Variations of the HL7 ORU^R01 Message Format

September 10th, 2007 by Mike Stockemer

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Posted in Healthcare Integration, HL7 Messaging, HL7 Standard

If you’ve been in healthcare integration for any amount of time, you’ve probably seen an HL7 ORU^R01 message. As we like to say at NeoTool, if you’ve seen one HL7 message, you’ve seen one. This is especially true in the case of an ORU^R01 message. The following example illustrates some possible variations to this message.

Scenario: An imaging center (IC) is receiving some order messages (ORM^O01) from 2 external hospitals for which they complete the orders and send back transcribed reports (ORU^R01) in an HL7 standard format. The IC is also completing their own internal orders, and the resulting reports need to be routed to their internal PACS system. Overall, there are 4 separate systems involved. In the world of HL7 messaging, this often means there will be 4 custom formats of the transcribed report.

Original Message from RIS/Dictation System:
Notice that the message is loaded with Z-segments. These Z-segments will most likely need to be stripped out of the message that will be delivered to the other 3 systems. Also, notice that in the OBX segment each line of the transcribed report becomes a separate repetition of the OBX-5 field (separated by the ‘~’ character).

MSH|^~\&|System1||||200707090801||ORU^R01|3542196||2.3
PID|1|000-0000|||”"|1922974|151-76-5760|||||||||||N
ZPI|1|N|N|N|N|N|”"|”"|”"|”"|”"| | | | | |”"|N|0|0|0|0|0|0
PV1|1|2|||||||| ||||||N|| ||
ZVI|1|”"|”"|”"|”"|”"|N|0|0|”"|”"|N|N|N|N|N|”"|”"|”"|”"|”"|0| | | |/NONE/
IN1|1|P|||||
ORC|RE||2060059||||^^^200707061707^^ ||200707051013|DIONA |||”"|||1007
OBR|||2060059|999991^Knee MRI WO| |200707061707|200707061621|200707061707||||”"|”"|||
ZOR|1|1831236|X|1|01|66696|2| |”"|”"|”"|
ZEX|1|2060059|5|G|CC11043257 |R/O MMT|1004959042 CASE # VERIFIED ONLINE DGC|APRV^APPROVED|200707090801||||||||||||0|0|0|0|N|N|N|N|N|”"|”"|”"|”"|”"||EOK
OBX|1|TX|||PROCEDURE: MRI OF THE LEFT KNEE WITHOUT CONTRAST~ ~HISTORY: Left knee pain for three months. Patient experienced a “pop” in her knee when playing tennis.~ ~TECHNIQUE: MRI of the left knee was performed on the 1.5 Tesla magnet operating at ECIC. Images were obtained in multiple planes and with varying pulse sequences. No contrast was utilized.~ ~FINDINGS: Comparison is made with radiographs of 6/22/07. These demonstrate a small joint effusion but otherwise unremarkable. ~ ~There is a very small joint effusion noted. There is also a small popliteal cyst on the posteromedial aspect of the knee.~ ~The anterior cruciate ligament is nearly completely torn with only a very thin strand of the anterior ventral fibers remaining intact. This involves the proximal third of the ligament. The posterior cruciate ligament is intact. The collateral ligaments are intact although the medial collateral ligament demonstrates mild thickening. ~ ~In the lateral compartment there is a mild impaction fracture near the sulcus terminalis of the lateral femoral condyle. There is a mild resolving contusion present on the posterior lip of the lateral tibial plateau. Along the periphery of the posterior horn of the lateral meniscus there is a subtle area of linear increased signal concerning for potential vertical meniscal tear. This would be in the excepted location of the red zone. ~ ~In the medial compartment, the meniscus is intact. No articular cartilage defects are seen. ~ ~In the patellofemoral joint the articular cartilage is intact. ~ ~IMPRESSION:~ ~1. Findings are consistent with a high grade, probably unstable, near complete tear of the anterior cruciate ligament. ~ ~2. Small peripheral vertical tear through the excepted location of the red zone of the posterior horn of the lateral meniscus.~ ~3. Contusions in the lateral femoral condyle with a mild impaction fracture at the sulcus terminalis as well as in the lateral tibial plateau consistent with a pivot shift mechanism of injury. ~ ~4. Small joint effusion and small popliteal cyst. ||||||F

Now, to illustrate how non-standard HL7 can be challenging, take a look at how the following 3 receiving systems are expecting to receive the transcribed report.
1. Internal PACS System
This system does not support the PID,PV1,IN1,ORC or any of the Z-segments. All these segments must be removed to make this message conform to the specifications of the PACS system.

MSH|^~\&|System1||||200707090801||ORU^R01|3542196||2.3
OBR|||2060059|999991^Knee MRI WO| |200707061707|200707061621|200707061707||||”"|”"|||
OBX|1|TX|||PROCEDURE: MRI OF THE LEFT KNEE WITHOUT CONTRAST~ ~HISTORY: Left knee pain for three months. Patient experienced a “pop” in her knee when playing tennis.~ ~TECHNIQUE: MRI of the left knee was performed on the 1.5 Tesla magnet operating at ECIC. Images were obtained in multiple planes and with varying pulse sequences………

2. External Hospital 1
This Hospital Information System (HIS) does not support multiple repetitions of the OBX-5 field for each line of the report. Instead each line of the report must be contained in its own OBX segment. Also, all Z-segments must be removed.

MSH|^~\&|System1||||200707090801||ORU^R01|3542196||2.3
PID|1|000-0000|||”"|1922974|111-22-3333|||||||||||N
PV1|1|2|||||||| ||||||N|| ||
IN1|1|8129||UNITED HEALTHCARE||||700049||P|||||
IN2||151-76-5760|||||||||||||||||||||||||||||||||||||”"|||^^ |||||
GT1|1|1075861|^”"^”"^”"||ALBUQUERQUE^NM^87111|||19711101|F|P|1|
ORC|RE||2060059||||^^^200707061707^^ ||200707051013|DIONA |||”"|||1007
OBR|||2060059|999991^Knee MRI WO| |200707061707|200707061621|200707061707||||”"|”"|||
OBX|1|TX|||PROCEDURE: MRI OF THE LEFT KNEE WITHOUT CONTRAST
OBX|2|TX|||
OBX|3|TX|||HISTORY: Left knee pain for three months. Patient experienced a “pop” in her knee when playing tennis.
OBN|4|TX|||
OBX|5|TX|||TECHNIQUE: MRI of the left knee was performed on the 1.5 Tesla magnet operating at ECIC. Images were obtained in multiple planes and with varying pulse sequences. No contrast was utilized.
OBX|6|TX|||
OBX|7|TX|||FINDINGS: Comparison is made with radiographs of 6/22/07. These demonstrate a small joint effusion but otherwise unremarkable.
OBX|8|TX|||
OBX|9|TX|||There is a very small joint effusion noted. There is also a small popliteal cyst on the posteromedial aspect of the knee
…
…
OBX|32|TX|||Small joint effusion and small popliteal cyst.||||||F

3. External Hospital 2
This HIS has no inbound results interface. Therefore, the reports are delivered to the inbound transcription interface. In this case, the ORU^R01 message must be converted to an MDM^T01 message. Also, they do not want the text of the report to be contained in the body of the HL7 message. Instead, they want the text written out to a formatted RTF file, complete with a report header and saved to a local share on their network. The path to this file needs to be included in TXA-16 (example C:\InterfaceShare\reports\42077460200.rtf). Notice also that the backslash characters (\) in the path need to be properly escaped using the HL7 escape sequence \E\.

MSH|^~\&|System1||||200707090801||MDM^T01|3542196|P|2.3
EVN|T01|200707090801|200707090801
PID|1|000-0000|||”"|1922974|151-76-5760|||||||||||N
PV1|1|2|||||||| ||||||N|| ||
TXA|1|DI|TX|200707191339|1578|200707200812|”"||1578||XI|42077460200||200|| C:\E\InterfaceShare\E\reports\E\42077460200.rtf

The interfacing challenge above was accomplished using an interface engine. The flexibility of the HL7 standard allows an interface engine to receive any format of HL7 and modify the data to be delivered to multiple destinations in the custom format that these systems require. Without this technology, these systems would have to create custom point-to-point interfaces in order to share information.

For more information on working with ORU messages, listen to a 15 minute presentation to learn more.