7.2. Outbound

The HL7 messages mentioned below are sent to other HL7 applications/receivers if the feature Synchronize External Receivers for Patient Updates has been configured in the archive.

7.2.1. Outbound Messages

7.2.1.1. ADT/ACK - Add Person or Patient Information (Event A28)

Supported HL7 version: 2.5.1 (ITI-30)

7.2.1.1.1. Trigger Event

This message is sent when a new patient is created in the archive by using archive UI and RESTful service. Patient IDs and other Patient Information for the new Patient record are sent in the PID segment of the outgoing ADT message mapped from corresponding DICOM attributes as defined in DICOM Patient Attributes to HL7 ADT mapping of PID segment.

7.2.1.1.2. Supported Segments

The following segments are sent in an outgoing ADT^A28^ADT_A05 message:

Table 7.15 Supported segments of ADT^A28^ADT_A05 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments (for PID)	O	[0..1]	2

7.2.1.1.3. Expected Actions

HL7 Application/Receiver should have the ability to receive and process the demographics of a new patient, as well as related information. Field MSH-9 Message Type is valued as ADT^A28^ADT_A05. It is expected that the receiver shall create a new patient record for the patient identified if there is no current record for the Patient ID (defined by the field PID-3). This message shall not be used by the receiver to update information in an existing patient record.

7.2.1.2. ADT/ACK - Update Person Information (Event A31)

Supported HL7 version: 2.5.1 (ITI-30)

7.2.1.2.1. Trigger Event

This message is sent when an existing patient is updated in the archive by using archive UI and RESTful service. Patient IDs and other Patient Information for the updated Patient record are sent in the PID segment of the outgoing ADT message mapped from corresponding DICOM attributes as defined in DICOM Patient Attributes to HL7 ADT mapping of PID segment.

7.2.1.2.2. Supported Segments

Same as specified in Section 7.2.1.1.2.

7.2.1.2.3. Expected Actions

HL7 Application/Receiver should have the ability to receive and process the demographics of an updated patient. Field MSH-9 Message Type is valued as ADT^A31^ADT_A05. It is expected that the receiver shall update the patient information of an existing patient record for the patient identified by the Patient ID (defined by the field PID-3).

7.2.1.3. ADT/ACK - Merge Patient - Patient Identifier List (Event A40)

Supported HL7 version: 2.5.1 (ITI-30)

7.2.1.3.1. Trigger Event

This message is sent when a one or more patients are merged with a target patient in the archive by using archive UI and RESTful service. Patient IDs and other Patient Information for the target Patient record are sent in the PID segment of the outgoing ADT message mapped from corresponding DICOM attributes as defined in DICOM Patient Attributes to HL7 ADT mapping of PID segment. Patient ID and the Patient name for the old Patient record are sent in the MRG segment of the outgoing ADT message and mapped from corresponding DICOM attributes as defined in HL7 ADT mapping of MRG segment to DICOM Patient Attributes.

7.2.1.3.2. Supported Segments

The following segments are sent in an outgoing ADT^A40^ADT_A39 message:

Table 7.16 Supported segments of ADT^A40^ADT_A39 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments (for PID)	O	[0..1]	2
MRG - MRG - Merge segment (HL7 v2.5.1)	Merge Information	R	[1..1]	3

7.2.1.3.3. Expected Actions

HL7 Application/Receiver should have the ability to receive and process the demographics of merged patients, as well as related information. Field MSH-9 Message Type is valued as ADT^A40^ADT_A39. It is expected that after receiving a Patient Merge message (A40) the receiving system will perform updates to reflect the fact that two patient records have been merged into a single record. If the correct target patient was not known to the receiving system, it is expected that the receiving system will create a patient record using the patient identifiers and demographics from the available PID segment data.

If the receiving application is an Image Manager/Image Archive, it is the responsibility of the Image Manager and the Report Manager to ensure that the patient information has been updated in the diagnostic reports and evidence objects (e.g., images, Key Image Notes, Grayscale Softcopy Presentation States, Evidence Documents, etc.) they manage when they are retrieved.

7.2.1.4. ADT/ACK - Change Patient Identifier List (Event A47)

Supported HL7 version: 2.5.1 (ITI-30)

7.2.1.4.1. Trigger Event

This message is sent when an patient ID of an existing patient is updated in the archive by using archive UI and RESTful service. Patient IDs and other Patient Information for the Patient record with changed patient identifiers are sent in the PID segment of the outgoing ADT message mapped from corresponding DICOM attributes as defined in DICOM Patient Attributes to HL7 ADT mapping of PID segment.

7.2.1.4.2. Supported Segments

Same as specified in Section 7.2.1.3.2.

7.2.1.4.3. Expected Actions

HL7 Application/Receiver should have the ability to receive and process the change in patient identifiers list of a patient. Field MSH-9 Message Type is valued as ADT^A47^ADT_A30. It is expected that the receiver shall change the patient identifiers list of an existing patient record for the patient identified by the Patient ID (defined by the field PID-3).

7.2.2. Outbound Message Segments

7.2.2.1. MSH - Message Header segment

Same as specified in MSH - Message Header segment (HL7 v2.5.1)

7.2.2.2. PID - Patient Identification Segment

Table 7.17 PID - Patient Identification segment (HL7 v2.5.1)

SEQ	LEN	DT	Usage	Card.	TBL#	ITEM #	Element Name
1	4	SI	O	[0..1]		00104	Set ID - PID
2	20	CX	O	[0..0]		00105	Patient ID
3	250	CX	R	[1..*]		00106	Patient Identifier List
4	20	CX	O	[0..0]		00107	Alternate Patient ID - PID
5	250	XPN	R	[1..*]		00108	Patient Name
6	250	XPN	O	[0..1]		00109	Mother’s Maiden Name
7	26	TS	CE	[0..1]		00110	Date/Time of Birth
8	1	IS	CE	[1..1]	0001	00111	Administrative Sex
9	250	XPN	O	[0..1]		00112	Patient Alias
10	250	CE	O	[0..1]	0005	00113	Race
11	250	XAD	CE	[0..*]		00114	Patient Address
12	4	IS	X	[0..1]	0289	00115	County Code
13	250	XTN	O	[0..*]		00116	Phone Number - Home
14	250	XTN	O	[0..*]		00117	Phone Number - Business
15	250	CE	O	[0..1]	0296	00118	Primary Language
16	250	CE	O	[0..1]	0002	00119	Marital Status
17	250	CE	O	[0..1]	0006	00120	Religion
18	250	CX	C	[0..1]		00121	Patient Account Number
19	16	ST	X	[0..1]		00122	SSN Number - Patient
20	25	DLN	X	[0..1]		00123	Driver’s License Number - Patient
21	250	CX	O	[0..*]		00124	Mother’s Identifier
22	250	CE	O	[0..1]	0189	00125	Ethnic Group
23	250	ST	O	[0..1]		00126	Birth Place
24	1	ID	O	[0..1]	0136	00127	Multiple Birth Indicator
25	2	NM	O	[0..1]		00128	Birth Order
26	250	CE	O	[0..1]	0171	00129	Citizenship
27	250	CE	O	[0..1]	0172	00130	Veterans Military Status
28	250	CE	X	[0..0]	0212	00739	Nationality
29	26	TS	CE	[0..1]		00740	Patient Death Date and Time
30	1	ID	C	[0..1]	0136	00741	Patient Death Indicator
31	1	ID	CE	[0..1]	0136	01535	Identity Unknown Indicator
32	20	IS	CE	[0..*]	0445	01536	Identity Reliability Code
33	26	TS	CE	[0..1]		01537	Last Update Date/Time
34	241	HD	O	[0..1]		01538	Last Update Facility
35	250	CE	CE	[0..1]	0446	01539	Species Code
36	250	CE	C	[0..1]	0447	01540	Breed Code
37	80	ST	O	[0..1]		01541	Strain
38	250	CE	O	[0..2]		01542	Production Class Code
39	250	CWE	O	[0..*]		01840	Tribal Citizenship

Element names in bold indicates that the field is sent by dcm4che DICOM Archive 5.

7.2.2.3. NTE - Notes and Comments Segment (for PID)

Table 7.18 NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)

SEQ	LEN	DT	OPT	RP/#	TBL#	ITEM #	Element Name
1	4	SI	O			00096	SetID - NTE
2	4	ID	O		0105	00097	Source of Comment
3	65536	FT	O	Y		00098	Comment
4	250	CE	O		0364	01318	Comment Type

Element names in bold indicates that the field is sent by dcm4che DICOM Archive 5.

7.2.2.4. MRG - Merge Segment

Table 7.19 MRG - Merge segment (HL7 v2.5.1)

SEQ	LEN	DT	Usage	Card.	TBL#	ITEM #	Element Name
1	250	CX	R	[1..*]		00211	Prior Patient Identifier List
2	250	CX	X	[0..0]		00212	Prior Alternate Patient ID
3	250	CX	O	[0..1]		00213	Prior Patient Account Number
4	250	CX	X		[0..0]	00214	Prior Patient ID
5	250	CX	X	[0..0]		01279	Prior Visit Number
6	250	CX	X	[0..0]		01280	Prior Alternate Visit ID
7	250	XPN	O	[0..*]		01281	Prior Patient Name

Element names in bold indicates that the field is sent by dcm4che DICOM Archive 5.

7.2.3. DICOM to HL7 ADT Mapping

Mappings between HL7 and DICOM are illustrated in the following manner:

• Element Name (HL7 item_number.component.sub-component #/ DICOM (group, element))

• The component/sub-component value is not listed if the HL7 element should not contain multiple components/sub-components.

Table 7.20 DICOM Patient Attributes to HL7 ADT mapping of PID segment

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Note
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	Mapping of MSH-18-Character Set to (0008,0005) Specific Character Set
Patient Identification
Patient’s Name	(0010, 0010)	Patient Name	00108	PID:5
Patient ID	(0010, 0020)	Patient Identifier List	00106.1	PID:3.1
Issuer of Patient ID	(0010, 0021)	Patient Identifier List	00106.4.1	PID:3.4.1
Issuer of Patient ID Qualifiers Sequence	(0010, 0024)
>Item	(FFFE, E000)
>Universal Entity ID	(0040, 0032)	Patient Identifier List	00106.4.2	PID:3.4.2
>Universal Entity ID Type	(0040, 0033)	Patient Identifier List	00106.4.3	PID:3.4.3
Patient’s Mother’s Birth Name	(0010, 1060)	Mother’s Maiden Name	00109	PID:6
Other Patient IDs Sequence	(0010,1002)	Patient Identifier List	00106	PID:3	[4]
Responsible Person	(0010, 2297)	Patient Alias	00112	PID:9
Patient Species Description	(0010, 2201)	Species Code	01539.2	PID:35.2	[1]
Patient Species Code Sequence	(0010, 2202)
>Code Value	(0008, 0100)	Species Code	01539.1	PID:35.1
>Code Scheme Designator	(0008, 0102)	Species Code	01539.3	PID:35.3
>Code Meaning	(0008, 0103)	Species Code	01539.2	PID:35.2
Patient Breed Description	(0010, 2292)	Breed Code	01540.2	PID:36.2	[2]
Patient Breed Code Sequence	(0010, 2293)
>Code Value	(0008, 0100)	Breed Code	01540.1	PID:36.1
>Code Scheme Designator	(0008, 0102)	Breed Code	01540.3	PID:36.3
>Code Meaning	(0008, 0103)	Breed Code	01540.2	PID:36.2
Patient Demographic
Patient’s Birth Date	(0010, 0030)	Date/Time of Birth	00110	PID:7
Patient’s Sex	(0010, 0040)	Administrative Sex	00111.1	PID:8.1
Patient Comments	(0010, 4000)	Comment	00098	NTE:3
Patient’s Address	(0010, 1040)	Patient Address	00114	PID:11
Military Rank	(0010, 1080)	Veterans Military Status	00130	PID:27.2
Patient’s Primary Language Code Sequence	(0010, 0101)	Primary Language	00118	PID:15
Patient Medical
Patient’s Sex Neutered	(0010, 2203)	Administrative Sex	00111.2	PID:8.2

Table 7.21 HL7 ADT mapping of MRG segment to DICOM Patient Attributes

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Note
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	Mapping of MSH-18-Character Set to (0008,0005) Specific Character Set
Patient Identification
Patient’s Name	(0010, 0010)	Prior Patient Name	01281	MRG:7	[3]
Patient ID	(0010, 0020)	Prior Patient Identifier List	00211.1	MRG:1.1
Issuer of Patient ID	(0010, 0021)	Prior Patient Identifier List	00211.1.1	MRG:1.1.1
Issuer of Patient ID Qualifiers Sequence	(0010, 0024)
>Universal Entity ID	(0040, 0032)	Prior Patient Identifier List	00211.1.2	MRG:1.1.2
>Universal Entity ID Type	(0040, 0033)	Prior Patient Identifier List	00211.1.3	MRG:1.1.3
Other Patient IDs Sequence	(0010,1002)	Prior Patient Identifier List	00211	MRG:1	[4]

[1]

If the Patient Species Code Sequence is present in the attributes, then the value is taken from the Code Meaning of the sequence else if only the Patient Species Description is present then the description value is used in component 2 of this field.

[2]

If the Patient Breed Code Sequence is present in the attributes, then the value is taken from the Code Meaning of the sequence else if only the Patient Breed Description is present then the description value is used in component 2 of this field.

[3]

This field value, if available, shall be present only in HL7 messages sent out of the archive for HL7 Forwarding case and IOCM triggered HL7 messages. For External Archive HL7 services case, this field value shall not be present in HL7 messages sent out of the archive.

[4] (1,2)

Each Other Patient IDs Sequence (0010,1002) item is populated in patient identifiers list in the specified segment field separated using Repetition Separator ~