CE – PH OBX-3 TABLE 4.2: CODED – PUBLIC HEALTH (CE-PH) SEQ Component Name LEN DT Usage TBL# Comments 1 Identifier 20 ST R Standard code system identifier MUST be used. 2 Text 199 ST RE It is strongly recommended that text SHOULD be sent to accompany any identifier. 3 Name of Coding System 199 ID R HL70396 Standard coding system identifiers or OIDs MAY be sent for Coding Systems. Both are supported. 4 Alternate Identifier 20 ST RE The alternate identifier (from the alternate coding system) SHOULD be the closest match for the identifier found in component 1. 5 Alternate Text 199 ST RE It is strongly recommended that alternate text SHOULD be sent to accompany any alternate identifier. 6 Name of Alternate Coding System 199 ID C(R/X) HL70396 Condition Predicate: If component 4 (Alternate Identifier) is valued. Standard coding system identifiers or OIDs MAY be sent for Coding Systems. Both are supported. Usage Note: Triplet population order: The sender shall always populate the first triplet before populating the other triplet. CQ – TABLE 4.3: COMPOSITE QUANTITY WITH UNITS (CQ) SEQ Component Name LEN DT Usage TBL# Comments 1 Quantity 16 NM O 2 Units 483 CE O Usage Note: Examples: |123.7^kg| kilograms is an ISO unit CWE – 4.4: CODED WITH EXCEPTIONS (CWE) SEQ Component Name LEN DT Usage TBL# Comments 1 Identifier 20 ST RE Standard code identifier is expected. COMPOSITE
Date/Time of the Observation 14 TS 26 RE [0..1] This field is the physiologically relevant date-time or the closest approximation to that date-time. Producer's Reference 15 CE 250 O [0..1] Responsible Observer 16 XCN 3242 O [0..1] Supported to allow for the sending of optional laboratory data elements of interest under the Laboratory Information Header . Optionally supported to allow mapping similar to ELR.. Observation Method 17 CE 250 O [0..1] Supported to allow for the sending of optional laboratory data elements of interest under the Laboratory Information Header . Optionally supported to allow mapping similar to ELR.. Equipment Instance Identifier 18 EI 424 O [0..*] Date/Time of the Analysis 19 TS 26 O [0..1] Supported to allow for the sending of optional laboratory data elements of interest under the Laboratory Information Header . Optionally supported to allow mapping similar to ELR.. Reserved for harmonization with V2.6 20 Reserved for harmonization with V2.6 21 Reserved for harmonization with V2.6 22 Performing Organization Name 23 XON 567 RE [0..1] Performing Organization Address 24 XAD 631 O [0..1] Performing Organization Medical Director 25 XCN 3242 O [0..1]
as constrained. The HL7 required SPM-4 remains required but the other fields are sent only if available. 5 Segment Profile Attributes OBX Segment The OBX segment is tightly constrained to only allow “question and answer” pattern and does not allow for some of the fields that ELR messages use. The Observation (OBX) segment’s constraints have been relaxed to allow the more usage of the OBX. 6 HL7 Message structure attributes All of the Notes and Comments (NTE) segments were constrained out/not supported. The Notes and Comments (NTE) segment has been included under the OBX segment to allow comments associated with Laboratory Observations to be in the message. 7 Segment Profile Attributes Throughout The message was very constrained to set many fields to “not supported.” In theory, this will kick out a lot of messages if the receiver profile is not relaxed. Many fields in used segments have been set to “optional” with the comment that if the field is optional, it is not defined in this document and not expected to be processed by the receiver. Fields that remained constrained as “not supported” are those that are no longer used for this HL7 version or ones that potentially contain PII data that should not be sent for this use case. 8 Message Structure ORU^R01 Message Syntax ORU^R01^ORU_R01 Message definition was a very simplified structure that only showed the required fields and segment groups. ORU^R01^ORU_R01 Message Syntax has been updated to align with the ELR version of the message syntax.
APPENDIX E – REVISION LIST Location Field Name Justifications / Comments Version 3.0 1 Pages 1-4 Release 3.0 Publication History Copyright text Version 3.0 Release 1 October 18, 2016 Updated with correct LOINC information 2 Throughout A number of conformance statements have been added and detailed in the appendix to clarify any ambiguities in the use of the message fields. APPENDIX C – CONFORMANCE STATEMENTS has been added. 3 Actors, Goals and Messaging Transactions The Case Notification Use Case was not included in the document, it was previously described in a separate document posted on the PHIN web site. The Use Case for National Notifiable Condition Reporting has been incorporated into the document. 4 HL7 Batch Protocol HL7 Batch Protocol was previously described in a separate document posted on the PHIN web site. HL7 Batch Protocol has been incorporated into this document under the Messaging Infrastructure section. 5 Reviewers Comments Throughout Incorporated feedback and comments. Incorporated many suggestions for edits and improvements to wording, typo corrections, etc. 6 Table 2.1. Information State case investigation identifier Message need to be structurally correct as well as have a minimum National Notifiable Case Notification containing data
Throughout set of required observations answered to be accepted and processed. Added requirement for the state case investigation identifier. Case Report to Case Notification elements related to a nationally notifiable disease. Required patient data for all National Notifiable Case Notification: Sending system’s Internal case investigation identifier Case Class Status MMWR Week MMWR Year Reporting State OR National Reporting Jurisdiction 7 4 Data Types Added datatype specifications for CQ EIP, NM, XCN and XON. Added a new comment in the Data Types introduction. Added a new comment in the Data Types introduction: “There may be some Optional fields in the segments used that are not further specified. If the field is used, the standard datatype definition from the 2.5.1 HL7 Standard, Chapter 2A, applies. This Guide does not further constrain those datatypes.” 8 4.1 CE Datatype Definition Needed further clarifications to the CE datatype Clarifications to the CE datatype specifications in Section 4.1. 9 4.3 CWE Datatype Definition Needed further clarifications to the CWE datatype Clarifications to the CWE datatype specifications in Section 4.3, particularly for usage of CWE.9.
10 4.5 DR Datatype Definition DR Datatype previously not supported. Added the DR Date/time Range datatype specification as section 4.5 and moved the rest of the numbers down one spot. 11 2.1.3 Functional Sender Sender requirements needed additional clarification. Added this verbiage: Each notification is in “snapshot mode”, meaning it is a complete record of the notification data at the time it was sent. 12 5.2.7 NTE - Notes and Comments Segment NTE-1 / Set ID - NTE Previously not supported Changed usage to R, updated cardinality to [1..1]. 13 5.2.7 NTE - Notes and Comments Segment NTE-3 / Comment The NTE segment cardinality is incorrect. Updated Cardinality to [1..*]. 14 5.2.6 SPM – Specimen Segment SPM-1 / Set ID – SPM The SPM segment usage and cardinality is incorrect with optional if sent with a related OBR, the SPM should indicate that it is required if sent. Changed usage to R, updated cardinality to [1..1]. 15 5.2.4 OBR – Request Segment OBR-16 / Ordering Provider Previously not supported Updated to be supported, changed usage from X to RE and removed the highlighting for OBR-16 in the OBR table to indicate it is available for use. 16 Contact Information Contact information added for assistance with the artifact. Added with the following text: This artifact is considered to be a technical document. Please
contact edx@cdc.gov for assistance with this artifact. 17 Section 1.2 Removal of unused acronyms and addition of used acronyms. Removed CSTE, IIS, NETSS, PHLIP, STD, STLT. Added ELR, MMG, OID. 18 Table 2.1 Corrected the required patient data list for “Reporting State OR National Reporting Jurisdiction,” replaced “OR” with “AND”. Reporting State AND National Reporting Jurisdiction 19 Tables 2.1, 2.2, 3.1 / Sections 3.10, 3.11, 4 Updated table numbering and section numbering due to table changes or for newly added tables and sections. Some tables used the ‘-’ notation and used the ‘.’ Notation. Example Table 2-1 or Table 2.1, replaced with the ‘.’ Notation. Table 2.1, Table 2.2, Table 3.1 Updated Usage Conformance Testing Recommendations section to 3.10. Various tables under 3.11 HL7 Batch Protocol. Various tables under section 4 Data Types. 20 Section 3.6-3.9 Added sections for information on the use of standard codes, literal values, unknown values and MMG constraints. Sections 3.6 – 3.9 21 Section 4.3 & 4.11 Addition of CQ and FT data types, mentioned or used but not listed in the data type list. CQ (Composite Quantity with Units) FT (Formatted Text Data)
22 Section 4.1, 4.2, 4.4 Update CWE, CE-PH, and CE data types to include reference to using standard codes for component 1. Also added the reference to OIDs MAY be used for component 3. Component 1: “Standard coding system identifier must be used.” Component 3: “Standard coding system identifiers or OIDs MAY be sent for Coding Systems, both are supported.” 23 Section 4.2, 4.4 Added wording for CWE and CE-PH text component 2 to indicate recommendations to send text and bolded key words, to be consistent with intended usage across CE and CWE data types. It is strongly recommended that text SHOULD be sent to accompany any identifier. 24 Section 4.1, 4.2, 4.4 Update wording for CWE, CE-PH, and CE data types to use “component” and removed CE or CWE. For consistency and clarification. Component 1, Component 4 25 Section 4.7 Correction to example for incorrect date for DT (date) data type. Removed “April 1999”. |199503| specifies March 1995. 26 Section 4.8 Corrected example date time format. “Example: |199904| specifies April 1999. Format:
The format does not show the optionality of MMDD. 27 Section 4.17 Example is incorrect, updated from MSH-10 to MSH-11. “Example: MSH-10 Processing ID: |D| or |P| or |T|.” Example: MSH-11 Processing ID: |D| or |P| or |T|. 28 Section 4.19 SN-3 and SN-4 Added Condition Predicate for the SN data type to identify the required order of components to be used. New condition predicate to require the 2nd component to be present if the before the 3rd and 4th components. Usage: C(RE/X) Condition Predicate: If component 2 (Numeric Value 1) is valued. 29 Section 4.19 Added conformance statement for SN data type to require the separator/suffix if both <num1> and <num2> are non-null values. CONFORMANCE STATEMENT CN-003: If <num1> and <num2> are both non-null, then the separator/suffix MUST be 30 Table 5.2.1 MSH-7 For consistent use of date/time sent in specific date/time fields the date format was updated to align with a specific level of precision to seconds. Conformance statement added for MSH-7: CONFORMANCE STATEMENT CN-006: MSH-7 (Date/Time of Message) SHALL follow the format:
of the Message Control ID to uniquely identify the message and updates to indicate appending a timestamp is an example to ensure uniqueness but not required. instance from the sending application. The unique record identifier for the notification as created by the sending surveillance system is a good candidate for this string. If the local record identifier is not unique (if the record is updated), as an example a timestamp can be appended to ensure a unique identifier. 35 Various Places Removal of the reference to “From Reference to a specific ELR guide may be misleading to requirements to how to provide the laboratory information. Various. 36 Table 5.2.1 MSH-21 Removal of the specific literals for indicating the profile and MMG to be used for a given message. The conformance statement was removed and added to each MMG instead of in this messaging guide, because each conformance is unique to each MMG. Conformance statement replaced with: “The conformance statements for NOT115 SHALL be obtained from the program specific MMG.” 37 Table 5.2.4 OBR-4 Updated the conformance statement to clearly state “one and only one” occurrence of the CONFORMANCE STATEMENT CN-014: There SHALL be one and only one occurrence of OBR-4 (Universal Identifier) valued ‘68991-9^Epidemiologic Information^LN‘in all types of Case Notification Messages.
40 Table 5.2.4 OBR-4 Added information regarding reference to condition specific MMG(s) for the use of other values used in OBR-4. For any other value used in OBR-4 refer to the condition specific MMG. 41 Various Updated wording “to allow ELR-like” to state “similar to ELR” to help with references to laboratory data elements. “similar to ELR” added where references are made for supporting the Laboratory Information Header. “Optionally supported to allow mapping similar to ELR.” 42 Various Added wording for intended data elements supported under the Laboratory Information Header. Supported to allow for the sending of optional laboratory data elements of interest under the Laboratory Information Header. 43 Table 5.2.4 OBR-25 Updated conformance statement for OBR-25 to include key words, added “SHALL be” to indicate the requirement for the listed OBR-25 values, added additional wording changes to clarify the usage of ‘X’. CONFORMANCE STATEMENT CN-019: OBR-25 Result Status SHALL be limited to the following values when OBR-4 is valued ‘68991-9^Epidemiologic Information^LN’: ‘F’ for Final, when the notification is first sent. ‘C’ for Correction, when an update/revision is sent. ‘X’ to indicate that the previously received notification has been deleted or rescinded. To update information on a previously submitted case, update the information in your surveillance system and re-send the case. Set the Notification Result Status (in OBR-25) to “C” to indicate a correction and, if needed, update the case
classification status (e.g., confirmed, probable, suspected, not a case.) The updated record will supersede the previous notification. Be careful not to change data elements used to define a unique case (see or you will cause a new case to be added to the CDC data base instead of updating a previously reported case. If you determine that a previously sent case should not be counted as a case, send an updated case notification using one of the following methods: Preferred Method: the case with case classification status data element ‘77990-0’ =“Not a Case” and Notification Result Status (OBR-25) = “C” to indicate this is a correction. Alternate Method: the case with case classification status data element ‘77990-0’ = “Not a Case” and Notification Result Status (OBR-25) = “X” to indicate this case is “rescinded”. Alternate Method for jurisdictions unable to send case classification status of “Not a Case”: Regardless of the value transmitted in the case classification status, re-send the case with Notification Result Status (in OBR-25) = “X” to indicate this case is rescinded. 44 Table 5.2.5 OBX-4 Updated the wording in the condition predicate to help clarify the usage Condition Predicate: If the OBX segment is allowed to repeat more than once within the same OBR segment and contain the same OBX-3 values.
when repeating segments. 45 Table 5.2.5 OBX-4 Added conformance statement to indicate the requirement for OBX-4 to have the same unique numeric value in each repeating group. CONFORMANCE STATEMENT CN-021: OBX-4 SHALL have the same unique numeric value in each repeating group. 46 Section 5.2.6 SPM Removed the reference to the Information^LN’ section header and added “Supported to allow for the sending of laboratory data elements of interest under the Laboratory Information Section Header (Lab OBR).” Original wording was determined to be unclear and unnecessary. The intent of this segment is to describe the characteristics of a specimen. It differs from the intent of the OBR, in that the OBR addresses order-specific information. Supported to allow for the sending of laboratory data elements of interest under the Laboratory Information Section Header (Lab OBR), Optionally supported to allow mapping similar to ELR. 47 Section 5.2.7 NTE Removed the reference to the Information^LN’ section header and added “Supported to allow for the sending of laboratory data elements of interest under the Laboratory Information Section Header (Lab OBR).” Original wording was determined to be unclear and unnecessary. The NTE segment is defined here to allow for inclusion in the Case Notification message, for Notes and Comments following an OBX Observation segment. Supported to allow for the sending of optional laboratory data elements of interest under the Laboratory Information Section Header (Lab OBR.), Optionally supported to allow mapping similar to ELR.