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custo diagnostic is a server based software (referenced as "software"), intended to support physicians to acquired, analyze, document and report cardio pulmonary observations. The inherent patient, order and observation database can be interfaced via HL7, DICOM and GDT to an superior system. This document describes the typical use of the HL7 interface version 5.6 and above and addresses the HL7 communication partner.
Starting from the HL7 Message types, the document describes the conetent content of each HL7 segment. The last sections describes the data handling (patient / order / observation / tenant), meaning the typical workflow / lifecycle of the data in custo diagnostic.
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| Field | o/r/i | s/so | Default Usage | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OBR-1 / OBR-5 | r | s/so | Order Control The combination of OBR-1 and OBR-5 can be configured as order control: Default:
By default, OBR-5 is not evaluated, but can be configured to specific values. In this case the combination of OBR-1 and OBR-5 must match. Outgoing: See also "Sending Obervation Status via ORR / ORU Messages" | |||||||||||||||
| OBR-2 | r | s | Placer ID | |||||||||||||||
| OBR-3 | i | s | Outgoing: Consecutive Number with an alphanumeric prefix, e.g. "CM00001234" or some GUID,. This can be configured by a fixed length consecutive number, with an arbitrary alphanumeric prefix, e.g. "CM00001234", or an GUID e.g. "36eea93b-bc1b-4769-a84e-4ebeaaaf387e" | |||||||||||||||
| OBR-4 | r | s | OBR-4 contains information about the type of observation which should by executed. OBR-4-1 is a coded value which must be defined. OBR-4-2 when incomfing, OBR-4-2 is shown to the user, e.g. "Resting ECG" OBR-4-1 and OBR-4-2 is requried, other components optional. ##bitte prüfen - when OBR-4-2 in eingehender Nachricht abweichen zur Konfiguration in "Untersuchung" - welcher Text wird dabei angezeigt - der aus der Konfig, oder der aus der Nachricht? Outgoing: The software sends OBR-4 as received with the order. | |||||||||||||||
| OBR-5 | see OBR-1 | |||||||||||||||||
| OBR-20 | o | so | Incoming: Flexible text-fields which can be used to show additional information regarding this order to the user. | |||||||||||||||
| OBR-21 | o | so | Incoming: Flexible text-fields which can be used to show additional information regarding this order to the user. | |||||||||||||||
| OBR-32 | s | ##to be done, siehe DS-815 |
Patient Data Logic (ADT)
ADT Messages
custo diagnostic accepts by default the following message types (further message types can be defined)
##bitte Liste einfügen
Patient / Visit Identification
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Creating and Updating Patient / Visit information
custo diagnostic accepts by default the following message types (further message types can be defined)
##bitte Liste einfügen##
In case a patient does not exists in custo diagnostic, by default, custo diagnostic creates the patient and visit by each of theses ADT messages (except delete messages A23, A29, ##DS-709##). For example, a patient/visit can be created in custo diagnostic by an A08 message - without any admission message.
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The software supports all messages to provide a full HL7 order-entry workflow and methods to update the superior system about the current order status.
Orders
Supported Message: ORM^O01
custo diagnostic receives orders and show them as a worklist to the users. One order is (by default) identified by the Placer Number, and may contain several observation requests, identified by Alternate Order ID. A clinical question is visible to the user, which can contain a free text, The intention of the clinical question is to avoid unstructured communication by E-Mail/Phone etc.
The user choose the requested observation, and custo diagnostic determines the diagnostic mode by the service identified given in OBR-4, e.g. Spirometry, Resting-ECG, Holter.
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##bitte einheiten noch prüfen - rechnet er um in cm/m/inch/fuß? müsste in OBX-6 stehenstehen Rechnet er um in pfund?
##was machen wir mit labor-werten?
Order Status
The acquired recording may be processed several times in the software by several users, before it is finally reported. This workflow must be stipulated for the specific customer.
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Observation Results (ORU)
Supported Message Type: ORU^R01
As mentioned above, an order / observation may be processed in different steps by different persons. This implies, that it may be send with different observation status several times to hte place, as stipulated for this specific installation and observation type. The observation gets and internal filler ID as soons as the observation is created.
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1) Incoming: See section "Orders" above.
Sending specific observation data
custo diagnostic can send specific observation data. The most common one is the manually typed in report (referenced as AKT_BEF) or the entire observation (referenced as FILE_PDF) as PDF / base64 embedded, but more than hundred specific numeric values can be defined which are described more specific below. One or more of the listed observation data can be exported in the same message. Alternatively one message per observation data can be send.
| OBX-2 | OBX-3-1 (Code) | OBX-3-2 (Human Readable Text) | OBX-5-1 | OBX-5-3 | OBX-5-4 |
|---|---|---|---|---|---|
| FT | AKT_BEF | Report | Formatted Report | ||
| RP | FILE_PDF | PDF File | Points to an PDF-File, including path. | ||
| ED | FILE_PDF | PDF File | Base64 | ||
##bitte ergänzen um alles was im CSC unter OBX-Segment steht.
Sample - Outgoing ORU Message with Formatted-Text Report and Base64-encoded PDF-File
| Code Block |
|---|
MSH|^~\&|||||20210604110853.844+0200||ORU^R01^ORU_R01|2401|P|2.5|||NE|NE|D PID|1||197051008||Benson^Joe||19570213|M|||Trebeck Street 14^^Tedworth, South^^10417 PV1|1|U|H1A^^B377T^IM^^^3^5e||||||||||||||||3044281008||K ORC|SC|12345|CM0000000001||CM OBR|1|12345|CM0000000001|EKG03^EKG03|||20210602160514|||||||20210602160514||||||||20210604103235||||||||||&Supervisor OBX|1|ED|FILE_PDF^PDF File||^^pdf^Base64^JVBERi0xLjQKJcOiw6MKMSAwIG9iago8PAovVGl0bGUgKP7AGMAdQBzAHQAbwBfAGQAaQBhA ... olJUVPRgo=||||||F OBX|2|STFT|AKT_BEF^Report|1|normofrequenter Sinusrhythmus\.br\Steiltyp||||||F |
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PDF Files
custo recommends to transfer the PDF-Files bas64 embedded as described above. In case this is not possible, the software can export the PDF-File on a file store / share, in general it should be located on the same host custo diagnostic server is executed. By default, the PDF-Filename is equivalent to the GUID (can be configured) of the observation. Already existing files with this filename are overwritten.
We recommend to move the file to another store while processing the referencing ORU/MDM message.
| Code Block |
|---|
MSH|^~\&|||||20210604125019.69+0200||ORU^R01^ORU_R01|2701|P|2.5|||NE|NE|D
PID|1||197051008||Benson^Joe||19570213|M|||Trebeck Street 14^^Tedworth, South^^10417
PV1|1|U|H1A^^B377T^IM^^^3^5e||||||||||||||||3044281008||K
ORC|SC|12345|CM0000000001||CM
OBR|1|12345|CM0000000001|EKG03^EKG03|||20210602160514|||||||20210602160514||||||||20210604103235||||||||||&Supervisor
OBX|1|RP|FILE_PDF^PDF File||\E\\E\myserver\E\theshare\E\30c5ef4b-a5db-4b26-beab-d6922d4a4d47.pdf^^pdf||||||P
OBX|2|ST|AKT_BEF^Report|1|Dnormofrequenter Sinusrhythmus\.br\Steiltyp||||||P |
The pointer to the file \\myserver\theshare\30c5ef4b-a5db-4b26-beab-d6922d4a4d47.pdf use the \E\ to escape the backslash. (can be deactivated).
Measurement-Values
The software analyzes the recorded evaluation - e.g. ECG values, execute several algorithms and produces hundreds of physiologicial / statistical data - named "Measured Values". A list of possible measured values can be obtained from the manufacturer of the software or the implementer.
Exemplary, we use here the the measured Values:
- Heart Rate, Resting (HF_R): The heart rate for a resting patient, e.g. 71 beats per minute.
- Heart Axis Type (H_AXIS_TYPE): This is an physiological type, reflecting the direction of the main activation of the heart. e.g. "vertical heart".
- QT Time (QT_Zeit): This is an (statistical) timespan between the Q and the T-wave of an ECG graph, e.g. 374 milliseconds.
| Code Block |
|---|
MSH|^~\&|||||20210604131051.208+0200||ORU^R01^ORU_R01|3301|P|2.5|||NE|NE|D
PID|1||197051008||Benson^Joe||19570213000000+0100|M|||Trebeck Street 14^^Tedworth, South^^10417
PV1|1|U|H1A^^B377T^IM^^^3^5e||||||||||||||||3044281008||K ORC|SC|12345|CM0000000001||CM
OBR|1|12345|CM0000000001|EKG03^EKG03|||20210602160514|||||||20210602160514||||||||20210604125008||||||||||&Supervisor
OBX|1|ST|AKT_BEF^Report|1|Demo-EKG||||||P
OBX|2|NM|HF_R^Heart Rate, Resting|1|71|^bpm|||||P
OBX|3|FT|H_AXIS_TYPE^Heart axis type|1|vertical heart||||||P
OBX|4|NM|QT_ZEIT^QT Time|1|374|^ms|||||P |
It is recommended to use the OBX-3-1 as a filter, and OBX-3-2 as the text which is shown to a user.
Medical Document (MDM)
Supported Message Types: MDM^T01, MDM^T02, MDM^T07, MDM^T08, MDM^T11