Application Acknowledgement Type 16 ID 2 O [0..1] Fixed to ‘NE’ if used Country Code 17 ID 3 O [0..1] Character Set 18 ID 16 O [0..1] Principal Language Of Message 19 CE 841 O [0..1] Alternate Character Set Handling Scheme 20 ID 20 O [0..1] )
Observation Method 17 CE 841 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 427 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 563 RE [0..1] Performing Organization Address 24 XAD 631 O [0..1] Performing Organization Medical Director 25 XCN 3725 O [0..1]
APPENDIX – REVISIONS V2.0 Location Field Name Topic in v2.0 Revision in V3.0 1 HL7 Message structure attributes ORDER_OBSERVATION groups were hard-coded to expect one OBR where defined the subject type and one OBR where OBR-4 defined the notification type. The message no longer specifies subject type or notification type in this manner. Subject type is derived from looking at the PID segment (i.e., whether the person or the fields are populated) and notification type is specified in MSH-21 Profile ID. 2 HL7 Message structure attributes ORDER_OBSERVATION groups were hard-coded to expect one OBR where defined the subject type and one OBR where OBR-4 defined the notification type. The new message specifies that one OBR – the one that conveys “epidemiologic information” - is required and is the source of truth for notification variables that are tied to the OBR segment (OBR-3, OBR-7, OBR-22, OBR-25, OBR-31.) Other OBRs are used for clinical, demographic, laboratory, treatment, or vaccine category information as needed. 3 HL7 Message structure attributes The Next of Kin/ Associated Parties (NK1) segment was not supported. The Next of Kin/ Associated Parties (NK1) segment has been included to allow additional subjects or parent or owner information. 4 HL7 Message structure attributes The Specimen (SPM) segment was not supported The Specimen (SPM) segment has been added, as the message supports it and it may be included in the ORDER_OBSERVATION group specific to laboratory reporting. The definition follows the ELR Implementation Guide but is not 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 ELR-like usage of the OBX. 6 HL7 Message All of the Notes and Comments (NTE) segments The Notes and Comments (NTE) segment has been included under the
Description structure attributes were constrained out/not supported. 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. 9 1.4 Summary of Changes Formerly described the use of the 6 categories of data. Reworked to clarify and correct the HL7 content change descriptions 10 6 Appendix A Technical Considerations Only contained a discussion about repeating groups Added a section to discuss repeating variables (that is, the use of the tilde in the field for a multi-select answer). 11 7 Appendix Messaging Examples Messages were conformant to specifications. Revised the messages 12 5.2 Segment and Field All CE fields Maximum length CE fields were not consistence. Maximum length increased to 841. This increase affected other datatypes that contain a CE datatype as a component, such as VID and XPN. 13 5.2 Segment and Field All CWE fields Maximum length CE fields were not consistence. Maximum length increased to 1063. This increase affected other datatypes that contain a CWE datatype as a component, such as XCN. 14 5.2.4 OBR Segment Detail OBR-22 Status Chg/Update Date/time The cardinality of OBR-22 was [1..1]. Technical correction to the cardinality of OBR-22 from [1..1] to [0..1]. This is not an HL7 required field so it is only required per Condition Predicate: If OBR-4 is populated with Information^LN’
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 Interchange Requirements State case investigation identifier Throughout Message needs to be structurally correct as well as have a minimum set of required observations answered to be accepted and processed. Added requirement for the state case investigation identifier. Case Report to Case Notification National Notifiable Case Notification containing data elements related to a national 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
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 – Observation 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 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)