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HL7 V2 messaging is widely used in Australia, including the transmission of Pathology results from laboratories to providers. This section provides a broad overview of the format and function of pathology messages before detailing specific elements in detail. Electronic ordering is less well developed currently but is used in some arenas and provides significant potential advantages for the requester and filler of laboratory tests.

HL7 V2 was developed before the introduction of xml or json and the format is text based and unique to HL7 v2. It was originally designed to pass 7 bit channels and optimizes file size and in Australia is restricted to the ASCII character set as described in the appendix on parsing HL7 v2. Implementers should read and understand Appendix 1 Parsing HL7v2. The file format contains no field names and requires pre-existing knowledge of its structure to process. It is highly storage and bandwidth efficient however.

Most results between laboratories and providers are currently sent in unsolicited mode, where no electronic order was sent, but a paper request was used. An HL7v2 ORU^R01 message is used for this and an example appears below.

 

Example Pathology Message
MSH|^~\&|EQUATORDXTRAY^EQUATORDXTRAY:3.1.2^L|QML^2184^AUSNATA|||20160612150255+1000||ORU^R01|BGC06121502965-8968|P|2.3.1^AUS&&ISO^AS4700.2&&L|||AL||AUS
PID|||||ANTHONY^JENNIFER^KAY||19490709|F|||225 Wises Road^^BUDERIM^QLD^4551||^^^^^^54455055||||||4157269354
PV1|1|O||||||0488077Y^MCKENZIE^RAY^^^DR^^^AUSHICPR^L^^^UPIN|0191324T^MCINTYRE^ANDREW^^^DR^^^AUSHICPR^L^^^UPIN
ORC|RE||15-57243112-CBC-0^QML^2184^AUSNATA||CM|||||||0488077Y^MCKENZIE^RAY^^^DR^^^AUSHICPR^L^^^UPIN
OBR|1||15-57243112-CBC-0^QML^2184^AUSNATA|CBC^MASTER FULL BLOOD COUNT^2184|||20151221|||||||201512211940||0488077Y^MCKENZIE^RAY^^^DR^^^AUSHICPR^L^^^UPIN||From QML"QMLG4399292.oru" 17.03.2016||DR=UMA2P,LN=15-57243112,RC=Y||201603171124||HM|F||^^^201512210000|0488077Y^MCKENZIE^RAY^^^DR^^^AUSHICPR^L^^^UPIN~0191324T^MCINTYRE^ANDREW^^^DR^^^AUSHICPR^L^^^UPIN||||Dr Davidson
OBX|1|ST|15430-2^^LN||FULL BLOOD EXAMINATION||||||F
OBX|2|NM|718-7^Haemoglobin^LN||121|g/L|115-160||||F|||201512212329
OBX|3|NM|789-8^Red Cell Count^LN||3.8|x10*12/L|3.6-5.2||||F|||201512212329
OBX|4|NM|4544-3^Haematocrit^LN||0.38||0.33-0.46||||F|||201512212329
OBX|5|NM|787-2^Mean Cell Volume^LN||100|fL|80-98|+|||F|||201512212329
OBX|6|NM|785-6^Mean Cell Haemoglobin^LN||32|pg|27-35||||F|||201512212329
OBX|7|NM|777-3^Platelet Count^LN||393|x10*9/L|150-450||||F|||201512212329
OBX|8|NM|6690-2^White Cell Count^LN||8.8|x10*9/L|4.0-11.0||||F|||201512212329
OBX|9|NM|770-8^Neutrophils^LN||53|%|||||F|||201512212329
OBX|10|NM|751-8^Neutrophils^LN||4.7|x10*9/L|2.0-7.5||||F
OBX|11|NM|736-9^Lymphocytes^LN||30|%|||||F|||201512212329
OBX|12|NM|731-0^Lymphocytes^LN||2.6|x10*9/L|1.1-4.0||||F
OBX|13|NM|5905-5^Monocytes^LN||14|%|||||F|||201512212329
OBX|14|NM|742-7^Monocytes^LN||1.2|x10*9/L|0.2-1.0|+|||F
OBX|15|NM|713-8^Eosinophils^LN||3|%|||||F|||201512212329
OBX|16|NM|711-2^Eosinophils^LN||0.26|x10*9/L|0.04-0.40||||F
OBX|17|NM|706-2^Basophils^LN||0|%|||||F|||201512212329
OBX|18|NM|704-7^Basophils^LN||0.00|x10*9/L|< 0.21||||F
OBX|19|FT|5909-7^Interpretation^LN||Comment:\.br\Mild monocytosis and borderline high mean cell volume.  Other significant haematology parameters are within normal limits for age and sex.\.br\||||||F|||201512212329

 

When this message is received and Acknowledgement message is produced and returned to the laboratory.

ACK Message
MSH|^~\&|EQUATORDXTRAY^EQUATORDXTRAY:3.1.2^L|Demo Server^1FFA8984-7166-4655-B195-7B4FFFD2F136^GUID|EQUATORDXTRAY^EQUATORDXTRAY:3.1.2 (Build 6387) [win32-i386] {SVV=76;DBV=76}^L|QML^2184^AUSNATA|20160612150923+1000||ACK^R01|HOM06121509607-198|P|2.3.1^AUS&&ISO^AS4700.2&&L|||||AUS
MSA|AA|BGC06121502965-8968

 

These two messages are the backbone of result delivery and acknowledgement of delivery for pathology result delivery. The first message is the results of the laboratory evaluation (a document), in this case a Full Blood Count, with a message wrapper to address the message and enable the delivery to be confirmed by the second message which is produced by the recipient and returned to the laboratory. The security and authentication around delivery is out of scope of this standard.

Messages are a stream of text which is divided into segments by the CR (ASCII13) character. Each segment starts with a three letter code identifying the content of the segment. eg "MSH", "PID", "OBX" etc. These segments are further defined by the standard to contain fields which are separated by the "|" character. Each field can optionally repeat and each repeat (if present) is separated by the "~" character. The fields themselves are divided into components by the "^" character and the components are divided into SubComponents by the "&" character. There are no levels of hierarchy possible below this. The text content of Fields/components or subcomponents must escape any delimitors used in HL7 ie |^~\& or Line breaks (ASCII 13/10). Escape sequences are provided for this. eg \.br\ replaces a line break in the original text. 

The segments in a message are specified by the standard and are ordered, can be optional and can optionally repeat. This creates a hierarchy at the level of the message.

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