9.2. Outbound

The Unsolicited Observation HL7 message is sent to other HL7 applications/receivers if HL7 receivers are to be notified about the availability of the imaging results using Encounter-Based Imaging Workflow (EBIW) - Notify of Imaging Results [RAD-132]. This notification can be triggered on receive of studies either by :

• DICOM Studies stored conforming to Storage AE Specification

• DICOM Studies / Bulkdata stored using STOW-RS Services

• Reports stored by HL7 ORU

9.2.1. Outbound Messages

9.2.1.1. ORU - Unsolicited Observation Message (Event R01)

Supported HL7 version: 2.5.1 (RAD-128)

9.2.1.1.1. Trigger Event

This message is sent out by the archive :

• when study received by the archive and notification about availability of imaging results is configured.

9.2.1.1.2. Supported Segments

The following segments are sent in an outgoing ORU^R01^ORU_R01 message:

Table 9.12 Supported segments of ORU^R01^ORU_R01 (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
PV1 - PV1 - Patient Visit segment (HL7 v2.5.1)	Patient Visit	R	[1..1]	3
ORC - ORC - Order Control segment (HL7 v2.5.1)	Common Order	O	[1..1]	4
TQ1 - TQ1 - Timing/Quantity segment (HL7 v2.5.1)	Timing and Quantity	R	[1..1]	4
OBR - OBR - Observation Request segment (HL7 v2.5.1)	Order Request Segment	R	[1..1]	7
OBX - OBX - Observation Result segment (HL7 v2.5.1)	Observation Result Segment	R	[1..1]	7

9.2.1.1.3. Expected Actions

The Receiver shall accept and process the message.The Receiver shall support receiving multiple imaging result messages for the same DICOM Study Instance UID. That is, multiple imaging Series may each result in a separate notification message despite being part of a single DICOM Study. Receiver actions subsequent to receiving an image result will depend on internal business logic and/or the profile in which the transaction is being performed.

9.2.2. Outbound Message Segments

9.2.2.1. MSH - Message Header segment

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

9.2.2.2. PID - Patient Identification segment

Same as specified in PID - Patient Identification segment (HL7 v2.5.1)

9.2.2.3. NTE - Notes and Comments segment for (PID)

Same as specified in NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)

9.2.2.4. PV1 - Patient Visit segment

Table 9.13 PV1 - Patient Visit segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		01627	Set ID - PV1
2	1	IS	R		00132	Patient Class
3	80	PL	C		00133	Assigned Patient Location
4	2	IS	O	0007	00134	Admission Type
5	20	CX	O		00135	Preadmit Number
6	80	PL	O		00136	Prior Patient Location
7	60	XCN	C	0010	00137	Attending Doctor
8	60	XCN	C	0010	00138	Referring Doctor
9	60	XCN	R2	0010	00139	Consulting Doctor
10	3	IS	C	0069	00140	Hospital Service
11	80	PL	O		00141	Temporary Location
12	2	IS	O	0087	00142	Preadmit Test Indicator
13	2	IS	O	0092	00143	Readmission Indicator
14	3	IS	O	0023	00144	Admit Source
15	2	IS	C	0009	00145	Ambulatory Status
16	2	IS	O	0099	00146	VIP Indicator
17	60	XCN	C	0010	00147	Admitting Doctor
18	2	IS	O	0018	00148	Patient Type
19	20	CX	C		00149	Visit Number
20	50	FC	O	0064	00150	Financial Class
21	2	IS	O	0032	00151	Charge Price Indicator
22	2	IS	O	0045	00152	Courtesy Code
23	2	IS	O	0046	00153	Credit Rating
24	2	IS	O	0044	00154	Contract Code
25	8	DT	O		00155	Contract Effective Date
26	12	NM	O		00156	Contract Amount
27	3	NM	O		00157	Contract Period
28	2	IS	O	0073	00158	Interest Code
29	1	IS	O	0110	00159	Transfer to Bad Debt Code
30	8	DT	O		00160	Transfer to Bad Debt Date
31	10	IS	O	0021	00161	Bad Debt Agency Code
32	12	NM	O		00162	Bad Debt Transfer Amount
33	12	NM	O		00163	Bad Debt Recovery Amount
34	1	IS	O	0111	00164	Delete Account Indicator
35	8	DT	O		00165	Delete Account Date
36	3	IS	O	0112	00166	Discharge Disposition
37	25	CM	O	0113	00167	Discharge to Location
38	80	CE	O	0114	00168	Diet Type
39	2	IS	O	0115	00169	Servicing Facility
40	1	IS	O	0116	00170	Bed Status
41	2	IS	O	0117	00171	Account Status
42	80	PL	O		00172	Pending Location
43	80	PL	O		00173	Prior Temporary Location
44	26	TS	O		00174	Admit Date/Time
45	26	TS	O		00175	Discharge Date/Time
46	12	NM	O		00176	Current Patient Balance
47	12	NM	O		00177	Total Charges
48	12	NM	O		00178	Total Adjustments
49	12	NM	O		00179	Total Payments
50	20	CX	O	0203	00180	Alternate Visit ID
51	1	IS	C	0326	01226	Visit Indicator
52	60	XCN	O	0010	01224	Other Healthcare Provider

9.2.2.5. ORC - Order Control segment

Table 9.14 ORC - Order Control segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	2	ID	R	0119	00215	Order Control
2	22	EI	R		00216	Placer Order Number
3	22	EI	X		00217	Filler Order Number
4	22	EI	C		00218	Placer Group Number
5	2	ID	O	0038	00219	Order Status
6	1	ID	O	0121	00220	Response Flag
7	200	TQ	X		00221	Quantity/Timing
8	200	EIP	C		00222	Parent
9	26	TS	O		00223	Date/Time of Transaction
10	250	XCN	O		00224	Entered By
11	250	XCN	O		00225	Verified By
12	250	XCN	O		00226	Ordering Provider
13	80	PL	O		00227	Enterer’s Location
14	250	XTN	O		00228	Callback Phone Number
15	26	TS	O		00229	Order Effective Date/Time
16	250	CE	O		00230	Order Control Code Reason
17	250	CE	O		00231	Entering Organization
18	250	CE	O		00232	Entering Device
19	250	XCN	O		00233	Action By
20	250	CE	O	0339	01310	Advanced Beneficiary Notice Code
21	250	XON	O		01311	Ordering Facility Name
22	250	XAD	O		01312	Ordering Facility Address
23	250	XTN	O		01313	Ordering Facility Phone Number
24	250	XAD	O		01314	Ordering Provider Address
25	250	CWE	O		01473	Order Status Modifier
26	60	CWE	C	0552	01641	Advanced Beneficiary Notice Override Reason
27	26	TS	O		01642	Filler’s Expected Availability Date/Time
28	250	CWE	O	0177	00615	Confidentiality Code
29	250	CWE	O	0482	01643	Order Type
30	250	CNE	O	0483	01644	Enterer Authorization Mode
31	250	CWE	O		02286	Parent Universal Service Identifier

9.2.2.6. TQ1 - Timing/Quantity segment

Table 9.15 TQ1 - Timing/Quantity segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		01627	Set ID - TQ1
2	20	CQ	O		01628	Quantity
3	540	RPT	O	0335	01629	Repeat Pattern
4	20	TM	O		01630	Explicit Time
5	20	CQ	O		01631	Relative Time and Units
6	20	CQ	O		01632	Service Duration
7	26	TS	R		01633	Start Date/Time
8	26	TS	O		01634	End Date/Time
9	250	CWE	O	0485	01635	Priority
10	250	TX	O		01636	Condition Text
11	250	TX	O	0065	01637	Text Instruction
12	10	ID	C	0472	01638	Conjunction
13	20	CQ	O		01639	Occurrence Duration
14	10	NM	O		01640	Total Occurrences

9.2.2.7. OBR - Observation Request segment

Table 9.16 OBR - Observation Request segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00237	SetID - OBR
2	22	EI	R2		00216	Placer Order Number
3	22	EI	R2		00217	Filler Order Number
4	250	CE	R		00238	Universal Service ID
5	2	ID	X		00239	Priority (retired)
6	26	TS	X		00240	Requested Date/Time
7	26	TS	R		00241	Observation Date/Time
8	26	TS	O		00242	Observation End Date/Time
9	20	CQ	O		00243	Collection Volume
10	250	XCN	O		00244	Collection Identifier
11	1	ID	O	0065	00245	Specimen Action Code
12	250	CE	X		00246	Danger Code
13	300	ST	C		00247	Relevant Clinical Info
14	26	TS	X		00248	Specimen Received Date/Time
15	300	SPS	X	0070	00249	Specimen Source
16	250	XCN	O		00226	Ordering Provider
17	250	XTN	O		00250	Order Callback Phone Number
18	60	ST	R		00251	Placer Field 1
19	60	ST	R2		00252	Placer Field 2
20	60	ST	O		00253	Filler Field 1
21	60	ST	O		00254	Filler Field 2
22	26	TS	O		00255	Results Rpt/Status Chng - Date/Time
23	40	MOC	O		00256	Charge to Practice
24	10	ID	R	0074	00257	Diagnostic Service Sect ID
25	1	ID	R	0123	00258	Result Status
26	400	PRL	O		00259	Parent Result
27	200	TQ	R		00221	Quantity/Timing
28	250	XCN	O		00260	Result Copies To
29	200	EIP	C		00261	Parent
30	20	ID	O	0124	00262	Transportation Mode
31	250	CE	R2		00263	Reason For Study
32	200	NDL	R2		00264	Principal Result Interpreter
33	200	NDL	R2		00265	Assistant Result Interpreter
34	200	NDL	R2		00266	Technician
35	200	NDL	O		00267	Transcriptionist
36	26	TS	O		00268	Scheduled Date/Time
37	4	NM	O		01028	Number of Sample Containers
38	250	CE	O		01029	Transport Logistics of Collected Sample
39	250	CE	O		01030	Collector’s Comment
40	250	CE	O		01031	Transport Arrangement Responsibility
41	30	ID	O	0224	01032	Transport Arranged
42	1	ID	O	0225	01033	Escort Required
43	250	CE	O		01034	Planned Patient Transport Comment
44	250	CE	R	0088	00393	Procedure Code
45	250	CE	O	0340	01036	Procedure Code Modifier
46	250	CE	O	0411	01474	Placer Supplemental Service Information
47	250	CE	O	0411	01475	Filler Supplemental Service Information
48	250	CWE	O	0476	01646	Medically Necessary Duplicate Procedure Reason
49	2	IS	O	0507	01647	Result Handling
50	250	CWE	O		02286	Parent Universal Service Identifier

9.2.2.8. OBX - Observation Result segment

Table 9.17 OBX - Observation Result segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00569	SetID - OBX
2	2	ID	C	0125	00570	Value Type
3	250	CE	R		00571	Observation Identifier
4	20	ST	C		00572	Observation Sub-ID
5	99999^1	varies	C		00573	Observation Value
6	250	CE	O		00574	Units
7	60	ST	O		00575	References Range
8	5	IS	O	0078	00576	Abnormal Flags
9	5	NM	O		00577	Probability
10	2	ID	O	0080	00578	Nature of Abnormal Test
11	1	ID	R	0085	00579	Observation Result Status
12	26	TS	O		00580	Effective Date of Reference Range
13	20	ST	O		0581	User Defined Access Checks
14	26	TS	O		00582	Date/Time of Observation
15	250	CE	O		00583	Producer’s ID
16	250	XCN	O		00584	Responsible Observer
17	250	CE	O		00936	Observation Method
18	22	EI	O		01479	Equipment Instance Identifier
19	26	TS	O		01480	Date/Time of the Analysis

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

9.2.3. DICOM to HL7 Unsolicited Observation Message 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.

9.2.3.1. ORU - DICOM Image Attributes to HL7 Unsolicited Observation Message mapping

Table 9.18 DICOM Image Attributes to HL7 Unsolicited Observation Message mapping

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Note
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	Mapping of MSH-18-Character Set to (0008,0005) Specific Character Set
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
Other Patient IDs Sequence	(0010,1002)	Patient Identifier List	00106	PID:3	[10]
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
Route of Admissions	(0038, 0016)	Patient Class	00132	PV1:2	[9]
Admission ID	(0038, 0010)	Visit Number	00149.1	PV1:19.1
Issuer of Admission ID Sequence	(0038, 0014)
>Item	(FFFE, E000)
>Local Namespace Entity ID	(0040, 0031)	Visit Number	00149.4.1	PV1:19.4.1
>Universal Entity ID	(0040, 0032)	Visit Number	00149.4.2	PV1:19.4.2
>Universal Entity ID Type	(0040, 0033)	Visit Number	00149.4.3	PV1:19.4.3
		Visit Indicator	01226	PV1:51	Set to V
		Order Control	00215	ORC:1	Set to SC
		Order Status	00219	ORC:5	Set to CM
		Start Date/Time	01633	TQ1:7	[1]
		Start Date/Time	01633	TQ1:7	[1]
Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
Issuer of Accession Number Sequence	(0008, 0051)	Placer Field 1 #	00251	OBR:18	[8]
Requested Procedure ID	(0040,1001)	Placer Field 2 #	00252	OBR:19
Placer Issuer and Number	(0040, 2016)	Placer Order #	00216.1	ORC:2.1
Order Placer Identifier Sequence	(0040, 0026)
>Local Namespace Entity ID	(0040, 0031)	Placer Order #	00216.2	ORC:2.2
>Universal Entity ID	(0040, 0032)	Placer Order #	00216.3	ORC:2.3
>Universal Entity ID Type	(0040, 0033)	Placer Order #	00216.4	ORC:2.4
Filler Issuer and Number	(0040, 2017)	Filler Order #	00217.1	ORC:3.1
Order Filler Identifier Sequence	(0040, 0027)
>Local Namespace Entity ID	(0040, 0031)	Filler Order #	00217.2	ORC:3.2
>Universal Entity ID	(0040, 0032)	Filler Order #	00217.3	ORC:3.3
>Universal Entity ID Type	(0040, 0033)	Filler Order #	00217.4	ORC:3.4
		Priority	01635	TQ1:9	Set to R^Routine^HL70078
		Quantity/Timing	00221	OBR:27	Set to ^^^^^R
		Universal Service ID	00238	OBR:4	[2]
		Observation Date/Time	00241	OBR:7	[3]
Institutional Department Type Code Sequence	(0008, 1041)
>Code Value	(0008, 0100)	Diagnostic Service Sect ID #	00257	OBR:24	[7]
		Result Status	00258	OBR:25	Set to R
		Reason For Study	00263	OBR:31	[4]
		Technician	00266	OBR:34	[5]
		Procedure Code	00393	OBR:44	[6]
		SetID - OBX	00569	OBX:1	Set to 1
		Value Type	00570	OBX:2	Set to ST
		Observation Identifier	00571	OBX:3	Set to 113014^DICOM Study^DCM
Study Instance UID	(0020, 000D)	Observation Value	00573	OBX:5
		Observation Result Status	00579	OBX:11	Set to O

[1] (1,2)

This value is populated from the created time of the task. (The task here refers to a task created in database for sending out the HL7 notification.)

[2]

This field shall contain a procedure code in the first three components: OBR-4.1 Identifier, OBR-4.2 text code meaning, OBR-4.3 coding system. The use of codes from a standardized coding system for procedures, such as the RadLex Playbook LOINC codes, is 1385 recommended. In order of preference, the procedure code may be taken from: - Procedure Code Sequence (0008,1032) - Requested Procedure Code Sequence (0032,1064)

[3]

Observation Date/Time shall contain a date/time representative of the imaging procedure. When choosing the date/time to use, consider that an EMR might use this date/time to find other clinical entries for the patient at or near this time which might provide context for the imaging procedure. The date/time might be taken from one of the following attributes in the associated DICOM image objects: - Study Date (0008,0020) & Study Time (0008,0030) - Series Date (0008,0021) & Series Time (0008,0031)

[4]

This field shall be valued, if known. This might be taken from one of the following attributes in the associated DICOM image objects: - Reason for Performed Procedure Code Sequence (0040,1012) - Reason for the Requested Procedure (0040,1002) or Code Sequence (0040,100A)1425 - Reason for Visit (0032,1066) or Code Sequence (0032,1066) - Admitting Diagnoses Description (0008,1080) or Code Sequence (0008,1084)

[5]

This field shall be valued, if the person who acquired the images is known. This might be taken from one of the following attributes in the associated DICOM image objects: - Operators’ Name (0008,1070) or Operator Identification Sequence (0008,1072) - Performing Physician’s Name (0008,1050) or Performing Physician Identification Sequence (0008,1052)

[6]

Procedure Code shall match OBR-4.

[7]

Value set to RAD as fallback, if no Institutional Department Type Code Sequence (0008, 1041) found in the object’s attributes.

[8]

As Encoding of Assigning Authority in ST data field OBR-19 needs to be clarified and it has been captured into Change Proposals, temporarily the HL7v2 Hierarchic Designator Macro Attributes of Issuer Of Accession Number Sequence have been encoded as per Example 3: ISO OID encoded in an ST subcomponent

[9]

Route of Admissions (0038, 0016) DICOM attribute, if present, shall be mapped to PV1:2. If this DICOM attribute is absent, default “U” (denoting Patient Class as Unknown) shall be used.

[10]

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