECHOIMS1||20040305143429||ORU^R01|188511534|P|2.3

PID|||3138383||Qtest^Fsi^H||20021006|M||W|324 Dead End^^Springfieldôh^98033

PV1|||||||||||||||||||5

OBR||00002336|5|270-30320^2D-Echocardiogram Congenital|||200402061000|||||||||^DavidÊliot|||||||||F||||||Test Interface|01767^Smith^James^L

OBX|1|TX||1|Patient Name: Qtest, Fsi||||||F

OBX|2|TX||1|Chart Number: 3138383||||||F

OBX|3|TX||1|Date of Appt: Friday, February 06, 2004||||||F

OBX|4|TX||1|Pediatric Echo Report:||||||F

OBX|5|TX||1|Sonographer: Tape #: ICD9: 280 - Iron deficiency anemias, 281.0 - ||||||F

OBX|6|TX||1|Pernicious anemia, 281.1 - Other vitamin B12 deficiency anemia, 281.2 - ||||||F

OBX|7|TX||1|Folate-deficiency anemia, 281.3 - Other specified megaloblastic anemias ||||||F

OBX|8|TX||1|not elsewhere classified, 281.4 - Protein-deficiency anemia, 281.8 - ||||||F

OBX|9|TX||1|Anemia associated with other specified nutritional deficiency ||||||F

OBX|10|TX||1|CPT: 93303 - TTE, congenital anomalies, complete, 93304 - TTE, congenital ||||||F

OBX|11|TX||1|anomalies, follow-up/limited ||||||F

OBX|12|TX||1|DOB: 06-Oct-2002 Age: 1.336 BSA (m 2): 0.63 Height (cm): 60.96 ||||||F

OBX|13|TX||1|Weight (kg): 20.45 Patient Location: ET5B Person requesting test: ||||||F

OBX|14|TX||1|Rosenkranz, Eliot, M.D. ||||||F

OBX|15|TX||1|Reason for test: Test Interface Referral diagnosis: Test ||||||F

OBX|16|TX||1| ||||||F

OBX|17|TX||1|Systemic Arterial Function:||||||F

OBX|18|TX||1| Z-SCORE Min Max||||||F

OBX|19|TX||1|Systolic BP ||||||F

OBX|20|TX||1| 120.00 mmHg 3.13 69.67 108.51 ||||||F

OBX|21|TX||1|Diastolic BP ||||||F

OBX|22|TX||1| 60.00 mmHg 1.52 28.11 64.09 ||||||F

OBX|23|TX||1|Pulse pressure ||||||F

OBX|24|TX||1| 60.00 mmHg ||||||F

OBX|25|TX||1|Mean Blood Pressure ||||||F

OBX|26|TX||1| 80.00 mmHg 1.33 49.75 85.86 ||||||F

OBX|27|TX||1| ||||||F

OBX|28|TX||1|M-Mode:||||||F


OBX|30|TX||1|LV Diastolic Septal Thickness ||||||F


OBX|31|TX||1| 5.00 cm 13.00 0.44 0.84 ||||||F

OBX|32|TX||1|LV Diastolic Dimension ||||||F

OBX|33|TX||1| 2.00 cm -5.52 2.68 3.70 ||||||F

OBX|34|TX||1|LV Diastolic Wall Thickness ||||||F

OBX|35|TX||1| 5.00 cm 16.78 0.45 0.74 ||||||F

OBX|36|TX||1|LV Systolic Dimension ||||||F

OBX|37|TX||1| 3.00 cm 3.89 1.63 2.46 ||||||F

OBX|38|TX||1|LV Fractional shortening ||||||F

OBX|39|TX||1| -50.00 % ||||||F

OBX|40|TX||1|LV Systolic Wall Thickness ||||||F

OBX|41|TX||1| 8.00 cm 21.02 0.78 1.16 ||||||F

OBX|42|TX||1|M-Mode Ejection time ||||||F

OBX|43|TX||1| 54.00 ms ||||||F

OBX|44|TX||1|M-Mode R-R interval ||||||F

OBX|45|TX||1| 87.00 ms ||||||F

OBX|46|TX||1|M-Mode LV Mass ||||||F

OBX|47|TX||1| 1431.64 g ||||||F

OBX|48|TX||1|M-Mode LV Mass index ||||||F

OBX|49|TX||1| 2272.44 g/m 2 ||||||F

OBX|50|TX||1| ||||||F

OBX|51|TX||1|2D:||||||F


OBX|53|TX||1|2D LV systolic volume ||||||F

OBX|54|TX||1| 1.67 ml -3.61 5.10 21.29 ||||||F

OBX|55|TX||1| ||||||F

OBX|56|TX||1|Cardiac Geometry:||||||F


OBX|58|TX||1|Heart rate ||||||F

OBX|59|TX||1| 78.00 BPM -2.80 88.38 137.36 ||||||F

OBX|60|TX||1|R-R interval ||||||F

OBX|61|TX||1| 769.23 ms ||||||F


OBX|63|TX||1| 54.00 ms ||||||F

OBX|64|TX||1|Rate-corrected ejection time ||||||F

OBX|65|TX||1| 5.79 s ||||||F

OBX|66|TX||1|M-Mode R-R interval ||||||F


OBX|67|TX||1| 87.00 ms ||||||F

OBX|68|TX||1|Time of end-systole ||||||F

OBX|69|TX||1| 56.00 ms ||||||F

OBX|70|TX||1|Pre-ejection period ||||||F

OBX|71|TX||1| 2.00 ms ||||||F


OBX|73|TX||1| 3.00 cm 3.89 1.63 2.46 ||||||F


OBX|75|TX||1| 2.00 cm -5.52 2.68 3.70 ||||||F


OBX|77|TX||1| 8.00 cm 21.02 0.78 1.16 ||||||F


OBX|79|TX||1| 5.00 cm 16.78 0.45 0.74 ||||||F

OBX|80|TX||1|LV posterior wall % thickening ||||||F

OBX|81|TX||1| 60.00 % ||||||F

OBX|82|TX||1|LV Systolic Septal Thickness ||||||F

OBX|83|TX||1| 344.00 cm 46.43 0.66 1.10 ||||||F


OBX|85|TX||1| 5.00 cm 13.00 0.44 0.84 ||||||F

OBX|86|TX||1|M-Mode LV Mass ||||||F

OBX|87|TX||1| 1431.64 g ||||||F

OBX|88|TX||1|M-Mode LV Mass index ||||||F

OBX|89|TX||1| 2272.44 g/m 2 ||||||F

OBX|90|TX||1|LV epicardial long axis ||||||F

OBX|91|TX||1| 4.00 cm ||||||F

OBX|92|TX||1|LV epicardial cross-sectional area ||||||F

OBX|93|TX||1| 3.00 cm 2 ||||||F

OBX|94|TX||1|LV systolic long axis dimension ||||||F

OBX|95|TX||1| 2.00 cm ||||||F

OBX|96|TX||1|LV systolic cross-sectional area ||||||F

OBX|97|TX||1| 1.00 cm 2 ||||||F

OBX|98|TX||1|LV midwall systolic dimension ||||||F

OBX|99|TX||1| 11.05 cm ||||||F

OBX|100|TX||1|LV midwall diastolic dimension ||||||F

OBX|101|TX||1| 7.00 cm ||||||F

OBX|102|TX||1|LV minimum dimension ||||||F


OBX|103|TX||1| 43.00 cm ||||||F

OBX|104|TX||1|Long axis es (LV) (2C) ||||||F

OBX|105|TX||1| 23.00 cm ||||||F

OBX|106|TX||1| ||||||F

OBX|107|TX||1|Systolic LV Function:||||||F


OBX|109|TX||1|2D LV systolic volume ||||||F

OBX|110|TX||1| 1.67 ml -3.61 5.10 21.29 ||||||F

OBX|111|TX||1|Endocardial % shortening ||||||F

OBX|112|TX||1| -50.00 % ||||||F

OBX|113|TX||1|Midwall % shortening ||||||F

OBX|114|TX||1| -57.88 % ||||||F

OBX|115|TX||1|VCF ||||||F

OBX|116|TX||1| -9.26 circ/s ||||||F

OBX|117|TX||1|Rate-corrected mean VCF ||||||F

OBX|118|TX||1| -8.12 circ/s ||||||F

OBX|119|TX||1|Midwall VCF ||||||F

OBX|120|TX||1| -31.26 circ/s ||||||F

OBX|121|TX||1|Midwall rate-corrected VCF ||||||F

OBX|122|TX||1| -0.10 circ/s ||||||F

OBX|123|TX||1|Septal % thickening ||||||F

OBX|124|TX||1| 6780.00 % ||||||F

OBX|125|TX||1|Circumferential peak stress ||||||F

OBX|126|TX||1| 4.88 g/cm 2 ||||||F

OBX|127|TX||1|VCFc vs Stress ||||||F

OBX|128|TX||1| -8.12 circ/s ||||||F

OBX|129|TX||1|FS vs Stress ||||||F

OBX|130|TX||1| -50.00 % ||||||F

OBX|131|TX||1|Circumferential peak fiberstress ||||||F

OBX|132|TX||1| 29.00 g/cm 2 ||||||F

OBX|133|TX||1|LV Fractional shortening ||||||F

OBX|134|TX||1| -50.00 % ||||||F

OBX|135|TX||1| ||||||F

OBX|136|TX||1|Analysis M-Mode Wall Stress:||||||F




OBX|139|TX||1| 54.00 ms ||||||F


OBX|141|TX||1| 3.00 cm 3.89 1.63 2.46 ||||||F


OBX|143|TX||1| 2.00 cm -5.52 2.68 3.70 ||||||F


OBX|145|TX||1| 8.00 cm 21.02 0.78 1.16 ||||||F


OBX|147|TX||1| 5.00 cm 16.78 0.45 0.74 ||||||F

OBX|148|TX||1|Midwall VCF ||||||F

OBX|149|TX||1| -31.26 circ/s ||||||F


OBX|151|TX||1| 5.00 cm 13.00 0.44 0.84 ||||||F

OBX|152|TX||1|Midwall rate-corrected VCF ||||||F

OBX|153|TX||1| -0.10 circ/s ||||||F

OBX|154|TX||1|LV minimum dimension ||||||F

OBX|155|TX||1| 43.00 cm ||||||F

OBX|156|TX||1|Circumferential peak fiberstress ||||||F

OBX|157|TX||1| 29.00 g/cm 2 ||||||F

OBX|158|TX||1|Heart rate ||||||F

OBX|159|TX||1| 78.00 BPM -2.80 88.38 137.36 ||||||F

OBX|160|TX||1|LV systolic long axis dimension ||||||F

OBX|161|TX||1| 2.00 cm ||||||F

OBX|162|TX||1|Mean Blood Pressure ||||||F

OBX|163|TX||1| 80.00 mmHg 1.33 49.75 85.86 ||||||F

OBX|164|TX||1|Time of end-systole ||||||F

OBX|165|TX||1| 56.00 ms ||||||F

OBX|166|TX||1| ||||||F

OBX|167|TX||1|Summary||||||F

OBX|168|TX||1|Kawasaki disease. No coronary artery aneurysms or ectasia. Normal ||||||F

OBX|169|TX||1|regional and global left ventricular function. No aortic regurgitation or ||||||F

OBX|170|TX||1|mitral regurgitation. No significant effusion.||||||F

OBX|171|TX||1|Smith, James L, M.D.||||||F

OBX|172|TX||1|Friday, February 06, 2004||||||F

OBX|173|TX||1| ||||||F
