Transcription

Achieving Stage 1Submitting the HL7 2.5.1 Test Message

(Excerpt from Page 17-19 of the IDPH Implementation Guide and Constrained Profile)The Message Quality Framework (MQF) – Initial Step towards Stage 1Meaningful UseAny Iowa reporting facility pursuing the Stage 1 Meaningful Use for electronic laboratory reportingobjective is directed to use the MQF as the initial step before contacting IDPH for test messagevalidation. The MQF is a web site maintained by the Centers for Disease Control and Prevention capableof providing detailed feedback on test messages to instruct senders on proper message construction. Afeature of this website allows for a pre-validation (both structural and vocabulary/content validation) ofstandard HL7 2.5.1 messages. The results can be sent from the MQF web site directly to IDPH to indicatethe first steps in constructing the message (structural and content pre-validation) have been achieved.Use of the MQF allows reporting facilities to achieve a high-level of compliance with the HL7 2.5.1message standard as quickly as its resources allow, without requiring feedback from IDPH.The following specific steps should be followed when using the MQF to pre-validate the standard HL72.5.1 ELR message:A. Construct a message according to the specifications found in this IDPH Constrained ELR251 LabSender Profile for an enteric culture test identifying Salmonella Species as the organism. Seeexample message in the section Appendix A on page 136.B. Navigate to the MQF web site at https://phinmqf.cdc.gov/default.aspxC. Review the MQF release notes by clicking on the Release Notes hyperlink under References inthe left margin of the web pageD. Select the preferred message domain1. The ‘Iowa Enteric Culture Profile’ is the preferred message domain, if available at thetime of the test2. The ‘Meaningful Use-Electronic Laboratory Reporting Receiver Profile’ is an acceptablemessage domainE. Select the appropriate “Load From” setting1. Select ‘File’ if uploading the message2. Select ‘Cut and Paste Message’ if pasting the test messageF. Load the messageG. Click the Submit button to perform the first of two levels of pre-validation: Structural validation1. Make modifications in the source system that generates the test message until youachieve a result that contains only the known errors found in the document referencedin 2 below.2. See the ‘MQF Known Errors’ document at http://www.idph.state.ia.us/adper/idss.asp.3. At this stage, do not modify the test message itself to achieve this objective. Thepurpose of this pre-validation is to get the originating system to generate a compliantmessageH. Send the pre-validation report to IDPH1. Click on the Print or Save button to save a copy of the report

I.2. Click on the Email button to open the e-mail function3. Insert information on the e-mail templateI.Insert [email protected] in the To: fieldII.Insert the official name of your facility and point of contact (POC) in themessage boxIII.Insert POC name, telephone #, and e-mail addressIV.If testing identifies another error that should be on the MQF Known Errors list,indicate so in the comment box.4. Click on the Send Email button to send the report to IDPHPerform the second of two levels of pre-validation: Vocabulary validation1. Carefully review the errors specified in the structural validation report2. Modify the actual test message as needed to pass the structural validation withouterrors3. Click on the Yes button next to ‘Perform Vocabulary Validation?’4. There are known errors with vocabulary validation on the MQF site. These known errorsare posted under Meaningful Use for Electronic Laboratory Reporting (ELR) athttp://www.idph.state.ia.us/adper/idss.aspI.Make appropriate changes to the source system until the content ofthe test message reaches the point where the validation identifiesonly the known vocabulary validation errorsII.Repeat steps in H above to send the vocabulary pre-validationreport to IDPH5. Send the final, unmodified system-generated message as an attachment in text format(accessible with Notepad) to the same e-mail address ([email protected]).6. IDPH will test this message against the MQF as a first step in its validation and expects toexperience only the known errors:I.The known structural validation errorsII.The known vocabulary validation errors7. If the message does not exhibit the expected results, the message will be returned tothe facility point of contact, without further review by IDPH, so the sending facility canmake further modifications.In summary, the pre-validation consists of both structural and vocabulary validation performed againstan enteric culture test message that identifies Salmonella Species as the result and requires that twopre-validation reports be sent from the MQF web site to IDPH.Once both reports and the final, unmodified system-generated message have all been received, IDPHwill evaluate the test message to confirm the MQF pre-validation, and issue a document verifying thatyour facility has achieved the Stage 1 Meaningful Use for ELR objective to the provided point of contact(POC). This places your facility in the ELR Queue. The ELR Queue concept provides a way for reportingfacilities to achieve the Stage 1 objective while IDPH either completes internal infrastructuredevelopment or establishing connections with other facilities in the ELR Queue.

Constructing the Test Message: The ScenarioDr. Tom Sawyer, of the Missouri Department of Public Health, sees a patient named Injun Joe onMarch 1, 2012. Injun Joe is complaining of stomach cramps and diarrhea that won’t go away. Thepatient cannot provide a symptom onset date. Dr. Sawyer obtains a stool specimen from Injun Joe.Patient’s legal name: Joe, InjunDate of birth: 8/15/1963Gender: MaleRace: half white, half American Indian or Alaska NativeEthnicity: HispanicMarital Status: MarriedPatient Address: 721 SPRING STREET, GRINNELL, IA 50112 USADr. Tom Sawyer provides the stool specimen to the Missouri Department of Health Laboratoryrequesting an enteric culture test. The lab manager sends the specimen to the IA Public Health Labfor testing.The IA Public Health Lab receives the stool specimen in good condition on 3/6/2012 at 1:51 PM. Theinformation on the test request contains the patient demographic information and details aboutspecimen collection, but no symptom information.Test Performed: Bacterial Culture testResult: preliminary result- Salmonella species (further testing is required to subtype theorganism)Result Date & Time: 3/14/2012Order Status: “Some, but not all, results available” – more tests are scheduled to be performed.

The Entire Sample Message (simple form)MSH \& IA PHIMS Stage 2.16.840.1.114222.4.3.3.5.1.2 ISO IA Public HealthLab 2.16.840.1.114222.4.1.10411 ISO IA.DOH.IDSS 2.16.840.1.114222.4.3.3.19 ISO IADOH 2.16.840.1.114222.4.1.3650 ISO 201203142359 ORU R01 ORU R01 2.16.840.1.114222.4.3.3.5.1.220120314235954.325 T 2.5.1 AL NE USA PHLabReport-Ack 2.16.840.1.113883.9.10 ISOSFT Orion Health L 2.4.3.52854 Rhapsody 2.4.3.52854 20070725111624PID 1 14 IA PHIMS Stage&2.16.840.1.114222.4.3.3.5.1.2&ISO PI IA Public HealthLab&2.16.840.1.114222.4.1.10411&ISO Joe Injun L 19630815 M 21063 White CDCREC 04/24/2007 1002-5 American Indian or Alaska Native CDCREC 04/24/2007 721SPRING STREET GRINNELL IA 50112 USA H M Married HL70002 2.5.1 H Hispanic orLatino HL70189 2.5.1ORC RE 986 IA PHIMS Stage 2.16.840.1.114222.4.3.3.5.1.2 ISO A SAWYER TOMMD L MISSOURI DEPARTMENT OF HEALTH LABORATORY - MISSOURI DEPARTMENT OF HEALTHLABORATORY L 307 W MCCARTY ST JEFFERSON CITY MO 65101 USA B WPN PH 1 5555555OBR 1 986 IA PHIMS Stage 2.16.840.1.114222.4.3.3.5.1.2 ISO 625-4 Bacteria identified in Stool byCulture LN 2.33 Enteric Culture 20120301 SAWYER TOMMD L 201203140957 PNTE 1 L Enteric culture includes testing for Salmonella, Shigella, Campylobacter, Yersinia, E.coliO157:H7 \T\ other STECs, and Aeromonas RE Remark HL70364 2.5.1OBX 1 CWE 625-4 Bacteria identified in Stool by Culture LN 2.33 result1 1 27268008 Salmonella SCT 20090731 Salmonella species A A HL70078 2.5 P 20120301 Bacterial Culture 201203140957 State Hygienic Laboratory L IA Public HealthLab&2.16.840.1.114222.4.1.10411&ISO FI 16D0648109 State Hygienic Laboratory UI Research Park Coralville Iowa City IA 52242-5002 USA B 19103 Atchison Christopher LSPM 1 2012999999&IA PHIMS Stage&2.16.840.1.114222.4.3.3.5.1.2&ISO 119339001 Stool specimen(specimen) SCT SL Stool L 20090731 v unknown P Patient HL70369 2.5.1 20120301 201203061451Required (R) – The field must be in the message and the field must be populated with a value.Required/Empty (R/E) – The field must be in the message, but it does not have to be populated. Send it if you have it.Conditional (C) – If the condition is met, this field must be in the message and must be populated with a value.Conditional/Empty (CE) – If the condition is met, this field must be populated; if the condition is not met, this field must be empty.

The Message Header (MSH) SegmentThe Message Header provides sending system and facility information as well as receiving systemand agency information. It also contains the message control ID used to uniquely identify eachmessage sent from the facility.OID of Sending app (information system)OID of receiving systemMSH \& IA PHIMS Stage 2.16.840.1.114222.4.3.3.5.1.2 ISO IA Public HealthLab 2.16.840.1.114222.4.1.10411 ISO IA.DOH.IDSS 2.16.840.1.114222.4.3.3.19 ISO IADOH 2.16.840.1.114222.4.1.3650 ISO 201203142359 ORU R01 ORU R01 2.16.840.1.114222.4.3.3.5.1.220120314235954.325 T 2.5.1 AL NE USA PHLabReport-Ack 2.16.840.1.113883.9.10 ISOOID of Sending facilityOID of receiving facilitymessage control ID (Sending app)You must obtain OIDs specific to your system either from your vendor or from an organization thatmaintains an OID registry. See page 27 in the IDPH Implementation Guide and Constrained Profile.OID Universal Object IdentifierRequired (R) – The field must be in the message and the field must be populated with a value.Required/Empty (R/E) – The field must be in the message, but it does not have to be populated. Send it if you have it.Conditional (C) – If the condition is met, this field must be in the message and must be populated with a value.Conditional/Empty (CE) – If the condition is met, this field must be populated; if the condition is not met, this field must be empty.

The Software (SFT) SegmentThe software segment provides information about the sending application or the integration engineused to manipulate the message before the receiving application processes the message (preferredsince sending app or information system already identified in the MSH segment).Software release numberSoftware install dateSFT Orion Health L 2.4.3.52854 Rhapsody 2.4.3.52854 20070725111624Software binary ID(or repeat of Software release number)Required (R) – The field must be in the message and the field must be populated with a value.Required/Empty (R/E) – The field must be in the message, but it does not have to be populated. Send it if you have it.Conditional (C) – If the condition is met, this field must be in the message and must be populated with a value.Conditional/Empty (CE) – If the condition is met, this field must be populated; if the condition is not met, this field must be empty.

The Patient Identification (PID) SegmentThe Patient Identification Segment is used to provide basic demographics regarding the subject(person) being tested. The subject can be a person or an animal.OID of Sending app (information system)PID 1 14 IA PHIMS Stage&2.16.840.1.114222.4.3.3.5.1.2&ISO PI IA Public HealthLab&2.16.840.1.114222.4.1.10411&ISO Joe Injun L 19630815 M 21063 White CDCREC 04/24/2007 1002-5 American Indian or Alaska Native CDCREC 04/24/2007 721SPRING STREET GRINNELL IA 50112 USA H M Married HL70002 2.5.1 H Hispanic orLatino HL70189 2.5.1OID of Sending facilityRepeating value separator (‘ ’ tilt symbol) followed by a 2nd race fora biracial patient.A Note about data types: The Data type column in the IDPH Implementation Guide identifies theComponent data type, which determines the general rule to follow for the entire component eventhough subcomponents may have different data types.Example: PID10 is Race and is a CWE data type. All components that use standard codes areidentified as the CWE data type. So this component will follow a common pattern for CWE regardlessof which segment the CWE data type component is found. Refer to IDPH Comments associated with eachspecific component or its subcomponent.Required (R) – The field must be in the message and the field must be populated with a value.Required/Empty (R/E) – The field must be in the message, but it does not have to be populated. Send it if you have it.Conditional (C) – If the condition is met, this field must be in the message and must be populated with a value.Conditional/Empty (CE) – If the condition is met, this field must be populated; if the condition is not met, this field must be empty.

The Common Order Information (ORC) SegmentThe Common Order Segment identifies basic information about the order for testing the specimen.This segment includes identifiers for the order, who placed the order, when it was placed, whataction to take regarding the order, etc.Order status codeORC RE 986 IA PHIMS Stage 2.16.840.1.114222.4.3.3.5.1.2 ISO A SAWYER TOMMD L MISSOURI DEPARTMENT OF HEALTH LABORATORY - MISSOURI DEPARTMENT OF HEALTHLABORATORY L 307 W MCCARTY ST JEFFERSON CITY MO 65101 USA B WPN PH 1 5555555The ordering physician name is required. If your system has only one field for this information,populate 12.2.1 with the first, last, and title as seen above.Required (R) – The field must be in the message and the field must be