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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 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. Each message type, which is specified in the MSH segment has its own segment structure, but all start with a MSH segment. This creates a hierarchy at the level of the specific message. The structure of a ORU^R01 message (The main message used to deliver results) is detailed below.

Legend:

"{}"  Repeat

"[]" Optional

 

ORU^R01 Message Structure
ORU^R01           Unsolicited Observation Message
MSH               Message Header 
{
  [
    PID           Patient Identification 
    [PD1]         Additional Demographics 
    [{NK1}]       Next of Kin/Associated Parties
    [{NTE}]       Notes and Comments
  [
    PV1           Patient Visit
    [PV2]         Patient Visit - Additional Info
  ]
  ]
  {
    [ORC]         Order common
    OBR           Observations Report ID
    {[NTE]}       Notes and comments
    [CTD]         Contact Data
  {
    [OBX]         Observation/Result
    {[NTE]}       Notes and comments
  }
  [{FT1}]         Financial Transaction
  {[CTI]}         Clinical Trial Identification
  }
}
[DSC]             Continuation Pointer

 

In the example message the MSH segment (Line 1) gives this message a Unique ID "BGC06121502965-8968" and Indicated it was sent by QML Pathology "QML^2184^AUSNATA". The response, The ACK^R01 message indicates that this message has been recieved using the Message Acknowledgment Segment (MSA, Line 2) with the original message ID "MSA|AA|BGC06121502965-8968" . The "AA" indicates "Application Accept".

The message contains a report. The report header is in the OBR Segment (Line 5) and the report has a Unique ID which will never change even if the report is updated "15-57243112-CBC-0^QML^2184^AUSNATA". It also gives the name of the report and who ordered it and who has been sent copies of the report along with the date the test was done.

The OBX segments, on lines 6-24, contain the atomic data that form the actual result. Each atomic result is identified with a code (eg Line 7 "718-7^Haemoglobin^LN") and a data type, in this case mostly Numeric(NM).

The details of the other fields and conventions, localized for Australia,  are specified in this standard, which should be read in concert with the International standard.

 

2.16 MESSAGE CONTROL SEGMENTS

The following segments are necessary to support the functionality described in this chapter.

Note: The HL7 message construction rules define the standard HL7 encoding rules, creating variable length delimited messages from the segments defined below. Although only one set of encoding rules is defined as a standard in HL7 Version 2.3, other encoding rules are possible (but since they are non-standard, they may only used by a site-specific agreement). The segments in this section are listed in alphabetical order. The following chart shows a summary of the segments listed by category.

Figure 2-8. HL7 message segments

Segment Category

Segment Name

HL7 Section Reference

Control

ADD2.16.1
 BHS2.16.2
 BTS2.16.3
 DSC 2.16.4 
 ERR2.16.5
 FHS 2.16.6 
 FTS 2.16.7 
 MSA 2.16.8
 MSH2.16.9
 General PurposeNTE2.16.10 
 Query

 

All query segments have been moved to chapter 5

2.16.1 ADD - addendum segment

The ADD segment is used to define the continuation of the prior segment in a continuation message. See Section2.15.2, “Continuation messages and segments,” for details.

 

HL7 Attribute Table - ADD – Addendum

SEQLENDTOPTRP/#TBL# ITEM#ELEMENT NAME
1-n

655

36

36O  00066Addendum Continuation Pointer

2.16.1.0 ADD field definition

2.16.1.1 ADD-1 Addendum continuation pointer (ST) 00066

Definition: This field is used to define the continuation of the prior segment in a continuation message.

See section 2.15.2, “Continuation messages and segments” for details. When the ADD is sent after the segment being continued, it contains no fields. It is only a marker that the previous segment is being continued in a subsequent message. Thus fields 1-N are not present. The sequence designation, 1-N, means the remainder of the fields in the segment being continued. These remainder of the segment being continued fields are present only when the ADD is sent with a continuation message.

2.16.2 BHS - batch header segment

The BHS segment defines the start of a batch.

HL7 Attribute Table - BHS – Batch Header

SEQLENDTOPTRP/#TBL#ITEM #ELEMENT NAME
11ST R  00081Batch Field Separator
23STR  00082Batch Encoding Characters
315STO  00083Batch Sending Application
420STO  00084Batch Sending Facility
515STO  00085Batch Receiving Application
620STO  00086Batch Receiving Facility
726TSO  00087Batch Creation Date/Time
840STO  00088Batch Security
920STO  00089Batch Name/ID/Type
1080STO  00090Batch Comment
1120STO  00091Batch Control ID
12 20ST   00092 Reference Batch Control ID 

2.16.2.0 BHS field definitions

2.16.2.1 BHS-1 Batch field separator (ST) 00081

Definition: This field contains the separator between the segment ID and the first real field, BHS-2-batch encoding characters. As such it serves as the separator and defines the character to be used as a separator for the rest of the message. Recommended value is |,(ASCII 124).

2.16.2.2 BHS-2 Batch encoding characters (ST) 00082

Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape characters, and subcomponent separator. Recommended values are ^~\& (ASCII 94,126, 92, and 38, respectively). See Section 2.8, “MESSAGE DELIMITERS.”

2.16.2.3 BHS-3 Batch sending application (ST) 00083

Definition: This field uniquely identifies the sending application among all other applications within the network enterprise. The network enterprise consists of all those applications that participate in the exchange of HL7 messages within the enterprise. Entirely site-defined.

2.16.2.4 BHS-4 Batch sending facility (ST) 00084

Definition: This field contains the address of one of several occurrences of the same application within the sending system. Absent other considerations, the Medicare Provider ID might be used with an appropriate sub-identifier in the second component. Entirely user-defined.

 

 

2.16.2.5 BHS-5 Batch receiving application (ST) 00085

 

 

Definition: This field uniquely identifies the receiving applications among all other applications within the network enterprise. The network enterprise consists of all those applications that participate in the exchange of HL7 messages within the enterprise. Entirely site-defined.

 

 

2.16.2.6 BHS-6 Batch receiving facility (ST) 00086

 

 

Definition: This field identifies the receiving application among multiple identical instances of the application running on behalf of different organizations. See comments BHS-4-batch sending facility. Entirely site-defined.

 

 

2.16.2.7 BHS-7 Batch creation date/time (TS) 00087

 

 

Definition: This field contains the date/time that the sending system created the message. If the time zone is specified, it will be used throughout the message as the default time zone.

 

 

2.16.2.8 BHS-8 Batch security (ST) 00088

 

 

Definition: In some applications of HL7, this field is used to implement security features. Its use is not yet further specified.

 

 

2.16.2.9 BHS-9 Batch name/ID/type (ST) 00089

 

 

Definition: This field can be used by the application processing the batch. It can have extra components if needed.

 

 

2.16.2.10 BHS-10 Batch comment (ST) 00090

 

 

Definition: This field is a comment field that is not further defined in the HL7 protocol.

 

 

2.16.2.11 BHS-11 Batch control ID (ST) 00091

 

 

Definition: This field is used to uniquely identify a particular batch. It can be echoed back in BHS-12-reference batch control ID if an answering batch is needed.

 

 

 

2.16.2.12 BHS-12 Reference batch control ID (ST) 00092

 

 

Definition: This field contains the value of BHS-11-batch control ID when this batch was originally transmitted.

 

Not present if this batch is being sent for the first time. See definition for BHS-11-batch control ID.

 

 

 

2.16.3 BTS - batch trailer segment

 

 

The BTS segment defines the end of a batch.

 

HL7 Attribute Table - BTS – Batch Trailer

 

 

SEQLENDTOPTRP/#TBL#ITEM #ELEMENT NAME
110STO  00093Batch Message Count
280STO  00090Batch Comment
3100NM OY 00095Batch Totals

2.16.3.0 BTS field definitions

2.16.3.1 BTS-1 Batch message count (ST) 00093

Definition: This field contains the count of the individual messages contained within the batch.

 

 

2.16.3.2 BTS-2 Batch comment (ST) 00090

 

 

Definition: This field is a comment field that is not further defined in the HL7 protocol.

 

 

2.16.3.3 BTS-3 Batch totals (NM) 00095

 

 

Definition: We encourage new users of this field to use the HL7 Version 2.3 data type of NM and to define it as “repeating.” This field contains the batch total. If more than a single batch total exists, this field may be repeated.

 

This field may be defined as a CM data type for backward compatibility with HL7 Versions 2.2 and 2.1with each total being carried as a separate component. Each component in this case is an NM data type.

 

 

2.16.4 DSC - continuation pointer segment

 

 

The DSC segment is used in the continuation protocol.

 

HL7 Attribute Table - DSC – Continuation Pointer

SEQLENDTOPTRP/#TBL#ITEM #ELEMENT NAME
       Continuation Pointer
        

 

 

      

 

 

 

1 180 ST O 00014

 

 

2 1 ID O 0398 01354 Continuation Style

 

 

 

2.16.4.0 DSC field definitions

 

2.16.4.1 DSC-1 Continuation pointer (ST) 00014

 

 

Definition: This field contains the continuation pointer. In an initial query, this field is not present. If the responder returns a value of null or not present, then there is no more data to fulfill any future continuation requests. For use with continuations of unsolicited messages, see chapter 5 and section 2.15.2, "Continuation messages and segments.” Note that continuation protocols work with both display- and record-oriented messages.

 

 

2.16.4.2 DSC-2 Continuation style (ID) 01354

 

 

Definition: Indicates whether this is a fragmented message (see Section 2.15.2, "Continuation messages and segments"), or if it is part of an interactive continuation message (see Section 5.6.3, "Interactive continuation of response messages").

 

 

Refer to HL7 Table 0398 – Continuation style code for valid values.

 

 

 

HL7 Table 0398 - Continuation style code

 

 

Value Description

 

 

 

F Fragmentation

 

I Interactive Continuation

 

 

 

 

 

 

 

 

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