Michigan Care Improvement Registry HL7 2.5.1 Specification For .
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Message types supported: Vaccination Update (VXU) Admission/Discharge/Transfer (ADT) Message formats supported: HL7 2.5.1 HL7 2.3.1 Document Description This guide is intended for immunization providers and their vendors to assist in connecting to the Michigan Care Improvement Registry (MCIR). MCIR is an immunization registry that compiles complete immunization histories for children and adults in Michigan. Electronic Health Record (EHR) systems that comply with Stage 1 Meaningful Use requirements must be able to submit immunization administration data to their state registry. This document explains the technical details of this interface. The recommendations here are in line with CDC and HL7 standards and should be compatible with EHR's who are following Meaningful Use guidelines. Revised August 23, 2013 Page 1 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Table of Contents Table of Contents .2 Michigan Care Improvement Registry .4 Introduction and History .4 Transfer Interfaces Available .4 How to Format Data .4 How to Send Data .5 Health Information Exchanges (HIE) and MCIR HL7 Messaging Requirements .6 Health Level Seven (HL7) .8 History .8 Message Specifications .8 Message Structure .9 Version Compatibility .9 Meaningful Use .9 Immunization Messages . 10 Vaccination Update (VXU) .10 Vaccination Query . 10 Patient Update (ADT) .10 How To Read This Document.10 Vaccination Update Message (VXU) .12 Message Structure . 12 Example Message . 12 Master Field List .13 MSH: Message Header Segment .17 MSH-1: Field separator .18 MSH-2: Encoding characters .18 MSH-3: Sending application . 18 MSH-4: Sending facility .18 MSH-5: Receiving application .18 MSH-6: Receiving facility .19 MSH-7: Date/time of message . 19 MSH-9: Message type .19 MSH-10: Message control id .19 MSH-11: Processing id .19 MSH-12: Version id. 20 MSH-16: Application acknowledgment type . 21 PID: Patient Identifier Segment . 21 PID-3: Patient identifier list . 22 PID-5: Patient name . 24 PID-6: Mother's maiden name .25 PID-7: Date of birth .25 PID-8: Sex . 26 PID-10: Race . 26 PID-11: Patient address .27 PID-13: Phone number - home .28 PID-15: Primary language .28 PID-22: Ethnic group . 30 PID-23: Birth place . 30 PID-29: Patient death date and time .30 PID-30: Patient death indicator .30 Revised August 23, 2013 Page 2 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages PID-33: Last Update Date/Time .30 PD1: Additional Demographics Segment .31 PD1-11: Publicity code .31 PD1-12: Protection Indicator . 32 PD1-16: Immunization registry status . 32 NK1: Next of Kin/Associated Parties Segment . 33 NK1-2: Name . 34 NK1-3: Relationship .35 NK1-4: Address . 36 NK1-5: Phone number .37 PV1: Patient Visit Segment . 37 PV1-2: Patient class .38 ORC: Order Request Segment.39 ORC-2: Placer Order Number .40 ORC-3: Filler Order Number .40 RXA: Pharmacy Administration Segment . 40 RXA-2: Administration sub-ID counter .41 RXA-3: Date/time start of administration . 42 RXA-4: Date/time end of administration . 42 RXA-5: Administered code .42 RXA-6: Administered amount .42 RXA-7: Administered units .42 RXA-9: Administration notes .43 RXA-10: Administering provider. 43 RXA-11: Administered at location . 44 RXA-15: Substance lot number.45 RXA-17: Substance manufacturer . 45 RXA-18: Substance refusal reason .45 RXA-20: Completion Status . 46 RXA-21: Action code .46 RXA-22: System entry date/time . 47 RXR: Pharmacy Route Segment .47 RXR-1: Route . 47 RXR-2: Site . 48 OBX: Observation Segment .49 OBX-1: Set ID – OBX .50 OBX-2: Value Type . 50 OBX-3: Observation Identifier .50 OBX-4: Observation Sub-ID .50 OBX-5: Observation Value (VFC Status) .50 OBX-6: Units . 51 OBX-14: Date/Time of the Observation . 51 What is VFC Status? . 51 How To Send VFC Status .51 VFC Status Codes . 51 Data Models . 52 Vaccination Update Message (VXU) .52 Code Tables . 56 Licensed Vaccine (CVX) & Manufacturer Codes .56 Revision History .57 Michigan County Codes . 60 Revised August 23, 2013 Page 3 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Michigan Care Improvement Registry Introduction and History MCIR was created in 1998 to collect reliable immunization information and make it accessible to authorized users online. In 2006, MCIR was expanded to include adults. By state law, providers are required to submit childhood immunizations within 72 hours of administration. In addition, providers are allowed and highly encouraged to report adult vaccinations. MCIR benefits health care organizations, schools, licensed childcare programs, and Michigan's citizens by consolidating immunization information from multiple providers. This reduces vaccine-preventable diseases, over-vaccination, and allows providers to see up-to-date patient immunization history. MCIR also has the ability to assist with pandemic flu preparedness and can track vaccines and medications during a public health emergency. Transfer Interfaces Available This document primarily describes the interface for accepting reports of administered and historical vaccinations via a VXU real-time or batch update. This is the first HL7 interface that MCIR has developed. Query and other bidirectional interface options will be developed soon and will be documented in an updated version of this document. How to Format Data MCIR currently supports the following versions of HL7 formatted messages: HL7 v2.5.1 Preferred format. HL7 v2.3.1 Supported format Revised August 23, 2013 Page 4 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages How to Send Data As HL7 specifically avoided defining how messages should be transported, there is no definitive national standard for doing so. MCIR requires connectivity through a Qualified Organization/Sub-State Health Information Exchange. Click on this link for a list of Qualified Organizations: visit http://mihin.org/exchanges/ Please contact the MCIR Help Desk 1-888-243-6652 option 3 or via E-mail MU mcirhelp@mphi.org for questions about information on how to establish an interface account. Revised August 23, 2013 Page 5 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Health Information Exchanges (HIE) and MCIR HL7 Messaging Requirements Effective May 1, 2013 The Michigan Care Improvement Registry (MCIR) is built to identify issues in incoming data and reject messages that do not meet minimum standards. Health Information Exchanges or Intermediaries should evaluate the message header for required fields before submission to the State. For example, if the MSH-4 does not contain a valid HL7 Facility ID that was issued by MCIR, then this is an Error. This means that a message with a missing HL7 Facility ID would be rejected. MSH Field Field Name MSH-4 Sending Facility MSH-5 MSH-6 MSH-12 Receiving Application Receiving Facility Version ID Requirements Must be populated, should be in the format of ‘####-##-##’ Must be populated with ‘MCIR’ Must be populated with ‘MDCH’ Must be populated with a valid HL7 version, current supported versions are 2.3.1, 2.5.1 Health Information Exchanges or Intermediaries will receive ACK messages from MCIR and should return these messages back to the provider site that submitted them to MCIR. This will become a mandatory function on October 1, 2013. In cases where returning the ACK to the original sender site would cause undue harm, this requirement can be waved on a case by case basis. If there are any other errors anywhere, especially in the RXA segment, then the message is rejected and MCIR will respond with an ACK error message. The MSA-1 field will be set to “AE” to indicate that there were errors and details of those errors will be reported in the ERR segment in accordance with HL7 standards. Examples of issues that may cause a message to be rejected include: Message violates HL7 2.3.1 or HL7 2.5.1 standards. Message is missing field required by MCIR. Value is not valid for the given type (e.g. there is an alphanumeric data value in a date field) or is not a recognized valid value. Value is inconsistent with other values given in the same message. Revised August 23, 2013 Page 6 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages MCIR has developed a list of all known or potential issues that may be identified in an incoming message and has assigned them one of the four following states: Error - entire message should be rejected. Warning - message may be accepted but with a comment. Accept - message may be accepted. Skip - message, segment, or associated concept should not be processed but no error needs to be generated (rarely used by MCIR). Warnings If there are any warnings in the VXU message, such as an invalid data type in an optional field or an invalid data code value in an optional field, MCIR will note these issues on data quality reports but will still process the message. The warnings will not cause MCIR to reject the message. However, those warnings will be reported in both the ERR segment and the MSA-3 field of MCIR’s response message in order to facilitate the HL7 data exchange partner’s integration testing of their system to promote data quality. Revised August 23, 2013 Page 7 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Health Level Seven (HL7) History HL7 was first formed as a standard in the late 1980's as a collaboration between vendors of health systems and hospitals. The goal was to create a standard message format that disparate systems could use to exchange health data. The name of HL7 was settled on because HL7 was originally conceived to define message structures in the seventh level of the ideal model of networks. At that time, the Internet was not widespread and there was quite a lot of variation in hospital networks. It was decided that HL7 would only define messages and not how these messages were sent. Within a year HL7 version 2 was released. This version has been in use for over 20 years. HL7 version 3 is a new standards track with major improvements over version 2. It is not fully completed. MCIR is currently using HL7 Version 2.5.1 messages. Message Specifications There are three controlling documents that define how the MCIR interface works. They are arranged in a hierarchy of documents, each refining and constraining the standard: The first is the HL7 2.5.1 standard, which was developed by Health Level Seven, a not-for-profit ANSIaccredited standards developing organization. This standard defines the structure and content of immunization messages but leaves many specific implementation details undecided. The second document is the CDC's Implementation Guide for Immunization Messaging. This guide gives specific instructions regarding how to report to immunization registries, but still leaves some implementation decisions to each state registry. This guide, and other technical information can be found at this CDC website: dards.htm Revised August 23, 2013 Page 8 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages What you are reading now is the third document. It finalizes all implementation decisions and defines exactly what MCIR will and will not accept. It is written in accordance with the standards set in the first two documents. Each of these standards should be consulted when developing an interface with MCIR. Message Structure Ó HL7 messages are made of multiple lines called segments. Each line/segment is separated by a carriage return. Note Windows systems separate lines by carriage returns line feeds, so some Windows applications will not correctly display HL7 messages. Windows Notepad will display HL7 messages as one long continuous line. This is very hard to read. It is better to view an HL7 message in WordPad or some other text editor. Ó Each segment starts with a three letter name that identifies the segment. Ó Each segment is broken into fields that are normally separated by vertical bars . Ó Each field can also be broken into sub-fields by a caret . Ó Separators are only sent to keep fields in their correct position. (For example: field1 field4) Separators at the end of segments and fields are omitted if all the values there are empty. Ó Some fields within a segment can also repeat. Repeating fields are separated by a tilde . For more information about HL7 formatting please read the CDC and HL7 guides which can be found here: dards.htm Version Compatibility HL7 is built to be backwards compatible with older versions. New fields that are introduced should be ignored by older versions and older messages should still process correctly in new systems. The version number in HL7 version 2 messages indicates the standards release that the message is associated with. A system built using the HL7 v2.5.1 should still be able to accept 2.3 messages, although it may not support improvements made in v2.5.1. MCIR currently support the current CDC Immunization Guide version 2.5.1 messages and the CDC Immunization Guide version 2.3.1 messages. Meaningful Use MCIR is ready to receive submissions for sites who are looking to attest for meaningful use in regards to submitting immunization messages. For more information please visit http://www.mcir.org/MeaningfulUse/ . Revised August 23, 2013 Page 9 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Immunization Messages Vaccination Update (VXU) Unsolicited Vaccination Update (VXU) messages are the preferred method for MCIR to receive and send vaccination information. The VXU is based off a pharmacy message and can indicate a patient's demographics and zero or more vaccinations. VXU messages may also be used to register a patient who does not have vaccinations yet, by simply sending a VXU without any vaccinations. Vaccination Query A Vaccination Query is used to query or pull a patient record from another system. These type of messages will be supported in the future. Patient Update (ADT) Admission/Discharge/Transfer (ADT) messages were the first messages created in HL7 and are one of the most ubiquitous messages used. They are used to indicate basic demographic information about a patient and don't usually indicate detailed medical information. ADT messages are used to register patients. MCIR would prefer patient registrations using a VXU, but will accept them via an ADT in order to support local processes currently in place. MCIR does not provide a specification for ADT messages, as it prefers VXU messages. How to Read This Document This document is written to be easy to read and implement. The finer details and explanations of HL7 have been glossed over and simplified. This guide is not a complete elaboration of HL7 rather it is a straightforward how-to guide. To see this original information please review the HL7 standard and the CDC guide. Each field and subfield in the message has a status. This status indicates what MCIR expects from a sending system. This status is descriptive and does not necessarily match the HL7 standard. A few important points about these status messages: Required means that the sending system is required to send it, if available. The sending system should never send filler or "dummy" data in required fields. If there is no value in a required field, because it was not entered or because there is no value known, then empty should still be sent. Some required fields cannot be left empty or the message will be rejected. These are clearly indicated in the notes. Highly recommended means that ideally the information should always be sent, but it is recognized that in some cases the information is simply not available. Optional means that MCIR may read or use the information but does not require it to be sent. Nevertheless, some optional fields are necessary to support MCIR functions and reports and should be sent. Please send values for optional fields if they are available. Ignored means that MCIR currently does not read from this field. The sender may leave it blank or send any kind of value. MCIR will not check it for conformance to any specification. Fields that are ignored may be used by MCIR in the future. MCIR recommends that all ignored fields conform to the CDC guide for future interoperability. Code values also have their own status. These are slightly different: Accepted means that MCIR recognizes the value and will read it. Ignored means that MCIR does not use this value and will act as if no value was sent. Revised August 23, 2013 Page 10 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Not accepted means that MCIR cannot accept the value and will generate some kind of error condition. Part or the entire message may be rejected. In addition, code values listed in this guide represent all code values MCIR expects to receive. In some tables HL7 defines a larger set of permissible or expected values. These are not listed in this guide for brevity or clarity. In most cases MCIR does not expect to receive these codes and may reject messages with invalid or unrecognized codes. However, invalid or unrecognized codes in non-critical fields are normally ignored and the rest of message is processed normally. In summary, the status messages are meant as a general guide. Please read the notes for further explanation. Revised August 23, 2013 Page 11 of 60
Michigan Care Improvement Registry HL7 2.5.1 Specification for Vaccination Messages Vaccination Update Message (VXU) Message Structure Segment Description Status MSH Message Header required PID Patient Identification required [PD1] Additional Demographics optional [{NK1}] Next of Kin/Associated Parties Required for patients up through 18 years of age [PV1 Patient Visit ignored Patient Visit Additional Information ignored Insurance ignored [IN2] Insurance Additional Information ignored [IN3] Insurance Additional information-Cert ignored Common Order highly recommended RXA Pharmacy Administration required [RXR] Pharmacy Route highly recommended [{OBX Observation/Result required where RXA-9 equals “00” Notes (Regarding Immunization) ignored [PV2]] [{IN1 }] [{[ORC] [{NTE}] }] }] Each message must begin with a Message Header (MSH) segment. The MSH indicates the start of the message and gives meta data about the message, including message type, sender and other important message information. Each message contains one Patient Identification (PID) segment. Only one patient at a time may be sent in a message. This segments gives identifying detail about the patient and is used to find matching patients in the registry. The Additional Demographics (PD1) segment is used to indicate reminder/recall participation. The Next of Kin/Associated Parties (NK1) must be sent at least once to identify the responsible party for patients under the age of 18. The Pharmacy Administration (RXA) segment indicates that a single vaccination was given. Zero or more of these may be sent for each patient. Some systems send only one vaccination in a message (thus multiple message are sent for a single patient), while others aggregate all received immunizations under one message. Either method is acceptable. The Pharmacy Route (RXR) segment should also be included to indicate where and how the vaccination was given. Example Message The example message below may be used as a template to create a test message. Here are the steps to create a test message: Revised August 23, 2013 Page 12 of 60
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This is the first HL7 interface that MCIR has developed. Query and other bidirectional interface options will be developed soon and will be documented in an updated version of this document. How to Format Data MCIR currently supports the following versions of HL7 formatted messages: HL7 v2.5.1 Preferred format. HL7 v2.3.1 Supported format
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