Posted by Valerie Haley · Jul 24, 2017 at 1:37 PM

HL7 needs facility identifier

Hello, I'm from New York State, using our electronically reported lab data to analyze Candida auris cases. We need to analyze the data by facility, but we can't always identify where the person is at the time of specimen because the HL7 only requires patient billing address and submitting facility name/address. Sometimes we only see a lab name instead of the nursing home name or hospital name where the person was staying. How do others deal with this problem? Is there a possibility of adding facility identifying number/name where the specimen was drawn to the HL7?
Thanks,
Val Haley

Comments & Events

Afua Sanders Kim

Hello Val,

I am having a similar issue in NYC. We are working with several laboratories to see if we can add this information, or at least better identify the ordering provider.

Sincerely,
Afua
asanderskim@health.nyc.gov (mailto:asanderskim@health.nyc.gov)

Jul 24, 2017 at 1:52 PM Notified 60 people

Matthew Buck

Hello Valerie,

Just a thought, and I’m not sure if this would fully address what you’re looking for, but the OBR segment might have the fields that could serve as a proxy for this information.

OBR.10 (“Collector Identifier”) could be used to show the individual who obtained the sample and/or the assigned facility in which it was obtained. The fields appear to be mostly optional, so there could be a lot of flexibility in how you could apply it. Also, OBR.11 (“Specimen Action Code”) could also be applied in these circumstances with the action code of ‘O’ to show that ‘Specimen [was] obtained by service other than lab.’

I’ve included the data type tables, below:

OBR.10 – Collector Identifier
Extended Composit ID Number and Name for Persons

SEQ

LENGTH

DT

OPT

TBL #

NAME

XCN.1

15

ST

O

Id Number

XCN.2

194

FN

O

Family Name

XCN.3

30

ST

O

FirstName

Given Name

XCN.4

30

ST

O

Second And Further Given Names Or Initials Thereof

XCN.5

20

ST

O

Suffix (e.g., Jr Or Iii)

XCN.6

20

ST

O

Prefix (e.g., Dr)

XCN.7

5

IS

B

360

Degree (e.g., Md)

XCN.8

4

IS

C

297

Source Table

XCN.9

227

HD

O

363

Assigning Authority

XCN.10

1

ID

O

200

Name Type Code

XCN.11

1

ST

O

Identifier Check Digit

XCN.12

3

ID

C

61

Check Digit Scheme

XCN.13

5

ID

O

203

Identifier Type Code

XCN.14

227

HD

O

Assigning Facility

XCN.15

1

ID

O

465

Name Representation Code

XCN.16

483

CE

O

448

Name Context

XCN.17

53

DR

B

Name Validity Range

XCN.18

1

ID

O

444

Name Assembly Order

XCN.19

26

TS

O

Effective Date

XCN.20

26

TS

O

Expiration Date

XCN.21

199

ST

O

Professional Suffix

XCN.22

705

CWE

O

Assigning Jurisdiction

XCN.23

705

CWE

O

Assigning Agency Or Department

OBR.10 – Specimen Action Code
Specimen Action Code

VALUE

LABEL

A

Add ordered tests to the existing specimen

G

Generated order; reflex order

L

Lab to obtain specimen from patient

O

Specimen obtained by service other than Lab

P

Pending specimen; Order sent prior to delivery

R

Revised order

S

Schedule the tests specified below

I hope this helps!

Thank you,

Matthew Buck
Health Informaticist
Michigan Department of Health and Human Services
Direct Line – 517.284.4948

Jul 24, 2017 at 2:06 PM Notified 60 people

Amy Drake

Hi,
My understanding is that this info should theoretically be in the PV1 segment.
We get this segment from many labs, but it rarely contains useful information.

Does anyone else have any experience with data in this segment?
Amy

Jul 24, 2017 at 7:44 PM Notified 59 people

Nancy Barrett, Epi 4/PH Informatics Specialist

Have you all looked at ORC-13 Enterer's location? We do see that in our regular ELR, and it would indicate where the person was at the time of specimen collection pretty closely.

Jul 24, 2017 at 7:50 PM Notified 59 people

Scott Troppy, Surveillance Epidemiologist at MA DPH

Here are some thoughts from Team MA -

Currently, MDPH ‘s XSL HL7 transformer attempts to derive Ordering Facility information from 3 fields in the ORC segment:

ORC-21-1(Ordering Facility):

~~ORC-21-3 (ID Number (NM)): Depreciated~~

ORC-21-6-2 (Universal ID):

ORC-21-10 (Organization Identifier (ST):

- Ideally, for information consistency, MDPH would like to utilize CLIA number as the primary identifier for ordering facility however:

- Not all ordering facilities have a CLIA number
- Sending facilities do always incorporate the CLIA number of ordering facilities in their HL7 messages

- MDPH’s ELR Implementation Guide does not explicitly specify the ORC segment field that should be populated by ordering facility CLIA number

- The information sent in ORC-21-6-2 and ORC-21-10 is observed to greatly vary across sending facilities (CLIA number, OID, Ordering Facility Name, Not Populated etc.)

image.png 472 KB • Download

Scott

Jul 25, 2017 at 5:44 PM Notified 58 people

Nancy Barrett, Epi 4/PH Informatics Specialist

Scott and others, you can make your local guide accept CLIA or OID for Universal ID type -- we did this when we developed our ELR NIST validation tool. although labs may vary, you can request they use CLIA preferably.

👏

Jul 25, 2017 at 6:43 PM Notified 58 people

Afua Sanders Kim

At New York City we use the ordering facility field and request CLIA and/or NPI. We are having problems identifying the initial ordering facility if the specimen is referred more than once though. Have you encountered similar issues? The ordering provider sometimes, but not always offers some clues.

Afua Sanders Kim
asanderskim@health.nyc.gov

Jul 25, 2017 at 8:37 PM Notified 58 people