HL7 relation to clinical flows

Question

Does anyone know of any articles our tutorials that describe the clinical flows as it relates to the hl7 message that is generated?

I have read the hl7 spec i am just looking to connect the dots on for example.

1. A patient is admitted to a hosptial and all the events that happen and theh hl7 triggers that are created.
2. A lab test is ordered how are all does it route to the respective systems etc...

Answer 1

Its actually pretty simple to understand clinical workflows. Here is a comprehensive list of all trigger events, and core HL7 components, that you can go through. If you google you will get many resources like interfaceware, that give more glorified examples.

In short,this is how it works.

There are 2 broad categories of application in healthcare

1. PMS - Practice Management System (in simple words the front desk). This acts as a repository of all the patient demographics, Appointment schedule of the doctors, Billing information etc. Most of the critical healthcare transactions are done at the PMS. Eg. GE Centricity, Allscripts ProPM etc

2. EHR - Electronic Health Record (in simple words the doctors application). This acts as a repository of all the patient medications, diagnosis, allergy, history and physical etc. Every medical information is recorded in the EHR. Eg. Cerner EHR, Allscripts ProEHR etc.

ADT -Admission, Discharge and Transfer is a broad category of trigger, and covers almost all the major events, Starting from ADT^A01 to ADT^A40.

When a patient is registered at the practice PMS, an A28 or add patient demographics is triggered. If any of the details of that patient is updated (eg his address), that's an A31. After you have demo of the patient you schedule an appointment.

Specifically you have a scheduling message(SIU) to do the job, or you can also use encounter demographics(ADT). The key difference is that SIU doesn't have complete demographics details(insurance,guarantor etc) of the patient in the message, and encounter demographics are more useful than SIUs for they contain demographic+appointment details. So, if the patient does a walk-in without previously being registered at the practice, an encounter demographics is sufficient.

Let us assume for sake of understanding, we go with schedule.So, an SIU^S12,^S14,^S15 is for appointment add, update and cancellation respectively.Now, this appointment shows on the respective Doctors application (EHR) if the PMS and EHR are connected via an interface.

Every procedure has a code associated to it. The billing happens on this procedure code and is done through a charge message(DFT^P03).A charge is placed in the EHR and it always travel from the EHR to the PMS. There is also another set of applications called as Billing applications - Whiteplume is an example that specifically process charges and handles billing. Also, there is something known as Clearing Houses that handles billing and Claim processing for insurances.

If we talk about Labs, the Lab connects to both the PMS and the EHR. It connects to the PMS through a Query interface (QRY^Q01,^Q04 trigger events) to request for patient demographics, for the lab should know whether the corresponding patient is registered or not. It connects to the EHR application through OM interface (orders management interface) or a Results only interface. ORM^O01 is for orders, ORU^R01 is for Results. OM interfaces are bi-directional. Results only interface is a unidirectional interface running from the Lab to the EHR and consists of results. The request is either placed manually through phone or fax.

The order or basically the tests that need to be performed on the patient are placed from the EHR, the order message (ORM^O01) is triggered containing the required procedure code of the test/battery that needs to be performed on the patient. The lab then queries for the respective patient through a QRY^Q01 message, and recieves a response containing the patient demographics(basically just a PID information), and after the tests are conducted sends the results using ORU^R01 message. However, you won't find Query interface that mandatory. The more you go deeper into it, there is Transcription(TRN), Radiology, document(MDM) message` for different content and purpose of Results.

Hope this helps!

Answer 2

If you are looking for a description of transactions occurring in healthcare processes and how they are mapped to HL7 messages, then the best and most standard way is to go for IHE:

http://www.ihe.net/Technical_Frameworks/

Regards

Davide