EDIS expects table (Encounter Create/Update?)

Add Booking - ADT^A05 - Trier -> HIH

Trier sends ADT^A05 message to HIH
Response is same A05 message with:
- PV1-19 field inserted, the unique identifier for the new record
- Additional OBX segment added indicating result, errors are sent back in this segment

Update Booking - ADT^A08 - Trier -> HIH

Trier sends ADT^A08 message to HIH
Response is same A08 message with:
- Additional OBX segment added indicating result, errors are sent back in this segment

Delete Booking - ADT^A38 - Trier -> HIH

Recommended not to use.

Trier sends ADT^A38 message to HIH
Response is same A38 message with:
- Additional OBX segment added indicating result, errors are sent back in this segment

Patient Search

Is this still necessary?

Demographic Search - Trier -> HIH

search by patient demographics and returns list of matching patients, including patient ids.

Sending type: QRY^A19^QRY_A19
- Set QRD-9 value = "APN"
Response type: ADR^A19^ADR_A19

Medical Record Number Query - Trier -> HIH

Search by MRN and return all patient demographics

Sending type: QRY^A19^QRY_A19
- Set QRD-9 value = "DEM"
Response type: ADR^A19^ADR_A19

HIH Sends Stuff

All EDIS Outbound HL7 messages generated by EDIS for SCGH will be sent to MEV
All webPAS Outbound messages generated by webPAS for SCGH ED will be sent to MEV

Conclusion: Need to read all message types

EDIS Output

EDIS Workflow/Function	Message Type

Creation of admission	A01	Admission/Visit Notification
Updating of admission

Discharge	A03	Discharge/End Visit
Discharge to Short Stay

Update Triage	A08	Update Patient Info
Update Clerical
Update Clinical
Update Admission
Update Transfer
Update Alert Screen

Triage deleted	A11	Cancel Admission
Admission date and time removed

Undischarge	A13	Cancel Discharge
Short Stay back to ED
Discharged Patient Unlinked

Triage Update	A31	Update Person Information
Clerical Screen Update
Alert screen update

Clinical Notes Created	MDM^T02	Original Document Notification and Content
Clinical Notes Updated
Clinical Notes Deleted

Discharge Patient - ADT^A03 - HIH -> EDIS

Transport Protocol

MLLP with TLS 1.2

Trier Integration Details

A05

Encounter Data Key	HL7 object key	Expected type	segment type
created	recorded_datetime		EVN
	patient_identifier_list?	object	PID
patient.lastName	patient_name.family_name
patient.firstName	patient_name.given_name
patient.dateOfBirth	datetime_of_birth	YYYYMMDD
patient.gender	administrative_sex	M/F
location	assigned_patient_location		PV1
	.point_of_care
	.facility
created	admission_datetime	YYYYMMDD
	patient_class	E (emergency?)

Comments

recorded_datetime - could also be the time of message creation and could be generated.

patient_identifier_list - for an A05 I think we can simply send a default value that indicates the id number is unknown.

Observations

example format

{
  value_type: 'ST', // atomic text result
  observation_identifier: {
    identifier: 'problem',
   name_of_coding_system: 'MEV'
  },
  observation_value: problem.patient,
  result_status: 'F' // TODO confirm correct value
}

Encounter Data Key	OBX structure
observation_value	value_type	identifier
problem.patient	ST	problem
problem.expect	ST	problem
problem.ambulance (to come)
pain	NM	pain scale
frailty	ST	frailty
patient.allergies.description	ST	allergies description
patient.allergies.severity	NM	allergies severity

value_types

ST - atomic text result
ED - full text report
NM - atomic numeric result
CWE - coded results (SNOMED or LOINC)

Trier Integration Using EDIS Expects Screen

For the first version of Trier, the proposed integration with EDIS uses the Expects Patient screen in EDIS. This Expects screen is how Trier will alert EDIS of incoming patients that registered with Trier.

Trier to EDIS by Expects

When a patient registers with Trier a new record will created in the EDIS Expects table by sending an ADT^A05 (an expect booking message). Trier will send this message with the following information:

Trier Info	Trier data key	EDIS Expects field	HL7 V2
patient brief description of problem	problem.patient	diagnosis/problem	OBX
patients pain score	pain	diagnosis/problem	OBX
how frail is patient	frailty	diagnosis/problem	OBX
patient allergies	patient.allergies.description	diagnosis/problem	OBX
severity	patient.allergies.severity	diagnosis/problem	OBX
surname	patient.lastName	surname	patient name (PID.1)
first name	patient.firstName	given name	patient name (PID.2)
date of birth	patient.dateOfBirth	DOB	datetime of birth (PID.7)
gender	patient.gender	Sex	sex (PID.8)
location	location		assigned patient location (PV1.3)

Trier will receive a response to the A05 message that includes a unique identifier for the created record in the EDIS Expects table.

If any patient information is updated in Trier. An ADT^A08 message will be sent to update the record in the EDIS Expects table. This update message will include the unique id for the record that needs to be updated.

EDIS to Trier

Our understanding for this first version is that triage will still be done in EDIS. Once triage is done in EDIS patient information can no longer be sent to EDIS by the expects screen. The expected process at this point is for EDIS to provide updated patient information to Trier through HL7 messaging. Trier will ingest these messages and update its internal database as necessary.

Trier is also expected to receive information on incoming patients that were first registered in EDIS. This is expected to arrive by an ADT^A01 message and Trier will use this information to create a new encounter in its system.

Finally, Trier expects to receive an ADT^A03 message when a patient is discharged and will use this information to complete the encounter in its system.

EDIS action	HL7 Message Type	Trier Action
create admission	ADT^A01	create encounter
cancel admission	ADT^A11	delete encounter
update: triage, clerical, clinical, admission, transfer, alert,	ADT^A08	update encounter
update: triage, clerical, alert,	ADT^A31	update encounter
create/update/delete clinical notes	MDM^T02	update encounter
cancel discharge	ADT^A13	update encounter
Discharge	ADT^A03	complete encounter

Inbound Messages Backend