SKYLIGHT ACCESS HL7 INTERFACE SPECIFICATION

TABLE OF CONTENTS
INTRODUCTION .............................................................................................................................................................3 GENERAL OVERVIEW ...................................................................................................................................................4 TECHNICAL OVERVIEW ................................................................................................................................................6 COMMUNICATION PROTOCOLS ...................................................................................................................................6 MINIMAL LOWER LAYER PROTOCOL..........................................................................................................................7 HOST NAMES, IP ADDRESS, AND PORT NUMBERS FOR TEST AND PROD.....................................................................7 ADMIT, DISCHARGE, AND TRANSFER INTERFACE .......................................................................................................8 MESSAGE HEADER SEGMENT (MSH) ........................................................................................................................11 EVENT TYPE SEGMENT (EVN)...................................................................................................................................12 PATIENT IDENTIFICATION SEGMENT (PID)...............................................................................................................13 PATIENT VISIT SEGMENTS (PV1 & PV2)...................................................................................................................14 PATIENT DIAGNOSIS (DG1 & DRG) ..........................................................................................................................15 ALLERGY SEGMENT (AL1).........................................................................................................................................16 MERGE PATIENT INFORMATION SEGMENT (MRG)..................................................................................................17 Z SEGMENTS ...............................................................................................................................................................17 APPENDIX A: RELATED DOCUMENTS/REFERENCE MATERIALS ...............................................................................18

LIST OF TABLES
TABLE 1: HOST NAMES, IP ADDRESSES AND PORT NUMBERS FOR TEST AND PROD .................................................7 TABLE 2 : ADT EVENTS ................................................................................................................................................8 TABLE 3: A01 ADMISSION EVENT EXAMPLE .................................................................................................................9 TABLE 4: MESSAGE HEADER SEGMENT (MSH).........................................................................................................11 TABLE 5: EVENT TYPE SEGMENT (EVN)....................................................................................................................12 TABLE 6: PATIENT IDENTIFICATION SEGMENT (PID)..................................................................................................13 TABLE 7: PATIENT VISIT 1 SEGMENT (PV1)...............................................................................................................14 TABLE 8: PATIENT VISIT 2 SEGMENT (PV2)...............................................................................................................14 TABLE 9: DIAGNOSIS INFORMATION SEGMENT (DG1) ...............................................................................................15 TABLE 10: ALLERGY SEGMENT (AL1) ........................................................................................................................16 TABLE 11: MERGE PATIENT INFORMATION SEGMENT (MRG)...................................................................................17

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INTRODUCTION
This document has been prepared to provide a specification for the HL7 ADT (Admit, Discharge and Transfer), which will be sent outbound from your hospital system(s) to Skylights ACCESS application. The intended audience for this document is: Healthcare Provider Customers Business Analysts Technical Personnel Vendor Partners

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GENERAL OVERVIEW
The HL7 ADT Standard Interface from an ADT system through an Interface Engine provides information to the Skylight Healthcare system, which transforms existing patient television sets into an interactive entertainment and communication platform. This interface allows hospital staff to provide patient services via ACCESS functionality. Such services include:

Welcome video to all new admits Message n hours after admit Daily scheduled messages 3rd party Survey integration 3rd party Dietary system integration Parental permission control clearing at point of discharge or new admit Transfer of Services Billing Services (if using bill to home phone option) Optional Patient Specific Events (Health Education Reporting)

If there is no standard ADT feed available for use with the ACCESS system the following rules apply. Data activity will be tracked at the location (Room/Bed) level and no patient specific data can be recorded and health education viewing will be generalized by ward. If a customer has chosen to charge for enhanced entertainment, Billing Services are limited to Credit Card and Gift Card If a customer has chosen to charge for enhanced entertainment, Transfer of Services between rooms will need to be called into our 24 hour support center and the transfer will be manually done Triggered event messaging will not be allowed

If there is an ADT feed available the following rules apply based on the hospitals level of product participation. These services are available with the basic ADT feed which is defined later in this document. If a customer has chosen to charge for enhanced entertainment, Transfer of Services between rooms will automatically be done. Use of triggered event messaging will be allowed (Optional Feature)

The additional features may be added on to the ACCESS system but will require an extension of the ADT data set be transmitted. Patient specific activity reporting requires the additional PID sequence noted fields on the detailed PID sequence table included below.

The following rules apply with Skylight Healthcare Systems with regard to handling of ADT data transmitted. 1. The Skylight Healthcare Systems ignores all fields not specifically used for the ACCESS system and prefers that the data transmitted only carries the sequences required. 2. Skylight Healthcare Systems typically maintains patient specific reporting data for only 30 days after discharge, but will extend this date upon hospital request and signoff.

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3. The ACCESS Systems is a receiving data only system and does not transmit into your hospital system with the exception of sending an acknowledgement that it received an HL7 message. Skylight treats transactions as admits, discharges or updates. If the patient does not exist in the Skylight database, the transaction creates the patient as an admit. If the patient is transferred to a bed not in Skylight, the patient is treated as a discharge. If the patient exists in Skylight, the transaction is an update.

Below are general assumptions, limitations and restrictions about the interface. This specification describes a real-time interface between the your interface engine and Skylight ACCESS All interface messages are in HL7 format, version 2.4. Note: Skylight will work with customers who are not able to provide HL7 V2.4 messages. All data from the registration system flows through the interface engine on its way to the ACCESS System.

Unless otherwise indicated, the following terms have the specified meaning in this document: Interface Engine ADT Interface Engine ACCESS Skylight Healthcare Application

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TECHNICAL OVERVIEW
The interface engine is a store-and-forward system. It receives HL7 transactions from an ADT system and passes the HL7 transactions onto the receiving application. All communication between the interface engine use TCP/IP protocols. Serial (RS-232) interfaces are not supported. The illustration below, Communication Overview Diagram, provides a high level overview of the interfaces supported by this implementation. Figure 1: Communication Overview Diagram

Communication Protocols
Communication between the interface engine and Skylight Healthcare uses HL7 version 2.4 encoding, with the HL7 minimal lower-level protocol and the TCP/IP protocol suite. Message transport is handled by the TCP/IP protocol suite, with physical connection via twisted pair (100 or 10 Mbps) or thin ethernet (10 Mbps). Data is formatted according to the HL7 version 2.4 standard, using the HL7 minimal lower layer protocol" without sequence numbers, but using the Message Control ID to associate messages and their acknowledgements. The sequence of events for sending an HL7 message from the interface engine to the receiving system is: 1. The interface engine opens a TCP connection (stream) to the receiving system. 2. The interface engine sends an HL7 message, according to the minimal lower layer protocol. The engine keeps the TCP connection open after sending the HL7 message. 3. The receiving system processes the message and returns a normal (not enhanced) acknowledgment message to the engine. 4. The engine closes the TCP connection to the receiving system. If the engine wishes to do so, it may leave the TCP connection open, going from step 3 back to step 2 for the next message. Only one HL7 conversation (data stream) may occur on each TCP port.

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HL7 messages include only normal data messages. Since the sequence numbers are not used, there are no initialization messages. The receiving system recovers from temporary TCP outages without human intervention and reestablishes communication with the interface engine based on your interface engine guidelines. For full details of the HL7 protocol, refer to http://www.hl7.org.

Minimal Lower Layer Protocol

The HL7 minimal lower layer protocol is documented here (in addition to the HL7 official documents) because draft (free) versions are not distributed by HL7. The full HL7 standard, excluding the lower layer protocol, is available via the HL7 web site. Let "X" be an HL7 message, consisting of an MSH segment followed by zero or more other segments. For the minimal lower layer protocol, message X is surrounded by additional characters so that the full message is now "sXer", where "s" is the ASCII vertical tab (VT) character, having decimal value 11; "e" is the ASCII field separator (FS) character, having decimal value 28; and "r" is the ASCII carriage return (CR) character, having decimal value 13. Since both the vertical tab and field separator characters are forbidden inside an HL7 message, these characters allow the receiver to positively identify the start and end of an HL7 message.

Host Names, IP Address, and Port Numbers for Test and Prod
The table below lists the machine host names, IP Address and Port Numbers that will be used by this interface for data sent from the interface engine to the Skylight ACCESS System. Skylight utilizes ACCESS control lists. Interface engine IP address changes that affect the ACCESS interface must be communicated to the ACCESS ADT Manager. Table 1: Host names, IP Addresses and Port Numbers for Test and Prod

IP ADDRESSES AND PORT NUMBERS FOR TEST AND PRODUCTION

Engine to GWTV Test Prod Host Name Receiving IP Address of ACCESS Port Number Determined by customer Determined by customer

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ADMIT, DISCHARGE, AND TRANSFER INTERFACE

Admit, Discharge, and Transfer messages identify patients within the hospital as well as their locations. This information is critical to the successful functionality of the Skylight ACCESS System. A successful interface with a Hospital Information System that provides this data will occur as close to real-time as possible. The HIS is expected to trigger ADT events for transmittal to the Skylight ACCESS without solicitation. The Skylight ACCESS System supports HL7 ADT events and at a minimum needs the following events if in use at the facility: Table 2 : ADT Events

ADT EVENTS
ADT Message Code
A01 A02 A03 A04 A061 A07 A08 A11 A12 A13 A16 A21 A22 A23 A25 A342 A352 A362 A402 A412 A47 A49
1 2

ADT Message Description

Admit a patient Transfer a patient Discharge a patient Register a patient Transfer outpatient to inpatient Transfer inpatient to outpatient Update patient information Cancel admit Cancel transfer Cancel discharge Pending Discharge Patient Goes on a Leave Of Absence Patient Returns From a Leave Of Absence Delete a Patient Record Cancel Pending Discharge Merge patient information - patient ID only Merge patient information - account number only Merge patient information - patient ID & account number Merge Patient Internal ID Merge Account Number Change Internal ID Change Patient Account Number

Skylight to Process
Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Needs careful review to address site-specific processes. Currently, these merge events are only minimally processed by the Skylight ACCESS System. The patient record is updated, but a true merge (i.e. orders, account information) is not permitted. Testing of this functionality requires additional review and testing on a site-specific basis

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There is no need for the HIS to hold any ADT event. Any messages received that are not processed will be ignored. Currently, these merge events are only minimally processed by the Skylight ACCESS System. The patient record is updated, but a true merge (i.e. orders, account information) is not permitted. Testing of this functionality requires additional review and testing on a site-specific basis The Skylight ACCESS System accepts the MSH, EVN, PID, PV1, PV2, AL1, DG1, and MRG segments for ADT transactions. The MSH, EVN, PID, PV1, and MRG are required. All other segments are optional but are recommended to be sent if available. The HL7 Data Exchange Specification discusses which segments are appropriate for which ADT events. In general, an ADT message will follow the proceeding format. When a patients visit is terminated, whether discharged, expired, or outpatient released, a discharge message (A03) should be sent. Note: This document describes only those segments that have fields that are processed by the Skylight ACCESS System. This document, in most cases, does not describe individual field components. For a more detailed description of field components and subcomponents, reference and comply with the HL7 Standard for Data Exchange, version2.3.

Table 3: A01 Admission Event Example

A01 EXAMPLE
ADT A013 MSH EVN PID PV1 [ PV2 ] [ { AL1 } ] [ { DG1 } ] Message Header Event Type Patient Identification Patient Visit Patient Visit Additional Info. Allergy Information Diagnosis Information ADT Message R R R R O ROC ROC Required

The above example represents an A01 (admission event). Not all segments are present in all events. However, the R (required) segments as shown above must be in all ADT messages. R (Required): Indicates the segment identified is required for proper patient identification. Also, a segment may be optional, but if sent, this field is required. ROC (Required On Condition): Indicates that this segment/field is required if the data is available or may be required under specific conditions. O (Optional): Indicates the segment identified is strongly desired, but is not absolutely required and can be considered optional. Segments and fields identified as optional should always be sent if available. Reserved characters (~, ^, &, |) cannot be sent in any text defined field. These characters must be converted to the appropriate escape sequence prior to being sent to ACCESS.

Source: Health Level 7 Standard for data exchange, version 2.3

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The Escape Sequence Identifier (\) should not be sent unless it is part of a true escape sequence (.i.e \T\,\S\, \F\, etc.). A blank or null field indicates no change to the existing value. To delete an existing value concurrent quotes ( ) must be sent.

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MESSAGE HEADER SEGMENT (MSH)

This table identifies the specific data elements that are most important to the Skylight ACCESS System as contained within the PID segment. This table is presented for reference. Skylight requests that the HIS vendor identify any fields that may not be supported prior to implementation. This will allow both parties to make the appropriate determination on any additional work that may be required. The HL7 specification defines the message header in the following manner; The MSH segment defines the intent, Source, destination, and some specifics of the syntax of a message. This is a very critical piece of the information that is transferred between the systems. The table below identifies the standard fields in the MSH segment and which ones are required or optional to the ACCESS System. Table 4: Message Header Segment (MSH)

MESSAGE HEADER SEGMENT (MSH)

HL7 Field 001 002 003 004 005 006 007 008 009 0010 0011 Description Field Separator Encoding Characters Sending Application Sending Facility Receiving Application Receiving Facility Date/Time Of Message Security Message Type Message Control ID Processing ID HL7 Required R R O O O O O O R R R Stored in Skylight N N Yes Yes N N Yes N Yes Y Y Notes

Hospital Number

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EVENT TYPE SEGMENT (EVN)

The EVN segment is used to communicate necessary trigger event information to receiving applications. Valid for all ADT event types.

Table 5: Event Type Segment (EVN)

EVENT TYPE SEGMENT (EVN)

HL7 Field 00099 00100 Description Event Type Code Recorded Date/Time R O HL7 Required Yes Yes Stored in Skylight Notes

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PATIENT IDENTIFICATION SEGMENT (PID)

This table identifies the specific data elements that are most important to the Skylight ACCESS System as contained within the PID segment. This table is presented for reference. Skylight requests that the HIS vendor identify any fields that may not be supported prior to implementation. This will allow both parties to make the appropriate determination on any additional work that may be required. Table 6: Patient Identification Segment (PID)

PATIENT IDENTIFICATION SEGMENT (PID)

No. 1 HL7 Field 00104 Description Patient Set ID identifies this transaction Patient ID (External) Patient ID (Internal) mapped to Skylight ACCESS Medical Record Number Alternate Patient ID Patient Name Date/Time of Birth Patient Sex (Male, Female, Other,Unknown) Patient Address HL7 Required O Stored in SkyLight Y Notes

2 3

00105 00106

O R

Y Y

External ID Medical Record Number

4 5 7 8

00107 00108 00110 00111

O R ROC ROC

N Y Y Y

Alternate ID LastName^FirstName^MiddleInitial Suffix^Prefix Birth Date Gender (M, F, O, U)

11

00114

Addreess1^Address2^City^State^Zi p^Country^^^County

13 15 18 29

00116 00118 00121 00740

Phone Number Language Patient Account Number Date/Time of Death

O O R O

Y Y Y Y

Account Number Death Date

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PATIENT VISIT SEGMENTS (PV1 & PV2)

This table identifies the specific data elements that are most important to the Skylight ACCESS System as contained within the PV1 & PV2 segments. This table is presented for reference. Skylight requests that the HIS vendor identify any fields that may not be supported prior to implementation. This will allow both parties to make the appropriate determination on any additional work that may be Table 7: Patient Visit 1 Segment (PV1)

PATIENT VISIT 1 SEGMENT (PV1)

No. 1 2 3 6 7 10 16 38 44 45 HL7 Field 00131 00132 00133 00136 00137 00140 00146 00168 00174 00175 Description Patient Set ID Patient Class Patient Location Prior Patient Location Attending Doctor Hospital Service VIP Indicators Diet Type Admit Date/Time Discharge Date/Time HL7 Required O R O O O O O O R ROC Stored in Skylight Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Notes Identifies this transaction (ER, In, Out, PreAdmit, Recurring, OB)

Table 8: Patient Visit 2 Segment (PV2)

PATIENT VISIT 2 SEGMENT (PV2)

No. 3 9 10 11 HL7 Field 00183 00189 00711 00712 Description Admit Reason Expected Discharge Date Estimated Length of Stay Actual Length of Stay HL7 Required O O O O Stored in Skylight Yes Yes Yes Yes Notes

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PATIENT DIAGNOSIS (DG1 & DRG)

This table identifies the specific data elements that are most important to the Skylight ACCESS System as contained within the DG1 & DRG segments. This table is presented for reference. Skylight requests that the HIS vendor identify any fields that may not be supported prior to implementation. This will allow both parties to make the appropriate determination on any additional work that may be required. This segment is valid only in the these ADT message types that are processed by Skylight: A01, A03, A04, A06, A07, A08,A11, A12, A13, A16. Table 9: Diagnosis Information Segment (DG1)

DIAGNOSIS INFORMATION SEGMENT (DG1)

No. 1 2 3 4 5 6 8 HL7 Field 00375 00376 00377 00378 00379 00380 00382 Description Set ID - DG1 Diagnosis Coding Method Diagnosis Code Diagnosis Description Diagnosis Date/Time Diagnosis/DRG Type Diagnostic Related Group HL7 Required O R R R O R O Stored in Skylight Yes Yes Yes Yes Yes Yes Yes Notes Seq. Number 2-Digit Coding Method

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ALLERGY SEGMENT (AL1)

This table identifies the specific data elements that are most important to the Skylight ACCESS System as contained within the AL1 segment. This table is presented for reference. Skylight requests that the HIS vendor identify any fields that may not be supported prior to implementation. This will allow both parties to make the appropriate determination on any additional work that may be required. This segment is valid only for ADT message types that are processed by Skylight: A01, A04, A06, A07, A08, A13. Table 10: Allergy Segment (AL1)

ALLERGY SEGMENT (AL1)

No. 1 2 3 4 6 HL7 Field 00203 00204 00205 00206 00208 Set ID Allergy Type Allergy Description Allergy Severity Date allergy was identified Description HL7 Required O O R O O Stored in Skylight Yes Yes Yes Yes Yes Notes Seq. Number (Drug, Food, Miscellaneous) (Some facilities use a code)

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MERGE PATIENT INFORMATION SEGMENT (MRG)

This segment is only required on patient merge message types (A34, A35, A36, A40, and A41). It contains the patients prior visit information. Only the data required by Skylight to process the MRG segment is included here. Table 11: Merge Patient Information Segment (MRG)

MERGE PATIENT INFORMATION SEGMENT (MRG)

No. 1 3 HL7 Field 00211 00213 Description Patients Prior MRN Patients Prior Account Number HL7 Required R R Stored in Skylight Yes Yes Notes

Z SEGMENTS
Z segments are custom to each site and are not typically processed by ACCESS. These segment types should not be sent without prior discussion with, and approval by, Skylight Healthcare Systems, Inc.

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APPENDIX A: RELATED DOCUMENTS/REFERENCE MATERIALS

1. HL7 Web Site: http://www.hl7.org 2. Information Technology HL7 Interface Engine Standard HL7 Version 2.4. 9.2 Ed. 3. Skylight Systems. Skylight Systems GetWellTV ADT Requirements. San Diego: Skylight Systems, April 21, 2005 (Note: Effective 6/23, Skylight Systems is now Skylight Healthcare Systems and the product formerly known as GetWellTV is now Skylight ACCESS.)

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