PAS Link (RIS_PD151) v1.20
PAS Link (RIS_PD151)
This document intends to define the transport protocols, message mappings and definitions for integration of CRIS with a local Patient Administration System (PAS).
Author: Healthcare Software Systems
Version: 1.20
Issue Date: 14th November 2013
Copyright 2013 Healthcare Software Systems. All Rights Reserved
These materials are or comprise restricted and proprietary confidential information of Healthcare Software Systems. Disclosure to or use by the recipient shall not convey any intellectual property rights in these materials. The right to use these materials by the recipient is subject to restrictions and limitations contained in the Provision of Integrated Care Record System and Associated Services Agreement and related agreements.
Document Control
Author / Steven Verdon / Date 29/01/2012
File Ref. / RIS_PD151_20910_PAS Spec.doc
Approval Sign-off (For formal issue)
Owner / Role / Signature / Date / Issue
Steven Verdon / Integration Services Manager
Approver / Role / Signature / Date / Issue
Dr Julia Paul / Software Developer
Review Panel
Name / Role
Nick Woods / Integration Specialist
Change History
Issue / Date / Author / Editor / Details of Change
0.1 / 10/05/05 / Alan Shields / First Draft
0.2 / 12/05/05 / Alan Shields / Changed HL7 version to 2.4
0.3 / 08/06/05 / Alan Shields / Added delete message, Patient identifiers section was incorrect, added mobile phone and email address to PID segment
0.4 / 24/06/05 / Alan Shields / Added an example to better explain patient identifiers
0.5 / 07/07/05 / Alan Shields / Added extract format section (Initial Data Upload)
0.6 / 23/07/05 / Alan Shields / Added ADT^A05 message
0.7 / 13/10/05 / Alan Shields / Added field sizes and reorganized segment definitions.
0.8 / 30/11/05 / Alan Shields / Fixed reference to delete message – was ADTR
0.9 / 07/01/06 / Alan Shields / Removed erroneous reference to outbound demographic messages.
1.0 / 12/05/2006 / Ian Judd / Fixed Typos
1.1 / 07/11/2006 / Steven Verdon / Removal of NHS number clarification
1.2 / 08/11/2006 / Steven Verdon / Clarification of ID’s in PMI extract
1.3 / 08/11/2006 / Steven Verdon / Clarify DOB/DOD requirements.
1.4 / 09/11/2006 / Steven Verdon / Title, Additional detail added. Note added about partial PMI loads and merges.
1.5 / 27/11/2006 / Alan Shields / Added comments to ADT^A40, ADT^A01, ADT^A02,ADT^A03 & ADT^A05 messages to make it clear that these messages do not update or create patients. Added further comments to ADT^A01 and ADT^A02 to make it clear that ward, referrer and date are required.
1.6 / 29/01/2007 / Alan Shields / Added application level acknowledgements. Added SIU^S12 & SIU^S13 messages.
Repaired incorrectly “fixed typos”.
Added SIU^S12 & SIU^S13 messages.
Added Registration & Update messaging.
1.7 / 16/03/2007 / Alan Shields / Added OBX segment to outbound ADT^A08 messages to indicate changed fields.
1.8 / 30/06/2010 / Matt Stevenson / Added support for ADT^A60 messages, as well as AL1 segments.
1.9 / 28/07/2010 / Gary Glover / PAS Unlink message (ADT^A37) stored to log.
1.10 / 23/09/2010 / Mark Warren / NK1 Segment added to inbound.
1.11 / 29/09/2010 / Chris King / Patient title standard codes added
1.12 / 11/11/2010 / Neil Twist / Home Address documentation added
1.13 / 15/11/2010 / Matt Stevenson / AL1 detail re-added.
1.14 / 07/03/2011 / Julia Paul / PD1:4 changes detailed.
1.15 / 29/01/2012 / Steven Verdon / Title version corrected
Removed 0604g reference (1.1)
NK1 DOB field wrong (8.14)
Minor tidy up of PID layout (8.6)
1.16 / 22/08/2012 / Steven Verdon / NK1 fields incorrect except DOB (8.14)
Removed Title from NK1 as we do not store it
Updated review panel
1.17 / 03/09/2012 / Steven Verdon / NK1 is sent for ADT^A04 and ADT^A08
1.18 / 06/11/2012 / Steven Verdon / Inaccuracies for Allergy data in the AL1 and IAM segments
1.19 / 18/04/2013 / Steven Verdon / Document review
1.20 / 14/11/2013 / Steven Verdon / Message Control ID (section 9) definition revised
Contents
1 Introduction 6
1.1 Purpose 6
1.2 Audience 6
2 Implementation Model 7
2.1 Overview 7
2.2 Application Data Flow 7
3 HL7 version 8
4 Message & Activity Mapping – PAS to CRIS 9
4.1 Register a new patient 9
4.2 Update existing patient 9
4.3 Deceased Patient 9
4.4 Merging Patients 9
4.5 Delete a Patient 9
4.6 Patient Admission 9
4.7 Patient Transfer 9
4.8 Patient Discharge 10
4.9 Patient Pre Admit 10
4.10 Schedule Patient 10
4.11 Patient Alarms 10
4.12 PAS Unlink Message (ADT^A37) 10
5 Message & Activity Mapping – CRIS to PAS 11
5.1 Register a new patient 11
5.2 Update existing patient 11
5.3 Merge patients 12
6 Message Transport 13
6.1 Connections 13
6.2 Transport level Acknowledgements 13
6.3 Application level Acknowledgements 13
6.4 Framing Characters 13
7 Error Handling 14
8 Data Mappings – Inbound messages 15
8.1 Patient Identifiers 15
8.2 Null values 16
8.3 Segment mappings 16
8.4 MSH 16
8.5 EVN 16
8.6 PID 16
8.7 AL1 18
8.8 IAM 18
8.9 PV1 19
8.10 PD1 19
8.11 SCH 19
8.12 ACK 19
8.13 MRG 20
8.14 NK1 20
9 Data Mappings – Outbound messages 22
9.1 MSH 22
9.2 MSA 22
9.3 EVN 23
9.4 PID 23
9.5 PD1 24
9.6 OBX 24
10 Initial Data Upload 26
11 Standard Coding Tables 28
11.1 Patient Title 28
1 Introduction
1.1 Purpose
This document intends to define the transport protocols, message mappings and definitions for integration of CRIS with a local Patient Administration System (PAS).
This version of the specification applies to CRIS interface release 2.09.10k.
1.2 Audience
This document is intended for system integrators, third party suppliers and potential customers. The reader is assumed to be familiar with the HL7 standard.
2 Implementation Model
2.1 Overview
CRIS maintains a mirror view of the PAS patient data base which is used to serve search requests of the PAS from within radiology. This view is kept up to date with the data received in HL7 ADT type messages.
2.2 Application Data Flow
CRIS receives HL7 messages over TCP/IP via the HL7 Minimal Lower Layer Protocol. Updates are applied to the PAS mirror database and where appropriate to matching records in the CRIS database.
CRIS may optionally be configured to send application level acknowledgements as incoming messages are processed, in which case these will be sent over TCP/IP again via HL7 MLLP to the PAS system.
CRIS may also be configured to send patient updates to PAS in response to changes made by CRIS users and also patient registrations.
Many sites may wish to make use of an integration engine, in which case as far as CRIS is concerned the integration engine is the PAS.
3 HL7 version
All messages referenced in this document conform to the 2.4 version of the HL7 standard. Message transport is HL7 MLLP over TCP/IP.
4 Message & Activity Mapping – PAS to CRIS
4.1 Register a new patient
When the details of a new patient are added to PAS it should send either an ADT^A04 or an ADT^A28 message.
4.2 Update existing patient
When an existing patient’s demographic details are updated on PAS it should send either an ADT^A31 or ADT^A08 message.
4.3 Deceased Patient
When a patient is identified as being deceased on PAS it should send either an ADT^A31 or ADT^A08 message with the date of death field populated in the PID segment. In case of patients mistakenly recorded as deceased CRIS supports the practice of subsequent ADT^A31/A08 messages being sent with the date of death set to null.
4.4 Merging Patients
When the details of two patient records are found to refer to the same patient the records are merged on PAS, PAS should send an ADT^A40 message. In cases where the demographic details of the destination record have been changed this should be communicated in a separate ADT_A08 or ADT_A31 message.
It is not possible to either register or update a patient’s demographics details with an ADT^A40 message.
4.5 Delete a Patient
When a patient is deleted (usually for administrative reasons) PAS should send an ADT^A29 message.
4.6 Patient Admission
When a patient is admitted, PAS should send an ADT^A01 message. CRIS uses this message to maintain a record of the last known ward and consultant for a patient. There is no episodic history held on CRIS and cancel admission is not supported.
The ward, consultant and date fields need to be present.
It is not possible to either register or update a patient’s demographics details with an ADT^A01 message.
4.7 Patient Transfer
When a patient is transferred between ward and/or consultant PAS should send an ADT^A02 message. CRIS uses this message to maintain a record of the last known ward and consultant for a patient. There is no episodic history held on CRIS and cancel transfer is not supported.
The ward, consultant and date fields need to be present.
It is not possible to either register or update a patient’s demographics details with an ADT^A02 message.
4.8 Patient Discharge
When a patient is discharged PAS should send an ADT^A03 message. CRIS uses this message to maintain a record of the last known ward and consultant for a patient. There is no episodic history held on CRIS and cancel discharge is not supported.
It is not possible to either register or update a patient’s demographics details with an ADT^A03 message.
4.9 Patient Pre Admit
When a patient is pre-admitted PAS should send an ADT^A05 message. This message will then be forwarded on to PACS for use by the pre fetching system.
It is not possible to either register or update a patient’s demographics details with an ADT^A05 message.
4.10 Schedule Patient
When a patient has an appointment booked PAS may send an SIU^S12 or SIU^S13 (schedule) message. This message will then be forwarded on to PACS for use by the pre fetching system. This message triggers the same functionality on CRIS and PACS as the patient pre admit message.
4.11 Patient Alarms
To update alarms for a patient, PAS should send an ADT^A60 message. CRIS uses this message to maintain a record of alarms added to a patient externally from within CRIS.
It is not possible to either register or update a patient’s demographic details with an ADT^A60 message.
4.12 PAS Unlink Message (ADT^A37)
Some PAS’ can send unlink messages. (A37)
HSS would not consider automatic unmerges to be a safe thing to do in a shared RIS/PAS environment. However, to give the RIS administrators visibility of unmerges performed on PAS the A37 message will flag in the logs when an unmerge has been received.
This way the RIS administrators will know that they have some remedial work to do. It is important to know that CRIS will not make any changes, only log the receipt of the message.
5 Message & Activity Mapping – CRIS to PAS
5.1 Register a new patient
When either the details of a new patient are added to CRIS or a patient is updated that does not currently exist within the CRIS PAS mirror, CRIS will send an ADT^A04 message. In addition to NHS number and any known hospital numbers the PID:3 field will contain the following identifiers.
Assigning authority / Identifier Type Code / DescriptionCRIS / PI / Uniquely identifies the patient on CRIS
CRISPASLINK / PI / Uniquely identifies the message being sent from CRIS. This field is populated with the message control ID from MSH:10 encoded in base 64 in order to reduce the width of the field required for external systems to process it.
In the case of an unsuccessful registration PAS should send either:
a) An A04 with the original “CRISPASLINK” value in PID:3 but without a PAS primary ID, and with an error message in EVN:4
b) An ACK with MSA:1 containing the value “AE”, MSA:2 containing the message control ID of the registration message sent by CRIS and MSA:6^2 containing an error message
In the case of a successful registration PAS may send either:
a) An A04 with PID:3 containing the original “CRISPASLINK” value supplied by CRIS along with the newly registered patients PAS primary ID. Warning messages indicating some problem with the demographics details may be passed in EVN:4. If other demographic information is supplied CRIS will update its database to match.
b) An ACK with MSA:1 containing the value “AA” and MSA:2 containing the message control ID from the original A04 sent by CRIS. MSA:3 should contain the newly allocated patient identifier. Note that this message is NOT suitable if the patient identifier is a hospital number.
5.2 Update existing patient
When an existing patient’s demographic details are updated on CRIS and the record already exists in within the CRIS PAS mirror, CRIS will send an ADT^A08 message. The update message will contain the CRIS and CRISPASLINK identifiers as described for the ADT^A04 message.
In the case of an error situation PAS may send one of:
a) An A08 with the original “CRISPASLINK” value in PID:3 and an error message in EVN:4. If the PAS primary ID is also supplied and the message contains demographic details CRIS will update it’s database to match.
b) An ACK with MSA:1 containing the value “AE”, MSA:2 containing the message control ID from the original A08 sent by CRIS and MSA:6^2 containing an error message.
In the case of a successful update PAS may send either:
a) An A08 with the original “CRISPASLINK” value in PID:3. If the PAS primary ID is also supplied and the message contains demographic details CRIS will update its database to match.
b) An ACK with MSA:1 containing the value “AA” and MSA:2 containing the message control ID from the original A08 sent by CRIS. If a message is present in MSA:6^2 it will be logged against the original transmitted event.
5.3 Merge patients
Merges of patients performed on CRIS will not be propagated to PAS.
6 Message Transport
All Messages are transmitted over TCP/IP using MLLP.
6.1 Connections
One socket connection is used for messages originating from each system. The port numbers to be used will be decided by mutual agreement. For messages from PAS, CRIS will act as a server listening for connections and PAS will initiate the connection as a client. For messages from CRIS, PAS will act as server listening for connections and CRIS will initiate the connection as client.