Welch Allyn Medical Diagnostic Equipment Connectivity Server User Manual

Welch Allyn Connectivity Server

Programmer’s guide

Software version 2.5x

ii Welch Allyn Connectivity Server

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Contents

1 - Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 - System overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

iii

Intended use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Warning and note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Related documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Welcome! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Data interface provided by the Welch Allyn Connectivity Server (WACS) . . . . . . 6

Data transfer and storage within the Acuity System network . . . . . . . . . . . . . . . 7

3 - HL7 standard protocols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Health Level Seven Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HL7 low-level protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

HL7 segment-level protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4 - WACS outbound HL7 protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Overview: Outbound HL7 Vital-sign Observations module . . . . . . . . . . . . . . . . 16

Labels and attributes of outbound segments . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Outbound patient identification fields. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Outbound vital-sign tags and filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Reconfiguring WACS outbound observation settings. . . . . . . . . . . . . . . . . . . . . 24

5 - WACS outbound HL7 messages . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Unsolicited observation message

ORU^R01/ACK^R01 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Query for results of observation message

QRY^R02/ORF^R04. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Query by parameter

QBP^Q11/RSP^Z90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Query by ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Query by location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

6 - Inbound ADT HL7 messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Overview: Inbound HL7 ADT Data module . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

How an Acuity System uses ADT information . . . . . . . . . . . . . . . . . . . . . . . . . . 43

ADT messages accepted and stored by WACS . . . . . . . . . . . . . . . . . . . . . . . . . 46

Examples of ADT messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Reconfiguration of ADT services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

iv Contents Welch Allyn Connectivity Server

7 - XML interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

8 - Contacts and specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Contact information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Introduction

Intended use

The Welch Allyn Connectivity Server (WACS) is an option to the Welch Allyn Acuity® Central Monitoring System. WACS consists of a server platform on which one or more of the following software options are installed:

• The Web Server option makes Adobe available from the Acuity System to certain Web browsers.

• The AcuityLink mobile devices and administrative software for WACS. Mobile devices running the Clinician Notifier software deliver patient alarm information and realtime waveforms gathered from patient monitors connected to the Acuity Central Monitoring System.

The software enables administrators to track the status of clinician-patient assignments, and it enables clinicians to track, respond to and view Acuity System patient alarms, view realtime patient waveforms and view historical alarm details and waveforms.

• The HL7 Interface options support the following features using HL7 messaging protocol: export of vital-signs data from the Acuity Central Monitoring System to hospital CIS/HIS systems, and import of ADT data from hospital clinical information systems/hospital information systems (CIS/HIS) to the Acuity System.

• The WACS Barcode Scanner option allows clinicians to enter patient IDs and room numbers into the Acuity System using barcode scanners on some mobile devices running Clinician Notifier software.

• The Third Party Data Stream Interface option supports sending patient alarms and equipment alerts in XML format to third party interfaces.

Portable Document Format (PDF) printout files

option consists of Clinician Notifier software for non-proprietary

WACS is to be used by authorized health care professionals using standard institutional procedures and good clinical practice guidelines for patient monitoring. Staff training in the operation of WACS is essential for optimal use. Users should be skilled at the level of clinicians, clinical administrators and hospital administrators, with the knowledge and experience to acquire and interpret patients’ vital signs. Each of these roles is assigned and associated with specific privileges and scopes. Access privileges are controlled through passwords.

Individuals using WACS should be familiar with its operation as described in this manual, and they should understand all warnings and cautions in the manual.

2 Introduction Welch Allyn Connectivity Server

Note

Conventions

The CE Mark and Notified Body Registration Number signify that the product meets all essential requirements of European Medical Device Directive 93/42/EEC.

WARNING Indicates conditions or practices that could lead to illness, injury, or death.

Warning and note

WARNING HL7 configuration must be performed only by qualified personnel who are familiar with the HL7 Standard and with local implementation of the WACS HL7 Interface. Improper configuration of the HL7 Interface can cause unexpected and unintended cessation of patient vital-signs data transfer.

In compliance with the U.S. Department of Health and Human Services Health Insurance Portability and Accountability Act (HIPAA), do not transfer or save patient data or information using any unsecured or public computer.

Programmer’s Guide Introduction 3

System overview

Welcome!

The Acuity Central Monitoring System is a real-time patient monitoring system that collects and displays vital-sign information for multiple patients over the Welch Allyn FlexNet™ network.

This document contains specifications intended as a guide for software developers to develop the HL7 or XML interface between a facility-controlled clinical information system (CIS or HIS) and an Acuity System. It is assumed that users of this guide are familiar with applicable HL7 standards or XML standards, and that users have standards available for reference.

For information about further configuring the WACS HL7 settings for your facility, see the Welch Allyn Connectivity Server Directions for Use, which describes using the WACS HL7 Manager pages to configure the HL7 interface.

6 System overview Welch Allyn Connectivity Server

Internet

Hardwired Welch Allyn monitors

Wireless LAN

Switch Access point

Wireless Welch Allyn monitors

Acuity Central Station

Welch Allyn Connectivity Server (WACS)

Acuity network

Facility network

Facility backbone

Access point Mobile device

Wireless LAN

CIS/HIS

Client browser

NTP server

Terminal server

VPN

Data interface provided by the Welch Allyn Connectivity Server (WACS)

The WACS option to the Acuity Central Monitoring System is able to provide these data interface options:

• HL7 (Health Level 7) Interface option

• Third-Party Data Stream Interface option (XML format)

Either WACS data interface option can include one or both of these distinct modules.

• Inbound HL7 ADT Data module: Admit/discharge/transfer (ADT) data from your CIS or

HIS to WACS. WACS uses the Acuity System network to send ADT information to the Acuity Central Monitoring System for storage.

• Outbound HL7 Vital-sign Observations module: Numeric patient vital-sign

observations from WACS to your facility-controlled clinical or hospital information system (CIS or HIS).

Programmer’s Guide System overview 7

Data transfer and storage within the Acuity System network

The Acuity System stores patient data for variable amounts of time, depending upon Acuity System license configuration.

Data export from patient monitors to the Acuity System

Welch Allyn portable patient monitors store vital-sign data and send it to the Acuity System in the following ways:

Table 1. Patient monitor data storage and export to the Acuity System

Patient Monitor Means of data export to

Acuity System

Hardwired monitors:

Propaq

Encore,

Propaq CS

Hardwired Welch Allyn 1500 Patient Monitor

Wireless monitors: Propaq CS, Propaq LT and Micropaq

Unshielded twisted pair (UTP)

Ethernet Stream Data stored up to 24

802.11 wireless LAN Stream Propaqs: Data stored

Mode of data export to Acuity System during normal conditions

Stream Data stored up to

Patient monitor data storage during temporary disconnection or dropout

monitor storage capacity

hours

up to monitor storage capacity

Micropaq: No storage

Data export to Acuity System after temporary disconnection or dropout

Trends data only, sent in batch mode

Propaqs: Trends data only, sent in batch mode

Micropaq: data lost

8 System overview Welch Allyn Connectivity Server

Data storage at the Acuity System

The Acuity System stores data for a period determined by the Full Disclosure license configuration.

Storage during Acuity connection to WACS

Table 2. Acuity System data storage configurations and Acuity System data export to WACS

Acuity System data storage configuration WACS capability for data receipt

Zero hours Continuous

24 hours Query for most recent 24 hours

96 hours Query for most recent 96 hours

a. Data is available for a period up to the Acuity Full Disclosure capability, but unsolicited push interfaces

are usually configured to a shorter period to avoid swamping the CIS/HIS.

Storage after Acuity disconnects from WACS or patient monitor

Table 3. Examples of Acuity System data export after disconnection

WACS HL7 message configuration

Unsolicited observation (push) from WACS to CIS 15-minute intervals

2-hour disconnect period Behavior upon reconnection

Patient monitor disconnected from Acuity System

Acuity System disconnected from WACS server

Acuity System sends 8 sets of vitalsign observations, covering the last two hours

Programmer’s Guide System overview 9

Data exported from the Acuity System to WACS

The Acuity System exports the following vital-sign data:

Table 4. Numeric vital-sign data exported from Acuity Systems to WACS

Vital sign Units Default units Preferred HL7 tag

(OBX-3)

Heart rate BPM (1/min) BPM (1/min) Heart Rate

Temperature 1, 2 DegF (°F),

DegC (°C)

SpO

In mmHg, kPa, % mmHg CO2(In)

Ex mmHg, kPa, % mmHg CO2(Ex)

RESP Br/M (1/min) Br/M (1/min) RR/BR

NIBP (DIA / SYS / MEAN) mmHg mmHg NIBP

IBP - 1 (DIA / SYS / MEAN)

unlabeled arterial intracranial umbilical artery umbilical vein pulmonary artery central venous

IBP - 2 (DIA / SYS / MEAN)

unlabeled arterial intracranial umbilical artery umbilical vein pulmonary artery central venous

PVCRate PVC/Min (1/min) PVC/Min (1/min) PVC

Per cent (%) Per cent (%) SPO2

mmHg mmHg

DegC (°C) Temperature

IBP1 ART ICP UA UV PA CVP

IBP2 ART ICP UA UV PA CVP

10 System overview Welch Allyn Connectivity Server

HL7 standard protocols

This chapter describes basic HL7 data structure as outlined in the Health Level Seven Messaging Standard.

Information in this chapter is organized as follows:

Health Level Seven Standard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HL7 low-level protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

HL7 segment-level protocols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Health Level Seven Standard

The Welch Allyn HL7 Interface option closely follows the data structure outlined in the

Health Level Seven Version 2.4 Messaging Standard.

The following excerpt is taken from section 7.3 and section 7.4 of this standard: “Many report headers (OBR) may be sent beneath each patient segment, with many separate observation segments (OBX) beneath each OBR. Note segments (NTE) may be inserted after any of the above segments. The note segment applies to the entity that immediately precedes it, i.e., the patient if it follows the PID segment, the observation if it follows the OBR segment, and the individual result if it follows the OBX segment.”

One result segment (OBX) is transmitted for each vitals component (such as Heart rate or RR/BR).

For updated information regarding this standard, see www.hl7.org/.

12 HL7 standard protocols Welch Allyn Connectivity Server

Group

Groups

Segments

|Fields|

&components&

^subcomponents^

HL7 low-level protocol

This section describes the low-level format of HL7 packet frames.

Packet frames

HL7 frames that are exchanged between the server and the client describe both sent and received data.

Table 5. HL7 packet frame: low-level format

Packet description Content Size (bytes)

Start block 0x0B ASCII <VT> 1

Body variable bytes variable

End block 0x1C ASCII <FS> 1

Carriage return 0x0D ASCII <CR> 1

HL7 segment-level protocols

This section describes HL7 message hierarchy and delimiters, segment notation and date/time format.

Message hierarchy and message delimiters

Segment notation

Table 6. HL7 segment notation: mandatory, optional and repeating

Notation example Definition

PID This segment is mandatory.

[PID] This segment is optional.

{IN1} This segment is mandatory, and it can repeat.

[{NK1}] This segment is both optional and repeating.

Programmer’s Guide HL7 standard protocols 13

Time/date in HL7 segments

When importing vital-sign data into an electronic patient-charting application, use the timestamp associated with the OBR for the vital-signs record in the chart.

Format

Date and time in the HL7 segments are represented in this format: YYYYMMDDHHMMSS.mmm±TZTZ

• Displayed time is local.

• Hours are in the range 0-23.

• Seconds (SS) are followed by the following:

3-digit millisecond value (which appears as 000 if no other value is provided)

+ or a -

4-digit time-zone code

Example of HL7 time/date format:

26 January 2009, at 0.193 seconds past 12:22:02 PM, Pacific time (8 hours behind GMT):

20090126122202.193-0800

14 HL7 standard protocols Welch Allyn Connectivity Server

WACS outbound HL7 protocols

The WACS Outbound HL7 Vital-sign Observations module uses JavaTM processes to read patient data files from an Acuity System and forward the messages to a CIS server.

This chapter describes WACS protocols used in the Outbound HL7 Observations module. The WACS protocols closely follow the data structure outlined in the Health Level Seven

Version 2.4 Messaging Standard.

Information in this chapter is organized as follows:

Overview: Outbound HL7 Vital-sign Observations module . . . . . . . . . . . . . . . . . 16

Labels and attributes of outbound segments . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Outbound patient identification fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Outbound vital-sign tags and filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Reconfiguring WACS outbound observation settings . . . . . . . . . . . . . . . . . . . . .24

16 WACS outbound HL7 protocols Welch Allyn Connectivity Server

Overview: Outbound HL7 Vital-sign Observations module

Patient vital-sign observations are transferred to the CIS server in this manner:

Acuity System

network

SQL database

Patient data

WACS

10.250.100.201:5600

Initiate connection to

WACS IP + port

HL7 outbound message

Clinical information system

(CIS)

Outbound HL7 patient data messaging

1. WACS is configured to accept requests on a preconfigured TCP port (usually in the

5600-5700 range).

2. Once a connection is established between the WACS system and the CIS, and once

the optional handshake and optional authentication are complete, The HL7 session begins.

3. WACS sends observations to the CIS in one of these ways, depending on the

configured model:

• Push model: WACS sends information to the CIS at configurable intervals

• Pull model: WACS listens for incoming queries from the CIS

The system maintains an open connection for as long as possible. Connections can be re-established if fatal errors or program crashes occur on either end. The WACS master program uses exit codes and return values of the interface components to manage child processes.

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