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Openhub (STC Datagate) Dietary implementation

Dietary HL7 Documentation for TDS to DFM

Joe Morrow/UYS Inc

For more information, please contact Charlie Lunn at UYS Inc www.uysinc.com

 

This document is still a work in process and is subject to approval by all parties involved.   There a still a few issues not resolved.          After review, changes will be made and this document will be updated and sent out again.

 

Notable HL7 Differences

1.                 Note Segments are not supported

2.                 ODT segment otherwise known as Tray messages will not be supported.

3.                 This interface will follow the HL7 definition of a Diet Order “The ODS segment is intended to cover the basic diet definition of one diet code.  A diet can be ordered as a combination of one or more diet specifications, followed by any number of supplements and/or preferences.”   With the following exceptions.

A.                Nourishment’s (Supplements) will be sent as a separate Diet Order (ODS)

B.                Preferences will not be supported

4.                 Only one ODS will be sent with an ORC segment per a Diet Order.

5.                 A diet specification will be referred to as a modifier, which can be a diet, nourishment or modifier for a diet or nourishment.

6.                 The Diet (modifier or diet specification) will only use 4 digits (numeric)  (HL7 allows up to a 6 character identifier)

7.                 ORC fields 1,7, 9 and 10 will be used.

8.                 ORC field 1 –  This interface only supports NW (New Orders only)

9.                 ORC filed 7 (Quantity Timing) Duration is hardcoded to “C” for all orders are continuous and start date and time for NPO orders.

 

 

Notes

1.       Diets, Nourishment’s  are the same as modifiers.    Each Diet, Nourishment and Modifier must have a unique number assigned in order to be distinguished by DFM.

               The only difference is the numbering scheme (note 4) and the Diet or Nourishment is generally the first modifier in the list of modifiers sent to DFM..

               DFM will use this “list” of modifiers to build Diets and Nourishment’s on DFM.

2.                 Diets and Nourishment’s be each assigned a unique number range.   

3.                 The maximum acceptable identifier is 09999 by DFM.

4.                 The number tentative number range will be assigned as follows:

               00000-00999 TDS internal use, a Diet or Nourishment will never be sent to

                           DFM with an identifier in this range.

               01000-04999 Diet Modifiers

               05000-06999 Diets

               07000-08999 Nourishment Modifiers

               09000-09999 Nourishment’s

               There are special cases, for example:

                 00999 item is ignored by the interface

                00005 Start Date

                00006 Start Time

6.            ZAX will be used to identify Diets and Nourishment’s, while ZA item numbers will be used to identify modifiers.        Any other item appearing in the order message will set a flag in the RFT to print the entire order message as text (which will cause an alert  to print the text on DFM).    In addition ZA modifiers with a range of 00000-00998 will do the same with some exceptions.         This logic can be tuned or made more specific, once messages are actually sent to DFM.     We don’t want to miss anything.

5.                 HL7 specs refer to three types of Diet Order messages, Diet, Supplements and Preferences.   Supplements are the same as Nourishment’s, Preference are not supported by this interface

6.                 .Nourishment’s will be printed on DFM and are not treated like a Diet Order

7.                 When Text is sent to DFM,  the text is printed right away to notify Dietary that there is something special about this order.   Text, which may consist of Quantity and Comments, should be used at discretion.

8.                 Quantity, text and any item that is not a Diet, Nourishment or modifier must be sent in the text field ODS Sequence 4,  coding may need to be made to relate these items to the modifier when displayed in the text field. 

To resolve this for now, the RFT is coded to print the entire order message in the text

field, when there is any kind of elements in the message, which is not a Diet,

Nourishment or modifier.

9.                 DFM will accept a maximum of 10 modifiers (A Diet is treated like a modifier),   Diet orders with over 10 modifiers will error on DFM.

10.              Currently NPO Diet orders with a supplied date time is the only time that Start Date/Time will not be the same time that the order is entered.

11.              The Date and Time for NPO Diet orders are ZA Category Codes,  these must be distinguished from modifiers.    For now Date and Time are ZA 00005 and ZA 00006 respectively (in checkout)

12.               The only way to Cancel or DC an order to DFM is to file an NPO (which means stop feeding the patient).    There is no way to handle a DC/Cancel messages since TDS can have several Diet orders on file.

13.              Each Diet order sent to DFM, replaces the previous Diet order.   This brings out the issue that TDS allows the user to enter multiple Diet orders.    I will add MSS Bounding logic to handle this, so that all are sent to DFM for now.  (it may be only the last Diet sent that matters)

14.              A  Diet order can not be changed,   A New order must be entered on TDS for the interface to work properly.   If there is a way to change a diet order on TDS,   it may have to be changed to re-enter the full order?????

15.              The Delay Tray  messages (or Tray Messages) won’t be supported by the interface, since these messages are for Nursing not dietary.

16.              All Dietary Orders on TDS will be considered continuous.     No One Time orders.

17.              Service Periods 1=Breakfast, 2=Lunch, 3=Dinner will only be supplied for Diet orders,

             Any NPO ordered after:

                  5:30AM will begin for Lunch

                10:00AM will begin for Dinner

                  5:30PM will begin for Breakfast

 

18.              Nourishment scheduling options may have to be mapped to Service Periods. (BID,TID etc)  For now they will display as message text ODS Field 4.

19.              Allergies can be sent  when the allergies are entered.    This will have to be setup as a different interface message containing PID, AL1 with the patient type (usually sent with PV1)

20.              DFM allows the ability to assign allergies code 01-50.    If allergies are not assigned this way on TDS then the will be treated as text and printed on DFM.

21.              Isolation Codes and Pre-Cautions will be sent as part of Dietary Text Instructions causing alert and printing on DFM.

22.              If start date is not entered, start date will be assumed to be today’s date.

23.              If start time is not entered, start time will be assumed to be now.

24.              Nourishment scheduling text (QID, TID etc)  will be printed to as message text, since these meanings may represent several service periods.

25.              Nourishements can also be sent as a PEG.  The RFT will accommodate.


 

TDS Coding Changes

1.                 Since Modifiers and Text are separated from each other, additional matrix coding may be

2.                 needed to insure that text/quantity items are related to the Modifier.  (Unless we keep current logic which will print entire order in text message which will cause an Alert and printing on DFM).

3.                 Since Change Order is not supported,  Changes may need to be made so that the entire

            order is re-entered.

4.                 Identify category codes for Allergies, Isolation and Pre-Cautions.

5.                 Add Unique ZAX Code/Item number for all Diets and Nourishment’s.

6.                 Change all modifiers currently coded with a ZA 00000 to a unique number.

Note: Once messages are sent to DFM, certain items may have to be adjusted to display properly.   We may not know this until after messages are sent.


 

MSH Message Header Segment

MSH

 

Seq

 

 

Element Name

 

 

Description

ROC

 

Cat

Code

 

 

LEN

 

 

OpenHub

 

 

Sample

-

Segment Header

3-char unique message segment identifier

R

 

3

 

“MSH”

1

Field Separator

|

R

 

2

 

“|”

2

Encoding Characters

Component Separator

Repetition Character

Escape Character

Subcomponent Separator 

 

 

 

 

“$”

3

Sending Application

HCM

R

 

3

 

“HCM”

5

Receiving Application

DFM

R

 

3

 

“DFM”

7

Date/Time of Message

 

 

 

 

 

“199809061400”

9

Message Type

ID’s the message

R

 

 

 

“ORM$O01”

11

Processing ID

P=Prod (Hospital 1)

D=Development (Hospital 4)

 

HP#

1

 

“T”

12

Version ID

HL7 Version 2.1

R

 

3

 

“2.1”

-

End of Segment

 

R

 

 

 

 

 


PID Patient Identification Segment

PID

Seq

Element Name

 

Description

 

ROC

Cat

Code

 

LEN

 

OpenHub

 

Sample

-

Segment Header

3-char unique message segment identifier

R

 

3

 

“PID”

3

Internal Patient ID

 

Field Repeats 3 times.

Medical Record Number  and Sysid

Episode Number

 

Sysid -

Consists of TDS Hospital Number Plus Patient PDF Number

O

AEA

SYSID#

EPEN#

?????

10

5

 

“000012359987~0400000770~00001”

5

Patient Name

In TDS format.  

R

UA

30

 

“Doe, John”

18

Patient Account Number

 

R

AFN

???????

 

“70011116 ”

 


 

ORC Common Order Segment

ORC

 

Seq

 

 

Element Name

 

 

Description

ROC

 

Cat

Code

 

 

LEN

 

 

OpenHub

 

 

Sample

-

Segment Header

3-char unique message segment identifier

R

 

3

 

“ORC”

1

Order Control

Always NW New Order

R

 

2

 

“NW”

2

Placer Order Number

TDS Order Number (Not used by DFM)

O

 

 

 

“3.1”

7

Quantity/Time

 

 

 

 

 

 

 

1

Quantity (Not Used)

 

 

 

 

2

Interval (Not Used)

 

 

 

 

3

Duration

      C – Continuous

      O -  one-time

 

 

 

 

4

Start Date

Start Time

 

ZA0005

ZA0006

 

 

9

Date/Time order is entered

 

 

 

 

 

 

10

Entered By

User that Entered the Order

 

 

 

 

 

 

 

Notes

1.                 Order is always considered a New Order, Discontinues and Cancels are not supported,  A change

Order is sent as a New Diet Order.   Hold Order and Release Order  are not supported.  Trays may be held and released (Delay Tray) via Tray messages.

2.                 TDS Order Number is only supplied for reference and for future use.

7.                 All Diet Orders and Supplements on TDS are considered to be continuous.

Tray messages are not supported.

Start Date and Time is current date and time except for NPO Diet orders with a supplied start date and Time.


 

ODS Dietary Order Segment     

ODS

Seq

 

Element Name

 

Description

 

ROC

Cat

Code

 

LEN

 

OpenHub

 

Sample

-

Segment Header

3-char unique message segment identifier

R

 

3

 

“ODS”

1

Diet Type

D – Diet

S – Supplement  (Nourishment)

P – Preference (Not Supported)

R

 

1

 

“D”

2

Service Period

1 – Breakfast

2 – Lunch

3 – Dinner

Blank=Immediate

O

 

1

 

“ ”

3

Diet, Supplement or Preference Code   

 

 

Repeating Field. DFM takes up to 10.

 

 

 

 

 

 

“5000^NPO”

1

Identifier

?

 

?

 

 

2

Literal

?

 

?

 

“NPO”

-

End of Segment

 

 

 

 

 

 

 

Notes:

1.                 Diets and Supplements are supported while Preferences are not.

2.                 Service Period is always NULL (Order is to take affect immediately),

except for NPO orders with a supplied date and time.

If more than 10 modifiers are supplied, DFM will error the transaction, to be resolved by Dietary.

 

The AL1 Segment will be added to this documentation.

Sample Diet Order Messages

 

Sample NPO at Midnight Order

 

MSH[$+&[HCM[[DFM[[199809091620[MORROW, JOE                   [ORMO01[    

              [D[2.1]

PID[[[000012359987040000077000001[[DOE, JOHN      

                [[[[[[[[[[[[[70011116    ]

ORC[NW[A252-0017 1017.01[[[[[  

 C9809090001[199809091620[MORROW, JOE                   [MORROW, JOE   

               JMCD[]

ODS[D[1[5000NPO AT[ ]

 

Other Samples will be included in future updates