HNAC Universal Interface Specification Supplement Site

HNA HL7 Universal Specification Supplement Draft BALL_IN

Cerner Corporation 5/19/2010 BALL_IN

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HNAC Foreign Systems Interface Specification Supplement

HNAC Universal Interface Specification Supplement

Site Specific Information

Pathologists Associated (BALL_IN)

MIE Interface

All rights reserved. This material contains the valuable properties and trade secrets of Cerner Corporation of Kansas City, Missouri, United States of America (CERNER) embodying substantial creative efforts and confidential information, ideas and expressions, no part of which may be reproduced or transmitted in any form or by any means or retained in any storage or retrieval system without the express written permission of CERNER. The information in this document is subject to change with prior notice and consent of all parties concerned.

1998 Cerner Corporation



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SUMMARY OF SITE SPECIFIC INFORMATION: ............................................................................... 5

2.1 Purpose ............................................................................................................................................. 5 2.2 Project Background .......................................................................................................................... 5 2.3 Special Design Considerations ......................................................................................................... 5 2.4 Scope ................................................................................................................................................. 5 2.5 Unit History ...................................................................................................................................... 5 2.6 Contacts ............................................................................................................................................ 6

SUMMARY OF SITE SPECIFIC OPTIONS AND EXCEPTIONS: ....................................................... 7

Interfaces to be implemented: ................................................................................................................. 7 HNA components in use: ......................................................................................................................... 7

UNIT 3 CONCEPTS AND DEFINITIONS ................................................................................................ 8

3.3 Escape Sequence Option ................................................................................................................... 8 3.5.3 Time Zone....................................................................................................................................... 8 3.5.4 Name Format Options .................................................................................................................... 8

UNIT 4 - TECHNICAL COMMUNICATION PARAMETERS .............................................................. 9

4.2 Communication Protocol .................................................................................................................. 9 Protocol Vendor ...................................................................................................................................... 9 Host Addresses ........................................................................................................................................ 9 Other Considerations .............................................................................................................................. 9

UNIT 5 - PATIENT AND ENCOUNTER IDENTIFICATION .............................................................. 10

5.1.2 Client Number Option .................................................................................................................. 10 5.1.3 Medical Record Number Option .................................................................................................. 10 5.1.4 Financial Number Option ............................................................................................................ 10 5.2.1 Visit Number ................................................................................................................................ 10 5.2.3 Alternate Patient Identification .................................................................................................... 11 5.2.4 Patient System Identification ....................................................................................................... 11

UNIT 6 - HNA PATIENT DATABASE CONSIDERATIONS ............................................................... 12

6.1.3 Patient Type Option ..................................................................................................................... 12 6.2.1 Institution Option ......................................................................................................................... 12 6.2.2 Facility ......................................................................................................................................... 12 6.2.3 Nursing Station Option ................................................................................................................ 12 6.2.4 Room and Bed Option .................................................................................................................. 13 6.3 Physician Identification ................................................................................................................. 13 6.3.1 Staff Providers ............................................................................................................................. 14 6.3.3 Free-Text Options ........................................................................................................................ 14 6.4.1 Clinical Height & Weight ............................................................................................................. 14 6.4.2 Allergy Information ...................................................................................................................... 14 6.5 Miscellaneous Patient Information. ................................................................................................ 15

UNIT 7 – INBOUND ATD PROCESSING ............................................................................................... 16

7.2 Trigger Events. ................................................................................................................................ 16 7.3.34 Medical Record Change Option ................................................................................................ 16

UNIT 8 - HNA ORDER DATABASE CONSIDERATIONS................................................................... 17

8.1.1.3 Procedure Identification Option ............................................................................................... 17 8.1.2 Supergroup Option....................................................................................................................... 17 8.1.3 Interval Test Option ..................................................................................................................... 17 8.2.1 PO Key1 Option ........................................................................................................................... 18



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8.2.2 Order Number Option .................................................................................................................. 18 8.2.4 HNA Accession Option ................................................................................................................. 19 8.2.5 Parent Order Option .................................................................................................................... 19 8.2.6 HIS Utility Option ........................................................................................................................ 19 8.2.7 Application Identification Option ................................................................................................ 19 8.3.1. Alpha Responses ......................................................................................................................... 20 8.3.2 Microbiology Coded Nomenclature ............................................................................................. 20 8.5.1 Label Comments ........................................................................................................................... 20 8.5.2 Incoming Comment Option .......................................................................................................... 20 8.5.3 Outgoing Chartable Comment Option ......................................................................................... 21 8.5.4 Prompt Test Option ...................................................................................................................... 21 8.6 Priority Option ................................................................................................................................ 21 8.8.1 Ordering Doctor .......................................................................................................................... 22 8.8.1 HNAC Related Doctor ................................................................................................................. 22 8.9.1 Microbiology Source Option ........................................................................................................ 22 8.10.3 Cancel Reason ........................................................................................................................... 23 8.10.6 Ordering Location ..................................................................................................................... 24 8.10.6 Performing Location .................................................................................................................. 24 8.10.7 Specimen Label Printer .............................................................................................................. 24

UNIT 9A - INBOUND ORDER PROCESSING ....................................................................................... 25

9A.4.2.3 Order/Admit Option ................................................................................................................ 25 9A.4.4.1 Cancel Order Option .............................................................................................................. 25 9A.2 Order Event Summary (to HNA) ................................................................................................... 25

UNIT 9B - OUTBOUND ORDER PROCESSING ................................................................................... 26

9B.3.1 Patient Selection ....................................................................................................................... 26 9B.3.2 Order Activity Selection - Hold Logic ....................................................................................... 26 9B.3.3 Ordered Procedure Option ........................................................................................................ 26 9B.4 Order Event Summary .................................................................................................................. 27

UNIT 10 - OUTBOUND RESULTS PROCESSING ................................................................................ 28

10.1 GENERAL DESCRIPTION ..................................................................................................................... 28 10.2 PATIENT IDENTIFICATION ................................................................................................................... 28 10.3 SELECTION CRITERIA ......................................................................................................................... 28

10.3.1 Patient Selection ........................................................................................................................ 28 10.3.2 Result Activity Selection - Hold Logic ....................................................................................... 29 10.3.3 Ordered Procedure Option ........................................................................................................ 29 10.3.4 Detail Procedure Option ............................................................................................................ 30 10.5.2 Result Footnotes Option............................................................................................................. 30 10.5.3 Interpretive Data Option ............................................................................................................ 30 10.7.1 Result Triggers ........................................................................................................................... 30 10.7 Result Format ................................................................................................................................ 31 10.7.1 Discrete Result Reporting .......................................................................................................... 31 10.7.2 Display (Chart Image) Result Reporting ................................................................................... 31

10.8 RESULT TYPES ................................................................................................................................... 31 10.8.1 Numeric and Alpha Result Options ............................................................................................ 32 10.8.5 Interpretive Results (Result Type “I”) ....................................................................................... 32 10.9.3 Abnormal Flags Option ............................................................................................................. 33 10.10.2.1 Microbiology Discrete Results (R01) .................................................................................... 33 10.10.4 Pathnet: Blood Bank Results.................................................................................................... 33

PROJECT DELIVERABLE TIMELINES: ............................................................................................. 34

REVIEW & APPROVAL: ......................................................................................................................... 35



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Summary of Site Specific Information:

2.1 Purpose

This site-specific specification supplement to the Cerner HNA Classic HNA.306 HL7 Universal Interface Specification describes and defines the real-time HL7 interfaces between MIE and the Cerner HNA Classic system and Misys and the Cerner HNA Classic system at Pathologists Associated (BALL_IN). This document refers to units within the complete Cerner interface specifications and includes options choices as well as other information necessary to support interface needs for Pathologists Associated.

2.2 Project Background

Pathologists Associated will implement the Cerner HNA Classic Universal Interface with MIE via Egate Engine. Inbound functionalities include ADT (A08 only) and General Laboratory, Microbiology and Blood Bank orders from MIE. The HNA Classic Universal Interface will also be configured to transmit orders and results (discrete General Laboratory and Blood Bank, and charted Microbiology- chart form 34) to MIE. Cancels will be performed manually in Cerner and MIE systems and will not be transmitted across the interface. Status updates will not be transmitted outbound from HNA Classic to MIE. Note: Since cancels and status updates will be transmitted between HNA Classic and Misys – do you want to send them for MIE as well? In addition, Pathologists Associated will use the same interface feed with MIE to transmit to Misys via Egate Engine. . Inbound functionalities include ADT (A08 only) and General Laboratory, Microbiology and Blood Bank orders from MIE. The HNA Classic Universal Interface will also be configured to transmit orders and results (discrete General Laboratory and Blood Bank, and charted Microbiology- chart form 34 to MIE. Cancels and status updates will be transmitted between HNA Classic and Misys. Additional Information: Items in pink designate action Items by a project team member. Items in green designate either a discrepancy between the MIE and Misys spec (in all cases, the item not highlighted is the build option chosen) or an action item for the Egate engine.

2.3 Special Design Considerations

None.

2.4 Scope

See 2.2 above.

2.5 Unit History

This unit contains specifications, which have been or will be revised from time to time. All changes made after the initial release of this document (as declared below) will be noted with the use of a "change bar" in the left-hand margin. These "change bars" indicate sections of the text, which have been modified from the original release. The history of this unit is outlined below:

Version Version Status Date Issued Author 1.0 Initial Document April 1, 2004 Suyani Liem 7.0 Modified to include

Misys scope November 29, 2004 Karen Jake

8.0 Misys / MIE scope

presented for signoff December Karen Jake



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** Cerner treats all units of this document with the exception of this unit as a “Living” document. As such, these documents will never be “FINAL”. This supplement is site specific and is “FINAL” upon signoff by the concerned parties. Clients may request updates to any section of the entire document by contacting Cerner for this information. Any new functionality that may be added after a client has converted on this code set MUST be passive for future release versions!

2.6 Contacts

Satisfactory design and implementation of any interface requires involvement of persons with: • an understanding of how the information system(s) stores and processes data • an understanding of institutional and departmental policies and procedures • an understanding of the need and requirements of system end-users This unit of the specification document will list client and supplier contacts involved in the design processes. It will also identify the client contact to whom Cerner will mail versions of the specification document during the design phase. It is the responsibility of this contact to make and distribute copies to other suppliers and client personnel. Specifications must be approved by Cerner, the client, and other suppliers before the construction of the interface can begin.

Cerner Corporation:

Name Title Phone Email Tobi Oakes FSI System Engineer 508.877.6767 [email protected]

Karen Jake FSI System Engineer 585.538.4322 [email protected]

Carrie James FSI System Engineer Team

Lead

816-201-3036 [email protected]

Pathologists Associated

Name Title Phone Email Brad Gollifer [email protected]

Sheila Zimmerman IT Manager 765.254.6214 [email protected]

Lesa Norman [email protected]

MIE

Name Title Phone Email Dave Juntgen 260.459.6270 [email protected]

Doug Horner [email protected]

Misys

Name Title Phone Email Allison Kinghorn Allison.kinghorn@misyshealth

care.com



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Summary of Site Specific Options and Exceptions:

Interfaces to be implemented:

ADTs Inbound (A08 only, input manager will be configured to perform update to admit if PR does not exist; auto discharge or manual discharge will be performed for MIE patients)

Orders inbound (General Laboratory, Microbiology and Blood Bank) Orders Outbound (General Laboratory, Microbiology and Blood Bank) Results Outbound (Discrete General Laboratory and Blood Bank, Charted Microbiology)

HNA components in use:

PathNet



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Unit 3 Concepts and Definitions

3.3 Escape Sequence Option

Option Chosen: 0 (Table 3.b – Option for Using Escape Sequences)

The Universal Interface will not send text or string data using the escape character to signal that reserved characters

are present in the value. For messages to HNA, the Universal Interface will not parse for escape sequences in text or

string data.

3.5.3 Time Zone

The Universal Interface will not send time zone information. If time zone is received in either the date/time field of

the MSH (MSH;7) or in a particular TM field, the Universal Interface will not adjust any transmitted times to local

times.

3.5.4 Name Format Options

The HNA system stores person name as a single display field and not as component fields. The HNA system stores patient name as a single 40 character field with or without a ‘,b’ delimiter separating the last name from the rest of the name, e.g., SMITH, MARY or SMITH MARY.

For Messages to HNA:

Option Chosen: 0 (Table 3.c – Option for Name Format - to HNA)

Post name characters exactly as transmitted. The Universal Interface will not convert lowercase letters to

uppercase.

Option Chosen: 4 Table 3.d - Option for Commas in Name – to HNA)

The Universal Interface will insert a space immediately following the patient’s last name. Example: SMITH JOHN

For Messages from HNA:

Option Chosen: 1 (Table 3.e - Options for Name Format - from HNA)

The Universal Interface will use a ‘best guess’ algorithm to derive HL7 name components (last name^first

name^middle name^suffix^prefix).



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Unit 4 - Technical Communication Parameters

4.2 Communication Protocol

Pathologists Associated has indicated that a TCP/IP connection will be used. For a description of TCP/IP, along with

protocol and address information, please refer to Unit 4 of the Universal Interface Specification document. The

messages will be sent and received in MLLP format. There will be one connection available in each of the

“Live/Production” environments. It is expected that a functional Certification environment is available, and the

interface will be constructed in this environment. After all testing has been completed, this interface will be moved to

the Production environment. However, the interface will also be retained in the Certification environment and future

functionality testing should occur in that environment.

Protocol Vendor

Multinet will be used.

Host Addresses

EGate 204.52.160.193 port 9533

Other Considerations

4.6.7 Sequence Numbers Option Chosen: 1 (Table 4.c – Sequence Number Option for Universal Interface)

HL7 sequence numbers will not be used in this interface.

4.7 Continuation Logic Not required.



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Unit 5 - Patient and Encounter Identification

5.1.2 Client Number Option

The client number is a five digit number which allows HNA applications to uniquely identify and maintain separate

patient entities for which services are provided. Client code refers to the facility.

Option Chosen: 4 (Table 5.b – Client Number Option)

Patients registered via interface processing may be assigned different client numbers. For messages to HNA, the

external system will send the valid HNA client number in the HL7 Sending Facility field (MSH-4). For messages

from HNA, the UI will send the valid HNA client n umber in MSH-6 Receiving Facility. This option is not currently

available on the outbound. The Egate engine will be responsible for moving the client code from

Additional Information: MIE scope used Option 2. Patients registered via interface processing may be assigned

different client numbers. The external system will send/accept the valid HNA client number in the HL7 Assigning

Facility Id component of the Internal Patient Id field (PID-3.4). The Egate engine will be responsible for moving

the client code from MSH-4 to PID-3.4

Egate Engine will be responsible for client number formatting and routing.

5.1.3 Medical Record Number Option

The Medical Record Number is a fifteen character identifier which always uniquely relates to a specific individual.

Typically, this is a permanent identification code assigned to a patient by the admissions office or medical records

department.

Option Chosen: 6 (Table 5.c – Medical Record Number Option)

The Medical Record Number will be provided as an HL7 numeric (NM) data type without leading zeros. This value

will be stored on the HNA Patient Registration (PR) file as a 15-character field with leading zeros. For example, a

medical record number received as ‘12345’ will be stored as ‘000000000012345’. For messages from HNA, the

zeros will be stripped. For example, a medical record number stored as ‘000000000012345’ will be sent as ‘12345’.

Additional Information: MIE scoped using option 1 The Medical Record Number will be provided as an HL7

numeric (NM) data type without leading zeros. This value will be stored on the HNA Patient Registration (PR) file

as a 15-character field with leading zeros. For example, a medical record number received as ‘12345’ will be stored

as ‘000000000012345’.

5.1.4 Financial Number Option

The Financial Number is a fifteen character identifier which corresponds to a patient’s clinical visit or billing

encounter on the patient management system. This identifier changes. Although duplicate financial numbers may be

used for client or institutional billing, patient financial numbers are usually unique, with no duplication.

Option Chosen: 1 (Table 5.e – Financial Number Options)

The Financial Number will be provided as an HL7 numeric (NM) data type without leading zeros. This value will be

stored on the HNA Patient Registration (PR) file as a 15-character field with leading zeros. For example, a financial

number transmitted as ‘12345’ will be stored as ‘000000000012345’.

Additional Information: Required field – Mysis wants to send order number, but could potentially show multiple fin

numbers per encounter. Sheila confirmed we can use PID3.1 in PID18. The Egate Engine will move PID-3.1 into

PID-18.

5.2.1 Visit Number



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The Visit Number is a 12-character identifier assigned by some Patient Management systems in addition to the

Medical Record Number and Financial Number to further identify a clinical visit. On the foreign system, Visit

Number is used to create ‘multiple visits’ or encounters with the same financial number. The Universal Interface

will accept and passively store Visit Number on the Patient Registration (PR) record; however, HNA will not, as

part of the Universal Interface processing, validate Visit Number to create a new encounter or to update an existing

encounter. Consequently, with current Universal Interface functionality and with ‘multiple visits’ per financial

number, only the most recently received Visit Number will be stored on the PR record.

Option Chosen: 3 (Table 5.f – Visit Number Option)

Not used.

5.2.3 Alternate Patient Identification

The Alternate Patient ID is a twenty character identifier utilized in the Patient Selection functionality of the HNA

system to group patient activity across encounters. HNA functionality allows for two occurrences of this identifier

on the patient registration file.

Option Chosen: 1 (Table 5.g – Alternate patient ID Requirement Option)

Alternate Patient Identification is not a required data element for message transmission

Option Chosen: not applicable (Table 5.h – Alternate Patient ID Placement Option)

Alternate Patient ID will not be implemented.

Option Chosen: not applicable (Table 5.i – Alternate Patient ID Format Option)

Alternate Patient ID will not be implemented.

5.2.4 Patient System Identification

The Patient System ID is a twelve character identifier used at the patient level to identify a client. The Universal

Interface will not perform any processing on the PAT-SYS-ID. It will be essentially treated as an Alternate Patient

Identifier.

Option Chosen: 0 (Table 5.j – Patient System ID Option)

Patient System Identification will not be implemented.



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Unit 6 - HNA patient database considerations

6.1.3 Patient Type Option

The Patient Type is used by the HNA applications to categorize patients. It is a one-character code that defines

group characteristics and processing parameters. (SR0150).

Option Chosen: 1 (Table 6.a – Option for Identification of HNA Patient Type)

The external system will always accept/send a valid HNA patient type as required for HNA processing in the HL7

Patient Type field (PV1;18). All mapping and defaults will be the responsibility of either the foreign system or

interface engine.

Additional Information – eGate engine will populate PV1:18 with ‘C’ for all messages

6.2.1 Institution Option

The two-digit institution code defines a unique physical entity, usually having separate physical building, separate

management and financial policies, a unique employee population, and sometimes different HIS and medical record

number pools.

Option Chosen: 2 (Table 6.b – Option for Institution Identification)

All patients registered via a single interface connection will be associated with the same institution. For messages to

HNA, the Universal Interface will default a valid institution code from SR8500.15. For messages from HNA, the

Universal Interface will send the default institution code from SR8500.15 or SR8502.80 in PID-18.4.

All patients are processed for Institution 01.

6.2.2 Facility

Facility is another high level identifier defining the patient’s physical location. ‘Facility Logic’ is used when an

ordered procedure can be scheduled or performed at more than one physically or geographically separate service

locations. If facility logic is implemented, each location or nursing station code is assigned to a four-character

SR0103 Facility code.

Option Chosen: 1 (Table 6.c – Option for Identification of Patient Facility)

The Universal Interface will do no processing to determine Patient Facility. The valid HNA facility code will be

determined internally during core interface processing from HNA database values.

6.2.3 Nursing Station Option

The Nursing Station or Location is a four-character code that identifies the specific location of a patient or the

person ordering a procedure.

Option Chosen: 1 (Table 6.d – Option for Identification of Patient Location)

For all patient types (including pre-admits and outpatients), the external system will send/accept a valid HNA

SR0100 Nursing Station / Location code as the HL7 Nurse Unit component of the Assigned Patient Location

(PV1;3.1). The external system will also send/accept a valid HNA SR0100 Site Prefix Code as the Facility Id

component of the Assigned Patient Location (PV1;3.4). If the Facility Id is not valued, the HNA interface will

default a valid Location Prefix Code from field SR8500.17. Nursing Station / Location codes must be unique within

a transmitted Facility Id or within the default Location Prefix Code.



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6.2.4 Room and Bed Option

HNA applications support a four-character room identifier and a two-character to further define a patient’s

location.

Option Chosen: 1 (Table 6.e – Option for Room Processing)

The external system will send/accept a valid HNA SR0010 room as the HL7 Room component of the Assigned

Patient Location field (PV1;3.2). The external system will send/accept a valid HNA SR0010 bed as the HL7 Bed

component of the Assigned Patient Location field (PV1:3.3). If a single digit bed is received without a leading

zero, the Universal Interface will provide the leading zero.

6.3 Physician Identification

HNA applications identify staff physicians using a seven-digit Doctor Number. The doctor number is a key to the

HNA staff physician section Provider (PRV) file.

When a patient is registered, the HNA interface can post a maximum of seven doctors to the Patient Registration

(PR) record. Although frequently the first doctor is the admit doctor and the second doctor is the attend doctor,

HNA does not reserve a specific positional occurs for any particular doctor type or relationship. Instead, the HNA

custom interface will identify each doctor with an appropriate doctor type or relationship code. Valid HNA doctor

type codes include: ‘A’ admit, ‘T’ attend, ‘R’ referring, ‘C’ consulting, ‘F’ family, ‘E’ emergency, ‘G’ surgeon, and

‘S’ resident, although the Universal Interface will assign only types ‘A’, ‘T’, ‘R’ and ‘C’.

HNA applications also store a doctor code for other clinical activities in addition to patient registration. For example,

‘O’ ordering doctor stored on the Patient Order (PO) file.

In the HNA Universal Interface using default processing, the physician identified in the Admitting Doctor field

(PV1;17) will be placed in the first occurrence of the Doctor list on the encounter PR file. Additionally, this doctor

will also be assigned a doctor type of ‘A’, admitting.

The physician identifiers in the remaining Provider fields of the PV1 segment will be processed by the Universal

Interface according to the following default rules:

Doctor positions 2-7 on the PR record will be filled by the Physicians identified in the Attending Doctor, Referring

Doctor, and Consulting Doctor fields of the PV1 segment, up to a total of seven doctors. If all eight HL7

doctors are valued, the Universal Interface will not post the last consulting doctor.

HL7 consulting doctors are sent as a repeating field. All HNA doctors for an encounter are stored on the PR file in a

doctor table composed of repeating fields.

Constraint: To assure doctor codes in the HNA doctor table (PR record) are synchronized with doctors in the

external system, the Universal Interface requires an HL7 ADT message to either contain all doctor codes or no

doctor codes.

The Universal Interface will not check for duplicate doctors. If the HL7 message provides the same doctor code in

both the admitting and the attending doctor fields, the Universal Interface will post this doctor twice, once with a

doctor type of ‘A’ and once with a doctor type of ‘T’.

The physician identified in the Attending Doctor field (PV1;7) will be assigned a doctor type of ‘T’, attending.

The physician identified in the Referring Doctor field (PV1;8) will be assigned a doctor type of ‘R’,

referring.



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The physician(s) identified in the Consulting Doctor field (PV1;9) will be assigned a doctor type of ‘C’, consulting.

Option Chosen: 1 (Table 6.f – Option for Processing Duplicate Doctors)

The Universal Interface will not check for duplicate doctor codes within a message.

6.3.1 Staff Providers

For messages to HNA applications, HNA interface programs will validate the transmitted doctor code and will

ignore the optional transmitted name.

For messages from HNA applications, the Universal Interface will send both doctor code and doctor name. Note

that the format of the doctor name from HNA will depend on how that name has been entered in the PRV file and

option selected for transmission of person names.

Option Chosen: 1 (Table 6.g - Options for Formatting Doctor Name from HNA)

The external system will send/receive doctor names as stored in PRV as |doctor code^the entire name|. This is the

default option.

Example: |0030015^BROWN SANDRA LEE|

Option Chosen: 1 (Table 6.h – Option for Synchronization of Doctor Codes)

The external system doctor codes are synchronized with the HNA 7-digit doctor numbers in PRV Key1. Although

stored in HNA as a numeric value, the doctor code will be transmitted as an 'ST' data type with leading zeros.

Doctor number cross-reference will be performed by MIE.

6.3.3 Free-Text Options

HNA applications support free-text doctors. A user-defined doctor number identifies the entry of a free-text doctor.

Traditionally, the free-text doctor number is all 9s, or “9999999”. This HNA free-text doctor number must be

defined on the SR9972 table, field 25 and 26, and should match the SR9951 free-text doctor number.

Option 1

Additional Information: eGate will transmit 9999999 for all physician numbers and name will transmit as freetext

MIE scoped as ‘Not Applicable’ Free text doctors will not be sent

6.4.1 Clinical Height & Weight

The HNA system has the ability to capture clinical height and weight at the patient encounter level. This

information can be passed to the HNA system during the Admission/Registration process, but is more appropriately

passed during the Update/Nursing Revision process. The HNA system may use these fields during the procedure

resulting process to compare results to appropriate reference ranges. While the quantifiable result may not change

because of incorrect information passed to the HNA system, the interpretation of that information may differ

significantly.

The Universal Interface will not process clinical height and weight.

6.4.2 Allergy Information

The HNA system has the ability to capture allergy information for specific HNA applications: (i.e. RadNet,

PharmNet). This information, when collected from a foreign system, can give the clinician/technician additional



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information through the use of application “clip” lights, etc. to better manage patient treatment/care and is posted

to the Clinical Patient Information file (PI).

The Universal Interface will not process allergy information.

6.5 Miscellaneous Patient Information.

6.5.1 PR Utility Area The PR utility area is a 15 byte area on the patient registration record that can be used to store “ad hoc” data from

the engine that, in turn, can be sent back to the engine on outbound HNA transactions. This information is free text

and if utilized, must be sent on all transactions to be maintained on the HNA system.

The HNA Universal Interface will accept/send the PR utility area using one of the following options.

Option Chosen: 0 (Table 6.j – Option for populating the PR Utility Area)

No special processing will occur.

6.5.2 Patient Comments In a discrete result outbound interface, patient comments will be provided in the ORU message via NTE segments

following the PID segment.

The Universal Interface provides the following options for transmitting patient comments in the ORU message:

Option Chosen: 0 (Table 6.k - Options for Patient Comments in Discrete ORU Messages)

Do not send patient comments



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Unit 7 – Inbound ATD Processing

7.2 Trigger Events.

BALL_IN will use the following ADT HL7 trigger events:

______________________________________________________________________________ SR8506

HL7 Accepted by HNA Default

Trigger Event Event Code HNA ADT Trans Code

Admit a patient A08 Y ADMT if PR does not

exist

Update patient information A08 Y UPDT

If an Update transaction is transmitted and there is no existing patient record, a user defined SR9972 :55 parameter can allow the update to

become an admit transaction.

***While HNA supports the ability to manually merge encounters using the CMB Combine function, Cerner no longer implements the

merging of two existing encounters via interface processing. HNA will use merge event to process an encounter specific client, medical

record and/or account number change

Discharges will be performed manually or via auto discharge.

7.3.34 Medical Record Change Option

If the PID account number field is valued, the HNA Universal Interface will process an encounter specific number

change.

If the PID account number field is not valued, the HNA Universal Interface will process a medical record number

change for all active encounters with the same medical record number and client group. At least one valid client

number is required.

Option Chosen: 0 (Table 7.b – Option for Medical Record Number Changes)

Do not process medical record number changes.



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Unit 8 - HNA order database considerations

8.1.1.3 Procedure Identification Option

One of several elements used to identify an ordered-level transaction.

Option Chosen: 1 (Table 8.c – Format Option for Procedure Identifier)

The sending and receiving systems are synchronized using the HNA procedure number. The procedure id is

formatted as an HL7 ‘ST’ type with leading zeros. The mnemonic is included in the text component for

documentation only. The long description is not included

Additional Information: Sheila will provide flat file of procedure information for upload into Mysis

8.1.2 Supergroup Option

A supergroup is an HNA procedure which consists of up to 10 orderable group and/or detail procedures. Each

procedure in the supergroup is considered a ‘component’ of the supergroup. A minimum of one group procedure

must be included in the supergroup. Supergroups are a billing and ordering convenience only and are not used for

any other special processing purpose. Supergroups are pre-defined in the HNA database. The HNA term

‘supergroup’ may be equivalent to the term(s) ‘order set’ or ‘panel’ or ‘convenience order’ used by a foreign

system. HNA applications that support supergroup orders include PathNet (General Laboratory, Microbiology,

Blood Bank) and MedNet.

Option Chosen: 2 (Table 8.d – Option for Supergroup) Supergroup order and order status messages will be transmitted at the supergroup level. The supergroup procedure identifier will

be transmitted in the HL7 Universal Service Identifier field (OBR;4). All subsequent activity (status, cancel, result) will be

transmitted using the same OBR identifier. If one component of a supergroup is canceled, the Universal Interface will not

transmit that cancel unless all components of the supergroup are canceled. Each time a supergroup component is has a status

change, the interface will transmit a status message for the supergroup. With this option, multiple status messages can be

transmitted for the same ordered supergroup procedure. Discrete results will be transmitted using only the supergroup identifier;

however, the detail results in a given message will include only the detail results of the component that triggered the message.

Charted results will be transmitted at the supergroup level and include all results available for the common HNA order number.

Constraint: Option 2 can be used for a charted results interface only if all components of the supergroup are

assigned the same charting order identifier.

8.1.3 Interval Test Option

An Interval Test is a special PathNet procedure which consists of a series of detail tests scheduled to be collected at

known predefined intervals. Each interval component will have a different requested date and time and a different

drawn date and time. Although all interval components may have the same order number, each component usually

has a different accession number.

Option Chosen: 1 (Table 8.e – Option for Interval Test)

Interval tests will be transmitted to and from HNA at the ordered procedure level (e.g., GTT 2HR). Status and

result messages will be transmitted at the ordered procedure level using the accession number, order number, drawn

date and time, and received date and time of the first interval component (e.g., Blood Glucose - Fasting). Multiple

identical status messages could possibly be triggered. If HNA users cancel a single component of the ordered

interval procedure, the Universal Interface will not transmit a cancel message; instead, the Universal Interface will

only transmit a cancel message when HNA users cancel all interval components either individually or at the ordered

procedure level. It is possible, depending on timing and how HNA users apply the cancel function, multiple

identical cancels could be triggered.

Additional Information:

SR9973:39 If Table 8.e option 1 or SR9973 options are changed (other than option 1) that component results are

sent prior to the ordered test is complete then we may need to do the following: If OBR:25 = P then Egate will



Page 2- 18

make OBX:11 = P. Once OBR:25 = final then all OBX will be resent with final status. For all results not just

Interval Tests.

8.2.1 PO Key1 Option

HNA applications that store order records in the Patient Order (PO) file identify each order using a combination of

the following data elements: HNA Encounter Number, Ordered Procedure Department and Section, Ordered

Procedure Number, and the Requested Date and Time for the procedure, Record Qualifier and HNA Record Type

(rcode). Microbiology sensitivities also use an isolate sequence number and Interval Tests use an ‘Add Test’

number. These values make up the primary key to the HNA PO file for the order. Internally, this 53-byte PO key1

is used as the HNA primary identifier.

Note: With the exception of PharmNet and CareNet ‘non-Net’ departmental orders, all other HNA applications

store order records in the PO file.

While the above items create a record key unique to the system and order, HNA applications use two other

identifiers to present order and result information to the user. These identifiers are the accession number and order

number.

The PO key1 identifier is only required for ‘order number notification’ when a foreign order system accepts an

HNA initiated order, then assigns and returns the order number. If order notification functionality is implemented

(i.e., Cerner sends ORM with ‘SN’ Order Control Code; foreign system returns ORR with ‘NA’ Order Control

Code), the Universal Interface will transmit (default option) the entire PO key1 in the Filler Field #1 (OBR;20)

and the foreign system must return the same entire PO key1 value with the order number notification.

If order notification functionality is implemented, the Universal Interface will use the following options to

send/accept the required 53-byte HNA PO Key1:

Option Selected: 1 (Table 8.f – Option for Providing PO Key1)

Provide the HNA PO Key1 in OBR-20-Filler Field #1.

8.2.2 Order Number Option

The HNA Order Number (PO key2) is a nine character identifier which identifies a specific order on a given

patient. The order number can be transmitted to HNA applications from a foreign system, manually entered during

HNA order entry, system assigned by HNA applications or assigned within a designated range by the Universal

Interface.

The HNA Order Number is an optional identifier for non-interface HNA processing and may not be valued if all

orders originate in HNA. However, for CareNet Order Management, the HNA Order Number is 1) required; 2)

always system assigned by HNA applications; and 3) always numeric. In most order and result interfaces, the HNA

Order Number will be a required identifier. HNA Order Number may be defined with core database parameters to

display in some core application functions (e.g., OID Order Inquiry by Date), to print on HNA collection labels, or

to select results eligible for reports printed with an order-level chart form.

Assumption and Constraint:

If possible, the HNA Order Number (PO key2) should uniquely identify a single ordered procedure within an

encounter and HNA domain. If duplicate order numbers exist or if order numbers are not unique or may be reused,

customization beyond standard Universal Interface functionality may be required.

Option Chosen: 1 (Table 8.g – Option for Assigning Order Number – PO Key2)

Option 1 - HNA is considered the filler system and will not assign the Order Number (PO key2). The foreign system

is the placer system and always assigns a placer order number. The Universal Interface will accept and store the

assigned Placer Order Number as the HNA PO key2 Order Number.

Option Chosen: 3 (Table 8.h – Option for Providing Order Number – PO Key2)



Page 2- 19

Post and return the HL7 Placer Order Number (ORC;2.1 and OBR;2.1) to the HNA PO Key 2 Order Number but do

not right justify and zero fill the order number

Additional Information: MIE scope uses option 1 Post and return the HL7 Placer Order Number (ORC;2.1 and

OBR;2.1) to the HNA PO Key 2 Order Number. Right justify and zero fill the order number.

8.2.4 HNA Accession Option

The HNA Accession Number (PO key4) is a thirteen character identifier used to group ordered procedures,

specimens or services. The accession format and the number of procedures per accession number can vary by

clinical department, HNA database parameters, and the order entry event. Depending on the clinical department,

order priority and parameters entered by the user during the order entry event, the accession number may not be

assigned at order entry but instead assigned at the time of order status. Multiple ordered procedures, each with a

unique order number may have the same accession number; however, an accession number will always be unique to

a specific encounter. Accession numbers are system assigned; however, downtime accessions can be manually

entered with system validation to prevent assignment of an accession number to more than one encounter.

Option Chosen: 1 (Table 8.j – Option for Assigning Accession Number- PO Key4)

HNA will always assign the accession number.

Option Chosen: 1 (Table 8.k – Option for Providing HNA Accession Number)

Provide the HNA Accession Number in OBR-21-Filler Field #2.

8.2.5 Parent Order Option

The HIS Parent Order Number is a 12-character field used to store and return information received with a

non-Cerner initiated order. This data is passively stored by HNA on the Patient Order (PO) record and cannot be

modified by HNA users. HNA interface programs can value this field when a new order (NW order control code)

or order notification (NA order control code) message is received.

Option Chosen: 0 (Table 8.m – Option for Providing HIS Parent Order Number)

Do not value or return the HIS Parent Order Field.

8.2.6 HIS Utility Option

The HIS Utility Area is a 15-character field used to store and return information received with a non-Cerner

initiated order. This data is passively stored by HNA on the Patient Order (PO) record and cannot be modified by

HNA users. HNA interface programs can value this field only when a new order (NW order control code) message

is received. At this time, core interface programs cannot update this field on receipt of an order notification (NA)

message.

Option Chosen: 0 (Table 8.n – Option for Providing HIS Utility Area)

Do not value or return HIS Utility Area on the PO.

8.2.7 Application Identification Option

HNA applications are identified using a two-character application id. This application code defines a diagnostic

service area associated with an order. The Universal Interface uses the application id to provide functionality and

meet requirements unique to each application. Currently, the HNA Universal Interface supports messages for the

following clinical applications:

Option Chosen: 1 (Table 8.o – Option for Identification of HNA Application)

Provide HNA Application Code in ORC-3.2 and OBR-3.2-Filler Order Number application Id.



Page 2- 20

HNA Code HNA Application

AP PathNet: Anatomic Pathology

BA PathNet: Blood Bank

LA PathNet: General Laboratory

MA PathNet: Microbiology

RA RadNet

CP MedNet

8.3.1. Alpha Responses

Alpha responses are stored on the PO using the HNA Medical Nomenclature entry name. The following options

exist for sending alpha responses:

Not applicable. Will not be implementing outbound micro discrete results.

8.3.2 Microbiology Coded Nomenclature

HNA systems use coded nomenclature to perform a variety of functions. Coded nomenclature is used to validate

data entry, flag abnormal responses and gather statistics. HNA applications identify coded nomenclature with a six

character code (Axis ID+ 5 character id), a unique 8 character mnemonic (entry name), and a non-unique 30

character description. Coded nomenclature are defined on the HNA Medical Nomenclature (MN) file. HNA will

use specific Axis ID’s for the different types of nomenclature stored on the MN file.

Table 8B.a - UI Supported Nomencature codes Axis ID Description HNA Comment

‘I’ Isolates Microbiology isolate identifiers

‘S’ Source Coded source for microbiology

‘L’ Alpha response Coded alpha responses valid for General Laboratory

Configurable

per site

Report phrases Coded report phrases for microbiology

Configurable

per site

Alpha response Coded alpha responses valid for Microbiology

Not applicable. Outbound Micro discrete results will not be implemented.

8.5.1 Label Comments

Label comments will be sent to Cener in OBR;13 (Relevant Clinical Information). This field may also be used for

Radiology Special Instructions.

Cerner will accept 38 characters only. Training issue, Misys can enter up to 255 characters in instructions field on

their screen that is passed in OBR:13. Instruct users to limit characters

8.5.2 Incoming Comment Option

Order Comments are comments associated with the specific ordered procedure. Order comments will be accepted

from a foreign system only with new order transactions. Order Comments are transmitted using NTE segments

following the OBR segment of a new order ORM message (‘NW’ order control code). The HNA Universal Interface

can post three order comment lines (three NTE segments) without additional configuration or processing. By

formatting special HNA ANU transactions, the HNA Universal Interface can accept up to eleven order comment

lines (eleven NTE segments) per order. Each NTE segment represents a comment line and can contain no more

than 78 characters.

Option Chosen: 2 (Table 8.w – Option for Order Comments to HNA)

Post order comments as chartable.



Page 2- 21

8.5.3 Outgoing Chartable Comment Option

The HNA Universal Interface can send order comments to a foreign system. When the order control code is ‘NW’

or ‘SN’, the Universal Interface will send order comments will be sent as an unlimited number of NTE segments per

ORM message. The HNA Universal interface can also send NTE order comments with an ORU discrete result

message. When the result message is display image or charted results, HNA users can define the interface chart

form to include chartable comments; consequently, the Universal Interface will not send NTE segments containing

order comments Each NTE segment represents a comment line and will contain no more than 78 characters.

Option Chosen: 3 (Table 8.x – Option for Chartable Order Comments – from HNA)

Send chartable order comments with both ORU (discrete only) and ORM messages

8.5.4 Prompt Test Option

Prompt Tests are a special type of PathNet comments stored as results on the Patient Order (PO) record. Prompts

are unique to a specific ordered procedure and valued with data or ‘results’ at the time of order entry. Prompt

‘results’ are usually short (8 characters or less) values that are needed either to perform the ordered procedure or

to calculate interpret other test results. e.g., Typical blood bank prompts associated with a crossmatch order

include: number of units, product, surgery date, ER band number. The Cerner interface can transmit but not accept

textual prompt results (greater than 8 characters). Note: If the foreign system cannot validate size and format of

prompt data, the HNA prompt result type should be defined as a free text result type and not a result type that

requires a specific format (e.g., numeric, date).

Option Chosen: 1 (Table 8.z – Option for Prompt Tests)

Inbound prompt data provided in OBX segment. The sending and receiving systems are synchronized using the HNA

procedure number. The procedure id is formatted as an HL7 ‘ST’ type with leading zeros. The mnemonic is

included in the text component for documentation only. The long description is not included.

8.6 Priority Option

HNA applications use two character priority codes to define specimen collection or order priorities and result

reporting priorities.

8.6.1 Collection / Order Priority Collection / order priority codes define parameters used primarily for PathNet order and collection programs.

When a specimen is to be collected, collection priorities will be used to determine when the specimen is to be

collected and whether specimen labels should print immediately or later with a scheduled collection list.

Although order priority is not as critical to RadNet or MedNet order processing, core interface processing requires

a valid order priority for all interface orders.

The collection / order priority will be provided in the Priority component in the first instance of the HL7

Quantity/Timing field (OBR;27.6).

Note: For a more detailed description of the TQ data type and the entire Quantity / Timing field, refer to the TQ

(Quantity/Timing) Data Type paragraph in Unit 3: Concepts and Definitions.

8.6.2 Order and Report Priority Reporting Priority codes define parameters for performing procedures and reporting results. This priority is

assigned at order entry either specifically or as a default of the collection priority.

The reporting priority will be provided in the Priority component in the second instance of the HL7

Quantity/Timing field (OBR;27~27.6). If Priority is not valued in the second instance, the order priority in the

first instance equals the reporting priority.



Page 2- 22

Option Chosen 1 (table 8.cc – Option for Order and Report Priority)

The Universal Interface will use SR8520, Order Priority Cross-reference Table, to cross-reference the order priority

(OBR027.6 repetition 1) to the HNA order priority. If the report priority (OBR-27.6 repetition 2) is valued, the

Universal Interface will use SR8520 to cross-reference the report priority to the HNA report priority. If the report

priority is not valued, the Universal Interface will use the default report priority (SR8501.37) Note: There must be

an entry on Table 8520 for a blank order priority.

Additional Information: MIE scope chose option 0. Priority codes are synchronized. Transmitted values are valid

HNA codes. The Universal Interface will define at the application level a default order and report priority. These

defaults will be used only when the HL7 priority fields are empty

8.8.1 Ordering Doctor

The ordering doctor will be specified in the HL7 Ordering Provider field (OBR;16). To review a more detailed

discussion of the format and transmit options available in HNA for doctor processing and identification, refer to the

Physician Identification paragraphs in Unit 5: Patient and Encounter Identification. The same options and

SR85nn parameters apply to Ordering Doctor including the ability to process a coded or free text doctor.

8.8.1 HNAC Related Doctor

A maximum of five related doctors can be associated with some HNA orders. HNA core interface processing will

accept only coded doctors.

Option Chosen 0 (table 8.ee – Option for RadNet Requisition Prompts)

Related doctors will not be processed. No Radiology orders will be transmitted through the interface.

8.9.1 Microbiology Source Option

HNA applications identify microbiology source as both a freetext and a specific. PathNet uses Specific Source for

statistical reporting and tracking purposes with microbiology reporting. To ensure accuracy of microbiology

departmental statistics, Cerner recommends that the Universal Interface accept only free text source with a

microbiology order from a foreign system. Specific source is required for results from a foreign system. Reference

Nomenclature formatting options in this unit to determine formatting and synchronization of specific source.

Note: The freetext source may also be used in conjunction with the coded source to further describe the source

location.

Note: Cerner does not provide a field for source body site. Additional source codes may be needed to incorporate

source and body site into a single code.

Note: Currently acceptance of freetext source via a results-in interface is unavailable. The microbiology

development team is currently investigating this issue. In the interim, freetext source must be posted when the order

is placed.

Option Chosen: 2 (Table 8.ff – Option for Microbiology Source to HNA)

The Universal Interface will concatenate code, free text, site components (OBR-15.1.1, 15.3, 15.4) to the HNA Free

Text Source separated by commas. Cerner recommends option 1 or 2. E.g., |CSF&Cerbrospinal Fluid^^middle

vial^1| [psted tp JMA as CSF,middle vial,1 Additional Information: MIE scope chose Option 1 The Universal Interface will not process the value in Source Id (OBR;15.1)

The Universal Interface will post only HNA Free Text Source using the value of the HL7 Free text (OBR;15.3). Cerner

recommends option 1 or 2.

e.g., |CSR&Cerebrospinal Fluid^^taken before starting antibiotics|



Page 2- 23

Outgoing Microbiology Source Option Option Chosen: 1 (Table 8.gg – Option for Microbiology Source from HNA) 1. The HNA Source Entry Name (mnemonic) will be provided in OBR-15.1.1-Specimen Source code. The actual data passed

will be further defined by the option selected in SR8502.47-Source MN Opt that defines how the source mnemonics are

synchronized between the receiving and sending systems.

2. The HNA Display Source will be provided in OBR-15.1.2-Specimen Source code text.

3. The HNA Freetext Source will be provided in OBR-15.3-Specimen Source freetext.

8.10.2 Action Codes

HNA supports the use of a “collected’ indicator to signal whether a specimen has been or will be collected by

ancillary department personnel using HNA’s collection system. The Universal Interface will post a status of Drawn

for specimens ‘collected’ or ‘to be collected’ by non-ancillary department personnel using a non-HNA collection

system. When the specimen is to be collected by the HNA clinical department, the order status will vary based upon

other order parameters. Usually HNA will post as status of ‘Pending Dispatch’ or ‘Dispatched’.

The ‘collected’ indicator essentially signals which system (HNA or non-HNA) will control specimen collection.

The Universal Interface will accept a standard HL7 Table 0065 Specimen Action Code in OBR-11-Specimen Action

Code and , by default, will process as follows:

HL7 Specimen HL7 Description UI Collect Status UI Pickup Flag UI Drawn Dt/TM UI Drawn ID

Action Code

___________________________________________________________________________________________________

L Laboratory to 1 – Pending Dispatch Y not valued

collect specimen from

patient

S Schedule tests 1 – Pending Dispatch Y not valued

specified

G Generated order; 1 – Pending Dispatch Y not valued

reflex order

A Add ordered tests to 1 – Pending Dispatch N not valued

the existing specimen

(accession NOT provided)

Add ordered tests to 4 – Collected N Requested dt/tm OBR-10

the existing specimen

(HNA accession provided)

O Specimen collected 2 – Drawn N OBR-7, if valued:

by service other than otherwise, Requested

Lab dt/tm

P Pending specimen: 2 – Drawn N OBR-27.4, if valued:

Order sent prior to otherwise, Requested

Delivery dt/tm

R Revised order N/A N/A N/A N/A

Not accepted by HNA

Mysis sends OBR11 Egate will translate all codes = P. No Cerner generated orders.

8.10.3 Cancel Reason

The HNA system can track and report the reason for canceling an order. If the sending system does not provide a

cancel reason code in ORC-16-Order Control Code Reason, the Universal Interface will provide a default cancel

code in SR8501.31.



Page 2- 24

Option Chosen: 0 (Table 8.jj – Options for Cancel Reason code in ORC-16-Order Control Code Reason)

The Universal Interface will send/receive codes as they are listed in SR0240, Cancel Reason Code. Synchronized

databases.

Additional Information: MIE spec said: Not applicable. Cancel transactions will not be processed through the

interface.

8.10.6 Ordering Location

The ordering location for a procedure can be used to determine a number of order processing options. For

interface orders to Cerner: The patient’s facility or nursing station is generally used as the ordering location.

However, if a different location is required, this should be provided in the Enterer’s Location field (ORC;13).

Option Chosen: 0 (Table 8.kk – Option for Ordering Location)

No special processing required. The Universal Interface will not value the order location. For orders to HNA, core

interface programs will default order location to the current patient location or current patient facility (SR9972.75-

Use Facility Order Location Indicator)

8.10.6 Performing Location

The performing location for a procedure is determined in HNA by comparing a number of patient and procedure

parameters to determine where the procedure should be performed. The performing location is referred to in HNA

as the Workcenter/Testing site (WC/TS) or the Reference Laboratory Institution (RL Inst). The performing location

can be used in specimen and exam processing. The performing location can be used to segregate procedures to be

performed in-house or at an alternate location.

The performing location is used in PathNet to designate specimens to be sent to outside laboratory. This

designation is used to flag results as “Reference Lab” results on the patient chart. This designation can also be

used to create Specimen Transfer Lists or Specimen Packing List for specimen shipping.

Option Chosen: 0 (Table 8.mm – Option for Performing Location to HNA)

No special processing required. The performing location will not be used by the Universal Interface.

Option Chosen: 1 (Table 8.nn – Option for Performing Location from HNA)

The Universal Interface will send the WC/TS description off SR0070, Testing Site, in OBX-15.5 – Producer’s ID

Alternate Text.

Additional Information: EGate will move 15.5 to 15.1

Additional Information: MIE scoped chose Option 0: No special processing required. The performing location will

not be processed by the Universal Interface.

Sheila will provide list of performing locations to Misys for database build prior to go live

8.10.7 Specimen Label Printer

The Universal Interface will provide the following options for default label printers. These options will only be used

when the inbound order generates an immediate print label. All other orders will be scheduled to a collection list

and will print to the printer designated in HNA when the collection list is run.

Option Chosen: 0 (Table 8.oo – Option for Override Label Printer)

Allow HNA to determine the label printer.



Page 2- 25

Unit 9A - Inbound Order Processing

9A.4.2.3 Order/Admit Option

The Universal Interface will provide options to use HNA order-admit logic. HNA order-admit or ‘quick-admit’

logic provides the ability to add a new encounter and to post an order with only an ORM message. A separate ADT

message is not required. Note however, that the Universal Interface can post only limited patient data elements

using order-admit logic. When the Universal Interface sets the input queue order-admit indicator to ‘Y’, the core

interface program (HPCOE) will ‘quick-admit’ or create a new patient encounter when an order is received without

an existing encounter. If the input queue order-admit indicator is not ‘Y’, the core interface program (HPCOE)

cannot process the order but instead will write a permanent error.

Option Chosen: 1 (table 9A.c – Option for Implementing Order-Admit)

Implement order-admit logic for every order received in this interface.

Additional Information: MIE scope chose Option 0 Do not use Order-Admits

9A.4.4.1 Cancel Order Option

By default, the Universal Interface will accept a request to cancel (CA) order control code and return a delayed

cancel as requested (CR) or unable to cancel (UC) response.

The Universal Interface will accept the transmitted Cancel Id (ORC;10) or use an SR8500 override/default cancel

id. The Universal Interface will also accept a Cancel Reason Code provided in the Order Control Reason Code

field (ORC;16) or use an SR8500 override/default cancel code. The Cancel Reason Code must be a valid HNA

SR0240 code.

The cancel date and time actually posted by HNA interface processing will always be the HNA system date and time

when the cancel is processed.

Cancels will be allowed

Additional Information: MIE scope says: Not applicable. Cancels will not be implemented.

9A.2 Order Event Summary (to HNA)

The Universal Interface will accept HL7 order messages with the following message types, event codes and order

control codes:

Table 9A.b - HL7 Order Events and Control Codes

Message

Type

Direction

Event

Code

Control

Code

Description

LA

BA

MA

AP

RA

CP

ORM to HNA O01 NW New Order Y Y Y NO Y Y

ORR to HNA O02 NA Number Assigned Y Y Y Y Y Y

Sending ORM’s translated to ORU’s into Mysis



Page 2- 26

Unit 9B - Outbound Order Processing

9B.3.1 Patient Selection

Selection of patient populations eligible for interface activity from Cerner will be determined by HNA core system

reference table parameters (SR9973 HIS HOQ Processing Table). Based on single interface requirements as well

as other interfaces implemented at a given site, the key to the SR9973 table used to determine interface selection

criteria will be either the SR0008 HIS institution id or the terminal digit of the output manager’s identification

number. Patient selection criteria include:

Table 9B.a - Patient Selection Criteria for HL7 Messages from HNA SR9973 Description Value Comment

Transmit by Client Y/N If ‘Y’, transmit only if client SR0008 transmit indicator is ‘T’

Transmit by Location Y/N If ‘Y’, transmit only if location SR0100 transmit indicator is ’T’

Transmit by Patient Type Y/N If ‘Y’, transmit only if pat type SR0150 transmit indicator is ‘T’

Transmit after discharge Y/N If ‘N’, do not transmit if patient discharged

If ‘Y’, possible but 1st check flag on pat type dsch days

Pat type dsch days Y/N If ‘Y’, use SR0150 days after discharge to send/skip record

If ‘N’, transmit if patient discharged. Don’t check number of days

Option Chosen: Patient selection will occur in the Egate engine.

9B.3.2 Order Activity Selection - Hold Logic

The HNA interface hold logic can delay transmission of result activity until the foreign system is ready to accept the

transaction. HNA core interface programs use the presence of an ‘HIS’ admit id on the Patient Registration (PR)

record and/or the presence of an order number on key 2 of Patient Order (PO) record to indicate that the foreign

system is ready to accept the message. HNA core interface programs determine hold criteria from system reference

table parameters, including the SR0008 HIS institution id, SR0008 hold indicator, SR9973 hold order result level,

and SR9969 hold indicator.

Table 9Bb - Hold Criteria for Order Messages from HNA SR description Value Comment

SR9969 hold indicator Y/N If ‘Y’, hold is turned on at system level for this interface

SR0008 hold indicator Y/N If ‘Y’, apply hold criteria for this client

If ‘N’, do not apply hold criteria for this client.

SR9973 hold order result level

(position 4)

1

2

3

4 or

space

Hold results only for ‘HIS’ admit id

Hold results only for PO order number

Do not hold results for either ‘HIS’ or order number

Hold results for both ‘HIS’ and Order Number

(default)

The Universal Interface will not provide additional hold options

Option Chosen: 2

BALL_IN will hold outbound transactions that do not have an order number.

9B.3.3 Ordered Procedure Option

Order, status, and cancel activity are eligible for transmission based first on application (RA, LA, MA, BA, CP, AP)

as defined on the SR9973 order, status, and cancel transmit indicators.



Page 2- 27

Option Selected: 3 (table 9B.c - Option for Ordered Procedure Selection from HNA)

Use SR8595 to Exclude Procedure. Transmit only if not on table. Skip if on table.

Additional Information: MIE scope chose option 1 Transmit if TD Transmit Indicator stored on the PO is ‘Y’. Do

not use SR8595 table.

Cerner recommends this option for single interfaces. If multiple interfaces are implemented, the TD transmit

indicator may not be appropriate for both interfaces and one of the following options must be used.

9B.4 Order Event Summary

The Universal Interface can send ORM messages using the O01 and one of the following order control codes

(ORC;1) as listed below:

Table 9B.d - HL7 Order Events and Order Control Codes

Message Direction Event Code Description LA BA MA AP RA CP

ORM from HNA O01 SN Send Order Number Y Y Y Y Y Y

Sending ORM’s translated to ORU’s into Misys



Page 2- 28

Unit 10 - Outbound Results Processing OBR16 Egate will remove Cerner doc number – send blank

10.1 General Description

The HNA Universal Interface will support the real-time transmission of HL7 ORU messages containing clinical

results and reports for the following applications: general laboratory (LA), microbiology (MA), anatomic pathology

(AP), blood bank (BA), radiology (RA), and cardiopulmonary (CP).

The HNA Universal Interface will support the transmission of HL7 ORU messages with an R01 event type

containing discrete, non-display (non-charted) results. The HNA Universal Interface will also support the

transmission of ORU messages with either an R01or an R03 event type containing user-defined display results

(Results formatted by HNA charting or Charted Results).

Result format (discrete, display, both) can be defined by application as detailed in the section Results Format

section in this Unit.

HNA applications provide a variety of result entry functions that can trigger an HNA result event. The HNA

Universal Interface will transmit an ORU message when a result entry event occurs and user-defined selection

criteria for the patient, procedure, order and result are satisfied.

When the Universal Interface formats and transmits a result message, the result message will be ‘cumulative’ for the

order. All eligible results (changed and unchanged) for the order will be sent. Eligibility of results for a given

result event varies by application, selection parameters, and result format. The receiving system must be able to

overlay a previous result with the current result.

HNA has the ability to retransmit results.

The HNA Universal Interface will provide accurate reliable result data consistent with the HL7 2.2

standard. The HNA Universal Interface cannot control the length of time results will be stored on the receiving

system. The HNA Universal Interface cannot control how the receiving system stores, uses, displays or prints HNA

result data.

10.2 Patient Identification

As detailed in Unit 5 - HNA Patient Identification, HNA clinical systems require two identifiers to uniquely

identify a patient - Client Number and Medical Record Number; and an additional identifier to uniquely identify an

encounter - Financial Number. The HNA Universal Interface will provide all three identifiers in the ORU message.

10.3 Selection Criteria

10.3.1 Patient Selection

Selection of patient populations eligible for interface activity from Cerner will be determined by HNA core system

reference table parameters (SR9973 HIS HOQ Processing Table). Based on single interface requirements as well

as other interfaces implemented at a given site, the key to the SR9973 table used to determine interface selection

criteria will be either the SR0008 HIS institution id or the terminal digit of the output manager’s identification

number. Patient selection criteria include:



Page 2- 29

Table 10.c - Patient Selection Criteria for HL7 Messages from HNA SR9973 Description Value Comment

Transmit by Client Y/N If ‘Y’, transmit only if client SR0008 transmit indicator is ‘T’

Transmit by Location Y/N If ‘Y’, transmit only if location SR0100 transmit indicator is ’T’

Transmit by Patient Type Y/N If ‘Y’, transmit only if pat type SR0150 transmit indicator is ‘T’

Transmit after discharge Y/N If ‘N’, do not transmit if patient discharged

If ‘Y’, possible but 1st check flag on pat type dsch days

Pat type dsch days Y/N If ‘Y’, use SR0150 days after discharge to send/skip record

If ‘N’, transmit if patient discharged. Don’t check number of days

Option Chosen: BALL_IN will filter patients using the eGate engine.

Additional Information: MIE scope chose BALL_IN will select and filter patients based upon Client Number using

the Universal Interface filtering. BALL_IN will provide a list of clients available for transmitting results.

10.3.2 Result Activity Selection - Hold Logic

The HNA interface hold logic can delay transmission of result activity until the foreign system is ready to accept the

transaction. HNA core interface programs use the presence of an ‘HIS’ admit id on the Patient Registration (PR)

record and/or the presence of an order number on key 2 of Patient Order (PO) record to indicate that the foreign

system is ready to accept the message. HNA core interface programs determine hold criteria from system reference

table parameters, including the SR0008 HIS institution id, SR0008 hold

indicator, SR9973 hold order result level, and SR9969 hold indicator.

Table 0.b - Hold Criteria for Result Messages from HNA SR description Value Comment

SR9969 hold indicator Y/N If ‘Y’, hold is turned on at system level for this interface

SR0008 hold indicator Y/N If ‘Y’, apply hold criteria for this client

If ‘N’, do not apply hold criteria for this client.

SR9973 hold order result level

(position 4)

1

2

3

4 or

space

Hold results only for ‘HIS’ admit id

Hold results only for PO order number

Do not hold results for either ‘HIS’ or order number

Hold results for both ‘HIS’ and Order Number

(default)

The Universal Interface will not provide additional hold options.

Option Selected: 1

BALL_IN will hold outbound transactions that do not have an order number.

10.3.3 Ordered Procedure Option

Results are eligible for result transmission at the interface level based first on application (RA, LA, MA, BA, CP,

AP), as defined by the core SR9973 HOQ result transmit indicators.

Option Chosen: 3 (Table 10.c - Ordered Procedure Selection for Result Messages from HNA)

Use SR8595 to exclude procedures. Transmit only if the ordered procedure is not on the table or SR8595.3,

Transmit Indicator is “Y”. If the ordered procedure is on the table and SR8595.3, Transmit Indicator, is not “Y”, do

not transmit the result.





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Note: If multiple interfaces are implemented, the TD transmit indicator may not be appropriate for both interfaces

and one of the following options must be used.

10.3.4 Detail Procedure Option

For charted (display format) result messages, the inclusion of a detail result in the chart is user definable in the

HNA charting module. The HNA Universal Interface cannot provide additional selection options.

Option Chosen: 3 (Table 10.d - Detail Procedure Selection for Result Messages from HNA)

Use SR8595 to exclude procedures. Transmit only if the observation is not on the table or SR8595.3. Transmit

Indicator is “Y”. If the observation is on the table and SR8595.3, Transmit Indicator, is not “Y”, do not transmit

the result.



Note: If multiple interfaces are implemented, the TD transmit indicator may not be appropriate for both interfaces

and one of the following options must be used.

10.5.2 Result Footnotes Option

In a discrete results interface, result footnotes will be provided via NTE segments following the OBX segment of the

ORU message.

Any procedure may have footnotes associated with the procedure. Footnotes should be considered as part of the

result, regardless of the result type.

Option Chosen: 1 (Table 10.e - Options for Result Footnote in Discrete ORU Messages)

Send only chartable footnotes.

10.5.3 Interpretive Data Option

Option Chosen: 2 (Table 10.f - Options for Interpretive Data in Discrete ORU Messages)

Send interpretive data. Send interpretive data only when it is verified.

10.7.1 Result Triggers

With the exception of RadNet ‘performed’ results, the HNA Universal Interface will send result or report

information only for verified procedures. HNA events and states that trigger result transmission are controlled by

various HNA system tables. The following core options (SR9973) define the ‘result trigger’ or result-completeness

level for transmitting results.

Option Chosen: 1

1. Order Complete ‘O’- HNA applications can provide a result trigger event when a patient’s ordered

procedure is complete. Order completion occurs when all required or pending tests for the ordered

procedure (PO) have been verified. Note: For supergroup orders, this option applies to each component

not to the entire supergroup.

2. Testing Site Complete ‘T’ - HNA applications can provide a result trigger event when all required or

pending tests performed at a particular Testing Site have been verified. A result transaction will be

triggered whether or not there are unverified pending tests to be performed at other Testing Sites for the

same ordered procedure.



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3. Detail Procedure Verified ‘D’ - HNA applications can provide a result trigger event when any procedure

within an order has been verified during a result entry conversation.

HNA applications will also provide a result trigger event when a previously verified result is corrected, when a

result footnote is added or corrected, or when an HNA user manually re-sends a result transaction.

Note: A change or addition to a patient comment will not trigger a result message.

A change or addition to an order comment will not trigger a result message.

A change or addition to a result footnote will trigger a result message

When the HNA Universal Interface transmits an ORU result message, all eligible verified results for the order or

ordered procedure will be sent. The HNA interface makes no attempt to limit transmission of results based upon the

fact that a result message may have previously been sent to a foreign system. This logic is used because the HNA

interface programs can only record that a result was eligible for transmission not that a specific result was

successfully posted by one or more receiving systems. For this reason, it is important that each receiving system be

able to accept re-transmitted results and overlay any previously received results.

10.7 Result Format

Either charted or discrete format must be chosen for each lab section. There is no default.

Send MA Charted, LA and BA Discrete

10.7.1 Discrete Result Reporting

Option Chosen: 1 (Table 10.g - Options for Sending Discrete Results for non-HNA Ordered Supergroups) Always identify the supergroup as the ordered procedure (OBR;4) but transmit cumulative discrete results within each

component.

E.g., CBC is an ordered supergroup transmitted at the supergroup level. When the result trigger is for the HEME

component, all verified detail tests within the HEME group will be sent. No results for the DIFF group will be sent.

OBR;4 will be CBC. When the result trigger is for the DIFF component, all verified detail tests for the DIFF group

will be sent. No results for the HEME group will be sent. OBR;4 will be CBC.

10.7.2 Display (Chart Image) Result Reporting

Option Selected: 0 (Table 10.h - Options to Limit Number of Lines (DSP, OBX, and NTE segments) per Result

Message)

Send all Chart Lines for this result.

Option Selected: 2 (Table 10.i - Options for Suppressing Blank Lines in Textual and Charted Results)

Send blank lines in charted results. Send all internal blank lines.

Enter info from 10.8.3 on OBX segments – Allison will check with development

10.8 Result Types

The Universal Interface will transfer results using one of the following HL7 Result Types:

HL7 Type Comment

NM The numeric value type is used for numeric type results.

Examples: 3.34, +1, 1013

HNA Result Types: ‘C’ Calculated, ‘O’ On Line, ‘N’ Numeric.

The maximum size of the HNA numeric result is 8 bytes (7 digits plus decimal)

HNA numeric results are stored on PO record



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HL7 Type Comment

ST The string data type is used for one or two word results or responses. This is the default HL7 Result Type.

Examples: ‘POSITIVE’, ‘O NEG’, ‘13APR95’

HNA Result Types: ‘A’ Alpha, ‘F’ Free Text, ’P’ Phrase

The maximum size of the HNA string result is 8 characters.

HNA string results are stored on PO record.

ID String data drawn from a table of legal values.

Examples: ‘POSITIVE’, ‘HAZY’.

HNA Result Type: ‘A’ Alpha, ‘S’ System Reference field

The result contains a response validated by HNA applications from a list of valid responses for a given detail procedure.

Cerner does not recommend trying to synchronize alpha responses.

By default, the Universal Interface will transmit ‘A’ alpha result type using the ‘ST’ HL7 data type. The maximum size

of the HNA ID result is 8 characters

TX The Text data type is used for textual results. These usually consist of multiple word, multiple sentence, and multiple

line results. Multiple OBX segments are normally needed. Each OBX segment implies a logical line break.

HNA Result Types: ‘T’ Text, ‘I’ Interpretations, ‘G’ Graphics.

HNA text results are stored on AN records. HNA text results have no size limitation. The maximum size of the HNA

interpretive and graphics results is 8 characters.

Charted results will be transmitted as TX result type.

CE Coded entry data type used in microbiology results for isolate identification. The maximum size of the HNA coded

result is 8 characters

DT The date value type is used for CCYYMMDD date formats, where CC indicates the Century; YY, the 2-digit year; MM,

the 2-digit month; and DD the 2-digit day of month.

Example: 19950506

HNA Result Types: ‘D’ Date

10.8.1 Numeric and Alpha Result Options

A procedure can be defined differently at each HNA testing site. The same test may be numeric at one testing site

and free text at another. In addition, during result entry, the user can convert a procedure defined as numeric to

accept alpha or free text result.

The HNA Universal Interface will provide an option to send HNA Alpha ‘A’ result types using the HL7 ‘ID’ type

instead of the default HL7 ‘ST’ result type. As previously stated, Cerner does not recommend attempting to

synchronize coded result values.

Option Chosen: 1 (Table 10.k - Options for Sending HNA Alpha Result Type)

Send HNA ‘A’ result type using HL7 ‘ST’ data type.

10.8.5 Interpretive Results (Result Type “I”)

When an HNA Interpretive result is sent across the Universal Interface, the Interface can format the result as either

an 8-character or unlimited free text Textual Response “TX”, depending on how the procedure was built in HNA. If

both abbreviated and free text results exist for the procedure, only the free text results will be sent.

The Universal Interface will provide an option to send the 8-character HNA Interp ‘I’ result types using the HL7

‘ST’ type instead of the default HL7 ‘TX’ result type.

Option Chosen: 1 (Table 10.l - Options for Sending HNA Interps Result Type)

Send HNA ‘I’ result type using HL7 ‘TX’ data type.



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10.9.3 Abnormal Flags Option

Option Chosen: “ “ (Table 10.o - Options for Abnormal Flags Interpretation)

Send whatever is in the PO Abnormal Flag.

10.10.2.1 Microbiology Discrete Results (R01)

Not applicable. Only Charted Micro Results will be transmitted to MIE.

10.10.4 Pathnet: Blood Bank Results

BALL_IN will not be sending Blood Bank product information across the interface.

Option Chosen : 0 (Table 10.r - Options for Blood Bank Crossmatch Product)

Send crossmatch results for single product.

Option Chosen : 0 (Table 10.s - Options for Blood Bank Product Information with Crossmatch Results)

Do NOT send product information in ZBP segment with crossmatch results

Option Chosen : 0 (Table 10.t - Options for Blood Bank Crossmatch Results)

Send results in OBX;5-Observation Value as stored in HNA.

Option Chosen: 0 (Table 10.u - Options for Blood Bank Product Identification)

Send the unique unit number in ZBP;2 - Unique Identifier. For crossmatch results, send the same value in OBX;4 -

Observation Sub-Id.

Option Chosen: 0 (Table 10.v - Options for Blood Bank Lot Products)

Send lot products in product dispensing and transfusion messages

Option Chosen: 0 (Table 10.w - Options for Blood Bank Antigens)

Send antigens in product dispensing and transfusion messages.

Option Chosen: 0 (Table 10.x - Options for Blood Bank Transfused/Returned Date/Time)

Send current date and time in OBR;7-Observation date/time as transfused/returned date and time



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Project Deliverable Timelines: As with any project, reasonable time lines are important to accomplish goals for all parties concerned. The following time lines are submitted for your approval. Please bear in mind that THESE TIME LINES ARE APPROXIMATE, but DO represent a chain of events that are dependent on the occurrence of the previous event!

EVENT RESPONSIBLE PARTY TARGET DATE Specification Meeting All Parties Follow-up Spec Meeting All Parties Specification Sign-off All Parties Code Delivery Cerner Protocol Setup Cerner / Engine UI Setup Cerner Unit testing All Parties System Testing Client ** Move UI to production All parties

Software Conversion All parties # ** Cerner will provide software support as needed during this time period. # Date must be confirmed in advance to plan for adequate support coverage. Time line, while included in this document for discussion, are subject to a number of outside influences and, as such, are not covered by any guarantee, written or oral.



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Review & Approval: Signatures below represent an agreement in principle to the basic functionality discussed in this document. Client #1 Date Client #2 Date

Cerner Corporation (HNAC) Date

HNAC Universal Interface Specification Supplement Site

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