T 3 DK

Auftragskommunikation
Detlef Kraska, Universittsklinkum Erlangen

Ren Spronk, Ringholm GmbH
HL7 Deutschland
Ablauf
Generic Order Workflow

Der radiologische Workflow
Scheduling of Ordered Tests
Implementierung des radiologischen
Workflows
Laboratory Automation
Zusammenfassung
HL7 Deutschland
Generic Order Workflow
HL7 Deutschland
Anforderungskommunikation HL7
Grundlagen
Order (z.B. der Auftrag fr ein groes Blutbild)
A request for a service from one application to a second application.
Observation (z.B. ein Laborbefund)

An observation which may be related to a prior request for a service.
Placer (z.B. das Klinische Arbeitsplatzsystem)

The application originating a request for services.
Filler (z.B. ein Radiologiesystem)

The application responding to a request for services.
Tracker (z.B. das Klinische Arbeitsplatzsystem)

The application recieving the observations.
HL7 Deutschland
Order related Workflow

Update
Patient Registry
Update
Placer Order Mgmt

Order Placer
Order Filler
Filler Order Mgmt
Order Mgmt
Order Tracker
HL7 Deutschland
Nachrichten und Trigger Events
Trigger Events (I):
Allgemeine klinische Anforderung

(veraltet!)
ORMÔ01: general order message
ORRÔ02: general order response message
Query
OSQÔ06: query for order status
OSRÔ06: response
HL7 Deutschland
Anforderungsnachrichten werden ber
MSH-9 (Event) und ORC-1 (Order Status)
identifiziert, ADT-Nachrichten nur ber
MSH-9; Beispiele:
New
Change
Cancel
ADT event
ADT A01
ADT A08
ADT A11
ORM event / ORC-1

ORM O01 / NW
ORM O01 / XO
ORM O01 / CA
HL7 Deutschland
Value
Description of use
NW
New Order.
OK
UA
Notification
or
request
accepted.
Unable to accept order/service.
SC
Status changed.
CA
Cancel order/ service request.
CR
Canceled as requested.
UC
Unable to cancel.
OC
Order service canceled.
SN
Send order/service number.
NA
Number assigned.
RP
Order/service replace request.
RQ
Replaced as requested.
UM
Unable to replace.
RU
Replaced unsolicited.
XO
Change order/service request.
XR
Changed as requested.
UX
Unable to change
Order Status
Codes (Auszug)
HL7 Tabelle 119
HL7 Deutschland
Use-Case: Order accept/reject

Order
Placer
Order
Filler
Order Tracker
New order
Accept order
Order accepted
Reject order
Placer sends order to Filler, Filler either confirms

or rejects the order. Status changes of the order
are sent by Filler to Tracker.
HL7 Deutschland
Order neu anlegen:
Order, gefolgt von ACK

Order ORMÔ01 mit Placer Number / NW
Order Placer
Order Filler
Order Acknowledgement ORRÔ02 /NA
- mit Placer Number
- mit Filler Number
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Stornierungen:
Order storniert durch den Placer
T1. Order: ORMÔ01 / CA
Result: ORRÔ02 / CR
System A
(Placer)
Order storniert durch den Filler
System B
(Filler)
T1. Filler Order: ORMÔ01 / OC

Result: ORRÔ02 / OK
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Trigger Events (II):
Allgemeine klinische Anforderung

OMGÔ19: order
ORGÔ20: response
Laboranforderungen
O21, O22, O33-O36
Bildanforderung
OMIÔ23: order
ORIÔ24: response
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Bildanforderung:
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Segmente
Wichtige HL7 V2 Segmente:
ORC (Order Control, Metadaten)
OBR (Order Details zu den angeforderten
Services)
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Segmente
ORMÔ01ÔRM_O01 General Order Message
MSH
Message Header
[{NTE}]
Notes and Comments
{
[
ORC
Common Order
[
PID
Patient Identification
OBR
Order Detail Segment
...
[{NTE}]
Notes and Comments (for
[CTD]
[{DG1}]
[{
OBX
[{NTE}]
Common
}]
]
{
ORC
...
]
[{FT1}]
[{CTI}]
[BLG]
Chapter
2
2
4
Contact Data
Diagnosis
4
2
11
6
Observation/Result
Notes and Comments (for Results)
Order
7
2
Financial Transaction
Clinical Trial Identification
Billing Segment
6
7
4
Detail)
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Eine neue Anforderung mit der Placer Order ID 100202 wird
vom Klinischen Arbeitsplatzsystem (KAS) zum RIS geschickt:
MSH|^~\&|KAS||RIS||200603011040||ORMÔ01|34234|P|2.5|||NE|AL|
PID|||30072663|
ORC|NW|100202||806||F|||200603011100||
ORC-1: Order Control Code
MSH-9: Message type, Event Type
Das RIS akzeptiert die Anforderung und vergibt eine eigene

Filler Order ID 7943:
MSH|^~\&|RIS||KAS||200603011040||ORRÔ02|23487|P|2.5|||NE|AL|
MSA|AA|34234
PID|||30072663|
ORC|OK|100202|7943|806||F|||200603011100||
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OBR (in IHE order message)

SE
Q
LE
N
DT
Usage
Card.
TBL#
ITEM#
Element name
22
EI
[1..1]
00216
Placer Order Number
22
EI
RE
[0..1]
00217
Filler Order Number
250
CE
[1..1]
00238
Universal Service Identifier
10
250
XCN
RE
[0..*]
00244
Collector Identifier *
11
ID
RE
[0..1]
00245
Specimen Action Code *
16
250
XCN
[1..1]
00226
Ordering Provider
17
250
XTN
RE
[0..2]
00250
Order Callback Phone Number
24
10
ID
[0..1]
0074
00257
Diagnostic Serv Sect ID
25
ID
[0..1]
0123
00258
Result Status +
26
400
PRL
[0..0]
00259
Parent Result +
28
250
XCN
[0..*]
00260
Result Copies To
29
200
EIP
[0..0]
00261
Parent
37
NM
[0..1]
01028
Number of Sample Containers *
0065
HL7 Deutschland
Placers
reference nbr.
Fillers
reference Nbr.
Requested/
Performed
service
Result Status
17
OBR-25 Status Field

Order
Table 0038
(ORC-5)
Request
Table 0123
(OBR-25)
Description (combined from 3 tables)
Order received; specimen not yet received. Order detail description only (OBX
contains no result).
This value should only be used in ORL event acknowledgment messages. It should
not be used in OML messages.
SC
No results available; procedure scheduled, but not done.

The specimen may not have arrived at the laboratory. No OBX is present
IP
In process; The specimen is available in the laboratory; results are pending; the
procedure is incomplete
Deletes the OBX record
(Some) results entered -- not yet verified
(Some) preliminary verified results: ( technically validated in T5, clinically validated in

T3). The final results are not yet obtained
CM
Final results; results stored and verified : ( technically validated in T5, clinically
validated in T3). Can only be changed with a corrected result.
(CM)
Record coming over is a correction and thus replaces a final result
CA
(OBX) Results cannot be obtained for this observation. (ORC/OBR) No results

available; Order canceled.
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(HL7 V2.5 / IHE)
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Gliederung
Anforderungskommunikation mit IHE
Grundlagen
Der Scheduled Workflow
IHE Datenmodell
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Ein Fall fr die Radiologie

Ein Beispiel:
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Ein Fall fr die Radiologie

report
report
Registration
report
Report
Repository
HIS patient
Diagnostic
Workstation
information
PACS
Film
Lightbox
images
retrieved
Orders Placed
examination orders
RIS
Orders Filled
procedure
scheduled
Image Manager
Prefetch any relevant
& Archive
prior studies
Acquisition
modality
images
Modality
worklist
stored
acquisition
completed
acquisition
images
in
-progress
completed
printed
Modality
HL7 Deutschland
Film
Folder
22
Normal Workflow
Typical workflow: One Order One Procedure One Report
DICOM
Modality Worklist
ORDER
A request for
Radiologic
Service
Scheduled
Procedure
Step
Requested
Procedure
Radiology Department
Performed
Procedure
Step
One or
more series
of images
Report
Set of
Codifiable,
Billable, Acts
Acquisition
Modality
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Multiple Modality Steps

ORDER
A request for
Radiologic
Service
DICOM
Modality Worklist Radiology Department
Scheduled
Procedure
Step A
Requested
Procedure
1
Scheduled
Procedure
Step B
DICOM
Modality Worklist
Performed
Procedure
Step P1
One or
more series
of images
Report
Set of
Codifiable,
Billable, Acts
Performed
Acquisition
Procedure
Step P2 Modality
One or
more series
of images
Acquisition
Modality
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Anforderungskommunikation - IHE
Grundlagen
Integrating the Healthcare Enterprise - von den USA nach
Europa bernommene Initiative
Ausgangspunkt war die Radiologische Abteilung
Ziel ist Plug&Play aller Komponenten der Abteilung (und
angrenzender Systeme)
Jedes Jahr werden neue sog. Integrationsprofile definiert,
die immer komplexere Szenarios beschreiben
Jeder Hersteller kann aus den Profilen beliebige sog.
Akteure whlen und die damit verbundenen Transaktionen
implementieren
Einmal im Jahr mssen sich die Hersteller im Rahmen von
Connect-a-thons beweisen
IHE definiert keine Standards, sondern verwendet sie und
fasst sie strenger!
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Grundlagen
IHE spielt in Deutschland/Europa noch keine so
groe Rolle wie in den USA
IHE hat seine Strken in der Beschreibung der
Ablufe, aber:
fokussiert auf die Ablufe in den Abteilungen
Ablufe werden zum Teil vereinfacht
Allgemeine Inhalte wie z.B. Patientendaten werden

zwar beschrieben im PAM-Profil sogar sehr
ausfhrlich knnen dabei aber von den
Empfehlungen von HL7 abweichen
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IHE Integration Profiles Radiology
Patient
Information
Reconciliation
Reconcile
Worklists,
Status
and
Data Objects
For
Unknown
Patients
and
Demographics
Changes
Charge
Posting
Scheduled Workflow
Admission, Order Management, Scheduling, Store, Retrieve
Manage
Worklists,
Track Status,
Perform &
Notify
Acquisition
Related Steps
Create,
Store,
Manage,
Retrieve &
Use
Images
Presentation of
Grouped
Procedures
Manage individual
procedure image
subsets from a
multi-procedure
acquisition for
viewing & reporting
PostProcessing
Workflow
Reporting
Workflow
Manage
worklists, track
status, perform
& notify image
processing &
CAD steps
Manage
worklists, track
status, perform
& notify
diagnostic
reporting steps
Evidence
Documents
Consistent
Presentation of
Images
Create, store,
manage, retrieve &
use objects for
hardcopy and
softcopy grayscale
presentation states
Create, store,
manage, retrieve
& use objects to
record study
evidence
Key Image
Notes
Create, store,
manage, retrieve &
use objects to flag
significant images
Collect and
post timely
billable
procedure
details
Simple Image
and Numeric
Reports
Create, store,
manage, retrieve &
use simple
diagnostic reports
with optional image
links &
Nuclear
Medicine
Image
Create, store,
manage, retrieve &
display of
NM Images &
NM Results
Access to Radiology Information

Consistent access to images and reports
Portable Data for Imaging

Exchangeability of Clinical Data on CD Media
Basic Security
Audit Trail Consolidation & Node Authentication
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Scheduled Workflow
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Scheduled Workflow
HL7 Actors & Transactions
ADT
Pt registration: 1 L
Pt Update: 12 L
Order Filler
I 2: Placer Order Management

J 3: Filler Order Management
L 1: Pt registration
L 12: Pt Update
Order Placer
L 4: Procedure Scheduled
L 12: Patient Update
L 13: Procedure Update
Image
Manager
HL7 Deutschland
HL7 Actors:
ADT/Patient
Registration
Order Placer
DSS / Order Filler
Image Manager
29
Scheduled Workflow
DICOM Actors & Transactions
DSS/ Order Filler
Modality PS in Progress [6]
Modality PS Completed [7]
Creator PS in Progress [20]
Creator PS Completed [21]
DICOM Actors:
Procedure Scheduled [4]

Image Availability Query [11]
Procedure Updated [13]
Performed Work Status Update [42]
Evidence Creator
Image Display

Performed
Procedure
Step Manager
Storage
Commitment [10]
Image
Manager
Storage
Commitment [10]
Creator Images
Stored [18]
Query Images [14]

Retrieve Images [16]
Image
Archive
Modality Image Stored [8]

Acquisition
Modality
DSS / Order Filler

PPS Manager
Image Manager /
Archive
Acquisition Modality
Evidence Creator
Image Display
Modality Worklist Provided [5]
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Acquisition Workflow Management

DSS/ Order Filler

DICOM:
Evidence Creator
Image Display

Performed
Procedure
Step Manager
Storage
Commitment [10]
Image
Manager

Storage
Commitment [10]
Creator Images
Stored [18]
Query Images [14]

Image
Archive
Modality Worklist
Management (MWL)
Modality Performed
Procedure Step
(MPPS)

Acquisition
Modality
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Image Management
DSS/ Order Filler

DICOM:
Evidence Creator
Image Display

Performed
Procedure
Step Manager
Storage
Commitment [10]
Image
Manager

Storage
Commitment [10]
Creator Images
Stored [18]
Query Images [14]

Image
Archive
Image Storage
Storage Commitment
Query/Retrieve

Acquisition
Modality
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Additional Workflow Management

DSS/ Order Filler

HL7:
Evidence Creator
Image Display

Performed
Procedure
Step Manager
Storage
Commitment [10]
Image
Manager

Storage
Commitment [10]
Creator Images
Stored [18]
Query Images [14]

Image
Archive

Acquisition
Modality
ORM Message
DICOM:
Query (C-FIND)
Modality Performed
Procedure Step
(MPPS)
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Scheduled Workflow
IHE basiert auf HL7 V2.3.1 und verwendet noch die Events
O01 und O02
Order Placer und Order Filler knnen beide Anforderungen
anlegen und stornieren
Eine Status Query ist nicht beschrieben
Der Order Filler kann Status Updates verschicken
ORRÔ02 findet nur in einer Transaktion Verwendung,
ansonsten werden HL7-ACKs zur Flusskontrolle verwendet
=> dies kann nachteilig sein!
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Scheduled Workflow
Der Standard-Workflow:
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Scheduled Workflow
Order neu anlegen/stornieren (Placer):
Update?
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Scheduled Workflow
Order neu anlegen/stornieren (Filler):
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Scheduled Workflow
Die Varianten an erlaubten Order Status
Codes sind bei IHE stark eingeschrnkt
Fr jede Transaktion ist der Status Code
vorgeschrieben
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Scheduled Workflow
Terminbenachrichtigung (Filler):
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Datenmodell
IHE kann sehr ntzlich sein, um sich ein
berblick ber das Zusammenspiel von HL7
und DICOM zu verschaffen
Bei der Parametrierung eines RIS und dem
Einrichten der Schnittstelle mssen die
Beziehungen folgender IDs festgelegt werden:
Placer Order Number (HL7)

Filler Order Number (HL7)
Accession Number (DICOM)
Study Instance UID (DICOM)
Series Instance UID (DICOM)
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Datenmodell
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Datenmodell
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Datenmodell
Im realen Leben ist die Hierarchie aber so nicht immer
abgebildet
Variante 1: Die Accession Number ist auf Ebene der Study
angesiedelt
Variante 2: Die Accession Number ist auf Ebene des Visits
angesiedelt
Wie ist der Report mit den IDs verknpft?

Welche IDs bekommt man in der HL7-Nachricht?
Welche IDs braucht man spter, um die Bilder
abzurufen?
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Scheduling of Ordered Tests
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Scheduling
The scheduling messages cover the
exchange of information related to the
planning of services and the use of resources
required for the delivery of such services.
Key issue is the planning of scarce resources
using a schedule which is used to record
appointments.
Present in HL7 version 2.3 and above.
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Scheduling: Roles
Placer application
Request messages
Response to request
Filler application
Query for
Information
Response to query
Quering application
Unsolicited
Informational
messages
General
ackowledgements
Auxillery application
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Scheduling:
Order vs. Appointment
Order
Request for the performance of a specified service
Formal transfer of responsibility (once the order has been
accepted) between two parts of an organization or between
organizations
Appointment
The scheduling the activity, based on the (implicit or explicit)
authorisiation by the performer of that activity
The scheduling of an accepted order
Order = request; appointment = order confirmation+

scheduling
Appointment may be caused by the order, but not
necessarily so.
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Scheduling: SRM
Schedule Request Messages
(Placer appl. request/Filler appl. response)
SRM^S01: request for new appointment

(response SRR^S01: schedule req. Response by filler)
SRM^S02: request to reschedule existing appointment
(SRR^S02)
SRM^S03: request to change (but not reschedule) existing
appointment (SRR^S03)
SRM^S04: request to cancel an appointment (SRR^S04)
Summarizing:
A series of messages for sending appointment requests, as well the
conformation messages for those requests.
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The SRM (request) message:

SRM^S01-S11^SRM_S01
Schedule Request Message
MSH
Message Header
ARQ
Appointment Request Information
10
[ APR ]
Appointment Preferences
10
[ NTE ]
Notes and Comments
PID
[ PV1 ]
Patient Visit
[ PV2 ]
Patient Visit - Additional Info
{ RGS
Resource Group Segment
10
[ { AIS
Chapter
2
Appointment Information - Service
10
[ APR ]
10
[ { NTE } ]
Notes and Comments
}
]
[ { AIL
Appointment Information - Location Resource
10
[ APR ]
10
[ { NTE } ]
Notes and Comments
}
]
[ { AIP
Appointment Information - Personnel Resource
10
[ APR ]
10
[ { NTE } ]
Notes and Comments
}
]
}
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The ARQ segment:

SEQ
LEN
DT
OPT
75
EI
75
EI
22
RP/#
ITEM#
ELEMENT NAME
00860
Placer Appointment ID
00861
Filler Appointment ID
NM
00862
Occurrence Number
EI
00218
Placer Group Number
250
CE
00864
Schedule ID
250
CE
00865
Request Event Reason
250
CE
0276
00866
Appointment Reason
250
CE
0277
00867
Appointment Type
20
NM
00868
Appointment Duration
10
250
CE
00869
Appointment Duration Units
11
53
DR
00870
Requested Start Date/Time Range
12
ST
00871
Priority-ARQ
13
100
RI
00872
Repeating Interval
TBL#
Indenfication Schedule/
Agenda
Reason: routine, Follow-up visit,
OR universal service ID
14
ST
00873
Repeating Interval Duration
15
250
XCN
00874
Placer Contact Person
16
250
XTN
00875
Placer Contact Phone Number
17
250
XAD
00876
Placer Contact Address
18
80
PL
00877
Placer Contact Location
19
250
XCN
00878
Entered By Person
20
250
XTN
00879
Entered By Phone Number
21
80
PL
00880
Entered By Location
22
75
EI
00881
Parent Placer Appointment ID
23
75
EI
00882
Parent Filler Appointment ID
24
22
EI
00216
Placer Order Number
25
22
EI
00217
Filler Order Number
HL7 Deutschland
duration
Unit of time
begin-/end time
50
Service / Appointment Reason

ARQ-7 Appointment Reason (CE) 00866
Components: <Identifier (ST)> ^ <Text (ST)> ^ <Name of Coding System (ID)> ^
<Alternate Identifier (ST)> ^ <Alternate Text (ST)> ^ <Name of Alternate Coding
System (ID)>
Definition: This field contains the identifier code for the reason that the appointment is to take place. This
field may contain a Universal Service ID describing the observation/test/battery/procedure or other activity
that is to be performed during the requested appointment, similar to the Universal Service ID defined for the
OBR segment in Chapter 4 on Order Entry. It may also contain a site-specific code describing a pre-defined
set of reasons that an appointment may be set to occur. This code can be based on local and/or universal
codes. The use of universal codes is recommended.
AIS-3 Universal Service Identifier (CE) 00238
Components: <Identifier (ST)> ^ <Text (ST)> ^ <Name of Coding System (ID)> ^
<Alternate Identifier (ST)> ^ <Alternate Text (ST)> ^ <Name of Alternate Coding
System (ID)>
Definition: This field contains an identifier code for a service to be scheduled. This field may contain a
universal service identifier describing the observation/test/battery/procedure or other activity that is to be
performed during the requested appointment, similar to the universal service identifier defined for the OBR
segment in the Order Entry chapter (Chapter 4). This code can be based on local and/or universal codes.
The use of universal codes is recommended.
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The SRR (response) message:

SRR^S01-S11^SRR_S01
Scheduled Request Response
MSH
Message Header
MSA
Message Acknowledgment
[ ERR ]
Error Information
[ SCH
Schedule Activity Information
10
[ NTE ]
Notes and Comments
PID
[ PV1 ]
Patient Visit
[ PV2 ]
Patient Visit - Additional Info
{ RGS
Resource Group Segment
10
Appointment Information - Service
10
Notes and Comments
[ { AIS
[ { NTE } ]
Chapter
}
]
[ { AIL
[ { NTE } ]
Appointment Information - Location Resource

Notes and Comments
10
2
}
]
[ { AIP
[ { NTE } ]
Appointment Information - Personnel Resource

Notes and Comments
10
2
}
]
}
]
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Scheduling: SIU
Schedule Information Unsolicited (Notification by Filler)
Change
Appointment
Content
SIU^S14
SIU^S13
Move
Appointment
SIU^S15
New
Appointment
SIU^S12
Appointment
SIU^S16
Block time slot

SIU^S23
Cancel
Appointment
Open time slot
Nullify
Appointment
SIU^S26
SIU^S24
HL7 Deutschland
Patient
No show
53
Scheduling: Example
Scheduling information:
MSH|^~\&|SPOCARD|EWHIN|JONES|EWHIN|199401040800||SIU^S13|02124
Schedule + time
4SPOCARD|P|2.4|||AL|ER||<cr>
SCH|1994047^SCH001|1994567^SCH100|||||047^Referral|NORMAL|30|m
in|^^^199401091300^199401091330^^^^|0045^Jones^Harold^S^^^M
Notes
D|555-4685|||087^Jensen^Helen^M^^^MD|555-9255||||BOOKED<cr>
NTE||The patient
Patient is going to be on vacation so cannot make
previous appointmentscheduled on January 6.<cr>
PID||4875439|484848||Peterson^Joseph^^Jerome^SR|Brown|19401121
|M|Jayjay||N 1234 Newport Highway^Mead^WA^99021||5554685|||M|||999-99-4413|||||||||||<cr>
Scheduled Person
RGS|001|<cr>
Scheduled Location
AIP|001|032^JENSEN^HELEN|002^CARDIOLOGIST|||||||NO|BOOKED<cr>
AIL|001|103^NORTH OFFICE|002^CLINIC|||||||NO|BOOKED<cr>
Acknowledgement
MSH|^~\&|JONES|EWHIN|SPOCARD|EWHIN|199401010802||ACK|035324JON
ES|P|2.4||||||<cr>
MSA|CA|021244SPOCARD||||<cr>
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Implementierung des
radiologischen Workflows
HL7 Deutschland
Gliederung
Das Beispielszenario
Implementierungsdetails: HL7 und IHE
Realisierung mit einem Kommunikationsserver
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Komponenten
Order Placer ist das Klinische
Arbeitsplatzsystem (KAS)
Order Filler ist das RadiologieInformationssystem (RIS)
Beide Systeme bringen einen eigenen
Kommunikationsserver mit (OPL)
Zwischen beide Systeme ist der zentrale
Kommunikationsserver gestellt (KomSrv)
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57
Vorgaben beim Design
Die gesamte Kommunikation geht ber
den KomSrv
OPL wird auf beiden Seiten nur zum
Durchreichen genutzt, es sollen sich
mglichst keine Nachrichten aufstauen
Die bersetzungslogik wird im KomSrv
implementiert
HL7 Deutschland
58

ORR vs. HL7-ACKs
Der Placer kann nach Absetzen der Order

gleich weiterarbeiten
Auf Ebene der Kommunikation wird ein HL7ACK ausgetauscht
Ein ORR kommt nicht zum Einsatz
59
HL7 Deutschland

ORR vs. HL7-ACKs
IHE geht von Point-zu-Point Anbindungen aus ->
in letzter Konsequenz braucht es bei
Verwendung von IHE auch keine
Kommunikationsserver mehr
Es wird nicht bercksichtigt, wie die
Anforderungskommunikation auf Seiten der
Anwendungen implementiert ist
IHE geht implizit davon aus, dass das
Schnittstellenmodul eng mit der Applikation
verknpft ist
60
HL7 Deutschland

ORR vs. HL7-ACKs
Alternativ:
mit ORR
Der Placer kann nach Absetzen der Order gleich weiterarbeiten

Auf Ebene der Kommunikation werden HL7-ACK und ORR
ausgetauscht (verzgert synchrone Kommunikation)
Der Placer wird ber die Verarbeitung der Order sofort informiert
HL7 Deutschland
61

Zusatzinformationen
Wo werden Zusatzinfos bertragen?
Herzschrittmacher
Schwangerschaft
Es fehlt (von HL7 und IHE) eine allgemeine Empfehlung,

und die Hersteller schaffen proprietre Lsungen
Z-Segmente mit benutzerdefinierten Feldern
OBX-Segmente
Umdefinierte Textfelder
Erst mit HL7 V3 gibt es Werkzeuge zur Modellierung

solcher Informationen
HL7 Deutschland
62

Zusatzinformationen Beispiel 1
ZOR||||||||||||||||||~^ÊxtendedOrderUserDe
finedString15^^Ja~^ÊxtendedOrderUserDefin
edString26^^0~^ÊxtendedOrderUserDefined
String33^^0~^ÔrderSuppInfoConsultNoOfVis
itsValues^^0~^ÔrderSuppInfoVerbalOrderIn
dicator^^False~^ÔrderSuppInfoIsolationFlag
^^False~^ÔrderSuppInfoTransportMethodCo
de^^0~^ÔrderSuppInfoSecondaryCDM^^,,||
False||2.000^DRCMK^M
OBX|1|ST|UnderAntibiotics||||||||F||||||
OBX|1|ST|PregnancyIndicator||||||||F||||||
OBX|1|ST|AllergyToDye||||||||F||||||
OBX|1|ST|AllergyToLatex||||||||F||||||
HL7 Deutschland
63

Zusatzinformationen Beispiel 2
Required
OBR
Field no.
Description
Format
Relevant Clinical
<Admitting Diagnosis>
Info.
13
13.2
Allergy
13.3
Diabetes
13.4
Thyriod Gland
13.5
Results
13.6
Implantat
13.7
Pacemaker
13.8
Medicine
15
Specimen Source
15.2
Additives
HL7 Deutschland
64

Terminvereinbarung (IHE)
Terminvereinbarung bei IHE nur sehr
rudimentr beschrieben
Der Order Placer kann in der ORMNachricht in ORC-7^4 bzw. OBR-27^4
einen Wunschtermin bermitteln
Der Order Filler kann Termine
bekanntgeben, ndern und stornieren
Es fehlt die Beschreibung eines
klinikumsweiten Schedulings
HL7 Deutschland
65

Updates
Fehlende Update-Mglichkeit erzwingt bei
nderungen an einer Anforderung ein
Storno gefolgt von einer Neuanlage
-> aber was will man eigentlich ndern?
Termininformationen?
Zusatzinformationen?
Auf jeden Fall scheint das IHE-Modell zu
starr zu sein
HL7 Deutschland
66
Realisierung mit einem Komserver

Nachrichtenfluss
ORM_xK
ORM_K
ACK
ACK
ORR_Kx
ORM_xR
ORM_R
ORR_K
ACK
ACK
ORR_xR
ORR_R
HL7 Deutschland
67

Nachrichtenfluss
In dem gezeigten Beispiel wrde ein
einfaches HL7-ACK nicht gengen, da das
KAS nach bergabe der ORM an OPL den
Kontext verliert
Eine synchrone Kommunikation sehen
KAS und RIS nicht vor
Eine synchrone Kommunikation wrde
KAS und RIS aber auch eng koppeln
HL7 Deutschland
68

Nachrichtenfluss
Die Behandlung von Fehlerfllen ist bei verzgert
synchroner Kommunikation besonders zu
beachten
Dies sollte wenn mglich innerhalb der
Integrationsplattform geschehen, ansonsten z.B.
ber die Generierung von Warn-Emails
Evtl. lohnt sich die Etablierung eines Werkzeugs
zur Geschftsprozess-Implementierung
HL7 Deutschland
69

Masterfiles
Essentiell fr die elektronische Anforderung ist
die Aktualitt der anforderbaren Untersuchungen
Hilfreich kann die Implementierung eines
Masterfile Updates (HL7 Kapitel 8) vom RIS zum
KAS sein
HL7 Deutschland
70
Laboratory Automation
HL7 Deutschland
Laboratory IHE Integration Profiles

Laboratory Scheduled
Workflow
(LSWF)
Laboratory Device
Automation
(LDA)
Laboratory Information
Reconciliation
(LIR)
Laboratory Code Set
Distribution
(LCSD)
Laboratory Point Of
Care Testing
HL7 Deutschland
(LPOCT)
72
Laboratory Point Of Care Testing
Tests of clinical biology, performed on point of care or patient bedside
In vitro tests: performed on a specimen, not on the patient itself
Usually quick tests, specimen collected, tested at once and eliminated
No pre or post-processing (like in LDA)
Results used immediately by the care provider in its clinical decisions
Supervision by a clinical laboratory of the healthcase enterprise
Training provided to the ward staff good practices on specimen and analyzer
Provision of reagent
Supervision of quality control
Clinical validation a posteriori
HL7 Deutschland
73
Contraints and benefits of point

of care testing
Results obtained at once increases the efficiency of
clinical decisions
Minimizes the blood quantity drawn from the patient,
because of the immediate use of the specimen. E.g. Two
drops are enough to test blood gaz, electrolyte and
hematocrit of a new-born baby.
Preserving a high level of quality of the POCT process
requires its supervision by a clinical laboratory.
(This is at least agreed upon in US and Europe)
HL7 Deutschland
74
Examples of LPOCT
Portable blood gaz and chemistry analyzer used by the nurse on

patient bedside
Blood gaz analyzer permanently installed in a surgery theater
Coagulation analyzer in acute care ward
Glucometer used by the patient in home care
Work station on which the nurse manually enters the results of

pregnancy stick tests.
HL7 Deutschland
75
Laboratory Device Automation (LDA)

Demographics
Demographics
ADT
Clinical Laboratory
Placer order
Order Placer
Order Filler
Filler order
Results
Work order
Order Result
Tracker
Results
Automation
Manager
Work
Order
Steps
LSWF
LDA
HL7 Deutschland
76
Example of workflow
Schedules steps 1 to 6
Schedules steps 1 to 6
Downloadssteps
steps1,1,2,2,3,3,5,5,66
Downloads
Perform electrolye Work Order

for serum n 123
Automation Manager
Blood
specimen
Step 1:
Convey to
decapper
Step 4:
Query
for test?
Step 2:
decap
centrifuging
decapper
Test
Na,
K, Cl
Send
the
results
Chemistry Analyzer
Step 3:
Convey to
chemistry
analyzer
Step 5:
Convey to
recapper
Step 6:
recap
recapper
Robotic Specimen Transportation System

Serum
HL7 Deutschland
77
Zusammenfassung
HL7 Deutschland
Zusammenfassung
KAS
Komm.server
Order Placer
Tracker
RIS
Radiologie
Order Filler
Modalitt
Terminplanung
Workflow = IHE. Nachrichten = HL7 Nachrichten Profile
HL7 Deutschland
79
Referenzen
HL7 version 2: Kapitel 4,7 und 13
www.hl7.de; www.hl7.org
IHE Profile (Radiology TF, Laboratory

TF, inkl. HL7 Nachrichtenprofile)
www.ihe.net
HL7 Deutschland
80
Fragen???
HL7 Deutschland
81

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Auftragskommunikation

Detlef Kraska, Universittsklinkum Erlangen

Generic Order Workflow

Generic Order Workflow

Observation (z.B. ein Laborbefund)

Placer (z.B. das Klinische Arbeitsplatzsystem)

Filler (z.B. ein Radiologiesystem)

Tracker (z.B. das Klinische Arbeitsplatzsystem)

Order related Workflow

Placer Order Mgmt

Allgemeine klinische Anforderung

ORM event / ORC-1

Cancel order/ service request.

Order service canceled.

Send order/service number.

Order/service replace request.

Change order/service request.

Use-Case: Order accept/reject

Placer sends order to Filler, Filler either confirms

Order, gefolgt von ACK

Order storniert durch den Filler

T1. Filler Order: ORM^O01 / OC

Allgemeine klinische Anforderung

ORC-1: Order Control Code

MSH-9: Message type, Event Type

Das RIS akzeptiert die Anforderung und vergibt eine eigene

OBR (in IHE order message)

Placer Order Number

Filler Order Number

Universal Service Identifier

Specimen Action Code *

Order Callback Phone Number

Diagnostic Serv Sect ID

Number of Sample Containers *

OBR-25 Status Field

Description (combined from 3 tables)

No results available; procedure scheduled, but not done.

(Some) results entered -- not yet verified

(Some) preliminary verified results: ( technically validated in T5, clinically validated in

Record coming over is a correction and thus replaces a final result

(OBX) Results cannot be obtained for this observation. (ORC/OBR) No results

Der radiologische Workflow

Ein Fall fr die Radiologie

Ein Fall fr die Radiologie

Multiple Modality Steps

Allgemeine Inhalte wie z.B. Patientendaten werden

Access to Radiology Information

Portable Data for Imaging

I 2: Placer Order Management

Procedure Scheduled [4]

Creator PS in Progress [20]

Query Images [14]

Modality Image Stored [8]

Modality PS in Progress [6]

DSS / Order Filler

Modality Worklist Provided [5]

Acquisition Workflow Management

Procedure Scheduled [4]

Creator PS in Progress [20]

Modality PS in Progress [6]

Query Images [14]

Modality Image Stored [8]

Modality PS in Progress [6]