Accumedscript

HL7
Transcription Interface
Technical Specification

Last Revised: August 27, 2010

2010 Accumedscript. All rights reserved. Certain information contained herein is confidential and must be treated accordingly.

Table of Contents
1.

ACCUMEDSCRIPT HL7 INTEGRATION/ARCHITECURE ................................................................................................................ 3

2.

MESSAGE SPECIFICATIONS ............................................................................................................................................. 4

3.

4.

2.1

SIU^S12 NOTIFICATION OF NEW APPOINTMENT BOOKING .............................................................................................................. 5

2.2

SIU^S13 NOTIFICATION OF APPOINTMENT RESCHEDULING ............................................................................................................. 5

2.3

SIU^S14 NOTIFICATION OF APPOINTMENT MODIFICATION .............................................................................................................. 5

2.4

MDM^T02 ORIGINAL DOCUMENT NOTIFICATION AND CONTENT........................................................................................................ 5

2.5

MDM^T03 DOCUMENT STATUS CHANGE NOTIFICATION ............................................................................................................... 5

2.6

MDM^T04 DOCUMENT STATUS CHANGE NOTIFICATION AND CONTENT ................................................................................................. 5

2.7

MDM^T08 DOCUMENT EDIT NOTIFICATION AND CONTENT ............................................................................................................ 5

2.8

MDM^T10 DOCUMENT REPLACEMENT NOTIFICATION AND CONTENT ................................................................................................... 5

2.9

MDM^T11 DOCUMENT CANCEL NOTIFICATION........................................................................................................................ 6

2.10

MESSAGE FORMAT FOR EVENT TYPE(S) T03 AND T11................................................................................................................... 6

2.11

MESSAGE FORMAT FOR EVENT TYPE(S) T02, T04, T08, AND T10 ....................................................................................................... 6

DETAILED SEGMENT LISTINGS ......................................................................................................................................... 7

3.1

MSH MESSAGE HEADER ............................................................................................................................................ 8

3.2

MSA MESSAGE ACKNOWLEDGMENT ................................................................................................................................. 9

3.3

ERR ERROR ...................................................................................................................................................... 10

3.4

EVN EVENT TYPE ................................................................................................................................................. 10

3.5

SIU - SCHEDULE ACTIVITY .......................................................................................................................................... 10

3.6

PID PATIENT IDENTIFICATION ...................................................................................................................................... 12

3.7

PV1 PATIENT VISIT ............................................................................................................................................... 13

3.8

TXA TRANSCRIPTION REPORT HEADER ............................................................................................................................. 16

3.9

OBX OBSERVATION/RESULT....................................................................................................................................... 19

3.10

NTE NOTES AND COMMENTS FOLLOWING OBX .................................................................................................................... 20

SAMPLE HL7 INCOMING & OUTGOING MESSAGES ................................................................................................................ 21

4.1
4.2

MDM MESSAGES .................................................................................................................................................. 21

SIU MESSAGE ...................................................................................................................................................... 21

1. Accumedscript HL7 Integration/Architecure

Accumedscript has the resources and tools to accept HL7 based ADT/ order transmissions via TCP/IP, HTTPS and /or VPN.
Accumedscript also has the capabilities to transmit back the transcribed document as a HL7 message back to client's interface
engine
via
TCP/IP,
HTTPS and or VPN. ADT
feeds accepted for
acquiring
patient
scheduling
and
demographic
information can be
done using standard of
customized
ADT
messages. Transcribed
reports are transmitted
back as text or rich text
embedded in multiple
ORU segments in a
single HL7 message.

2. Message Specifications
The Accumedscript HL7 transcription interface sends and receives HL7 messages to integrate with the EMRs that are capable of handling
standard HL7. Accumedscript supports following HL7 incoming/outgoing messages.
1. Incoming Interface
a. Scheduling messages (SIU)
i. SIU-S12 Notification of new appointment booking
ii. SIU-S13 Notification of appointment rescheduling
iii. SIU-S14 Notification of appointment modification
b. ADT
i. ADT-A01 patient admit
ii. ADT-A02 patient transfer
iii. ADT-A03 patient discharge
iv. ADT-A04 patient registration
v. ADT-A08 patient information update
vi. ADT-A11 cancel patient admit
vii. ADT-A12 cancel patient transfer
viii. ADT-A13 cancel patient discharge
2. Outgoing messages (MDM)
i. T02 original Document Notification and Content
ii. T03 Document Status Change Notification
iii. T04 Document Status Change Notification and Content
iv. T08 Document Edit Notification and Content
v. T10 Document Replacement Notification and Content
vi. T11 Document Cancel Notification
The full HL7 message is described for reference. This interface might not support the entire HL7 specification, depending on the particular
functional needs of this interface.

2.1

SIU^S12 Notification of new appointment booking

Accumed can receive S12 schedule message, which is a new appointment scheduled for a patient that can be used as a patient list for the
transcriptionists.

2.2 SIU^S13 Notification of appointment rescheduling

Accumedscript modifies the previously received S12 schedule message to update its schedule time.

2.3 SIU^S14 Notification of appointment modification

Accumedscript modifies the previously received S12 schedule message to update its schedule information.

2.4 MDM^T02 Original Document Notification and Content

This message is used to notify EMR that a new document exists. It includes information about the type of dictation, authentication status, and
other status indicators. The message includes the dictation in one or more OBX segments. The document is identified by a unique document ID.

2.5 MDM^T03 Document Status Change Notification

This message is sent when the document status changesfor example, from Preliminary to Authenticated.

2.6 MDM^T04 Document Status Change Notification and Content

This message is functionally the same as T03, but the content of the document is included.

2.7 MDM^T08 Document Edit Notification and Content

The only valid use of this trigger event is for a document with a status of Unavailable, i.e., the document has not been made available for patient
care. In this case, the original document should be completely replaced by the new document.

2.8 MDM^T10 Document Replacement Notification and Content

This message is used to send a new document, which replaces the original document. In this case, the original document is retained but its status
changed to Obsolete. The replacement document should be linked to the original document. The EMR should only display the replacement
document, not the original.

2.9 MDM^T11 Document Cancel Notification

This event is used to notify Epic that a previously sent document was in error and needs to be canceled. For example, if a transcription was sent
over for the wrong patient, this event type could be used. Note that the document ID used in the original document cannot be reused. The only
valid use of this trigger event is for a document with a status of Unavailable, i.e., the document has not been made available for patient care.

2.10 Message Format for Event Type(s) T03 and T11

MDM^T03,T11

Transcription Message

MSH

Message Header

EVN

Event Type

PID

Patient Identification

[{NTE}]

Notes and Comments

PV1

Patient Visit Information

[{
ORC

Common Order

OBR

Observation Request

[{NTE}]

Notes and Comments

}]
TXA

Document Notification

ACK

General Acknowledgment

MSH

Message Header

MSA

Message Acknowledgment

[ ERR ]

Error Information

2.11 Message Format for Event Type(s) T02, T04, T08, and T10
MDM^T02,T04,T08,T10

Transcription Message

MSH

Message Header

EVN

Event Type

PID

Patient Identification

[{NTE}]

Notes and Comments

PV1

Patient Visit Information

[{
ORC

Common Order

OBR

Observation Request

[{NTE}]

Notes and Comments

}]
TXA

Document Notification

{
OBX

Observation notes

[{NTE}]

Notes and Comments

ACK

General Acknowledgment

MSH

Message Header

MSA

Message Acknowledgment

[ ERR ]

Error Information

3. Detailed Segment Listings

The following tables list the HL7 segments and the corresponding data elements which are used by the standard EMR Incoming Transcription
Interface. The HL7 column in each table reflects the HL7 standard documentation for whether or not a field is required. In active rows, the Epic
column contains a Y in fields that are recommended for optimal workflow and interface operation. A C means that it might be conditionally
required depending on message type or workflow.

3.1 MSH Message Header

Seq

Type

HL7

Element Name

Notes

ST

Field Separator

Value is typically: |

ST

Encoding Characters

Value is typically: ^~\&

HD

Sending Application

Free text

HD

Sending Facility

Free text, configurable.

HD

Receiving Application

Free text

HD

Receiving Facility

Free text

DTM

Date/Time of Message

ST

Security

CM

Message Type

<Message type>^<Trigger event>

10

ST

Message Control ID

Value returned in Acknowledgment message (MSA)

11

PT

Processing ID

D Debugging P Production T Training

12

VID

Version ID

HL7 version number, e.g., 2.3

13

NM

Sequence Number

Optional field used in sequence number protocol;

14

ST

Continuation Pointer

In conjunction with the HL7 DSC segment, this field is used to define
continuations of messages. It allows large messages to be broken into
multiple smaller messages, which is necessary under certain implementation
limitations.

15

ID

Accept Acknowledgment Type

This field identifies the conditions under which Accept Acknowledgments are
required to be returned in response to this message. Required for enhanced
acknowledgment mode. If null, acknowledgments are sent in original
acknowledgment mode.
Values:
AL Always
ER Error/reject conditions only
NE Never

Seq

Type

HL7

Element Name

Notes
SU Successful completion only

16

ID

Application Acknowledgment Type

17

ID

Country Code

18

ID

Character Set

19

CWE

Principal Language of Message

20

ID

Alternate Character Set Handling

Scheme

21

ID

Conformance Statement ID

3.2 MSA Message Acknowledgment

Seq

Type

HL7

Element Name

Notes

ID

Acknowledgment Code

Indicates successful/not successful processing of message

Original Mode Values:
AA Application Accept
AE Application Error
AR Application Reject
Enhanced Mode Values:
CA Commit Accept
CE Commit Error
CR Commit Reject

ST

Message Control ID

ST

Text Message

Optional field that can contain an error message

NM

Expected Sequence Number

Optional field used in sequence number protocol;

ID

Delayed Acknowledgment Type

CWE

Error Condition

3.3 ERR Error

Seq

Type

HL7

Element Name

Notes

CM

Error Code and Location

Identifies erroneous segment in message

Format: <Segment ID>^<Sequence>^<Field>^<Error number>&<Error text>

3.4 EVN Event Type

Seq

Type

HL7

Element Name

Notes

ID

Event Type Code

Event type code

Example: T02

DTM

Recorded Date/Time

Date/time of event

DTM

Date/Time Planned Event

IS

Event Reason Code

XCN

Operator ID

DTM

Event Occurred

HD

Event Facility

3.5 SIU - Schedule Activity

SEQ

Element Name

DATA TYPE

COMMENTS

Placer Appointment ID

EI

Appointment or Visit Number

Filler Appointment ID

EI

Occurrence Number

NM

Placer Group Number

EI

Schedule ID

CE

Event Reason

CE

Appointment Reason

CE

Reason for Visit

Appointment Type

CE

Visit Type, NEW, FUP

Appointment Duration

NM

Duration of Appointment

10

Appointment Duration Units

CE

MIN (minutes)

11

Appointment Timing Quantity

TQ

^^^YYYYMMDDHHMM Date & time of Appointment

12

Placer Contact Person

XCN

IDX Dictionary #302

13

Placer Contact Phone Number

XTN

14

Placer Contact Address

XAD

15

Placer Contact Location

PL

16

Filler Contact Person

XCN

17

Filler Contact Phone Number

XTN

18

Filler Contact Address

XAD

19

Filler Contact Location

PL

20

Scheduling Provider # and name

CN
Entered by Person

Security Plus User Initials

21

Entered by Phone Number

XTN

22

Entered by Location

PL

23

Parent Placer Appointment ID

EI

24

Parent Filler Appointment ID

EI

25

Filler Status Code

CE

26

Placer Order Number

EI

27

Filler Order Number

EI

Initials of Person who Scheduled Appointment

Appointment Status (PEN,RSC,ARR,CAN,NOS)

3.6 PID Patient Identification

Seq

Type

HL7

Element Name

Notes

SI

Set ID PID

CX

Patient ID

This field is for backward compatibility only.

CX

Patient Identifier List

The patient identifier list can contain values for the Social Security number
or drivers license number, formatted as follows.
<Social Security number>^^^USSSA^SS
<License number>^^^<State>^DL

CX

Alternate Patient ID PID

This field is for backward compatibility only.

XPN

Patient Name

Patient name
Prefix
Suffix
Academic title

XPN

Mothers Maiden Name

DTM

Date/Time of Birth

Only date of birth is supported; available for patient validation.

IS

Sex

Available for patient validation, This field is mapped using the associated
translation table.

XPN

Patient Alias

10

CWE

Race

11

XAD

Patient Address

12

IS

County Code

13

XTN

Phone Number Home

14

XTN

Phone Number Work

15

CWE

Primary Language

16

CWE

Marital Status

Seq

Type

HL7

Element Name

17

CWE

Religion

18

CX

Patient Account Number

19

ST

SSN Number Patient

20

DLN

Drivers License Number Patient

21

CX

Mothers Identifier

22

CWE

Ethnic Group

23

ST

Birth Place

24

ID

Multiple Birth Indicator

25

NM

Birth Order

26

CWE

Citizenship

27

CWE

Veterans Military Status

28

CWE

Nationality

29

DTM

Patient Death Date and Time

30

ID

Patient Death Indicator

Notes

3.7 PV1 Patient Visit

The PV1 segment is used to provide information that can be used to locate the proper encounter for storing the transcription document.
Seq

Type

HL7

Element Name

SI

Set ID Patient Visit

ID

Patient Class

PL

Assigned Patient Location

ID

Admission Type

Notes

<Point of care/Department>^<Room>^
<Bed>^<Facility>^^^<Building>^<Floor>^

Seq

Type

HL7

Element Name

ST

Pre-admit Number

CM

Prior Patient Location

CN

Attending Doctor

CN

Referring Doctor

CN

Consulting Doctor

10

ID

Hospital Service

11

CM

Temporary Location

12

ID

Pre-admit Test Indicator

13

ID

Readmission Indicator

14

ID

Admit Source

15

ID

Ambulatory Status

16

ID

VIP Indicator

17

CN

Admitting Doctor

18

ID

Patient Type

19

NM

Visit Number

20

CM

Financial Class

21

ID

Charge Price Indicator

22

ID

Courtesy Code

23

ID

Credit Rating

24

ID

Contract Code

25

DT

Contract Effective Date

26

NM

Contract Amount

Notes

Seq

Type

HL7

Element Name

27

NM

Contract Period

28

ID

Interest Code

29

ID

Transfer to Bad Debt Code

30

DT

Transfer to Bad Debt Date

31

ID

Bad Debt Agency Code

32

NM

Bad Debt Transfer Amount

33

NM

Bad Debt Recovery Amount

34

ID

Delete Account Indicator

35

DT

Delete Account Date

36

ID

Discharge Disposition

37

CM

Discharged to Location

38

ID

Diet Type

39

ID

Servicing Facility

40

ID

Bed Status

41

ID

Account Status

42

CM

Pending Location

43

CM

Prior Temporary Location

44

DTM

Admit Date

45

DTM

Discharge Date

46

NM

Current Patient Balance

47

NM

Total Charges

48

NM

Total Adjustments

Notes

Seq

Type

HL7

Element Name

49

NM

Total Payments

50

CM

Alternate Visit ID

Notes

3.8 TXA Transcription Report Header

The TXA segment contains information specific to a transcribed report but does not include the text of the report.
Seq

Type

HL7

Element Name

SI

Set ID Document

IS

Report Type

Notes

Sample transcription types are:

AR Autopsy report
CD Cardiodiagnostics
CN Consultation
DI Diagnostic imaging
Format: String

ID

Document Content Presentation

DTM

Activity Date/Time

Date/time the procedure or activity was performed.

Format:
Standard HL7 date/time format
Can also be used for order-based MDM transcriptions to set the order
collection date and time based on the customers Epic configuration settings.
Note: If a message is intended to create an order a date must be sent in ORC9, OBR-7 or TXA-4.

XCN

Primary Activity Provider Code/Name

This is the ID and name of the primary provider responsible for performing
the procedure or activity.
Format: <ID>^<Last name>^<First name>^<Middle initial>^^^^^<Assigning
authority>^^^^<ID type>

DTM

Origination Date/Time

Date and time the report was dictated.

DTM

Transcription Date/Time

Date and time the report was transcribed.

Seq

Type

HL7

Element Name

Notes

DTM

Edit Date/Time

Date and time the report was edited. (T03, T04, and T08 events).

XCN

Originator Code/Name

Identifies the person responsible for dictating the report, which may differ
from the person who performed the activity.
Format:
<ID>^<Last name>^<First name>^<Middle initial>^^^^^<Assigning
authority>^^^^<ID type>

10

XCN

Assigned Document Authenticator

Identifies the person responsible for authenticating the document if the

authenticating provider is a resident.

11

XCN

Transcriptionist Code/Name

Ideally this field is sent as: . <ID>^<Last Name>^<First Name>^

can also accept ^<Last Name>^<First Name>^
The name is formatted and stored as a free-text string.

12

EI

Unique Document Number

Partial Dictation ID

13

EI

Parent Document Number

14

EI

Placer ID

15

EI

Order Filler Number

Format:
<Application ID>^^<Accession number>

16

ST

Unique Document File Name

For T11 messages, you may optionally specify the unique reference pointer
(file name)

Document number that indicates the parent document to which this

document belongs.

Format:
<Reference Pointer>
17

ID

Document Completion Status

Identifies the current state of the document:

AU Authenticated
DI Dictated
IN Incomplete
IP In progress
LA Legally authenticated
PA Pre-authenticated

18

ID

Document Confidentiality Status

Indicates the documents confidentiality status.

Values:
U Unrestricted

Seq

Type

HL7

Element Name

Notes
R Restricted
V Very restricted

19

ID

Document Availability Status

Indicates the documents availability for patient care.

Format:
Code
Values:
AV Available
UN Unavailable
OB Obsolete
1
DE Deleted
CA Canceled
Note:
This is usually a required field. However, if the source cannot populate this
field, there are Epic configuration settings that can be set up to determine the
availability status that corresponds to the transcription type.

20

ID

Document Storage Status

21

ST

Document Change Reason

Identifies the reason for the document status change.

Format: Code

22

PPN

Authentication Person, Timestamp

Identifies the person who authenticated the document, the authentication

date, and the timestamp. The format will be either (assuming ^ and & are the
defined separators):
<ID>^<Last Name>^<First Name>^<MI>^^^^^^^^^^^<timestamp>
e.g., 44039^Smith^Bill^J^^^^^^^^^^^200207111230
Or
<Person>^<Timestamp>~<Person>^<Timestamp>~
where <Person> format:<ID>&<Last name>&<First name>
e.g., 44039&Smith&Bill^200207111230

23

XCN

Distributed Copies (Code and Name of

Recipients)

Indicates to whom copies are to be routed.

Format: Preferred:
<ID>^<Last name>^<First name>^<Middle initial>^^^^^<Assigning
authority^^^^<ID type>~<ID>^<Last name>^<First name>^<Middle

Seq

Type

HL7

Element Name

Notes
initial>^^^^^<Assigning authority>^^^^<ID type>~
or
<ID>^<Name>~<ID>^<Name>~

3.9 OBX Observation/Result

The document text itself is sent in one or more OBX segments. Large documents should be split into multiple OBX segments.
Seq

Type

HL7

Element Name

Notes

SI

Set ID

Sequentially numbered for each OBX segment

Format:
Numeric

ID

Value Type

Supported types are:

TX Text
FT Formatted text
RP Reference pointer (can be used to receive information about scanned
documents, web pages, etc.)

CWE

Observation ID (Component ID)

ST

Observation Sub-ID

Observation Value

This field should contain the content of the document. Explicit hard line
breaks are indicated by using the ~ character. If the document is in RTF format
it will stored in both human readable and RTF format as sent.
If multiple OBX segments are sent, the information will be concatenated
together.
If OBX-2 is set to RP, the reference pointer should be sent in this field. The
Pointer (OBX-5.1) and Subtype (OBX-5.4) are also stored.
Format (if OBX-2=RP):
<Pointer (ST)>^<Application ID (HD)>^<Type of data (ID)>^<Subtype
(ID)>^<Document Type (ID)>
Example:
DOC123.TIFF^EPIC^Image^TIFF^POA

CWE

Units

Seq

Type

HL7

Element Name

ST

References Range

ID

Abnormal Flags

NM

Probability

10

ID

Nature of Abnormal Test

11

ID

Observation Result Status

12

DTM

Date Last Observed Normal Values

13

ST

User Defined Access Checks

14

DTM

Date/Time of the Observation

15

CWE

Producers ID

16

CN

Responsible Observer

Notes

A non-normal value in this field will cause the interface to mark all the orders
associated with the transcription to be abnormal.

3.10 NTE Notes and Comments Following OBX

This optional segment can contain comments for reference pointers sent in the preceding OBX segment.
Seq

Type

HL7

Epic

SI

Set ID Notes and Comments

ID

Source of Comment

FT

Element Name

Comment

Notes

4. Sample HL7 Incoming & outgoing messages

4.1 MDM messages
MSH|^~\&|IScribe|AccumedscriptA|CARECENTER^HL7NOTES|HFH|20060105180000| D61AFEF1-B10E-11D5-8666-0004ACD80749|MDM^T01|20060105180000999999|T|2.3
EVN|T01|20060105180000
PID|1||1112388^BS||ESPARZA^MARIA
PV1|1|O|BS^15^15
TXA|1|GENNOTES|TX|200601051800|50041^SMITH^CHRIS^M|200601051800|200601051800|200601051800|||
SC^ROBINSON^JESSICA^A|1234567890||||FILE0001.TXT|PR

MSH|^~\&|IScribe|Accumedscript|AMR01|NCA|20100709154314||MDM^T02|2010070915430942000|P|2.3|
EVN|T02|20100709115408|20100709115419|01||
PID|||E88^^^^EPI||Washington^George^K||20100709101000|M|||||||||||123456666||||||
PV1||O|||||||||||||||||22222|
TXA|1|CN||20100709151000|314^THODER^JOSEPH^^^^^^EPIC^^^^PROVID|20100709151000|20100709151000||314^THODER^JOSEPH^^^^^^EPIC^^^^PROVID|314^THODER^JOSEPH^^^^^^EPIC
^^^^PROVID||^^20100709151301|||||AU||AV|
OBX|1|TX|||George Washington is here today for a recheck on his left knee. He is now approximately four years status post replacement. He is two years status post right hip replacement. He
admits his hip is doing fine. He does have no real symptoms of pain in his left knee eithis. He does have occasional difficulty with walking. He is unsure why. He admits he has really no symptoms in
the right knee. He has severe scoliosis and degeneration in the lumbar spine. I do feel that this is giving his difficulty at times with his gait. Radiographs: Again, I did a thorough physical exam and xrays, which were obtained today, AP, weight bearing, and lateral view of the left knee. These show excellent position and alignment of the left knee replacement. No signs of loosening or problems.
Advanced osteoarthritic change in the right knee with varus deformity appreciated. Plan: I have advised his of conservative treatments for this and also I offered his some options regarding more
aggressive treatment for his lumbar and thoracic condition. He is not interested in any treatment for his spine at this point and will continue conservative path.||||||C||||||

4.2 SIU message

MSH|^~\&|||||201007211102||SIU^S12|61928_206_SC1|P|2.3||||||ASCII|<13>
SCH|2769|||||||FUP|20|MIN|201007210800|6579^ALI MD^S. ASIM^^^^||||||||LEM|||||PEN|<13>
PID|1||08003874^30034714^ ||TEST^JACKIE^^^^||19600417|F|||2401 GREENSWARD &WELSH ROAD^^HONOLULU^HI^96817||(215)707-5232|||S||08003874|212-54-8454||||||||||||<13>
PV1|1|O|CCO|||||207419^PONNURU MD,RAVITEJA L^3322 NORTH BROAD STREET^NORTHEAST MEDICAL OFFICE BLDG^COLUMBUS,OH^43215^614-1231547|||||||||||2769|||||||||||||||||||||||||20100721|20100721|<13>
AIS|1||2769|201007210800|||20|MIN||P|<13>
AIG|1||235^CCO|||||201007210800|||20|MIN||P|<13>
AIL|1||TUS|||201007210800|||20|MIN||P|<13>
AIP|1||6579^ALI MD^S. ASIM^^^^|||201007210800|||20|MIN||P|<13>
NTE|1|||<13>
NTE|1|||<13>