The patient requests hospital specific services for a certain period of time. This can be a phone, fax, or TV in the room, or the delivery of a newspaper every day. Another example may be the use of specialized chip cards that give access to hospital specific services. Typically, a request for these services is made at the time of admission. Another example may be the printing of a form (e.g., the receipt for a payment). In case of using phones it might be a detailed list of calls for a patient or for a special extension.
To support these scenarios, the following fields are used to communicate the appropriate message:
Segment/Field |
Definition |
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ORC-1 |
Order Control |
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ORC-2 |
Placer Order Number |
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ORC-5 |
Order Status |
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TQ1-7 |
Start Date/Time |
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TQ1-8 |
End Date/Time |
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ORC-16 |
Order Control Code Reason |
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ORC-25 |
Order Status Modifier |
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OBR-4 |
Universal Service ID |
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OBX-5 |
Observation Value |
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FT1-17 |
Fee Schedule |
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FT1-11 |
Transaction amount - extended |
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BLG |
Billing segment |
ORC-1 |
OBR-4 (in textual form) |
ORC-16.1 Code |
Description |
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NW |
chip card |
Issue a chip card the first time |
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XO |
chip card |
defective |
Change the previous order. Issue a new chip card for a defective one. |
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XO |
chip card |
lost |
Change the previous order. Issue a new chip card for a defective one. |
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DC |
Return chip card |
Cancel the chip card order |
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DC |
Return chip card |
lost |
Cancel the chip card order because lost. |
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DC |
Return chip card |
defective |
Cancel the chip card order because defective. |
Use of different universal service IDs allows for the ability to charge an additional fee.
Phone Number Assignment
In case the patient requests a bedside phone and the number of this phone is assigned to that patient personally, a number of messages are transmitted. The objective is to connect a phone number to a patient and a room.
The update of the location master file depends on the setup of the private branch exchange system (PABX):
When the patient is admitted, an ADT^A01 message is sent to create a patient record in the phone number assigning application. Typically, the patient ID (PID-3), patient location (PV1-3), and visit number (PV1-19) are at least required. This message is acknowledged accordingly with an ACK. Then, the order for the phone number to the phone number assigning application is placed with the ORM^O01 message where the essential fields are ORC-1 = "NW", ORC-2 =
The ORR^O02 message is used to acknowledge the order and communicate the filler order number and order status. Then, when the phone number is available, an ORU^R01 message is used to communicate the phone number using OBX-5 for the phone number.
Any status changes to the order are communicated with the ORM^O01 message where ORC-1 = "SC", ORC-2 =
Next, the location master files are updated. The phone number assigning application may send a MFN^M05 message to have the location master file reflect the phone number assignment as well. The fields on the message are valued as follows:
After processing the order: MFI-1 = "LOC", MFI-3 = "UPD", MFI-5 =
Transfer a patient (A02)
If a patient keeps the same phone number during the whole visit the assigned phone number must be mapped to a different phone outlet whenever a patient is transferred to a new location. In that case, the ADT^A02 message is sent to the phone number assigning application. That application not only acknowledges the message, but also sends an ORM^O01 message with ORC-1 = "SC" and the other fields the same as described in the Phone Number Assignment section. Additionally, it sends a MFN^M05 message to change the location master file accordingly for the old location and another MFN^M05 to synchronize the phones for the new location.
Leave of absence (A21/A22)
When the patient leaves the hospital or the bed is vacated for a significant amount of time, the phone needs to be de-activated and re-activated appropriately. The same ORM^O01 and MFN^M05 messages are used as described above following the ADT^A21 and ADT^22 messages.
Patient makes calls or (de-)activates his phone.
The patient can use the phone whenever he wants to. This implies that his balance does not exceed the limit. Otherwise the phone is deactivated automatically. Furthermore the patient can activate or deactivate the phone by entering the authorization key for his own. In these scenarios the phone number assigning application sends and ORM^O01 message with ORC-1 = "OD" and the appropriate order status. The status update is necessary to provide a call switching system with the actual information.
Discharge a patient (A03)
When the patient is discharged, the ADT^A03 message is sent to indicate a discharge. The phone number assigning application sends an ORM^O01 message with a change of status to indicate completion of the order, as well as an MFN^M05 message to synchronize the location master file.
After discharging a patient his final charges must be billed. Using the query P04 returns the data in a display oriented format which can be used for printing. Alternatively a print request can be used. The billing system issues a QRY^P04 message where the fields are valued as follows: QRD-2 = "R" (record oriented format), QRD-3 = "I" (immediate response), QRD-8.1 =
Phone Call Queries (Z73)
The new query modes using a query by parameter query with a virtual table response allows for obtaining call information from the phone system to be used for charging. The query can be for accumulated data or detailed data. Both requests use this conformance statement:
MSH-15 | MSH-16 | Immediate ACK | Application Ack |
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Blank | Blank | - | RTB^Z74^RTB_Z74 |
NE | NE | - | - |
AL, ER, SU | NE | ACK^Z73^ACK | RTB^Z74^RTB_Z74 |
QPD Input Parameter Specification:
Input Parameter Field Description and Commentary:
Response Grammar:
Segment | Cardinality | Implement | Status |
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RTB^Z74^RTB_Z74 | |||
MSH Message Header |
[1..1] | SHALL | |
MSA Message Acknowledgment |
[1..1] | SHALL | |
ERR Error |
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SFT Software Segment |
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UAC User Authentication Credential Segment |
[0..1] | ||
QAK Query Acknowledgment |
[1..1] | SHALL | |
QPD Query Parameter Definition |
[1..1] | SHALL | |
ROW_DEFINITION | [0..1] | ||
RDF Table Row Definition |
[1..1] | SHALL | |
RDT Table Row Data |
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DSC Continuation Pointer |
[0..1] |
MSH-15 | MSH-16 | Immediate ACK | Application Ack |
---|---|---|---|
Blank | Blank | ACK^Z73^ACK | - |
NE | NE | - | - |
AL, ER, SU | NE | ACK^Z73^ACK | - |
Virtual Table:
Example 1:
Query the accumulated list for patient 12345 from 3/2/00 till 3/3/00. Transfer the first 20 records.
Query:
MSH|^&~\|PCR|Gen Hosp|Pharm||20000303201400-0800||QBP^Z73^QBP_Z73|9901|P|2.8|
QPD|Z89^Query Phone Calls^HL70471|Q010|12345|2000030100000^20000302235959|Y
RCP|I|20^RD|
Answer:
MSH|^&~\|Pharm|Gen Hosp|PCR||20000303201430-0800||RTB^Z74^RTB_Z74|8858|P|2.8|
MSA|AA|9901|
QAK|Q010|OK|Z89^Query Phone Calls^HL70471|4
QPD|Z89^Query Phone Calls^HL70471|Q010|12345|2000030100000^20000302235959|Y|
RDF|9|Provider^ST^20|Region^ST^40|Extension^XTN^40|Destination^XTN^40|Date/Time^DTM^24|Quantity^NM^4|Duration^NM^4|Units^NM^4|Amount^MO^8|
RDT|DTAG|CITY||||5|20|3|3.25|
RDT|DTAG|R50||||1|10|2|1.00|
RDT|DTAG|R200||||0|0|0|0|
RDT|DTAG|NAT||||0|0|0|0|
RDT|DTAG|INT||||0|0|0|0|
Example 2:
Query the detailed information for patient 12345 from 3/1/06 till 3/3/06. Transfer the first 10 records.
Query:
MSH|^&~\|PCR|Gen Hosp|Pharm||200611201400-0800||QBP^Z73^QBP_Z73|ACK9901|P|2.8|
QPD|Z89^Query Phone Calls^HL70471|Q010|12345|2006030100000^20060302235959|Y|
RCP|I|10^RD|
Answer:
MSH|^&~\|Pharm|Gen Hosp|PCR||200611201401-0800||RTB^Z74^RTB_Z74|8858|P|2.8|
MSA|AA|8858 QAK|Q010|OK|Z89^Query Phone Calls^HL70471|4
QPD|Z89^Query Phone Calls^HL70471|Q010|12345|2006030100000^20060302235959|Y|
RDF|9|Provider^ST^20|Region^ST^40|Extension^XTN^40|Destination^XTN^40|Date/Time^DTM^24|Quantity^NM^4|Duration^NM^4|Units^NM^4|Amount^MO^8|
RDT|DTAG|CITY|12345|555-1234|200603021715||20|12|2.25|
RDT|DTAG|CITY|12345|555-4569|200603011252||21|3|0.48|
Requesting a Chip card
In case the hospital provides additional services that can be accessed through chip cards, this card has to be issued to the patient. At the end of the visit this chip card is returned. Distributing a chip card to a patient is a service which must be ordered from the chip card dispensing system, too. When discharging the patient the service (= order) is complete.
The messages are essentially the same as for issuing a phone number. The filler for the chip card order is a chip card dispensing application and instead of returning a phone number, it returns a chip card number. The following scenarios have slight variations.
New Chip Card requested due to, e.g., loss
When a card is lost, or a new chip card must be requested, an additional fee can be communicated by including the FT1 segment in the ORM^O01 message and valuing FT1-11 =
Request a new Chip card for a defective one
Sometimes a chip card is defective. Then the patient needs a new one. This situation requires an order using the XO control code in the ORM^O01 message. The chip card dispensing system returns the new chip card number using the ORU^RO1. The ORC-16-Order Control Code Reason is used to clarify the request.
Return a chip card
When the patient returns the chip card, a discontinue message is send with ORC-1 = "DC". This message is acknowledged accordingly by the chip card dispensing system.
Printing a form
When form needs printing, the ORM^O01 could also be used. The OBR segment would contain the print form service and the OBX would contain the specific print form. A notification when completing the printing is feasible as well using the ORM^O01 with a status update associated to the appropriate placer/filler order number.