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RIS_PD163_CRIS_

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Contents

1 Introduction......................................................................................................41.1. Purpose.......................................................................................................................................4

1.2. Audience.....................................................................................................................................4

2 Implementation Model.....................................................................................52.1. Overview.....................................................................................................................................5

2.2. Application Data Flow.................................................................................................................5

2.3. HL7 version.................................................................................................................................5

3 Message and Activity mapping......................................................................63.1. Find CRIS Patient ID...................................................................................................................6

3.2. Retrieve CRIS event details........................................................................................................6

3.3. Create / update an attendance....................................................................................................6

3.4. Create / Update a report.............................................................................................................7

3.5. IEP Sending................................................................................................................................7

4 Message Transport..........................................................................................84.1 Connections...................................................................................................................................8

4.2 Transport level Acknowledgements...............................................................................................8

4.3 Framing Characters........................................................................................................................8

5 Error handling..................................................................................................96 Data Mappings - General..............................................................................10

6.1 Patient Identifiers..........................................................................................................................10

6.2 Time Stamp values.......................................................................................................................10

7 Data Mappings – In bound results...............................................................117.1 ORU^R01 Result..........................................................................................................................11

7.2 ACK^R01 Acknowledgement.......................................................................................................12

8 Data Mappings – Inbound events.................................................................148.1 OMGÔ19 Order..........................................................................................................................14

8.2 ORGÔ20 Order Acknowledgement............................................................................................16

9 Data Mappings – Inbound IEP......................................................................209.1 OMGÔ19 Order..........................................................................................................................20

9.2 Field mappings.............................................................................................................................20

10 Data Mappings – Patient Query..................................................................22


10.1 QRY^Q01 Query.......................................................................................................................22

10.2 DSR^Q01 Query Response......................................................................................................23

11 QBP^Z01 Event Query conformance statement.......................................2511.1 Overview...................................................................................................................................25

11.2 Query Grammar........................................................................................................................25

11.3 Response Grammar..................................................................................................................26

12 QBP^Z02 Patient Query conformance statement.....................................3212.1 Overview...................................................................................................................................32

12.2 Query Grammar........................................................................................................................32

12.3 Response Grammar..................................................................................................................33

13 Sample Messages........................................................................................3613.1 Results inbound........................................................................................................................36

14 Configuration Questionnaire......................................................................37


1 Introduction1.1. Purpose

This document intends to define the transport protocols, message mappings and definitions for integration of CRIS with another system for the purpose receiving radiological results and or event details via HL7.

The functionality described in this document may be used in conjunction with the HL7 outbound interface document as a solution for several requirements such as:

a) Inbound results feed to receive results from an imaging contractor for events previously booked on CRIS. Typically the HL7 Outbound feed would be used to deliver patient and order details to the external system which would deliver result messages in return.

b) Inbound Result and Event Feed to receive details of events that have been performed at another hospital. The external system would use the patient query functionality to identify the patient, and then send order messages followed by result messages.

c) Integration with an external scheduling system. The external system would send order messages to create and update events. Changes, status updates and results would be returned by the HL7 outbound interface.

This version of the specification applies to CRIS interface release 2.09.10t1b.

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

The remote system sends HL7 messages in order to create or update events and results. As each incoming message is processed by CRIS an application layer acknowledgement is generated and returned to the sending system.

2.2. Application Data Flow

Messages flow from the remote system to CRIS. Application level acknowledgements flow from CRIS to the remote system. All messages are transmitted over TCP/IP using HL7 MLLP.

2.3. 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.


3 Message and Activity mapping


3.1. Find CRIS Patient IDGiven an NHS number the CRIS identifier of a patient may be determined by sending a QRY^Q01 message. CRIS will respond with a DSR^Q01 containing the CRIS patient id.Alternatively a QBP^Z02 message may be sent which CRIS will respond to with an RSP^Z02 containing the demographic details and patient identifiers known on CRIS.

The QBP^Z02 message may be sent with a) NHS Numberb) Hospital Numberc) CRIS Numberd) Patients surname, forenames, DOB and gender

For QBP^Z02 messages, if ExactNHSMatch is set to true then an NHS search will only return the patient if there is a match with the surname, forenames, DOB and gender sent in the message. It will search for PAS patients and for CRIS only patients with a local event as determined by LocalSitesForQuery.

3.2. Retrieve CRIS event detailsGiven either an accession number or CRIS exam key the order and result details may be queried by sending a QBP^Z01 message. CRIS will respond to this with an RSP^Z01 message containing the order and report details.

3.3. Create / update an attendanceIf the remote system has details for an externally ordered and processed attendance it may send an OMG^O19 message to CRIS. CRIS will return an ORG^O20 message in response containing the CRIS exam key.

The remote system may also update the status of an existing attendance from SC -scheduled to IP – in progress.

This functionality is currently intended for use with two different types of application. These are not mutually exclusive and may be combined on one CRIS system.

External Booking of CRIS attendances / AppointmentsIn this application an external system manages booking of all CRIS attendances and appointments.Each Order message will contain the patient ID from the local PAS system. The processing on CRIS is as follows

1. The CRIS orders table is checked for the order ID in case we have received a duplicate message.

2. The PAS patient record referenced in the order is checked for a link to the CRIS database.

3. If a link does not exist a new CRIS patient record is created from the PAS details and linked to the PAS record

4. The order is stored as an event / exam directly on CRIS.

5. The order is also stored as an accepted order against the PAS record.

Import of attendances from another trust


In this application the external system receives attendance and image details from another trust which it needs to deliver to CRIS and PACS. The processing is as follows.

1. If the external system holds an NHS number it sends a query message to CRIS which will respond with the CRIS ID if found.

2. The external system sends an order containing NHS number and CRIS number if known.

3. If the CRIS number is not present on the order CRIS will again attempt to find the patient by NHS number (if present) on both the CRIS and PAS databases. If the patient is found just on the PAS database CRIS will register the patient on CRIS. If ExactNHSMatch is true the patient will only be matched if all demographic details match and a CRIS only patient must have a local event.

4. If the patient is still not identified CRIS will attempt to find the patient based on an exact match of surname, forenames, DOB and postcode.

5. If the patient is still not found a new patient will be registered based on the details in the PID segment.

6. The order is stored as an event / exam directly on CRIS.

7. An order message is sent to the PACS

3.4. Create / Update a reportWhen the remote system has report data it sends an ORU^R01 message to CRIS. CRIS creates and updates report data as necessary.The report message should reference a CRIS exam key which will either have been obtained from the acknowledgement of a previously sent attendance or in the case of an attendance booked directly on CRIS from an order message sent out by CRIS.Once a report has been marked as final it may only be updated with a report marked as changed.

3.5. IEP SendingWhen an event is sent from a remote system via IEP, an OMG^O19 is received by CRIS. CRIS creates or updates the event as appropriate.

A report may or may not be sent as part of the message and each message will have a send reason to inform the receiving system of why the message was sent.


4 Message Transport All Messages are transmitted over TCP/IP using MLLP.

4.1 ConnectionsOne socket connection is used for messages originating from the remote system. A further socket connection is used for application level acknowledgement messages from CRIS. The port numbers to be used will be decided by mutual agreement. The system sending the message will initiate the connection (The remote system will initiate the connection for report/order/query messages, CRIS will initiate the connection for application level acknowledgements).

4.2 Transport level AcknowledgementsEach message will be acknowledged by the receiving system prior to delivery of the next message. Messages that are NAK’d will by logged by CRIS and should also be logged by the receiving system.

4.3 Framing CharactersStandard HL7 MLLP framing characters will be used, these are

<0B> start of message<1C> end of message

In addition MLLP requires that each message be followed by the segment delimiter which is carriage return <0D>


5 Error handlingCRIS logs errors that are encountered when generating and processing messages as well as any error messages in the MSA segments received in response to outbound messages. It is expected that the connected system will also maintain its own logs.


6 Data Mappings - General6.1 Patient IdentifiersWhere required patient identifiers should be present in the PID:3 field. Each identifier should have an assigning authority and an identifier type code present. The following table shows the expected assigning authority and identifier type codes for various patient identifiers.

Patient Identifier Assigning Authority Identifier Type Code

CRIS number. This is the internal primary key for patients held on CRIS.

CRIS PI

NHS Number. NHS NHCHI Number. This is the community health index number used in Scotland.

CHI NH

Trust wide patient identifier Three letter NACS code identifying the trust.

MR

Hospital/Casenote number Five letter NACS code identifying the hospital.

MR

Internal primary key for another system. Code to identify the system.

PI

6.2 Time Stamp valuesCRIS generally requires time stamps be precise at least to the minute. However if a timestamp containing only the date is received the time will be assumed to be midnight.


7 Data Mappings – In bound results

7.1 ORU^R01 ResultThis message is sent by the remote system when a report is available. It should contain the following segments:

MSH PID (Optional – depending upon configuration) ORC OBR (Optional) OBX (Multiple)

MSHPosition Name Notes1 Field Separator Should be Populated with “|”. CRIS does not support the use of

non-standard field separators.2 Encoding Characters Should Populated with “^~\&”. CRIS does not support the use of

non-standard field separators9 Message Type Should be set to “ORU^R01”10 Message Control ID This value will be returned in the acknowledgement message.

12 Version ID Should be set to “2.4”

PID PID is required if CRIS is configured to check that order exists on CRIS for the specified patient.Position Name Notes3 Patient ID (Internal ID) Should contain the CRIS patient ID with an assigning authority

of “CRIS” and an identifier type code of “PI”. This is only required if CRIS is configured to check that the received order id is attached to the specified patient.

ORCPosition Name Notes2 Placer Order Number One of these fields should contain the CRIS exam key of the

study being reported. By default CRIS will use ORC:3 – Filler order number. However for some applications it may seem to make more sense to use Placer order number in which case CRIS may be configured to use this field instead.

3 Filler Order Number


OBRPosition Name Notes32 Principal Result Interpreter Name should identify the radiologist responsible for the

report. If this is not provided CRIS will insert a default value of “EXTERNAL” which may also be overridden at configuration time.

The radiologist identified should exist in the CRIS radiologist table.

Start Date/Time should contain the date and time that the report was created. If this is not present the date and time of observation from the OBX segment(s) is used.

33 Assistant Result Interpreter Name should identify the radiologist responsible for the report. If this is not provided CRIS leave this field blank, however a default may be provided at configuration time.

The radiologist identified should exist in the CRIS radiologist table.

35 Transcriptionist Start Date/Time should contain the date and time that the report was typed. If this is not present the date and time of observation from the OBX segment(s) is used.

OBXOBX contains the report text and should be present on ORU^R01 messages. The remote system may choose to send multiple OBX segments (in which case each segment implies a line feed terminator) or a single segment.The text may contain HL7 line break sequences (\.br\).CRIS has no limit to line length, long lines are wrapped on the display and represented as paragraphs.Position Name Notes2 Value Type Should be TX3 Observation Identifier May be used to specify the type of report. Expected values are

“REPORT” – Normal report for an examination“SUMMARY” – Summary report for the whole attendance.If this field is not populated or none of the above values are present CRIS will assume a value of “REPORT”

5 Observation Value Report Text11 Observation Result Status If set to “F” or “C” the report is marked as verified. Otherwise

the report is marked as provisional.If a verified report already exists on CRIS for this examination the report message will be rejected unless this field is set to “C”.CRIS will prefix changed reports with the text “THIS REPORT HAS BEEN CHANGED”

14 Date/Time of the observation

Should specify when the report was created. If the date/time values specified above in OBR are not present this value is used instead. If this value is also blank today’s date is used.


7.2 ACK^R01 AcknowledgementThis message is sent by CRIS in response to ORU^R01 messages. It will contain the following segments:

MSH MSA

MSHPosition Name Notes1 Field Separator Always Populated with “|”2 Encoding Characters Always Populated with “^~\&”3 Sending Application Defaults to “CRIS” may be configured to send any fixed value.4 Sending Facility Defaults to “LIVE” may be configured to send any fixed value.5 Receiving Application Default is empty, may be configured to send any fixed value.6 Receiving Facility Default is empty, may be configured to send any fixed value.7 Date Time of Message Populated with the date and time that the message was

generated. Century, year, month, day, hour, minute, second, millisecond and time zone offset are all present.

9 Message Type Set to “ACK^R01”10 Message Control ID Populated with a unique id for the message. This is generated by

taking the unique id of the inbound message and adding the prefix “RESPONSE”

11 Processing ID Set to “P”12 Version ID Set to “2.4”

MSAPosition Name Notes1 Acknowledgement Code Set to “AE” for error responses where the incoming message failed

to be processed. Set to “AA” for success responses.

2 Message Control ID The message control ID of the message being responded to.

3 Text Message Contains further information regarding processing of the message. Typically this will be the reason that a message was rejected or (for a successful message) blank.


8 Data Mappings – Inbound events8.1 OMG^O19 OrderThis message is sent by the remote system to add an attendance directly to CRIS. It should contain the following segments:

MSH PID ORC OBR OBX (Optional, Multiple)



non-standard field separators9 Message Type Should be set to “OMG^O19”10 Message Control ID This value will be returned in the acknowledgement message.


PID Position Name Notes3 Patient ID (Internal ID) Should identify the patient that the event is to be attached to.

If a CRIS ID is known this field should contain the CRIS patient ID with an assigning authority of “CRIS” and an identifier type code of “PI”.

If a PAS unique ID is known this field should contain the PAS id with an appropriate assigning authority and identifier type code. This functionality requires CRIS to be configured in advance with the assigning authority to be used.

ORCPosition Name Max

WidthUsage


1 Order Control 2 Identifies the type of order message. Possible values are“NW” New Order“CA” Cancel Order“XC” Change Order“SC” Status Change

2 Placer Order Number 30 Unique order ID allocated by the sending system. This field is required for New order messages.

By default CRIS does not persist this value and it is merely returned in the OMG^O20 response message. However CRIS may optionally be configured to persist this value as an order id.

Only <Entity Identifier> is used.3 Filler Order Number 10 Unique order ID allocated by CRIS. Unless CRIS has been

configured to persist the placer order number this field should be populated on all order change or cancel messages. For New order messages it should be blank.

5 Order Status 2 Status of the event.CRIS accepts the following three status codesSC – Scheduled, used for an appointment.IP – In progress. Used when the patient attends.CM – Completed. Used for delivering historical attendance data collected on an external system.

12 Ordering Provider 15 The clinician responsible for entering the request, this field maps to the referrer field on CRIS. Only <id number> is used.

13 Enterers Location 15 This maps to the ward field on CRIS. Only <point of care> is used.

17 Entering Organization

8 <identifier> should contain the specialty of the ordering clinician.

19 Action By Should identify the person who initiated the event that triggered this message, In the case of a NW order this would be the same person identified in ORC:10, in the case of a CA it would be the person who cancelled the order. CRIS does not currently make use of this field

21 Ordering facility Name

9 <id number> should contain the code identifying the hospital / gp practice etc that the request was made from. In the case of a ward request CRIS can default this value based on the ward code.

OBRPosition Name Max

WidthUsage

4 Universal Service ID 8 The examination being requested. Only <identifier> is used.


20 Filler Field 1 20 Accession Number. If present on a new order the accession number of the created exam will be set to this value, otherwise CRIS will generate an accession number.

27 Quantity/Timing 26 <start date/time> should contain the date and time the examination is required. <priority> should contain the priority of the order, this component may need translation.

30 Transportation Mode 1 Transportation mode for this patient.This field may require translation, refer the CRIS installation on site for actual values.

OBXPosition Name Max

WidthUsage

2 Value Type 2 TX or ED – see note below on images3 Observation Identifier 30 See table below

5 Observation Value 8 Dependant on observation value – see below.

The following observation identifiers are recognized by CRISID Max

WidthDescription

LMP 8 Date of patients last menstrual period, this should be in the format dd-mm-yyyy

PREGNANT 1 Whether or not the patient may be pregnant, values should be Y,N or blank

CATEGORY 1 Request category, If this is not supplied CRIS will default the value based on the ward code

SITE 5 Site the order is to be performed at, If this is not supplied CRIS will default the value based on the ward code or from the MSH:Receiving Facility field.

ImagesImages and other documents may be sent to CRIS by including them as OBX segments with a value type of ED. The image is stored within the standard CRIS AVData format used for request cards. The elements of the OBX segment are treated as followsObservation Identifier <Identifier> should contain the data type – eg

REQCARD for request cardObervation Value <Data Sub Type> should the encoding of the

document being delivered – e.g. JPEG<Data> Should contain the data for the document encoded as Base 64

8.2 ORG^O20 Order AcknowledgementThis message is sent by CRIS in response to the OMG^O19 message. It will contain the following segments:

MSH MSA


PID ORC OBR

MSHPosition Name Notes

1 Field Separator Always Populated with “|”2 Encoding Characters Always Populated with “^~\&”3 Sending Application Defaults to “CRIS” may be configured to send any fixed value.4 Sending Facility Defaults to “LIVE” may be configured to send any fixed value.5 Receiving Application Default is empty, may be configured to send any fixed value.6 Receiving Facility Default is empty, may be configured to send any fixed value.7 Date Time of Message Populated with the date and time that the message was generated.

Century, year, month, day, hour, minute, second, millisecond and time zone offset are all present.

9 Message Type Set to “ORG^O20”10 Message Control ID Populated with a unique id for the message. This is generated by

taking the unique id of the inbound message and adding the prefix “RESPONSE”


MSAPosition Name Max

WidthUsage

1 Acknowledgement Code

2 Will be set to Either “AA” (Application accept) or “AE” (Application error) depending upon the success or failure of the message being responded to.

2 Message Control ID 20 The ID of the order message being responded to

PIDThe transmitted PID segment will be a copy of the PID segment received in the OMG^O19 message.

ORCPosition Name Max

WidthNotes

1 Order Control 2 Populated according to order control and status summary table above.

2 Placer Order Number 30 Contains the placer order number received in the original new order message. In unsolicited result messages this field will be blank.

3 Filler Order Number 10 Contains the CRIS allocated order id.

5 Order status 2 Populated according to order control and status summary table above.

7 Quantity/Timing 26 <start date/time> will, for orders that have status “SC”, contain © Healthcare Software Solutions 2015 All Rights Reserved Commercial In ConfidenceEffective Date – SJV 09/10/2006HSS Doc ref: document.docx of 41

the date and time that the examination is booked for, for orders with a status of “IP” and clinical results it will contain the date and time that the examination was done.

<priority> will contain the priority of the order, this component may need translation.

9 Date Time of transaction

26 Date and time of the user action on CRIS that resulted in this message.

10 Entered By The user on CRIS that entered the order/status/result.10.1 ID Number 10 populated with the ID of the user20.2 Family Name 40 populated with the users name12 Ordering Provider 15 <id number> is populated with the code identifying the referrer

on CRIS13 Enterers location 15 <point of care> is populated with the code identifying the

ward/location on CRIS

OBRPosition Name Max

WidthNotes

2 Placer Order Number 30 Contains the placer order number received in the original new order message. In unsolicited result messages this field will be blank.This field contains the same value as ORC:2

3 Filler Order Number 10 Contains the CRIS allocated order id.This field contains the same value as ORC:3

4 Universal Service ID 8 <identifier> contains the examination procedure code from CRIS

20 Filler Field 1 40 CRIS generated event key. The external system may use this field to identify which orders have been performed as a single attendance.

21 Filler Field 2 40 CRIS generated Accession Number, this field is used by PACS systems to identify the examination. The external system may find this value useful if it needs to interface to PACS in order to view images.

22 Result rpt status changeDate/time

26 Populated on report messages onlyThis will contain the date and time that the report was typed, verified or changed (depending on result status)

24 Diagnostic Serv Sect ID 1 Populated with the modality of the examination.27 Quantity/Timing 26 <start date/time> will, for orders that have status “SC”,

contain the date and time that the examination is booked for, for orders with a status of “IP” and clinical results it will contain the date and time that the examination was done.

<priority> will contain the priority of the order, this component may need translation.This field contains the same value as ORC:7

32 Principal ResultInterpreter

Populated on report messages only


32.1.1 Name.ID 10 <id number> of <name> contains the id of the first radiologist.

32.2 Start Date/Time 26 <start date/time> contains the date & time the report was created.

33 Assistant ResultInterpreter

Populated on report messages only

33.1.1 Name.ID 10 <id number> of <name> contains the id of the second radiologist.

34 Technician Populated on status change status “CM” messages only

34.1.1 Name.ID 10 <id number> of <name> contains the id of the radiographer that performed the procedure

34.2 Start Date/Time 26 <start date/time> contains the date and time the procedure was performed

34.5 Room 6 <room> contains a code identifying the xray room where the procedure was performed,

34.7 Facility 5 <facility> contains a code identifying the hospital at which the procedure was performed

35 Transcriptionist Populated on report messages only35.1.1 Name.ID 10 <id number> of <name> contains the id of the person that

typed the report.35.2 Start Date/Time 26 <start date/time> contains the date & time the report was

typed.


9 Data Mappings – Inbound IEP

9.1 OMG^O19 OrderThis message is sent by the remote system via IEP. It should contain the following segments:

MSH PID ORC OBR OBX (Optional, Multiple)

These segments with be the same as those described for the OMG^O19 messages in Subsection 8.1.

The following observation identifiers are recognized by CRIS in addition to those described in Subsection 8.1.ID Value

TypeObservation Value

SND_REASON_CD CE <identifier>, <text> are reason code, reason respectively and will be one of the following:SRMDT, Sent: MDTSRREP, Sent: ReportingSRRFY, Sent: Reference onlySRRFN, Sent: Ref only, no imagesSRARFY, Sent: Reference only (auto)SRARFN, Sent: Ref only,no images(auto)SRRES, Sent: Reported<name of coding system> will be “CRIS3”.

SND_REASON_NTE TX Free text note, optionally added when selecting a send reason.

STUDY UID TX Study UID, if it exists.EVENT_SUMMARY TX Summary of the event and status history.REASON TX Reason for exam text field from the information field on the Event Info

tab.HISTORY TX Clinical history text field from the information field on the Event Info

tab.COMMENT TX Event comment text field from the information field on the Event Info

tab.SAFETYQ TX Clinical safety questions text field from the information field on the

Event Info tab.SUMMARY TX Text of summary report.EXAM CODE TX Text of report for this exam.SITE TX Site the event was sent from. Will be the site code with ‘EXT’

appended to the start.


9.2 Field mappingsBefore the CRIS system starts processing a message, the following mappings take place.

ORCPosition Field information Change12 Ordering Provider (referrer) Old value mapped to “EXTERNAL”

13 Enterers Location (ward) Old value mapped to “EXTERNAL”

OBRPosition Field information Change20 Accession Number Field mapped to the value of field 21 in order for the correct

accession number to be accessible.32 Principal Result

Interpreter (principal radiologist)

Old value mapped to “EXTERNAL”

33 Assistant ResultInterpreter (assistant radiologist)

Old value mapped to “EXTERNAL”

34 Technician Old value mapped to “EXTERNAL”35 Transcriptionist Old value mapped to “EXTERNAL”


10 Data Mappings – Patient Query

10.1 QRY^Q01 QueryPlease note that this query duplicates some of the functionality provided in the QBP^Z02 message which is more flexible and discussed in the next chapter.

This message is sent by the remote system in order to query the CRIS patient identifier for a patient identified by NHS number. It should contain the following segments

MSH QRD



non-standard field separators9 Message Type Should be set to “QRY^Q01”10 Message Control ID This value will be returned in the acknowledgement message.


QRD

Position Name Notes4 Query ID This field is not required by CRIS, however if present it will be

returned in the response message.8 Who subject filter This field may contain multiple values,

One of the values should be as follows:ID Number should contain the traced NHS number of the patient being searched.Assigning Authority should be “NHS”Identifier Type Code should be “NH”

All other search criteria will be ignored.


10.2 DSR^Q01 Query ResponseThis message is sent by CRIS in response to the QRY^Q01 message. It will contain the following segments:

MSH MSA QRD QAK DSP

MSH

Position Name Notes1 Field Separator Always Populated with “|”2 Encoding Characters Always Populated with “^~\&”3 Sending Application Defaults to “CRIS” may be configured to send any fixed value.4 Sending Facility Defaults to “LIVE” may be configured to send any fixed value.5 Receiving Application Default is empty, may be configured to send any fixed value.6 Receiving Facility Default is empty, may be configured to send any fixed value.7 Date Time of Message Populated with the date and time that the message was generated.

Century, year, month, day, hour, minute, second, millisecond and time zone offset are all present.

9 Message Type The type of the message. CRIS sends the messagesACK^R01DSR^Q01ORG^O20

10 Message Control ID Populated with a unique id for the message. This is generated by taking the unique id of the inbound message and adding the prefix “RESPONSE”


MSA

Position Name Notes1 Acknowledgement Code Set to “AE” for error responses where the incoming message

failed to be processed. Set to “AA” for success responses.

2 Message Control ID The message control ID of the message being responded to.

3 Text Message Contains further information regarding processing of the message. Typically this will be the reason that a message was rejected or (for a successful message) blank.


QRDQRD will be a copy of the QRD segment received in the QRY^Q01 message.

QAKPosition Name Notes3 Query Response Status Has one of the following values.

OK – Query success, patient found. DSP contains CRIS Identifier.NF – Query Success, patient not found.AE – Application Error, CRIS failed to process the query for some internal technical reason.AR – Application Reject, CRIS rejected the query because it could not find required information in the message.

DSPDSP appears on DSR^Q01 messages generated in response to a successful query. Position Name Notes3 Data Line Contains the CRIS identifier of the patient.


11 QBP^Z01 Event Query conformance statement

11.1 OverviewQuery Statement ID Z01Type QueryQuery Name Event QueryQuery Trigger (MSH:9) QBP^Z01^QBP_Q11

Response Trigger RSP^Z01^RSP_K11Query Priority Deferred – Queries are queued for processing, however in normal circumstances

should execute immediatelyQuery Characteristics Returns order and report details for a specific examination on CRIS.

The examination may be specified either by Accession number or CRIS examination key.

Purpose To allow an external system to obtain order and result data pertaining to a specific examination (order).

Response Characteristics If the exam is found returns a group containing a PID segment, and ORC segment, and OBR segment and a list of OBX segments.

11.2 Query GrammarMSH Message header segmentQPD Query parameter definition



non-standard field separators9 Message Type Should be set to “QBP^Z01^QBP_Q11”10 Message Control ID This value will be returned in the acknowledgement message.


QPDPosition Name Notes1 Message Query Name Should be valued “Z01^Event Query”2 Query Tag Should be unique to each query message instance, this value is

not important to CRIS but will be returned in the response message.

3 Accession Number If present CRIS will attempt to return the exam matching this accession number.


4 CRIS Exam Key If present (and Accession number is NOT present) CRIS will attempt to return the exam matching this exam key.

5 CRIS Number If present (and neither of the above search fields is present) CRIS will attempt to return all the exams for the patient identified by the specified CRIS number.

11.3 Response GrammarMSH Message header segmentMSA Message acknowledgementQAK Query acknowledgementQPD Query parameter definition[ PID Patient details { ORC Order details OBR Order details [ { TXA } ] Request card image details [ { OBX } ] Report details } ]

MSHPosition Name Notes1 Field Separator Always Populated with “|”2 Encoding Characters Always Populated with “^~\&”3 Sending Application Defaults to “CRIS” may be configured to send any fixed value.4 Sending Facility Defaults to “LIVE” may be configured to send any fixed value.5 Receiving Application Default is empty, may be configured to send any fixed value.6 Receiving Facility Default is empty, may be configured to send any fixed value.7 Date Time of Message Populated with the date and time that the message was generated,

century, year, month, day, hour, minute, second, millisecond and time zone offset are all present.

9 Message Type The type of the message. RSP^Z01^RSP_K1110 Message Control ID Populated with the message control id of the query message with

the word “RESPONSE” appended.11 Processing ID Set to “P”12 Version ID Set to “2.4”

MSAPosition Name Notes1 Acknowledgement code If the CRIS encountered an error set to “AE”, otherwise set to

“AA”.2 Message Control ID Set to the message control ID of the query message

QAKPosition Name Notes


1 Query Tag Set to the Query tag from the QPD segment of the query message

2 Query Response Status Set to either NF or OK depending upon whether any patients where found

3 Message Query Name Set to the query name from the QPD segment of the query message

4 Hit Count The number of order records returned in this message (all matches are returned in one message).

5 This Payload The number of order records returned in this message.6 Hits Remaining Will always be 0

QPDThe QPD segment will be a copy of the QPD segment received in the original query message.

PIDIf any orders are returned there will be one PID segment.Position Name Notes3 Patient ID Internal Will contain a list of the patient identifiers known by CRIS, refer to

the notes on patient identifiers in the PD160 document.

5 Patient Name <Family Name> is populated with surname from CRIS.Forenames on CRIS is split at the first space character, the substring prior to the space is placed in <Given Name>, the substring after the space is placed in <Middle Initial Or Name>, patients title is placed in <prefix>

7 Date Time Of Birth Patients date of birth, only century, year, month and day are populated

8 Patient Sex This field may require translation, values on CRIS areF FemaleM MaleI IndeterminateU Unknown

10 Race Patient’s race. Only populated if SendAdditionalPatientInfo is TRUE. By default this is FALSE

11 Address CRIS has four lines of address.The first line is placed in <street address>The second line is placed in <other designation>The third line is placed in <city>The Fourth line is placed in <province>The two components of post code are combined and placed in <zip or postal code>

12 County Code County code. Only populated if SendAdditionalPatientInfo is TRUE. By default this is FALSE


13 Phone number home Patients home telephone number, email address and mobile number.Home Telephone number is the first sub field,Email address is the 4th subfieldMobile telephone number is placed in the next repeating instanceEg|0115874245^^^[email protected]~07785342542|

14 Phone number business Patients work telephone number15 Primary Language Primary language. Only populated if SendAdditionalPatientInfo is

TRUE. By default this is FALSE16 Marital Status Marital status. Only populated if SendAdditionalPatientInfo is

TRUE. By default this is FALSE17 Religion Relgion. Only populated if SendAdditionalPatientInfo is TRUE. By

default this is FALSE18 Patient Account Number Patient account number. Only populated if

SendAdditionalPatientInfo is TRUE. By default this is FALSE22 Ethnic Group This field may require translation26 Citizenship Citizenship. Only populated if SendAdditionalPatientInfo is TRUE.

By default this is FALSE29 Patient Death Date and Time For Deceased patients this will contain the date of death, century,

year, month and day are present. Otherwise this field will contain null (“”)

30 Patient Death Indicator For deceased patients this field will contain “Y” otherwise it will be “N”

ORC

There will be one ORC for each examination found.

Position Name Notes1 Order Control Blank.2 Placer Order Number Contains the placer order number received from and Order

communications system. If no order communications system is in use or this event was not received electronically this field will be blank.

3 Filler Order Number Contains with the CRIS allocated examination key.5 Order status Blank.7 Quantity/Timing <start date/time> will contain the date and time that the

examination is booked for or the date and time that the examination was done.

<priority> will contain the priority of the order, this component may need translation.

9 Date Time of transaction Date and time of the user action on CRIS that resulted in this message.

10 Entered By <id number> is populated with the ID of the user on CRIS that entered this order/status/result.


12 Ordering Provider <id number> is populated with the code identifying the referrer on CRIS

13 Enterers location <point of care> is populated with the code identifying the ward/location on CRIS

17 Entering Organization <identifier> will contain the specialty of the ordering clinician.

21 Ordering facility name <id number> will contain the code identifying the hospital / gp practice etc that the request was made from.

OBR

There will be one OBR for each examination found.

Position Name Notes2 Placer Order Number Contains the placer order number received in the original new

order message. In unsolicited result messages this field will be blank.This field contains the same value as ORC:2

3 Filler Order Number Contains the CRIS allocated examination key.This field contains the same value as ORC:3

4 Universal Service ID <identifier> contains the examination procedure code from CRIS

20 Filler Field 1 CRIS generated event key. PACS may use this field to identify which orders have been performed as a single attendance.

21 Filler Field 2 CRIS generated Accession number. This field is used by PACS systems to identify the examination.

22 Result rpt status changeDate/time

Populated on report messages onlyThis will contain the date and time that the report was typed, verified or changed (depending on result status)

24 Diagnostic Serv Sect ID Contains the modality of the procedure being performed

27 Quantity/Timing <start date/time> will, for orders that have status “SC”, contain the date and time that the examination is booked for, for orders with a status of “IP” and clinical results it will contain the date and time that the examination was done.

<priority> will contain the priority of the order, this component may need translation.This field contains the same value as ORC:7

32 Principal ResultInterpreter

If no report has been created and a radiologist has been assigned <id number> of <name> contains the id of the intended radiologist.

If a report is present <id number> of <name> contains the id of the first radiologist. <start date/time> contains the date & time the report was created.


33 Assistant ResultInterpreter

Populated only if a report is present.<id number> of <name> contains the id of the second radiologist.

34 Technician Populated only if the procedure has been post processed

<id number> of <name> contains the id of the radiographer that performed the procedure <start date/time> contains the date and time the procedure was performed<room> contains the examination room that the exam is to be /was performed in.<Facility> contains the hospital that the exam is to be/was performed in.

35 Transcriptionist Populated only if a report is present<id number> of <name> contains the id of the person that typed the report. <start date/time> contains the date & time the report was typed.

TXA

There will be one TXA segment for each scanned image available. The TXA segments appear directly after the OBX for the exam that the images belong to.

Position Name Notes1 Set ID Sequence, first TXA for an order will be 1, followed by 2 etc.

Sequence restarts for each order.2 Document Type The type of document, default types are

REQCARD – Request CardsREFERAL – Referral Letters

However additional types may be defined on a site specific basis.3 Document Content

PresentationAlways set to “AP”

7 Transcription Date/Time The Date/Time that the image was scanned into CRIS11 Transcriptionist Code Name <ID Number> contains the CRIS login ID of the user that scanned

the image into CRIS12 Unique document number The number identifying the scanned document within CRIS

14 Placer Order Number The CRIS exam key for this order.16 Unique document filename The URL that the document may be accessed at. – eg

ftp://hostname/images/00/00/00/00000001Note that authentication information is not included in the URL.

OBX


ftp://hostname/images/00/00/00/00000001

There will be one OBX segment for each line of report. The OBX segments appear directly after the OBR (and TXA) segment for the exam that the report belongs to.

Position Name Notes1 Set ID Sequence, first OBX for an order will be 1, followed by 2 etc.

Sequence restarts for each order.2 Value Type Set to “TX”3 Observation Identifier <identifier> contains the examination code for the order5 Observation Value Contains one line of the textual report.11 Observation Result

StatusOnly populated on reportsIndicates the status of the report on CRISP Preliminary reportF Final ReportC Changed report

14 Date & Time OfThe Observation

Only populated on reportsThis will contain the date and time that the report was typed, verified or changed (depending on result status)This is the same value as OBR:22

Scanned Documents

If scanned documents are to be sent by the query interface they will be included as OBX segments as follows:

Value Type EDObservation Identifier <identifier> contains the code for the document type – eg REFERAL or REQCARD

<text> contains a description of the document type

REFERAL=Referral LetterREQCARD=Request card

All other document types will have a <text> of “Scanned Document”Observation Value ED type

<Type of Data> = “IM”<Data Sub Type> = “JPEG”<Encoding> = “Base64”<Data> Contains the jpeg image data encoded as base64. CRIS does not split or truncate images where the base64 data exceeds the normal HL7 limit of 64k


12 QBP^Z02 Patient Query conformance statement

12.1 OverviewQuery Statement ID Z02Type QueryQuery Name Patient QueryQuery Trigger (MSH:9) QBP^Z02^QBP_Q11

Response Trigger RSP^Z02^RSP_K11Query Priority Deferred – Queries are queued for processing, however in normal circumstances

should execute immediatelyQuery Characteristics Returns basic demographic details and patient identifiers for patients matching the

supplied criteria.Search criteria may be:1) CRIS patient id2) NHS Number3) Hospital Number4) Combination of name, DOB and sex.

Purpose To allow an external system to obtain demographic data and patient identifiers for a patient.

Response Characteristics For each patient found returns a PID segment populated with the patients details.

12.2 Query GrammarMSH Message header segmentQPD Query parameter definition



non-standard field separators9 Message Type Should be set to “QBP^Z02^QBP_Q11”10 Message Control ID This value will be returned in the acknowledgement message.12 Version ID Should be set to “2.4”

QPDPosition Name Notes

1 Message Query Name Should be valued “Z02^Patient Query”

2 Query Tag Should be unique to each query message instance, this value is not important to CRIS but will be returned in the response message.


3 CRIS Number If present CRIS will attempt to return the patient matching this identifier

4 NHS Number If present (and CRIS number is NOT present) CRIS will attempt to return the patient with a matching NHS number.

5 Hospital Number If present (and the above defined identifiers are NOT present) CRIS will attempt to return patients with a matching hospital number, this query may return multiple patients.

6 Surname If the above defined identifiers are NOT present, CRIS will attempt a patient search based on surname, forenames, DOB and sex. Surname, forenames and sex must be provided, DOB is optional but should be provided if possible. Partial surnames and forenames may be supplied. This query may return multiple patients.Note that this uses the same search algorithm as is used in the CRIS User Interface and will return a list of patients that are possible matches. If patients are to be selected without human intervention each of the returned results should be compared with the known patient details using an algorithm acceptable to the trust.

7 Forenames8 DOB9 Sex

12.3 Response GrammarMSH Message header segmentMSA Message acknowledgementQAK Query acknowledgementQPD Query parameter definition[ { PID } ] Patient data

MSHPosition Name Notes1 Field Separator Always Populated with “|”2 Encoding Characters Always Populated with “^~\&”3 Sending Application Defaults to “CRIS” may be configured to send any fixed value.4 Sending Facility Defaults to “LIVE” may be configured to send any fixed value.5 Receiving Application Default is empty, may be configured to send any fixed value.6 Receiving Facility Default is empty, may be configured to send any fixed value.7 Date Time of Message Populated with the date and time that the message was generated,

century, year, month, day, hour, minute, second, millisecond and time zone offset are all present.

9 Message Type The type of the message. RSP^Z02^RSP_K1110 Message Control ID Populated with the message control id of the query message with

the word “RESPONSE” appended.11 Processing ID Set to “P”12 Version ID Set to “2.4”

MSAPosition Name Notes1 Acknowledgement code If the CRIS encountered an error set to “AE”, otherwise set to

“AA”.2 Message Control ID Set to the message control ID of the query message


QAKPosition Name Notes1 Query Tag Set to the Query tag from the QPD segment of the query

message2 Query Response Status Set to either NF or OK depending upon whether any patients

where found3 Message Query Name Set to the query name from the QPD segment of the query

message4 Hit Count The number of patient records returned in this message (all

matches are returned in one message).5 This Payload The number of patient records returned in this message.

6 Hits Remaining Will always be 0

QPDThe QPD segment will be a copy of the QPD segment received in the original query message.

PIDThere will be one PID segment for each patient found by the query.Position Name Notes3 Patient ID Internal Will contain a list of the patient identifiers known by CRIS, refer to the

notes on patient identifiers in the PD160 document.5 Patient Name <Family Name> is populated with surname from CRIS.

Forenames on CRIS is split at the first space character, the substring prior to the space is placed in <Given Name>, the substring after the space is placed in <Middle Initial Or Name>, patients title is placed in <prefix>

7 Date Time Of Birth Patients date of birth, only century, year, month and day are populated8 Patient Sex This field may require translation, values on CRIS are

F FemaleM MaleI IndeterminateU Unknown

10 Race Patient’s race. Only populated if SendAdditionalPatientInfo is TRUE. By default this is FALSE

11 Address CRIS has four lines of address.The first line is placed in <street address>The second line is placed in <other designation>The third line is placed in <city>The Fourth line is placed in <province>The two components of post code are combined and placed in <zip or postal code>

12 County Code County Code. Only populated if SendAdditionalPatientInfo is TRUE. By default this is FALSE

13 Phone number home Patients home telephone number, email address and mobile number.Home Telephone number is the first sub field,Email address is the 4th subfield


Mobile telephone number is placed in the next repeating instanceEg|0115874245^^^[email protected]~07785342542|

14 Phone number business Patients work telephone number15 Primary Language Primary language. Only populated if SendAdditionalPatientInfo is TRUE.

By default this is FALSE16 Marital Status Marital status. Only populated if SendAdditionalPatientInfo is TRUE. By

default this is FALSE17 Religion Religion. Only populated if SendAdditionalPatientInfo is TRUE. By

default this is FALSE18 Patient Account Number Patient account number. Only populated if SendAdditionalPatientInfo is

TRUE. By default this is FALSE22 Ethnic Group This field may require translation26 Citizenship Citizenship. Only populated if SendAdditionalPatientInfo is TRUE. By

default this is FALSE29 Patient Death Date and

TimeFor Deceased patients this will contain the date of death, century, year, month and day are present. Otherwise this field will contain null (“”)

30 Patient Death Indicator For deceased patients this field will contain “Y” otherwise it will be “N”


13 Sample Messages 13.1 Results inbound

The following is an example of the bare minimum message content allowed, please note that CRIS can get by with some HL7 mandatory fields missing so this message is not actually valid HL7.MSH|^~\&|||||||ORU^R01|10016194||2.4ORC||9406OBX||TX|||No abnormality detected

The following message contains all possible fields that CRIS can make use of.

MSH|^~\&|||||||ORU^R01|10016195||2.4PID|||12345^^^CRIS^PIORC||9407OBR||||||||||||||||||||||||||||||||ARADL^200610100900|RICH||^200610100945OBX|1|TX|||No abnormality detected|||||||P||200610100940

The following message is an example of an application level acknowledgement sent by CRIS

MSH|^~\&|CRIS|LIVE|||20061010134240||ACK^R01|RESPONSE10016195|P|2.4MSA|AA|10016195

The following is an example of an application level acknowledgement sent by CRIS in response to a message that failed.

MSH|^~\&|CRIS|LIVE|||2006101109MSA|AE|10016197|Order number is not for this patient


14 Configuration QuestionnairePlease answer the following questions regarding the preferred configuration of the CRIS Inbound HL7 Interface.

Item Description Required ValuePort Number TCP Port number to listen for incoming messages

(3326 suggested)IP Address IP Address to send response messages toInbound Port Number TCP Port number to send messages to (3326

suggested)Check Patients Should CRIS check that the exam identified in the

incoming message belong to the patient identified in the message? If this is required then each message must contain a PID segment with the CRIS number present in PID:3. Default is false.

Radiologist Default code to use in case the incoming messages do not identify radiologist. Default is “EXTERNAL”

Radiologist 2 Default code to use in case the incoming messages do not identify radiologist. Default is blank.

Report Type Type of report to store if not specified on the incoming messages. Default is “REPORT”

Primary Identifier Assigning authority.

The assigning authority of the primary identifier provided in the PID:3 field. This is required when the remote system is not providing CRIS number and is a PAS that we are receiving a demographic feed from.

CRIS is placer for inbound results

When processing inbound results should CRIS act as placer? If yes the CRIS exam key is taken from Placer Order Number, otherwise it is taken from Filler Order Number. Default is no.

Create Orders When order messages are received should CRIS create an order record in addition to the event/exam. Default is no.

Lookup By NHS When processing an inbound order message where neither a CRIS or PAS patient identifier is present should CRIS attempt to identify the patient by NHS number? Default is No.

NameSearch When processing an inbound order message where neither a CRIS or PAS patient identifier is present and the patient has not been found by NHS number should CRIS attempt to identify the patient via a name search? Default is No.

DestinationHospitalInMSH If set When processing an incoming order message CRIS will send an order message to each PACS interface configured to send messages to the destination specified in the MSH Receiving Facility field. Default is No.

SourceHospitalInMSH If set when processing an incoming order message CRIS will set the site code of the created event to


the value specified in the MSH Sending Facility field.AppendAddendums Should reports with a status of “C” (changed) be

appended to the existing reportLookup by Hospital number When processing an inbound order message should

CRIS use a CRIS local hospital number (no PAS interface) to identify the patient – if so what is the assigning authority of the hospital number

Create Patients When processing an inbound order should a patient be created if it does not already exist

Hide VIP Patients Should the query interface hide VIP patients?Send Scanned Documents Should scanned documents be returned by the

query interface


Document Control

Title RIS_PD163_Owner Steve Verdon Date Created 09/10/2006File Ref. RIS_PD163_CRIS VersionChange HistoryIssue Date Author / Editor Details of Change1.0 09/10/2006 Alan Shields First Draft.1.1 25/10/2006 Alan Shields Added description of verified and changed report behaviour2.0 28/04/2007 Alan Shields Added inbound event functionality and patient search.

Changed document title.2.1 30/05/2007 Alan Shields Added detail for status, alternative patient identification and

persistence of foreign system order id.2.2 27/07/2007 Alan Shields Added new style Event and patient queries2.3 26/08/2008 Steven Verdon Minor changes after comments back from review panel3.0 08/10/2009 Steven Verdon Finalised version ready for release.3.1 15/10/2009 Steven Verdon Changes to document properties3.2 09/09/2010 Alan Shields Added document/image transfer3.3 28/02/2011 Julia Paul IEP additions3.4 07/03/2011 Julia Paul Changes to include exact NHS patient search3.5 29/01/2012 Steven Verdon Version number corrections3.6 13/04/2013 Steven Verdon Document review3.7 01/08/2014 Steven Verdon Document review3.8 05/04/2016 Steven Verdon Added PID:10/12/15/16/17/18/26 to QBP^Z01 and QBP^Z02

responses3.9 07/04/2016 Steven Verdon Updated format4.0 15/07/2016 Steven Verdon OBX segment of 2nd sample message incorrect4.1 23/08/2016 Steven Verdon Response triggers incorrect, changed to RSP^Z01^RSP_K11

and RSP^Z02^RSP_K11Review Date April 2017
