Preface (organization of this chapter)

This chapter has been organized into six major sections, General, Diet, Supply, Pharmacy, Vaccine and Transfusion Services. Each section contains the trigger events, message definitions, segments and examples for the specific type of order messages. Each section about a type of order is organized into background and overview, message structure, and message segments (that are specific to the order class in question). Special discussions of the use of fields, segments or messages, and examples are included. Segments are introduced in order of occurrence in a message. A list of allowable values for a field is included in the body of the text, along with the field definition for easier reference.

Section 4.3    refers the reader to Chapter 2 for an outline of the Quantity Timing (TQ) Data Type Definition.

Sections 4.4 to 4.6    'General' includes the triggers and segments for the clinical observations and diagnostic studies as well as the triggers and message segments that are common to all of the order entry messages. Orders for laboratory tests, bedside monitoring, diagnostic imaging, electrocardiograms, vital signs, etc., are subsumed under this order message set.

Sections 4.7 to 4.9    'Diet' includes all of the usual diet specifications including snacks and guest trays

Sections 4.10 to 4.12    'Supply' includes order messages for both Stock and No-stock orders. Supply orders are different in that they often are not patient-centered (e.g., requests to stock the ward supply room).

Sections 4.13 to 4.16    'Pharmacy / Treatment' includes all pharmacy and treatment related order messages. These sections additionally include triggers related to the dispensing, giving and administration of orders. In the development of the treatment order transaction set, the focus has been on medication treatments, but the same transaction set works well for total parenteral nutrition (TPN). There is hope that it is also sufficient for other kinds of treatment orders, such as those performed by the nursing service. But it has not yet been exercised in that context and may well need further development.

Sections 4.17 to 4.19    'Vaccine' includes triggers and segments specific to vaccination order messages. These sections also include RXA definitions specific to vaccination messages.

Sections 4.20 to 4.22    "Transfusion Service (Blood Bank)" includes triggers and segments specific to transfusion service messages.

Glossary

ORM – general order message

Attention: Retained for backwards compatibility only as of v2.4.and withdrawn as of v2.7. Refer to OMG, OML, OMD, OMS, OMN, OMI, and OMP instead.

ORR – general order response message response to any ORM

Attention: Retained for backwards compatibility only as of v2.5 and withdrawn as of v2.7. Refer to ORG, ORL, ORD, ORS, ORN, ORI, and ORP instead.

OSQ/OSR- query response for order

Attention: Retained for backwards compatibility only as of v2.4.and withdrawn as of v2.7. Refer to Chapter 5.

OMG – general clinical order message (event O19)

The function of this message is to initiate the transmission of information about a general clinical order that uses the OBR segment. OMG messages can originate also with a placer, filler, or an interested third party.

The trigger event for this message is any change to a general clinical order. Such changes include submission of new orders, cancellations, updates, patient and non-patient-specific orders, etc.

This trigger includes segments identified as being for 'previous results.' These segments allow the sending system to include demographic and/or result information from previous result reports when they are related to the current order.

For example:

• Diagnostic laboratories referring tests to another lab for either confirmation of results (HIV, etc.) or due to not being equipped to do the tests (genetic testing, etc.).

• Diagnostic laboratories sending test results to Knowledge Bases for the automated generation of diagnostic comments for inclusion into the lab report.

The CTD segment in this trigger is used to transmit temporary patient contact details specific to this order.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

ORG – general clinical order acknowledgement message (event O20)

The function of this message is to respond to an OMG message. An ORG message is the application acknowledgment to an OMG message. See Chapter 2 for a description of the acknowledgment paradigm.

In ORG the PID and ORC segments are optional, particularly in case of an error response. However, ORC segments are always required in ORG when the OBR is present. For example, a response ORG might include only the MSH and MSA.

The function (e.g., cancel, new order) of both OMG and ORG messages is determined by the value in ORC-1-order control. (See the table of order control values for a complete list.)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OML – laboratory order message (event O21)

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where it is required that the Specimen/Container information is within the ORC/OBR segment group.

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc. OML messages can originate also with a placer, filler, or an interested third party.

Note: The additional patient information, which is sent after the OBR with the current order (the segments PID, PD1, PV1, PV2, etc, indicated below with words "previous result"), could have been transferred with the previous result because the patient demographics related to the previous result can differ from the demographics related to the current order. The current intent is to only allow references to the same patient as in the header PID.

The SAC segments included in the message allow the transfer of, e.g., a laboratory order with multiple containers and multiple test orders related to each container, or laboratory orders with test order requiring multiple containers.

Refer to Chapter 13, "Laboratory Automation" for examples of usage, particularly to clarify the use of two references to SAC segments in this one message.

The CTD segment in this trigger is used to transmit temporary patient contact details specific to this order.

The IPC segment in this trigger is used to transmit imaging process identifiers for observations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, O35, and O39 this message/trigger (O21) should be used where an order with multiple samples and optionally multiple containers per order item are to be communicated, but not against a complete specimen shipment (O39)

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

ORL – general laboratory order response message to any OML

The function of this message is to respond to an OML message. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O21:

• With patient segments

• Optionally without patient segments

OML – Laboratory order for multiple orders related to a single specimen (event O33)

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc., where multiple orders are associated with a single sample which may be carried in multiple containers. OML messages can originate also with a placer, filler, or an interested third party.

This allows for a Specimen-centric message with multiple orders per specimen grouped by the specimen.

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where the message requires Specimen/container information to group a number of orders.

The IPC segment in this trigger is used to transmit imaging process identifiers for observations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, and O35, this message/trigger (O33) should be used where a specimen, with optional multiple containers, may have multiple orders to be communicated.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

ORL – Laboratory order response message to a multiple order related to single specimen OML (Event O34 and O54)

The function of this message is to respond to an OML message where the original trigger event produced an OML with the Specimen Group segment above the ORC. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O34:

• With patient segments

• Optionally without patient segments

OML – Laboratory order for multiple orders related to a single container of a specimen (event O35)

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc., where multiple orders are associated with a single sample which may be carried in multiple containers. OML messages can originate also with a placer, filler, or an interested third party.

This allows for a Specimen-centric message with multiple orders per specimen grouped by the specimen.

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where the message requires Specimen/container information to group a number of orders.

The IPC segment in this trigger is used to transmit imaging process identifiers for obsrevations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, and O35, this message/trigger (O35) should be used for laboratory orders where there is 1 or more Specimens with 1 to many containers and each container may have 1 to many orders with previous result(s) per container.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

ORL – Laboratory order response message to a single container of a specimen OML(Event O36 and O55)

The function of this message is to respond to an OML message where the original trigger event produced an OML with the Specimen Group segment above the ORC. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O36:

• With patient segments

• Optionally without patient segments

OML – Specimen shipment centric laboratory order (event O39)

The function of this message is to apply an order to all specimens in a shipment or a package within a shipment.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

ORL – Specimen shipment centric laboratory order response message to specimen shipment OML(Event O40 and O56)

The function of this message is to respond to an OML message. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O40:

• With patient segments

• Optionally without patient segments

OMI – Imaging Order Message (Event O23)

This message is used in communication between the information systems involved in the fulfillment of the request directed to the imaging department, such as a Radiology Information System (RIS) and a Picture Archiving and Communication System (PACS). For the purpose of the following discussion these systems will be identified as Imaging Department Information Systems (IDIS). Information contained in the Imaging Procedure Control (IPC) segment allows multiple IDIS to share the context of Imaging Studies (collections of images acquired, processed, stored, and interpreted) in Image Management tasks.

The order for the imaging service is communicated between the Order Placer (such as an Order Entry system) and the Order Filler (such as an RIS). In the imaging department environment, the Order Filler also identifies the set of procedures (studies) and sub-procedures (procedure steps) that have to be performed in the process of fulfilling the order. Each sub-procedure is performed using a single device (station). The Order Filler identifies the type of device and either a specific device or group of devices (for example, by geographic location) one of which is to be used in performing the procedure step. Thus, the system performs an aspect of workflow management in the department.

Another information system in the department may be managing storage and distribution of the images within the department as well as providing them to the enterprise. This system will have to operate within the same context as the system managing the workflow. This context includes identifiers, content of the order, and details of procedures and procedure steps that have to be performed to fulfill that particular order.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

It is expected that the OMI message will typically be used in communication between IDIS as depicted in figure 4-1.

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).