Page Comparison

4.1 Purpose

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The triggering events that follow are all served by the ORU (Observational report – Unsolicited) or the ORF (Observational Report Response) messages in combination with ACK and QRY. Only the ORU messsage message is covered in the Australian localisation and some of the optional segments have been removed.

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The ORU^R01 message is sent out by the laboratory and in respose response a ACK^R01 message should be produced to confirm receipt of the ORU message. The structure of the ACK message is as below:

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The OBR segments confirm the status and completion of the ordered tests back to the placer allowing the placer to check off each test ordered as it is received. The OBR segments do not contain the results or when the results will be available. However, the structure of the OBR and OBX segments in the ORU can reflect the specimen used to determine the results e.g. specimen ID. 

HL7 Attribute Table – OBR – Observation Request 

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Since third party providers at another site (those other than the placer and filler of an order) can send and receive ORM and ORR messages (ie i.e. create orders), the placer site ID in this field may not be the same as any sending and receiving HDs  (as identified in the MSH segment).

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Definition: This field is the order number associated with the filling application. It is a case of the Entity Identifier data type (See Datatypes, “EI - Entity Identifier”). Its first component is a string that identifies an order detail segment (e.g., OBR). It is assigned by the order filler application. This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time. The second through fourth components contain the the original authoring filler site ID, in the form of the HD data type (see Datatypes, “HD - hierarchic designator”). The second component of the filler order number always identifies the actual filler of an order. Since third party sites/applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the filler application ID in this field may not be the same as any sending and receiving application HDs (as identified in the MSH segment).

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Definition: This field is the identifier code for the requested observation/test/battery. This can be based on local and/or “universal” codes. We recommend the “universal” procedure identifier if available (eg e.g. SNOMED-CT). 

This field is used for the requested service. The RCPA Board approved Requesting Pathology Terminology Reference Set is available on the RCPA website. 

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In referral messages the referral summary is indicated by the OBR-4 code, which should be either a child concept of the SNOMED CT-AU concept 373942005 Discharge Summary (record artifact), for hospital discharge or a child of 3457005 | Patient referral (procedure) for provider to provider referral. This OBR/OBX group should contain the VMR data if available. Senders may include older referrals in a REF message but the current referral must appear as the first OBR/OBX group. A initial candidate set of record artifact decended descended codes has been submitted to the Australian Digital Health Agency 

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Subcomponents of units: <identifier (ST)> & <test (ST)> & <name of coding system (IS)> & <alternate identifier (ST)> & <alternate text (ST)> & <name of alternate coding system (IS)>
Definition: For laboratory tests, the collection volume is the volume of a specimen. The default unit is ML. Specifically, units should be expressed using UCUM (unitsofmeasure.org). This is a results-only field except when the placer or a party has already drawn the specimen.

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Definition: This field is the action to be taken with respect to the specimens that accompany or precede this order. The purpose of this field is to further qualify (when appropriate) the general action indicated by the order control code contained in the accompanying ORC segment. For example, when a new order (ORC - “NW”) is sent to the lab, this field would be used to tell the lab whether or not to collect the specimen (“L” or “O”).

HL7 Table 0065 - Specimen Action Code

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Snomed-CT AU is a recommended source terminology for this field. 

ege.g. 71837009^Cytotoxic agent (product)^SCT

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SNOMED-CT AU is recommended as a terminology source this field. e.g. 122575003&Urine Specimen&SCT

HL7 Table 0070 – Specimen source codes

The second component should include free text additives to the specimen such as Heparin, EDTA, or Oxlate, when applicable.

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The fourth component specifies the body site from which the specimen was obtained, and the fifth is the site modifier. For example, the site could be antecubital fossa, and the site modifier “right.” The components of the CE fields become subcomponents. Refer to HL7 Table 0163 - Body site.  SNOMED-CT AU is recommended as a terminology source this field. e.g. 64033007&kidney structure&SCT

HL7 Table 0163 – Body site

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The ST field is encoded with repeating name=value pairs separated by commas. ege.g. |name=value,name=value,name=value|

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When transmitted all reserved HL7 delimiters must be escaped and the OBR-20 ST result extracted, unescaped and then parsed as a comma separated name=value pairs.

ege.g. |LN=2016-1234-XYZ\T\LBA| is extracted as LN=2016-1234-XYZ&LBA

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Refer to HL7 Table 0074 - Diagnostic service section ID for valid entries. This field is required in Australian implementations to indicate to the placer system which clinical area to display the results. 

HL7 Table 0074 - Diagnostic service section ID 

Note: † An Australian extension to the the laboratory department code. 

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Refer to HL7 Table 0123 - Result status for valid OBR Result Status entries.

HL7 Table 0123 - Result status 

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Definition: This field identifies how (or whether) to transport a patient, when applicable. Refer to HL7 Table 0124 - Transportation mode for valid codes.

HL7 Table 0124 - Transportation mode 

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Snomed-CT AU is a recommended source terminology for this field. 

ege.g. 274640006^Fever with chills (finding)^SCT

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e.g. 161156004^Language difficulty (finding)^SCT161156004 | Lang161156004 | Language difficulty (finding)uage difficulty (finding)

4.4.1.40 OBR-40 Transport arrangement responsibility (CE) 01031

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Definition: This field is an indicator of whether transport arrangements are known to have been made.

Refer to HL7 Table 0224 - Transport arranged for valid codes.

HL7 Table 0224 - Transport arranged 

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Definition: This field is an indicator that the patient needs to be escorted to the diagnostic service department. Note: The nature of the escort requirements should be stated in the OBR-43-planned patient transport comment field. See 

HL7 Table 0225 - Escort required 

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Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the Universal Service ID reported in field 4. User-defined Table 0088 - Procedure code is used as the HL7 identifier for the user-defined table of values for this field. This field is a CE data type for compatibility with clinical and ancillary systems. 

User-defined Table 0088 - Procedure code

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Definition: This field contains the procedure code modifier to the procedure code reported in field 44, when applicable. Procedure code modifiers are defined by regulatory agencies. Multiple modifiers may be reported. User-defined Table 0088 - Procedure code is used as the HL7 identifier for the user-defined table of values for this field.

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Definition: This field contains supplemental service information sent from the placer system to the filler system for the universal procedure code reported in OBR-4 Universal Service ID. This field will be used to provide ordering information detail that is not available in other, specific fields in the OBR segment. Multiple supplemental service information elements may be reported. Refer to User-defined table 0411 - Supplemental service information values for suggested values. This field can be used to describe details such as whether study is to be done on the right or left, for example where the study is of the arm and the order master file does not distinguish right from left or whether the study is to be done with or without contrast (when the order master file does not make such distinctions).

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User-defined Table 0411 - Supplemental service information values  

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Following the final atomic OBX segment are the OBX display segment(s) with the presented report. There must be at least one display segment per OBR segment and where there is more than one display type it must contain the same report detail. If there is a digital signature it will appear after the OBX display segments.

HL7 Attribute Table – OBX – Observation/Result

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All HL7 data types are valid, and are included in Table 0125 except CM, CQ, SI, and ID. For a CM definition to have meaning, the specifics about the CM must be included in the field definition. OBX-5- observation value is a general field definition that is influenced by the data type OBX-3, so CMs are undefined in this context. CQ is invalid because units for OBX-5-observation value are always specified explicitly in an OBX segment with OBX-6 units. SI is invalid because it only applied to HL7 message segments, and ID because it requires a constant field definition. The RP value (reference pointer) must be used if the actual observation value is not sent in OBX but exists somewhere else. For example, if the observation consists of an image (document or medical), the image itself may not necessarily be sent in OBX. The sending system may in that case opt to send a reference pointer. The receiving system can use this reference pointer whenever it needs access to the actual image through other interface standards, e.g., DICOM, or through appropriate servers.

HL7 Table 0125 - Value type 

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When local codes are used as the first identifier in this field we strongly encourage sending a universal identifier as well to permit receivers to equivalence results from different providers of the same service (e.g., a hospital lab and commercial lab that provides serum potassium to a nursing home). LOINC® is an HL7 approved code system for the Observation identifier. It covers observations and measurements, such as laboratory tests, physical findings, radiology studies, and claims attachments and can be obtained from loinc.org. LOINC codes, selected by the RCPA for Standards for Pathology Informatics in Australia (SPIA) reporting terminology reference sets which can be obtained at RCPA website or from the National Clinical Terminology Service.

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On occasions no code will be defined or available and only the text component of the CE will be valued. Where a coded term exists in a standard terminology then the identifer identifier and coding system name component should be valued.

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Definition: This field contains a table lookup indicating the normalcy status of the result. We strongly recommend sending this value when applicable. (See ASTM 1238 - review for more details). Refer to User-defined Table 0078 - Abnormal flags for valid entries.

When the laboratory can discern the normal status of a textual report, such as chest X-ray reports or microbiologic culture, these should be reported as N when normal and A when abnormal. Multiple codes, e.g., abnormal and worse, would be separated by a repeat delimiter, e.g., A~W.

User-defined Table 0078 - Abnormal flags 

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Definition: This field contains the nature of the abnormal test. Refer to HL7 Table 0080 - Nature of abnormal testing for valid values. As many of the codes as apply may be included, separated by repeat delimiters. For example, normal values based on age, sex, and race would be codes as A~S~R.

HL7 Table 0080 - Nature of abnormal testing 

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Definition: This field contains the observation result status.

Refer to HL7 table 0085 - Observation result status codes interpretation for valid values.

This field reflects the current completion status of the results for one Observation Identifier. It is a required field. Previous versions of HL7 stated this implicitly by defining a default value of “F.” Code F indicates that the result has been verified to be correct and final. Code W indicates that the result has been verified to be wrong (incorrect); a replacement (corrected) result may be transmitted later. Code C indicates that data contained in the OBX-5-observation value field are to replace previously transmitted (verified and) final result data with the same observation ID (including suffix, if applicable) and observation sub-ID usually because the previous results were wrong. Code D indicates that data previously transmitted in a result segment with the same observation ID (including suffix) and observation sub-ID should be deleted.

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Multiple preliminary results may be reported at different observation times. e.g. a microbiology culture.

HL7 Table 0085 - Observation result status codes interpretation 

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See conformance points section HL7au:000008.

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4.5.3 Using the HTML display Format

The html HTML format uses xhtml XHTML and the details regarding the format of the html are given in the Appendix. xHTML XHTML display data should be base64 encoded in an ED segment. The xhtml XHTML should be valid xml. Any html HTML display segment SHOULD be displayed with a compliant browser control. These are available of virtually all platforms an ensure reliable display of compliant xhtmlXHTML. When handled correctly xhtml XHTML is the most inter-operable of all formats.

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NTE segments are not used in the Australian setting but comments about individual results (A single OBX) or a report (All OBX segments under a OBR Segment) are supported by the use of OBX segments with specific LOINC codes. Result Comments are in an OBX segment immediately following the result OBX and report comments are contained in an OBX segment at the end of the report but before the display orientated OBX segments detailed in Section 4.5. The LOINC code in a Comment OBX Segment (In OBX-3) allows differentiation between result and report comments. Ideally result comments should be linked to result by use of OBX-4 Observation Sub-ID as well as the position in the message.

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When these codes are used the display of OBX-3 should be suppressed and the Value component displayed as a heading. The value component is usually of type CE (Coded Entry) or ST (String). These LOINC codes are usually used in conjunction with the OBX-4 Observation SubID to allow repetition of the codes for multiple headings and nested sections.

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This OBX segment can be omitted from the display but for systems capable of interpreting the template provides an identifier for the template that the data confirms to. Any data in the list of OBX segments under the current OBR segment that has a OBX-4 Observation SubID starting with the SubID of the Template identifier OBX is a part of the templated data.

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OBX-8 Abnormal flags should be taken into consideration and atomic results with abnormal flags SHOULD be highlighted. If colour is used, then highlighting must be achived achieved by an additional method not relying on colour to accomodate colour accommodate colour blind readers. The abnormal flags SHOULD be displayed and displayed immediately after any Numeric, Structured numeric, String or Coded data.

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The display of Free Text (FT) data SHOULD use a non proportional font to allow data of separate lines to align. This display SHOULD allow for a minimum of 80 characters before any word wrapping occurs. Free Text that is specified as able to be wordwrapped should word wrapped should be word wrapped to make it visible to the user on one screen and not be hidden off the right hand side of the screen as one line of text.

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4.9 Pathology terminology

Pathology terminology is published on the RCPA website and the National Clinical Terminology Service.

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3. Numeric results are incomplete without associated units and guidance for interpretation (eg e.g. reference intervals) and so these must always be shown with the number.

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More recently in the RCPA PITUS 15-16 working group 5 "Report modelling for safe atomic reporting to registries" have progressed FHIR artefacts which are then transported in a HL7 V2.4 message. The initial work is based on the colorectal cancer protocol and the prostate (radical prostatectomy) cancer protocol and is available at http://fhir.hl7.org.au/fhir/rcpa/index.html.

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In the OBX segments, the same LOINC code is used to indicate the item eg e.g. unit of blood or fresh frozen plasma etc, and OBX-4 Observation sub-ID is used to indicate the separate units of red cells or fresh frozen plasma etc.

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MSH|^~\&|EQUATORDXTRAY^EQUATORDXTRAY^L|Acme Pathology^1001^AUSNATA|||20150420221113+1000||ORU^R01^ORU_R01|20150420.123321|P|2.4^AUS&&ISO3166_1^HL7AU.ONO.1&&HL7AU|||AL||AUS
PID|1|...
PV1|1|O||||||01234567W^BROWN^Bill^^^DR^^^AUSHICPR^L^^^UPIN|01234567W^BROWN^Bill^^^DR^^^AUSHICPR^L^^^UPIN
ORC|RE||03-7654321-URC-0^Acme Pathology^1001^AUSNATA||CM|||||||01234567W^BROWN^Bill^^^DR^^^AUSHICPR^L^^^UPIN
OBR|1||03-7654321-URC-0^Acme Pathology^1001^AUSNATA|URC^URINE MICRO^L|||201503081300+1000|||||||201503081928+1000||01234567W^BROWN^Bill^^^DR^^^AUSHICPR^L^^^UPIN||||DR=MME,LN=03-7654323,RC=Y||201504181642+1000||MB|F||^^^201503080000+1000|01234564W^GREEN^Wilma^^^DR^^^AUSHICPR^L^^^UPIN||||Reporting Pathologist
OBX|1|ST|19159-3^Collection Method^LN||Mid stream urine||||||F|||201503082316+1000
OBX|2|ST|25428-4^Glucose^LN||Negative||||||F|||201503082350+1000
OBX|3|ST|2514-8^Ketones^LN||Negative||||||F|||201503082350+1000
OBX|4|ST|20454-5^Protein^LN||+||||||F|||201503082350+1000
OBX|5|NM|30405-5^Leucocytes^LN||40|10*6/L^10*6/L^UCUM|<10|+|||F|||201503090015+1000
OBX|6|NM|30391-7^Erythrocytes^LN||20|10*6/L^10*6/L^UCUM|<10|+|||F|||201503090015+1000
OBX|7|SN|30383-4^Epithelial cells^LN||<^10|10*6/L^10*6/L^UCUM|||||F|||201503090015+1000
OBX|8|ST|8269-3^^LN|1|Organism 1||||||F
OBX|9|CE|630-4^Bacteria Identified^LN|1|40886007^Klebsiella oxytoca^SCT|||A|||F
OBX|10|SN|19090-0^Colony Count^LN|1|>^10|||A|||F
OBX|11|ST|18864-9^Amp/Amoxycillin^LN|1|R|||R|||F
OBX|12|ST|18862-3^Amoxycillin+Clavulanic acid^LN|1|R|||R|||F
OBX|13|ST|18897-9^Cephalexin^LN|1|R|||R|||F
OBX|14|ST|18955-5^Nitrofurantoin^LN|1|R|||R|||F
OBX|15|ST|18956-3^Norfloxacin^LN|1|S|||S|||F
OBX|16|ST|18997-7^Trimethoprim^LN|1|R|||R|||F
OBX|17|ST|18928-2^Gentamicin^LN|1|S|||S|||F
OBX|18|ST|8270-1^^LN|2|Organism 2||||||F
OBX|19|CE|630-4^Bacteria Identified^LN|2|73457008^Protues mirabilis^SCT|||A|||F
OBX|20|SN|19090-0^Colony Count^LN|2|>^100|||A|||F
OBX|21|ST|18864-9^Amp/Amoxycillin^LN|2|R|||R|||F
OBX|22|ST|18862-3^Amoxycillin+Clavulanic acid^LN|2|S|||S|||F
OBX|23|ST|18897-9^Cephalexin^LN|2|S|||S|||F
OBX|24|ST|18955-5^Nitrofurantoin^LN|2|S|||S|||F
OBX|25|ST|18956-3^Norfloxacin^LN|2|S|||S|||F
OBX|26|ST|18997-7^Trimethoprim^LN|2|R|||R|||F
OBX|27|ST|18928-2^Gentamicin^LN|2|S|||S|||F
OBX|28|FT|8251-1^Generated comment^LN||\.br\May be suggestive of UTI in the presence of symptoms.\.br\||||||F

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The pathology provider will respond with the the following ORR^O02 message - ignoring the two-stage acknowledgement for this scenario: 

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In this scenario the test resulted is the same the the test ordered; hence there no combining or replacing of test codes as per scenario 1 and 2.

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A pathology provider will want to match the patient identifier to enable the provision of cumulative results which provides more information over time than just a snapshot and Medicare has rules on some tests regarding the frequency a test can be ordered over a period of a specific period of time.  The pathology results receiver will want the patient identifier to match results on a patient where the order originated from another provider eg e.g. copy to doctor, to determine if it is an existing patient or a new patient to their patient management system. It is therefore useful to the receivers of the request or the results to receive as many patient identifiers as possible.

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When an electronic request is made the order will be transmitted to the laboratory, the laboratory must respond with with a Filler Order Number: If the order contains more than one order on the same request ie i.e. same Placer Group Number then the laboratory must respond with the same number of order responses. 
The preferred response is to respond immediately to the order with an ACK message and transmit an ORR message with a Filler Order Number when the specimen is received.
An optional method is for the laboratory to hold the order and not respond until the specimen has been received by the laboratory and the lab number can be used as one part of the Filler Order Number. 

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ORC|RE||2.25.263498878813690208021966154988434320272^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN
OBR|1||2.25.263498878813690208021966154988434320272^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|18842-5^Discharge Summarization Note^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830
OBX|1|ED|18842-5^Discharge Summarization Note^LN||^application^x-hl7-cda-xdm-zip^base64^UEsDBBQ
OBX|2|ED|HTML^Display format in HTML^AUSPDI||^text^html^Base64^PD94bWwgdmVyc2lvbj0iMS4wIj8+Cjwh....
OBX|3|ED|PDF^Display in PDF Format^AUSPDI||^application^pdf^Base64^JVBERi0xLjQNCiXi48/TDQolDQol...ORC|RE||12123-1^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN

ORC|RE||12123-2^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN
OBR|3||12123-2^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52033-8^General correspondence^LN Note^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830
OBX|1|ED|52033-8^General correspondence^LN|2|^application^octet-stream^Base64^...||||||F
OBX|2|ED|PDF^Display format in PDF^AUSPDI||^application^pdf^Base64^...||||||F|||20170322

ORC|RE||12123-3^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN
OBR|4||12123-3^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52033-8^General correspondence^LN Note^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830
OBX|1|ED|PDF^Display format in PDF^AUSPDI|Supporting Letter|^application^pdf^Base64^...||||||F|||20170322
OBX|1|ED|RTF^Display format in RTF^AUSPDI|Supporting Letter|^application^rtf^Base64^...||||||F

ORC|RE||12123-4^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO||CM|||||||0191324T^MCINTYRE^ANDREW^^^^^^AUSHICPR^L^^^UPIN
OBR|5||12123-4^Good Hospital^1.2.36.1.2001.1003.0.8003629900024197^ISO|52070-0^Workers compensation^LN|||20140825103830|||||||||2671351T^Doctor^Good^^^Dr^^^AUSHICPR||||||20140825103830||PHY|F||^^^20140825103830
OBX|1|ED|PDF^Display format in PDF^AUSPDI|claimform1|^application^pdf^Base64^...||||||F|||20170322

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To refer to another document under another OBR then the OBR can be referenced using an OBX EI (Entity Identifier) with a OBX-3 Observation Identifier value of LP72255-0^Citation^LN.

ege.g. 

OBX|4|EI|LP72255-0^Citation^LN||1234^ACME Pathology^7654^AUSNATA||||||F

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