Incoming – Scenario One

MSH-3 – Sending App / RE / LIS1 - GU
MSH-4 – Sending Facility / R / Laboratory United - GU
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / MemorialPennsylvaniaHospital - GU
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.17 or
2.16.840.1.113883.9.18 or
2.16.840.1.113883.9.12 included

Accept Acknowledgement by a MemorialPennsylvaniaHospital module

MSH-3 – Sending App / RE
MSH-4 – Sending Facility / R / MemorialPennsylvaniaHospital– GU
Echoed from incoming MSH-6
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United – GU
Echoed from incoming MSH-4
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.28 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.21

OR

Accept Acknowledgement by an intermediary module

MSH-3 – Sending App / RE
MSH-4 – Sending Facility / R / Intermediary XYZ
Set by intermediary
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United – GU
Echoed from incoming MSH-4
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.28 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.21
OR (depending on uniqueness of MSH-4)
2.16.840.1.113883.9.27 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.25

Incoming - Scenario Two

MSH-3 – Sending App / RE / LIS1 – GU
MSH-4 – Sending Facility / R / Laboratory United – GU
MSH-5 – Receiving App / O / EHR1 - ??
Not covered under GU list, so unknown
MSH-6 – Receiving Facility / RE / MemorialPennsylvaniaHospital
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.17 or
2.16.840.1.113883.9.18 or
2.16.840.1.113883.9.12 included

Accept Acknowledgement by a MemorialPennsylvaniaHospital module

MSH-3 – Sending App / RE / EHR1 - ??
MSH-4 – Sending Facility / R / MemorialPennsylvaniaHospital
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.27 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.25
Since EHR1 has unknown uniqueness.

OR

Accept Acknowledgement by an intermediary module

MSH-3 – Sending App / RE / EHR1 - ??
MSH-4 – Sending Facility / R / Intermediary XYZ
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.27 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.25

Safest is to send NG back as EHR1 may or may not be globally unique. Even the presence of OID + “ISO” does not necessarily mean the identifier is fully unique.
Incoming – Scenario Three

MSH-3 – Sending App / RE / LIS1 – NG
MSH-4 – Sending Facility / R / Laboratory United – GU
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / MemorialPennsylvaniaHospital - NG
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.19 or
2.16.840.1.113883.9.20 or
2.16.840.1.113883.9.13 included

Accept Acknowledgement by a MemorialPennsylvaniaHospital module

MSH-3 – Sending App / RE
MSH-4 – Sending Facility / R / MemorialPennsylvaniaHospital-NG
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United – GU
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.27 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.25

Accept Acknowledgement by an intermediary module

MSH-3 – Sending App / RE
MSH-4 – Sending Facility / R / Intermediary XYZ - ??
MSH-5 – Receiving App / O
MSH-6 – Receiving Facility / RE / Laboratory United – GU
MSH-21 – Message Profile / R / 2.16.840.1.113883.9.27 or
2.16.840.1.113883.9.26 and 2.16.840.1.113883.9.25

Proposed re-wording of LRI-22 and LRI-23

LRI-22: MSH-21 (Message Profile Identifier) SHALL be valued with 2.16.840.1.113883.9.21 (GU_Acknowledgment_Profile) when acknowledging ORU GU Profiles where MSH-21 contains 2.16.840.1.113883.9.17 (LRI_GU_RU_Profile), or 2.16.840.1.113883.9.18 (LRI_GU_RN_Profile), or 2.16.840.1.113883.9.12 (LRI_GU_Component).

LRI-23: MSH-21 (Message Profile Identifier) SHALL be valued with 2.16.840.1.113883.9.25 (NG_Acknowledgment_Profile) when acknowledging LRI IG conformant results messagesORU NG Profiles where MSH-21 contains 2.16.840.1.113883.9.19 (LRI_NG_RU_Profile), or 2.16.840.1.113883.9.20 (LRI_NG_RN_Profile), or 2.16.840.1.113883.9.13(LRI_NG_Component).

Usage Notes:

  • When the initial results transaction uses the GU profile in MSH.21 this means that a defined set of fields, including MSH-3, MSH-4, and MSH-6, are considered globally unique by the sender. Therefore, when providing an accept acknowledgement to that result transaction and the acknowledgement uses the exact same values from MSH-3, MSH-4, and MSH-6 to populate the appropriate MSH fields in the acknowledgement and any fields under the control of the acknowledgement transaction sender are also globally unique, then MSH-21 can assert that the GU profile is used.
  • As long as MSH-3, MSH-4, and/or MSH-6 are echoed back as-is and MSH-21 indicates the use of the GU profile, it is not necessary to validate that MSH-3, MSH-4, and/or MSH-6 in fact are unique.
  • When the acknowledgement sender populates fields referenced by the GU profile without using MSH-3, MSH-4, and MSH-6 originally received then the acknowledgement sender has all the knowledge to determine whether their values are considered globally unique or not and can populate MSH-21 accordingly.