...
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. (The intention is not, to give a deep insight about the configuration in our service applications to configure this options).
Starting from the HL7 Message types, the document describes the 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.
(Typical use / default does not imply, that the software has activated this options out of the box. Some manual configuration work is necessary by the authorized custo diagnostic vendor / implementer.)
Content
| Table of Contents |
|---|
General Data Used
...
optional - not reuqired, in some cases must be activated in custo diagnostic.
i - ignored.
Supported Message Types
The software supports the following message types.
...
General HL7 information
| Supported HL7 Version | 2.3, 2.5 (global for all message-types) |
| Character Sets | All typical character sets supported. In general, custo diagnostic is configured to export via Windows-1252 (global for all export messages) |
| Supported Transfer | TCP/IP Socket File based |
| Supported Message Types |
The message types must be licenced individually - which means not |
...
all installations provide all message types |
...
. |
HL7 Segments
Optionality Key
Incoming
...
| Empty Value / Null Value | In general custo diagnostic supports the null value for receiving messages.
|
HL7 Segments
This HL7-Segements section describes the typical mapped data fields and components. For special purpose and installations, a divergent mapping can be agreed.
Optionality Key
Incoming
| r | required | This value is required for a proper function of the software |
| o | optional | This value is not required but may be used for some functionality in custo diagnostic. |
| i | ignored | This value is ignored |
Outgoing
| s | send | This value will be send by default, in case the data is available |
| so | send optional | This value will be send, in case it is agreed between the communication partners. |
MSH - Segment
| Field | o/r/i | s/so | Default Usage |
|---|---|---|---|
| MSH-3 | o | so | Sending Application. Incoming: Expected value can be configured (default empty) in custo |
Outgoing
...
MSH - Segment
| Field | o/r/i | s/so | Default Usage |
|---|---|---|---|
| MSH-3 | o | so | Sending Application. Incoming: Expected value can be configured (default empty) in custo diagnostic and works as a filter - meaning messages with deviant content in MSH-3 are ignored. Outgoing: Sending Application, e.g. "CUSTO" can be configured in custo diagnostic. |
| MSH-4 | o | so | Sending Facility Incoming: Expected value can be configured in custo diagnostic and works as a filter - meaning messages with deviant content in MSH-4 are ignored. Outgoing: Sending Application, e.g. "CUSTO" can be configured in custo diagnostic. When a tenant system (german "Mandantensystem") is configured, this field contains the information about the tenant. See "Tenant System" below. |
| MSH-5 | o | so | Receiving Application Incoming: Expected value can be configured (default empty) in custo diagnostic and works as a filter - meaning messages with deviant content in MSH-3 are ignored. Outgoing: Receiving Application, can be configured (default empty) in custo diagnostic e.g. "HIS". |
| MSH-6 | o | so | Receiving Facility Incoming: Expected value can be configured in custo diagnostic and works as a filter - meaning messages with deviant content in MSH-3 are ignored. When a tenant system (german "Mandantensystem") is configured, this field should contain the information about the tenant. See "Tenant System" below. Outgoing: Receiving Facility, can be configured (default empty) in custo diagnostic e.g. "HIS". |
| MSH-7 | r | s | Date/Time Of Message, see HL7 Standard. ##DTM## |
| MSH-9 | r | s | Message Type. By default, custo diagnostic sends Messagetype^Event^Message-Structure, e.g. ORU^R01^ORU_R01. |
| MSH-10 | r | s | Message Control ID, see HL7 Standard |
| MSH-12 | r | s | Version ID, Outgoing: Custo diagnostic supports Version 2.3, 2.5 ##Verhalten bei eingehenden Nachrichten noch prüfen, wenn 2.7 2.9 oder 1.5 o.ä. drin steht## |
| MSH-13 | r | s | Sequence Number, see HL7 Standard |
| MSH-15 | s | Accept Acknowledge see below "Accept / Application Acknowledge" | |
| MSH-16 | i | s | Application Acknowledge Receiving: ignored. Sending: Always set to "NE" see below "Accept / Application Acknowledge" |
| MSH-18 | i | s | Character Set Receiving messages: custo diagnostic considers the character set specified in MSH-18 (##bitte prüfen)18. custo diagnostic can be configured to use a specific character set. In general Windows-1252 is used and send out via MSH-18. This one setting is used for alle outgoing messages. |
...
| 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 Observation 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 a 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/agreed between interface partner. OBR-4-2 when incomfing, OBR-4-2 is shown to the user, e.g. "Resting ECG", must be defined/agreed between interface partner. OBR-4-1 and OBR-4-2 is requriedrequired, 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
...
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, . For example, a patient/visit can be created in custo diagnostic by an A08 message - without any admission message.
...
Patients and visits can be deleted in custo diagnostic by A23, A29. A deletion means that it is marked as deleted and will be purged by the next purge-run which by default runs each night.
##bitte prüfen
Tenant System
Tenant Systems can be configured in different ways to separate orders/observation and/or patients/visits.
...
Sample:
| Tenant (Description) | Receiving (e.g. ORM) MSH-6 (code) | Sending (e.g. ORU) MSH-4 | |
|---|---|---|---|
| Sea View Hospital | SVH | SVH | |
| Lake Hospital | LH | LH |
By default, custo diagnostic send back the tenant code in MSH-4.
...
Supported Message: ORM^O01
Typical workflow: 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.
...
The acquired recording may be processed several times in the custo software by several users, before it is finally reported. This workflow must be stipulated for the specific customer and may vary for the different ECG types (like holter, Resting-ECG).
custo supports three methods to update the superior system (placer of the order) about the current state of the observation:
...
Furthermore the software can be configured, that only specific users/results with specific status can be transferred to the superior system.
When the orders are processed, custo diagnostic adds an internal "Filler ID" . This can be configured by a fixed length consecutive number, with an arbitrary alphanumeric prefix, e.g. "CM00001234", or an GUID.
Sending Observation Status Sending Observation Status via ORR / ORU Messages
ORR Message and / or ORU Status Messages can be configured on special activity / events.
...
In most installations, the manually typed in Report-Text (german "Befund") and a created PDF-File (also base64-embedded) are the most important data of the observation.
OBX-Segment
When the orders are processed, custo diagnostic adds an internal "Filler ID" . This can be configured by a fixed length consecutive number, with an arbitrary alphanumeric prefix, e.g. "CM00001234", or an GUID (OBR-3, ORC-3)
OBX-Segment
| Field | o/r/i | s | Field | o/r/i | s/so | Default Usage |
|---|---|---|---|---|---|---|
| OBX-1 | 1) | s | Set-ID | |||
| OBX-2 | 1) | s | Value Type (ST, NM, FT, RP, ED) | |||
| OBX-3 | 1) | so | observation identifier, see below OBX-3-1 code, OBX-3-2 text/human readable | |||
| OBX-5 | 1) | so | observation value, see below | |||
| OBX-6 | 1) | so | OBX-6-1 empty, OBX-6-2 units | |||
| OBX-11 | so | Observation Result Status. (see above, section "Observation Result Status") |
...
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.
Most used OBX-3 Codes:
| 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, as typed in or automatcially generated by the software | ||
| RP | FILE_PDF | PDF File | Points to an PDF-File, including path. | ||
| ED | FILE_PDF | PDF File | Base64 |
...
| ST | STUDYUID_DCM | Study Instance UID | In combination with DICOM, that Study Instance UID of the DICOM object. | ||
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|FT|AKT_BEF^Report|1|normofrequenter Sinusrhythmus\.br\Steiltyp||||||F |
...
| 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 reference pointer to the file \\myserver\theshare\30c5ef4b-a5db-4b26-beab-d6922d4a4d47.pdf use the \E\ to escape the backslash. (can be deactivated).
...
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. . The export of these values is normally not activated.
Exemplary, we use here the the measured Values:
...
The export is done via TXA Segment and points to the file in the file share:
#####################
Additionally an OBX Segment can be added to the MDM message which follows the same syntax as in ORU message. (see section "OBX-Segment" above).
Physical Transport
custo diagnostic server supports TCP/IP socket based (recommended) and file based communication.
TCP/IP socket communication
For HL7 socket communication custo diagnostic server can act as an server or client.
In general for incoming messages (e.g. ADT) custo diagnostic server listens as a server on incoming connections. For safety and security reasons, the sending IP must be whitelisted.
In general for outgoing messages (e.g. ORU) custo diagnostic server acts as client and initiates the socket to the counterpart.
File based communication
custo diagnostic can poll for HL7-files in different file locations, process the files and deletes them.
custo diagnostic can write HL7 files to a specific file locations.
By default, the custo diagnostic server operates by Local System account on the windows host, meaning that the service is able to access all local files but no remote file share, residing on a different windows host.