General Electric MUSE NX HL7 Interface Reference Manual_SM_2102027-227_A A35 Ultrasound Reference Manual

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Page 1

GE Healthcare

MUSE™ NX

Cardiology Information System

HL7 Interface Reference Manual

2102027-227A

MUSE™ NX Cardiology Information System English

2018 General Electric Company

Page 2

Publication Information

The information in this manual applies only to the MUSE™ NX Cardiology Information System. It does not apply to earlier product versions. Due to continuing product innovation, specifications in this manual are subject to change without notice.

12SL, CASE, CardioSoft, InSite ExC, MAC, MACCRA, MARS, MUSE, Marquette, MobileLink, and MULTI-LINK are trademarks owned by GE Medical Systems Information Technologies, Inc., a General Electric Company going to market as GE Healthcare. All other trademarks contained herein are the property of their respective owners.

For more information about compliance, refer to the Regulatory and Safety Guide for this product.

The document part number and revision are on each page of the document. The revision identifies the document’s update level. The revision history of this document is summarized in the following table.

Table 1: Revision History

Revision Date Comments

A 30 October 2018 Customer release.

To access other GE Healthcare Diagnostic Cardiology documents, go to the Common Documentation Library (CDL), located at http://

apps.gehealthcare.com/servlet/ClientServlet, and select Cardiology.

To access Original Equipment Manufacturer (OEM) documents, go to the device manufacturer's website.

This document describes HL7 for the MUSE™ NX Cardiology Information System, also referred to as the ”product,” “system,” or “device.” This document is intended to be used by GE Healthcare service personnel.

Support

GE Healthcare maintains a trained staff of application and technical experts to answer questions and to respond to issues and problems that may arise during the installation, maintenance, and use of this product.

If you require additional assistance, contact your GE Healthcare representative, or GE Healthcare support at one of the following numbers:

• North America: 1-800-558-7044

• Europe: +49 761 45 43 -0

• Asia: +86 21 3877 7888

Training

This document is intended as a supplement to, not a substitute for, thorough product training. If you have not received training on the use of the product, you should request training assistance from GE Healthcare.

To see available training, go to the GE Healthcare training website www.gehealthcare.com/training.

For more self-paced course offerings, tools, and reference guides you may find useful, visit the GE Healthcare Education Store at

www.gehealthcare.com/educationstore.

2 MUSE™ NX 2102027-227A

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Service Manual Language Information

WARNING (EN)

ПРЕДУПРЕЖДЕНИЕ (BG)

警告

ZH-CN

This service manual is available in English only.

• If a customer's service provider requires a language other than English, it is the customer's responsibility to provide translation services.

• Do not attempt to service the equipment unless this service manual has been consulted and is understood.

• Failure to heed this warning may result in injury to the service provider, operator, or patient, from electric shock, mechanical or other hazards.

Това упътване за работа е налично само на английски език.

• Ако доставчикът на услугата на клиента изиска друг език, задължение на клиента е да осигури превод.

• Не използвайте оборудването, преди да сте се консултирали и разбрали упътването за работа.

• Неспазването на това предупреждение може да доведе до нараняване на доставчика на услугата, оператора или пациент в резултат на токов удар или механична или друга опасност.

本维修手册仅提供英文版本。

•

如果维修服务提供商需要非英文版本，客户需自行提供翻译服务。

•

未详细阅读和完全理解本维修手册之前，不得进行维修。

•

忽略本警告可能对维修人员，操作员或患者造成触电、机械伤害或其他形式的伤害。

警告

(ZH-TW)

UPOZORENJE (HR)

本維修手冊只提供英文版。

•

如果客戶的維修人員有英語以外的其他語言版本需求，則由該客戶負責提供翻譯服務。

•

除非您已詳閱本維修手冊並了解其內容，否則切勿嘗試對本設備進行維修。

•

不

重視本警告可能導致維修人員、操作人員或病患因電擊、機械因素或其他因素而

受到傷害。

Ove upute za servisiranje dostupne su samo na engleskom jeziku.

• Ukoliko korisnički servis zahtijeva neki drugi jezik, korisnikova je odgovornost osigurati odgovarajući prijevod.

• Nemojte pokušavati servisirati opremu ukoliko niste konzultirali i razumjeli ove upute.

• Nepoštivanje ovog upozorenja može rezultirati ozljedama servisnog osoblja, korisnika ili pacijenta prouzročenim električnim udarom te mehaničkim ili nekim drugim opasnostima.

2102027-227A MUSE™ NX 3

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VAROVÁNÍ (CS)

Tento provozní návod existuje pouze vanglickém jazyce.

• Vpřípadě, že externí služba zákazníkům potřebuje návod vjiném jazyce, je zajištění překladu doodpovídajícího jazyka úkolem zákazníka.

• Nesnažte se oúdržbu tohoto zařízení, aniž byste si přečetli tento provozní návod a pochopili jeho obsah.

• Vpřípadě nedodržování této varování může dojít kporanění pracovníka prodejního servisu, obslužného personálu nebo pacientů vlivem elektrického proudu, respektive vlivem mechanických či jiných rizik.

ADVARSEL (DA)

WAARSCHUWING (NL)

HOIATUS (ET)

Denne servicemanual findes kun på engelsk.

• Hvis en kundes tekniker har brug for et andet sprog end engelsk, er det kundens ansvar at sørge for oversættelse.

• Forsøg ikke at servicere udstyret medmindre denne servicemanual har været konsulteret og er forstået.

• Manglende overholdelse af denne advarsel kan medføre skade på grund af elektrisk, mekanisk eller anden fare for teknikeren, operatøren eller patienten.

Deze service manual is alleen in het Engels verkrijgbaar.

• Indien het onderhoudspersoneel een andere taal nodig heeft, dan is de klant verantwoordelijk voor de vertaling ervan.

• Probeer de apparatuur niet te onderhouden voordat deze service manual geraadpleegd en begrepen is.

• Indien deze waarschuwing niet wordt opgevolgd, zou het onderhoudspersoneel, de gebruiker of een patiënt gewond kunnen raken als gevolg van een elektrische schok, mechanische of andere gevaren.

Käesolev teenindusjuhend on saadaval ainult inglise keeles.

• Kui klienditeeninduse osutaja nõuab juhendit inglise keelest erinevas keeles, vastutab klient tõlketeenuse osutamise eest.

• Ärge üritage seadmeid teenindada enne eelnevalt käesoleva teenindusjuhendiga tutvumist ja sellest aru saamist.

• Käesoleva hoiatuse eiramine võib põhjustada teenuseosutaja, operaatori või patsiendi vigastamist elektrilöögi, mehaanilise või muu ohu tagajärjel.

VAROITUS (FI)

4 MUSE™ NX 2102027-227A

Tämä huolto-ohje on saatavilla vain englanniksi.

• Jos asiakkaan huoltohenkilöstö vaatii muuta kuin englanninkielistä materiaalia, tarvittavan käännöksen hankkiminen on asiakkaan vastuulla.

• Älä yritä korjata laitteistoa ennen kuin olet varmasti lukenut ja ymmärtänyt tämän huolto-ohjeen.

• Mikäli tätä varoitusta ei noudateta, seurauksena voi olla huoltohenkilöstön, laitteiston käyttäjän tai potilaan vahingoittuminen sähköiskun, mekaanisen vian tai muun vaaratilanteen vuoksi.

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ATTENTION (FR)

Ce manuel technique n'est disponible qu'en anglais.

• Si un service technique client souhaite obtenir ce manuel dans une autre langue que l'anglais, il devra prendre en charge la traduction et la responsabilité du contenu.

• Ne pas tenter d'intervenir sur les équipements tant que le manuel technique n'a pas été consulté et compris.

• Le non-respect de cet avertissement peut entraîner chez le technicien, l'opérateur ou le patient des blessures dues à des dangers électriques, mécaniques ou autres.

WARNUNG (DE)

FIGYELMEZTETÉS (HU)

AÐVÖRUN (IS)

Diese Serviceanleitung ist nur in englischer Sprache verfügbar.

• Falls der Kundendienst eine andere Sprache benötigt, muss er für eine entsprechende Übersetzung sorgen.

• Keine Wartung durchführen, ohne diese Serviceanleitung gelesen und verstanden zu haben.

• Bei Zuwiderhandlung kann es zu Verletzungen des Kundendiensttechnikers, des Anwenders oder des Patienten durch Stromschläge, mechanische oder sonstige Gefahren kommen.

Ez a szerviz kézikönyv kizárólag angol nyelven érhető el.

• Ha a vevő szerviz ellátója angoltól eltérő nyelvre tart igényt, akkor a vevő felelőssége a fordítás elkészíttetése.

• Ne próbálja elkezdeni használni a berendezést, amíg a szerviz kézikönyvben leírtakat nem értelmezték és értették meg.

• Ezen figyelmeztetés figyelmen kívül hagyása a szerviz ellátó, a működtető vagy a páciens áramütés, mechanikai vagy egyéb veszélyhelyzet miatti sérülését eredményezheti.

Þessi þjónustuhandbók er eingöngu fáanleg á ensku.

• Ef að þjónustuveitandi viðskiptamanns þarfnast annars tungumáls en ensku, er það skylda viðskiptamanns að skaffa tungumálaþjónustu.

• Reynið ekki að afgreiða tækið nema þessi þjónustuhandbók hefur verið skoðuð og skilin.

• Brot á að sinna þessari aðvörun getur leitt til meiðsla á þjónustuveitanda, stjórnanda eða sjúklingi frá raflosti, vélrænum eða öðrum áhættum.

PERINGATAN (ID)

2102027-227A MUSE™ NX 5

Manual servis ini hanya tersedia dalam bahasa Inggris.

• Jika penyedia jasa servis pelanggan memerlukan bahasa lain selain dari Bahasa Inggris, merupakan tanggung jawab dari penyedia jasa servis tersebut untuk menyediakan terjemahannya.

• Jangan mencoba melakukan servis terhadap perlengkapan kecuali telah membaca dan memahami manual servis ini.

• Mengabaikan peringatan ini bisa mengakibatkan cedera pada penyedia servis, operator, atau pasien, karena terkena kejut listrik, bahaya mekanis atau bahaya lainnya.

Page 6

AVVERTENZA (IT)

Il presente manuale di manutenzione è disponibile soltanto in Inglese.

• Se un addetto alla manutenzione richiede il manuale in una lingua diversa, il cliente è tenuto a provvedere direttamente alla traduzione.

• Si proceda alla manutenzione dell'apparecchiatura solo dopo aver consultato il presente manuale ed averne compreso il contenuto.

• Il non rispetto della presente avvertenza potrebbe far compiere operazioni da cui derivino lesioni all'addetto, alla manutenzione, all'utilizzatore ed al paziente per folgorazione elettrica, per urti meccanici od altri rischi.

警告

(JA)

경고

(KO)

ЕСКЕРТУ (KK)

このサービスマニュアルは英語版しかありません。

•

サービスを担当される業者が英語以外の言語を要求される場合、翻訳作業はその業者の責任で行うものとさせていただきます。

•

このサービスマニュアルを熟読し、十分に理解をした上で装置のサービスを行ってください。

•

この警告に従わない場合、サービスを担当される方、操作員あるいは患者が、感電や機械的又はその他の危険により負傷する可能性があります。

본 서비스 지침서는 영어로만 이용하실 수 있습니다.

•

고객의 서비스 제공자가 영어 이외의 언어를 요구할 경우, 번역 서비스를 제공하는 것은 고객의 책임입니다.

•본

서비스 지침서를 참고했고 이해하지 않는 한은 해당 장비를 수리하려고 시도하지

마십시오.

•이

경고에 유의하지 않으면 전기 쇼크, 기계상의 혹은 다른 위험으로부터 서비스 제

공자, 운영자 혹은 환자에게 위해를 가할 수 있습니다.

Бұл қызмет көрсету

Тұтынушының қызмет

• етсе, аудару бойынша болуы тиіс.

Бұл қызмет көрсету

•

қызмет көрсетуден

Бұл

•

ескертуді елемеу

шогынан,

мүмкін.

механикалық

бойынша

бас

нұсқаулығы

провайдері

қызметтерімен қамтамасыз

бойынша

қызмет

нұсқаулығын назарға

тартыңыз.

провайдері, оператор немесе

немесе

тек

ағылшын

басқа қауіптер нəтижесінде жарақат

ағылшын

тілінен

қолжетімді.

тілінде

басқа

тілдегі

тұтынушы

ету

түсінбегенше, жабдыққа

алып,

емделушінің

нұсқаны

жауапкершілігінде

талап

электр

алуына

əкелуі

BRĪDINĀJUMS (LV)

6 MUSE™ NX 2102027-227A

Šī apkalpotāju rokasgrāmata ir pieejama tikai angļu valodā.

• Ja apkalpošanas sniedzējam nepieciešama informācija citā, nevis angļu, valodā, klienta pienākums ir nodrošināt tās tulkošanu.

• Neveiciet aprīkojuma apkopi, neizlasot un nesaprotot apkalpotāju rokasgrāmatu.

• Šī brīdinājuma neievērošana var radīt elektriskās strāvas trieciena, mehānisku vai citu risku izraisītu traumu apkopes sniedzējam, operatoram vai pacientam.

Page 7

ĮSPĖJIMAS (LT)

Šis eksploatavimo vadovas yra prieinamas tik anglų kalba.

• Jei kliento paslaugų tiekėjas reikalauja vadovo kita kalba - ne anglų, numatyti vertimo paslaugas yra kliento atsakomybė.

• Nemėginkite atlikti įrangos techninės priežiūros, nebent atsižvelgėte į šį eksploatavimo vadovą ir jį supratote.

• Jei neatkreipsite dėmesio į šį perspėjimą, galimi sužalojimai dėl elektros šoko, mechaninių ar kitų paslaugų tiekėjui, operatoriui ar pacientui.

ADVARSEL (NO)

OSTRZEŻENIE (PL)

AVISO (PT-BR)

Denne servicehåndboken finnes bare på engelsk.

• Hvis kundens serviceleverandør trenger et annet språk, er det kundens ansvar å sørge for oversettelse.

• Ikke forsøk å reparere utstyret uten at denne servicehåndboken er lest og forstått.

• Manglende hensyn til denne advarselen kan føre til at serviceleverandøren, operatøren eller pasienten skades på grunn av elektrisk støt, mekaniske eller andre farer.

Niniejszy podręcznik serwisowy dostępny jest jedynie w języku angielskim.

• Jeśli dostawca usług klienta wymaga języka innego niż angielski, zapewnienie usługi tłumaczenia jest obowiązkiem klienta.

• Nie należy serwisować wyposażenia bez zapoznania się i zrozumienia niniejszego podręcznika serwisowego.

• Niezastosowanie się do tego ostrzeżenia może spowodować urazy dostawcy usług, operatora lub pacjenta w wyniku porażenia elektrycznego, zagrożenia mechanicznego bądź innego.

Este manual de assistência técnica só se encontra disponível em inglês.

• Se o serviço de assistência técnica do cliente não for GE, e precisar de outro idioma, será da responsabilidade do cliente fornecer os serviços de tradução.

• Não tente reparar o equipamento sem ter consultado e compreendido este manual de assistência técnica.

• O não cumprimento deste aviso pode por em perigo a segurança do técnico, operador ou paciente devido a choques elétricos, mecânicos ou outros.

AVISO (PT-PT)

2102027-227A MUSE™ NX 7

Este manual técnico só se encontra disponível em inglês.

• Se a assistência técnica do cliente solicitar estes manuais noutro idioma, é da responsabilidade do cliente fornecer os serviços de tradução.

• Não tente reparar o equipamento sem ter consultado e compreendido este manual técnico.

• O não cumprimento deste aviso pode provocar lesões ao técnico, ao utilizador ou ao paciente devido a choques eléctricos, mecânicos ou outros.

Page 8

AVERTISMENT (RO)

Acest manual de service este disponibil numai în limba engleză.

• Dacă un furnizor de servicii pentru clienţi necesită o altă limbă decât cea engleză, este de datoria clientului să furnizeze o traducere.

• Nu încercaţi să reparaţi echipamentul decât ulterior consultării şi înţelegerii acestui manual de service.

• Ignorarea acestui avertisment ar putea duce la rănirea depanatorului, operatorului sau pacientului în urma pericolelor de electrocutare, mecanice sau de altă natură.

ПРЕДУПРЕЖДЕНИЕ (RU)

UPOZORENJE (SR)

VAROVANIE (SK)

Настоящее руководство по обслуживанию предлагается только на английском языке.

• Если сервисному персоналу клиента необходимо руководство не на английском, а на каком-то другом языке, клиенту следует обеспечить перевод самостоятельно.

• Прежде чем приступать к обслуживанию оборудования, обязательно обратитесь к настоящему руководству и внимательно изучите изложенные в нем сведения.

• Несоблюдение требований данного предупреждения может привести к тому, что специалисты по обслуживанию, операторы или пациенты получат удар электрическим током, механическую травму или другое повреждение.

Ovo servisno uputstvo je dostupno samo na engleskom jeziku.

• Ako klijentov serviser zahteva neki drugi jezik, klijent je dužan da obezbedi prevodilačke usluge.

• Ne pokušavajte da opravite uređaj ako niste pročitali i razumeli ovo servisno uputstvo.

• Zanemarivanje ovog upozorenja može dovesti do povređivanja servisera, rukovaoca ili pacijenta usled strujnog udara, ili mehaničkih i drugih opasnosti.

Tento návod na obsluhu je k dispozícii len v angličtine.

• Ak zákazníkov poskytovateľ služieb vyžaduje iný jazyk ako angličtinu, poskytnutie prekladateľských služieb je zodpovednosťou zákazníka.

• Nepokúšajte sa o obsluhu zariadenia skôr, ako si neprečítate návod na obsluhu a neporozumiete mu.

• Zanedbanie tohto varovania môže vyústiť do zranenia poskytovateľa služieb, obsluhujúcej osoby alebo pacienta elektrickým prúdom, mechanickým alebo iným nebezpečenstvom.

OPOZORILO (SL)

8 MUSE™ NX 2102027-227A

Ta servisni priročnik je na voljo samo v angleškem jeziku.

• Če ponudnik storitve stranke potrebuje priročnik v drugem jeziku, mora stranka zagotoviti prevod.

• Ne poskušajte servisirati opreme, če tega priročnika niste v celoti prebrali in razumeli.

• Če tega opozorila ne upoštevate, se lahko zaradi električnega udara, mehanskih ali drugih nevarnosti poškoduje ponudnik storitev, operater ali bolnik.

Page 9

ADVERTENCIA (ES)

Este manual de servicio sólo existe en inglés.

• Si el encargado de mantenimiento de un cliente necesita un idioma que no sea el inglés, el cliente deberá encargarse de la traducción del manual.

• No se deberá dar servicio técnico al equipo, sin haber consultado y comprendido este manual de servicio.

• La no observancia del presente aviso puede dar lugar a que el proveedor de servicios, el operador o el paciente sufran lesiones provocadas por causas eléctricas, mecánicas o de otra naturaleza.

VARNING (SV)

UYARI (TR)

ЗАСТЕРЕЖЕННЯ (UK)

Den här servicehandboken finns bara tillgänglig på engelska.

• Om en kunds servicetekniker har behov av ett annat språk än engelska ansvarar kunden för att tillhandahålla översättningstjänster.

• Försök inte utföra service på utrustningen om du inte har läst och förstår den här servicehandboken.

• Om du inte tar hänsyn till den här varningen kan det resultera i skador på serviceteknikern, operatören eller patienten till följd av elektriska stötar, mekaniska faror eller andra faror.

Bu servis klavuzunun sadece İngilizcesi mevcuttur.

• Eğer müşteri teknisyeni bu klavuzu İngilizce dşnda bir başka lisandan talep ederse, bunu tercüme ettirmek müşteriye düşer.

• Servis klavuzunu okuyup anlamadan ekipmanlara müdahale etmeyiniz.

• Bu uyarya uyulmamas, elektrik, mekanik veya diğer tehlikelerden dolay teknisyen, operatör veya hastann yaralanmasna yol açabilir.

Дане керівництво з сервісного обслуговування постачається виключно англійською мовою.

• Якщо сервісний інженер потребує керівництво іншою мовою, користувач зобов'язаний забезпечити послуги перекладача.

• Не намагайтеся здійснювати технічне обслуговування даного обладнання, якщо ви не читали, або не зрозуміли інформацію, надану в керівництві з сервісного обслуговування.

• Недотримання цього застереження може призвести до травмування сервісного інженера, користувача даного обладнання або пацієнта внаслідок електричного шоку, механічного ушкодження або з інших причин невірного обслуговування обладнання.

CẢNH

BÁO

(VI)

2102027-227A MUSE™ NX 9

Liệu Hướng Dẫn Sửa Chữa chỉ

Tài

Nếu

• Anh, thì khách hàng sẽ có trách

• Không

• Không tuân

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Page 10

1:MUSE HL7 Interface........................................................................................... 15

HL7 Standard Background............................................................................................................................. 15

Theory of Operation...........................................................................................................................................16

Pre-defined CCG Sites........................................................................................................................... 17

Default Site Layout.................................................................................................................................18

Interaction with the MUSE System............................................................................................................. 18

ADT Interface.............................................................................................................................................18

ADT Query Interface.............................................................................................................................. 19

Order Interface.........................................................................................................................................19

Result Interface........................................................................................................................................ 19

Result Batch Interface.......................................................................................................................... 20

Financial Interface..................................................................................................................................20

Financial Batch Interface.................................................................................................................... 20

ADT, Order, and Result Data Storage.............................................................................................20

Graphical Result Reporting Messages.......................................................................................... 21

Depth of Merge.................................................................................................................................................... 21

2:HL7 Inbound Implementation.......................................................................... 22

General Description............................................................................................................................................22

Introduction................................................................................................................................................22

Low-level Communications................................................................................................................22

Interface Data Content........................................................................................................................ 22

Transactions to the MUSE HL7 Interface................................................................................................ 23

MUSE System Incoming HL7 Message Configuration Options..........................................23

ADT Messages...........................................................................................................................................24

ADT Message Composition.................................................................................................................25

Order Message......................................................................................................................................... 26

Order Message Composition............................................................................................................. 26

Depth of Merge Implementation................................................................................................................. 27

Site Configuration: Update Master MUSE Patient List...........................................................27

Site Configuration: Update Unconfirmed Tests........................................................................ 28

Site Configuration: Update Confirmed Tests for Merge Transactions Only..................28

Site Configuration: Update Full Patient Demographics from Merge Transactions....29

Application High-Level Acknowledgment Messages......................................................................... 29

Acknowledgment Message Composition................................................................................................ 30

3:HL7 Outbound Implementation.......................................................................31

General Description............................................................................................................................................31

Low-Level Communications...............................................................................................................31

Interface Data Content........................................................................................................................ 31

Transactions From the MUSE HL7 Interface..........................................................................................32

MUSE System Outgoing HL7 Message Configuration Options..........................................33

Batch Data Transfer.............................................................................................................................. 38

PDF to File Share.................................................................................................................................................40

4:HL7 Query Implementation.............................................................................. 41

About Query Implementation........................................................................................................................41

Page 11

Low-level Communications............................................................................................................................41

Interface Data Content.................................................................................................................................... 42

Query Transactions of the MUSE HL7 Interface...................................................................................42

Query Transaction HL7 Messages.................................................................................................. 42

5:System Data Field Definitions..........................................................................44

ADT Fields................................................................................................................................................................44

Order Fields............................................................................................................................................................ 47

6:HL7 Data Segment Definitions........................................................................ 49

Inbound (to MUSE) Segments........................................................................................................................49

Outbound (from MUSE) Segments.............................................................................................................. 58

7:HIS Data Management......................................................................................70

Setup..........................................................................................................................................................................70

Scheduling HIS Data Maintenance.............................................................................................................71

Maintaining the Log and Queue..................................................................................................................72

8:HL7 Implementation FAQs................................................................................74

ADT Fields and Functions................................................................................................................................74

Orders Fields and Functions.......................................................................................................................... 75

Result and Financial Messages Fields and Functions....................................................................... 76

Communication Protocol Options............................................................................................................... 77

9:HL7 Interface Testing........................................................................................ 79

Introduction............................................................................................................................................................79

Test Goals................................................................................................................................................................79

Customer Prerequisites for Interface Testing........................................................................................80

Test Procedures....................................................................................................................................................81

Test Sequence.......................................................................................................................................................81

Test Templates......................................................................................................................................................82

Testing ADT Interface Transactions........................................................................................................... 82

ADT Transactions that Add Patient Data.....................................................................................82

Testing Transactions that Add Patient Data..............................................................................83

ADT Transactions that Change Patient Data.............................................................................84

Testing Transactions that Change Patient Data......................................................................84

Site Level Merge Settings.................................................................................................................... 85

ADT Transactions that Merge Patient Data................................................................................85

HL7 Merge Transactions......................................................................................................................86

Testing Transactions that Merge Patient Data.........................................................................88

ADT Transactions that Delete Patient Data............................................................................... 88

Testing Transactions that Delete Patient Data.........................................................................88

How to View Patient Admitting and Visit Information.......................................................................89

MUSE Order Transactions............................................................................................................................... 92

Testing Order Transactions................................................................................................................ 93

How to View Patient Order Information on the MUSE System......................................................94

Testing Result Transactions........................................................................................................................... 97

Result Transactions Test Procedures.........................................................................................................97

Test Data................................................................................................................................................................. 97

Testing the Results on MUSE with Inbound HL7 ADT Interface.................................................... 98

Sending Test HL7 Results from the MUSE System (with Inbound HL7 ADT Interface)........99

Testing Results on MUSE System with Inbound HL7 ADT and Order Interfaces................. 106

Sending Test HL7 Results from MUSE System (Inbound HL7 ADT and Order Interfaces).. 108

Testing Financial Transactions...................................................................................................................116

Page 12

Testing Financial Transactions on MUSE Systems............................................................... 117

Testing Interface Transactions.......................................................................................................118

Monitoring HL7 Transactions on MUSE System................................................................................ 118

MUSE HIS Event Log........................................................................................................................... 118

MUSE HIS Change Log.......................................................................................................................119

A:Abbreviations and Acronyms Used in this Manual....................................122

Abbreviation List................................................................................................................................................122

B:OBX Code Tables.............................................................................................. 126

OBX Observation Code Tables...................................................................................................................126

C:Waveform Processing Rules.......................................................................... 134

Encoding and Encryption..............................................................................................................................134

Decryption............................................................................................................................................................135

D:ADT Test Plan Templates............................................................................... 136

Introduction......................................................................................................................................................... 136

ADT Transactions for Adding Patient Data.......................................................................................... 137

A01 – Admit Patient............................................................................................................................ 137

A04 – Register Outpatient................................................................................................................ 140

A10 – Patient Arriving.........................................................................................................................142

A13 – Cancel Patient Discharge....................................................................................................144

A05 – Pre-Admit Inpatient................................................................................................................147

A05 – Pre-Admit Outpatient............................................................................................................ 149

ADT Transactions for Changing Patient Data.....................................................................................151

A08 – Update Patient Information – Change Date of Birth..............................................152

A08 – Update Patient Information – Change Race..............................................................152

A08 – Update Patient Information – Change Sex.................................................................153

A08 – Update Patient Information – Change Street Address..........................................153

A08 – Update Patient Information – Change Patient Name............................................154

A08 – Update Admitting MD Name and HIS ID..................................................................... 154

A02 – Transfer Patient Location....................................................................................................155

A06 – Transfer Outpatient to Inpatient......................................................................................155

A07 – Transfer Inpatient to Outpatient......................................................................................156

A12 – Cancel Patient Transfer....................................................................................................... 156

A17 – Swap Patient Locations....................................................................................................... 157

A03 – Discharge Patient....................................................................................................................158

A09 – Patient Departing....................................................................................................................158

ADT Transactions for Deleting Patient Data........................................................................................159

TA11 – Cancel Patient Admit.......................................................................................................... 159

A23 – Delete Patient........................................................................................................................... 160

E:Order Test Plan Templates.............................................................................161

Introduction......................................................................................................................................................... 161

NW – New Order - EKG.................................................................................................................................162

NW – New Order - Signal Averaged....................................................................................................... 164

NW – New Order - Holter.............................................................................................................................165

NW – New Order - Stress.............................................................................................................................167

Change Orders...................................................................................................................................................169

XO – Change Order - EKG................................................................................................................169

XO – Change Order - Signal Averaged...................................................................................... 169

XO – Change Order – Holter........................................................................................................... 170

XO – Change Order – Stress........................................................................................................... 170

Page 13

Order Priority.......................................................................................................................................................171

NW – Enter Order – EKG STAT Priority........................................................................................171

NW – Enter Order – EKG Routine Priority................................................................................. 171

NW – Enter Order – EKG ASAP Priority.......................................................................................171

New EKG Orders with a Future Date...................................................................................................... 172

Multiple Occurrence EKG Order.................................................................................................................172

Cancel EKG Order.............................................................................................................................................173

Discontinue EKG Order...................................................................................................................................174

F:Results Test Plan Templates.......................................................................... 175

Introduction......................................................................................................................................................... 175

MUSE Preliminary Results on ADT Interface Only.............................................................................176

Preliminary Results for EKG............................................................................................................. 176

Preliminary Results for HiRes..........................................................................................................178

Preliminary Results for Holter.........................................................................................................180

MUSE Preliminary Results for Stress........................................................................................... 181

MUSE Demographic Complete Results on ADT..................................................................................183

Demographic Complete Results for EKG.................................................................................. 183

MUSE Demographic Complete Results for HiRes..................................................................185

Demographic Complete Results for Holter.............................................................................. 186

Demographic Complete Results for Stress.............................................................................. 188

MUSE Final Results on ADT Interface Only...........................................................................................190

Final Result for EKG.............................................................................................................................190

Final Result for HiRes..........................................................................................................................191

Final Result for Holter.........................................................................................................................193

Final Result for Stress.........................................................................................................................195

MUSE Corrected Results on ADT Interface Only................................................................................196

Corrected Result for EKG.................................................................................................................. 196

Corrected Result for HiRes...............................................................................................................198

Corrected Result for Holter..............................................................................................................200

Corrected Result for Stress..............................................................................................................201

MUSE Preliminary Results on ADT and Orders................................................................................... 203

Preliminary Results for EKG............................................................................................................. 203

Preliminary Results for HiRes..........................................................................................................205

Preliminary Results for Holter.........................................................................................................207

Preliminary Results for Stress.........................................................................................................209

MUSE Demographic Complete Results on ADT..................................................................................211

Demographic Complete Results for EKG.................................................................................. 211

Demographic Complete Results for HiRes............................................................................... 213

Demographic Complete Results for Holter.............................................................................. 215

Demographic Complete Results for Stress.............................................................................. 217

MUSE Final Results on ADT and Orders Interface.............................................................................219

Final Results for EKG...........................................................................................................................219

Final Results for HiRes....................................................................................................................... 221

Final Results for Holter...................................................................................................................... 223

Final Results for Stress.......................................................................................................................225

MUSE Corrected Results on ADT and Orders...................................................................................... 227

Corrected Result for EKG.................................................................................................................. 227

Corrected Result for HiRes...............................................................................................................229

Corrected Result for Holter..............................................................................................................231

Corrected Result for Stress..............................................................................................................233

G:Results and Financials Test Plan.................................................................. 235

Introduction......................................................................................................................................................... 235

MUSE Preliminary Results and Billing..................................................................................................... 236

Preliminary Results and Billing for EKG......................................................................................236

Preliminary Results and Billing for HiRes.................................................................................. 238

Page 14

Preliminary Results and Billing for Holter................................................................................. 240

Preliminary Results and Billing for Stress................................................................................. 242

MUSE Demographic Complete Results and Billing...........................................................................244

Demographic Complete Results and Billing for EKG...........................................................244

Demographic Complete Results and Billing for HiRes........................................................246

Demographic Complete Results and Billing for Holter.......................................................247

Demographic Complete Results and Billing for Stress....................................................... 249

MUSE Final Results and Billing...................................................................................................................251

Final Results and Billing for EKG...................................................................................................251

Final Results and Billing for HiRes................................................................................................253

Final Results and Billing for Holter...............................................................................................255

Final Results and Billing for Stress...............................................................................................257

MUSE Corrected Results and Billing........................................................................................................ 259

Corrected Results and Billing for EKG........................................................................................ 259

Corrected Results and Billing for HiRes..................................................................................... 261

Corrected Results and Billing for Holter.................................................................................... 263

Corrected Results and Billing for Stress.................................................................................... 265

Page 15

MUSE HL7 Interface

The GE Healthcare system can be connected to a hospital information system by the Health Level Seven Standard Interface (HL7). This document is intended to be a technical reference for GE Healthcare customers implementing the HL7 interface. It contains data formats for the transmission of data and describes the requirements for interfacing to the GE Healthcare system using the HL7 standard. This document does not describe how transactions are processed by the GE Healthcare system, or the clinical impact of using some of the features described here.

MUSE HL7 Interface

This document is not intended to provide instructions for implementing and using the HL7 Standard. Details of the HL7 standard can be found in Health Level Seven Version

2.2 or later. NOTE:

This document details all options within the GE HL7 interface. Not all features and functions described in this manual are included with a standard interface. The purchase of additional modules in conjunction with the GE HL7 Standard Interface may be required to obtain the desired functionality.

HL7 Standard Background

The Health Level Seven Standard (HL7) is used to exchange data between computer systems. It does not require a specific computer operating system, programming language, or communication protocol for its implementation.

The goal of the HL7 Standard is to standardize message content and usage, while allowing user-specific variations within the standard. To accomplish this, the HL7 Standard specifies encoding rules used to create the message format. Based on these rules, the messages generally consist of data fields and data segments.

A message is comprised of multiple segments. While some of the segments are required to create a message, others are optional. Each segment within the HL7 message is separated by special segment separator characters.

Each segment contains data elements. The data elements may be of varying lengths. Like the segments, elements are separated from each other by special characters. The data elements and their separators are logically grouped together to create data segments such as the message header segment or the patient identification segment. Data contained in HL7 messages consists of displayable ASCII characters.

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MUSE HL7 Interface

Each segment begins with a three-character value, for example “MSH” for the message header segment. These three characters uniquely identify the segment within a given message. Segments are identified as either required or optional, and some may be repeated. Data segments are separated from each other by segment separator characters.

Based on the HL7 encoding rules, each message within the HL7 protocol has a known structure. The segments and data fields that comprise a given message are always the same, plus or minus the defined optional segments and data fields. An individual data field can be found within a message simply by knowing its configured position in a segment.

HL7 messages are passed between computer systems as parts of valid transactions. For example, admitting a patient on the Hospital Information System (HIS), or receiving a completed study result on the MUSE system would cause an HL7 message to be generated and sent. After a message is sent, the receiving system processes the message. When processing is complete, the receiving system can process the next message, or it can optionally generate an application-level acknowledgment that is returned to the sending system.

Since the HL7 Standard provides flexibility in message content and format, and in communication protocol options, its implementation requires agreement between the sending and receiving computer systems on the following items:

• Message formats

• Acknowledgment protocol

• Communication protocol

• Data handling Communication between Hospital Information Systems personnel and MUSE

Interface personnel is essential to determine the customer-specific use of the HL7 Standard.

NOTE:

This document is not intended to provide instructions for implementing and using the HL7 Standard. Details of the HL7 standard can be found at http://

www.hl7.org/.

Theory of Operation

The following diagram depicts a typical production deployment environment for the HL7 Standard Interface and the MUSE file server. CCG (Centricity Clinical Gateway) is the HL7 interface engine.

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Page 17

MUSE HL7 Interface

The MUSE HL7 Interface is defined as the combination of HL7 parsers on the MUSE Server and configured MUSE-specific CCG Sites on the CCG Server, that allow MUSE to communicate with an external system via HL7.

CCG receives the inbound ADT and Order (ORM) messages from external systems (DIS/RIS/HIS) and routes them to the MUSE Server. It also routes the outbound Results (ORU) and Billing (DFT) messages from the MUSE file server to external systems. CCG also processes ADT Query messages which MUSE may use to request ADT data from external systems.

The data exchange between CCG and MUSE file server is done using TCP/IP socketbased communication protocol. A pre-defined HL7 message format is used to route data between CCG and MUSE server.

Pre-defined CCG Sites

The MUSE system ships with three pre-defined interfaces:

• muse_prod

• batch_muse

• batch_his NOTE:

his_prod currently ships with CCG.

These sites include the necessary threads and configurations to receive and route messages between the MUSE file server and external systems (DIS/RIS/HIS).

Your HL7 engineer will configure the pre-defined interface to meet the needs of your hospital systems. Your configuration may not resemble the default layout exactly as presented.

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MUSE HL7 Interface

Default Site Layout

The MUSE HL7 Interface is designed to meet the goals of the HL7 Standard. It provides the flexibility to easily support user-specific differences in the HL7 message formats, and also supports a variety of communication protocols for the exchange of messages.

The MUSE HL7 Interface supports only the HL7 Standard message types that have an equivalent function on the MUSE system. Message types which do not have an equivalent function on the MUSE system are not supported.

The MUSE system supports immediate processing rules for all message types. Outbound batch transactions (deferred processing) are supported for result and financial messages.

Interaction with the MUSE System

The MUSE HL7 Interface consists of seven standard component interfaces:

• ADT (Admit/Discharge/Transfer)

• ADT Query

• Order

• Result

• Result Batch

• Financial

• Financial Batch Each interface component is a purchasable option. The purchased interface may

include one or any combination of these components. An ADT interface is required with an Order interface. GE Healthcare recommends that an Order interface be included with every Financial interface.

NOTE:

ADT Interface

The MUSE HL7 Interface accepts unsolicited messages for ADT transactions from the host system. The MUSE HL7 Interface can respond with an application-level acknowledgment if required by the host system. This acknowledgment indicates that the message was received. Once the messages are forwarded to and processed on the MUSE system, entries are made in the MUSE ADT databases and MUSE system users can then access the data.

The implementation of one or more of the interfaces will affect the operations of the respective department(s) and its personnel. Changes will affect how patient information is entered and/or how billing is completed.

NOTE:

The MUSE HL7 interface does not support batch processing of ADT messages.

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ADT Query Interface

The MUSE HL7 Interface can query the host system for Patient Demographics based on the MUSE system user actions, or the MUSE system events. The messages returned by the host system are entered into the MUSE ADT database and MUSE system users can then access the data.

The ADT Query feature is for customers who cannot send Unsolicited Admit messages (ADT messages) to the MUSE system to populate Patient Information in the ADT Database. Instead the MUSE system sends a Query Message to the HIS, providing the least Patient Information (PatientID or Patient Last Name) asking for Patient Demographics and with the Query response received from HIS, MUSE adds/updates Patient Details in the ADT Database.

There are three triggers in the MUSE system for ADT Query:

• Editor

• Normalization

MUSE HL7 Interface

• Device ADT Query, if configured for these trigger events, will send a query message out to the

configured port on the CCG system, receives the response from the HIS system, and performs update operations on the MUSE system.

Order Interface

The MUSE HL7 Interface receives and processes real-time order transaction messages from the host system. The order message must contain an order for only one study. The MUSE HL7 Interface can respond with an application-level acknowledgment if required by the host system. This acknowledgment indicates that the message was received. Once the messages are forwarded to and processed on the MUSE system, entries are made in the MUSE ADT databases and the MUSE system users can then access the data.

NOTE:

The MUSE HL7 interface does not support batch processing of order messages. The MUSE order interface cannot be configured to query the host system for orders, nor does it create order numbers.

Result Interface

The MUSE HL7 Interface can deliver result messages to the host system. The messages can be configured to be sent as the:

• Study is acquired by the MUSE system.

• Study is confirmed.

• Patient demographics are confirmed . If necessary, confirmed messages can be regenerated and resent to the host by a

user. However, unconfirmed messages may have been updated, and thus may not be regenerated exactly as they were initially acquired.

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MUSE HL7 Interface

The HIS can use the result messages in either of the following ways:

• To make study results available for access on the hospital computer system.

• To generate charges for completed studies. The MUSE HL7 interface does not send formatted text and does not support HL7 DSP

segments.

Result Batch Interface

The MUSE HL7 Interface can deliver batches of result messages. The MUSE system user can create a schedule based on daily, weekly, or monthly intervals.

Financial Interface

The MUSE HL7 Interface can be configured to send financial messages to the host system. The messages can be configured to be sent as the:

• Study is acquired by the MUSE system.

• Study is confirmed.

• Patient demographics are confirmed. If necessary, messages can be regenerated and resent to the host by a user. If study

data is updated in the interim, the messages may not be regenerated exactly as they were initially sent.

The HIS can use the financial messages in either of the following ways:

• To generate professional fee charges for completed studies.

• To generate technical fee charges for completed studies.

Financial Batch Interface

The MUSE HL7 Interface can deliver batches of financial messages. The MUSE system user can create a schedule based on daily, weekly, or monthly intervals.

ADT, Order, and Result Data Storage

The ADT and order data is stored on the MUSE system in three interface tables: patients, order, and visit. The data on these short-term interface tables are maintained on the MUSE system for a configured length of time.

The study result data is stored on the MUSE system, separate from the interface tables. The study result data is first acquired into the MUSE system as unconfirmed data and stored on the edit list until they are confirmed. The confirmed studies are stored long-term in the patient’s study database on the MUSE system.

As a study is acquired into the MUSE system, information from the interface tables is incorporated into the unconfirmed study data. While the study remains unconfirmed on the edit list, the interface information may be updated and the study data may be edited. Once the study is confirmed to the patient’s study database, the information in the study (including interface data) does not change unless the system is configured for depth of merge for confirmed studies.

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Graphical Result Reporting Messages

The MUSE HL7 interface supports reporting of both digitized waveform images and waveform data points in an HL7 result message. The MUSE system interface can be configured to write a PDF of the study into a shared folder. With this "COLD feed" method, a custom file name can be created for each test while sending an optional HL7 ORU message that can include a pointer or a reference to the location of the file.

With the digitized waveform image method, a Z-segment that supports graphical results of several image formats is included in the result message. The supported formats for graphical result data include Adobe Portable Document Format (PDF), Postscript Level 2, TIFF fax image, PCL-5, and Windows 16–bit metafile formats. All image types except Postscript are sent in the HL7 message either UUencoded or Base64 encoded.

The waveform data point option follows the HL7 standard for waveforms. Only the 12-lead resting ECG data type is supported when generating HL7 messages that include the detailed waveform data points.

MUSE HL7 Interface

Depth of Merge

You can configure MUSE to allow the stored patient-study demographics, and visit and account information to be synchronized with the HIS system when specific HL7 messages are received. This data synchronization may be configured to operate on both confirmed and unconfirmed study data as well as the MUSE site level patient demographics data store. The following site level settings are available to control depth of merge:

• Update Master MUSE Patient List – All depth of merge HL7 messages will update the MUSE site level demographics data. This setting is not recommended. The Master Patient List is not used on systems that have an ADT interface.

• Update Unconfirmed Tests – All HL7 messages will update unconfirmed patient tests.

• Update Confirmed Tests for Merge Transactions Only – Merge specific HL7 message will update confirmed patient tests.

• Update Full Patient Demographics Information From Merge Transactions – Update all fields (if not checked only Patient ID, Last Name, First Name, and Date of Birth are updated).

Merge specific HL7 message are those that change Patient ID, Visit or Account identifiers to the correct values. These are currently the only type of messages that target confirmed patient test data.

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HL7 Inbound Implementation

General Description

Introduction

The HL7 Standard Interface is used to connect a hospital's information system (HIS) to the MUSE HL7 Interface to exchange data. The MUSE HL7 Interface supports inbound ADT and Order data. The inbound data is unsolicited, and is processed in real-time.

The MUSE HL7 Interface does not support inbound batch messages.

Low-level Communications

The specific installation determines which low-level communication protocol is used. The HL7 interface standard is designed to accommodate a wide variety of communication methodologies, from message-based communications to file transfer schemes.

Implementation of the low-level communication protocol does not directly affect the HL7 interface message content and functionality. Not all low-level communication protocols support high-level acknowledgments. Therefore, if highlevel acknowledgments are desired, a low-level protocol that supports them must be selected.

The HL7 interface assumes that the low-level communication protocol ensures that the data arrives error-free. As a result, no data integrity checking is done at the application level. The MUSE HL7 interface allows only TCP/IP socket communication for receiving inbound HL7 transactions.

Interface Data Content

For HL7 ADT and order messages, data fields are mapped to the MUSE system data fields according to the configured position in the HL7 segment structures. The MUSE HL7 Interface Configuration programs define the mapping.

The configuration programs use data tables and simple scripting to determine how to deal with incoming HL7 messages. The configuration programs align the HL7 fields and functions specified by a customer to the MUSE data fields.

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The following pages provide the general format of the various HL7 data messages recognized by the MUSE system for inbound interfaces. This document describes only the messages, data fields, and segments that are required or used by the MUSE system. Messages, fields, and segments not listed here will be ignored by the MUSE system, unless optionally configured with a customized setup. Some customers may incorporate a special Z segment in the HL7 message format. The MUSE system may support the information contained in the Z segment on a case by case basis. The MUSE HL7 Interface is capable of parsing information in a special segment if the information corresponds to the MUSE system database information.

NOTE:

The MUSE system message processing follows the HL7 immediate processing rules. It does not support deferred processing.

Transactions to the MUSE HL7 Interface

The HIS sends ADT and/or order messages to the MUSE HL7 Interface. Once the messages enter the MUSE system, a task parses the message data and creates or alters entries in the MUSE database. MUSE system users may then view the information. An inbound interface may consist of ADT only, or ADT and orders.

HL7 Inbound Implementation

The HL7 ADT transactions transmit patient demographic and patient visit information from the hospital’s ADT system to the MUSE system. New or updated patient information is entered into the hospital’s ADT system and sent to the MUSE system as an unsolicited transaction. MUSE system users can then view the patient information received from the HIS. The MUSE system will not accept batch ADT messages.

The order entry transactions transfer the order information for a requested study from a hospital’s order entry system to the MUSE system. All orders originate on the host system and are sent to the MUSE system as unsolicited transactions.

NOTE:

The MUSE HL7 Interface does not originate orders, create order numbers, query for orders, cancel orders to the HIS, or accept batch order messages.

In HL7 terminology, the MUSE HL7 Interface is considered a “filler” of orders. It receives orders from the hospital’s order entry system, allows users to view the order information, and tracks order status as studies are completed on the MUSE system.

MUSE System Incoming HL7 Message Configuration Options

The MUSE HL7 Interface maps incoming HL7 ADT and order message segment data fields to corresponding HL7 messages recognized by MUSE. In turn, MUSE parses the known messages and updates its database as needed. The mapping is based on known message configurations, and is done in CCG using data mapping tables. The flexibility provided by these tables allows the MUSE HL7 Interface to accommodate differences between systems in HL7 ADT and order message implementations.

Not all HL7 data fields are supported by the MUSE HL7 Interface. The HL7 segments and data fields supported by the MUSE HL7 Interface are tabulated in "ADT Fields" on

page 44 and "HL7 Data Segment Definitions" on page 49.

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HL7 Inbound Implementation

The following sections describe MUSE data mapping tables and message configurations for inbound interfaces

ADT Messages

The following HL7 event types are supported by the MUSE HL7 Interface for ADT messages:

HL7 event MUSE function MUSE Action

A01 Admit patient Patient is admitted. Patient and open visit are

A02 Transfer patient Patient visit location is changed

A03 Discharge patient Patient visit ends. Visit status is changed to

A04 Admit patient Patient is admitted. Patient and open visit are

created in MUSE ADT tables.

closed

created in MUSE ADT tables.

A05 Admit patient Patient is admitted. Patient and open visit are

created in MUSE ADT tables.

A06 Transfer outpatient to

inpatient

A07 Transfer inpatient to

outpatient

A08 Update patient information Patient and visit information are updated

A09 Discharge patient Patient visit ends. Visit status is changed to

A10 Admit patient Patient is admitted. Patient and open visit are

A11 Cancel admit Patient visit is deleted if visit does not have

A12 Transfer patient Patient visit location is changed

A13 Cancel discharge Visit status is changed to Open

A17 Swap patients Two patient Visit locations are swapped

Patient location and type are changed for visit

closed

created in MUSE ADT tables.

active orders

A18 Merge patient ID Visits and orders associated with one PID are

moved to a different PID

A19 Update patient information Patient query (ADT query) results

A23 Delete patient Patient visit is deleted if visit does not have

active orders

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HL7 event MUSE function MUSE Action

A34 Merge patient ID Visits and orders associated with one PID are

moved to a different PID

A35 Merge account Updates account number with new account

number

A36 Merge patient ID and account Patient ID and account number are updated

with new Patient ID and account number

A42 Merge visit The visit and all associated orders are moved

to new visit number

A46 Merge visit The visit and all associated orders are moved

to new visit number

NOTE:

A18 functionality is reserved for backwards compatibility. A34 should be used.

All other HL7 messages are unsupported and will not be processed by the MUSE HL7 interface application. When an unsupported HL7 message is sent to the MUSE interface, an error is logged.

NOTE:

In order to maximize performance, unsupported messages should be filtered out by the HIS system.

ADT Message Composition

The general format for the various ADT messages is given below. Segments enclosed by square brackets, [ ], are optional. The MUSE HL7 Interface allows only one Patient Identification Segment per HL7 message, with the exception of the A17 Swap transaction. A tabulation of all the HL7 segments and data fields as supported by the MUSE HL7 Interface is included in "ADT Fields" on page 44 and "HL7 Data Segment

Definitions" on page 49.

The MUSE HL7 interface supports the following HL7 ADT message segments. MUSE HL7 Interface message configuration allows the use of additional standard HL7 segments, or special Z-segments, for specific data that is supported on the MUSE system. HL7 segments not listed below, or that are not configured in the MUSE HL7 Interface are ignored by the MUSE HL7 Interface when received in an HL7 ADT message. The MUSE HL7 Interface supports fields for patient height, patient weight, and admitting diagnosis which do not directly correlate with fields defined by HL7 ADT messages.

ADT Common Trigger Events A01, A02, A03, A04, A05, A06, A07, A08, A09, A10, A11, A12, A13, A23

• MSH-Message Header segment

• EVN-Event Type segment

• PID-Patient Identification segment

• PV1-Patient Visit segment

• [DG1] - Patient diagnosis segment

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• [NTE] - Note segment

• {[OBX]}- Observation segment

ADT Merge A18, A34, A35, A36, A42, A46

• MSH-Message Header segment

• EVN-Event Type segment

• PID-Patient Identification segment

• PV1-Patient Visit segment

• MRG-Merge Information segment

ADT Swap A17

• MSH-Message Header segment

• EVN-Event Type segment

• PID-Patient 1 Identification segment (with sequence number 1, required)

• PV1-Patient 1 Visit segment (with sequence number 1, required)

• PID-Patient 2 Identification segment (with sequence number 2, required)

• PV1-Patient 2 Visit segment (with sequence number 2, required)

Order Message

The following HL7 order functions are supported by the MUSE HL7 Interface:

Table 2: Order Functions

Order Description

NW New Order A new order is created.

CA Cancel Order Request An existing order is cancelled if not already in

OD Delete Order An existing order is cancelled.

XO Change Order Request An existing order is changed. If order did not

All other order functions are unsupported and will be rejected by the MUSE HL7 interface application.

process in MUSE.

previously exist in MUSE, new order is created.

NOTE:

In order to maximize performance, unsupported order functions should be filtered out so they do not transmit to the MUSE interface.

Order Message Composition

The general format of an order message is given below. Segments enclosed in square brackets, [ ], are optional. The MUSE HL7 Interface allows only one common order segment and one Observation Request segment per message (only one order is allowed per HL7 order message). A tabulation of all the HL7 segments and data fields

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supported by the MUSE HL7 Interface is included in "ADT Fields" on page 44 and

"HL7 Data Segment Definitions" on page 49 .

In general, these are the only HL7 order message segments supported by the MUSE HL7 Interface. MUSE HL7 Interface message configuration may allow for the use of additional standard HL7 segments, or special Z-segments, for specific data that is supported on the MUSE system. HL7 segments not listed below or not set up in the MUSE HL7 Interface configuration program are ignored by the MUSE HL7 Interface when received in a HL7 order message.

Although the PV1 segment is shown as an optional segment in the HL7 order message, the MUSE system stores values sent in PV1 segment fields to the MUSE database. The MUSE HL7 Interface also supports fields for ordering comments which do not directly correlate with fields defined by HL7 ORM messages.

• MSH-Message Header segment

• PID-Patient Identification segment

• [PV1]-Patient Visit segment

• ORC-Common Order segment

• OBR-Observation Request segment

• [NTE] - Note segment

• [DG1] - Patient diagnosis segment

• {[OBX]}- Observation segment

Depth of Merge Implementation

The types of HL7 messages, along with the MUSE site configuration setting that will trigger automatic updates to patient study data stored on the MUSE system are described in the following sections.

NOTE:

If a study which is the target for an update or merge is checked out for editing at the time the transaction is sent to the MUSE system the study will not be merged.

Site Configuration: Update Master MUSE Patient List

The following messages will cause the MUSE site level patient demographics data to be updated for the specified patient:

NOTE:

Update Master MUSE Patient List should be enabled only when the workflow

requires that the current site level patient demographics on the MUSE system is always in synchronization with the HIS system. Since all A08 messages will trigger an update to the site level demographics, and since A08 messages are very common, this may place an unnecessary load on the system. The site level demographics will be updated when unconfirmed records are updated. We recommended that you clear this check box.

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Table 3: Message Events

MUSE Function HL7 Event

Admit Patient ADT [A01, A04, A05, A10]

Update Patient ADT [A08]

Transfer Patient ADT [A12, A02]

Merge PID ADT [A18, A34]

Merge Account ADT [A35]

Merge PID & Account ADT [A36]

Merge Visit ADT [A42, A46]

Site Configuration: Update Unconfirmed Tests

The following messages will cause unconfirmed studies to be updated for the specified patient:

NOTE:

PID/Name and Date of Birth mismatches will prohibit the update of unconfirmed studies.

Table 4: Message Events

MUSE Function HL7 Event

Admit Patient ADT [A01, A04, A05, A10]

Update Patient ADT [A08]

Transfer Patient ADT [A12, A02]

Update Patient Status ADT [A07, A06]

Update Order ORM [XO], if order status = unconfirmed

Merge PID ADT [A18, A34]

Merge Account ADT [A35]

Merge PID & Account ADT [A36]

Merge Visit ADT [A42, A46]

Site Configuration: Update Confirmed Tests for Merge Transactions Only

The following messages will cause confirmed studies to be updated for the specified patient:

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Table 5: Message Events

MUSE Function HL7 Event

Merge PID ADT [A18, A34]

Merge Account ADT [A35]

Merge PID & Account ADT [A36]

Merge Visit ADT [A42, A46]

Site Configuration: Update Full Patient Demographics from Merge Transactions

The following messages will cause all fields of the confirmed studies to be updated for the specified patient:

NOTE:

If not checked only Patient ID, Last Name, First Name, and Date of Birth are updated.

Table 6: Message Events

MUSE Function HL7 Event

Merge PID ADT [A18, A34]

Merge Account ADT [A35]

Merge PID & Account ADT [A36]

Merge Visit ADT [A42, A46]

Application High-Level Acknowledgment Messages

The MUSE HL7 Interface supports application-level message acknowledgments in response to inbound messages formatted as HL7 original mode acknowledgments. This function allows an application to acknowledge that it has received data and has determined the message is valid HL7. The acknowledgment message returned to the sending application is used to determine whether to initiate a re-send of the message, to abort the transaction or to continue processing the next transaction.

By default, the MUSE HL7 Interface will always send an HL7 acknowledgment message to the host system after receiving an ADT or order message.

The MUSE interface does not support single character or ACK/NACK acknowledgment responses.

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HL7 Inbound Implementation

Acknowledgment Message Composition

Acknowledgment messages contain the following HL7 interface segments:

• MSH-Message Header

• MSA-Message Acknowledgment

HL7 acknowledgment messages may contain one of three statuses from the receiving system: accept (AA), application error (AE), or application reject (AR). According to the HL7 specification, AE messages contain an error and are not to be retransmitted. AR messages may be retransmitted based on a local agreement between all parties involved in the interface implementation.

The MUSE HL7 Interface is not capable of detecting application-level errors. Because of this, it is capable only of responding with an AA or AE acknowledgment. It will respond with an AE acknowledgment when the HL7 message itself is corrupt or incomplete.

The MUSE HL7 Interface returns the ADT or order message MSH segment Control ID field as sent by the HIS in the MSA segment of the acknowledgment response.

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HL7 Outbound Implementation

General Description

The HL7 Standard Interface is used to connect a hospital’s information system (HIS) to the MUSE HL7 Interface for the exchange of data. Using the MUSE HL7 interface, the MUSE system can send result and financial messages to the HIS.

HL7 Outbound Implementation

The MUSE HL7 Interface may be configured to provide result and/or financial messages. The MUSE HL7 Interface can be configured to format textual test results and/or financial files and transmit them to the HIS. Credits cannot be generated with the financial message interface. Result and financial messages can be configured to be sent as individual messages or in batches.

One or any combination of the result or financial functions may be implemented. NOTE:

A financial interface is only recommended with an established ADT or order interface which ensures patient data matches the host computer system data.

Low-Level Communications

The specific installation determines which low-level communication protocol will be used. The HL7 interface standard is designed to accommodate a wide variety of communication methodologies, from message-based communications to file transfer schemes. Because of this flexibility, implementation of the low-level communication protocol does not directly affect the HL7 interface message content and functionality. However, not all low-level communication protocols support highlevel acknowledgments. If high-level acknowledgments are desired, select a low-level protocol that supports them.

The HL7 interface assumes that the low-level communication protocol ensures that the data arrives error-free. Data-integrity checking is not done at the application level. Examples of possible communication methods are: FTP, TCP/IP, sockets and shared drives.

Interface Data Content

For HL7 outbound messages, the study data gathered from the MUSE system is mapped to the configured data field positions in the HL7 segment structures to

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create result and/or financial messages. Data mapping is accomplished through the MUSE HL7 Interface configuration programs (CCG).

The following pages provide the general format of the various HL7 data messages recognized by the MUSE system for outbound interfaces. This document describes only the data fields and segments that are provided by the MUSE system. Fields and segments not listed here are not sent by the MUSE system.

NOTE:

Transactions From the MUSE HL7 Interface

The MUSE system manages and stores patient studies such as resting ECGs, Holters, and exercise stress studies. Initially, the studies are performed on ancillary MUSE devices and the study results are then acquired into the MUSE system for processing. At acquisition, the studies are generally unconfirmed with a status of preliminary which means that the results have not been interpreted or read by a physician. When a study is interpreted or read by a physician and confirmed, the status of the report updates to final. The stored results can be retrieved and/or edited as necessary. Tests that are re-edited and saved are in corrected/revised status.

The MUSE Report Distribution setup utility is used to configure the generation of result and financial messages to the MUSE interface engine and then to the HIS. As with other report distribution configurations, each MUSE study type has its own configuration. The report distribution configurable parameters within each study type are:

• Patient/study location parameter — The setup of the location parameter for HL7 messaging conforms to the same rules as other reports or devices. Refer to the MUSE Cardiology Information System Operator’s Manual for detailed configuration.

• Triggers for generation of message — The available triggers for generation of an HL7 message are the same as those for reports to devices. Setting up an HL7 result in the unconfirmed section of the Report Distribution utility generates an HL7 message on acquisition of the study from the ancillary device to the MUSE server. Entries in the Demographics Complete section are executed when the study is marked as "Demographics Complete.” Entries in the confirmed section are generated when the study is confirmed and when the study is revised and reconfirmed. If the format is “HIS billing,” the HL7 message is generated only once for each trigger, even if the action to trigger another message is executed. Special user privileges are required to generate additional billing messages.

• Device — A communication device is created and used to transmit the HL7 message formatted by the MUSE system to the MUSE interface engine. Multiple

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HL7 devices may have been created for transmitting different message types. When configuring report distribution to send HL7 result and financial messages to the HIS, it is necessary to choose the correct device. The HL7 integration engineer who configured the MUSE HL7 interface will communicate the correct device to use.

• Message formats — Message formats are configured by the HL7 integration engineer and can include text messages, results messages with encoded waveforms, and messages formatted for billing. The message format selected in report distribution that is sent to the MUSE HL7 interface engine may be associated with the HL7 device, or be a stand-alone format. The HL7 integration engineer who configured the system will communicate the correct format to select.

Additional notes on generation of Financial messages: The MUSE system is configured to recognize when a user performs an action that

would generate a second financial message and will either allow or suppress the message. When an event that could generate a duplicate message occurs (user triggers a Report Distribution route for Demographics Complete or confirms a study and the route is configured for billing), MUSE will evaluate the MUSE user’s privilege to determine if they have sufficient privileges to bill a study more than once. If the user has this privilege, they will be prompted to confirm the request to send another transaction for the study. If the user does not have re-bill privileges, MUSE will suppress the the financial message, even if the Report Distribution settings are configured to route on this event.

Due to the potential that duplicate messages may be sent from MUSE the receiving HIS system must handle duplicate financial messages. Ultimately it is the responsibility of the HIS billing system to ensure proper charges and credits.

NOTE:

Use of financial messages based on newly acquired studies is not recommended.

MUSE System Outgoing HL7 Message Configuration Options

Outbound Message Statuses

The following is a description of the HL7 message statuses that are used by the MUSE HL7 interface for Outbound (ORU and DFT) messages.

• Preliminary Result Status indicates a study has been performed and acquired by the MUSE system. The message contains ADT and order information as entered at or available at the device. It may include a combination of preliminary study measurements and computer generated diagnosis statements. The preliminary status is indicated by the “P” in OBR-25 and in field 11 of each OBX segment.

NOTE:

Sending financial messages based on newly acquired studies is not recommended.

• Demographics Complete Status indicates that the patient demographics information in the MUSE system for a study is complete. This interim status

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can also be triggered by a MUSE user. The message contains ADT and order information as updated at the MUSE system. It may include a combination of preliminary study measurements and computer generated diagnosis statements. Sending a result message when a study reaches Demographics Complete status may be a better choice than sending a Preliminary Result or Billing Message, as it gives the MUSE users a chance to complete any missing patient information from the study before sending the message. The demographics complete status is indicated by the “I” in OBR-25 and in field 11 of each OBX segment.

• Final Result Status indicates a study has been edited at the MUSE system, and the study results have been confirmed by an overreader. The message contains ADT and order information as updated during the editing session. It may include a combination of confirmed study measurements and diagnosis statements. The final status is indicated by the “F” in OBR-25 and in field 11 of each OBX statement.

• Corrected Result Status indicates that a previously confirmed study has been re-edited and re-confirmed after the initial confirmation. The message contains ADT and order information as updated during the editing session. It may include a combination of confirmed study measurements and diagnosis statements. The corrected status is indicated by the “C” in OBR-25 and in field 11 of each OBX statement.

Result reporting from a MUSE system that does not include an order interface is possible. This type of interface will not include all of the data found in the following examples. Without an order interface, the order number may not be available on the MUSE system to include in the result or financial messages. Other information, such as the ordering physician, may also not be available. Please refer to the tables in the Data Segment section at the end of this document for details on the data contained in the MUSE system order table.

Study Result Message Composition (ORU)

All study result messages have the same basic segments:

• MSH - Message header

• PID - Patient identification

• PV1 - Patient visit

• [OBR] - Observation request

• [OBX] - Observation result

• [ZRI] - Report image (for waveform segment only)

OBX Segments

The OBX segments can repeat and will contain measurements, a single (noncoded diagnosis) line, the MUSE Enterprise Integration URL, or a specially formatted measurement and diagnosis statement. An ORU message can be configured to include specific measurement segments and various combinations of the URL and diagnosis segments.

Below are examples of each type of OBX segment and commonly used combinations of the segments.

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OBX Discrete Measurement Data Segments (1 to n)

Each MUSE data type has a different set of reportable measurements that can be sent in a results ORU message. Using the OBX discrete measurement option, the ORU message can be configured to contain only the specific measurements requested by the EMR/HIS. Discrete OBX measurements are frequently sent along with the Non-coded, single-line diagnosis OBX segment (described below). See tables in "OBX

Observation Code Tables" on page 126 for available measurement elements and

their corresponding codes for each MUSE test type. NOTE:

The OBX descriptions below do not all apply to studies acquired to MUSE via the eDoc Connect module. Consult with your GE HL7 engineer regarding which measurement and diagnosis components may be available from the imported eDoc studies at your facility.

Sample OBX segments with discrete measurements from a 12 Lead ECG:

OBX|1|ST|552^Ventricular Rate||140|BPM||||F OBX|2|ST|553^Atrial Rate||140|BPM||||F OBX|3|ST|554^P-R Interval||120|ms||||F OBX|4|ST|555^QRS Duration||92|ms||||F OBX|5|ST|556^Q-T Interval||272|ms||||F OBX|6|ST|557^QTC Calculation(Bezet)||415|ms||||F OBX|7|ST|558^P Axis||73|degrees||||F OBX|8|ST|559^R Axis||66|degrees||||F OBX|9|ST|560^T Axis||55|degrees||||F

OBX Non-coded Diagnosis Segment

MUSE study diagnosis and interpretations are entered on MUSE studies as individual statements, groupings of statements, or as free text. Statements from the MUSE statement library are entered singularly or in groups on individual lines in the interpretation and diagnosis window in the MUSE application. These individual lines can be sent from the MUSE application in a single OBX segment with each line separated by the message repetition separator, or as individual OBX segments.

The single line and multi-line diagnosis statements are commonly used with a selection of measurement OBX segments.

Sample single-line OBX interpretation and diagnosis statement: OBX|11|TX|208.0^Diagnosis||Sinus tachycardia~Acute pericarditis~Nonspecific T

wave abnormality~Abnormal ECG~Confirmed by Wenzel, Mark A. (201) on 6/29/2010 10:28:30 AM|||||F

Sample multi-line OBX interpretation and diagnosis statement:

OBX|12|TX|208.1^Diagnosis||Sinus tachycardia|||||F OBX|13|TX|208.1^Diagnosis||Acute pericarditis|||||F OBX|14|TX|208.1^Diagnosis||Nonspecific T wave abnormality|||||F OBX|15|TX|208.1^Diagnosis||Abnormal ECG|||||F OBX|16|TX|208.1^Diagnosis|Confirmed by MuseAdmin, MuseAdmin (20001) on 6/21/2006 10:28:30 AM|||||F

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OBX Measurement and Diagnosis Segment (1)

Another option for Measurement and Diagnosis reporting is to use the pre-configured single OBX segment. This segment includes a pre-defined set of measurements and the interpretation diagnosis statements in a single minimally formatted field. This option also uses repeating fields in OBX-5 using the message repetition separator to create line breaks.

Sample combined Measurement and diagnosis segment: OBX|1|FT|ECGMEASANDDIAG^||Test Reason : Chest Pain ~Blood Pressure : 120/085

mmHG~Vent. Rate : 140 BPM Atrial Rate : 140 BPM~ P-R Int : 120 ms QRS Dur : 092 ms~ QT Int : 272 ms P-R-T Axes : 073 066 055 degrees~ QTc Int : 415 ms~~Sinus tachycardia~Acute pericarditis~Nonspecific T wave abnormality~Abnormal ECG~ Confirmed by Wenzel, Mark A. (201) on 6/29/2010 10:28:30 AM~~Referred By: Holman, Robert G. Overread By: Wenzel, Mark A.||||||F

When an ECG result is displayed in an EMR in fixed width or monospaced font, the Measurement and Diagnosis data will display similarly to the layout of the data on the actual ECG from the GE Healthcare ECG acquisition device as shown below:

OBX URL Segment (1)

A URL compatible with the MUSE Enterprise Integration application can also be sent in an OBX segment. This URL can then be stored with the study data in the EMR and launched from compatible EMRs to show the study image in PDF format. A webbased MUSE Enterprise Integration application is required to view the image launched with the URL. Contact your EMR vendor for information.

Sample OBX segment with URL: OBX|10|RP|MUSEWebURL^||http://MUSETEST/musescripts/museweb.dll

%3FRetrieveTestByDateTime%3FPatientID=0002749255%26Date=28-06

-2010%26Time=15%3a32%3a03%3a255%26TestType=ECG%26Site

=1%26OutputType=PDF%26Ext=PDF||||||F

OBX Coded Diagnosis Segments and Data Points (1 to n)

OBX segments that contain Diagnosis statements, MUSE statement library codes, and waveform data points can be sent in the ORU message. These formats are not

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commonly used. A MUSE HL7 integration engineer can explain the formats and use of these OBX segments.

Embedded Image Option

If the HL7 embedded waveform option is purchased, the MUSE ORU message will be configured to contain an encoded image of the ECG report or selected pages from a Stress or Holter study. The image data is converted to an ASCII format that is compatible with HL7 and can be passed through the MUSE interface. The image can be passed in the HL7 message encoded in either UUencoding or Base64 encoding.

UUencoded Encoding

UUencoded images are sent in the ORU message in a Z segment. In addition, all datatypes except postscript are encrypted. The receiving system must decrypt and decode the waveform image component of the message to return the data to an image file that can be saved in the EMR.

Sample Z-segment (PDF option): ZPD|1|PDF|89448^73272^ begin 644 WAV.DAT\X0D\\X0A\

HL7 Outbound Implementation

M) 5!$1BTQ+C`*)>+C….. See "Encoding and Encryption" on page 134 for more information on ZRI waveform

encryption and encoding.

Base64 Encoding

Base64 encoded images can be sent in the ORU message in a Z segment or in an OBX segment. Base64 encoded images are not encrypted.

Sample Z-segment with Base64 image in ZPD-3.5: ZPD|1|PDF||^^7288^^JVBERi0xLjAKJeLjz9PoCiAgNSAw...|||||F Sample OBX with Base64 image in OBX-5.5:

OBX|11|ED|CARDLRR||^^PDF^Base64^JVBERi0xLjAKJeLjz9PoCiAgNSA....|||||F

Study Financial Message Composition

If a financial interface is purchased, the MUSE HL7 outbound interface is configured to send financial transactions from the MUSE system. Financial transactions are sent real-time or as batches as configured by the report distribution and batch settings in the MUSE system.

Financial (DFT) messages may contain the following message segments. See "HL7

Data Segment Definitions" on page 49 for segment definitions.

MSH – Message Header PID – Patient identification PV1 – Patient visit [OBR] – Observation request FT1 – Financial Transaction

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Batch Data Transfer

Individual result or financial files are generated as described in "Transactions From

the MUSE HL7 Interface" on page 32. Outbound Batch files can be set up as an

addition to the standard outgoing HL7 interface. You can configure batches to be sent once per day, twice per day, weekly, or monthly. At the preconfigured times, a batch message is created by gathering individual messages into a single file that is then sent to the HIS.

Batch Data Transfer Messages

Batch Data Transfer is an addition to the GE HL7 Outbound Interfaces. Batch Data Transfer can be used for either result or Financial messages. The Batch Data Transfer option includes a management tool for the batch file queue and batch file log entries in the MUSE application.

At the times configured in the MUSE Batch scheduler, the batch file is created by gathering the individual messages into batches and then into a single message file. The format of the Batch message is configurable in the MUSE application.Each Result format type or Billing format type will be sent in its own batch file.The GE HL7 Interface supports multiple BHS/BTS segment sets in a single batch file.

High level acknowledgment messages can be supported by the GE HL7 Interface for batch messages, but an acknowledgment for each individual message contained within the batch message is not supported

The batch files are maintained on the GE Healthcare system from 1 to 365 days and may be resent if needed during that time. The length of time the files are maintained is configurable.

A batch message has a batch block consisting of File Header, File Trailer, Batch Header, and Batch Trailer segments. Within the batch block we have Results ORU messages for Batch Results or Billing (DFT) messages for Batch Billing message.

Batch Results Message Structure

FHS BHS ORU Message 1 ORU Message 2 . . . BTS FTS

Batch Billing Message Structure

FHS

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BHS DFT Message 1 DFT Message 2 . . . BTS FTS

Segment Definition

FHS File Header Segment

HL7 Outbound Implementation

SEQ Optional/

Required

1 O File Field Separator 1 |

2 O File Encoding Characters 4 ^~\&

3 O File Sending Application 15 MUSE Batch

4 O File Sending Facility 20 MUSE

5 O File Receiving Application 15 CCG

6 O File Receiving Facility 20 CCG

7 O File Creation Date/Time 26

8 O File Security 40

9 O Filename/ID 20

10 O File Header Comment 80

11 O File Control ID 20

12 O Reference File Control ID 20

ELEMENT NAME MUSE Field

Length

MUSE Equivalent

FTS—File Trailer Segment

SEQ Optional/

Required

1 O File Batch Count 10

2 O File Trailer Comment 80

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ELEMENT NAME MUSE Field

Length

MUSE Equivalent

Page 40

HL7 Outbound Implementation

BHS—Batch Header Segment

SEQ Optional/

Required

1 O Batch Field Separator 1 |

2 O Batch Encoding

3 O Batch Sending Application 15 MUSE Batch

4 O Batch Sending Facility 20

5 O Batch Receiving

6 O Batch Receiving Facility 20

7 O Batch Creation Date/Time 26

8 O Batch Security 40

9 O Batch Name ID/Type 20

10 O Batch Comment 80

11 O Batch Control ID 20

12 O Reference Batch ControlID20

ELEMENT NAME MUSE Field

Length

4 ^~\&

Characters

15 CCG

Application

MUSE Equivalent

BTS—Batch Trailer Segment

SEQ Optional/

1 O Batch Message Count 10

2 O Batch Comment 80

3 O Batch Totals 100

PDF to File Share

An alternative method of result outbound transmission from the MUSE system is to create a PDF of the test with a custom file name and write the PDF to a network share. The MUSE CCG renames the PDF with a customer-specified format and sends the PDF to a share where the EMR can pick it up and process it.

This method is sometimes referred to as a COLD feed.

Required

ELEMENT NAME MUSE Field

Length

MUSE Equivalent

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HL7 Query Implementation

About Query Implementation

The HL7 Standard Interface is used to connect a hospital's information system (HIS) to the MUSE HL7 Interface to exchange data. The MUSE HL7 Interface supports querying for patient demographics by patient ID. The response message (inbound data) is processed in real-time. This gives MUSE the ability to ensure that it has upto-date patient demographics when interacting with a system that does not provide unsolicited HL7 updates.

HL7 Query Implementation

The MUSE system can be configured to trigger a demographics query based on certain user or system actions.

The MUSE HL7 Interface can be configured to query a HIS through the Standard HL7 Interface, or it can be configured to query data provided by a web service (this is a common approach in MPI interactions).

Low-level Communications

The HL7 interface assumes that the low-level communication protocol ensures that the data arrives error-free. Data integrity is not checked at the application level. The MUSE HL7 interface allows only TCP/IP socket communication for HL7 queries.

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Interface Data Content

There are only two HL7 message types involved in the MUSE-supported demographics query (Q01 - the query message, and A19 - the response message). Certain data fields within the HL7 segments for the outgoing and incoming messages may need to be mapped. The MUSE HL7 Interface configuration program (CCG) defines the mapping.

The following section, Query Transactions of the MUSE HL7 Interface, provides the general format of the Q01 query, the A19 response, and the L7 data messages for the demographics query.

Query Transactions of the MUSE HL7 Interface

The MUSE system manages and stores patient studies and related patient demographics associated with them. In some situations, patient demographics are not sent by a HIS, but the HIS supports being queried for them. In these cases, the MUSE HL7 Interface can be configured to query the HIS for patient demographics by patient ID. Patient demographic queries can be initiated manually by a user, and/or can be configured to take place automatically. Queries may be configured to execute automatically in the following cases:

• A study is normalized (acquired).

• A study is opened in the MUSE Editor.

• On an ancillary device's or system's demographics request.

Once the messages enter the MUSE system, a task parses the message data and creates or alters entries in the MUSE database.

Query Transaction HL7 Messages

Q01 - Immediate response query and A19 - ADT Response are two HL7 messages used in the patient demographics query.

Q01 - Immediate Response Query

This message is generated by the MUSE system. It contains the patient ID for which demographics are requested.

It consists of the following data segments:

• MSH - Message header

• QRD - Query definition

• QRF - Query filter

Figure 1: Example HL7 Query Message (Q01)

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A19 - ADT Response

This message is generated by the HIS. It contains the requested demographics. It consists of the following data segments:

• MSH - Message header

• QRD - Query definition

• EVN - Event type

• PID - Patient identification

• PV1 - Patient visit

NOTE:

Depending on the configuration of the HIS, it may require a different HL7 query message, and respond with a different HL7 response message. In this case, the required data segments can be mapped using tables in the MUSE HL7 Interface.

HL7 Query Implementation

Figure 2: Example HL7 Response Message (A19)

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System Data Field Definitions

ADT Fields

Table 7: MUSE System ADT Fields — Patient Demographic Information

Type Description Length

Patient ID Patient Identifier, unique

alphanumeric value

Last, First name Patient last and first name 40, 20

Alternate PID Alternate Patient Identifier, 16

Date of birth Patient date of birth 16

Sex Patient gender, mapped from

HIS ADT or ORM message

Race Patient race, mapped from HIS

ADT or ORM message

Height Patient height n/a

Weight Patient weight n/a

Kanji name Alternate patient identifier 64

Prior alternate ID Prior alternate patient identifier 16

Mailing address line 1 Mailing Address 32

Mailing address line 2 Mailing Address 32

City City 32

State State 32

Postal code postal/zip code 32

Country Country 32

Phone number 1 Patient’s first phone number 32

44 MUSE™ NX 2102027-227A

Page 45

Type Description Length

Phone number 2 Patient’s second phone number 32

System Data Field Definitions

Extra data 1 Additional textual information

field

Extra data 2 Additional textual information

field

Extra data 3 Additional textual information

field

Extra data 4 Additional textual information

field

Table 8: MUSE System ADT Fields — VISIT - Patient Visit Information

Type Description Length

Account number Account number 20

Patient location Patient location 20

Room Patient room identifier 32

Bed Patient bed identifier (number) 12

HIS Disposition HIS patient disposition 19

Admission type Admission type (ER, Accident,

L&D, Routine)

Alternate Location Alternate patient location 20

Attending MD name Name of attending physician 40, 20

Attending MD HIS ID HIS ID of attending physician 32

Admitting MD name Name of admitting physician 40, 20

Admitting MD HIS ID HIS ID of admitting physician 32

Referring MD name Name of referring physician 40, 20

Referring MD HIS ID HIS ID of referring physician 32

Consulting MD name Name of consulting physician 40, 20

Consulting MD HIS ID HIS ID of consulting physician 32

Primary Care Provider name Name of primary care provider 40, 20

Primary Care Provider HIS ID HIS ID of primary care provider 32

Primary Diagnosis Primary patient diagnosis 32

Secondary Diagnosis Secondary patient diagnosis 32

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System Data Field Definitions

Type Description Length

Tertiary Diagnosis Tertiary patient diagnosis 32

Admit Diagnosis Patient admit diagnosis 80

Admission Date/Time Admission Date/Time n/a

Hospital Service Hospital Service expected for

this visit

Admission source Source of patient admission 32

Ambulatory status Ambulatory status of patient 64

Alternate Visit Number Alternate visit number 20

Visit number Visit/encounter number 20

Discharge disposition Discharge disposition

(discharged to home, expired)

Service facility Facility where service is being

performed

Discharge Date/Time Date of patient discharge date/time

Extra data 1 Additional textual information

field

Extra data 2 Additional textual information

field

Extra data 3 Additional textual information

field

Extra data 4 Additional textual information

field

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Order Fields

Table 9: MUSE System Order Fields — Information for an order for a study occurrence

Type Description Length

Placers order number HIS-generated order number 22

System Data Field Definitions

NOTE:

Some older GE Healthcare acquisition devices accept a maximum of nine characters. If you will upload orders to acquisition devices, consult with integration engineers to manage nine-character order numbers.

Start date/time Time the order is scheduled for

the study to be performed

Filler’s Order Number Filler’s Order Number 22

Priority Scheduled priority for order

(STAT, Routine,…)

Parent order number Parent Order Number 22

Order placed date/time Date and time the order was

placed on the HIS system

Placed by name Name of person who placed

order

Placed by HIS ID HIS System ID of person who

placed the order

Ordering MD name Ordering physician first and last

name

Ordering MD HIS ID HIS System ID of ordering

physician, alphanumeric value

HIS test type Universal service indicator code

or billing code

n/a

40, 20

HIS test type text Textual description of study 64

Test reason Reason for Test (textual) 80

Comments Ordering Comments (textual) 80

Danger Code Danger Code n/a

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System Data Field Definitions

Type Description Length

Extra Data Field 1 Additional textual information

field

Extra Data Field 2 Additional textual information

field

Extra Data Field 3 Additional textual information

field

Extra Data Field 4 Additional textual information

field

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HL7 Data Segment Definitions

The following tables provide definitions for the various HL7 data segments supported by the MUSE HL7 interface. Each segment is provided in a separate table that describes the fields supported by the MUSE system, including the field length and optionality. The tables display the default locations for the data in a MUSE message. The MUSE HL7 engineer works with the customer to determine if they need to re-map any data field for proper message processing.

HL7 Data Segment Definitions

NOTE:

The field lengths are the maximum lengths the MUSE system supports, not the maximum length by the HL7 definitions.

Inbound (to MUSE) Segments

Table 10: Explanation of Table Headings — Inbound

Table Heading Description

HL7 Seq This indicates the sequence numbers that can be included as part of the message.

Item # The HL7 standard item identifier.

MUSE Field Length

Supported Y/N Yes if the default MUSE interface configuration supports this field.

Required Y/C/N Y if the field is required. C if the field is conditionally required. N if the field is

HL7 Element Name

This is the maximum length of the field within the MUSE application. This length does not include HL7 delimiters.

optional

This is the specific HL7 field referenced by the segment and sequence number.

MUSE Equivalent

TT This is a Y/N indicator specifying if this field requires a translation table.

Notes This space is provided for adding notes.

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This indicates the field in the MUSE application that corresponds to the HL7 field. Not applicable indicates that the field does not have a corresponding field within the MUSE application.

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HL7 Data Segment Definitions

Table 11: Message Header Segment (MSH) Definitions

HL7

Item#MUSE

Seq

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

1 00001 1 Y Y Field

Separator

2 00002 4 Y Y Encoding

Characters

3 00003 15 Y N Sending

Application

4 00004 20 Y N Sending

Facility

5 00005 15 Y N Receiving

Application

6 00006 20 Y Y Receiving

Facility

7 00007 26 Y N Date/

Time of Message

9 00009 15 Y Y Message

Type

Not Applicable

MUSE Site Y

Not Applicable

N The Sending Application

field value is dependent on the message originator.

N The Receiving

Application Field value is dependent on the message originator.

10 00010 20 Y Y Message

control ID

11 00011 3 Y Y ProcessingIDNot

12 00012 60 Y Y Version ID Not

50 MUSE™ NX 2102027-227A

Not Applicable

Applicable

N The format of the

Message Control ID

is determined by the originating application. The receiving system must be able to accept transactions regardless of the format of this field, and must return the Control ID in its original format. This field is not required when high level acknowledgments are not used.

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Table 12: Message Acknowledgment Segment (MSA) Definitions

HL7 Seq

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

HL7 Data Segment Definitions

1 00002 2 Y Y Acknowl-

edgment Code

2 00003 26 Y Y Message

Control ID

3 00004 80 Y N Text

Message

Not Applicable

Table 13: Event Type Segment (EVN) Definitions

HL7

Item#MUSE

Seq

1 00099 3 Y Y (see

Field Length

Supported Required HL7

Element Name

Event Type

note)

Code

MUSE Equivalent

Not Applicable

Table 14: Patient Identification Segment (PID) Definitions

HL7 Seq.

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

N The message control ID

for the acknowledgment will match the control ID of the message being acknowledged.

TT Notes

N Required for ADT

messages only.

TT Notes

1 00104 4 Y Y Set ID-PID Not

Applicable

3 00106 16 Y Y Patient

Identifier List

4 00107 16 Y N Secondary

Patient IDPID

5.1 00108 40 Y N Patient Last Name

5.2 00108 20 Y N Patient First Name

7 00110 26 Y N Date/Time

of Birth

8 00111 16 Y N Sex Sex Y

2102027-227A MUSE™ NX 51

Patient ID N

SecondaryIDN

Last Name

First Name

Date of Birth

N Time value will be

disregarded by the MUSE system.

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HL7 Data Segment Definitions

HL7

Item#MUSE

Seq.

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

9 00112 64 Y N Patient

Alias

10 00113 16 Y N Race Race Y

11.1 00114 32 Y N Patient Address Line

11.2 00114 32 Y N Patient Address Line

11.3 00114 32 Y N City City N

11.4 00114 32 Y N State State N

11.5 00114 32 Y N Postal Code

11.6 00114 32 Y N Country Code

13 00116 32 Y N Phone

Number – Home

14 00117 32 Y N Phone

Number Business

Kanji Name

Mailing Address

Postal Code

Country N

Phone Number 1

Phone Number 2

18 00121 20 Y N Patient

Account Number

19 00122 16 Y N SSN-

Patient

Account Number

Not Applicable

N SSN is stored in the ADT

database but is not displayed in the MUSE system.

Table 15: Patient Visit Segment (PV1) Definitions

HL7

Item#MUSE

Seq.

1 00131 4 Y Y Set ID-PV1 Not

2 00132 16 Y N Patient

52 MUSE™ NX 2102027-227A

Supported Required HL7 Field Length

Element Name

Class

MUSE Equivalent

Applicable

Patient Class

TT Notes

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HL7 Seq.

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

HL7 Data Segment Definitions

TT Notes

3.1 00133 20 Y N Assigned Patient Location — Point of Care

3.2 00133 20 Y N Room Room N

3.3 00133 16 Y N Bed Bed N

4 00134 4 Y N Admission

Type

7.1 00137 32 Y N Attending Doctor

7.2 00137 40 Y N Attending Doctor

7.3 00137 20 Y N Attending Doctor

8.1 00138 32 Y N Referring Doctor

8.2 00138 40 Y N Referring Doctor

HIS Location

Admission Type

Attending MD HIS ID

Attending MD Name Last

Attending MD Name First

Referring MD HIS ID

Referring MD Name Last

Y This value is mapped to

the MUSE Location in the MUSE system.

8.3 00138 20 Y N Referring Doctor

9.1 00139 32 Y N Consulting Doctor

9.2 00139 40 Y N Consulting Doctor

9.3 00139 20 Y N Consulting Doctor

10 00140 19 Y N Hospital

Service

14 00144 3 Y N Admit

Source

15 00145 2 Y N Ambulatory

Status

2102027-227A MUSE™ NX 53

Referring MD Name First

Consulting MD HIS ID

Consulting MD Name Last

Consulting MD Name First

Hospital Service

Admit Source

Ambulatory Status

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HL7 Data Segment Definitions

HL7

Item#MUSE

Seq.

Supported Required HL7 Field Length

Element Name

MUSE Equivalent

TT Notes

17.1 00147 32 Y N Admitting Doctor

17.2 00147 40 Y N Admitting Doctor

17.3 00147 20 Y N Admitting Doctor

19 00149 20 Y Y Visit

Number

36 00166 3 Y N Discharge

Disposition

39 00169 2 Y N Servicing

Facility

44 00174 26 Y N Admit

Date/Time

45 00175 26 Y N Discharge

Date/Time

Admitting MD HIS ID

Admitting MD Name Last

Admitting MD Name First

Visit Number

Discharge Disposition

Servicing Facility

Admit Date

Discharge Date

N For Customer Facilities

that don't have or use Visit Numbers, the MUSE system can use the Account number (from PID-18) for this field.

50 00180 20 Y N Alternate

Visit Number

52.1 01274 32 Y N Other Healthcare Provider

52.2 01274 40 Y N Other Healthcare Provider

52.3 01274 20 Y N Other Healthcare Provider

54 MUSE™ NX 2102027-227A

Not Applicable

Primary Care MD HIS ID

Primary Care MD Name Last

Primary Care MD Name First

N This value is not

displayed in the MUSE application.

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Table 16: Merge Patient Information Segment (MRG) Definitions

HL7 Seq

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

HL7 Data Segment Definitions

1 00211 16 Y C Prior

Patient Identifier List

3 00231 20 Y C Prior

Patient Account Number

5 01279 20 Y C Prior Visit

Number

Prior ID N Required for A18, A34,

Not Applicable

Table 17: Common Order Segment (ORC) Definitions

HL7

Item#MUSE

Seq

1 00215 2 Y Y Order

2 00216 22 Y Y Placer

3 00217 22 Y N Filler Order

Field Length

Supported Required HL7

Element Name

Control

Order Number

Number

MUSE Equivalent

Not Applicable

Placer's Order Number

Filler's Order Number

and A36 message types.

N Required for A35

messages.

N Required for A36, A42,

A46 message types.

TT Notes

7.4 00221 26 Y N Quantity/

Timing

- Start Date/Time

7.6 00221 22 Y N Quantity/

Timing Priority

8 00222 22 Y N Parent Parent

9 00223 26 Y N Date/

Time of Transaction

10.1 00224 32 Y N Entered

By - ID number

2102027-227A MUSE™ NX 55

Start Date/ Time

Priority Y

Order Number

Order Placed Time

Placed By

- HIS ID

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HL7 Data Segment Definitions

HL7

Item#MUSE

Seq

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

10.2 00224 40 Y N Entered By

- Family Name

10.3 00224 20 Y N Entered

By –Given Name

12.1 00226 32 Y N Ordering

Provider ID Number

12.2 00226 40 Y N Ordering

Provider – Family Name

12.3 00226 20 Y N Ordering

Provider – Given Name

Placed By - last name

Placed By –first name

Ordering Provider — HIS ID

Ordering Provider – Last Name

Ordering Provider – First Name

Table 18: Observation Request Segment (OBR) Definitions (Inbound)

HL7 Seq

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

TT Notes

1 00237 4 Y Y Set ID —

OBR

4.1 00238 32 Y Y Universal

Service ID — Identifier

4.2 00238 32 Y N Universal

Service ID – Text

12 00246 64 Y N Danger

Code

31.2 00263 80 Y N Reason for

Study

56 MUSE™ NX 2102027-227A

Not Applicable

HIS Test Type

HIS Test Type Text

Not Applicable

Test Reason

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Table 19: Note Segment (NTE) Definitions

HL7 Seq

Item#MUSE

Field Length

Supported Required HL7

Element Name

MUSE Equivalent

HL7 Data Segment Definitions

TT Notes

1 00096 4 Y Y Set – ID

NTE

3 00098 80 Y N Comment Order

Not Applicable

Comments

Table 20: Observation Result Segment (OBX) Definitions

HL7

Item#MUSE

Seq

1 00569 4 Y Y Set ID –

5.1 00573 10 Y N Observation

Supported Required Element Field Length

name

OBX

Value

MUSE Equivalent

Not Applicable

SegID = 1, Height Value in Inches SegID = 2, Weight Value in lbs

TT Notes

N Segment Repetition

1 contains the patient

height. Segment Repetition 2 contains the patient weight.

5.2 00573 10 Y N Observation Value

SegID 1, Height Value in cm SegID = 2, Weight Value in kg

Table 21: Diagnosis Segment (DG1) Definitions

HL7

Item#MUSE

Seq

1 00375 4 Y Y Set ID –

2102027-227A MUSE™ NX 57

Supported Required Element field length

name

DG1

MUSE Equivalent

Not Applicable

TT Notes

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HL7 Data Segment Definitions

HL7

Item#MUSE

Seq

Supported Required Element field length

name

MUSE Equivalent

TT Notes

3 00377 32 Y N Diagnosis

Code – DG1

4 00378 80 Y N Diagnosis

Description

Outbound (from MUSE) Segments

Table 22: Explanation of Table Headings — Outbound

Table Heading Description

HL7 Seq This indicates the sequence numbers that can be included as part of the message.

Primary Diagnosis Secondary Diagnosis Tertiary Diagnosis (see note)

Admitting Diagnosis

N As DG1 can be a

repeating group, DG1-3.1 can be used for multiple diagnoses. The MUSE system accepts up to 3 repeats and places the values in DG1-3.1 in to the Primary (first repeat), Secondary (second repeat), and Tertiary (third repeat) Diagnosis fields in the MUSE. system.

N From the first repetition of

the DG1 segment.

Item # The HL7 standard item identifier

MUSE Field Length

Present A/C A (Always) indicates fields that are populated for any MUSE OB message. C

HL7 Element Name

MUSE Equivalent

Notes This space is provided for adding notes.

This is the maximum length of the field within the MUSE application. This length does not include HL7 delimiters.

(Conditional) indicates a field that may be populated depending on the study status, and/or study administrative or clinical completeness.

This is the specific HL7 field referenced by the segment and sequence number.

This indicates the field in the MUSE application that corresponds to the HL7 field. Not applicable indicates that the field does not have a corresponding field within the MUSE application.

Table 23: Message Segment (MSH) Definitions

HL7

Item # MUSE

Seq

1 00001 1 Y Field

field length

Present A/C

HL7 Element name

Separator

MUSE Equivalent

Notes

58 MUSE™ NX 2102027-227A

Page 59

HL7 Seq

Item # MUSE

field length

Present A/C

HL7 Element name

MUSE Equivalent

HL7 Data Segment Definitions

Notes

2 00002 4 Y Encoding

Characters

3 00003 15 Y Sending

Application

4 00004 20 Y Sending

Facility

5 00005 15 Y Receiving

Application

6 00006 20 Y Receiving

Facility

7 00007 26 Y Date/Time Of

Message

9 00009 15 Y Message Type ORU

10 00010 20 Y Message

Control ID

^~|&

MEI MUSE

HIS System

CCG

messages will send ORU^R01 DFT messages will send DFT^P03

date/time stamp

CCYYMM DDHH MMSS

11 00011 3 Y Processing ID P

12 00012 60 Y Version ID 2.4

Table 24: Patient ID (PID) Segment Definitions (ORU and DFT)

HL7

Item # MUSE

Seq

1 00104 4 A Set ID - PID Not

3 00106 16 A Patient

4 00107 16 C Secondary

2102027-227A MUSE™ NX 59

field length

Present A/C

HL7 Element name

Identifier List

Patient ID PID

MUSE Equivalent

Applicable

Patient ID

SecondaryIDPresent if entered by user or sent

Notes

to the MUSE system in the ADT registration message.

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HL7 Data Segment Definitions

HL7

Item # MUSE

Seq

field length

Present A/C

HL7 Element name

MUSE Equivalent

Notes

5.1 00108 40 C Patient Last Name

5.2 00108 20 C Patient First Name

7 00110 26 C Date/Time of

Birth

8 00111 16 C Sex Sex Present if entered by user or sent

9 00112 64 C Patient Alias Kanji Name Present if sent in the ADT

10 00113 16 C Race Race Present if entered by user or sent

11.1 00114 32 C Patient Address Line 1

11.2 00114 32 C Patient Address Line 2

Last Name Present if entered by user or sent

to the MUSE system in the ADT registration message.

First Name Present if entered by user or sent

to the MUSE system in the ADT registration message.

Date of Birth Present if entered by user or sent

to the MUSE system in the ADT registration message.

to the MUSE system in an ADT registration message.

registration message.

to the MUSE system in the ADT registration message.

Mailing Address

Present if sent in the ADT registration message.

11.3 00114 32 C City City Present if sent in the ADT

registration message.

11.4 00114 32 C State State Present if sent in the ADT

registration message.

11.5 00114 32 C Postal Code Postal Code Present if sent in the ADT

registration message.

11.6 00114 32 C Country Code Country Present if sent in the ADT

registration message.

13 00116 32 C Phone

Number Home

14 00117 32 C Phone

Number Business

18 00121 20 C Patient

Account Number

19 00122 16 C SSN Number -

Patient

60 MUSE™ NX 2102027-227A

Phone Number 1

Phone Number 2

Account Number

Not Applicable

Present if sent in the ADT registration message.

Page 61

HL7 Data Segment Definitions

Table 25: Patient Visit Segment (PV1) Descriptions (ORU and DFT)

HL7

Item # MUSE

Seq

1 00131 4 A Set ID - PV1 Not

2 00132 16 C Patient Class Patient Class Present if sent in the ADT

field length

Present A/C

HL7 Element name

MUSE Equivalent

Applicable

Notes

registration message.

3.1 00133 20 A Assigned Patient Location point of care

3.2 00133 20 C Assigned Patient Location Room

3.3 00133 16 C Assigned Patient Location - Bed

3.4 00133 8 A Assigned Patient Location Facility

3.7 00133 16 C Assigned Patient Location Building

3.8 00133 4 A Assigned Patient Location Floor

MUSE Location Name

Room Present if entered by user or sent

to the MUSE system in the ADT registration message.

Bed Present if entered by user or sent

to the MUSE system in the ADT registration message.

MUSE Site

HIS Location Present if sent in the ADT

registration message.

MUSE Location ID

4 00134 4 C Admission

Type

7.1 00137 32 C Attending Doctor

7.2 00137 40 C Attending Doctor

7.3 00137 20 C Attending Doctor

8.1 00138 32 C Referring Doctor

2102027-227A MUSE™ NX 61

Admission Type

Attending MD HIS ID

Attending MD Name Last

Attending MD Name First

Referring MD HIS ID

Present if sent in the ADT registration message.

Present if entered by user or sent to the MUSE system in the ADT registration message.

Page 62

HL7 Data Segment Definitions

HL7

Item # MUSE

Seq

field length

Present A/C

HL7 Element name

MUSE Equivalent

Notes

8.2 00138 40 C Referring Doctor

8.3 00138 20 C Referring Doctor

9.1 00139 32 C Consulting Doctor

9.2 00139 40 C Consulting Doctor

9.3 00139 20 C Consulting Doctor

10 00140 19 C Hospital

Service

14 00144 3 C Admit Source Admit

15 00145 2 C Ambulatory

Status

Referring MD Name Last

Referring MD Name First

Consulting MD HIS ID

Consulting MD Name Last

Consulting MD Name First

Hospital Service

Source

Ambulatory Status

Present if entered by user or sent to the MUSE system in the ADT registration message.

Present if sent in the ADT registration message.

17.1 00147 32 C Admitting Doctor

17.2 00147 40 C Admitting Doctor

17.3 00147 20 C Admitting Doctor

19 00149 20 C Visit Number Visit Number Present if entered by user or sent

36 00166 3 C Discharge

Disposition

39 00169 16 C Servicing

Facility

44 00174 26 C Admit Date/

Time

45 00175 26 C Discharge

Date/Time

Admitting MD HIS ID

Admitting MD Name Last

Admitting MD Name First

Discharge Disposition

Service Facility

Admit Date Present if sent in the ADT

Discharge Date

Present if sent in the ADT registration message.

to the MUSE system in the ADT registration message.

Present if sent in the ADT registration message.

registration message.

Present if sent in the ADT registration message.

62 MUSE™ NX 2102027-227A

Page 63

HL7 Seq

Item # MUSE

field length

Present A/C

HL7 Element name

MUSE Equivalent

HL7 Data Segment Definitions

Notes

50 00180 20 C Alternate Visit

Number

52.1 01274 32 C Other Healthcare Provider

52.2 01274 40 C Other Healthcare Provider

52.3 01274 20 C Other Healthcare Provider

Not Applicable

Primary Care MD HIS ID

Primary Care MD Last Name

Primary Care MD First Name

Present if sent in the ADT registration message.

Table 26: Observation Request Segment (OBR) Definitions

HL7

Item # MUSE

Seq

1 00237 4 A Set ID Not

2 00216 22 C Placer Order

field length

Present A/C

HL7 Element name

Number

MUSE Equivalent

Applicable

Placer's Order Number

Notes

Present if entered by user or sent to the MUSE system in the ORM Order message.

3 00217 22 C Filler Order

Number +

4.1 00238 32 C Universal Service ID Identifier

4.2 00238 32 C Universal Service ID Text

4.5 00238 12 A Universal Service ID Alternate Text

6 00240 26 A Requested

Date/Time

7.1 00241 26 A Observation Date/Time #

7.2 00241 26 A Observation Date/Time #

2102027-227A MUSE™ NX 63

Filler's Order Number

HIS Test Type Present if sent to the MUSE

HIS Test Type Text

MUSE Test Name

Current Date/Time

Test Date/ Time

Test Time Study Time is in Web format.

Present if sent to the MUSE system in the ORM Order message.

system in the ORM Order message.

Present if sent to the MUSE system in the ORM Order message.

The date/time the study was performed.

Page 64

HL7 Data Segment Definitions

HL7

Item # MUSE

Seq

field length

Present A/C

HL7 Element name

MUSE Equivalent

Notes

10 00244 32 C Collector

Identifier

13.1 00247 12 A Relevant Clinical Info Text

13.2 00247 10 C Relevant Clinical Info

14 00248 26 C Specimen

Received Date/Time

16.1 00226 32 C Ordering Provider - ID Number

16.2 00226 40 C Ordering Provider Family Name

16.3 00226 20 C Ordering Provider Given Name

20 00253 60 A Filler Field 1 + MUSE Test ID

Medicare ID of Acquisition Tech

User Defined Label

User Defined Text

Edit Date/ Time

Ordering Provider HIS ID

Ordering Provider Last Name

Ordering Provider First Name

Returned if built in MUSE Setup.

If entered by a MUSE user

Present if study was edited.

Present if sent to the MUSE system in the ORM Order message.

22 00255 26 A Results Rpt/

Status Chng Date/Time

25 00258 1 A Result Status MUSE Test

29 00261 22 C Parent Parent Order

31 00263 80 C Reason for

Study

32.1 00264 32 C Principal Result Interpreter

32.2 00264 40 C Principal Result Interpreter

32.3 00264 20 C Principal Result Interpreter

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Current Date/Time

Status

Present if sent to the MUSE

Number

Test Reason Present if entered by user or sent

Overreader Medicare ID

Overreader Last Name

Overreader First Name

system in the ORM Order message.

to the MUSE system in the ORM Order message.

Present if the study was overread and the overreader was assigned a Medicare ID.

Present if the study was overread.

Page 65

HL7 Seq

Item # MUSE

field length

Present A/C

HL7 Element name

MUSE Equivalent

HL7 Data Segment Definitions

Notes

32.11 00264 5 C Principal Result Interpreter

33.1 00265 32 C Assistant Result Interpreter

33.2 00265 40 C Assistant Result Interpreter

33.3 00265 20 C Assistant Result Interpreter

33.11 00265 5 C Assistant Result Interpreter

34.1 00266 32 C Technician Acquisition

34.2 00266 40 C Technician Acquisition

Overreader MUSE User ID

Fellow Medicare ID

Fellow Last Name

Fellow First Name

Fellow MUSE User ID

Tech Medicare ID

Tech Last Name

Present if the study was overread.

Present if study was read by a Fellow and the Fellow was assigned a Medicare ID.

Present if the study was read by a Fellow.

34.3 00266 20 C Technician Acquisition

Tech First Name

34.11 00266 5 C Technician Acquisition

Tech MUSE User ID

35.1 00267 32 C Transcriptionist Editor

Medicare ID

35.2 00267 40 C Transcriptionist Editor Last

Name

35.3 00267 20 C Transcriptionist Editor First

Name

35.11 00267 5 C Transcriptionist Editor MUSE

User ID

36 00268 26 C Scheduled

Date/Time

Order Start Date/Time

Present if study was edited and the editor was assigned a Medicare ID.

Present if the study was edited.

Present if sent to the MUSE system in the ORM Order message.

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HL7 Data Segment Definitions

Table 27: Financial Transaction Segment (FT1) Definitions

Seq HL7

Item Number

1 00355 4 A Set ID

4 00358 26 A Transaction

5 00359 26 A Transaction

6.2 00360 8 A Transaction

7.2 00361 32 C Transaction

8 00362 32 C Transaction

10 00364 4 A Transaction

GE Field Length

Present A/C

Element Name

Date

Posting Date

Type

Code

Description

Quantity

MUSE Equivalent

Test Date/ Time

Current Date/Time

CG The MUSE interface only

HIS Test Type Text

HIS Test Type Present if sent to the MUSE

Notes

supports charge transaction types. Credits are not supported through the interface.

Present if sent to the MUSE system in the ORM Order message.

system in the ORM Order message.

The MUSE interface reports financial information on a studyby-study basis, therefore the quantity field is always one (1).

16.1 00133 20 A Assigned Patient Location Point of Care

16.2 00133 20 C Assigned Patient Location Room

16.3 00133 16 C Assigned Patient Location - Bed

16.4 00133 8 A Assigned Patient Location Facility

16.7 00133 16 C Assigned Patient Location Building

MUSE Location Name

Room Present if entered by the user or

Bed Present if entered by the user or

MUSE Site

HIS Location Present if sent in the ADT

MUSE Location name of where the study was performed.

sent to the MUSE system in the ADT registration message.

registration message.

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HL7 Data Segment Definitions

Seq HL7

Item Number

16.8 00133 4 A Assigned

18 00148 2 C Patient Type Present if sent in the ADT

20.1 00264 32 C Principal

20.2 00264 40 C Principal

20.3 00264 20 C Principal

20.11 00264 5 C Principal

GE Field Length

Present A/C

Element Name

Patient Location Floor

Result Interpreter

MUSE Equivalent

MUSE Location ID

Overreader Medicare ID

Overreader Last Name

Overreader First Name

Overreader MUSE User ID

Notes

MUSE Location ID of where the study was performed.

registration message.

Present if the study was overread and the overreader was assigned a Medicare ID.

Present if the study was overread.

21.1 00226 32 C Ordering Provider - ID number

21.2 00226 40 C Ordering Provider Family Name

21.3 00226 20 C Ordering Provider Given Name

23 00267 22 C Placer Order

Number

24.1 00267 32 C Transcriptionist Editor

24.2 00267 40 C Transcriptionist Editor Last

24.3 00267 20 C Transcriptionist Editor First

24.11 00267 5 C Transcriptionist Editor MUSE

Ordering Provider HIS ID

Ordering Provider Last Name

Ordering Provider First Name

Placer's Order Number

Medicare ID

Name

User ID

Present if sent to the MUSE system in the ORM Order message.

Present if entered by the user or sent to the MUSE system in the ORM Order message.

Present if study was edited and the editor was assigned a Medicare ID.

Present if the study was edited.

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HL7 Data Segment Definitions

Table 28: Observation Result Segment (OBX) Definitions

HL7

Item # MUSE

Seq

1 00569 4 A Set ID –OBX

field length

Present A/C

HL7 Element name

MUSE Equivalent

Notes

2 00570 2 A Value Type ST, RP. CE,

TX, FT

3 00571 80 A Observation

Identifier

5 00573 65536 C Observation

Value

6 00574 60 C Units If Applicable

11 00579 1 A Observ

Results Status

"OBX Observation Code Tables" on page

126.

Measurement, Diagnosis, or Encoded Image Value

MUSE Test Status

Configurable

Repeating Field

Table 29: Waveform Segment (ZRI) Definitions, UUencoded

HL7

Item # MUSE

Seq

1 N/A 4 A Set ID N/A

field length

Present A/C

HL7 Element name

MUSE Equivalent

Notes

2 N/A 3 A N/A Waveform

Description

3.1 N/A 10 A N/A Number of

Encrypted Bytes

3.2 N/A 10 A N/A Number of

Unencrypted Bytes

3.3 N/A N/A A N/A Data

See "Graphical Result Reporting

Messages" on page 21

Total number of bytes in the data field.

Total number of bytes of data once the HL7 escape characters are removed from the data and possibly UUDecoded.

Table 30: Waveform Segment Definitions, Base64 encoded

HL7

Item # MUSE

Seq

1 N/A 3 A N/A Waveform

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field length

Present A/C

HL7 Element name

MUSE Equivalent

Image Type

Notes

See "Graphical Result Reporting

Messages" on page 21

Page 69

HL7

Item # MUSE

Seq

3.3 N/A 16 A N/A Encoded

3.5 N/A N/A A N/A Encoded

11 N/A 1 A N/A Test Status

field length

Present A/C

HL7 Element name

MUSE Equivalent

Waveform String Length

Waveform String

HL7 Data Segment Definitions

Notes

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HIS Data Management

This section describes how to configure MUSE to perform clean-up of old HIS Patient, Visit Account and Order Data. The user can configure number of days to consider for clean up and also schedule the time when this scheduled task can run on MUSE.

Setup

MUSE must be set up to perform clean-up of old HIS data.

1. Go to Setup> Sites> HIS Settings> General.

2. To set the number of days to retain discharged accounts, at Number of days to retain visits after discharge is received , type a number up to 366 days.

3. To define the number of days before completed orders are purged, at Number of days to retain completed Orders, enter the number of days, up to 255.

4. To set how many days you want an order left in the open order list, at Default number of days to retain open Orders after Order date, enter a number, up to 255 days.

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HIS Data Management

5. Select Apply and then OK .

Scheduling HIS Data Maintenance

The HIS Data Management task will clean expired accounts, visits, patients and orders from the temporary HIS tables as configured in the HIS settings configuration. The user can set the time of day that the HIS Data Maintenance will run.

1. Go to Setup> Scheduled Tasks> HIS Data. The General screen opens.

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HIS Data Management

2. Select Schedule Time to start the maintenance process.

3. Select Apply and then OK.

Maintaining the Log and Queue

This option allows the user to set the number of days the HIS Event Log entries can be held in the MUSE system before cleanup.

1. Highlight Scheduled Tasks in the menu tree at the left side of the window.

2. Highlight Log and Queue Maintenance. Right-click and select Properties. The Scheduled Task Property — Logs and Queues window opens.

3. Highlight the HIS Event Log in the menu tree at the left side of the window. Set the Days to Hold.

4. Click Apply, and then OK when finished.

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HIS Data Management

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HL7 Implementation FAQs

ADT Fields and Functions

My HIS system uses ADT function A18 as an Account Number Merge, is this compatible with the MUSE system?

The MUSE system normally maps the A18 transaction to a Patient ID merge. Otherwise, the MUSE system can be configured to ignore the A18 transaction, or if the necessary data is present in the message, change the message to a message type that the MUSE system supports such as an A35. Health Level Seven Version 2.2 and later define new merge transactions that are also supported by the interface that may apply to this functionality. All merge transactions on the MUSE system require the Patient ID at a minimum.

My HIS system uses patient names larger than the MUSE system accepts. The original HIS name must be returned in result and billing messages. Will this work?

The MUSE system supports 40 character last names and 20 character first names. The system will truncate longer names.

At times, we admit patients under an alias that we want to send to the MUSE system. How does this work?

The MUSE interface and MUSE systems do not support a patient alias.

The ADT transactions A20 (patient bed status update), A21 (patient goes on a leave of absence), and A22 (patient returns from leave of absence) are not listed, does the MUSE interface support them?

No. The functions supported by the MUSE system are listed in this manual. If sent, A20, A21, and A22 transactions will error out in the HL7 interface engine. These transaction types should be filtered on the HIS side.

The PR1, GT1, IN1, ACC, and UB1 segments are not listed. Does the MUSE interface support them?

No. The segments supported by the MUSE system are listed in this manual. Depending upon the particular data sent in the PR1, GT1, IN1, ACC, or UB1 segments, the MUSE system may be optionally configured to store the data. This must be determined on a case by case basis. The data may not be viewable by the MUSE system users. The data may not be available to return in result or financial messages. Also, see next FAQ.

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HL7 Implementation FAQs

Our system uses a special Z segment (Z02, ZPV, etc.). Is this accepted by the MUSE system?

Possibly. In general, the MUSE system ignores segments not listed in this manual. However, the MUSE system interface may be optionally configured to map data fields from any segment in the HL7 message to corresponding fields in the MUSE databases. If the special Z segment contains data that can be stored on the MUSE system, it can be used. For example, HL7 does not specify patient height and weight in the standard segments, but it can be sent in a special Z segment. If the MUSE system is configured to recognize the Z segment as patient height and weight, the data will be accepted. Fields mapped like this may not be viewable on the MUSE system and/or may not be available to be returned in result or financial messages.

Our system uses system id and episode identifiers that are required in results. Can you store this information?

No. The MUSE interface does not store the system id and episode.

Does the MUSE system update order information in the studies on the MUSE server?

An ADT interface will update ADT information on the MUSE system; an order interface will update order information on the MUSE system. Order information is updated on a study only until the study is set to Demographics Complete status or higher.

Orders Fields and Functions

Our order messages may contain multiple OBR segments. Can the MUSE system accept it?

No. The MUSE system only processes one procedure per patient per message, i.e. one OBR segment per order message with quantity 1 (one).

We order recurring studies, 1 every day for 5 days at a set time or 1 every hour for 5 hours. How does the MUSE system handle this?

The MUSE system only processes one procedure per patient per message, i.e. one OBR segment per order message with quantity 1 (one). For this example, the HIS system would generate five individual order messages for a single study with the requested date and time for each study.

The PV1 segment is listed as optional. What does that mean?

The MUSE system uses information in the PV1 segment to update ADT and visit database information. When the HIS system is sending order messages only, more information can be gathered if the PV1 segment is sent with the order message. For HIS systems sending both ADT and order messages, the PV1 segment in the order message may be used to update ADT and visit information if configured to do so.

Our order system uses a 25-digit placer order number. Can the MUSE system accept that?

No. The MUSE system accept a maximum of 22 characters for the place order number.

NOTE:

Some ancillary devices accept nine-character order numbers.

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HL7 Implementation FAQs

Our order system uses order number and occurrence number to identify patient studies. Does the MUSE system store this information?

The MUSE system requires a place order number which is a key to the order database (maximum of 22 characters).

Can you create order numbers for studies on the MUSE system?

No. The MUSE system is considered a filler of orders, not a placer.

Does the MUSE order interface use control codes NA, SN, OC, SS for processing orders?

No. The only order control codes applicable to the MUSE system are NW (new order), CA (cancel order), OD (Delete Order), and XO (update order).

Can the MUSE order interface assign order numbers to order requests or create requests for orders?

No. The MUSE system is considered a filler of orders not a placer.

Does the MUSE system send cancel order messages to the HIS?

No. The MUSE system depends on the HIS order system to create, cancel, and change orders. The MUSE system can be configured to allow users to cancel orders locally on the MUSE system, but this does not affect the HIS order system and is not communicated to the HIS system. In general, orders should be canceled on the HIS order system, not on the MUSE system.

Can the MUSE system users edit orders?

No. Order information is only changed by the updates from the HIS order system.

Result and Financial Messages Fields and Functions

Does the Physician ID on the MUSE system match the HIS ID?

Generally the MUSE ID and the HIS ID for physicians are not the same, however the HIS ID can be mapped, or "matched," to a MUSE user in MUSE User setup. The physicians on the MUSE system are given a User ID anywhere in the range from 1 – 65,535. Not all physicians in the HIS system have User IDs on the MUSE system.

We require the Hospital ID for physicians (overreader, referring, ordering), transcriptionists, etc. Does the MUSE system use the Hospital ID?

The MUSE system uses the Medicare ID field in the user list to store Hospital ID or mnemonics that are needed for result and financial messages. This field data is entered and maintained by the customer. The HIS system can maintain a lookup table that correlates the MUSE Information System User ID and the Hospital ID.

Our ADT and Order messages include the physician’s hospital ID. We want this information returned in the results/financial messages.

The Physician ID information sent in the ADT and/or order messages is stored in the database HIS ID field up to 32 characters. When ADT and order information is matched to a study, physician information is stored with the study and can be returned in a results or financial message.

The only allowable status values for our results are pending and draft.

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HL7 Implementation FAQs

The MUSE interface has four standard report statuses, two unconfirmed statuses: Preliminary and Demographics Complete and two confirmed statuses: Final and Corrected/Revised Final. The interface can map the MUSE report status sent in the HL7 message to customer specifications.

Can you send the transaction dollar amount in the financial message?

The MUSE interface does not support transaction dollar amounts.

How does the MUSE system do credits?

The MUSE interface does not send credit messages

What are the options for interfacing waveform image data?

Waveform image data can be sent from the MUSE system to the HIS in an HL7 message. The image can be sent as PDF, TIFF, PostScript, PCL, and Windows Metafile. The image in the HL7 message will either be UUencoded or Base64 encoded and the HIS system will decode and display the graphics.

Do I need a Financial Interface and a Result Interface?

The MUSE HL7 interface option for sending HL7 financial transactions can be purchased. These are sent in real time or in batches. Some HIS systems may be able to generate charges based on the result transactions, and would therefore not require the separate financial option.

How and when will I receive duplicate financial messages?

There are three study states that can trigger a charge message, Newly Acquired, Demographics Complete, and Confirmed. If configured to do so, and a study is set to one of these states, a charge message is triggered and a billing message is formatted and sent to the HIS. When the billing message is properly formatted, a bit flag is set to indicate that a financial message has been sent for that test status. Note that there is a separate billing bit for each of the billing triggers (Newly Acquired, Demographics Complete, and Confirmed).

If after the first occurrence of a billing trigger a study is again set to the same state, the system will block a second financial message from being sent for that state. However, if the user has "re-bill" privileges, the user will receive a prompt and can then elect to either suppress the charge message or allow a second charge message to be generated.

NOTE:

You can add columns to the Edit List and Retrieval Pane to identify whether charges have been generated for a particular state. You can also find this information through a database search.

Communication Protocol Options

Our communication’s protocol does not follow the HL7 standard; it uses a single character acknowledgment. Can the MUSE system be configured to accept this?

The MUSE supports standard HL7 original mode acknowledgment messages, not a single character or ACK/NACK acknowledgment.

We use the HL7 standard acknowledgments. Does MUSE support sequence protocol?

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HL7 Implementation FAQs

No.

Our system uses TCP/IP. When our side goes down, we send a shutdown message to our interfaces and want a shutdown message sent when the MUSE side goes down.

The MUSE system does not send shutdown messages, and they will be ignored. The MUSE system functions properly without shutdown messages. The MUSE inbound interface for ADT and orders starts and opens a listening port and waits for a connection from the HIS. When the connection from the HIS is released, the MUSE inbound side releases the connection and reopens the listening port and waits for a connection to the host. The MUSE outbound interface only makes a connection to the HIS when messages are available to send. If the connection is not accepted, the MUSE system maintains the messages as it continues to try the connection.

Who is the client and who is the server?

The MUSE system will be the server for ADT and order transactions (including the patient demographics query). The MUSE system will be the client for result and financial transactions. This follows “the sending application is the client” rule.

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HL7 Interface Testing

Introduction

This is a guide for customers to develop test plans. The customer can review and revise the testing information contained in the reference-only test plans and customize them to meet their specific workflows and data exchange requirements.

HL7 Interface Testing

The customer is responsible for ensuring that the interfaces from their information systems to the MUSE system and from the MUSE system to their information systems update as expected.

The customer’s information system department may have test plans in place to use for data validation and integrated testing. In that case, they can choose not to use the test example included in this document.

The implementation of each HL7 interface will vary from customer to customer depending on the site’s cardiology and other departments’ workflow.

Test Goals

To completely exercise your system in the test environment, you should test all interface options and features, such as ADT (Admit/Discharge/Transfer), Orders, Results, and Financials.

You should test your system under two different conditions: single transaction (functional or unit) tests and multiple transaction (end to end or integrated) tests.

Type of Testing Description

Unit Tests Functional or unit testing involves initiation

of individual transactions and following them through the test environment to ensure that all data fields on the MUSE application are updated properly.

Integrated Tests Integrated testing involves the simulation of the

production workflow.

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HL7 Interface Testing

Customer Prerequisites for Interface Testing

Follow these steps to confirm that all the prerequisites for testing the HL7 interface are complete.

1. Review the MUSE Cardiology Information System HL7 Reference, available from your GE Healthcare HL7 engineer or GE Healthcare project manager.

2. Verify that your test environment mirrors the production environment.

3. Participate in the HL7 specification review with the GE Healthcare HL7 engineer. Customers upgrading from a prior MUSE release to a MUSE system v9 or higher

are not required to have an in-depth specification review, unless new interfaces are being implemented as part of the upgrade. Existing interfaces on a MUSE installation will be configured to match the prior interface formats as closely as possible. The MUSE v9 or higher system may require some changes to the inbound or outbound HL7 messages that were used in the prior releases.

Customers who are new to the MUSE system or who will be implementing new HL7 interfaces are required to have an in-depth specification review with their GE Healthcare HL7 engineer.

4. Verify the connectivity and message validation, and that all HL7 transactions between the MUSE system and the site’s HIS/EMR systems were successfully transmitted and processed.

Initial interface connectivity and high-level message validation must be completed prior to formal unit testing. These tasks are to be completed by the customer’s HL7 or clinical analyst and the GE Healthcare HL7 engineer.

5. Identify and schedule resources for interface testing. Customer resources that are typically involved with the testing are included in

the list below. Unit and integrated testing will vary based on interfaces, number of sites defined in the MUSE system, number of inbound HIS and outbound EMR, and billing systems sending or receiving data.

• HL7 engineer/interface analyst

• IT clinical analyst

• IT network engineer

• IT registration analyst

• IT EMR analyst

• IT hospital billing analyst

• IT technical billing analyst

• Biomedical technician

• Patient registration staff

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• Health information management staff

• Nursing and clinical staff

• EKG technicians

• MUSE system administrator

Test Procedures

The following is a reference-only test plan. It is important to test all aspects of your HL7 interface software. Be sure to create examples for each transaction and event type, and provide data that will test all of your systems options and features.

The interface tests should be performed for each site configured on the MUSE system.

Test Sequence

HL7 Interface Testing

The MUSE HL7 Interface consists of seven standard component interfaces:

• ADT (Admit, Discharge, and Transfer).

• ADT query.

• Order.

• Result.

• Result batch.

• Financial.

• Financial batch.

The complete interface may include one or any combination of these components. However, an ADT interface is required with an Order interfaces. We recommend that an Order interface be included with each Financial interface.

While this varies depending on the interface component options, we recommended this test sequence for each site:

• ADT transactions.

• ADT Query.

• Order transactions.

• Result transactions.

• Result batch processing.

• Financial transactions.

• Financial Batch transactions.

• Test system recovery from any shutdown that could occur during transaction

processing.

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HL7 Interface Testing

Test Templates

Sample templates are provided for the major transaction types.

Testing ADT Interface Transactions

The MUSE HL7 ADT interface accepts unsolicited messages for ADT transactions from the HIS (Hospital Information System). These messages include data for only one patient.

NOTE:

The MUSE HL7 ADT interface does not support batch processing of ADT transaction messages.

For thorough ADT interface testing, patient admission, discharge, and transfer events entered in the HIS trigger a corresponding HL7 ADT message and event. The message and event type sent in the HL7 transaction indicates what type of workflow event took place for the patient.

To ensure that the MUSE database is updated as expected, each HL7 event type that you will be sending to MUSE needs to be tested.

To validate that an HL7 event type updates the MUSE database as expected, perform the action that triggers the event on your HIS (for example, to trigger an A01 event, Admit an Inpatient to your hospital test system; to trigger an A02 event, Transfer an existing Inpatient to a different room/bed on your hospital system; etc.), then compare the ADT data fields entered for the patient on your HIS with the data fields populated on the Admit and Visit information screens in the MUSE system.

To simplify testing and verification of the ADT transaction processing, we separate the tests into four groups:

• Transactions that add patient data.

• Transactions that change patient data.

• Transacations that merge patient data.

• Transactions that delete patient data.

ADT Transactions that Add Patient Data

HL7 Event Type

A01 Admit patient A new record is added to the MUSE database.

Transaction Description Action

A04 Register a patient A new record is added to the MUSE database.

A05 Pre-admit a patient A new record is added to the MUSE database.

A10 Patient arriving A new record is added to the MUSE database.

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HL7 Interface Testing

HL7 Event Type

A13 Cancel discharge A visit record is changed to Open status and the

Transaction Description Action

discharge date is removed.

Testing Transactions that Add Patient Data

These transactions primarily affect patient identification data and can be verified on the MUSE system by viewing the MUSE Admitting Information and Visit Information screens.

Only HL7 event types that will be sent to the MUSE system from the HIS (Hospital Information System) need to be tested.

Use the following steps to test the ADT transactions that add patient data:

1. On your test HIS, begin by admitting a new patient. An A01 (Admit Patient) transaction is sent to the MUSE system.

2. Log on to the test MUSE system to verify that the newly admitted patient is in the MUSE system.

Follow the following instructions to view patient admitting and visit information in "How to View Patient Admitting and Visit Information " on page 89.

3. Verify that the information displayed on the MUSE Admitting and Visit Information screen matches the information entered on your HIS.

It is recommended that you do a field-by-field comparison between the data valued on the MUSE screens and the data valued on your HIS.

4. Record any field that is not valued on the MUSE system, but was valued on your HIS.

5. Record any field that contains a value on the MUSE system that does not match the value in your HIS.

NOTE:

Verification of the Patient ID, as it is valued in the MUSE system, is critical. Most customers value the patient’s medical record number in the Patient ID field. The Patient ID field on the MUSE system is used to uniquely identify the patient. The length and format on this field must remain consistent to ensure unique identification of the patient. During HL7 specification review, you need to determine the length and format of the Patient ID field.

6. After verifying that all of the data fields for the Admit transaction has updated the MUSE system correctly, send another transaction that adds patient data and repeat the verification process.

7. Continue testing until all the transactions that add patient data for each site defined on the MUSE system have been tested and verified.

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HL7 Interface Testing

ADT Transactions that Change Patient Data

HL7 Event Type

A02 Transfer a patient The patient record is changed to reflect the new

A06 Transfer outpatient to

A07 Transfer inpatient to

A08 Update patient

A03 Discharge a patient Patient record (account) status changes from open to

A09 Patient departing Patient record (account) status changes from open to

A12 Cancel transfer A patient transfer is canceled. The patient record is

A17 Swap patients Used when two patients will exchange beds. Both

Transaction Description Action

location information.

The patient record is changed to reflect the new patient

inpatient

outpatient

information

classification and location.

The patient record is changed to reflect the new patient classification and location.

The patient record is changed to reflect the new information.

closed and a discharge date is added.

closedand a discharge date is added.

changed to show the location prior to the transfer.

patient records are changed to reflect the location changes.

Testing Transactions that Change Patient Data

Only HL7 event types that will be sent to the MUSE system from the HIS need to be tested.

1. On your test HIS, admit a new patient. An A01 (Admit Patient) transaction is sent to the MUSE system.

2. Log on to the test MUSE system to verify that the newly admitted patient is in the MUSE system.

See "How to View Patient Admitting and Visit Information " on page 89.

3. On your test HIS, select the new patient and transfer the patient to another Nursing Unit Room or Bed.

4. Verify that the patient location displayed on the MUSE Visit Information screen matches the new patient's HIS location.

5. After verifying that the patient location on MUSE was updated by the Transfer transaction, send another transaction that changes patient data and verify that any data changed on the HIS is updated or changed on the MUSE Admitting and Visit Information screens.

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6. Continue testing until all of the transactions that change patient data for each site define on MUSE have been tested and verified.

Site Level Merge Settings

We recommended that the customer’s Health Information Management, Integration Team, and Cardiology Department staff review the site configuration options for the depth of the merge implementation with the GE Healthcare HL7 engineer.

The MUSE system can be configured to allow stored patient study demographics and visit and account information to be synchronized with the HIS system when specific HL7 messages are received. Synchronization can be configured to operate on both confirmed and unconfirmed study data as well as the MUSE site-level patient demographics data store. Merge-specific HL7 messages are those that change patient ID, visit or account identifiers to the correct values. Currently, these are the only type of messages that target confirmed patient test data. The HL7 merge event type, along with the MUSE Depth of Merge Site configuration, determines what tables are updated in the MUSE system when the message is received. The following table describes the transactions that merge patient data:

HL7 Interface Testing

Merge Level Setting Description of Depth of Merge

Update Master MUSE Patient List All depth of merge HL7 messages will update the

Update Unconfirmed Tests All depth of merge HL7 messages will update

Update Confirmed Tests for Merge Transactions Only

Update Full Patient Demographics Information from Merge Transactions

ADT Transactions that Merge Patient Data

Merge-specific HL7 messages are those that change patient ID, visit and/or account identifiers to the correct values. Currently, these are the only type of messages that target confirmed patient test data. The HL7 merge event type, along with the MUSE Depth of Merge Site configuration, determines what tables are updated in the MUSE system when the message is received. The following table describes the transactions that merge patient data:

MUSE site level demographics data.

NOTE:

Due to high traffic of update messages, it is not recommended to enable this option.

unconfirmed patient tests.

Merge specific HL7 message will update confirmed patient tests.

Update all fields. If not selected, only Patient ID, Last Name, First Name, and Date of Birth fields are updated.

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Table 31: ADT Transactions that Merge Patient Data

HL7 Event Type

A18 Merge patient ID Visits and orders associated with one PID (Non-surviving

A34 Merge patient ID Visits and orders associated with one PID (Non-surviving

A35 Merge account Updates account number with new account number.

A36 Merge patient ID and

Transaction Description Action

PID) are moved to a different PID (Surviving PID.). The non-surviving PID is deleted.

NOTE:

PID) are moved to a different PID (Surviving PID). The non-surviving PID is deleted. (Same as A18.)

If a non-surviving account number exists for a specific visit number, the non-surviving account number is changed to the surviving account number.

Moves a specific visit associated with the non-surviving

account

PID to the surviving PID. patient ID and account number are updated with the new patient ID and account number.

A18 functionality is reserved for backwards compatibility. Use A34 instead.

A42 Merge visit The visit number and all associated orders are moved

A46 Merge visit The visit number and all associated orders are moved

HL7 Merge Transactions

The following table describes the behavior of the HL7 Merge transactions and the MUSE Site Depth of Merge configuration.

to the new visit number. All orders associated with the non-surviving visit number are moved to the surviving visit number and the non-surviving visit number is deleted.

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Transaction MUSE Patients Test Unconfirmed Test Confirmed

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Merge Patient ID (A18, A34) Move all Visits associated with the non-surviving PID to the surviving PID and then deleting the Non surviving PID

Merge Patient ID and Account (36) Move a specific visit associated with the Non surviving Patient ID to the Surviving Patient ID

Merge Visits (A42, A46) Move all orders associated with Non surviving Visit Number to the Surviving Visit Number and delete the Non surviving Visit Number

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates

all patient level demographics fields.

No Change:Other than standard synchronization of changing demographics on tests.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates all

fields.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates all

fields.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates all

fields.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates

all patient level demographics.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge:Updates

all patient level demographics.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge: Updates

all patient level demographics.

Merge Accounts (A35) Changes Account Number

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No Change:Other than standard synchronization of changing demographics on tests.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and

Date of Birth fields.

If configured for full merge: Updates all

fields.

If configured:Updates record with nonsurviving PID to surviving PID and updates the Name and Date of Birth fields.

Only HL7 event types that will be sent to MUSE from the HIS need to be tested.

If configured for full merge:Updates

all patient level demographics.

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Testing Transactions that Merge Patient Data

Follow these steps to test the ADT transactions that merge patient data:

1. On the test HIS, admit two new patients of the same gender and with the same birthdate.

Two A01 (Admit Patient) transactions are sent to the MUSE system.

2. Log on to the test MUSE system to verify that both patients are in the MUSE system.

See "How to View Patient Admitting and Visit Information " on page 89.

3. Determine which of the test patients has the correct medical record number and information. This patient will have the surviving PID information following the merge.

4. On your test HIS, merge the medical record numbers for the two registered patients, generate an A18 or A34 transaction.

5. Verify that the patient with the Non-Surviving medical record number can no longer be found in MUSE using that Non-Surviving number.

Verify that any open orders, visits, and associated results for the patient with the non-surviving number are now displayed under the patient with the surviving medical record number.

NOTE:

The patient demographic, unconfirmed tests, and confirmed tests data will be updated according to the Site Depth of Merge configuration. The merge test plans must be modified to meet the expected behavior for each MUSE site.

6. Test each HL7 merge event type that will be sent from the HIS system along with the Site Depth of Merge configuration for each site.

ADT Transactions that Delete Patient Data

The following table describes the transactions that delete patient data:

HL7 Event Type

A23 Delete Patient Deletes visit-specific information.

Transaction Description Action

A11 Cancel admit If no in-progress orders are associated with the patient

account that is canceled, the visit information, including open orders, is removed from the MUSE system.

Testing Transactions that Delete Patient Data

Only HL7 event types that will be sent to MUSE from the HIS need to be tested. Follow these steps to test the ADT transactions that delete patient data:

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1. On the test HIS, admit a new patient. An A01 (Admit Patient) transaction is sent to the MUSE system.

2. Log on to the test MUSE system to verify that the newly admitted patient is in the MUSE system.

See the following instructions to view patient admitting and visit information in

"How to View Patient Admitting and Visit Information " on page 89.

3. On the test HIS, select the test patient and cancel the patient's admission.

4. Verify that the visit information, including open orders, is removed from the patient’s record.

5. Test all of the transactions that change patient data for each MUSE site has been tested and verified.

How to View Patient Admitting and Visit Information

Follow these steps to view the data on the MUSE Admitting and Visit Information screen:

1. Select the Patient tab in the Patient Retrieval List panel.

2. Select ADT.

3. Enter the patient search criteria.

4. Select Search.

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Searching with no criteria produces a list of all patients with ADT registrations in the MUSE system in the bottom right-hand panel. Note that the there is a maximum number of patients that can be displayed at a time. You may be asked to enter criteria to reduce the result set.

Searching with criteria will display the patient registration(s) that meet the search criteria as shown in the following screen.

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Use the following steps to view patient information:

1. Select the patient row from the Patient Retrieval List.

2. Press Enter or double-click the row. Patient Admit and Visit information sent on ADT interface transactions can be

viewed on the Admitting Information tab and Visit Information tab. The patient demographic information contained on the Admitting Information

screen (1) is usually static. For example, the Patient ID (usually the medical record number assigned to the patient on the HIS) does not change each time the patient has a new encounter or visit at the hospital. The patient date of birth, sex, race, address, etc. are also items that do not generally change from visit to visit.

The following screen shows the Admitting Information tab.

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The patient demographic information contained on the Visit Information (2) screen is usually dynamic. For example, the Account Number usually changes each time the patient has a new encounter or visit at the hospital. The patient location, patient class, Admitting MD, etc. generally change from visit to visit.

NOTE:

The patient may have one or many accounts/visits that are on the MUSE system. Each visit stored on the MUSE system is listed in the upper section of the Visit Information tab. To view the data for a specific visit, highlight the visit. The data displayed in the center of the screen is related to the highlighted, specific visit.

The following screen shows the Visit Information tab.

MUSE Order Transactions

The MUSE HL7 Order interface accepts unsolicited messages for Order transactions from the HIS. A message can only include data for one order.

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The MUSE HL7 Order interface does not support batch processing of Order transaction messages.

The following table describes the Order transactions that are supported by MUSE HL7 Order interface:

Table 32: ADT Transactions that Delete Patient Data

Order Control Code

NW New order Adds a new order to the database.

CA Cancel order request An existing order is canceled (discarded).

DC Discontinue order request An existing order is discontinued (discarded).

XO Change order request An existing order is changed.

Transaction Description Action

Testing Order Transactions

Use the following steps to test the order transactions.

1. On your test HIS, admit a new patient. An A01 (Admit Patient) transaction is sent to the MUSE system.

NOTE:

The MUSE system identifies unique orders by their Placer Order Number. A change to an existing order needs to have the same Placer Order Number for the MUSE system to update the target (original) order.

2. On your test HIS, place a new order for an EKG. Type the data for all comment fields available in your HIS OE (Order Entry)

system.

3. Log on to the test MUSE system to verify that the new order for the patient is in the MUSE system.

Follow the following instructions to view patient order information in "How to

View Patient Order Information on the MUSE System" on page 94.

4. Verify the information displayed on the MUSE Order Information screen matches the information entered on your HIS.

It is recommended that you do a field-by-field comparison between the MUSE screens and your HIS.

Record any mismatches. You will need to determine why the fields do not match.

5. Send a Change Order transaction for the same order requisition and check the various screens to verify that the appropriate data has changed.

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6. Follow the procedures to test the Discontinue Order Request and the Cancel

7. Continue testing steps "1" through "6" for each test type (EKG, HiRes, Holter, and

NOTE:

To ensure that Change Order transactions are tested completely, make a list of all of the fields that can be changed on the HIS OE (Order Entry) screens. Make sure that tests are executed that change these fields. Orders can be distinguished from tests by the case of the item’s status. An order’s status is all upper-case letters (for example, OPEN, DISCARDED). A test’s status is noted in mixed case (for example, Newly Acquired, Confirmed).

Order Request. Verify that the order has been discontinued or cancelled.

Stress), each test code (refer to list of test codes identified on the HL7 Survey), and each Order Priority that can be selected on the HIS system.

How to View Patient Order Information on the MUSE System

There are several ways to view patient orders on the MUSE system. Because the focus of this document is how to validate data sent from the HIS system to the MUSE system and not designed to train clinical staff on the use of the MUSE application, only one example is given.

1. Select the Admitting Information tab in the test MUSE system. If the patient has an Order for tests, the orders are listed in the bottom panel of

the Admitting Information window. The patient in the following screen has one order for an ECG.

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2. To view the Order Information screen, double-click the order to open it. The Order Information window opens. This screen displays the details of the order that was sent from the hospital

ordering system. When testing the Orders interface, verify that the data in each of the information fields matches the information that was entered in the ordering system.

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When an order is downloaded to an ECG device, only specific fields are transferred to the ECG device. The fields from the order that transfer to an ECG device on order download are:

• Patient Name

• Patient ID

• Date of Birth/Age

• Gender

• Race

• Referring MD

• Placer’s Order Number

• Alternate ID/Secondary ID

• MUSE Location

• Room

• Ht. (height) and Wt. (weight)

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NOTE:

Height and Weight are not viewed with the patient data in the MUSE system. If they are sent to the MUSE system in an HL7 ADT message, they will download to the ECG device with the rest of the patient or order data.

Testing Result Transactions

This section describes how to test the MUSE HL7 Results interface to ensure successful transmission and processing of preliminary, final (confirmed), and corrected (or retransmitted) result messages. It is recommended that a clinical staff member view the results post to the HIS or EMR. All data identified during the HL7 specification review should be on the report. The data values of the result report on the MUSE system and the HIS or EMR should match.

Each of your HIS or EMR systems that receive results from MUSE need to be tested. Each type of test that will be sent will need to be tested.

HL7 Interface Testing

Several HL7 result options are available:

HL7 Result Option Description

Text Discrete measurements and/or measurement and

interpretation summary.

Waveform Images Both digitized (UUEncoded) and waveform data points.

URL Link A URL link can be stored on your HIS or EMR to launch

the PDF image stored on the MUSE system. The link goes to MUSE Web or CV Web.

Result Transactions Test Procedures

The test procedures for result transactions are divided into two separate sets of instructions:

• Testing Result transactions on the MUSE system with inbound HL7 ADT interface

only.

• Testing Result transactions from the MUSE systems with inbound HL7 ADT and

Order interface.

Test Data

Before you test results, the MUSE system must acquire the test report data. You will need to acquire data for reference-only studies. Your GE Healthcare HL7

engineer will populate numerous sample tests for each type of test that you will be implementing into your test MUSE system acquisition folder.

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You will need to acquire studies for test patients from an ECG device if you have Order download to the ECG device in the HL7 interface implementation.

Testing the Results on MUSE with Inbound HL7 ADT Interface

As you select scenarios and data to test, you may want to also test what-if scenarios. Work with your GE Healthcare HL7 engineer to ensure that report distribution is set

up to match your intended production workflow. Work with your hospital’s HL7 engineer and HIS system analyst to have several test

patients registered on your HIS test system. For each MUSE site and test result type that you will be sending from the MUSE

system to your HIS or EMR, follow these steps:

1. Open a newly acquired test on the Edit List using the Tests by Date/Time preset.

To send test HL7 Results to the MUSE system, use the instructions in "Sending

Test HL7 Results from the MUSE System (with Inbound HL7 ADT Interface)" on page 99.

2. Revise Test Date/Time to reflect the date/time you are performing the test.

3. Type the medical record number for one of the active test patients.

4. Update the patient name to resolve the mismatch. Click on the visit number field and select a visit. Save as Demographics Complete and Route to the edit list.

5. Verify that a Result Report with a Preliminary status was successfully received and processed by your HIS or EMR system.

NOTE:

If you will not be sending preliminary results to your HIS or EMR, step "5".

6. Log on to the MUSE system using the test doctor credentials.

7. Select the Preliminary test on the Edit List using the Tests by Date/Time preset and select the Confirm and Route icon from the Edit List tool bar (be sure to select the icon with the check mark next to it, or from the menu, select Test, Save, Confirm, or Route).

8. Verify that a Result Report with a Final status was successfully received and processed by your HIS/EMR system.

NOTE:

The MUSE system can send discrete text results, summary text results, UUEncoded waveform results, and URL link pointing to specific results on MUSE Web or CV Web in the result message depending on option purchased. When validating the result transactions, verify that each component that you are expecting in the ORU (result) message updates your HIS/EMR correctly.

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9. Log on to MUSE using test doctor credentials.

10. Select the Final (Confirmed) test from the Test Retrieval List.

11. Open the confirmed study and type testing corrected report in the interpretation section.

12. Select the Confirm and Route icon from the Edit List tool bar.

13. Verify that a Result Report with a Corrected or Amended status was successfully received and processed by your HIS/EMR system.

NOTE:

The MUSE system does not send out HL7 Order Status Update messages. Some customers use the ORU (Result) message to create an Order Status Update message on their interface engine to send to their HIS Ordering system. You will need to include this in your customized test plans if this is a part of your hospital’s workflow.

Sending Test HL7 Results from the MUSE System (with Inbound HL7 ADT Interface)

1. To attach ADT (Admit and Visit) information to a test on the Edit List, record the PID/MRN (1) of a test patient existing in the MUSE system.

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2. Open a Newly Acquired test (1) from the Edit List.

3. Confirm that there is no mismatch on this test and that the test displays the No ADT record for patient notification message. (1)

4. Select the PID/MRN (2) on the test and enter the PID/MRN.

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General Electric MUSE NX HL7 Interface Reference Manual_SM_2102027-227_A A35 Ultrasound Reference Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Table of Contents

MUSE HL7 Interface

HL7 Standard Background

Theory of Operation

Pre-defined CCG Sites

Default Site Layout

Interaction with the MUSE System

ADT Interface

ADT Query Interface

Order Interface

Result Interface

Result Batch Interface

Financial Interface

Financial Batch Interface

ADT, Order, and Result Data Storage

Graphical Result Reporting Messages

Depth of Merge

HL7 Inbound Implementation

General Description

Introduction

Low-level Communications

Interface Data Content

Transactions to the MUSE HL7 Interface

MUSE System Incoming HL7 Message Configuration Options

ADT Messages

ADT Message Composition

Order Message

Order Message Composition

Depth of Merge Implementation

Site Configuration: Update Master MUSE Patient List

Site Configuration: Update Unconfirmed Tests

Site Configuration: Update Confirmed Tests for Merge Transactions Only

Site Configuration: Update Full Patient Demographics from Merge Transactions

Application High-Level Acknowledgment Messages

Acknowledgment Message Composition

HL7 Outbound Implementation

General Description

Low-Level Communications

Interface Data Content

Transactions From the MUSE HL7 Interface

MUSE System Outgoing HL7 Message Configuration Options

Outbound Message Statuses

Study Result Message Composition (ORU)

OBX Segments

OBX Discrete Measurement Data Segments (1 to n)

OBX Non-coded Diagnosis Segment

OBX Measurement and Diagnosis Segment (1)

OBX URL Segment (1)

OBX Coded Diagnosis Segments and Data Points (1 to n)

Embedded Image Option

UUencoded Encoding

Base64 Encoding

Study Financial Message Composition

Batch Data Transfer

Batch Data Transfer Messages

Batch Results Message Structure

Batch Billing Message Structure

Segment Definition

FHS File Header Segment

FTS—File Trailer Segment

BHS—Batch Header Segment

BTS—Batch Trailer Segment

PDF to File Share

HL7 Query Implementation

About Query Implementation

Low-level Communications

Interface Data Content

Query Transactions of the MUSE HL7 Interface

Query Transaction HL7 Messages

Q01 - Immediate Response Query

A19 - ADT Response

System Data Field Definitions

ADT Fields

Order Fields

HL7 Data Segment Definitions

Inbound (to MUSE) Segments