Add Alert Trigger Event
V 2.8 HL7 Proposal
Change Request ID:
File Name: Add_Alert_Trigger_Event.doc
Description:
Status: proposed
HL7-Version 2.8
Chapter/Section 7.3
Sponsoring Person Harry Solomon
Sponsoring Business Unit GE Healthcare
Date Originated: 5/11/2009
Date HL7 approved:
Backward Compatible:
Forward Compatible:
HL7 Status & Date
Justification Detail
It would be useful to have an additional Trigger Event associated with the ORU to identify an
observation that has been identified as an alert. This would allow message handling processes
(e.g., interface engines) to provide appropriate routing of such observations to alert
notification applications. This Trigger Event would imply an expected action at the ultimate
message receiver for presentation of the alert to a human or computer application for possible
intervention in patient care.
The use case is than an observation creator, or a clinical decision support application that is
monitoring observations, identifies an observation as an alert that requires notification. This
observation is sent with an alert Trigger Event, possibly in addition to the message with the
original observation with the usual R01 Trigger Event (although the specific use of this
message in combination with other messages is beyond the scope of this specification).
A specific application level Ack regarding disposition of the alert is also defined.
Proposal
See next page.
V3 Implications
none
v2.xml Implications
none
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Add alert trigger event
7.3 GENERAL TRIGGER EVENTS & MESSAGE DEFINITIONS
The triggering events that follow are all served by the ORU (Observational Report –
Unsolicited), the OUL (Observational Report – Automated Lab), or the OPU (Observational
Report – Population) messages in combination with ACK and ORA (Observational Report -
Application Acknowledgement). Each triggering event is listed below, along with the
messages exchanged, and the segments that comprise the messages. The notation used to
describe the sequence, optionality, and repeating of segments is described in Chapter 2,
"Format for defining abstract messages."
7.3.1 ORU – Unsolicited Observation Message (Events R01, R40)
The ORU message is for transmitting laboratory or other observational results to other systems. The
OUL message is designed to accommodate the laboratory processes of laboratory automation systems.
With the segment (OBX) defined in this chapter, and the OBR defined in Chapter 4, one can construct
almost any clinical report as a multi-level hierarchy, with the PID segment defined in Chapter 3 at the
upper level, an order record (OBR) at the next level with one or more observation records (OBX),
followed by the specimen information (SPM) and one or more observations (OBX) directly associated
with the specimen.
One result segment (OBX) is transmitted for each component of a diagnostic report, such as an EKG or
obstetrical ultrasound or electrolyte battery.
The CTD segment in this trigger is used to transmit temporary patient contact details specific to this
observation.
The R01 trigger event is used for general reports; there are no specific expected actions on the part of
the receiver.
The R40 trigger event is used for observation reports that include an alertable condition, i.e., for which
some timely human or application intervention in patient care may be indicated by the findings. If the
reporting application can identify a preferred recipient for the alert, that may be conveyed in the PRT
segment related to the OBR or OBX (with PRT-4 value RCT “Results Copies To”); however, there is no
expectation that the reporting application will a priori know that recipient, or that the receiving
application will deliver the alert to that preferred recipient. Several ORA-related trigger events are
associated with an application level response to the ORU^R40.
ORU^R01^ORU_R01, ORU^R40^ORU_R01: Observation Message
Segments Description Status Chapter
MSH Message Header 2
...
...
7.3.11 ORA – Observation Report Alert Acknowledgement (Events R41, R42)
This message enables an application level acknowledgement in response to the ORU^R40 alert
observation message.
The R41 trigger event is used to indicate that the alert observation of the ORU^R40 has been accepted
into a queue for guaranteed delivery to an appropriate clinical user. The R42 trigger event is used to
indicate that the alert observation has been delivered to, and acknowledged by, a clinical user. If the
clinical user can be identified, that identity can be conveyed in the PRT segment (with PRT-4 value
AAP Alert Acknowledging Provider).
ORA^R41^ORA_R41, ORA^R42^ORA_R41 : Observation Report Acknowledgement
Segments Description Status Chapter
MSH Message Acknowledgment 2
[{ SFT }] Software segment 2
[UAC] User Authentication Credential 2
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Add alert trigger event
MSA Message Acknowledgment 2
[{ ERR }] Error 2
[{ PRT }] Participation (Acknowledging User) 7
2.C.2.313 0912- Participation
Table Metadata
Table Steward V3 Harmonization V3 Equivalent Where used Status
0912 OO TBD TBD 7.4.4.4 Active
HL7-defined Table 0912 - Participation
Value Description Used with
…
AAP Alert Acknowledging Provider PRT-4
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