Guidance for use of the HL7 Automated Dispensing System Interface for Automated...

Guidance for use of the HL7 Automated Dispensing System Interface for Automated Dispensing in the

Long Term and Post-Acute Care Settings

VERSION 1.Ø This paper offers guidance to the pharmacy industry for consistent use of the HL7 ADS Interface for automated dispensing in the Long Term and Post-Acute Care settings. November 2Ø12 National Council for Prescription Drug Programs 924Ø East Raintree Drive Scottsdale, AZ 8526Ø Phone: (48Ø) 477-1ØØØ Fax: (48Ø) 767-1Ø42 E-mail: [email protected] http: www.ncpdp.org

Version 1.Ø January 2013 ***DRAFT RELEASE***

©National Council for Prescription Drug Programs, Inc.

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Guidance for the use of the HL7 ADS Interface for Automated Dispensing in the Long Term and Post-Acute

Care Settings Version 1.Ø

NCPDP recognizes the confidentiality of certain information exchanged electronically through the use of its standards. Users should be familiar with the federal, state, and local laws, regulations and codes requiring confidentiality of this information and should utilize the standards accordingly. NOTICE: In addition, this NCPDP Standard contains certain data fields and elements that may be completed by users with the proprietary information of third parties. The use and distribution of third parties' proprietary information without such third parties' consent, or the execution of a license or other agreement with such third party, could subject the user to numerous legal claims. All users are encouraged to contact such third parties to determine whether such information is proprietary and if necessary, to consult with legal counsel to make arrangements for the use and distribution of such proprietary information.

Published by: National Council for Prescription Drug Programs

Publication History: Version 1.Ø January 2Ø13

HL7 ® Material included in the NCPDP document is copyrighted by Health Level Seven® International. All Rights Reserved. Use of HL7 copyrighted materials is limited to HL7 Members and is governed by HL7 International’s Intellectual Property Policy. HL7 and Health Level Seven are registered trademarks of Health Level Seven International Reg. U.S. Pat & TM Off.

All rights reserved. Permission is hereby granted to any organization to copy and distribute this material as long as

the copies are not sold. National Council for Prescription Drug Programs

924Ø E. Raintree Drive Scottsdale, AZ 8526Ø

(48Ø) 477-1ØØØ [email protected]

Guidance for the Use of the HL7 ADS Interface for Automated Dispensing in the Long Term and Post-Acute Care Settings



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TABLE OF CONTENTS 1. SCOPE...................................................................................................................................... 6

1.1 PURPOSE ......................................................................................................................................... 6 1.2 GOALS.............................................................................................................................................. 6 1.3 RECOMMENDATION .......................................................................................................................... 6

2. SYSTEM TOPOLOGY .............................................................................................................. 7 2.1 INTERNAL PHARMACY SYSTEMS ..................................................................................................... 7 2.2 EXTERNAL PHARMACY SYSTEMS .................................................................................................... 7

3. COMMUNICATION RULES ..................................................................................................... 9

3.1 ENCODING CHARACTERS ................................................................................................................ 9 3.2 DELIMITERS ..................................................................................................................................... 9 3.3 ACKNOWLEDGEMENTS .................................................................................................................... 9 3.4 MESSAGE SEGMENTS ..................................................................................................................... 9

4. MESSAGES ............................................................................................................................ 10 4.1 PATIENT ADMINISTRATION ............................................................................................................. 10

4.1.1 ADT ÂØ1ÂDT_AØ1- Admit/Visit Notification .............................................................. 10 4.1.1.1 ADT ÂØ1ÂDT_AØ1 Sequence ................................................................................................. 10 4.1.1.2 Message ADT ÂØ1ÂDT_AØ1 Structure ................................................................................. 11 4.1.1.3 ADT ÂØ1ÂCK Structure ............................................................................................................ 11

4.1.2 ADT ÂØ2ÂDT_AØ2 - Transfer a patient ...................................................................... 12 4.1.2.1 ADT ÂØ2ÂDT_AØ2 Sequence ................................................................................................. 12 4.1.2.2 Message ADT ÂØ2ÂDT_AØ2 Structure ................................................................................. 12 4.1.2.3 ADT ÂØ2ÂCK Structure ............................................................................................................ 12

ADT ÂØ3ÂDT_AØ3- Discharge/End Visit ................................................................................... 13 4.1.2.4 ADT ÂØ3ÂDT_AØ3 Sequence ................................................................................................. 13 4.1.2.5 Message ADT ÂØ3ÂDT_AØ3 Structure ................................................................................. 13 4.1.2.6 ADT ÂØ3ÂCK Structure ............................................................................................................ 13

4.1.3 ADT ÂØ8ÂDT_AØ1 - Update patient Information ...................................................... 14 4.1.3.1 ADT ÂØ8ÂDT_AØ1 Sequence ................................................................................................. 14 4.1.3.2 Message ADT ÂØ8ÂDT_AØ1 Structure ................................................................................. 14 4.1.3.3 ADT ÂØ8ÂCK Structure ............................................................................................................ 14

4.2 ORDERS ......................................................................................................................................... 15 4.2.1 RDEÔ11^RDE_O11 - Pharmacy Encoded Order Message ....................................... 15

4.2.1.1 RDEÔ11^RDE_O11 Sequence .................................................................................................. 15 4.2.1.2 Message RDEÔ11^RDE_O11 Structure................................................................................... 15 4.2.1.3 RDEÔ11ÂCK Structure.............................................................................................................. 15

4.2.2 RDSÔ13^RDS_O13 - Pharmacy Dispense Message ................................................. 16 4.2.2.1 RDSÔ13^RDS_O13 Sequence .................................................................................................. 16 4.2.2.2 Message RDSÔ13^RDS_O13 Structure................................................................................... 16 4.2.2.3 RDSÔ13ÂCK Structure.............................................................................................................. 16

5. SEGMENTS ............................................................................................................................ 18 5.1 ERR - ERROR SEGMENT .............................................................................................................. 19 5.2 EVN - EVENT TYPE SEGMENT ...................................................................................................... 19 5.3 MSA - MESSAGE ACKNOWLEDGE SEGMENT ............................................................................... 19 5.4 MSH - MESSAGE HEADER SEGMENT ........................................................................................... 19 5.5 ORC – COMMON ORDER SEGMENT ............................................................................................. 20

5.5.1 SEQ 1: Order Control ......................................................................................................... 21 5.5.2 SEQ 2: Placer Order Number .......................................................................................... 21 5.5.3 SEQ 3: Filler Order Number ............................................................................................. 21 5.5.4 SEQ 9: Time of Transaction .............................................................................................. 21 5.5.5 SEQ 1Ø: Entered By ........................................................................................................... 21




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5.5.6 SEQ 11: Verified By ............................................................................................................ 22 5.5.7 SEQ 12: Ordering Provider ................................................................................................ 22

5.6 PID - PATIENT IDENTIFICATION SEGMENT .................................................................................... 23 5.6.1 SEQ 3: Patient Identifier List ............................................................................................. 23 5.6.2 SEQ 4: Alternate Patient ID .............................................................................................. 23 5.6.3 SEQ 5: Patient Name ......................................................................................................... 24

5.7 PV1 - PATIENT VISIT SEGMENT .................................................................................................... 24 5.7.1 SEQ 3: Assigned Patient Location ................................................................................... 25

5.8 RXD – PHARMACY DISPENSE SEGMENT ...................................................................................... 25 5.9 RXR – ROUTE SEGMENT .............................................................................................................. 26 5.1Ø RXE – PHARMACY ENCODED ORDER SEGMENT ......................................................................... 26 5.11 TQ1 – TIMING & QUANTITY SEGMENT .......................................................................................... 28

5.11.1 SEQ 3 Repeat Pattern ........................................................................................................ 28

6. FREQUENTLY ASKED QUESTIONS .................................................................................... 30

7. REFERENCE INFORMATION ............................................................................................... 31

8. APPENDIX A. HISTORY OF CHANGES ............................................................................... 32




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Disclaimer This document is Copyright © 2Ø12 by the National Council for Prescription Drug Programs (NCPDP). It may be freely redistributed in its entirety provided that this copyright notice is not removed. It may not be sold for profit or used in commercial documents without the written permission of the copyright holders. This document is provided “as is” without any express or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. If you require legal advice, you should consult with an attorney. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by NCPDP. The listing of an organization does not imply any sort of endorsement and the NCPDP takes no responsibility for the products or tools. The existence of a link or organizational reference in any of the following materials should not be assumed as an endorsement by the NCPDP. The writers of this paper will review and possibly update their recommendations should any significant changes occur. This document is for Education and Awareness Use Only.




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1. SCOPE The guidance put forth in this document are based on the use of the Automated Dispensing System (ADS) Interface used for automated dispensing in the Long Term and Post-Acute Care (LTPAC) settings. The interface is based on the Health Level Seven (HL7) messaging currently in use in LTPAC today.

1.1 PURPOSE Work Group 14 (WG14) Long Term and Post-Acute Care (LTPAC) formed the Long-Term Post-Acute Care (LTPAC) Automated Dispensing System (ADS) Interface Task Group in August 2Ø1Ø to perform a gap analysis of current and proposed technology standards, including NCPDP, HL7, and proprietary implementations, in order to prepare recommendations for dispensing automation interface standards in the LTPAC setting. The task group focused on automation used in the LTPAC setting for packaging, labeling, and distributing medications, including internal pharmacy and remote dispensing technologies. The task group did not address any upstream and/or downstream technologies, such as ePrescribing and Document Management.

1.2 GOALS When the task group was formed, the following goals were defined:

• Identify types of automated dispensing used in LTPAC • Identify current and proposed technology standards and other proprietary implementations • Perform a gap analysis of existing standards/implementations for each type dispensing • Provide a recommendation to use an existing standard, such as HL7, modify an existing NCPDP

standard, or create an entirely new NCPDP standard. 1.3 RECOMMENDATION WG14 recommends the usage of the HL7 messages, segments, and fields as outlined in this document. HL7 is the most commonly used interface standard for automated dispensing in the LTPAC setting. However, the work group identified significant variations of the standard across different systems and implementations. As a result, most – if not all – systems will require modification in order to adhere to the recommendations outlined in this document. Despite that challenge, the work group recommends that adoption of a standard interface will lower implementation and support costs in the long-term, ultimately benefiting the entire industry.




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2. SYSTEM TOPOLOGY To establish the boundaries and provide an understanding of the systems involved in automated dispensing in the LTPAC setting, a system topology has been created. The two categories of automated dispensing, as described below, are Internal Pharmacy Systems and External Pharmacy System (i.e. Remote Dispensing).

2.1 INTERNAL PHARMACY SYSTEMS Traditional pharmacy operations manage the fulfillment of prescriptions (orders) within the four walls of the pharmacy. The following diagram describes the local interface requirements for automated fulfillment, verification, and packing.

Figure 2.1: Pharmacy Internal Systems

All pharmacies have some type of Pharmacy Information System (PhIS) while the other items noted in figure 2.1 may be contained within the application space of the PhIS or supplied by different vendors. Since PV2 (second level pharmacist verification) and Packing/Shipping solutions are generally contained within the application space of the PhIS, and third party Document Management solutions are connected through proprietary interfaces, this guide focuses on the interface between PhIS and the internal fulfillment system (i.e. automated dispensing system). The use of the this guide is recommended only in situations in which the PhIS and the internal fulfillment system are supplied by different vendors. In situations in which PhIS and the internal fulfillment system are closed loop, this guide is not applicable.

2.2 EXTERNAL PHARMACY SYSTEMS With the advancement in technology systems that allow for patient-specific dispensing at the long-term care facility, this guide also addresses the connectivity between the PhIS and remote dispensing systems in order to prevent the propagation of proprietary interfaces. In this case, multiple systems are distributed across multiple facilities outside of the pharmacy. As such, this guide assumes the remote dispensing systems are managed by a “controller” that routes the orders to the correct system. Therefore, in this scenario, the PhIS is not expected to be responsible for the proper routing to each system.




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Figure 2.2: Pharmacy External Systems with Controller

The additions of a Wide Area Network (WAN) adds a few considerations when establishing a communication security methodology; however the same message sets will be used in either internal fulfillment or external dispensing of patient specific orders. Furthermore, it is the remote dispensing systems responsibility to establish and maintain the WAN connections, thus under the message security section Figure 2.2 will be addressed as the ADS messages leave the local networks protection.




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3. COMMUNICATION RULES This section describes the general and minimum communication standards. Communication rules will follow the HL7 messaging standards to include the message structures and message transmission protocols.

3.1 ENCODING CHARACTERS The intent of this guide is for use in the United States of America and systems that recognize the US exchanges. The only printable character set is the ASCII set. Valid characters are ASCII hexadecimal characters 2Ø to 7E inclusive. 3.2 DELIMITERS It is recommended that the standard HL7 delimiters be used for messages unless changes are agreed upon by the trading partners.

Message Delimiters

Segment Terminator <CR> No substitution Field Separator | MSH-1 Component Separator ^ MSH-2 position 1 Subcomponent Separator & MSH-2 position 2 Repetition Separator ~ MSH-2 position 3 Escape Character / MSH-2 position 4

3.3 ACKNOWLEDGEMENTS The ADS Interface will use a logical level acknowledgement. These acknowledgement values will be described for each message in the sequence portion of the message. In general it is the responsibility of the sending application to ensure the transmission and receipt of the message. It is the responsibility of the receiving application to acknowledge the logical acceptance or rejection of the message. It is not the responsibility of the receiving application to ensure the receipt of the message. 3.4 MESSAGE SEGMENTS With the diversity of the HL7 protocol and the multi-use of many messages, this guide describes each of the messages supported as well as the standard and minimum data elements required in the message. If a receiving application receives additional segments and/or fields the receiving application should not reject the message if the primary data set is complete and logically acceptable.




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4. MESSAGES This section outlines the events that drive certain message transmissions as well as the expected/acceptable return messages. The segment usage will be summarized, and the segment definitions will be described in the following section.

4.1 PATIENT ADMINISTRATION To support proper order grouping, package labeling and general ADS management, the following Patient Administration messages are needed:

LTPAC ADS Patient Administration Messages

ADTÂØ1ÂDT_AØ1 Admit/Visit Notification ADTÂØ2ÂDT_AØ2 Transfer a Patient ADTÂØ3ÂDT_AØ3 Discharged/End Visit ADTÂØ8ÂDT_AØ1 Update patient Information ADTÂ22ÂDT_A21 Delete a Patient Record

4.1.1 ADT ÂØ1ÂDT_AØ1- ADMIT/VISIT NOTIFICATION

Message Considerations

HL7 - Message ADT ÂØ1ÂDT_AØ1 NCPDP Name Patient Admit Usage Optional - ADS can alternatively

obtain patient information sent in the New Order message. Additional info such as Diagnosis and Allergies are included in this message, but are optional.

Trigger Patient Admitted to LTPAC Facility 4.1.1.1 ADT ÂØ1ÂDT_AØ1 SEQUENCE




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4.1.1.2 MESSAGE ADT ÂØ1ÂDT_AØ1 STRUCTURE

Segment Name Usage Cardinality Comment

MSH Message Header R [1..1] EVN Event Type R [1..1] PID Patient Identification R [1..1] [PD1] Additional Demographics R [1..1] PV1 Patient Visit R [1..1]

4.1.1.3 ADT ÂØ1ÂCK STRUCTURE


MSH Message Header R [1..1] MSA Message

Acknowledgment R [1..1]

[{ERR}] Error O [Ø..1]




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4.1.2 ADT ÂØ2ÂDT_AØ2 - TRANSFER A PATIENT


HL7 - Message ADT ÂØ2ÂDT_AØ2 NCPDP Name Patient Transfer Usage This is Optional unless the ADS

defines this field as Required. A Patient Transfer will only be processed via an ADTÂØ2 and not an ADTÂØ8 It is also the responsibility of the ADS to update the active orders with the new patient location.

Trigger Patient Transferred within a LTPAC Facility

4.1.2.1 ADT ÂØ2ÂDT_AØ2 SEQUENCE






MSH Message Header R [1..1] MSA Message Acknowledgment R [1..1] [{ERR}] Error O [Ø..1]




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ADT ÂØ3ÂDT_AØ3- DISCHARGE/END VISIT


HL7 - Message ADT ÂØ3ÂDT_AØ3 NCPDP Name Patient Discharge Usage This is Optional unless the ADS defines this

field as Required. ADS should discontinue all orders when a Discharge message is received (dispensing system would decide if discontinued order message is required). Follows same guidelines as transfer AØ3 followed by AØ8.

Trigger Patient Discharged from LTPAC Facility






Segment Name Usage Cardinality Comment MSH Message Header R [1..1] MSA Message Acknowledgment R [1..1] [{ERR}] Error O [Ø..1]




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4.1.3 ADT ÂØ8ÂDT_AØ1 - UPDATE PATIENT INFORMATION


HL7 - Message ADT ÂØ8ÂDT_AØ1 NCPDP Name Patient Update Usage This is Optional unless the ADS

defines this field as Required Should not be used for transfer and discharge, but can follow a transfer or discharge record.

Trigger Patient Data changed for given LTPAC Facility. Note if transfer use Patient Transfer "ADTÂØ2"



Segment Name Usage Cardinality Comment MSH Message Header R [1..1] EVN Event Type R [1..1] PID Patient Identification R [1..1] [PD1] Additional Demographics R [1..1] PV1 Patient Visit R [1..1]


Segment Name Usage Cardinality Comment MSH Message Header R [1..1] MSA Message Acknowledgment R [1..1] [{ERR}] Error O [1..1]




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4.2 ORDERS In order to support patient and time-specific dispensing, as well as accurate billing of medications dispensed via an automated system, the following Order messages are needed:

LTPAC ADS Order Messages

RDEÔ11^RDE_O11 Pharmacy Encoded Order Message RDSÔ13^RDS_O13 Pharmacy Dispense Message

4.2.1 RDEÔ11^RDE_O11 - PHARMACY ENCODED ORDER MESSAGE


HL7 - Message RDEÔ11^RDE_O11 NCPDP Name Pharmacy Encoded Order Message Usage Required Trigger Order is created, changed, or discontinued in

pharmacy system

4.2.1.1 RDEÔ11^RDE_O11 SEQUENCE

4.2.1.2 MESSAGE RDEÔ11^RDE_O11 STRUCTURE


MSH Message Header R [1..1] PID Patient Identification R [1..1] PD1 Additional Demographics R [1..1] PV1 Patient Visit R [1..1] ORC Common Order R [1..1] TQ1 Timing/Quantity R [1..1] RXR Treatment Route R [1..1] RXE Treatment Encoded Order R [1..1]

4.2.1.3 RDEÔ11ÂCK STRUCTURE




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MSH Message Header R [1..1] MSA Message Acknowledgment R [1..1] [{ERR}] Error O [1..1]

4.2.2 RDSÔ13^RDS_O13 - PHARMACY DISPENSE MESSAGE


HL7 - Message RDSÔ13^RDS_O13 NCPDP Name Pharmacy Dispense Message Usage This is Optional unless the ADS defines this field as

Required. Information sent to pharmacy system about what doses were dispensed from the system. Can be a partial dispense of the order (i.e. order was for 3Ø days but dispense log is what was dispensed that day on a dose by dose basis.)

Trigger ADS packages one or more doses for the order 4.2.2.1 RDSÔ13^RDS_O13 SEQUENCE

�

4.2.2.2 MESSAGE RDSÔ13^RDS_O13 STRUCTURE


MSH Message Header R [1..1] PID Patient Identification R [1..1] PD1 Additional Demographics R [1..1] PV1 Patient Visit R [1..1] ORC Common Order R [1..1] RDE Treatment Dispense R [1..1]

4.2.2.3 RDSÔ13ÂCK STRUCTURE


MSH Message Header R [1..1]




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MSA Message Acknowledgment R [1..1] [{ERR}] Error O [1..1]




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5. SEGMENTS HL7 Optionality and Conformance Usage

HL7 Optionality Allowed Conformance Usage Comment

R - Required R O - Optional R, RE, O, C, CE, X O is only permitted for constrainable

profiles C - Conditional C, CE, R X – Not Supported X B – Backward Compatibility R, RE, O, C, CE, X O is only permitted for constrainable

definitions W - Withdrawn R, RE, O, C, CE, X

Usage Value Description Comment

R Required A conforming sending application shall populate all “R” elements with a non-empty value. conforming receiving application shall process (save/print/archive/etc.) or ignore the information conveyed by required elements. A conforming receiving application must not raise an error due to the presence of a required element, but may raise an error due to the absence of a required element. Any element designated as required in a standard HL7 message definition shall also be required in all HL7 message profiles of that standard message.

RE Required but may be empty

The element may be missing from the message, but must be sent by the sending application if there is relevant data. A conforming sending application must be capable of providing all "RE" elements. If the conforming sending application knows the required values for the element, then it must send that element. If the conforming sending application does not know the required values, then that element will be omitted. Receiving applications will be expected to process (save/print/archive/etc.) or ignore data contained in the element, but must be able to successfully process the message if the element is omitted (no error message should be generated because the element is missing).

O Optional This code indicates that the Usage for this element has not yet been defined. A usage of ‘Optional’ may not be used in ‘implementation’ profiles (no-optionality profiles). Conformance may not be tested on an Optional field. Narrower profiles may be defined based on this profile, and may assign any usage code to the element

C Conditional This usage has an associated condition predicate (See section Error! Reference source not found., "Error! Reference source not found."). If the predicate is satisfied: A conformant sending application must always send the element. A conformant receiving application must process or ignore data in the element. It may raise an error if the element is not present. If the predicate is NOT satisfied: A conformant sending application must NOT send the element. A conformant receiving application must NOT raise an error if the condition predicate is false and the element is not present, though it may raise an error if the element IS present.

CE Conditional but it may be empty

This usage has an associated condition predicate (See section Error! Reference source not found., "Error! Reference source not found."). If the predicate is satisfied: If the conforming sending application knows the required values for the element, then the application must send the element. If the conforming sending application does not know the values required for this element, then the element shall be omitted. The conforming sending application must be capable of knowing the element (when the predicate is true) for all 'CE' elements. If the element is present, the conformant receiving application shall process (display/print/archive/etc.) or ignore the values of that element. If the element is not present, the conformant receiving application shall not raise an error due to the presence or absence of the element. If the predicate is not satisfied: The conformant sending application shall not populate the element. The conformant receiving application may raise an application error if the element is present.




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Value Description Comment

X Not supported For conformant sending applications, the element will not be sent. Conformant receiving applications may ignore the element if it is sent, or may raise an application error.

5.1 ERR - ERROR SEGMENT

SEQ LEN DT NAME USAGE COMMENTS

1 493 ELD Error Code and Location B USE ERR 2 & 3 leave blank 2 18 ERL Error Location O 3 7Ø5 CWE HL7 Error Code R 4 2 ID Severity R 5 7Ø5 CWE Application Error Code O 6 8Ø ST Application Error Parameter O 7 2Ø48 TX Diagnostic Information O 8 25Ø TX User Message O 9 2Ø IS Inform Person Indicator O

1Ø 7Ø5 CWE Override Type O 11 7Ø5 CWE Override Reason Code O 12 652 XTN Help Desk Contact Point O

5.2 EVN - EVENT TYPE SEGMENT


1 3 ID Event Type Code B USE MSH-9 leave blank 2 26 TS Recorded Date/Time R 3 26 TS Date/Time Planned Event O 4 3 IS Event Reason O 5 25Ø XCN Operator ID O 6 26 TS Event Occurred O 7 241 HD Event Facility O

5.3 MSA - MESSAGE ACKNOWLEDGE SEGMENT

SEQ LEN DT NAME USAGE COMMENTS 1 2 ID Acknowledge Code R 2 2Ø ST Message Control ID R 4 15 NM Expected Sequence

Number O

Note MSA-3, 5, 6 have been deprecated

5.4 MSH - MESSAGE HEADER SEGMENT

SEQ LEN DT NAME USAGE COMMENTS 1 1 ST Field Separator R "|" ACSII 124 2 4 ST Encoding Characters R "^~\&" ASCII 94,126,92,38 3 227 HD Sending Application R PhIS or ADS 4 227 HD Sending Facility R Pharmacy or Location of ADS 5 227 HD Receiving Application R PhIS or ADS




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SEQ LEN DT NAME USAGE COMMENTS 6 227 HD Receiving Facility R Pharmacy or Location of ADS 7 26 TS Date/Time of Message R 8 4Ø ST Security O 9 15 MSG Message Type R

1Ø 2Ø ST Message Control ID R 11 3 PT Processing ID R 12 6Ø VID Version ID R 13 15 NM Sequence Number O 14 18Ø ST Continuation Pointer O 15 2 ID Accept Acknowledgement

Type O

16 2 ID Application Acknowledgement Type

O

17 3 ID Country Code O 18 16 ID Character Set O 19 25Ø CE Principal language of

Message O

2Ø 2Ø ID Alternative Character Set Handling Scheme

O

21 427 EI Message Profile Identifier O

5.5 ORC – COMMON ORDER SEGMENT


1 2 ID Order Control R 2 22 EI Placer Order Number C CPOE Tracking Number 3 22 EI Filler Order Number R Prescription Number 4 22 EI Placer Group Number O 5 2 ID Order Status O 6 1 ID Response Flag O 7 2ØØ TQ Quantity/Timing B Use TQ1 Segment 8 2ØØ EIP Parent O 9 26 TS Time of Transaction R

1Ø 25Ø XCN Entered By R Pharmacy Tech 11 25Ø XCN Verified By R Pharmacist 12 25Ø XCN Ordering Provider R Doctor/Prescriber 13 8Ø PL Enterers Location O 14 25Ø XTN Call Back Phone Number O 15 26 TS Order Effective Date/Time O 16 25Ø CE Order Control Code Reason O 17 25Ø CE Entering Org. O 18 25Ø CE Entering Device O 19 25Ø XCN Action By O 2Ø 25Ø CE Advanced Beneficiary Notice O 21 25Ø XON Ordering Facility Name O 22 25Ø XAD Ordering Facility Address O 23 25Ø XTN Ordering Facility Phone O 24 25Ø XAD Ordering Provider Address O 25 25Ø CWE Order Status Modifier O




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26 6Ø CWE Advanced Beneficiary Notice Override Reason

C

27 26 TS Sellers Expected Availability DT O 28 25Ø CWE Confidentiality Code O 29 25Ø CWE Order Type O 3Ø 25Ø CWE Enterer Authorization Mode O 31 25Ø CWE Parent Universal Service ID O

5.5.1 SEQ 1: ORDER CONTROL

NW - New Order DC- Discontinue RF - Refill XO - Update Order CA - Cancel Order RE - Observation to Follow

Example: |NW|

5.5.2 SEQ 2: PLACER ORDER NUMBER CPOE Tracking Number 5.5.3 SEQ 3: FILLER ORDER NUMBER Prescription Number 5.5.4 SEQ 9: TIME OF TRANSACTION Date time stamp of the transaction must use second as the precision domain and it is the option of the sending application to use fractional seconds if needed. Format: 1) YYYYMMDDMMSS.SS^S 2) YYYYMMDDMMSS^S 5.5.5 SEQ 1Ø: ENTERED BY Entered By will use the first 7 SEQ of the XCN data type.

SEQ LEN NAME Example

1 15 ID Number 123456789 2 194 Family Name Doe 3 3Ø Give Name John 4 3Ø Initials JED 5 2Ø Suffix JR 6 2Ø Prefix DR 7 5 Degree RPH TECH




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Example: |123456789^DOE^JOHN^JED^^TECH|

5.5.6 SEQ 11: VERIFIED BY Verified By will use the first 7 SEQ of the XCN data type.


1 15 ID Number 123456789 2 194 Family Name Doe 3 3Ø Give Name John 4 3Ø Initials JED 5 2Ø Suffix JR 6 2Ø Prefix DR 7 5 Degree RPH

Example: |123456789^DOE^JOHN^JED^^RPH|

5.5.7 SEQ 12: ORDERING PROVIDER Ordering Provider will use the first 7 SEQ of the XCN data type.


1 15 ID Number 123456789 2 194 Family Name Doe 3 3Ø Give Name John 4 3Ø Initials JED 5 2Ø Suffix JR 6 2Ø Prefix DR 7 5 Degree MD

Example: |123456789^DOE^JOHN^JED^^MD|




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5.6 PID - PATIENT IDENTIFICATION SEGMENT

SEQ LEN DT NAME USAGE COMMENTS 1 4 SI Set ID-PID O 2 2Ø CX Patient ID B Use PID-3 3 25Ø CX Patient Identifier List R PhIS Patient ID 4 2Ø CX Alternate Patient ID O ADS Patient ID 5 25Ø XPN Patient Name R 6 25Ø XPN Mother’s Maiden Name O 7 26 TS Date/Time of Birth C 8 1 IS Administrative Sex O 9 25Ø XPN Patient Alias O

1Ø 25Ø CE Race O 11 25Ø XAD Patient Address O 12 4 IS Country Code B 13 25Ø XTN Phone Number - Home O 14 25Ø XTN Phone Number - Business O 15 25Ø CE Primary language O 16 25Ø CE Marital Status O 17 25Ø CE Religion O 18 25Ø CX Patient Account Number O 19 16 ST SSN Number B 2Ø 25 DLN Driver License Number B 21 25Ø CX Mother's Identification O 22 25Ø CE Ethnic Group O 23 25Ø ST Birth Place O 24 1 ID Multiple Birth Indicator O 25 2 NM Birth Order O 26 25Ø CE Citizenship O 27 25Ø CE Veterans Military Status O 28 25Ø CE Nationality B 29 26 TS Patient Death Date and

Time O

3Ø 1 ID Patient Death Indicator O 31 1 ID Identity Unknown Indicator O 32 2Ø IS Identity Reliability Code O 33 26 TS Last Update Date/Time O 34 241 HD Last Update Facility O 35 25Ø CE Species Code C 36 25Ø CE Breed Code C 37 8Ø ST Strain O 38 25Ø CE Production Class Code O 39 25Ø CWE Tribal Citizenship O

5.6.1 SEQ 3: PATIENT IDENTIFIER LIST Patient ID in the PhIS 5.6.2 SEQ 4: ALTERNATE PATIENT ID




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Patient ID in the ADS system or secondary Patient ID in dual systems 5.6.3 SEQ 5: PATIENT NAME

SEQ LEN NAME Example1 194 Family Name Doe 2 3Ø Give Name John 3 3Ø Middle Name James 4 2Ø Suffix JR

Example: |DOE^JOHN^JAMES^JR|

5.7 PV1 - PATIENT VISIT SEGMENT


1 4 SI Set ID-PID O 2 1 IS Patient Class R Default to “I” for Inpatient 3 8Ø CX Assigned Patient Location R 4 2 IS Admission Type O 5 25Ø CX Preadmit Number O 6 8Ø PL Prior Patient Location O 7 25Ø XCN Attending Doctor O 8 25Ø XCN Referring Doctor O 9 25Ø XCN Consulting Doctor B

1Ø 3 IS Hospital Service O 11 8Ø PL Temporary Location O 12 2 IS Preadmit Test Indicator O 13 2 IS Re-admission Indicator O 14 6 IS Admit Source O 15 2 IS Ambulatory Status O 16 2 IS VIP Indicator O 17 25Ø XCN Admitting Doctor O 18 2 IS Patient Type O 19 25Ø CX Visit Number O 2Ø 5Ø FC Financial Class O 21 2 IS Charge Price Indicator O 22 2 IS Courtesy Code O 23 2 IS Credit Rating O 24 2 IS Contract Code O 25 8 DT Contract Effective Date O 26 12 NM Contract Amount O 27 3 NM Contract Period O 28 2 IS Interest Code O 29 4 IS Transfer to Bad Debt Code O 3Ø 8 DT Transfer to Bad Debt Date O 31 1Ø IS Bad Debt Agency Code O 32 12 NM Bad Debt Transfer Amount O 33 12 NM Bad Debt Recovery

Amount O

34 1 IS Delete Account Indicator O




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35 8 DT Delete Account Date O 36 3 IS Discharge Disposition O 37 47 DLD Discharged to Location O 38 25Ø CE Diet Type O 39 2 IS Servicing Facility O 4Ø 1 IS Bed Status B 41 2 IS Account Status O 42 8Ø PL Pending Location O 43 8Ø PL Prior Temporary Location O 44 26 TS Admit Date/Time O 45 26 TS Discharge Date/Time O 46 12 NM Current Patient Balance O 47 12 NM Total Charges O 48 12 NM Total Adjustments O 49 12 NM Total Payments O 5Ø 25Ø CX Alternate Visit ID O 51 1 IS Visit Indicator O 52 25Ø XCN Other Healthcare Provider O

5.7.1 SEQ 3: ASSIGNED PATIENT LOCATION


1 2Ø Nursing Unit West Wing 2 2Ø Room W1Ø1 3 2Ø Bed 1 4 2Ø Facility ID 1234567 5 2Ø Floor Number 1 6 2Ø Facility LTC HOME

Example: |West Wing^W1Ø1^1^1234567^1^LTC HOME|

5.8 RXD – PHARMACY DISPENSE SEGMENT


1 4 NM Dispense Sub-ID Counter R 2 25Ø CE Dispense/Give Code R NDC of actual drug dispensed 3 26 TS Date/Time for Dispense R 4 2Ø NM Actual Dispense Amounts R 5 25Ø CE Actual Dispense Units C 6 25Ø CE Actual Dosage Form O 7 2Ø ST Prescription Number R 8 2Ø NM Number of Refills Remaining

9 2ØØ ST Dispense Notes O Use for dose disposition (Dispensed, Destroyed, Re-Dispensed) and disposition reason code

1Ø 2ØØ XCN Dispensing Provider O 11 1 ID Substitution Status O




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12 1Ø CQ Total Daily Dose O 13 2ØØ LA2 Dispense-to Location C 14 1 ID Needs Human Review O 15 25Ø CE Pharmacy/Treatment Supplier

Special Dispensing Instructions

O

16 2Ø NM Actual Strength O 17 25Ø CE Actual Strength Unit O 18 2Ø ST Substance Lot Number O 19 26 TS Substance Expiration Date O 2Ø 25Ø CE Substance Manufacturer

Name O

21 25Ø CE Indication O 22 2Ø NM Dispense Package Size O 23 25Ø CE Dispense Package Size Unit O

24 2 IC Dispense Package Method O 25 25Ø CE Supplementary Code O 26 25Ø CE Initiating Location O 27 25Ø CE Packaging/Assembly Location O

28 5 NM Actual Drug Strength Volume O

29 25Ø CWE Actual Drug Strength Volume Units

O

3Ø 18Ø CWE Dispense to Pharmacy O 31 1Ø6 XAD Dispense to Pharmacy

Address O

32 1 ID Pharmacy Order Type O 33 25Ø CWE Dispense Type O

5.9 RXR – ROUTE SEGMENT


1 25Ø CE Route R 2 25Ø CWE Administration Site O 3 25Ø CE Administration Device O 4 25Ø CWE Administration Method O 5 25Ø CE Routing Instruction O 6 25Ø CWE Administration Site Modifier O

5.10 RXE – PHARMACY ENCODED ORDER SEGMENT


1 2ØØ TQ Quantity/Timing B Use TQ1 Segment 2 25Ø CE Give Code R NDC | Drug Name | Drug ID 3 2Ø NM Give Amount - Minimum R 4 2Ø NM Give Amount - Maximum O




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5 25Ø CE Give Units R 6 25Ø CE Give Dosage Form 7 25Ø CE Provider's Administration

Instructions O e.g. Take with Food

8 2ØØ LA1 Deliver-to Location O 9 1 ID Substitution Status O

1Ø 2Ø NM Dispense Amount O 11 25Ø CE Dispense Units O 12 3 NM Number of Refills O 13 25Ø XCN Ordering Provider's DEA

Number O

14 25Ø XCN Pharmacist/Treatment Supplier's Verifier ID

O

15 2Ø ST Prescription Number O 16 2Ø NM Number of Refills

Remaining O

17 2Ø NM Number of Refills/Doses Dispensed

O

18 26 TS D/T of Most Recent Refill or Dose Dispensed

O

19 1Ø CQ Total Daily Dose O 2Ø 1 ID Needs Human Review O 21 25Ø CE Pharmacy/Treatment

Supplier's Special Dispensing Instructions

O

22 2Ø ST Give Per (Time Unit) O 23 6 ST Give Rate Amount O 24 25Ø CE Give Rate Units O 25 2Ø NM Give Strength O 26 25Ø CE Give Strength Units O 27 25Ø CE Give Indication O 28 2Ø NM Dispense Package Size O 29 25Ø CE Dispense Package Size

Unit O

3Ø 2 ID Dispense Package Method O 31 25Ø CE Supplementary Code O 32 26 TS Original Order Date/Time O 33 5 NM Give Drug Strength Volume O 34 25Ø CWE Give Drug Strength Volume

Units O

35 6Ø CWE Controlled Substance Schedule

O

36 1 ID Formulary Status O 37 6Ø CWE Pharmaceutical Substance

Alternative O

38 25Ø CWE Pharmacy of Most Recent Fill

O

39 25Ø NM Initial Dispense Amount O 4Ø 25Ø CWE Dispensing Pharmacy O




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41 25Ø XAD Dispensing Pharmacy Address

O

42 8Ø PL Deliver-to Patient Location O 43 25Ø XAD Deliver-to Address O 44 1 ID Pharmacy Order Type O

5.11 TQ1 – TIMING & QUANTITY SEGMENT


1 4 SI ID R Counter starting at 1 and going up 2 2Ø CQ Quantity R 3 54Ø RPT Repeat Pattern R 4 2Ø TM Explicit Time R Comma separated HOA times 5 2Ø CQ Relative Time and Units O 6 2Ø CQ Service Duration O 7 26 TS Start Date Time R 8 26 TS End Date Time R 9 25Ø CWE Priority O

1Ø 25Ø TX Condition Text O 11 25Ø TX Text Instructions R Text SIG 12 1Ø ID Conjunction O Not needed for ADS 13 2Ø CQ Current Duration O 14 1Ø NM Total Occurrences O

5.11.1 SEQ 3 REPEAT PATTERN

• Use Hour of Administration (HOA) code if it is a daily med. Examples: 4 times daily = QID 3 times daily = TID

If it is a skip day order, use HOA~QxD.

A skip of 1 becomes Q2D QOD~Q2D

Q<integer>J<day#> repeats on a particular day of the week. If <integer> is missing, the repeat rate is assumed to be 1.

Day numbers are counted from 1=Monday to 7=Sunday. So Q2J2 means every second Tuesday; Q1J6 means every Saturday.

If it is a day of the week order, use QxJØØØØØØØ. MWF becomes Q1J135

• D (Daily) QJ#

Only included when all of the days are not selected 1 = Mon, 2 = Tue, 3 = Wed, 4 = Thu, 5 = Fri, 6 = Sat, 7 = Sun Example: QJ135 = MWF

• E (Every x Days) Q#D




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Example: Q2D = every 2nd days Example: Q3D = every 3rd day

• M (Monthly) QL#,#

Each # represents a day of the month. Only those days selected are included in the list. Example: QL3 = 3rd

• Example: QL1,15 = 1st and 15th\

Examples: 1. 1 tab bid at 8am and 8pm |TQ1|1|1^TAB|BID|Ø8ØØ, 2ØØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH TWICE DAILY|| 2. 1 tab in the morning and 2 tabs at bedtime |TQ1|1|1^TAB|QD|Ø8ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH ONCE DAILY|A| |TQ1|2|2^TAB|HS|2ØØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH AT BEDTIME|| 3. 1 cap 9am every other day |TQ1|1|1^CAP|QOD~QOD|Ø9ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH EVERY OTHER DAY|| 4. 1 tab qid x 3, tid x 3, bid x 3, qd x 3 |TQ1|1|1^TAB|QID|Ø8ØØ||3^D| 2Ø1ØØ5Ø5161Ø|2Ø1ØØ5Ø816Ø9|||TAKE 1 TABLET BY MOUTH 4 TIMES A DAY FOR 3 DAYS|S| |TQ1|2|1^TAB|TID|Ø8ØØ||3^D| 2Ø1ØØ5Ø8161Ø|2Ø1ØØ51116Ø9|||TAKE 1 TABLET BY MOUTH 3 TIMES A DAY FOR 3 DAYS|S| |TQ1|3|1^TAB|BID|Ø8ØØ||3^D| 2Ø1ØØ511161Ø|2Ø1ØØ51416Ø9|||TAKE 1 TABLET BY MOUTH 2 TIMES A DAY FOR 3 DAYS|S| |TQ1|4|1^TAB|QD|Ø8ØØ||3^D| 2Ø1ØØ514161Ø|2Ø1ØØ51716Ø9|||TAKE 1 TABLET BY MOUTH 1 TIME DAILY FOR 3 DAYS|| 5. 1 tab daily at 9am on M W F |TQ1|1|1^TAB|MWF~Q1JØ1Ø1Ø1Ø|Ø9ØØ|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH ONCE DAILY ON MONDAY, WEDNESDAY, AND FRIDAY|| 6. 1 tab PRN |TQ1|1|1^TAB|PRN|PRN|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH AS NEEDED|| 7. 1 tab Q 4 H prn Pain |TQ1|1|1^TAB|Q4HP|PRN|||2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH EVERY FOUR HOURS AS NEEDED|| 8. 2 tabs to start, then 1 tab daily x 4 days |TQ1|1|2^TAB|STAT|Ø8ØØ||1|2Ø1ØØ512162Ø22|2Ø11Ø512162Ø22|||TAKE 2 TABLETS BY MOUTH TO START|| |TQ1|1|1^TAB|QD|Ø8ØØ||4|2Ø1ØØ513162Ø22|2Ø11Ø512162Ø22|||TAKE 1 TABLET BY MOUTH DAILY ||




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6. FREQUENTLY ASKED QUESTIONS




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7. REFERENCE INFORMATION HL7: www.hl7.org




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8. APPENDIX A. HISTORY OF CHANGES

Guidance for use of the HL7 Automated Dispensing System Interface for Automated...

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