Connection sheet

SHEET # CONNECTION NAME REV # VERSION

11

Order Reception (HL7 2.4 / TCP-IP Socket)

V02.01

This interface specification is confidential and is strictly reserved for communication with a Hospital Information System. An End User Agreement containing the text on the final page of the present document must be agreed by the Customer (End User). This interface specification is for the exclusive use of sites covered by an End User Agreement. Use of this interface specification implies full acceptance of the terms and conditions of the End User Agreement included hereafter.

Table of contents
Technical pre-requisites 4 References 4
Program identification 4

Presentation 5
Communication diagram 5 Management of order cancelation or duplicate order message (Step 4 in the above diagram) 6

Communication layers: TCP / IP socket 7

Transmission diagram 7 Data Block Structure 7 Information exchange description 10

Installation procedure 11 Implementation 11

"Labconf" parameters 11 Device dictionary 12 Activation of the Connection service 15

Relevant HL7 messages, segment types and fields 17

Processed messages 17 Supported segment types 17 Acknowledgement CNXR011 / 3 HL7: Order Reception V02.01 Confidential. This specification requires an end user agreement. Page 1/27

Connection sheet 18

Segment descriptions 20
MSH - Message Header Segment 20 EVN - Event type segment 21 PID - Patient identification segment 21 PV1 - Patient visit information 21 ORC - Common order Segment 21 OBR - observation request segment 23 OBX - observation / result 24 General constraints 25

Examples of ORM messages 26

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Connection sheet

History of document modifications

Related version V01.53 V01.53 V02.01 Rev. 0 1 2 Short description of the modification Creation of the connection sheet. Change layout/format of the connection sheet. In the Device dictionary definition paragraph, Type of flow. Order Reception: Addition of the following properties Accept assigned message number (NA). Exam grouping, Exam grouping time frame, Topography parameter code, Collection source parameter code and related Notes 1 and 2. - Addition of the paragraph Management of order cancelation or duplicate order message in the Presentation topic. - Modification of the Communication diagram: Addition of the Step (4). - In the Device dictionary definition, Type of flow Order Reception: the following property and its related Note4, have been added: Process order cancelation or duplicate order message

V02.01.h

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Connection sheet

Technical pre-requisites
The connection for Order Reception (in HL7 2.4 / TCP-IP Socket) must be installed on a computer connected to the network 24 hours/day and 7 days/week (computer on which is installed the connection service). The computer must be installed with at least Windows 2000 or XP and must be conform to the recommendations specified in the Description of System components document, available on our website (www.technidata-web.com).

References
Reference number of HL7 standard (High Level Protocol): Date of this standard: Reference number of HL7 standard (Low Level Protocol) Date of this standard: High Level protocol HL7 2.4 Chapter 4 Order Entry November 2000 Low Level protocol HL7 2.3 Appendix C Lower Layer Protocols June 1998

Program identification
Application DLL: TDCnxAppWRH.DLL (Patients \ Order \ Results processing). Protocol DLL: TDCnxProtoHISADT.DLL (HL7 Low Level Protocol (Socket)) Format DLL: TDCnxFormHL7.DLL (HL7 High Level Protocol) Transport DLL: TDCnxTransTCPIPSocket.DLL (TCP-IP Socket Transport if TCP-IP Socket transport)

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Connection sheet

Presentation
This document describes the rules for reception of Order Entry messages (ORM messages) transmitted from a HOST via: - HL7, for the high-level protocol and, - TCP/IP socket. This description is based on the principles given by the HL7 Appendix C Lower Layer Protocols chapter. The generic rules that apply to all messages and the specific messages to be exchanged among certain applications can be found in the HL7 documentation. HL7protocol (Health Level Seven) objective is to provide standards relative to the structure of the information to be exchanged between multiple healthcare information systems, such as laboratories, radiology. The referenced high-level protocol is the HL7 version 2.4 (Standard specification for transferring clinical observations between independent computer systems) and the aim of this document is to present the mechanisms of that protocol implemented for receiving order on the management database.

Communication diagram

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Connection sheet

Management of order cancelation or duplicate order message (Step 4 in the above

diagram) When this management is enabled (by the property Process order cancelation or duplicate order message in the Device dictionary, "Order reception" data flow), the following cases are processed:

Duplicate order asked by the HIS

1. The PON (Placer Order Number) does not exist in the request When the LIS receives a test code already present in the order but with a PON different from the already received order, an ORM message is sent to the HIS with the field ORC-1=OC (Order Canceled). This message is sent whatever the tube status (collected or not) may be. The HIS has to acknowledge this message. 2. The PON already exists in the request When the LIS receives a test already present in the order with a PON already received: - If at least one tube associated with the request has been collected, the LIS does not take into account this new order, but no cancelation message (ORM message with ORC-1 = OC) is sent to the HIS. - If no tube associated with the request has been collected, the test is updated normally.

Order cancelation asked by the HIS

When the HIS wants to cancel a test, it sends an ORM message with the field ORC-1=CA (Cancel Order). In this case a number of verifications are made. 1. If the PON already exists and the tube associated with the test B is already collected or declared arrived at the laboratory, the test cannot be canceled. Then an ORM message is transmitted to the HIS with the field ORC-1=UC (Unable to Cancel). 2. If the PON already exists and the tube associated with the test B is not collected, the requested cancelation is performed. Examples: 1) The request contains the tests A and B Test A tube 1 (collected) Test B tube 2 (not collected) The HIS sends a cancelation message for test B, and test B is canceled. 2) The request contains the tests A and B Test A tube 1 (collected) Test B tube 1 The HIS sends a cancelation message for the test B, and - test B is NOT canceled - an ORM message with ORC-1=UC (Unable to Cancel) is sent to the host. In this case, test B is not canceled because, in some cases, tests are billable as soon as the sample is collected.

Addition of a test asked by the HIS

When the HIS wants to add a test to an existing order, it sends an ORM message with the field ORC-1=NW (New). After verification, if the test cannot be added (the order contains a tube already "collected") an ORM message is transmitted to the HIS with the field ORC-1=OC (Order Canceled). When this management is enabled an Output device must be specified to transmit orders to the HIS. Refer to the connection sheet CNXR023 Transmission of orders for this part of the communication.

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Connection sheet

Communication layers: TCP / IP socket

TCP/IP socket low-level protocol is the transport layer used for exchanging data between devices located on the same network. The purpose of this chapter is to describe the exchange between a Host Information System and the Communication engine when TCP/IP socket is implemented as low-level protocol.

Transmission diagram
After the connection between the client and the server connection task, data are sent to the server by the client.
Host Information System (Client) Connection (Server)

Connection phase between the client and the server: Socket creation, establishment of the connection etc (cf : Information exchange description)

<SB>tvv<CR>ddddcccccxxx<EB><CR>

> <

Data block sent by the server with a HL7 ACK message embedded

Data block sent by the client with an HL7 ADT (patient administration) embedded message. After control of the correct data transfer (physical integrity), the HL7 message is parsed and managed. Depending on the result of these processes, an HL7 ACK message is sent with the error code in case of problem. <SB>tvv<CR>ddddcccccxxx<EB><CR> "dddd" contains the different HL7 messages composing the logical acknowledgement (MSH, MSA and ERR segments).

It is up to the client system to close the connection upon reception of the Acknowledgement

Connection phase between the client and the server: Socket creation, establishment of the connection etc (cf : Information exchange description)
<SB>tvv<CR>ddddcccccxxx<EB><CR>

> <

Data block sent by the server with a physical NAK message embedded into it (character 'C')

Data block sent by the client with an HL7 ADT (Patient administration)message embedded. On the physical integrity control, a wrong block format has been detected. A special data block is sent (NAK block). <SB>Nvv<CR>C000EBxxx<EB><CR> Negative physical acknowledgement sent by the connection if something is wrong on the physical transmission (wrong checksum, wrong count of characters)

It is up to the client to send the data block back or to discard it and to execute its own error handling routine
<SB>tvv<CR>ddddcccccxxx<EB><CR>

>

Data block sent by the server with a HL7 ACK message embedded into it

<

Data block sent by the client with an HL7 ADT (Patient administration)message embedded into it. After control of the correct data transfer (physical integrity), the HL7 message is parsed and managed. Depending on the result of these processes, an HL7 ACK message is sent with the error code in case of problem or without error code if all is correct. <SB>tvv<CR>ddddcccccxxx<EB><CR> "dddd" contains the different HL7 messages composing the logical acknowledgement (MSH, MSA and ERR segments).

It is up to the client to close the connection upon reception of the Acknowledgement

Data Block Structure

Depending on the TCP-IP Lower Layer Protocol parameter in the Device Dictionary, 2 data block structures are possible. The Hybrid and the Minimal.

1. Hybrid HL7 Low Layer Protocol

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Connection sheet

There are two types of blocks: the data blocks and the NAK blocks. HL7 messages are transmitted in single data blocks. NAK blocks are used to signal physical transmission errors (NAK is used at low level protocol, instead of Nack used at high level protocol). Both block types have the same format: <SB>tvv<CR>ddddcccccxxx<EB><CR> Blocks consist of the following fields: <SB> = Start Block character (1 byte). Configurable on site specific basis. Unless there is a conflict, the value should be ASCII <VT>, i.e. <0x0B>. This should not be confused with the SOH or STX ASCII characters. This character must equal the one configured as "Start of block character" in the device dictionary. Block Type (1 byte). "D" = Data block "N" = NAK block Protocol ID (2 bytes). Characters "24" for this version. Carriage Return (1 byte). The ASCII carriage return character, i.e. <0x0D>. Data (variable number of bytes). In a data block, it corresponds to the data content of the block. The data can contain any displayable ASCII characters and the carriage return character, <CR>. Carriage returns that are not part of the HL7 message may be inserted as described in "Carriage Return Stuffing." In a NAK block, this field contains a 1-byte reason code as follows: 'C' - character count wrong in previous data block received 'X' - checksum wrong in previous data block received 'B' - data too long for input buffer in previous block received 'G' - Error not covered elsewhere. ccccc = Block Size (5 bytes). Character count of all characters so far in the data block up to and including the data last character. For this protocol version, it corresponds to 5 + the size of the "dddd" field. Note: HL7 message ends with a <CR> character. This character is considered as part of the data. Checksum (3 bytes). Exclusive-OR checksum of all characters in the block up to and including the data last character. The checksum is expressed as a decimal number in three ASCII digits. If the value of this field is 999, the checksum should not be computed. Processing will proceed as if it were correct. This feature is used for applications where the messages will be translated from one character set to another during transmission. The "Checksum type" parameter in the device dictionary must be set to "Checksum for HL7 low layer protocol".

t=

vv = <CR> = dddd =

xxx =

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Connection sheet <EB> = End Block character (1 byte). Configurable according to the site. Unless there is a conflict, the value should be ASCII <FS>, i.e. <0x1C>. This should not be confused with the ETX or EOT ASCII characters. This character must equal the one defined as "End of block character" parameter in the Device dictionary. Carriage Return (1 byte). The ASCII carriage return character, i.e., <0x0D>.

<CR> =

2. Minimal HL7 Low Layer Protocol

HL7 messages are enclosed by special characters to form a block. The format is as follows: <SB>dddd<EB><CR> <SB> = Start Block character (1 byte) ASCII <VT>, i.e. <0x0B>. This should not be confused with the ASCII characters SOH or STX. This character must equal the one configured as "Start of block character" in the Device dictionary. dddd = Data (variable number of bytes) This is the HL7 data content of the block. The data can contain any displayable ASCII characters and the carriage return character, <CR>. <EB> = End Block character (1 byte) ASCII <FS>, i.e., <0x1C>. This should not be confused with the ASCII characters ETX or EOT. Carriage Return (1 byte) The ASCII carriage return character, i.e. <0x0D>. This character must equal the one configured as "End of block character" in the Device dictionary.

<CR> =

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Connection sheet

Information exchange description

Data exchange between the Host Information system and the Communication engine corresponds to data blocks being transmitted through a socket. In order to perform the data exchange, a socket (connection) must be established first. One system has to be the server, the other must be the client. The client will ask the server permission to connect to a specific port. The server on its side must be listening to this port. The sequence order in which operations must be performed is: 1. The server must be created and must be listening to a specific port. 2. The client will ask the server permission to connect to this port. If granted, a socket is established between the client and the server. Data can be sent back and forth via the previously established socket. In our case, the Communication engine will act as the server and the Host Information system as the client.

Pre-requisites and sequence of operations (see also "Example of definition for TCP/IP socket" paragraph further in the document)
In order for the TCP/IP socket low-level protocol to work properly, several parameters must be set: 1. The machine on which the server will be created, must be declared as the "recipient's network address" (it can be the network name or the dotted address). 2. The port the server will be listening to is declared as the listening port. 3. The transmission mode is set to Mono client server transmission mode. 4. The connection (Communication engine) has to be started and listening to the configured port. 5. At this time one and only one simultaneous connection will be accepted by the server. After being allowed to access to the server, the client can send its data blocks through the socket and it can read answers back. 6. When it is finished, the client disconnects.

Incidents managed on the socket

* If the server tries to accept a client connection while already having a client connected to it, the following error is generated: More than one connection has been opened on the server! If the server could not instantiate a client socket upon creation, the following error is generated: Invalid client socket retrieved! If the server cannot accept a client connection, the following error is generated: Couldn't accept connection! If any exception occurs while reading from the socket, the next error is generated: Couldn't receive data through socket!

* * *

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Connection sheet

Installation procedure
The Communication engine must be installed with a Client instance. When the connection selection screen is displayed: 1. Select HL7: Order reception by left-clicking on the corresponding line 2. Choose This feature will be installed on local hard drive option.

Implementation
To implement this connection, a number of parameter settings must be performed at different levels, as listed hereafter: - Definition of Labconf parameters on the management database - Device dictionary the management database - Activation of the service specified in the Device dictionary

"Labconf" parameters
You must verify some "Labconf" parameters on the management database before starting the implementation. Make sure that the lengths of the following fields are the same as on the production database (Parameter setting zone GST block): These parameters are: - Patient number length - Alternate patient number length - Hospitalization number length - Reduced access number length - Database name (*) * Database name is the logical name of the database. It is used both by the Web module and this connection. It must be the same for both. Refer to the Web module parameters to verify it (Administration tool, File menu, Databases item, Name field.

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Device dictionary
This step consists in defining and customizing the parameters used for the reception of orders (new or updated information about orders). This connection must be defined as a device and consequently it must be defined in the Device dictionary. Create a new device. From the TD Control panel, select System Setup (Dictionaries), General dictionaries then Device. In the menu bar, click on the + sign. Name Code Device type Service Name Abbreviated text Full text Protocol Format Transport Application Properties Value TDCnx_InstanceName_Computernam e Comment name of the computer where is installed the service.

HL7 low layer Protocol (Socket) HL7 format TCP-IP socket transport Patients/Order/Results processing More...

The Protocol, Transport, Format and Application parameters give the user-friendly names of the different DLLs used for the connection. These DLLs are automatically installed by the setup program. Once you reach this step, you must click the OK button to update the Properties. The Properties parameters are used for defining the parameters related to a type of flow. Three types of flow must be defined: 1. All (displayed by default). 2. Patient demographic data reception flow. 3. Order reception

1. Type of flow: All

Only the connection specific parameters are described here. Device properties Type of flow: All Name General
Interval before task purging (days)

Value If this parameter is not defined here, the same parameter defined in the Laboratory configuration is applied.
1000

Comment

Maximum size of spy file (KB)

Number of insertion retries in the database

Path of spy file Spy traces enabled

1
C:\technidata\spy.txt Yes

Do not modify. Once the installation is finished and you have checked it runs well, set it to No. Three level of traces are available: minimum, regular, maximum

Trace level of spy file

Maximum

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Connection sheet Format

HL7 version

Message recipient code Message sender code Unicode messaging

Transport

2.3 TDR HOST

For example

The Transport section contains the different parameters used for defining the characteristics of the TCP-IP. Name Checksum type End of block character Listening port Message time-out Value Checksum applied on the socket frame. Last character of the socket (<1C> in the definition of the socket frame) Input port Period of time (in seconds) during which data is expected on the socket. After this time, the server considers the link broken. Output port Comment Must be set to HL7 Low Layer Protocol Do not modify 8102 for example 30 for example

Outgoing port

When selecting a port (either listening or outgoing), make sure that the port is not already used by another application. Name
Protocol version

Recipient network address Sender network address Start of block character

TCP-IP layer protocol

Value 23 IP address or logical name of the receiver IP address or logical name of the sender. First character of the socket (<0B> in the definition of the socket frame)
Hybrid/Minimal

Comment 23 for Keane

Do not modify To modify on site Minimal for Keane Must be set to Mono client server transmission mode

Transmission mode File location Chameleon file path Input processed folder

Defines the mode used by the socket connection (client/server, Mono/Multi client). Name of the path for the hl7.vmd Chameleon file. c:\technidata

For example

2. Type of flow: Patient demographics reception

A patient demographics reception flow must be defined. Refer to the connection sheet CNXR010 to define the Patient demographics reception flow.

3. Type of flow: Order reception

Device properties Type of flow: Order reception Name
General

Value

Comment

The General section defines how the test order data received in the HL7 message are managed: These test order data can be: CNXR011 / 3 HL7: Order Reception V02.01 Confidential. This specification requires an end user agreement. Page 13/27

Connection sheet only set in the Management database, only forwarded to another device, for this flow only demographic data is forwarded (via a FTP transfer of ASTM 1238 files to send the demographic data to the Production database for example), set in the Management database and forwarded to another device. set in the Management database and transmitted to laboratory by (through a file transfer of ASTM 1238 files by the "rectube" process of the Web module).

"Set in Management database" and "forwarded to another device" possibilities are both managed by the Update local database and Output devices parameters. If Output devices is filled in with the connection identification used to ensure the patient data transfer to another device, a job is created to enable the patient data transfer through the customized connection. Name Stream active Accept assigned message number (NA) Automatic activation for immediate orders Automatic activation for routine orders Automatic activation for urgent orders Value Yes, activated flow. No, not activated flow Yes, activated flow Comment Set Yes to enable the reception of the Number Assigned by the Host, in answer to a Placer order number query message from the Laboratory Information System

Yes, activated No, not activated Yes, activated No, not activated Yes, activated No, not activated

Numbering of order: This parameter is used to define how to create the Full Access Number. If the Host sends this number (numbering mechanism should be identical to the numbering supported by the Management database), the automatic number mechanism is ignored. Name Automatic number for orders Value Select the counter which are used for create the Full Access Number Comment

The counter must be previously declared and set up on TDNTPanel. Refer to the related documentation to create this counter. When defining the counter, make sure that the range of numbers is reserved for order creation on the Management database It is possible to transmit test order automatically to the production database by ASTM 1238. The following parameters are used to activate automatic transmission of test order to the production database or another H.I.S. Name Exam grouping Exam grouping timeframe (minutes) Output devices Processing type Process order cancelation or duplicate order message Value Comment Yes (to enable grouping several tests into a single order) 10 See Note 1 Default value = 35 [] Set to HL7 device used to Opens a window to select the Device send data to HIS: and the data flow it is used for HL7HIS / Order sending Must be set to Test Orders. Yes/No See Note 4 Default value = Yes

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Connection sheet Sample reception DLL file path Update local database Format Collection source parameter code Topography parameter code Mapping Coded texts Doctors Locations Tests Titles Path to access to TD-Web Rectube process (TDCollectionReception.dll). Yes Code of the complementary parameter used with results received in OBR-15.1 Code of the complementary parameter used with results received in OBR-15.4 Code of the coding system used to map coded text codes. See Note 3. Code of the coding system used to map doctor codes. See Note 3. Code of the coding system used to map location codes. See Note 3. Code of the coding system used to map test codes. See Note 3. Code of the coding system used to map title codes. See Note 3. See (*)

See Note 2 To define if needed by the H.I.S. See Note 2 To define if needed by the H.I.S. Create/select the code of a coding system. Create/select the code of a coding system. Create/select the code of a coding system. Create/select the code of a coding system. Create/select the code of a coding system.

Note 1: An algorithm is used to group together several tests into a same order. This algorithm respects the following rules: -Same patient and same hospital stay for the test order -The location of the new test should be the same as for the other tests -The reference collection date/time corresponds to the scheduled collection date/time of the first received test ( with +/- n minutes definable in the Exam grouping timeframe parameter. Note 2: Both data will be stored as coded text type results and are associated with two complementary parameters. These complementary parameters are used to store the corresponding information. Note 3: Mapping is used to create correspondences between the Management database and Host systems code values (local codes and alternate codes). You can find the description of "Mapping alternate codes" in the Technical guide online help under Installation book. Note 4: This property is used to enable (answer Yes) or disable (answer No) the processing of order cancelation or duplicate order message. To enable the transmission of order cancelation or duplicate order messages to the H.I.S, answer Yes and specify an Output device. The Output device used should be the one used for the connection Transmission of Orders (CNXR023). If this property is enabled and no Output device is associated with the order reception device the task created by the received message will be set to the error status and a message will ask the user to specify an output device.

(*)TD-Web Reception of tubes tool (Rectube)

The Reception of tubes tool of the Web module is installed with the setup of the Web module. Please refer to the Web module installation for this components and its parameter setting. For the Sample DLL reception file path parameter, please specify the path to access to the TDCollectionReception.dll (in the path of Reception of tubes tool installation) In the Parameters window of the Reception of tubes tool, under Connection tab, field Directory, you must enter an absolute pathname and not a volume mounting (e.g.,\\labo\tmp\ftp

Activation of the Connection service

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Connection sheet

Use the Windows Service manager to start the TDConnexion service. The connection service appears under the name "TDCnx_InstanceName".

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Connection sheet

Relevant HL7 messages, segment types and fields Processed messages

This connection can manage three types of messages: - ORM : General order message (event O01) - OMG : General clinical order message (event O19) - OML : Laboratory order message (event O21) For the OML message, the information or the segments relating to the sample data or to the previous results are ignored. This connection is limited to the processing of Segment / Field / SubField described further.

Supported segment types

You will find in this chapter general information of these segment types. MSH - Message Header Segment. It defines the type, the event of the message and indicates other information such as the sender, the receiver. EVT - Event information segment. It defines the Event of the message. PID - Patient information segment It contains patient information exchanged between the sender and the receiver. PV1 - Hospitalization information segment. It contains hospitalization visit information exchanged between the sender and the receiver. ORC - Common Order segment. It contains information necessary to create or update prescriptions. OBR - Observation Request Segment It contains information necessary to create or update prescription tests. OBX - Observation / Result Segment It contains information necessary to create or update additional parameters for the tests. Each message must be identified by a "message header" segment. A segment is composed of fields. A field is the basic element of information in any segment. For each type of record, HL7 protocol lists all the fields possibly used for medical information exchanges. Only the processed fields and their corresponding meaning are described for each record type in "Segments description". The next part of the paragraph deals with characteristics common to all fields. It concerns field rules and the different abbreviations used all along in the document. The field identification In each segment type, fields are identified by a number. This identification corresponds to the HL7 definition. The field delimiters A character defined as a delimiter separates each field from the next one. This field delimiter must even follow the last field of a record.

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Connection sheet The field size All field sizes given in the document are maximum sizes as specified in HL7 standards. Each field contains only significant information, without any left or right filling characters. The DT column of the HL7 data types by category table gives the Data Type of the field. The complete list of the HL7 Data Types is defined in the Chapter 2-Control of the HL7 version 2.4.

Acknowledgement
If no problem occurs during the management of the message, a positive logical acknowledgement is sent to the Host and the created job is set to the "Completed" status. In the positive logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AA" (application acknowledgement Accept) and the ERR-1 field, subfield 4, "Error code" is set to the "0" error code. 0 Message accepted Success. Optional, as the AA conveys success. Used for systems that must always return a status code.

During the management of the ADT (Patient administration) message , some errors can occur. In such cases, the created job is set to the "Error" status.

Incident management
Case 1: The connection has detected X differences between the demographic data of the patient in the management database and the transmitted demographic data (the controls on the demographic data are done on the first name and last name, the maiden name, the sex and the birth date of the patient). X is greater than the authorized number of differences customized with the Patient differences parameter. In such a case, the OMG / OML / ORM message is not integrated in the management database and a negative logical acknowledgement is sent to the host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AR" (application acknowledgement Reject) and the ERR-1 field, subfield 4, "Error code" is set to the "207" error code, and the MSA-3 field is filled in with the string "A catchall for internal errors not explicitly covered by other codes". 207 Application internal error A catchall for internal errors not explicitly covered by other codes.

Case 2: The previous control is correct but the connection has detected two different patients with the same "Alternate number" in the management database. In such a case, the OMG / OML / ORM message is not integrated in the management database and a negative logical acknowledgement is sent to the host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AR" (application acknowledgement Reject) and the ERR-1 field, subfield 4, "Error code" and the "ERR-1" fields are set to the error code "205". The MSA-3 field is filled in with the string "The ID of the patient, order, etc., already exists". 205 Duplicate key identifier The ID of the patient, order, etc., already exists. Used in response to addition transactions (Admit, New Order, etc.).

Case 3: The OMG / OML / ORM message sent by the Host cannot be properly parsed (problem on the HL7 structure). In such a case, the OMG / OML / ORM message is not integrated in the management database and a negative logical acknowledgement is sent to the Host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AE" (application acknowledgement Error) and the ERR-1 field, subfield 4, "Error code" Page 18/27 V02.01 HL7: Order Reception Confidential. This specification requires an end user agreement. CNXR011 / 3

Connection sheet and "ERR-1" fields are set to the error code "100". The MSA-3 field is filled in with the string The message segments were not in the proper order, or required segments are missing. 100 Segment sequence error The message segments were not in the proper order, or required segments are missing.

Case 4: The OMG / OML / ORM message sent by the Host is properly parsed and managed but the database is locked / not available or the patient / Prescription record to update is protected. In such a case, the OMG / OML / ORM message cannot be integrated in the management database and a negative logical acknowledgement is sent to the Host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgement code is set to "AR" (application acknowledgement Reject) and the ERR-1 field, subfield 4, "Error code" and "ERR-1" fields are set to the error code "206". The MSA-3 field is filled in with the string The transaction could not be performed at the application storage level. 206 Application record locked The transaction could not be performed at the application storage level, e.g. database locked.

Case 5: The test order message sent by the Host is properly parsed but some data are no correct, for example: - A test or an additional parameter is unknown - A test is not requestable - A test is duplicate - A results of type coded text is expected and the coded results is not defined In such a case, the test order message is partially integrated in the management database and a negative logical acknowledgement is sent to the Host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AR" (application acknowledgement Reject) and the ERR-1 field, subfield 4, "Error code" and "ERR-1" fields are set to the "207" error code. The MSA-3 field is filled in with the string "A catchall for internal errors not explicitly covered by other codes (Test order : #XXXXXXXXXX)."XXXXXX corresponds to the access number or external order number if it is transmitted by the Host. 207 Application internal error A catchall for internal errors not explicitly covered by other codes.

Case 6: The update test order message sent by the Host is properly received but for this test order the corresponding specimen is already received in the laboratory. In such a case, the test order message cannot be integrated in the management database and a negative logical acknowledgement is sent to the Host. In the negative logical acknowledgement sent by the connection, the MSA-1 field Acknowledgment code is set to "AR" (application acknowledgement Reject) and the ERR-1 field, subfield 4, "Error code" and "ERR-1" fields are set to the "207" error code. The MSA-3 field is filled in with the string " A catchall for internal errors not explicitly covered by other codes (Specimen received for test order: #XXXXXXXXXX)." XXXXXX corresponds to the access number or external order number if it is transmitted by the Host. 207 Application internal error A catchall for internal errors not explicitly covered by other codes.

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Segment descriptions MSH - Message Header Segment

SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 LEN 1 4 180 180 180 180 26 40 13 20 3 60 15 180 2 2 3 16 250 20 10 DT ST ST HD HD HD HD TS ST CM ST PT VID NM ST ID ID ID ID CE ID ID FIELD NAME Field Separator Encoding Characters Sending Application Sending Facility Receiving Application Receiving Facility Date/Time Of Message Security Message Type Message Control ID Processing ID Version ID Sequence Number Continuation Pointer Accept Acknowledgment Type Application Acknowledgment Type Country Code Character Set Principal Language Of Message Alternate Character Set Handling Scheme Conformance Statement ID On Communication Engine Used to parse the HL7 message Used to parse the HL7 message Used for message acknowledgment Not Used Used for message acknowledgment Not Used Not Used Not Used Used to determine the message type Used to identify the rejected message in case of error (job information) Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used

MSH 1 - 2 Field Separator / Encoding Characters

Defines the message delimiters. The first five-character set following the H character |^~\& defines which field separators are used. The following ones are used: | = Field delimiter. ^ = Sub-field delimiter. ~ = Repeat sub-field delimiter. \ = ESCAPE sequence & = Sub-field component delimiter.

MSH - 3 Sending Application

Determines the connected Host. Used for acknowledgment message.

MSH - 5 Receiving Application

Determines the receiving application. Used for acknowledgment message.

MSH - 9 Message Type

Determines the message type (Message type code + event code).

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EVN - Event type segment

The EVN segment is used for communicating necessary trigger event information to receiving applications. SEQ 1 2 3 4 5 6 7 LEN 3 26 26 3 250 26 180 DT ID TS TS IS XCN TS HD FIELD NAME Event Type Code Recorded Date/Time Date/Time Planned Event Event Reason Code Operator ID Event Occurred Event Facility On Communication Engine Not Used Not Used Not Used Not Used Not Used Not Used Not Used

None of EVN information is managed by the connection.

PID - Patient identification segment

The PID segment contains patient information exchanged between the sender and the receiver. The description of that segment can be found in the "Patient Administration Reception" connection sheet, referenced "CNXR010".

PV1 - Patient visit information

The description of that segment can be found in the "Patient Administration Reception" connection sheet, referenced "CNXR010".

ORC - Common order Segment

SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 LEN 2 22 22 22 2 1 200 200 26 250 250 250 80 250 26 250 250 250 250 250 250 250 250 DT ID EI EI EI ID ID TQ CM TS XCN XCN XCN PL XTN TS CE CE CE XCN CE XON XAD XTN ELEMENT NAME Order Control Placer Order Number Filler Order Number Placer Group Number Order Status Response Flag Quantity/Timing Parent Date/Time of Transaction Entered By Verified By Ordering Provider Enterers Location Call Back Phone Number Order Effective Date/Time Order Control Code Reason Entering Organization Entering Device Action By Advanced Beneficiary Notice Code Ordering Facility Name Ordering Facility Address Ordering Facility Phone Number On Communication Engine Order control External Order Number Full Access Number Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Prescriber Code Location Code Test order comment Collection date and time Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Page 21/27

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Connection sheet SEQ 24 25 LEN 250 250 DT XAD CWE ELEMENT NAME Ordering Provider Address Order Status Modifier On Communication Engine Not Used Not Used

ORC - 1 Order Control

NW (New order), causes the creation of the Test Order. CA (Cancel order), causes the cancellation/deletion of the order if the associated specimen are not yet received by the laboratory. OC (Order Cancelled), same as CA but does not require acknowledgement.

ORC - 2 Placer Order Number

This field contains the External order number. It must be unique for a test order.

ORC - 3 Filler Order Number

This field contains the Full Access Number or the Reduced Access Number of the request defined on the production database . In most cases, it should be left empty by the Host, unless the Request/Specimen numbering mechanism is identical to the Request/Specimen numbering of the production database. It must be unique for a test order. It is not possible to change this number by a CDE (the first value is kept). In the case of a Reduced Access Number: The Full Access Number is built from the collection date (ORC-15) if specified or with the system date otherwise. The length of the received Reduced Access Number must be in accordance with the parameter Reduced access number length defined on the management database (Laboratory configuration).

ORC - 12 Ordering Provider

The first subfield contains either the Host system Text or the Mnemonic code of the Prescriber (Dr1 in production database). This field should be identical to the OBR 16 field.

ORC - 13 Enterers Location

The first subfield contains either the Host system Text or the Mnemonic code of the requesting Location (CR in production database).

ORC - 14 Call Back Phone Number

Since there is no dedicated field in the production database to store this information, the content of this field is stored in Clinical Details field (RCO) of the production database.

ORC - 15 Order Effective Date/Time

This field contains the Collection date and time. If the specimen are "To Be collected", this field indicates the date and time when they should be collected.

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OBR - observation request segment

SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 LEN 4 22 22 250 2 26 26 26 20 250 1 250 300 26 300 250 250 60 60 60 60 26 40 10 1 400 200 250 200 20 250 200 200 200 200 26 4 250 250 250 30 1 250 250 250 250 250 DT SI EI EI CE ID TS TS TS CQ XCN ID CE ST TS CM XCN XTN ST ST ST ST TS CM ID ID CM TQ XCN CM ID CE CM CM CM CM TS NM CE CE CE ID ID CE CE CE CE CE ELEMENT NAME Set ID - OBR Placer Order Number Filler Order Number Universal Service Identifier Priority - OBR Requested Date/Time Observation Date/Time # Observation End Date/Time # Collection Volume Collector Identifier Specimen Action Code Danger Code Relevant Clinical Information Specimen Received Date/Time Specimen Source Ordering Provider Order Callback Phone Number Placer Field 1 Placer Field 2 Filler Field 1 + Filler Field 2 + Results Rpt/Status Chng - Date/Time + Charge to Practice + Diagnostic Serv Sect ID Result Status + Parent Result + Quantity/Timing Result Copies To Parent Transportation Mode Reason for Study Principal Result Interpreter + Assistant Result Interpreter + Technician + Transcriptionist + Scheduled Date/Time + Number of Sample Containers Transport Logistics of Collected Sample Collectors Comment Transport Arrangement Responsibility Transport Arranged Escort Required Planned Patient Transport Comment Procedure Code Procedure Code Modifier Placer Supplemental Service Information Filler Supplemental Service Information On Communication Engine Not Used External Order Number Full Access Number Test Code Not Used Not Used Not Used Not Used Not Used Not Used Action Code Not Used Prescription comment Not Used Not Used Doctor Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Priority Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used

OBR - 2 Placer Order Number

Same as ORC-2 field. If this information is present in the ORC segment, then it is ignored in the OBR segment.

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OBR - 3 Filler Order Number

Same as ORC-3 field. If this information is present in the ORC segment, then it is ignored in the OBR segment.

OBR - 4 Universal Service Identifier

The first subfield must contain the Host System text of the requested test. The requested test must be present in the replicated Tests Dictionary and must be defined as requestable separately.

OBR - 11 Specimen Action Code

On reception of the Test Order, the communication engine only processes the A (Added test), R (Revised Order) action codes.

OBR - 13 Relevant Clinical Info

The content of this field is stored in Clinical Details field (RCO) of the production database for the first OBR segment of the test order.

OBR - 16 Ordering Provider

The first sub-field contains the doctor code of the Prescriber (Dr1 on the production database).

OBR - 27 Quantity/Timing
The communication engine only processes the 6th subfield (priority). The values that are processed are: S (Stat), A (ASAP), R (Routine). Value P (preoperative) is processed as R. Value C (Call back) is processed as S. Value T (Timing Critical) is processed as S.

OBX - observation / result

SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 LEN 4 2 250 20 65536i 250 60 5 5 2 1 26 20 26 250 250 250 22 26 DT SI ID CE ST * CE ST IS NM ID ID TS ST TS CE XC N CE EI TS ELEMENT NAME Set ID OBX Value Type Observation Identifier Observation Sub-ID Observation Value Units Reference Range Abnormal Flags Probability Nature of Abnormal Test Observation Result Status Date Last Observation Normal Value User Defined Access Checks Date/Time of the Observation Producer's ID Responsible Observer Observation Method Equipment Instance Identifier Date/Time of the Analysis On Communication Engine Not Used Result type Test Code Not Used Result Value Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used Not Used

OBX - 2 Value Type

i

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Type of result. For additional parameter, the Communication Engine supports the following values: CE for Coded Text; DT for Date; NM for Numeric; TX for free text (limited to 2000 char.); and ST for String Data, SN for structured numeric. Processing ST String data result: String Data result is stored as "Limit" result type if the result is in the format <xxxx or >xxxx; it is stored as Alphabetical string if the result is no more than 4 characters long; it is stored as a free text in all other cases. Processing DT Date : Only the complete date is accepted by the connection (YYYYMMDD). The partial date is not integrated correctly. Processing NM Numeric : The decimal separator must be .. Processing SN Structured numeric : Structured Numeric result is stored as "Limit" result type if the result is in the format <^xxxx or >^xxxx and xxxx is numeric, else it is stored as a free text.

OBX - 3 Observation Identifier

The first subfield must contain the Host System text of the Additional Parameter.

OBX 5 Observation Value

If the Value type is CE, the first subfield corresponds to the Mnemonic code of the coded text.

General constraints
The External Order Number is limited to 9 numeric characters. This number must be unique for a test order. The Full Access Number must be unique for a test order. A HL7 test order message contains only a message and a test order. If the specimen identification and collection are managed by the Host, the specimen numbering mechanism should be identical to the specimen numbering supported by the production database. Only the first ORC segment of each order is processed. In every segment ORC External order number or/and Full Access Number is repeated as the first one. The requested test (field OBR-4) must be a Single test or a Combined test. Profile cannot be used as they are just a facility for manual order entry and the code of a profile cannot be returned to the Host with the results. If there is a need to transmit additional parameters for a requested test, each result of these additional parameters should be transmitted in dedicated OBX record that immediately follows the OBR segment of the requested test.

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Examples of ORM messages

Simple test order : MSH|^~\&|SSI|SI|LMX|TECHNIDATA|200305081258||ORM^O01|SI030000000000095401|P|2.04 PID||261055502^^^106|ALTNUMBER1^^^N^CODFISC||MARTIN^Jean^^^^^L||19750421|M|||9 rue Marcel Cachin^^Meylan^^38100^FRANCE^L^||604582||||||261055501 ORC|NW|^050901^019201^L|9000000032^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|1|^050901^019201^L|9000000032^050901^003900^L|ADEN2^^L|||20030508|||||||||019201 ORC|NW|^050901^019201^L|9000000032^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|2|^050901^019201^L|9000000032^050901^003900^L|ACTDI^^L|||20030508|||||||||019201 Test order with urgent test and full access number : MSH|^~\&|SSI|SI|LIS|TECHNIDATA|200305081258||ORM^O01|SI030000000000095400|P|2.04 PID||98700021^^^106|98900021^^^L^ASSIPCA~98600021^^^N^CODFISC~98700021^^^060^CODSAN|| DUPOND^Jean^^^^^L~Fleurus^^^^^^M||19850724|M||2056-5^Blanc|9 rue Marcel Cachin^^Meylan^^38100^FRANCE^L^|| 0476001122^^PH~0600112233^^CP~dupondjean@free.fr^^Internet||||||261055501 PV1|1||MEDIR^2^Lit19^^^^^^|||||CLAD^Maraul2^Doc|||||||||||20020001|~~~||||||||||||||||||||||||20030709||||||954|| NTE|||Patient comment ORC|NW|^050901^019201^L|4021200009^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|1|^050901^019201^L|4021200009^050901^003900^L|ADEN2^^L|||20030508|||||||||019201||||||||||| ^^^^^A| ORC|NW|^050901^019201^L|4021200009^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|2|^050901^019201^L|4021200009^050901^003900^L|ACTDI^^L|||20030508|||||||||019201| Test order with external order number and complementary parameter : MSH|^~\&|SSI|SI|LMX|TECHNIDATA|200305081258||ORM^O01|SI030000000000095401|P|2.04 PID||261055502^^^106|ALTNUMBER1^^^N^CODFISC||MARTIN^Jean^^^^^L||19750421|M|||10 rue du Gnrale^^Meylan^^38100^FRANCE^L^||604582||||||261055501 ORC|NW|HOSTNUM1^050901^019201^L|^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|1| HOSTNUM1^050901^019201^L|^050901^003900^L|ADEN2^^L|||20030508|||||||||019201 ORC|NW|HOSTNUM1^050901^019201^L|^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|2| HOSTNUM1^050901^019201^L|^050901^003900^L|ACTDI^^L|||20030508|||||||||019201 ORC|NW|HOSTNUM1^050901^019201^L|^050901^003900^L||||||200305081258|||ALBM|BDR| OBR|3| HOSTNUM1^050901^019201^L|^050901^003900^L|NUM^^L|||20030508|||||||||019201| OBX||DT|PDAT^Date||20040101| OBX||TX|PFT^Free texte||Free texte| OBX||CE|PCT^Coded texte||POS|

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TECHNIDATA
M E D I C A L S O F T W A R E E N G I N E E R I N G

END USER AGREEMENT FOR CONNECTION The interface specification described in the attached Connection Sheet # CNXR011 "HL7: Order Reception" is confidential and is strictly reserved for communication with a Hospital Information System. An End User Agreement containing the text hereunder must be agreed by the Customer (End User). The interface specification "Connection Sheet # CNXR011" is for the exclusive use of sites covered by an End User Agreement. Use of the interface specification "Connection Sheet # CNXR011" implies full acceptance of the terms and conditions of the End User Agreement hereunder.

END USER AGREEMENT FOR CONNECTION SHEET # CNXR011

PLEASE READ THIS AGREEMENT CAREFULLY. THE USE OF THE INTERFACE SPECIFICATION SHALL IMPLY ACCEPTANCE OF THIS AGREEMENT. IF YOU DO NOT AGREE, YOU MUST NOT USE THE INTERFACE SPECIFICATION.
OWNERSHIP

TECHNIDATA shall retain all titles and intellectual property rights of the attached interface specification. The interface specification is protected under international laws related to intellectual property rights. The Customer agrees that it does not have any title or ownership on the attached interface specification.
USE

The Customer may use the Interface Specification, provided that the product license has been properly acquired. The Customer shall only use the Interface Specification for his own needs. The Customer shall only use the Interface Specification for the purpose of communication with a Hospital Information System. Consequently, Customer is not authorized, in any way, to use the Interface Specification for any other type of communication or for any other purpose. The Customer shall not use any portion of the said Interface Specification for the purpose of interfacing or creating new software programs to be made available to any third party, either free of charge or for pecuniary benefit. The Customer shall not disclose, communicate or use for the benefit of any third party any portion of the said Interface Specification. The Customer must be aware that the Interface Specification is likely to evolve. The Customer therefore agrees that any software that relies on this Interface Specification may require to be updated to maintain existing functionality. Upon termination of this Agreement, the Customer shall return all materials which contain information related to the Interface Specification, including written notes, photographs, memoranda or notes taken.

Confidential. This specification requires an end user agreement.