Enhanced Cancel & Discontinue Control Codes

V 2.8 HL7 Proposal Change Request ID: File Name: Enhanced Cancel & Discontinue Control Codes Description: Status: proposed HL7-Version 2.8 (or V2.5.1 Addendum) Chapter/Section 4. Sponsoring Person Hans Buitendijk Sponsoring Business Unit Siemens Healthcare – on behalf of HITSP Date Originated: 12/10/2009 Date HL7 approved: Backward Compatible: Forward Compatible: HL7 Status & Date

Justification Detail During the HITSP reviews of the General Lab Order Capability (CAP99) and Construct (C163), a requirement arose to support the ability of the Filler to not only notify of the Cancellation or Discontinue, but to alternately be able to request the Cancellation or Discontinue to which the Placer may then respond with either an O.K. or Unable To Cancel or Discontinue.

Discussion The use case that indicated this that in the Long Term Care setting the Lab is not allowed to unilaterally cancel an order but has to request the ordering physician whether it can be cancelled. Policies/procedures typically in place in inpatient Lab settings where protocol does allow the Lab to unilaterally cancel or discontinue in defined circumstances without having to first confirm with the ordering physician.

To support the LTC setting where the intent is for the systems to follow the required processes involving confirmation of a cancel or discontinue, the HL7 standards need to be expanded to allow for this use case.

It should be noted that common practices have already started to do so, but has never been formally acknowledged.

V3 Implications none v2.xml Implications none

1 Add alert trigger event

Proposal Make the following adjustments relative to 2.5.1, 2.6/2.7

V2.5.1 Section 4.5.1.1.1 Table notes for order control codes of ORC  CA A cancellation is a request not to do a previously ordered service. Confirmation of the cancellation request is provided by the filler or placer, e.g., a message with an ORC-1-order control value of CR.  UC An unable-to-cancel code is used when the ordered service is at a point that it cannot be canceled by the filler or placer, or when local rules prevent cancellation by the filler. The use of this code is dependent on the value of ORC-6-response flag. If the filler initiated the request to cancel and the placer is unable to cancel while the filler cannot proceed with the fulfillment of that order, then the necessary communication to resolve the conflict is outside the scope of these messages.  DC A discontinue request code is used to stop an ongoing ordered service. It is not the same as a cancellation request, which is used in an attempt to prevent an order from happening.

Section 4.23.1 HL7 Table 0119 – Order Control Codes

CA Cancel order/service request P,F a

CR Canceled as requested F,P

UC Unable to cancel F,P b

DC Discontinue order/service request P,F c

DR Discontinued as requested F,P

UD Unable to discontinue F,P

V2.6 Change in Section 4.23.1 Table 0119 – Order Control Codes the text as highlighted:

CA Cancel order/service Placer or Filler Applications. request A cancellation is a request by the placer for the filler, or the filler to the placer, not to do a previously ordered service. Confirmation of the cancellation request is provided by the filler or placer, e.g., a message with an ORC-1-order control value of CR. Typical responses include, but are not limited to, CR – Cancelled as requested, UC – Unable to Cancel.

CR Canceled as requested Filler or Placer Applications. A response by the filler or placer application that a request to cancel (CA by the placer application) was performed successfully.

UC Unable to cancel Filler or Placer Applications. An unable-to-cancel code is used when the ordered service is at a point that it cannot be canceled by the placer or filler or when local rules prevent cancellation by the filler. The use of this code is dependent on the value of ORC-6-response flag. If the filler initiated the request to cancel and the placer is unable to cancel while the filler cannot proceed with the fulfillment of that order, then the necessary communication to resolve the conflict is outside the scope of these messages.

2 Add alert trigger event

DC Discontinue order/service Placer orFiller Applications. request A request by the placer application for the filler application, or the filler to the placer, to discontinue a previously requested service. The differentiation between discontinue and cancel is that discontinue effects the order/service and all future occurrences, cancel refers to just the present action. Typical responses include, but are not limited to, CR – Cancelled as requested, UC – Unable to Cancel.

DR Discontinued as Filler or Placer Applications. requested The filler or placer, in response to a request to discontinue (DC from the placer or filler application), has discontinued the order/service.

UD Unable to discontinue Filler or Placer Applications. An unable-to-discontinue code is used when the ordered service is at a point that it cannot be discontinued by the placer or filler or when local rules prevent discontinuance by the filler. The use of this code is dependent on the value of ORC-6- response flag. If the filler initiated the request to discontinue and the placer is unable to discontinue while the filler cannot proceed with the fulfillment of that order, then the necessary communication to resolve the conflict is outside the scope of these messages.

V2.7 Same changes as in V2.6, but in Chapter 2c where table 0119 is now located

V2.8 Same changes as in V2.6, but in Chapter 2c where table 0119 is now located.