Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7)

Standard Protocol

Implementation Guide Version 2.0 June 1999

Centers for Disease Control and Prevention National Immunization Program

Data Management Division Systems Development Branch

This document replaces previous National Immunization Program (NIP) Guidelines for Immunization Data Transactions versions dated May 1997 and earlier. The earlier versions were intended to help familiarize developers of immunization information systems with Health Level Seven (HL7) immunization message definitions and encoding rules. As immunization registries developed HL7 implementations, they discovered that the coding flexibility built into Versions 2.x of HL7 resulted in transactions that were not plug and play among the developers. That is, before testing could be successful, site-specific negotiations had to be conducted to harmonize different variations. Some implementers added Z segments and developed code sets to represent needed data within the rules allowed by HL7, but these were not done consistently. When State-based public health registries approached commercial vendors, they were encouraged to develop one nationally consistent implementation. To explore this possibility, a small workgroup of six registries met in September 1998 to review each registrys implementation plan. The group reached consensus on an implementation that would ensure that all needs were met in one common way.

This Implementation Guide represents the agreed-upon implementation. It has been reviewed by the six original participants and several other interested users. The participants are listed below. They have indicated their intention to implement this version as written and to resist adding Z segments or otherwise changing the implementation to one that is not consistent with this document. CDC representatives have agreed to continue working with HL7 and the coding committees to meet the groups ongoing needs as they develop.

Note: This Implementation Guide is intended for use by immunization registries that want to participate in a strictly-defined record exchange agreement that limits the amount of optionality normally expected when using the HL7 standard. The Guide describes the most frequently used segments in their entirety, while giving a minimum description of segments containing only a few useful fields for registries. Within the segments, it fully describes the fields used frequently by immunization registries, while the others are omitted in this document. With this limited scope, this Guide can in no way serve as a substitute for a thorough study of the entire set of HL7 specifications for electronic data interchange in health care environments. For more complete information about HL7, visit the website at .

Acknowledgments Representatives from immunization registries in the following areas participated in the development of this Guide:

California Georgia Michigan San Bernardino County, CA Illinois New York State

We would like to thank those participants as well as others who contributed to discussions around this Guides contents and use, including representatives from Northern California Kaiser Permanente and the Indian Health Service. We also want to express our appreciation for the contribution of Suzy Feikema, Public Health Informatics Fellow with NIP, for her substantial help in revising this Implementation Guide and preparing it for publication.

For information about HL7, contact: For information about this Guide, contact:

Health Level Seven Susan Abernathy 3300 Washtenaw Avenue, Suite 227 Systems Development Branch Ann Arbor, MI 48104-4250 Data Management Division Phone: (734) 677-7777 National Immunization Program Fax: (734) 677-6622 Centers for Disease Control and Prevention E-Mail: hq@hl7.org Phone: (404) 639-8177 or (404) 639-8245 Website: Fax: (404) 639-8548

E-mail: saa6@cdc.gov Website:

This Implementation Guide is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated. Additional copies may be obtained from the National Immunization Program or downloaded from our website (addresses above).

http:www.hl7.org

TABLE OF CONTENTS

HL7 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Basic Message Construction Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IMMUNIZATION DATA TRANSACTION MESSAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4.14.1 Query for Vaccination Record (VXQ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

VXQ Example #1 (Query with many identifiers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 VXQ Example #2 (Query with only a name identifier) . . . . . . . . . . . . . . . . . . . . . . . . . . 4

4.14.2 Response to Vaccination Query Returning Multiple PID Matches (VXX) . . . . . . . . 4 VXX Example (Response with many matches) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

4.14.3 Response to Vaccination Query Returning the Vaccination Record (VXR) . . . . . . 5 VXR Example (Response to VXQ Example #1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

4.14.4 Unsolicited Vaccination Record Update (VXU) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 VXU Example #1 (Message with only required fields valued) . . . . . . . . . . . . . . . . . . . . 7 VXU Example #2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

2.13 Acknowledgment Messages (With errors or finding no match to query parameters) . 9 Acknowledgment Example #1 (ACK with error) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Acknowledgment Example #2 (QCK with no matching records found) . . . . . . . . . . . . . 9

SEGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2.24 MESSAGE CONTROL SEGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.24.1 Message Header (MSH) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.24.2 Message Acknowledgment (MSA) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.24.3 Error (ERR) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.24.22 Query Acknowledgment (QAK) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.24.4 Query Definition (QRD) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.24.5 Query Filter (QRF) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

2.23.3 HL7 BATCH PROTOCOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.24.11 File Header (FHS) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.24.12 File Trailer (FTS) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.24.14 Batch Trailer (BTS) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

3.3 PATIENT ADMINISTRATION MESSAGE SEGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.3.2 Patient Identification (PID) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.3.9 Patient Additional Demographic (PD1) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . 36 3.3.3 Patient Visit (PV1) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 3.3.4 Patient Visit - Additional Information (PV2) Segment . . . . . . . . . . . . . . . . . . . . . . 42 3.3.5 Next of Kin (NK1) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

6.4 FINANCIAL MANAGEMENT MESSAGE SEGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 6.4.6 Insurance (IN1) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 6.4.7 Insurance Additional Information (IN2) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . 48 6.4.8 Insurance Additional Information, Certification (IN3) Segment . . . . . . . . . . . . . . . 50

4.8 PHARMACY/TREATMENT ORDERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.3.1 Common Order (ORC) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.8.3 Pharmacy/Treatment Route (RXR) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4.8.14 Pharmacy/Treatment Administration (RXA) Segment . . . . . . . . . . . . . . . . . . . . . . 53

Implementation Guide for HL7 Immunization Transactions i

7.3 OBSERVATION REPORTING SEGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 7.3.2 Observation/Result (OBX) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 2.24.15 Notes and Comments (NTE) Segment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

3.2 PATIENT ADMINISTRATION MESSAGE DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.2.28 Admission/Discharge/Transfer and Acknowledgment (ADT/ACK) - add person

information (event A28) . . . . . . . . . . . . . . . . . . . . . . . . . .