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					                         TRANSCRIPTION SCENARIOS AND
                             INTERFACE SPECIFICATIONS
     (Modified for University of Washington /Harborview Medical Center HL7 Interface)


Healthcare facilities implementing Sunrise Chart Manager Transcription may utilize a
number of different approaches toward medical record transcription as listed below:

1)       On-site Transcriptionists
2)       Home-based Remote Transcriptionists
3)       Outside (Remote) Transcription Services

Each of the three above approaches involves a different setup to feed transcribed
documents to the Sunrise Chart Manager system, and these different setups are described
below. Though we are looking for functionality for on-site transcriptionist and home-
based remote transcriptionist inbound interfacing to be delivered, we are looking only
to use the functionality for outside (remote) transcription services interfacing at this
time.

On-site Transcriptionists

The on-site transcriptionists utilize PC workstations (configured as specified by Eclipsys
in writing) attached to the facility’s network. These PCs communicate on a real-time
basis with the primary Sunrise Chart Manager server via standard TCP/IP
communications and database communications software (configured on both the PC
workstation and at the server level). The Transcription software application is installed
locally on each PC and runs at the client level (client-server architecture). As each
transcribed report is saved, it is automatically loaded into the database on the primary
Sunrise Chart Manager server, which in turn communicates any appropriate distribution
instructions to the PC-based auxiliary (document-distribution) servers. If the customer is
using a clinical data repository (CDR) system to which transcribed documents will be
permanently archived, and Eclipsys will be establishing an outbound interface to that
system, once each transcribed report is electronically signed that signing “event” triggers
an outbound interface transaction to the CDR system for permanent storage.

The customer is responsible for the purchase and installation of these PC workstations on
the facility’s network unless the customer purchases PC workstation hardware through
Eclipsys. Eclipsys instructs the customer’s designated representative(s) in loading the
Transcription application and database software on the PCs, and the customer is
responsible for loading this software onto the on-site transcriptionist PCs. Eclipsys
installs and sets up the PC-based auxiliary servers at the designated site(s) provided that
Eclipsys is supplying such hardware; otherwise, the customer is responsible for installing
such PC servers on its network, and Eclipsys configures and sets up the document-
distribution application. Eclipsys tests communications between the primary Sunrise
Chart Manager server and the PCs in conjunction with the customer’s Information
Systems department. Eclipsys is responsible for setting up the Transcription application

Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   1
Finalized July 16, 2001
Version 4.1
and workflow software in accordance with the customer site’s specific requirements (as
detailed in the customer’s completed “Eclipsys 2000 Implementation Guide”).


Home-based Remote Transcriptionists

The PC configurations for home-based remote transcriptionists are the same as those for
the on-site workers, except that the home-based PCs are set up with a 56-KB modem or
an ISDN modem (terminal adapter)—or connect to the customer’s network via frame
relay (128K speed required). Eclipsys recognizes that, depending on the availability of
lines in the customer’s service area, there may need to be a mix of “traditional” modem,
ISDN modem, and/or frame-relay connectivity established for the home-based users.
Eclipsys has recommended ISDN connectivity where possible. While it has been our
experience that, in most cases, frame relay is cost prohibitive, it is an option the customer
may utilize. Telephone, ISDN, and/or frame-relay lines connect the home-based
modem/user to the hospital network.

In performing their transcription assignments, the home-based workers simply dial into
the Sunrise Chart Manager system and transcribe in a real-time mode. Once logged onto
the system, these home-based users are, in essence, no different from the on-line, on-site
users. Saved transcribed documents are automatically loaded into the database on the
primary Sunrise Chart Manager server and distributed (if applicable) as described in the
preceding section.

The customer is responsible for arranging the installation and setup (or for installing and
setting up on its own) the home-based PCs and is further responsible for arranging remote
communications (modems, lines, frame-relay connectivity) and for loading of the
Transcription application and database software components (based upon Eclipsys’
instructions/training).

Outside (Remote) Transcription Services

Medical record reports may be transcribed through the use of an outside (contracted or
“outsourced”) agency/service. Such outside companies typically utilize their own
computer systems for performing transcription work, and these third-party systems are
interfaced with Sunrise Chart Manager using one of the following interface approaches.
(If the customer wishes to allow the contracted firm to utilize the Eclipsys system, then
the transcription agency’s employees would be set up in the same manner as the home-
based users described in the preceding section). Assuming that the outside service is
using its own system, however, this means that—until the point at which the agency
transcriptionists save their documents—transcribing occurs completely “external” to the
Sunrise Chart Manager system.

1)      Health Level Seven (HL7) Version 2.3 – a real-time HL7 interface is our
        preferred method. We have attached to this document the HL7 specifications for
        an inbound transcription interface (Attachment 1). Using this approach the

Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   2
Finalized July 16, 2001
Version 4.1
        transcription document is included in the interface transaction as ASCII or
        embedded RTF (rich text formatting) text.

2)      Batch (non-realtime) – alternatively, a batch interface could be established
        between the transcription agency’s system and Sunrise Chart Manager. Given
        this approach, the transcribed document files are sent in ASCII, Rich Text Format
        (RTF), or as Microsoft Word 97 files. An index file accompanies each
        transcription document, and the fields included in the index file are dependent on
        the customer’s unique episode criteria and on whether the report is an episode-
        linked report (or linked to the patient only). We have attached a sample index file
        as Attachment 2.

        With the batch interface approach, the document and index files can be FTP’d to
        Sunrise Chart Manager (preferred method) or sent to an NFS-mounted drive that
        our system can access to retrieve the interfaced documents and indices.

The customer is responsible for distributing a copy of this document and its attachments
to each outside transcription vendor it uses (in compliance with the mutually agreed-upon
confidentiality/nondisclosure provisions) and for ensuring that each such vendor’s
outbound interface “side” is set up in accordance with Eclipsys’ specifications. Eclipsys
is responsible for setting up the receiving side of the interface in the Sunrise Chart
Manager system to accept (and distribute, based on report type, etc.) inbound
transcription documents from the outside agencies.

Outbound Transcription Interface

Finally, electronically signed transcribed reports may be exported to the customer’s CDR
system for permanent storage based on the scope of the project agreed upon by the
customer and Eclipsys. Assuming that the receiving system supports HL7 Version 2.3
interface standards, this would be our preferred approach to sending these documents.
We have attached a copy of our specifications for this outbound transcription interface as
Attachment 3.




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   3
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 1

                             Inbound Transcription Interface
                      Version 2.3 Health Level Seven (HL7) Segments


1.      MESSAGE SPECIFICATIONS

        The Eclipsys Health Level Seven (HL7) inbound transcription interface imports
        transcriptions from external systems/transcription services and stores them within
        the Eclipsys system. The interface operates in one of two modes; (1) importing
        the content of the documents or (2) importing a pointer to where the document
        can be located on an NFS or SFS (network file system or shared file systems)
        drive connected to the system server. We are currently using option (1) at the
        Academic Medical Centers.

        These specifications are based on the HL7 Version 2.3, Chapter 9 – Medical
        Records/Information Management, Membership Ballot No. 2, Revised. The
        supporting triggering event is listed below, along with a short description of
        Eclipsys’ use for these events. The notation used to describe the message
        structure is described in the HL7 manual under Chapter 2 – Control/Query.

        MDMT02 Original Document Notification and Content
        This is a notification that a new document has been transcribed. The content of
        the document is included. (See the Workflow Specification, Attachment 4, for a
        description of how addenda will be processed.)

        MDMT08 Edit Notification and Content
        This is a notification that an existing document has been edited/updated. The
        content of the document is included.

        For each event type, Chart Manager expects the following HL7 segments:

                          MDM                         Transcription Message                    Chapter
                           MSH               Message Header                                       2
                           EVN               Event Type                                           3
                           PID               Patient Identification                               3
                           PV1               Patient Visit                                        3
                           TXA               Document Notification                                9
                          {OBX}              Observation Notes                                    7




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    4
Finalized July 16, 2001
Version 4.1
       2.      DETAILED SEGMENT LISTINGS

               MSH – Message Header

Sequence      Required    Required by            Element Name                                 Notes
               by HL7      Eclipsys
                          Application
    1            Y                        Field Separator                Typically: |
    2            Y                        Encoding Characters            Typically: ^~\&
    3            Y                        Sending Application            MTS
    4            Y                        Sending Facility               MEDQ
    5            N                        Receiving Application          chart-mq-ts-hmc or chart-mq-ts-uwmc
    6            N                        Receiving Facility             Blank
    7            Y                        Date/Time of Message           Standard HL7 format
    9            Y                        Message Type                   MDM^T02
   10            Y                        Message Control ID             Unique message ID
   11            Y                        Processing ID                  D: Debug, P:Production
   12            Y                        Version ID                     2.3
   13            N                        Sequence Number
   14            N                        Continuation Pointer
   15            N                        Accept Acknowledgment
                                          Type
   16            N                        Application
                                          Acknowledgment Type
   17            N                        Country Code
   18            N                        Character Set
   19            N                        Principal Language

               EVN – Event Type

Sequence     Required     Required by            Element Name                                Notes
                           Eclipsys
                          Application
    1            Y            Y           Event Type Code                T02, T08, T11
    2            Y                        Date/Time of Event             Standard HL7 format



               PID – Patient Identification

Sequence     Required     Required by            Element Name                                Notes
                           Eclipsys
                          Application
   1             N                        Set ID – Patient ID            1,2,3,4 (Usually set at 1)
   2             N                        Patient ID (External ID)
   3             Y              Y         Patient ID                     Medrec Number
                                                                         (See Attachment 4)
   5             Y                        Patient Name                   Needed if not sending MRN
   7             N                        Date of Birth                  Needed if not sending MRN
   8             N                        Sex                            Needed if not sending MRN
        19       N                        SSN Number Patient             Needed if not sending MRN

       Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   5
       Finalized July 16, 2001
       Version 4.1
               PV1 – Patient Visit

Sequence     Required     Required by            Element Name                                Notes
                           Eclipsys
                          Application
   3             N           CC           Patient Location               Depending on customer’s unique episode
                                                                         criteria and on whether report is episode
                                                                         linked or only linked to patient
   4             N                        Episode Type
   7             Y              Y         Attending Physician            Code^Lname^Fname^Mname (See
                                                                         Attachment 4)
   10            N                        Hospital Service
   19            N             CC         Visit Number                   Unique identifier for an episode; see note for
                                                                         sequence no. 3 above
   39            Y              Y         Clinic Code                    (See Attachment 4)
   44            Y             CC         Admit Date/Serv. Date          See note for sequence no. 3 above
   45            N                        Discharge Date                 See note for sequence no. 3 above
   50            N                        Alternate Visit ID             Billing account number

               TXA – Transcription Report Header

Sequence     Required     Required by            Element Name                                Notes
                           Eclipsys
                          Application
     2           Y            Y           Document Type                  Document type (See Attachment 4)
     4           Y                        Activity Date/Time             e.g., service date
     6           Y                        Origination Date/Time          Dictation date
     7           Y                        Transcription Date/Time        Transcription date
     8           N                        Edit Date/Time                 For updates only
     9           Y              Y         Originator Code/Name           Dictating doctor
    11           N                        Transcriptionist               Transcriptionist code/name; can be set up to
                                                                         be required and could be Eclipsys login
    12           Y              Y         Unique Document ID             Transcription serial key (cannot exceed 12
                                                                         char.) (See Attachment 4)
    13           N                        Parent Document Number         Unique number for parent document, only
                                                                         used with the T06 event (for addenda)
    17           Y              Y         Document Status                Document completion status (F, A, or I)
                                                                         (See Attachment 4)
    18           N                        Confidentiality Status         Site-specific code values
    19           N                        Document Availability          Document availability status (AV –
                                                                         available, UN – unavailable, CA – canceled)
    22           N                        Authentication Person          Authenticating person and time stamp; this is
                                                                         populated if electronically signed
    23           N                        Distributed Copies             Carbon copies (cc’s)
                                                                         (See Attachment 4)




               OBX – Observation

Sequence     Required     Required by            Element Name                                Notes
                           Eclipsys
       Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface       6
       Finalized July 16, 2001
       Version 4.1
                    Application
1         Y                        Set ID                         Sequential numbering for each OBX segment
2         Y                        Value Type                     TX – text
5         Y              Y         Observation Value              The text of the document.
                                                                  (See Attachment 4)




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   7
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 2
                         Standard Inbound Transcription Interface
                                Index File Header Layout

We are looking for this functionality to be delivered, but we are not testing it at this
time.

This is the standard layout for the index header for a batch inbound transcription
interface. If the report is to be attached at the episode level, certain fields become critical
based on how the episode is to be found in the database. If the document attaches just at
the patient level, then only the medical record number would be required.

Seq#    Opt/Req          Field Name

1       O                Patient Last Name
2       O                Patient First Name
3       O                Patient Middle Name
4       C                Medical Record Number
5       CC               Account Number
6       C                Unique Document ID (4 digit job number + facility key)
7       CC               Dictating Physician Number (Dictator Code)
8       CC               Attending Physician Number (Attending Code)
9       O                Date Dictated
10      O                Time Dictated
11      CC               Admit Date (critical if not discharged)
12      CC               Service Date (critical if report type can have multiple deficiencies)
13      CC               Discharge Date (critical if discharged)
14      O                Date Transcribed
15      O                Time Transcribed
16      O                Transcriptionist (Sunrise Chart Manager Login ID)
17      C                Report Type
18      C                Name of the Document File (must be job number.txt)
19      CC               Facility Key (Required if Multi-facility)
20      O                Length of dictation (minutes)
21      O                CC Physician Number 1 (code or one-time CC – see below)
22      O                CC Physician Number 2
23      O                CC Physician Number 3
        .
        .
        .
41      O                CC Physician Number 21

Optional/Required:
C = critical (required and routes to fix queue if empty), O = optional, CC = critical
conditional (critical depending on another condition)


Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   8
Finalized July 16, 2001
Version 4.1
All dates must be mm/dd/yyyy
All times must be based on 24-hour clock hh:mm
Any fields that are optional and not filled must be left as a blank line


Please refer to Attachment 4 for the workflow detail.

 If the CC field begins with "^", then the CC field is not considered a provider ID but the
doctor's name - it will be added as a one-time cc. The format MUST BE:
^first_name^last_name^credential^address1^address2^address3^city^state^zip^country
^foreign_zip^mail_stop
(Note the line is split in 2 for reading clarity in this document).

If any piece is not available, use a blank character. Example:

^SAM^SMITH^DR^123 MAIN ST^ ^ ^ALEXANDRIA^VA^12345^ ^ ^

Here are the maximum character lengths for the one-time CC fields:

first_name:      12      address1: 30              city: 16         country:         12
last_name:       16      address2: 30              state: 2         foreign_zip:     6
credential:      12      address3: 30              zip: 10          mail_stop:       6

Following is the logic used to link the document to a patient and/or episode. Select
method that will find the greatest number of matches. Only one method can be used per
facility.

NOTE: "Recording an error” means the transcription load error table will be updated with
an error message and the report routed to the "Fix" file based on the routing setup

If how_to_read_episode = P attach the document to a patient only.

If how_to_read_episode = M (use episode uniqueness model) read episode using
uniqueness model to find the episode. If not found, record an error.

If how_to_read_episode = S find the first episode for the medrec number where either the
episodes.episode_date (discharge date) = the episode date passed in or the
episodes.admission_date is <= the episode date passed in and the episodes.episode_date
is null (the episode would be an admission). If none exist, record an error.

If how_to_read_episode = E find the first episode for the medrec number where either the
episodes.episode_date (discharge date) = the episode date passed in or the
episodes.admission_date is <= the episode date passed in and the episodes.episode_date =
the episodes.admission_date (the episode would be an admission if the site sets episode
date to admit date until discharge). If none exist, record an error.


Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   9
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 3

We are looking for this functionality to be delivered, but we are not testing it at this
time.

                            Outbound Transcription Interface
                      Version 2.3 Health Level Seven (HL7) Segments

                 Sequence         Element                       Value            Comment


MSH:                 1            Field Separator               |
                     2            Encoding Characters           ^~\&
                     3            Sending Application           chartflo
                     4            Sending Facility              TCPIP
                     5            Receiving Application                          Blank
                     6            Receiving Facility                             Blank
                     7            Date/Time of Message                           yyyymmddmmss
                     8            Security                                       Blank
                     9            Message Type                  ORU^XXX          XXX = T02 for
                                                                                 new, T08 for
                                                                                 update, T11 for
                                                                                 delete
                    10            Message Control ID                             Unique Trans Key
                    11            Processing ID                 P
                    12            Version ID                    2.3
                    13            Sequence Number                                Blank


EVN:                 1            Event Type Code                                T02, T08, T11, T06
                     2            Date/Time of Event                             yyyymmddmmss


PID:                 1            Set ID                                         Blank
                     2            Patient ID                                     Blank
                     3            Patient ID (Internal)                          Medrec #
                     4            Alternate Patient ID                           Blank
                     5            Patient Name                                   Lname^Fname^MI
                     6            Mother’s Maiden Name                           Maiden Name
                     7            Date of Birth                                  yyyymmdd
                     8            Sex
                     9            Alias                                          Blank
                    10            Ethnic Group
                    11            Address                                        Blank
                    12            Country                                        Blank
                    13            Home Telephone Number                          Blank
                    14            Work Telephone Number                          Blank
                    15            Language                                       Blank
                    16            Marital Status                                 Blank
                    17            Religion                                       Blank
                    18            Account Number
                    19            Social Security Number
                    20            Driver’s License Number                        Blank
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface      10
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 3
                                                                                       (Continued)

                            Outbound Transcription Interface
                      Version 2.3 Health Level Seven (HL7) Segments

                 Sequence         Element                       Value            Comment


PV1:                 1            Set ID                                         Blank
                     2            Patient Class                 D
                     3            Assigned Location                              ^2NS^
                   4-6                                                           Blank
                     7            Attending Doctor                               ID^Lname^Fname^I
                  8-18                                                           Blank
                    19            Visit Number                                   May Be Blank
                 20-43                                                           Blank
                    44            Admission Date                                 yyyymmdd0000
                    45            Discharge Date                                 yyyymmdd0000


TXA:                 2            Document Type                                  Document Type
                     4            Activity Date                                  Service Date
                                                                                 yyyymmdd0000
                     6            Origination Date                               Dictation Date
                                                                                 yyyymmdd0000
                     7            Transcription Date                             Transcription Date
                                                                                 yyyymmdd0000
                     8            Edit Date                                      Blank
                     9            Dictating Doctor                               ID^Lname^Fname^I
                    11            Transcriptionist                               Blank
                    12            Unique Document Number                         Unique Trans Key
                    17            Document Status                                P/F/A = preliminary/
                                                                                 final/addendum
                    18-22                                                        Blank
                    23                                                           Distributed Copies


OBX:                 1            Set ID                                         Incrementing #
                     2            Value Type                    FT
                   3-4                                                           Blank
                     5            Results                                        1 line of text
                  6-10                                                           Blank
                    11            Status                                         P/F/A = preliminary/
                                                                                 final/addendum




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    11
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 4

PID - Patient Identification
        PID-3    Patient ID

                 Patient ID will follow this format:
                         1 Character Hospital Code
                                 ‘U’ for University of Washington Medical Center
                                 ‘H’ for Harborview Medical Center
                         7 Digit Patient Number

                         No hyphenation will occur within the number

                         Examples: U6999999 or H1234567

PV1 – Patient Visit
        PV1-7 Attending Physician

                 As described in the PV1 section above, Attending Physician is defined as:
                 Code^Lname^Fname^Mname. This note is to describe in more detail, what the
                 Code means and where it comes from.

                 Attending Physician Code is up to a 6 digit numeric value that uniquely
                 identifies the Attending Physician. See Workflow Specification under
                 Maintenance for details about how Medquist receives the message and
                 how Eclipsys makes changes to it.

                 Note: Zero left-filling is not required for this interface.

                 For purposes of this interface, the Database of Record for this data is PDS.

                 PDS at each Medical Center will provide Medquist with a regular extract
                 of their Physician Data. The delivery of this data is outlined in the Work
                 Flow Document.

        PV1-39 Clinic Code     (This is specific to HMC only at this time.)

                 Clinic Code is a 2 digit numeric value that uniquely identifies the Clinic
                 for the Medical Center.

                 For purposes of this interface, the Database of Record of this data is PDS.

                 PDS at each Medical Center will provide Medquist with a regular extract
                 of their Clinic Codes. The delivery of this data is outlined in the
                 Workflow Specification.
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   12
Finalized July 16, 2001
Version 4.1
                 This list of clinics is subject to change. See the Workflow Specification
                 regarding changes (Attachment 4). NOTE: In the database, all of the
                 entries below will be followed by the word “Clinic”, with the exception of
                 #78, Urgent Care, and #98, Northwest Family Center (e.g., Surgery 1
                 Clinic, Neurology Clinic, Ophthalmology Clinic, and so on).


                 Clinic #         Clinic Name              Clinic #         Clinic Name

                 01               Arthritis Clinic         31               Renal Clinic
                 02               General Surgery          32               Liver Clinic
                 03               Surgery 1                33               Surgery III Clinic
                 04               Epilepsy                 34               Endocrinology Clinic
                 06               Neurology                36               Vascular Clinic
                 07               Neurosurgery             37               Diabetic Clinic
                 08               Ophthalmology            41               Allergy
                 09               Oral Surgery/Dental      43               Occupational Med
                 10               Orthopedics              44               Lipid Clinic
                 11               Otolaryngology           46               Viral Disease
                 12               Chronic Fatigue          55               Adult Medicine
                 13               Rehab Med                58               Hepatitis
                 15               Urology                  65               Cardiology
                 16               Thoracic Clinic          66               Hematology/Oncology
                 17               Pain Clinic              68               Children/Teen Clinic
                 18               Senior Care              73               Burn Clinic
                 19               Women’s Clinic           74               Dermatology
                 20               Behavioral Med           78               Urgent Care
                 22               International Med        83               Plastics Clinic
                 23               Surgery II               90               Madison Clinic
                 24               Chest                    91               Long Term Care
                 27               GI Clinic                92               Stroke Clinic
                 28               Infectious Disease       93               Pioneer Square
                 30               Family Medicine          94               Sleep Disorders
                                                           98               Northwest Family




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   13
Finalized July 16, 2001
Version 4.1
                 TXA – Transcription Report Header
        TXA-2 Document Type

                 Here are the lists of document types at both Harborview Medical Center and the
                 University of Washington.

                 The HL7 interface will not accept a document unless it matches one of the document
                 types listed below.

                 Note: Medquist will only initially send a subset of these types, that
                 subset containing outpatient reports only, to include the 49 clinic note
                 work types, listed on the prior page for Harborview Medical Center
                 along with work types 71 (Family Medicine) and 30 (Clinic Note) for
                 the University of Washington. These document types are subject to
                 change. See the Workflow Specification regarding changes
                 (Attachment 4).

                 HARBORVIEW MEDICAL CENTER:

                         TYPE    DESCRIPTION
                         ----    -------------------------
                         0       PULMONARY FUNCT - TRANSCR
                         87       URGENT CARE-TRANSCRIBED
                         8       CLINICAL SUMMARY - TRANSC
                         A       COLPOSCOPY - TRANSCR
                         C       CLINIC NOTE - TRANSCRIBED
                         CC      CONSULTATION - TRANS
                         D       DISCH SUMMARY - TRANSCR
                         E       INIT CLINIC VISIT – NEW CONS
                         H       HEMATOLOGY - TRANSCR
                         I       INTERIM SUMMARY - TRANSCR
                         L       LETTER - TRANSCR
                         N       PROCEDURE NOTE - TRANSC
                         O       OPERATIVE REPORT - TRANSC
                         OO      CLINIC NOTE - OTH HX -TRA
                         P       PSYCHOSOCIAL HISTORY - TRAN
                         ***Q       ECHO TRANSCRIBED
                         R       PANEL SUMMARY - TRANSCR
                         ***S       SPINAL CORD MONITOR - TRANS
                         SS      SLEEP STUDY - TRANSCRIBED
                         U       LT CARE SUMMARY - TRANSCR
                         Z       ADMISSION NOTES – TRANSCR
                         98      PT CARE/AGREEMENT PLAN
                         99      STAT DISCHARGE SUMMARY
                         41      SURGICAL NEUROMONITORING




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface      14
Finalized July 16, 2001
Version 4.1
                 UNIVERSITY OF WASHINGTON:

                         TYPE   DESCRIPTION
                         ----   --------------------------
                         6      ER/UCC
                         7      PT CARE AGREEMENT
                         9      PATIENT CARE PLAN
                         AC     ATT CONF NOTE
                         B      REHAB LETTER
                         C      CLINIC NOTE
                         D      DISCH SUMM
                         DA     DAILY ATT NOTE
                         E      INI. C/N
                         F      CARD SHORT
                         G      CARD LONG
                         HP     HISTORY & PHYSICAL
                         I      INTERIM SUMM
                         J      ORTHO LETTER
                         K      FMC CLIN LTR
                         L      STD LTR
                         M      MICRO SURG
                         N      PROCEDURE
                         O      OP REPORT
                         Q      ECHO CARD
                         R      REHAB CN
                         SO     SCCA OUTPATIENT REPORT
                         SL     SCCA LETTER
                         T      TRANS SUMMARY
                         U      CONSULT
                         V      DOCTOR LTR
                         W      PATIENT LTR
                         X      PAIN COMBINED
                         Y      FMC CLIN NT
                         Z      TELEPHONE NOTE
                         SZ     SCCA TELEPHONE NOTE




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   15
Finalized July 16, 2001
Version 4.1
        TXA-12 Unique Document ID

                 The Medquist system will generate a unique identifier for each report sent through the
                 interface. This ID must not exceed 12 characters, and may contain alphanumeric
                 characters.

        TXA-17 Document Status

                 This field identifies the current state of the document.

                 Document completion status (P, F, A, or I)

                          P:       Preliminary
                          F:       Final
                          A:       Addendum
                          I:       Incomplete

        TXA-23 Distributed Copies

                 TXA-23 is a repeating field. MSH-2 Repetition Separator specifies what character will be
                 used to separate each provider occurrence, A tilde ‘~’ is the usual value.

                 The first component of each repeating occurrence is the provider id. If the provider-id is
                 present then it will use the same source as the PV1-7 Attending Physician above.

                 If the CC field begins with "^", the first sub-component is blank., then the CC field is not
                 considered a provider ID but the doctor's name - it will be added as a one-time cc.

                 The format for one-time cc’s MUST BE:

                          ^first_name^last_name^credential^address1^address2^address3^city^state^zip^
                          country^foreign_zip^mail_stop

                          Note: This format does not comply with the HL7 spec for this field, which does
                          not allow for the specification of an address.

                 Examples:

                          No one time providers:

                                   TXA| … |37320~20019~106568|…
                                         Specifies that 3 known providers should be cc’d.

                          A single one time cc:

                                   TXA|…|^SAM^SMITH^DR^123 MAIN ST^ ^
                                   ^ALEXANDRIA^VA^12345^ ^ ^|…

                          A mix of one time and known providers:

                                   TXA| … |37320~20019~106568~^SAM^SMITH^DR^123 MAIN ST^
                                   ^ ^ALEXANDRIA^VA^12345^ ^ ^|…




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface           16
Finalized July 16, 2001
Version 4.1
                                                                                    Attachment 4U
                      Standard Inbound Transcription Interface
                Workflow Specification for HL7 Interface with Medquist
                             University of Washington

The following document describes the workflow in its entirety, from the point of dictation to
transcription by the outsource vendor and to the point of printing the finalized document. The
purpose of this document is to clarify each step in the process and identify the expected outcome.

HL7 Workflow

Responsible Person:                       Action:

Patient Care Provider                     Dictates a clinic note (work type 30 or 71) into the
                                          Lanier digital dictation system (206-685-0186) OR
                                          dictates a clinic note directly into the Medquist DVI
                                          dictation system (206-805-XXXX)

                                          Keypad entry at time of dictation includes 5-digit Lanier
                                          Provider ID code, 2-digit work type, and 7-digit Medical
                                          Record Number.

Medquist Transcriptionist                 Medquist Medical Transcriptionist (MT) accesses the
                                          UWMC clinic note one of two ways: 1) Lanier transcribe
                                          station to access reports dictated on the UWMC dictation
                                          system 2) Medquist MTS system to access reports on
                                          the Medquist DVI dictation system.

                                          Medquist MT transcribes the report in the Medquist MTS
                                          system (which is a proprietary software program).

                                          If Provider dictates addendum to previously transcribed
                                          report, addendum must be created as a separate
                                          document with an “A” (addendum) status and will not be
                                          linked to original document.

                                          Medquist MT completes transcription of report including
                                          the addition of CCs and one-time CCs (within outbound
                                          HL7 message within TXA23 segment). See Attachment
                                          1 for more detail. Reports sent via batch to the Seattle
                                          Medquist office (frequency to be determined).

                                          If a report is incomplete, the MQ MT generates a
                                          deficiency. The report is then sent through the interface
                                          with an “I” status, causing it to fall into the Fix file.

Medquist Seattle office                   Medquist Seattle office filters report(s) for: 1) Quality
                                          Assurance 2) Matching ADT information provided via
                                          HL7 interface from HMC MCIS Dept. (currently from
                                          MIMI 2-Cloverleaf). If automatic ADT match fails, MQ
                                          support staff will do manual matching from the ADT feed.
                                          If unable to match manually, the report will be sent
                                          through the interface with an “I” status, causing it to fall

Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   17
Finalized July 16, 2001
Version 4.1
                                          to the Fix file. MQ will fax a list of failed matches to PDS
                                          Transcription by the end of that business day.

                                          The footer of each Clinic Note contains the following
                                          data elements: Patient Name, Patient Number, Date of
                                          Birth, Date of Service, Clinic Name.

                                          The signature block of each Clinic Note contains the
                                          following data elements: Attending Provider, Dictating
                                          Provider, Date of Dictation, Date of Transcription, MT
                                          initials, Lanier Job number.

                                          Batch send process creates RTF file (Rich Text Format).

                                          Combination RTF/HL7 message sent in batches to
                                          Medquist Atlanta to the Technical Call Center (currently
                                          on the Purple Haze server).

Medquist Atlanta Technical                Socket connection is utilized to send combination
Call Center                               RTF/HL7 message via a VPN (Virtual Private Network)
                                          for encryption and security.

                                          Combination RTF/HL7 message sent via socket
                                          interface to server (currently Dimaggio) located in
                                          UWMC MCIS in Seattle.

MCIS                                      UWMC MCIS server (currently Dimaggio) collects
                                          RTF/HL7 messages and sends to the Cloverleaf engine
                                          (currently MIMI2).

                                          Cloverleaf engine (MIMI2) then distributes the messages
                                          to the appropriate medical center based on the hospital
                                          code defined in the PID3 segment of the HL7 message
                                          (U for University of Washington).

                                          UWMC server (currently Simba) runs queries every 30
                                          seconds to identify new messages. If new messages
                                          are identified, a flag is then set in the system for the
                                          Prep Server to identify that there are messages to
                                          process.

Eclipsys Prep Server                      Prep server (an NT server) runs constantly, searching
                                          the UWMC database (currently Simba) for new HL7
                                          message flags.

                                          Once new messages are identified, the prep server
                                          retrieves those messages and downloads the HL7
                                          message to a temporary workspace.

                                          The prep server then opens up MS-Word and grabs the
                                          temporary file, saves it as an ASCii file, and closes the
                                          file.

                                          The prep server reopens the temporary file and saves it
                                          as a WordPerfect file, then closes the file.

Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface     18
Finalized July 16, 2001
Version 4.1
MCIS                                      A new HL7 message is generated and sent to the
                                          Cloverleaf engine any time there is a new message from
                                          the prep server, an update to an existing message, or if
                                          MCIS resets the server job number and regenerates all
                                          outbound interface messages.

                                          The row of data then drops to the database server
                                          (Simba). This includes Medical Record number,
                                          Dictator, Date and Time of dictation, MT initials, Date of
                                          transcription, Provider ID number, and Authentication
                                          date/time if applicable.

                                          The document itself is sent to the database for storage
                                          (currently Scuttle).

Mindscape                                 Mindscape utilizes the row of data held in the database
                                          server (Simba) as a pointer to the location of the
                                          transcribed document and allows the document to be
                                          displayed in Mindscape.


UWMC Transcription Services:


                 Fix File                 Document routes to the FIX file if any of the required
                                          data elements are missing (required data elements are
                                          specified in Attachment 1 of the HL7 specification) OR if
                                          the document has an “I” status (Incomplete).

                 Electronic Signature     If document NOT missing any required data elements,
                                          the document passes into the Electronic Signature
                                          queue of the Resident and/or Attending Physician
                                          simultaneously. (*See below.)

                 Printing                 If document is for a Non-Electronic Signature Provider,
                                          the document queues to print automatically. Original
                                          document prints along with any CC copies identified at
                                          the time of transcription along with envelopes containing
                                          addresses for any CC(s). Non-Esign documents remain
                                          “unverified” in Mindscape.

                                          *Document queues to print once Authentication occurs
                                          for Electronic Signature Providers. Document then
                                          appears as finalized in Mindscape via the new HL7
                                          message that is sent back to the Cloverleaf engine as
                                          outlined above in the “MCIS ” portion of the workflow.
                                          These are considered “updates” to an existing
                                          document, the former version of the document is no
                                          longer accessible at this point.

                 CCs                      CCs queue to print upon authentication of document
                                          along with envelopes containing the CC address from
                                          the Provider Database.

                                          One-time CCs are Providers/Addressees who are not
                                          located in the Provider database. One-time CCs will be
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    19
Finalized July 16, 2001
Version 4.1
                                          identified in the HL7 message (see Attachment 4 for
                                          details) and will NOT contain a Provider ID.

                                          A copy and envelope with the address for any one-time
                                          CCs will print upon authentication of the report (unless
                                          Provider is non-Esign).

                                          One-time CCs entered by Medquist MT will fall out to the
                                          one-time CC list that is run by Transcription Services
                                          weekly. All one-time CCs from the weekly list are
                                          manually entered into the Provider Database by
                                          Transcription Services staff for the possibility of future
                                          use.


Weekly Maintenance                        UWMC MCIS will provide Medquist Seattle office with an
                                          updated version of the Provider Database on a weekly
                                          basis. This process will be automated by UWMC MCIS.
                                          This updated extract will capture any new entries
                                          including all one-time CC addresses that have been
                                          added.

                                          UWMC MCIS will send the entire Provider Database to
                                          Medquist with the expectation that Medquist will over-
                                          write their current version of the Provider Database upon
                                          receipt.

                                          The weekly send from UWMC MCIS will also include the
                                          report table in CFLO to capture any changes that are
                                          made by UWMC.


Reconciliation                            A process will run in MCIS daily at the same time to
                                          identify all messages sent from the Eclipsys prep server
                                          from the day before. The message will contain the
                                          number of documents and the “row” where it is located in
                                          the database server (Simba).

                                          The message then passes to the Mindscape backup
                                          system for both Medical Centers.

                                          The Medical Record numbers from the messages are
                                          then parsed for comparison purposes.

                                          The parsed messages are then queried against the
                                          documents available via Mindscape from the past 6
                                          months to 3 months in the future (purpose is to catch
                                          any documents that came through the interface since the
                                          reconciliation process began).

                                          The list of documents available in Mindscape is
                                          compared to the parsed messages, providing verification
                                          that the file exists in Mindscape. The result captured by
                                          this process is whether a report exists for a given
                                          Medical Record number for a specific date.

Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   20
Finalized July 16, 2001
Version 4.1
                                          If the file is not found, an automated email message
                                          containing the error log is sent to Transcription Services
                                          for troubleshooting.




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   21
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 4H
                      Standard Inbound Transcription Interface
                Workflow Specification for HL7 Interface with Medquist
                            Harborview Medical Center

The following document describes the workflow in its entirety, from the point of dictation to
transcription by the outsource vendor and to the point of printing the finalized document. The
purpose of this document is to clarify each step in the process and identify the expected outcome.


HL7 Workflow

Responsible Person:                        Action:

Patient Care Provider                      Dictates a Clinic Note (work type 30) or an Urgent Care
                                           Note (work type 87) into the Lanier digital dictation
                                           system (206-731-3743)

                                           Keypad entry at time of dictation includes 5-digit Lanier
                                           Provider ID code, 2-digit report type, 2-digit service/clinic
                                           code and 7-digit Medical Record Number. (See
                                           Attachment 4 for the Clinic Codes/Names.)

Medquist Transcriptionist                  Medquist Medical Transcriptionist (MT) accesses the
                                           HMC Clinic Note via a Lanier transcribe station.

                                           Medquist MT transcribes the report in the Medquist MTS
                                           system (which is a proprietary software program).

                                           If Provider dictates addendum to previously transcribed
                                           report, addendum must be created as a separate
                                           document with an “A” status (Addendum) and will not be
                                           linked to original document.

                                           Medquist MT completes transcription of report including
                                           the addition of CCs and one-time CCs (located within
                                           outbound HL7 message, TXA23 segment). See
                                           Attachment 1 for more detail. Reports are sent via batch
                                           to the Seattle Medquist office (frequency to be
                                           determined).

                                           If a report is incomplete, the MQ MT generates a
                                           deficiency. The report is then sent through the interface
                                           with an “I” status, causing it to fall into the Fix file.

Medquist Seattle office                   Medquist Seattle office filters report(s) for: 1) Quality
                                          Assurance 2) Matching ADT information provided via
                                          HL7 interface from HMC MCIS Dept. (currently from
                                          MIMI 2-Cloverleaf). If automatic ADT match fails, MQ
                                          support staff will do manual matching from the ADT feed.
                                          If unable to match manually, the report will be sent
                                          through the interface with an “I” status, causing it to fall
                                          to the Fix file. MQ will fax a list of failed matches to PDS
                                          Transcription by the end of that business day.
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface      22
Finalized July 16, 2001
Version 4.1
                                          The footer of each Clinic Note contains the following
                                          data elements: Patient Name, Patient Number, Date of
                                          Birth, Date of Service, Clinic Name.

                                          The signature block of each Clinic Note contains the
                                          following data elements: Attending Provider, Dictating
                                          Provider, Date of Dictation, Date of Transcription, MT
                                          initials, Lanier Job number.

                                          Batch send process creates RTF file (Rich Text Format).

                                          Combination RTF/HL7 message is sent in batches to
                                          Medquist Atlanta to the Technical Call Center (currently
                                          on the Purple Haze server).

Medquist Atlanta Technical                A socket connection is utilized to send combination
Call Center                               RTF/HL7 message via a VPN (Virtual Private Network)
                                          for encryption and security.

                                          Combination RTF/HL7 message is sent via socket
                                          interface to server (currently Dimaggio) located in HMC
                                          MCIS in Seattle.

MCIS                                      HMC MCIS server (currently Dimaggio) collects
                                          RTF/HL7 messages and sends to the Cloverleaf engine
                                          (currently MIMI2).

                                          Cloverleaf engine (MIMI2) then distributes the messages
                                          to the appropriate medical center based on the hospital
                                          code defined in the PID3 segment of the HL7 message
                                          (H for Harborview).

                                          HMC server (currently Odie) runs queries every 30
                                          seconds to identify new messages. If new messages
                                          are identified, a flag is then set in the system for the
                                          Prep Server to identify that there are messages to
                                          process.

Eclipsys Prep Server                      Prep server (an NT server) runs constantly, searching
                                          the HMC database (currently Odie) for new HL7
                                          message flags.

                                          Once new messages are identified, the prep server
                                          retrieves those messages and downloads the HL7
                                          message to a temporary workspace.

                                          The prep server then opens up MS-Word and grabs the
                                          temporary file, saves it as an ASCii file, and closes the
                                          file.

                                          The prep server reopens the temporary file and saves it
                                          as a WordPerfect file, then closes the file.


Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface     23
Finalized July 16, 2001
Version 4.1
MCIS                                      A new HL7 message is generated and sent to the
                                          Cloverleaf engine any time there is a new message from
                                          the prep server, an update to an existing message, or if
                                          MCIS resets the server job number and regenerates all
                                          outbound interface messages.

                                          The row of data then drops to the database server
                                          (Charlotte). This data row includes Medical Record
                                          number, Dictator, Date and Time of dictation, MT initials,
                                          Date of transcription, Provider ID number, and
                                          Authentication date/time if applicable.

                                          The document itself is sent to the database for storage
                                          (currently Figaro).

Mindscape                                 Mindscape utilizes the row of data held in the database
                                          server (Charlotte) as a pointer to the location of the
                                          transcribed document (Figaro) and allows the document
                                          to be displayed in Mindscape.


HMC Patient Data Services:


                 Fix File                 Document routes to the Fix file if any of the required data
                                          elements are missing (required data elements are
                                          specified in Attachment 1 of the HL7 specification) OR if
                                          the document has an “I” status (Incomplete).

                 Printing                 Documents queue to print automatically. Original
                                          document prints along with any CC copies identified at
                                          the time of transcription along with envelopes containing
                                          addresses for any CC(s). Documents are “unverified” in
                                          Mindscape.

                 CCs                      One-time CCs are Providers/Addressees which are not
                                          located in the Provider database. One-time CCs will be
                                          identified in the HL7 message (see Attachment 4 for
                                          details) and will NOT contain a Provider ID.

                                          A copy and envelope with the address for any one-time
                                          CCs will print.

                                          One-time CCs entered by Medquist MT will fall out to the
                                          one-time CC list that is run by Patient Data Services
                                          weekly. All one-time CCs from the weekly list are
                                          manually entered by PDS Transcription into the Provider
                                          Database for the possibility of future use.


Weekly Maintenance                        HMC MCIS will provide Medquist Seattle office with an
                                          updated version of the Provider Database on a weekly
                                          basis. This process will be automated by HMC MCIS.
                                          This updated extract will capture any new entries
                                          including all one-time CC addresses that have been
                                          added.
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    24
Finalized July 16, 2001
Version 4.1
                                          HMC MCIS will send the entire Provider Database to
                                          Medquist with the expectation that Medquist will over-
                                          write their current version of the Provider Database upon
                                          receipt.

                                          The weekly send from HMC MCIS will also include the
                                          report table in CFLO, as well as the Clinic Code Table,
                                          to facilitate capture of any changes made by HMC
                                          Patient Data Services.

Reconciliation                            A process will run in MCIS daily at the same time to
                                          identify all messages sent from the Eclipsys prep server
                                          from the day before. The message will contain the
                                          number of documents and the “row” where it is located in
                                          the database server (Charlotte).

                                          The message then passes to the Mindscape backup
                                          system for both Medical Centers.

                                          The Medical Record numbers from the messages are
                                          then parsed for comparison purposes.

                                          The parsed messages are then queried against the
                                          documents available via Mindscape from the past 6
                                          months to 3 months in the future (purpose is to catch
                                          any documents that came through the interface since the
                                          reconciliation process began).

                                          The list of documents available in Mindscape is
                                          compared to the parsed messages, providing verification
                                          that the file exists in Mindscape. The result captured by
                                          this process is whether a report exists for a given
                                          Medical Record number for a specific date.

                                          If the file is not found, an automated email message
                                          containing the error log is sent to Patient Data Services
                                          for troubleshooting.




Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    25
Finalized July 16, 2001
Version 4.1
                                                                                      Attachment 5
                         Standard Inbound Transcription Interface
                                HL7 Project Team Roster
                                       March 2001



PDS HMC:                                  E-MAIL                                     PHONE:
Beth Powell, Project Manager,
HMC/UWMC                                  bpowell@u.washington.edu                   206-521-1514
Tim Halsey                                timh@u.washington.edu                      206-731-2963


PDS UWMC:
Sally Beahan                              sbeahan@u.washington.edu                   206-598-6176
Nancy Dunnington                          dunningt@u.washington.edu                  206-598-4348
Jim Mazurk                                mazurk@u.washington.edu                    206-598-6956


UW MCIS:
Mike Jellison                             jellison@u.washington.edu                  206-685-8130
Brian Parkhurst                           brianp@u.washington.edu                    206-543-7458
Fred Peet                                 fpeet@u.washington.edu                     206-543-7574
Blair Cockerline                          blairac@u.washington.edu                   206-543-3154


ECLIPSYS:
Jim Gitell, Project Manager               jim.gitell@eclipsys.com                    602-389-8115
Joe Maloney                               joe.maloney@eclipsys.com                   800-228-6363
Marley Weaver                             marley.weaver@eclipsys.com                 800-228-6363
Nava Dweck                                nava.dweck@eclipsys.com                    800-228-6363
Tana Rezonable                            tana.rezonable@eclipsys.com                800-228-6363


MEDQUIST:
Tracey Tanner, Project Manager            ttanner@medquist.com                       800-557-1776, 257
Brook Wagner                              bwagner@medquist.com                       801-208-4800
Jeff Sacre                                jsacre@medquist.com                        503-390-3151
John Quaintance                           jquaintance@medquist.com                   602-212-0944
Melinda Patten                            mpatten@medquist.com                       303-779-1500
Mary Ann German                           mgerman@medquist.com                       206-805-5700
Rod Espinoza                              respinoza@medquist.com
T.R. Garwick                              tgarwick@medquist.com                      800-557-1776, 252
Becky Adams                               badams@medquist.com                        206-805-5700
Jason Babcock                             jbabcock@medquist.com                      800-557-1776, 258



Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface    26
Finalized July 16, 2001
Version 4.1
Specs for Harborview Medical Center and the University of Washington HL7 Transcription Interface   27
Finalized July 16, 2001
Version 4.1

				
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