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Japanese Extension for Transactions based on HL7 in IHE Radiology Domain

Japanese Extension for Transactions based on HL7 in IHE Radiology Domain. 2007/01/08-09 IHE-Japan Technical Committee. Background. Why IHE-J needs extensions for HL7 transactions ? More detail order information is needed Patient arrival is important event

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Japanese Extension for Transactions based on HL7 in IHE Radiology Domain

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  1. Japanese Extension for Transactions based on HL7in IHE Radiology Domain 2007/01/08-09 IHE-Japan Technical Committee

  2. Background • Why IHE-J needs extensions for HL7 transactions ? • More detail order information is needed • Patient arrival is important event • Support for medical billing system is required • Why HL7 V2.5 is needed ? • Expression power • V2.3.1 is poor • Detail description of order information • Expression of information for medical billing • To keep consistency of HL7 version with other domain • LAB domain, Cardiology domain and so on Japanese Extensions for HL7 Transaction

  3. Japanese Extensions for Transaction • X.7.0.1 Japanese extension for SWF integration profile • X.7.0.2 Affected Existing Transactions Japanese Extensions for HL7 Transaction

  4. ADT ←Placer Order Management [RAD-2] →Filler Order Management [RAD-3] →Appointment Notification [RAD-48] →Patient Accepted Notification [RAD-X] →Order Performed Notification [RAD-Y] Pt. Registration [RAD-1]↓ Patient Update [RAD-12]↓ ↓Pt. Registration [RAD-1] ↓Patient Update [RAD-12] DSS/Order Filler Order Placer ↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49] ↑ Modality PS in Progress [RAD-6] ↑ Modality PS Completed [RAD-7] ↑ Creator PS in Progress [RAD-20] ↑ Creator PS Completed [RAD-21] Evidence Creator Image Display ↓ Creator PS in Progress [RAD-20] ↓ Creator PS Completed [RAD-21] Storage Commitment [RAD-10]↓ ↓ Creator Images Storage [RAD-18] ↓Query Images [RAD-14] ↓ Retrieve Images [RAD-16] Performed Procedure Step Manager Image Manager Image Archive → Modality PS in Progress [RAD-6] → Modality PS Completed [RAD-7] → Creator PS in Progress [RAD-20] → Creator PS Completed [RAD-21] ↑ Modality Image Stored [RAD-8] Storage Commitment [RAD-10]↓ ← Modality PS in Progress [RAD-6] ← Modality PS Completed [RAD-7] Acquisition Modality ←Query Modality Worklist [RAD-5] Scheduled Workflow Diagram Japanese Extensions for HL7 Transaction

  5. Image Manager Image Archive Parts of Scheduled Workflow Diagram ADT ↓Pt. Registration [RAD-1] ↓Patient Update [RAD-12] Pt. Registration [RAD-1]↓ Patient Update [RAD-12]↓ ←Placer Order Management [RAD-2] →Filler Order Management [RAD-3] →Appointment Notification [RAD-48] →Patient Accepted Notification [RAD-X] →Order Performed Notification [RAD-Y] DSS/Order Filler Order Placer ↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49] Bold Modified Bold + Underline New Plane Optional Plane Unchanged Japanese Extensions for HL7 Transaction

  6. X.7.0.1 Japanese extension for SWF integration profile • 2 New Transactions ! • Patient Accepted Notification [RAD-X] • This is used for the patient arrival notice. • In Japan, it is important that the system detects the patient arrival to the radiology department. • To lock order modification, to know where the patient is • ORU message is used for this transaction • Order Performed Notification [RAD-Y] • This is used for the information transfer for medical billing system as performed procedure information. • Method for examinations, additional billing, material (film, drug, instrument etc) • This transaction is usually used instead of RAD-3 • OMI message is used for this transaction Japanese Extensions for HL7 Transaction

  7. X.7.0.2 Affected Existing Transactions(1/2) • [RAD-1] Register Patient • A08 is only event that is used in IHE-J • [RAD-2] Placer Order Management • OMG message is used instead of ORM • Detail information is set in ORC segment by using JJ1017 Code (Japanese master code for Radiology) • [RAD-3] Filler Order Management • This transaction is optional • RAD-Y should be used instead of This transaction Japanese Extensions for HL7 Transaction

  8. X.7.0.2 Affected Existing Transactions(2/2) • [RAD-4] Procedure Scheduled • This transaction is used between DSS/OF and IM/RM • OMI message is used from DSS/OF to IM/RM • ORI used for reply from IM/RM to DSS/OF • ORM message is not used • [RAD-12] Patient Update • A08 is only event that is used in IHE-J • [RAD-13] Procedure Update • OMI message is used from DSS/OF to IM/RM • ORM message is not used Japanese Extensions for HL7 Transaction

  9. Japanese Extensions for HL7 Transaction

  10. Japanese Extensions • X.7.0.3 Use of Start Block Control Characters like 0b • X.7.0.4 Use of HL7 Messages • X.7.0.5 Use of HL7 Message Segments • X.7.0.6 Data Type Japanese Extensions for HL7 Transaction

  11. X.7.0.3 Use of Start Block Control Characters like 0b • An implementation example describes a case which uses a start block character ahead of MSH segment. • However, this example is for the case where the physical layer is RS232C, and this is not proper to the case where the lower layer is TCP/IP. • It is normal that implementation of HL7 in Japan does not append these start block character like 0x0b. Japanese Extensions for HL7 Transaction

  12. X.7.0.4 Use of HL7 Messages (1) Use of ADT/ACK Messages • The consistency of patient information between Order Placer, DSS/Order Filler and Image Manager/Image Archive (2) Use of OMG/ORG Messages • OMG messages are used for transmission of the requested messages for radiology exam from HIS to RIS. And ORG messages are used for the reply. (3) Use of OMI/ORI Messages • The exam and procedure information between systems in the radiology department is transmitted by using OMI message. And ORI messages are used for the reply. (4) Use of ORU/ACK Messages • ORU messages are used for the patient arrival and ACK message is used for the reply. Japanese Extensions for HL7 Transaction

  13. X.7.0.5 Use of HL7 Message Segments(1/4) (1) MSH Segment • MSH segment is required for each message of requested order. (2) EVN Segment • The EVN Segment is used for backward compatibility. (3) PID Segment • According to HL7 V2.5, PID segment in OMG message is optional. • But IHE-J requests PID segment in each order information for one patient. (4) PV1 Segment • According to HL7 V2.5, PV1 segment in OMG message is optional. • But the PV1 segment is used for distinction between outpatient and inpatient. Japanese Extensions for HL7 Transaction

  14. X.7.0.5 Use of HL7 Message Segments(2/4) (5) PV2 Segment • IHE-J does not use PV2 segment. (6) AL1 Segment • Basically the allergy information is described in OBX segment as patient profile. • The allergy information is used as contraindication information for radiology exam. So it should be described in OBX segment with other contraindication information (e.g. Lab result information). The reason of this is that all contraindication information should be kept in one place (OBX segment) in the message. (7) TQ1 Segment • According to HL7 V2.5, TQ1 segment in OMG message is optional. • But the TQ1 segment is used for priority of message. So TQ1 segment is required. Japanese Extensions for HL7 Transaction

  15. X.7.0.5 Use of HL7 Message Segments(3/4) (8) TQ2 Segment • IHE-J does not use TQ2 segment. (9) DSC Segment • IHE-J does not use DSC segment. (10) ZE1 Segment (Billing Segment) • It is difficult to put billing information as performed procedure information in segment structure according to HL7 V2.5 standard. • ZE1 segment is defined to transmit billing information. • Some items are described in the ZE1 segment, procedures, drugs, instrument, additional billing items, films and practitioners. Japanese Extensions for HL7 Transaction

  16. X.7.0.5 Use of HL7 Message Segments(4/4) (11) ZE2 Segment (Radiation Dose Segment) • In Japan, the exposure information usually has been transmitted from RIS to HIS. But it is difficult to describe the exposure information in standard HL7 V2.5 message structure. • ZE2 segment is defined to describe exposure information. • The exposure information is usually transmitted from modality to RIS by using DICOM MPPS. That information is described in HL7 message structure by using ZE2 segment. Japanese Extensions for HL7 Transaction

  17. X.7.0.6 Data Type • new data type “ZRD” • This is used to describe amount of quantities like medicine, film, film segment, etc. • For example, the number of sheets of film taken in an examination is specified with ZRD. Japanese Extensions for HL7 Transaction

  18. Japanese Extensions for HL7 Transaction

  19. Discussion Points Japanese Extensions for HL7 Transaction

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