ACCESS ADT HL7 Specifications v1!1!07

8/3/2019 ACCESS ADT HL7 Specifications v1!1!07

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SKYLIGHT ACCESS

HL7 INTERFACE SPECIFICATION



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TABLE OF CONTENTS

INTRODUCTION .............................................................................................................................................................3

GENERALOVERVIEW ...................................................................................................................................................4

TECHNICALOVERVIEW................................................................................................................................................6

COMMUNICATION PROTOCOLS ...................................................................................................................................6 MINIMAL LOWER LAYER PROTOCOL..........................................................................................................................7 HOST NAMES, IP ADDRESS, AND PORT NUMBERS FOR TEST AND PROD.....................................................................7

ADMIT, DISCHARGE, ANDTRANSFER INTERFACE.......................................................................................................8

MESSAGEHEADERSEGMENT (MSH) ........................................................................................................................11

EVENT TYPE SEGMENT (EVN)...................................................................................................................................12

PATIENT IDENTIFICATIONSEGMENT (PID)...............................................................................................................13

PATIENTVISIT SEGMENTS (PV1 & PV2)...................................................................................................................14

PATIENTDIAGNOSIS (DG1 & DRG)..........................................................................................................................15

ALLERGY SEGMENT (AL1).........................................................................................................................................16

MERGE PATIENT INFORMATIONSEGMENT (MRG)..................................................................................................17

Z SEGMENTS ...............................................................................................................................................................17

APPENDIX A: RELATED DOCUMENTS /REFERENCE MATERIALS...............................................................................18

LIST OF TABLES

TABLE 1: HOST NAMES, IP ADDRESSES AND PORT NUMBERS FOR TEST AND PROD.................................................7 TABLE 2 : ADT EVENTS ................................................................................................................................................8 TABLE 3: A01 ADMISSION EVENT EXAMPLE.................................................................................................................9 TABLE 4: MESSAGE HEADER SEGMENT (MSH).........................................................................................................11 TABLE 5: EVENT TYPE SEGMENT (EVN)....................................................................................................................12 TABLE 6: PATIENT IDENTIFICATION SEGMENT (PID)..................................................................................................13 TABLE 7: PATIENT VISIT 1 SEGMENT (PV1) ...............................................................................................................14 TABLE 8: PATIENT VISIT 2 SEGMENT (PV2) ...............................................................................................................14 TABLE 9: DIAGNOSIS INFORMATION SEGMENT (DG1) ...............................................................................................15 TABLE 10: ALLERGY SEGMENT (AL1) ........................................................................................................................16 TABLE 11: MERGE PATIENT INFORMATION SEGMENT (MRG)...................................................................................17



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INTRODUCTION

This document has been prepared to provide a specification for the HL7 ADT (Admit, Discharge andTransfer), which will be sent outbound from your hospital system(s) to Skylight’s ACCESS application.The intended audience for this document is:

• Healthcare Provider Customers

• Business Analysts

• Technical Personnel

• Vendor Partners



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GENERAL OVERVIEW

The HL7 ADT Standard Interface from an ADT system through an Interface Engine provides information tothe Skylight Healthcare system, which transforms existing patient television sets into an interactiveentertainment and communication platform. This interface allows hospital staff to provide patient servicesvia ACCESS functionality. Such services include:

• Welcome video to all new admits • Message “n” hours after admit • Daily scheduled messages

• 3rd

party Survey integration • 3

rdparty Dietary system integration

• Parental permission control clearing at point of discharge or new admit • Transfer of Services •

Billing Services (if using bill to home phone option) • Optional Patient Specific Events (Health Education Reporting)

If there is no standard ADT feed available for use with the ACCESS system the following rules apply.

• Data activity will be tracked at the location (Room/Bed) level and no patient specific data canbe recorded and health education viewing will be generalized by ward.

• If a customer has chosen to charge for enhanced entertainment, Billing Services are limited toCredit Card and Gift Card

• If a customer has chosen to charge for enhanced entertainment, Transfer of Servicesbetween rooms will need to be called into our 24 hour support center and the transfer will bemanually done

• Triggered event messaging will not be allowed

If there is an ADT feed available the following rules apply based on the hospitals level of productparticipation. These services are available with the basic ADT feed which is defined later in this document.

• If a customer has chosen to charge for enhanced entertainment, Transfer of Services betweenrooms will automatically be done.

• Use of triggered event messaging will be allowed (Optional Feature)

The additional features may be added on to the ACCESS system but will require an extension of the ADTdata set be transmitted.

• Patient specific activity reporting requires the additional PID sequence noted fields on thedetailed PID sequence table included below.

The following rules apply with Skylight Healthcare Systems with regard to handling of ADT datatransmitted.

1. The Skylight Healthcare Systems ignores all fields not specifically used for the ACCESSsystem and prefers that the data transmitted only carries the sequences required.

2. Skylight Healthcare Systems typically maintains patient specific reporting data for only 30 daysafter discharge, but will extend this date upon hospital request and signoff.



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3. The ACCESS Systems is a receiving data only system and does not transmit into yourhospital system with the exception of sending an acknowledgement that it received an HL7message.

Skylight treats transactions as admits, discharges or updates. If the patient does not exist in the Skylightdatabase, the transaction creates the patient as an admit. If the patient is transferred to a bed not inSkylight, the patient is treated as a discharge. If the patient exists in Skylight, the transaction is an update.

Below are general assumptions, limitations and restrictions about the interface.

• This specification describes a real-time interface between the your interface engine andSkylight ACCESS

• All interface messages are in HL7 format, version 2.4.Note: Skylight will work with customers who are not able to provide HL7 V2.4 messages.

• All data from the registration system flows through the interface engine on its way to theACCESS System.

Unless otherwise indicated, the following terms have the specified meaning in this document:

• “Interface Engine” – ADT Interface Engine

• “ACCESS” – Skylight Healthcare Application



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TECHNICAL OVERVIEW

The interface engine is a store-and-forward system. It receives HL7 transactions from an ADT system andpasses the HL7 transactions onto the receiving application.

All communication between the interface engine use TCP/IP protocols. Serial (RS-232) interfaces are notsupported. The illustration below, “Communication Overview Diagram”, provides a high level overview ofthe interfaces supported by this implementation.

Figure 1: Communication Overview Diagram

Communication Protocols

Communication between the interface engine and Skylight Healthcare uses HL7 version 2.4 encoding, with

the “HL7 minimal lower-level protocol” and the TCP/IP protocol suite.

Message transport is handled by the TCP/IP protocol suite, with physical connection via twisted pair (100or 10 Mbps) or thin ethernet (10 Mbps).

Data is formatted according to the HL7 version 2.4 standard, using the HL7 “minimal lower layer protocol"without sequence numbers, but using the Message Control ID to associate messages and theiracknowledgements.

The sequence of events for sending an HL7 message from the interface engine to the receiving system is:

1. The interface engine opens a TCP connection (stream) to the receiving system.2. The interface engine sends an HL7 message, according to the minimal lower layer protocol.

The engine keeps the TCP connection open after sending the HL7 message.3. The receiving system processes the message and returns a normal (not enhanced)acknowledgment message to the engine.

4. The engine closes the TCP connection to the receiving system.

If the engine wishes to do so, it may leave the TCP connection open, going from step 3 back to step 2 forthe next message.

Only one HL7 conversation (data stream) may occur on each TCP port.



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HL7 messages include only normal data messages. Since the sequence numbers are not used, there areno initialization messages.

The receiving system recovers from temporary TCP outages without human intervention and re-

establishes communication with the interface engine based on your interface engine guidelines.

For full details of the HL7 protocol, refer to http://www.hl7.org.

Minimal Lower Layer Protocol

The HL7 minimal lower layer protocol is documented here (in addition to the HL7 official documents)because draft (free) versions are not distributed by HL7. The full HL7 standard, excluding the lower layerprotocol, is available via the HL7 web site.

Let "X" be an HL7 message, consisting of an MSH segment followed by zero or more other segments. Forthe minimal lower layer protocol, message X is surrounded by additional characters so that the full

message is now "sXer", where "s" is the ASCII vertical tab (VT) character, having decimal value 11; "e" isthe ASCII field separator (FS) character, having decimal value 28; and "r" is the ASCII carriage return (CR)character, having decimal value 13. Since both the vertical tab and field separator characters areforbidden inside an HL7 message, these characters allow the receiver to positively identify the start andend of an HL7 message.

Host Names, IP Address, and Port Numbers for Test and Prod

The table below lists the machine host names, IP Address and Port Numbers that will be used by thisinterface for data sent from the interface engine to the Skylight ACCESS System.

Skylight utilizes ACCESS control lists. Interface engine IP address changes that affect the ACCESSinterface must be communicated to the ACCESS ADT Manager.

Table 1: Host names, IP Addresses and Port Numbers for Test and Prod

IP ADDRESSES AND PORT NUMBERS FOR TEST AND PRODUCTION

Engine toGWTV

Host Name Receiving IPAddress of ACCESS

Port Number

Test Determined by customer

Prod Determined by customer



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ADMIT, DISCHARGE, AND TRANSFER INTERFACE

Admit, Discharge, and Transfer messages identify patients within the hospital as well as their locations.This information is critical to the successful functionality of the Skylight ACCESS System. A successfulinterface with a Hospital Information System that provides this data will occur as close to real-time aspossible. The HIS is expected to trigger ADT events for transmittal to the Skylight ACCESS withoutsolicitation.

The Skylight ACCESS System supports HL7 ADT events and at a minimum needs the following events ifin use at the facility:

Table 2 : ADT Events

ADT EVENTS

ADTMessage

CodeADT Message Description

Skylight toProcess

A01 Admit a patient Yes

A02 Transfer a patient Yes

A03 Discharge a patient Yes

A04 Register a patient Yes

A061

Transfer outpatient to inpatient Yes

A07 Transfer inpatient to outpatient Yes

A08 Update patient information Yes

A11 Cancel admit YesA12 Cancel transfer Yes

A13 Cancel discharge Yes

A16 Pending Discharge Yes

A21 Patient Goes on a “Leave Of Absence” Yes

A22 Patient Returns From a “Leave Of Absence” Yes

A23 Delete a Patient Record Yes

A25 Cancel Pending Discharge Yes

A342

Merge patient information - patient ID only Yes

A352

Merge patient information - account number only Yes

A362

Merge patient information - patient ID & account number Yes

A402 Merge Patient – Internal ID YesA41

2Merge Account Number Yes

A47 Change Internal ID Yes

A49 Change Patient Account Number Yes

1 Needs careful review to address site-specific processes.

2 Currently, these merge events are only minimally processed by the Skylight ACCESS System. The patient record is updated, but a

“true” merge (i.e. orders, account information) is not permitted. Testing of this functionality requires additional review and testing on asite-specific basis



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There is no need for the HIS to hold any ADT event. Any messages received that are not processed will beignored.Currently, these merge events are only minimally processed by the Skylight ACCESS System. The patient

record is updated, but a “true” merge (i.e. orders, account information) is not permitted. Testing of thisfunctionality requires additional review and testing on a site-specific basis

The Skylight ACCESS System accepts the MSH, EVN, PID, PV1, PV2, AL1, DG1, and MRG segments forADT transactions. The MSH, EVN, PID, PV1, and MRG are required. All other segments are optional butare recommended to be sent if available. The HL7 Data Exchange Specification discusses whichsegments are appropriate for which ADT events.

In general, an ADT message will follow the proceeding format. When a patient’s visit is terminated,whether discharged, expired, or outpatient released, a discharge message (A03) should be sent.

Note: This document describes only those segments that have fields that are processed by the SkylightACCESS System. This document, in most cases, does not describe individual field components. For a

more detailed description of field components and subcomponents, reference and comply with the HL7 Standard for Data Exchange, version2.3.

Table 3: A01 Admission Event Example

A01 EXAMPLE

ADT A013

ADT Message Required

MSH Message Header R

EVN Event Type R

PID Patient Identification R

PV1 Patient Visit R

[ PV2 ] Patient Visit – Additional Info. O

[ { AL1 } ] Allergy Information ROC

[ { DG1 } ] Diagnosis Information ROC

• The above example represents an A01 (admission event). Not all segments are present in allevents. However, the R (required) segments as shown above must be in all ADT messages.

• R (Required): Indicates the segment identified is required for proper patient identification.Also, a segment may be optional, but if sent, this field is required.

• ROC (Required On Condition): Indicates that this segment/field is required if the data isavailable or may be required under specific conditions.

• O (Optional): Indicates the segment identified is strongly desired, but is not absolutelyrequired and can be considered optional.

• Segments and fields identified as optional should always be sent if available.

• Reserved characters (~, ^, &, |) cannot be sent in any text defined field. These charactersmust be converted to the appropriate escape sequence prior to being sent to ACCESS.

3 Source: Health Level 7 Standard for data exchange, version 2.3



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• The Escape Sequence Identifier (\) should not be sent unless it is part of a true escapesequence (.i.e \T\,\S\, \F\, etc.).

• A blank or null field indicates no change to the existing value. To delete an existing valueconcurrent quotes ( “” ) must be sent.



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MESSAGE HEADER SEGMENT (MSH)

This table identifies the specific data elements that are most important to the Skylight ACCESS System ascontained within the PID segment. This table is presented for reference. Skylight requests that the HISvendor identify any fields that may not be supported prior to implementation. This will allow both parties tomake the appropriate determination on any additional work that may be required.The HL7 specification defines the message header in the following manner; “The MSH segment definesthe intent, Source, destination, and some specifics of the syntax of a message.” This is a very critical pieceof the information that is transferred between the systems. The table below identifies the standard fields inthe MSH segment and which ones are required or optional to the ACCESS System.

Table 4: Message Header Segment (MSH)

MESSAGE HEADER SEGMENT (MSH)

HL7 Field Description HL7Required

Stored inSkylight

Notes

001 Field Separator R N

002 Encoding Characters R N

003 Sending Application O Yes

004 Sending Facility O Yes Hospital Number

005 Receiving Application O N

006 Receiving Facility O N

007 Date/Time Of Message O Yes

008 Security O N

009 Message Type R Yes

0010 Message Control ID R Y

0011 Processing ID R Y



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EVENT TYPE SEGMENT (EVN)

The EVN segment is used to communicate necessary trigger event information to receiving applications.Valid for all ADT event types.

Table 5: Event Type Segment (EVN)

EVENT TYPE SEGMENT (EVN)

HL7 Field Description HL7 RequiredStored inSkylight

Notes

00099 Event Type Code R Yes

00100 Recorded Date/Time O Yes



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PATIENT IDENTIFICATION SEGMENT (PID)

This table identifies the specific data elements that are most important to the Skylight ACCESS System ascontained within the PID segment. This table is presented for reference. Skylight requests that the HISvendor identify any fields that may not be supported prior to implementation. This will allow both parties tomake the appropriate determination on any additional work that may be required.

Table 6: Patient Identification Segment (PID)

PATIENT IDENTIFICATION SEGMENT (PID)

No.HL7Field

DescriptionHL7

RequiredStored inSkyLight

Notes

1 00104 Patient Set ID – identifies thistransaction

O Y

2 00105 Patient ID(External)

O Y External ID

3 00106 Patient ID(Internal) – mapped toSkylight ACCESSMedical RecordNumber

R Y Medical Record Number

4 00107 Alternate PatientID

O N Alternate ID

5 00108 Patient Name R Y LastName^FirstName^MiddleInitialSuffix^Prefix

7 00110 Date/Time of Birth ROC Y Birth Date

8 00111 Patient Sex (Male,Female,Other,Unknown)

ROC Y Gender (M, F, O, U)

11 00114 Patient Address O Y Addreess1^Address2^City^State^Zip^Country^^^County

13 00116 Phone Number O Y

15 00118 Language O Y

18 00121 Patient AccountNumber

R Y Account Number

29 00740 Date/Time ofDeath O Y Death Date



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PATIENT VISIT SEGMENTS (PV1 & PV2)

This table identifies the specific data elements that are most important to the Skylight ACCESS System ascontained within the PV1 & PV2 segments. This table is presented for reference. Skylight requests that theHIS vendor identify any fields that may not be supported prior to implementation. This will allow bothparties to make the appropriate determination on any additional work that may be

Table 7: Patient Visit 1 Segment (PV1)

PATIENT VISIT 1 SEGMENT (PV1)

No. HL7 Field DescriptionHL7

RequiredStored inSkylight

Notes

1 00131 Patient Set ID O Yes Identifies this transaction

2 00132 Patient Class R Yes

(ER, In, Out, PreAdmit,

Recurring, OB)3 00133 Patient Location O Yes

6 00136 Prior Patient Location O Yes

7 00137 Attending Doctor O Yes

10 00140 Hospital Service O Yes

16 00146 VIP Indicators O Yes

38 00168 Diet Type O Yes

44 00174 Admit Date/Time R Yes

45 00175 Discharge Date/Time ROC Yes

Table 8: Patient Visit 2 Segment (PV2)

PATIENT VISIT 2 SEGMENT (PV2)



Notes

3 00183 Admit Reason O Yes

9 00189 Expected Discharge Date O Yes

10 00711 Estimated Length of Stay O Yes

11 00712 Actual Length of Stay O Yes



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PATIENT DIAGNOSIS (DG1 & DRG)This table identifies the specific data elements that are most important to the Skylight ACCESS System ascontained within the DG1 & DRG segments. This table is presented for reference. Skylight requests that

the HIS vendor identify any fields that may not be supported prior to implementation.This will allow both parties to make the appropriate determination on any additional work that may berequired.This segment is valid only in the these ADT message types that are processed by Skylight: A01, A03, A04,A06, A07, A08,A11, A12, A13, A16.

Table 9: Diagnosis Information Segment (DG1)

DIAGNOSIS INFORMATION SEGMENT (DG1)



Notes

1 00375 Set ID - DG1 O Yes Seq. Number

2 00376Diagnosis CodingMethod R Yes 2-Digit Coding Method

3 00377 Diagnosis Code R Yes

4 00378 Diagnosis Description R Yes

5 00379 Diagnosis Date/Time O Yes

6 00380 Diagnosis/DRG Type R Yes

8 00382Diagnostic RelatedGroup O Yes



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ALLERGY SEGMENT (AL1)This table identifies the specific data elements that are most important to the Skylight ACCESS System as

contained within the AL1 segment. This table is presented for reference. Skylight requests that the HISvendor identify any fields that may not be supported prior to implementation. This will allow both parties tomake the appropriate determination on any additional work that may be required.This segment is valid only for ADT message types that are processed by Skylight: A01, A04, A06, A07,A08, A13.

Table 10: Allergy Segment (AL1)

ALLERGY SEGMENT (AL1)



Notes

1 00203 Set ID O Yes Seq. Number

2 00204 Allergy Type O Yes (Drug, Food, Miscellaneous)

3 00205 Allergy Description R Yes (Some facilities use a code)

4 00206 Allergy Severity O Yes

6 00208Date allergy wasidentified O Yes



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MERGE PATIENT INFORMATION SEGMENT (MRG)This segment is only required on patient merge message types (A34, A35, A36, A40, and A41). It contains

the patient’s prior visit information. Only the data required by Skylight to process the MRG segment isincluded here.

Table 11: Merge Patient Information Segment (MRG)

MERGE PATIENT INFORMATION SEGMENT (MRG)



Notes

1 00211 Patients Prior MRN R Yes

3 00213Patients Prior AccountNumber R Yes

Z SEGMENTS Z segments are custom to each site and are not typically processed by ACCESS. These segment typesshould not be sent without prior discussion with, and approval by, Skylight Healthcare Systems, Inc.



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APPENDIX A: R ELATED D OCUMENTS /R EFERENCE M ATERIALS

1. HL7 Web Site: http://www.hl7.org

2. Information Technology “HL7 Interface Engine Standard HL7 Version 2.4”. 9.2 Ed.

3. Skylight Systems. “Skylight Systems GetWellTV ADT Requirements.” San Diego: SkylightSystems, April 21, 2005 (Note : Effective 6/23, Skylight Systems is now Skylight HealthcareSystems and the product formerly known as GetWellTV is now Skylight ACCESS.)

Documents

ACCESS ADT HL7 Specifications v1!1!07