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HL7 Attribute Table – OBR – Observation Request

Scroll Table Layout
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SEQLENDTOPTRP/#TBL#ITEM#ELEMENT NAME
14SIO  00237Set ID - OBR
2250**EIC  00216Placer Order Number
3250**EIC  00238Filler Order Number
4250CER  00238Universal Service Identifier
52IDX  00239Priority - OBR (Superseded)
626TSX  00240Requested Date/Time (Superseded)
726TS   00241Observation Date/Time #
826TSO  00242Observation End Date/Time #
9250***CQO  00243Collection Volume *
10250XCNOY 00244Collector Identifier *
111IDO 006500245Specimen Action Code *
12250CEO  00246Danger Code
13300STO  00247Relevant Clinical Info
1426TSC  00248Specimen Received date/Time *
15300CMO 007000249Specimen Source *
16250XCNOY 00226Ordering Provider
17250XTNOY/2 00250Order Callback Phone Number
1860STO  00251Placer Field 1
1960STO  00252Placer Field 2
2060STO  00253Filler Field 1 +
2160STO  00254Filler Field 2 +
2226TSC  00255Results Rpt/Status Chng - Date/Time +
2340CMO  00256Charge to Practice +
2410IDR 007400257Diagnostic Serv Section ID
251IDC 012300258Result Status +
26400CMO  00259Parent Result + (Refer to notes in OBR-26 below)
27200TQOY 00221Quantity/Timing
2828XCNOY/5 00260Result Copies To
29200CMO  00261Parent (Refer to notes in OBR-29 below)
3020IDO 012400262Transportation Mode
31250CEOY 00263Reason for Study
32200CMO  00264Principle Result Interpreter +
33200CMOY 00265Assistant Result Interpreter +
34200CMOY 00266Technician +
35200CMOY 00267Transcriptionist +
3626TSO  00268Scheduled date/Time +
374NMO  01028Number of Sample Containers *
38250CEOY 01029Transport Logistics of Collected Sample *
39250CEOY 01030Collectors's Comment
40250CEO  01031Transport Arrangement Responsability
4130IDO 022401032Transport Arranged
421IDO 022501033Escort Required
43250CEOY 01034Planned Patient transport Comment
44250CEO 008800393Procedure Code
45250CEOY034001316Procedure Code Modifier
46250CEOY041101474Placer Supplemental Service Information
47250CEOY041101475Filler Supplemental Service Information

Legend:

** ALERT: The field length of OBR-2 and OBR-3 of 250 characters for Australian usage is a variance to the HL7 V 2.4 field length of 22 characters.
*** ALERT: The field length of OBR-9 of 250 characters for Australian usage is a variance to the HL7 V 2.4 field length of 20 characters.

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HL7 Table 0065 - Specimen Action Code

ValueDescription
AAdd ordered tests to the existing Specimen
GGenerated order; reflex order
Llab to obtain specimen from patient
OSpecimen obtained by service other than Lab
PPending specimen; Order sent prior to delivery
RRevised order
SSchedule the test specified below


OBR-12 Danger code (CE) 00246

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HL7 Table 0163 – Body site

ValueDescription
BEBilateral Ears
OUBilateral Eyes
BNBilateral Nares
BUButtock
CTChest Tube
LALeft Arm
LACLeft Anterior Chest
LACFLeft Antecubital Fossa
LDLeft Deltoid
LELeft Ear
LEJLeft External Jugular
OSLeft Eye
LF Left Foot
LGLeft Gluteus Medius
LHLeft Hand
LIJLeft Internal Jugular
LLAQLeft Lower Abd Quadrant
LLFALeft Lower Forearm
LMFALeft Mid Forearm
LNLeft Naris
LPCLeft Posterior Chest
LSCLeft Subclavian
LTLeft Thigh
LUALeft Upper Arm
LUAQLeft Upper Abd Quadrant
LUFALeft Upper Forearm
LVGLeft Ventragluteal
LVLLeft Vastus Lateralis
NBNebulized
PAPerianal
PERINPerineal
RARight Arm
RACRight Anterior Chest
RACFRight Antecubital Fossa
RDRight Deltoid
RERight Ear
REJRight External Jugular
ODRight Eye
RFRight Foot
RGRight Gluteus Medius
RHRight Hand
RIJRight Internal Jugular
RLAQRt Lower Abd Quadrant
RLFARight Lower Forearm
RMFARight Mid Forearm
RNRight Naris
RPCRight Posterior Chest
RSCRight Subclavian
RTRight Thigh
RUARight Upper Arm
RUAQRight Upper Abd Quadrant
RUFARight Upper Forearm
RVLRight Vastus Lateralis
RVGRight Ventragluteal

The fifth component indicates whether the specimen is frozen as part of the collection method. Suggested values are F (Frozen); R (Refrigerated). If the component is blank, the specimen is assumed to be at room temperature.

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The current allowable codes are:

CodeMeaning
AUSEHRMy Health Record consent flag. For example AUSEHR=Y indicates that consent has been given for this report to be uploaded to the My Health Record.
CPCopy result - this is a copy result i.e., the receiving doctor is not the requesting doctor. An example entry is "CP=Y".
DRProvider code used by laboratory
LNLaboratory Number. The lab assigns a unique number for an episode of testing. This differs from the Filler order number Entity identifier, which must be unique for each report transmitted, but the Laboratory number is potentially common to many reports.
RCRequest complete - the value in this case is the original place group number. This indicates all tests are complete for this order.

When transmitted all reserved HL7 delimiters must be escaped and the OBR-20 ST result extracted, unescaped and then parsed as a comma separated name=value pairs.

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HL7 Table 0074 - Diagnostic service section ID 

ValueDescription
AUAudiology
BGBlood Gases
BLBBlood Bank
CGCytogenetics
CUSCardiac Ultrasound
CTHCardiac Catheterization
CTCAT Scan
CHChemistry
CPCytopathology
EC

Electrocardiac (e.g. ECG, EEC, Holter)

ENElectroneuro
GE †Genetics
HMHaematology
ICUBedside ICU Monitoring
IMMImmunology
LAB

Regional laboratory (departments not distinguishable)

MBMicrobiology
MCBMycobacteriology
MYCMycology
NMRNuclear Magnetic Resonance
NMSNuclear Medicine Scan
NRS

Nursing Services Measures

OUSOB Ultrasound

OT

Occupational Therapy
OTHOther
OSLOutside Lab
PHRPharmacy
PTPhysical Therapy
PHY

Physician (Hx. Dx, admission note, etc)

PFPulmonary Function
RADRadiology
RUSRadiology Ultrasound
RC

Respiratory Care (therapy)

RTRadiation Therapy
RXRadiograph
SRSerology
SP

Histology and Anatomical Pathology

TXToxicology
VUSVascular Ultrasound
VRVirology
XRCCineradiograph

Note: † An Australian extension to the the laboratory department code. 

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HL7 Table 0123 - Result status 

ValueDescription
OOrder received; specimen not yet received
INo results available; specimen received, procedure incomplete
SNo results available; procedure scheduled, but not done
ASome, but not all, results available
PPreliminary: A verified early result is available, final results not yet obtained
CCorrection to results
RResults stored; not yet verified
FFinal results; results stored and verified. Can only be changed with a corrected result.
XNo results available; Order canceled.
YNo order on record for this test. (Used only on queries)
Z

No record of this patient. (Used only on queries)

OBR-26 Parent result (CM) 00259

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HL7 Table 0124 - Transportation mode 

ValueDescription
CARTCart - patient travels on cart or gurney
PORTThe examining device goes to patient's location
WALKPatient walks to diagnostic service
WHLCWheelchair

OBR-31 Reason for study (CE) 00263

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HL7 Table 0224 - Transport arranged 

ValueDescription
AArranged
NNot Arranged
UUnknown

OBR-42 Escort required (ID) 01033

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HL7 Table 0225 - Escort required 

ValueDescription
RRequired
NNot Required
UUnknown

OBR-43 Planned patient transport comment (CE) 01034

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User-defined Table 0088 - Procedure code

ValueDescription
 No suggested values defined

OBR-45 Procedure code modifier (CE) 01316

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User-defined Table 0411 - Supplemental service information values  

ValueDescription
1STFirst
2NDSecond
3RDThird
4THFourth
5THFifth
ANTAnterior
A/PAnterior/Posterior
BLTBilateral
DECDecubitus
DSTDistal
LATLateral
LFTLeft
LLQLeft Lower Quadrant
LOWLower
LUQLeft Upper Quadrant
MEDMedial
OROperating Room
PEDPediatric
POSPosterior
PRTPortable
PRXProximal
RECRecumbent
RLQRight Lower Quadrant
RGHRight
RUQRight upper Quadrant
UPPUpper
UPRUpwright
WCTWith Contrast
WOCWithout Contrast
WSDWith Sedation

Individual implementations may extend this table using other appropriate vocabularies.

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HL7 Attribute Table – OBX – Observation/Result

SEQLENDTOPTRP#TBL#ITEM#ELEMENT NAME
14SIO  00569Set ID - OBX
23**IDC 012500570Value Type
3250CER  00571Observation Identifier
420STC  00572Observation Sub-ID
516 MB†*C  00573Observation Value
6250CEO  00574Units
760STO  00575References Range
85ISOY/5007800576Abnormal Flags
95NMO  00577Probability
102IDOY008000578Nature of Abnormal Test
111IDR 008500579Observation Result Status
1226TSO  00580Date last Observation Normal value
1320STO  00581User Defined Access Checks
1426TSO  00582Date/Time of the Observation
15250CEO  00583Producers ID
16250XCNOY 00584Responsible Observer
17250CEOY 00936Observation Method
18250***EIOY 01479Equipment Instance Identifier
1926TSO  01480Date/Time of the Analysis

** ALERT: The field length of OBX-2 of three characters for Australian usage is a variance to the HL7 V 2.4 field length of two characters.

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HL7 Table 0125 - Value type 

ValueDescription
ADAddress
CECoded Entry
CFCoded Element with Formatted values
CKComposite ID With Check Digit
CNComposite ID And Name
CPComposite Price
CXExtended Composite ID With Check Digit
DRDate/Time Range
DTDate
ED Encapsulated Data
FT Formatted Text (Display)
MOMoney
NM Numeric
PNPerson Name
RPReference Pointer
SN Structured Numeric
STString Data.
TMTime
TNTelephone Number
TSTime Stamp (Date & Time)
TXText Data (Display)
XADExtended Address
XCNExtended Composite Name And Number For Persons
XONExtended Composite Name And Number For Organizations
XPNExtended Person Name
XTNExtended Telecommunications Number

Strikethrough Elements should not be used in Australian implementations. FT should be used instead of TX. The extended version of datatypes should be used rather than datatypes from prior versions of HL7 V2.

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User-defined Table 0078 - Abnormal flags 

ValueDescription
In the Australian context the three-tier scale is:
+At least one level above normal limit
++Two levels above
+++Three levels above
-At least one level below normal limit
--Two levels below
---Three levels below
In the Australian context the two-tier scale is:
LBelow low normal
HAbove high normal
LL Below lower panic limits
HH Above upper panic limits
For Microbiology use:
SSusceptible. Indicates for microbiology susceptibilities only.
RResistant. Indicates for microbiology susceptibilities only.
IIntermediate. Indicates for microbiology susceptibilities only.
For non-numeric results:
AAbnormal (applies to non-numeric results)
NNormal (applies to non-numeric results)

OBX-9 Probability (NM) 00577

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HL7 Table 0080 - Nature of abnormal testing 

ValueDescription
AAn age-based population
NNone - generic normal range
R A race-based population
S

A sex-based population

OBX-11 Observation result status (ID) 00579

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HL7 Table 0085 - Observation result status codes interpretation 

ValueDescription
CRecord coming over is a correction and thus replaces a final result
DDeletes the OBX record
FFinal results; Can only be changed with a corrected result.
ISpecimen in lab; results pending
NNot asked; used to affirmatively document that the observation identified in the OBX was not sought when the universal service ID in OBR-4 implies that it would be sought.
OOrder detail description only (no result)
PPreliminary results
RResults entered -- not verified
SPartial results
XResults cannot be obtained for this observation
UResults status change to final without retransmitting results already sent as ‘preliminary.’ E.g., radiology changes status from preliminary to final
WPost original as wrong, e.g., transmitted for wrong patient

 

OBX-12 Date last observation normal value (TS) 00580

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Australia uses an extension to the HL7 conventions by including at least one, but potentially many OBX segments that contain a display orientated version of the data included in the message. Ideally the data should be transmitted in atomic form as well as a display orientated form, but in some cases only the display orientated data is transmitted. (In which case the display segment will be the only OBX segment present) These OBX segments are positioned as the last OBX segments and can be identified by the use of the coding scheme "AUSPDI" in OBX-3 Observation Identifier, Name of Coding System. There are multiple potential formats that the display orientated version of the data can be transmitted but all display segments should be equivalent and contain a rendering of all the data and (if atomic data is present) should not contain clinical results not included in the atomic data. The potential formats are given in the following table.

Display Format codes

Identifier (ST)Text (ST)*Name of Coding System (IS)OBX Value Type
RTFDisplay Format in RTFAUSPDIED
HTMLDisplay Format in HTMLAUSPDIED
PDFDisplay Format in PDFAUSPDIED
TXTDisplay Format in TextAUSPDIFT
PITDisplay Format in PITAUSPDIFT*
  • Only the Code and Coding System are significant and the text may be absent or vary from what is shown.
  • *PIT display is deprecated and has/will/was/must/rumoured to have been removed in this and future standards. 

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NTE segments are not used in the Australian setting but comments about individual results (A single OBX) or a report (All OBX segments under a OBR Segment) are supported by the use of OBX segments with specific LOINC codes. Result Comments are in an OBX segment immediately following the result OBX and report comments are contained in an OBX segment at the end of the report but before the display orientated OBX segments detailed in Section 4.5. The LOINC code in a Comment OBX Segment (In OBX-3) allows differentiation between result and report comments. Ideally result comments should be linked to result by use of OBX-4 Observation Sub-ID as well as the position in the message.

Comment TypeStart LOINC CodeEnd LOINC Code
Result Comments15412-015431-0
Report Comments8251-18270-1

Most Comment OBX segments are of type FT and no display of the code or text in OBX-3 is expected but comment OBX segments can be of other value types and OBX-3 should not be displayed in those cases either.

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In structured reports there may be a number of sections in a report and these OBX segments are defined buy 2 specific LOINC codes

LOINC CodeLong Name
70949-3Pathology report.section heading
73983-9Report.section heading Unspecified body region

When these codes are used the display of OBX-3 should be suppressed and the Value component displayed as a heading. The value component is usually of type CE (Coded Entry) or ST (String). These LOINC codes are usually used in conjunction with the OBX-4 Observation SubID to allow repetition of the codes for multiple headings and nested sections.

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When highly structured reports are used to report complex results such as Colorectal Cancer Histopathology the reports as based on a template. The template is identified by:

LOINC CodeLong Name
60572-5Report template ID

This OBX segment can be omitted from the display but for systems capable of interpreting the template provides an identifier for the template that the data confirms to. Any data in the list of OBX segments under the current OBR segment that has a OBX-4 Observation SubID starting with the SubID of the Template identifier OBX is a part of the templated data.

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We will match the URL parts as follows:

URL PartValue
scheme https://
server labtest.com.au
application path/mylabapp
data path/data%20path/id/2016F0001000-1
query ?view=jpegrender&mode=online

 

These parts would be encoded into a RP datatype as follows:

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https://images.rad.com.au/imageserver?Parameter1&Parameter2=Value2

URL PartValue
scheme https://
server images.rad.com.au
application path/imageserver
data path 
query ?Parameter1&Parameter2=Value2

This then would be encoded into an OBX as follows:

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Hence, the use of the correlation between the placer order number and the requested test provides the most suitable way of determining if an order has been completed. This process does not rely on matching order codes with result codes which are quite often different.

Order to report scenario

ORC-1 Order control code

(HL7 table 0119)

Order control code description
Comment
Direct 1:1 matching of order with the reportREObservations/Performed Service to followNote: This is a variance to HL7 V2.4, section 4.5.1.1.1(j) which states that this codes is not necessary in an ORU message. However, HL7 provides no option to filling this mandatory field.
Greater than one ordered test on a single report - Results with no direct orderCNCombined result 
Greater than one ordered test on a single report - Final test sent in reportREObservations/Performed Service to follow 
Reflex or self determined tests or where a single test generates greater than one report - result for the original orderPAParent order/serviceMedicare Australia permits the laboratory automatically adding on tests based on initial results, though these add-ons are more likely to be non-billable. These add-on tests will not have a Placer Order Number; however they can be matched using the Placer Group Number.
Reflex or self determined tests or where a single test generates greater than one report - child ordersPA/CHParent order/service / Child order/service 
Reflex or self determined tests or where a single test generates greater than one report - final test sent with the reportREObservations/Performed Service to follow 
Report copies to recipients that are not the original requesterREObservations/Performed Service to follow

Placer group number and placer order number shall be <null>.

Add-on tests - requested by someone who is not the original requesterREObservations/Performed Service to follow

The placer group number should be sent as for the original request.

For the ordering provider, placer order number will be returned. However, for the original requester, the placer order number shall be <null> ie although the original requester did not order the test they would generally be included in the copy to doctors.

An order may be cancelled by the placer up until the time the result is sent or by the filler due to an unsatisfactory specimen. Once a test is resulted it cannot be cancelled.CA

Cancel order/service
request

Placer Applications.
A cancellation is a request by the placer for the filler not to do a previously ordered service. Confirmation of the cancellation request is provided by the filler, e.g., a message with an ORC-1-order control value of CR.
Typical responses include, but are not limited to, CR – Cancelled as requested, UC – Unable to Cancel.

4.17.2 Reconciling Results

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Comments can be associated with results and more generally with the report.  To indicate which is being referenced the following protocol is used:

Result comments
Use LOINC Codes
Specified in which field
Comment
Result comments associated with individual results

15412-0 to 15431-0

i.e. 15413-8, 15414-6,
15415-3, 15416-1,
15417-9, 15418-7,
15419-5, 15420-3,
15421-1, 15422-9,
15423-7, 15424-5,
15425-2, 15426-0,
15427-8, 15428-6,
15429-4, 15430-2,
15431-0.

OBX-3The actual comment should be placed in OBX-5 and have the same OBX-4 value.
To facilitate backwards compatibility the OBX with the comment should immediately follow the OBX with the result.
Report comments associated with the entire report

8251-1 to 8270-1

i.e. 8262-8, 8264-4,
8265-1, 8266-9,
8267-7, 8268-5,
8269-3, 8270-1,
8252-9, 8253-7,
8254-5, 8255-2,
8256-0, 8257-8,
8258-6, 8259-4,
8260-2, 8261-0,
8263-6.

OBX-3The report comments shall be in the OBX segment immediately before the OBX display segment(s).

4.21 Processing FT value types in OBX segments

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In the Australian context the following elements are defined for OBR-20.

CodeDefinitionAdditional comments and examples
AUSEHRMy Health Record consent flag. For example AUSEHR=Y indicates that consent has been given for this report to be uploaded to the My Health Record.
CPThis is a copy result ie the receiving doctor is not the requesting doctor.

Useful to the receiving site when a result is received with no corresponding order or the patient has no history at the medical practice.
This item is not required when the receiving doctor is the requesting doctor.

Example: |CP=Y| for the case when it is a copy doctor. 

DR

The doctor code or Provider Number used by the diagnostics provider for the Receiving
Doctor.

The code can be used by the diagnostics provider to write a ‘tracking’ record for the result after the surgery has acknowledged receipt of the result. It is not required to be returned by the surgery; the diagnostics provider will retrieve the code from their copy of the message when the acknowledgment is received.
Alternatively, the receiving site can use the code to identify the receiving doctor.
It should be assumed to be a Provider Number, although in some instances the provider number will not be available when the receiver is not a Medicare registered practitioner.
Example:
DR=ABC12 — doctor code
DR=123456XY — provider number

LN

Laboratory/Diagnostic imaging Number assigned by the diagnostics provider to the specimen or procedure.

For electronic orders the Filler Order Number is used to acknowledge receipt of the order. This may not necessarily correspond to the diagnostics provider's identifier for the result. This value must be retained and displayed by the PMS because referral to the performing diagnostics provider will usually require this number to be quoted (NOT the Filler Order Number).
In cases where no electronic order was made, and consequently no Filler Order Number was returned in an Order Acknowledgment (ORR message), the result message may contain the Laboratory/Diagnostic imaging Number in the ‘Filler Order Number’ field.
For consistency it should be recorded under the ‘LN’ item.

RCRequest complete

HL7 only allows an ‘order’ to be flagged complete—not a list of orders that formed a request.
Tests that are ordered may be reported under a different test name. The PMS needs to be aware when all results for the request have been reported.
This is indicated via the ‘RC = Placer Group Number’ item.
Example: RC=1249\S\RX32615492\S\ROCK\S\L
NOTE: The \S\ separators in the Placer Group Number. The normal ‘^’ component separators have been replaced in the Placer Group Number to
avoid parsing conflicts.

4.23 Tracking Result Identifiers

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