RIS PD160 CRIS Outbound Interface Specification
RIS_PD160_CRIS_Outbound Interface Specification
Contents:
1 Introduction 4
1.1 Purpose 4
1.2 Audience 4
2 Implementation Model 5
2.1 Overview 5
2.2 Application Data Flow 5
2.3 HL7 version 5
3 Message and Activity mapping 6
3.1 Register a patient 6
3.2 Update a patients Demographic details 6
3.3 Merge two patients 6
3.4 Create an appointment 6
3.5 Patient Attends 6
3.6 Appointment/Examination Cancelled 6
3.7 Appointment/Examination Changed 6
3.8 Examination performed 6
3.9 Report entered 6
3.10 Report verified 7
3.11 Report amended 7
3.12 Pre Admit a Patient 7
4 Message Transport 8
4.1 Connections 8
4.2 Transport level Acknowledgements 8
4.3 Framing Characters 8
5 Error handling 9
6 Data Mappings 10
6.1 Patient Identifiers 10
6.2 Time Stamp values 11
6.3 Messages 11
6.4 ADT^A04 Patient registration 11
6.5 ADT^A08 Patient demographic update 11
6.6 ADT^A05 Pre Admit, SIU^S12 Scheduling 11
6.7 ADT^A40 Patient Merge 11
6.8 OMG^O19 Order Message 11
6.9 ORU^R01 Clinical Report 12
6.10 Order control and status summary 14
7 MSH 15
8 EVN 16
9 PID 17
10 MRG 19
11 PD1 20
12 PV1 21
13 AL1 22
14 SCH 23
15 ORC 24
16 OBR 26
17 OBX 28
17.1 Scanned Documents 28
17.2 IEP Remote Sending 29
18 NTE 30
19 ZDS 31
20 Sample Messages 32
21 Configuration Questionnaire 34
22 Quick Reference 36
22.1 Patient 36
22.2 Referral 36
22.3 Performing 36
22.4 Reporting 36
22.5 Pre fetching 36
1 Introduction
1.1 Purpose
This document intends to define the transport protocols, message mappings and definitions for integration of CRIS with another system via HL7.
This version of the specification applies to CRIS interface release 2.09.t1b.
1.2 Audience
This document is intended for system integrators, third party suppliers and potential customers. The reader is assumed to be familiar with the HL7 standard.
2 Implementation Model
2.1 Overview
CRIS sends HL7 messages in response to significant activity occurring on the CRIS database. Events such as patient registrations, updates, examination bookings, status changes and results may all generate messages which a connected system may use to maintain its patient’s database, manage work lists and store results. To reduce network traffic unnecessary messages may be suppressed, for instance a results feed system may only require the verified result messages, whereas a PACS or another RIS would likely require all messages.
This document does not describe messaging activity for use with an Order communications system.
2.2 Application Data Flow
Messages flow from CRIS to the remote system as a result of user activity on CRIS. All messages are transmitted over TCP/IP using HL7 MLLP.
2.3 HL7 version
All messages referenced in this document conform to the 2.4 version of the HL7 standard. Message transport is HL7 MLLP over TCP/IP.
3 Message and Activity mapping
3.1 Register a patient
When a patient is registered on CRIS an ADT^A04 message is sent to the connected system.
3.2 Update a patients Demographic details
When a patients demographic details are changed on CRIS an ADT^A08 message is sent to the connected system.
3.3 Merge two patients
When two patient records are found to refer to the same patient the two records are merged and an ADT^A40 message is sent to the connected system.
3.4 Create an appointment
When a user on CRIS makes an appointment CRIS will send an OMG^O19 message with order control set to “NW” and a status value of “SC” (scheduled)
3.5 Patient Attends
When a patient attends for their examination they will be booked in to the CRIS reception module, at this point CRIS will send an OMG^O19 message. For attendances that had an appointment booked order control will be set to “SC” (status changed), otherwise order control will be “NW” (new). Order status will be “IP” (in process).
3.6 Appointment/Examination Cancelled
A user on CRIS may decide to cancel an appointment or an examination. At which point CRIS will send and OMG^O19 message with order control set to “CA” and a status of “CA”
3.7 Appointment/Examination Changed
The radiology dept may decide to change the type of procedure being performed. At this point CRIS will send an OMG^O19 message with order control set to “XO” with the revised details.
If the connected system is unable to accept changes to orders working practice will need to be changed, and the previous exam cancelled and a new one entered.
3.8 Examination performed
When the procedure has been performed the radiographer enters the screening and projection data on CRIS. At this point CRIS will send an OMG^O19 message with order control set to “SC” and a status of “CM” (complete).
3.9 Report entered
When the clinical report is entered on CRIS an ORU^R01 message containing the preliminary report is sent with a result status of “P” (preliminary).
3.10 Report verified
Once the Radiologist is satisfied with the clinical report it will be verified. At this point CRIS will send an ORU^R01 containing the report with a result status of “F” (final)
3.11 Report amended
If for some reason the radiologist later needs to change a previously verified report and addendum will be added. If CRIS is configured to send unverified results then an ORU_R01 containing the report with a result status of “C” (changed) will be transmitted. When the report is subsequently re verified an ORU_R01 will be sent, again with a result status of “C”.
3.12 Pre Admit a Patient
When a pre admit message is received from PAS CRIS can be configured to send either an ADT^A05 message or an SIU^S12 message. CRIS may also be configured to buffer these messages until a specified number of days prior to the patient attendance date.
4 Message Transport
All Messages are transmitted over TCP/IP using MLLP.
4.1 Connections
One socket connection is used for messages originating from CRIS. The port numbers to be used will be decided by mutual agreement. CRIS will initiate the connection (acting as client).
4.2 Transport level Acknowledgements
Each message will be acknowledged by the receiving system prior to delivery of the next message. Messages that are NAK’d will by logged by CRIS and should also be logged by the receiving system.
4.3 Framing Characters
Standard HL7 MLLP framing characters will be used, these are
<0B> start of message
<1C> end of message
In addition MLLP requires that each message be followed by the segment delimiter which is carriage return <0D>
5 Error handling
CRIS logs errors that are encountered when generating and processing messages as well as any error messages in the MSA segments received in response to outbound messages. It is expected that the connected system will also maintain its own logs.
6 Data Mappings
6.1 Patient Identifiers
All known patient identifiers will be passed in PID:3. Components 1, 4 & 5 are populated, component 2 is optional and is for the NHS number only, and other components are left blank. The primary key to be used is determined at configuration time. The order of identifiers sent is configurable so that the remote systems preferred primary key can be sent first if necessary.
Sequence / Name / Usage1 / ID Number / Patient Identifier
2 / Check Digit / Optional, for NHS number use only. If required then you must request that SendNHSVerStatus is set TRUE, NHSVerStatusInIDReliabilityCode is set FALSE, if set TRUE then we put this value in PID:32. If you only want verified NHS numbers (01) then you must request SendVerifiedNHSNumOnly is set to TRUE (default is FALSE)
4 / Assigning Authority / NameSpace ID contains:
“NHS” for nhs number
“CHI” for chi number
“CRIS” for CRIS number
Otherwise the code identifying a hospital for hospital numbers.
5 / Identifier Type Code / “NH” for nhs number/ chi number
“MR” for hospital numbers
“PI” for CRIS number
Note that on CRIS the only patient identifier that is guaranteed to be present at all times is the CRIS number. If another identifier (such as a hospital number for a particular hospital) is selected to be used as primary key CRIS will send a dummy value for that identifier if it is not present, when the required identifier is subsequently provided CRIS will send a merge message with the dummy value as the source patient id.
As an example, suppose that hospital numbers for hospital RNZ04 have been selected as primary key, a patient attendance is entered on CRIS but no hospital number yet exists, however an NHS number and CRIS number are both available. In this case the PID:3 segment will be populated as so:
3289329^^^CRIS^PI~8772332778^^^NHS^NH~CRIS3289329^^^RNZ04^MR
As you can see the hospital number for RNZ04 was not available so CRIS generated a temporary dummy hospital number by inserting the string “CRIS” at the beginning of the CRIS number.
Sometime later a hospital number of A786345 is allocated to the patient, CRIS will then generate a merge (ADT^A40) message with PID:3 populated as:
3289329^^^CRIS^PI~8772332778^^^NHS^NH~A786345^^^RNZ04^MR
and a merge segment as follows:
MRG|CRIS3289329^^^RNZ04^MR
6.2 Time Stamp values
CRIS will always populate time stamps with as much data as is available, in some cases this will include year, month, day , hours, minutes, seconds, milliseconds and time zone offset, in other cases hours, minutes seconds milliseconds and time zone may not be available. The connected system should follow the standard HL7 guidelines for processing of time stamps.
6.3 Messages
CRIS sends six messages, ADT^A04, ADT^A08, ADT^A05 or SIU^S12, ADT^A40, OMG^O19 and ORU^R01.
6.4 ADT^A04 Patient registration
This message is sent when a patient is first registered on CRIS.
6.5 ADT^A08 Patient demographic update
This message is sent when a patients demographic details are changed on CRIS.
6.6 ADT^A05 Pre Admit, SIU^S12 Scheduling
If CRIS receives ADT^A05 or SIU^S12/S13 messages from PAS these messages are in turn passed through this outbound interface either as ADT^A05 or as SIU^S12 messages.
6.7 ADT^A40 Patient Merge
Merge messages in sent either when two patients’ details are merged on CRIS, or when the connected systems preferred primary key changes for a patient.
6.8 OMG^O19 Order Message
The order message is used to pass status information, new examinations booked on CRIS and cancellations. The meaning of an order message is specified in ORC:1 - Order Control.
Code / Message TypeNW / New order booked
CA / Cancellation of an existing order
XO / Change order request
SC / Status Changed
6.9 ORU^R01 Clinical Report
The ORU^R01 message is used to transmit clinical reports to OCMS. ORC:1 will always contain “SC” for status change with a status value , ORC:5, of “CM” for complete.
On CRIS multiple examinations/orders may be performed in the same attendance, the clinical report entry screen allows the user to create a clinical report comprised of multiple sections, one section for the attendance summary plus one section for each examination.
For Example, two examinations are ordered, a Left Foot and a Right Arm. The radiology department decides to perform the two examinations on the one attendance the following three section report is entered.
Summary
This person can neither walk nor write.
Left Foot
Left foot appears to be missing
Right Arm
The right arm is mostly complete; however the patient is missing four fingers and a thumb.
CRIS has several configuration options available that affect the generation of clinical report messages and OBX segments, these are configured by HSS and should be chosen according to the capabilities and requirements of the receiving system.
Setting / DescriptionUnique By Event / Normally, a report message is generated for each exam, with this setting enabled one report message is generated for the event, so PACS would in the above example receive 1 message instead of two.
Send Report For All Exams / This setting is normally enabled and causes CRIS to send the entire report text for the attendance in each message, so for the above example each message would contain
This person can neither walk nor write.
Left foot appears to be missing
The right arm is mostly complete, however the patient is missing four fingers and a thumb.
If this setting is disabled the message for the Left Foot exam would contain
This person can neither walk nor write.
Left foot appears to be missing
And the message for the right arm would contain
This person can neither walk nor write.
The right arm is mostly complete, however the patient is missing four fingers and a thumb.
Note that summary text is sent in each report message regardless.
This setting should not disabled if Unique By Event is enabled as report content would be missed.
Send Examination Names In Report / Normally only the text entered by the user is sent in OBX:5, with this setting enabled the above example would generate a message with the following contents
[Summary Report]
This person can neither walk nor write.
[Left Foot]
Left foot appears to be missing
[Right Arm]
The right arm is mostly complete, however the patient is missing four fingers and a thumb.
Individual Exams In Observation ID / This setting affects the population of the OBX:3 segment, by default OBX:3 is populated with the examination code of the exam that generated the report message, so will contain the same value as OBR:4.
With this setting enabled each OBX:3 will contain the examination code of the exam relating to the report text contained in OBX:5, so in the example above, the following OBX segments would be generated (note that only OBX:3 and OBX:5 are shown for clarity and examination codes are examples only)
OBX|||SUMMARY^Report Summary||This person can neither walk nor write
OBX|||SUMMARY^Report Summary||
OBX|||FOOL^Left Foot||Left foot appears to be missing
OBX|||FOOL^Left Foot||
OBX|||ARMR^Right Arm||The right arm is mostly complete, however the patient is missing four fingers and a thumb.
OBX|||ARMR^Right Arm||
ReportMargin / Specifies a right margin for the report text. By default there is no margin and each OBX:5 will contain text up to the next carriage return. If PACS is unable to wrap long lines a suitable manner for display purposes a suitable value should be chosen for ReportMargin. With margin set to 60 the report text would be as follows
This person can neither walk nor write.
Left foot appears to be missing
The right arm is mostly complete, however the patient is missing four fingers and a thumb.
Note that an additional line break is inserted between the words “is” and “missing”.
Send Unverified Reports / Normally CRIS will only transmit report messages for verified reports. This setting allows unverified reports to also be sent.
6.10 Order control and status summary