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The referral request will consist of an XDM package containing:
<div class="clr-fig-caption">Figure 7.1: 360X compliant transport protocol and referral request payload</div> |
<div class="clr-fig-caption">Figure 7.2: 360X compliant application providing a single message to accommodate both 360X compliant and legacy recipients</div> |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.21^ISO||^1.3.6.1.4.1.21367.2016.10.1.32^ISO|20160930153834+0000||OMG^O19^OMG_O19|17882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|NW|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO||||||||||34225PC^Allen^Anthony^M^III^MD^^^&1.3.6.1.4.1.21367.2016.10.1.21.10&ISO^L^^DN| TQ1||||||||20161018235959+0000| OBR||889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO||57133-1^^LN||||||||||||34225PC^Allen^Anthony^M^III^MD^^^&1.3.6.1.4.1.21367.2016.10.1.21.10&ISO^L^^DN|||||||||||||||^Rule out headache^| |
The 360X referral request package SHALL contain a C-CDA document for the related clinical information. The C-CDA is represented as a distinct document entry object in the XDM metadata, and it shall be present as a separate file within the XDM structure, with a file extension of .xml.The following spreadsheet contains the analysis of available C-CDA document and section templates:
The XD metadata will represent the following information which includes and augments the data defined in the paragraph above, for the initial referral request. Defined below is the meta data for
| Attribute | Purpose within 360X | Source data | R/RE/C/O (Source of Requirement) |
| author | MUST indicate the message sender as a slot named "authorTelecommunication", see Extensions. When converted from an RFC 5322 message, MUST indicate the value of the from the header. Even though the authorPerson slot is required by IHE, since authorTelecommunication is valued the authorPerson may be omitted. | R (XDR and XDM for Direct Messaging) | |
| intendedRecipient | Recipient of the referral message – person, department, institution. Contains the Direct address. MUST indicate the message receiver. When converted from RFC 5322, MUST carry the recipient address. See Extensions for how to carry the Direct Address. Note that this is not necessarily the provider who will perform or is asked to perform the referral; it is simply the message recipient which is negotiated at the time of implementation. | Direct Address from the SMTP message handler | R (XDR and XDM for Direct messaging) |
| patientId | Per IHE for XD*, the patientId is as defined in context of the document registry (i.e. known to the message recipient), whereas the sourcePatientId (on the document entry) is in the context of the message initiator. The submission set patientId MUST be identical to the Document Entry patientId. Note per above, source is PID-3 segment of the HL7 V2 OMG message where the value from the list of identifiers is the ID as known to the referral request recipient. If not known, this value may be empty. See the discussion on patient identifiers in section 3.4 | R2 XDR and XDM for Direct messaging) | |
| submissionTime | Point in time, as defined at the initiator of the message, of when the submission set was created. Shall be a single value. | R (XDM and XDR for Direct Messaging) | |
| uniqueId | Globally unique ID for the submission set. The format is an OID per IHE, assigned by the message initiator. This ID MUST be different than the uniqueId for any documentEntry. | Generated and assigned by message initiating technology | R (XDM/XDR) |
| contentTypeCode | Describes the content of the submissions set | 57133-1 LOINC code indicates that this is a referral request | R (360X) |
The document for the initial referral request SHALL be the HL7 V2 order message OMG^O19^OMG_O19 defined in section 3.1.1 in the Closed Loop Referral Implementation Guide: HL7 V2 message Payload Definition in Appendix C. Example message can be found in that document.
The XD meta data for the document entry, based on the minimal XDR data set and extended as needed for 360X is defined below.
| Attribute | Purpose within 360X | Required (Source of Requirement) | Corresponding HL7 Field/Component/Subcomponent | ||
| author | If supplied, MUST indicate the document's (order) author, which may be different from the message sender. For the order, this is the clinician who is requesting the referral. | >R2 (XDR and XDM for Direct Messaging) | Ordering Provider in ORC-12 | ||
| classCode | Identifies the specific document type, in this case an HL7 V2 Order. See also typeCode which further refines the class definition and should not be ambiguous | R (360X) (R2 XDR and XDM for Direct Messaging) | Message Type in MSH-9.1 (OMG) | ||
| confidentialityCode | Identifies the confidentiality defined for the order. Implementations SHOULD NOT use codes that reveal the specific trigger causes of confidentiality (e.g., ETH, HIV, PSY, SDV) | R2 (XDR and XDM for Direct Messaging) | Confidentiality Code in ORC-28 Implementations SHOULD constrain to values that do not reflect the cause of confidentiality such as: V Very restricted R Restricted U Usual control | ||
| creationTime | Defines the creation time of the message (vs. the order) | R2 (XDR and XDM for Direct Messaging) | Date/Time of Message in MSH-7 | ||
| entryUUID | The identifier used for referencing the Document Entry object within the metadata | R (XDR and XDM for Direct Messaging) | N/A | ||
| eventCodeList | This list of codes represents the main clinical acts which does not conflict with the class and type codes. In this case, extends the document type (classCode=OMG, type=O19) to define the specific service requested. | O (IHE XDR) | Universal Service Identifier in OBR-4, CWE_2.1 Where XDR classification scheme is name of coding system in CWE_2.3 | ||
| formatCode | Globally unique identifier specifying the format of the document (referral request/order) to allow systems to determine if / how to process. For 360X can be formed from MSH-9 Message Type MSH-12 Version ID MSH-21 MessageProfileIdentifier | R (360X) | OMG^O19_2.5.1_360XReferralRequest | ||
| healthcareFacilityTypeCode | See also practice setting type. This code represents the type of organizational setting of the clinical encounter during which the documented act occurred. Note that in context of 360X, this is the facility type of the Referral Request Initiator. | R2 (XDR and XDM for Direct) | Should be derived from / mapped to the information in ORC-21 through 24 | ||
| languageCode | Specifies the language of the document (order / referral request) | R2 (XDR and XDM for Direct) | Principal Language of Message in MSH-19 | ||
| mimeType | The MIME type of the document | R (XDR and XDM for Direct Messaging) | x-application/hl7-v2+er7 | ||
| patientId | See also sourcePatientID. patient ID MUST be the same as the patientID in the submission set (which, not does not include the sourcePatientID) and all document entries. Per IHE, is the ID as known to the referral request recipient / target document registry, if known. | R2 (360X) (R2 XDR and XDM for Direct Messaging) | The patientID in context of the message recipient (referral request recipient), if known, from the PID-3 list in the order. Referral request acceptance/responses will include a sourcePatientID (ID in context of referral request recipient) which the initiator shall use as patientID in subsequent transactions to aid in matching. | ||
| sourcePatientId | See also Patient ID. The sourcePatientID is the ID as known by the document submitter (in this case, the referral request initiator). This ID Shall be the same as that for the C-CDA document meta data. | R (360X) | The patient ID in the PID-3 list that represents the referral request initiator’s patient ID. | ||
| sourcePatientInfo | Relevant patient demographics such as last name, first name, sex, DOB that may help in matching (electronically or by a person) if IDs are insufficient. | R2 per XDR, O per IHE?? | PID-5, PID-7, PID-8 content should be used. | ||
| practiceSettingCode | Identifies the setting that created the order at a high granularity e.g., Cardiology, FamilyPractice. Should not create ambiguity as compared to healthcareFacilityTypeCode. | R2 (XDR and XDM for Direct) | Should be derived from/mapped to the information in ORC-21 through 24 | ||
| typeCode | Further refines classCode and should not make ambiguous. Defines the specific HL7 V2 message event type, for this message it is O19 | R (360X) | MSH-9.2^9.3 OMG^O19^OMG_O19 | ||
| uniqueId | Globally unique identifier assigned to the document by its creator. | R (XDR and XDM for Direct Messaging) | May be based on Message Control ID in MSH-10 | ||
The Document Entry metadata is usually derived from the C-CDA header, as shown in the table below:
| Attribute | Purpose within 360X | Required (Source of Requirement) | Corresponding C-CDA element |
| author | If supplied, MUST indicate the document's author, which may be different from the message sender. For the order, this is the clinician who is requesting the referral. Note that C-CDAs are often multi-authored and author may be defaulted in the document. | R2 (XDR and XDM for Direct Messaging) | Author entry in US Realm header. |
| classCode | Identifies the specific document type, in this case a C-CDA template (e.g., CCD, SOEN, Referral Note). See also typeCode which further refines the class definition and should not be ambiguous | R (360X) (R2 XDR and XDM for Direct Messaging) | Type ID entry in US Realm header. |
| confidentialityCode | Identifies the confidentiality defined for the document. Implementations SHOULD NOT use codes that reveal the specific trigger causes of confidentiality (e.g., ETH, HIV, PSY, SDV) | R2 (XDR and XDM for Direct Messaging) | ConfidentialityCode in US Realm Header |
| creationTime | Defines the creation time of the document (vs. the message) | R2 (XDR and XDM for Direct Messaging) | effectiveTime in US Realm Header |
| entryUUID | Globally unique identifier UUID for the document as assigned by the message sender and used only in the XD* handling. | R (XDR and XDM for Direct Messaging) | N/A |
| formatCode | Globally unique identifier specifying the format of the document to allow systems to determine if / how to process. | R (360X) | Per the C-CDA specificaiton |
| healthcareFacilityTypeCode | See also practice setting type. This code represents the type of organizational setting of the clinical encounter during which the documented act occurred. Note that in context of 360X, this is the facility type of the Referral Request Initiator. | R2 (XDR and XDM for Direct) | N/A |
| languageCode | Specifies the language of the document (order / referral request) | R2 (XDR and XDM for Direct) | languageCode of US Realm Header |
| mimeType | The MIME type of the document | R (XDR and XDM for Direct Messaging) | Currently the MIME type for CDA documents is simply "text/xml" |
| patientId | See also sourcePatientID. patient ID MUST be the same as the patientID in the submission set (which, not does not include the sourcePatientID) and all document entries. Per IHE, is the ID as known to the referral request recipient / target document registry, if known. | R2 (360X) (R2 XDR and XDM for Direct Messaging) | N/A |
| sourcePatientId | See also Patient ID. The sourcePatientID is the ID as known by the document submitter (in this case, the referral request initiator). This ID Shall be the same as that for the C-CDA document meta data. | R (360X) | targetID in US Realm Header |
| sourcePatientInfo | Relevant patient demographics such as last name, first name, sex, DOB that may help in matching (electronically or by a person) if IDs are insufficient. | R2 per XDR, O per IHE?? | Elements in patient section of US Realm Header such as name, administrative sex, birth time, etc. |
| practiceSettingCode | Identifies the setting that created the order at a high granularity e.g., Cardiology, FamilyPractice. Should not create ambiguity as compared to healthcareFacilityTypeCode. | R2 (XDR and XDM for Direct) | Should be derived from/mapped to the information in ORC-21 through 24 |
| typeCode | Further refines classCode and should not make ambiguous. Defines the specific C-CDA document type such as <code code="34133-9" displayName="Summarization of Episode Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" /> | R (360X) | Code element from the US realm header |
| uniqueId | Globally unique identifier assigned to the document by its creator. | R (XDR and XDM for Direct Messaging) | Id element (Globally unique identifier) in US realm header |
<div class="clr-fig-caption">Figure 7.3: 360X compliant transport protocol and accept payload</div> |
Meaningful use content is not required for this step in the process.
| Attribute | Source | Expectations |
| sourceId | MSH-4 | R |
| patientId | PID-3 | R |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
Example:
XDM package for an Accept Response
Example:
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161003092015+0000||OSU^O51^OSU_O51|19882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|OK|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO|||IP|||||||| |
The decline referral payload is the other possible REQUIRED response to the referral request in the referral process. It is necessary to indicate to the initiator that the transfer of patient care will not be occurring with the declining provider. By declining the referral, the receiver will NOT be expected to perform the treatment and/or provide the requested input per the specified reason for referral in the referral request. This payload will consist of a XDM package (containing an HL7 status update message and associated metadata) as described below.
<div class="clr-fig-caption">Figure 7.4: 360X compliant transport protocol and decline payload</div> |
Meaningful use content is not required for this step in the process.
| Attribute | Expectations |
| sourceId | MSH-4 |
| patientId | PID-3 |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
Example:
Example:
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161003092015+0000||OSU^O51^OSU_O51|22882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|UA|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO|||CA||||20130629074500|||||||^Unable to schedule patient within the timeframe requested| |
<div class="clr-fig-caption">Figure 7.5: 360X compliant transport protocol and scheduled notification payload</div> |
Meaningful use content is not required for this step in the process.
| Attribute | Expectations |
| sourceId | MSH-4 |
| patientId | PID-3 |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161004142352+0000||SIU^S12^SIU_S12|31882|P|2.5.1|||NE|NE|||||360X| SCH||18467^^1.3.6.1.4.1.21367.2016.10.1.32.14^ISO||||57133-1^^LN||||||||||^Name^Registrar||||^Name^Enterer||||||889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO| TQ1|||||||20161009140000+0000|20161009143000+0000| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| RGS|1|A| AIP|1||^Brown^Beatrice| |
<div class="clr-fig-caption">Figure 7.6: 360X compliant transport protocol and no show notification payload</div> |
7.5.2 MU2 Required Data Elements
Meaningful use content is not required for this step in the process.
| Attribute | Source | Expectations |
| sourceId | MSH-4 | R |
| patientId | PID-3 | R |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
MSH|^~\&||^1.3.63.998.999.3^ISO||^1.3.63.5444.345.2.1^ISO|20161010172813+0000||SIU^S26^SIU_S26|25882|P|2.5.1|||NE|NE|||||360X| SCH||18467^^1.3.6.1.4.1.21367.2016.10.1.32.14^ISO||||57133-1^^LN||||||||||^Name^Registrar||||^Name^Enterer||||||889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO| TQ1|||||||20161009140000+0000|20161009143000+0000| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| RGS|1|D| |
<div class="clr-fig-caption">Figure 7.7: 360X compliant transport protocol and interim consultation note payload</div> |
The Document Entry metadata is usually derived from the C-CDA header, as shown in the table below:
| Attribute | Purpose within 360X | Required (Source of Requirement) | Corresponding C-CDA element |
| author | If supplied, MUST indicate the document's author, which may be different from the message sender. For the order, this is the clinician who is requesting the referral. Note that C-CDAs are often multi-authored and author may be defaulted in the document. | R2 (XDR and XDM for Direct Messaging) | Author entry in US Realm header. |
| classCode | Identifies the specific document type, in this case a C-CDA template (e.g., CCD, SOEN, Referral Note). See also typeCode which further refines the class definition and should not be ambiguous | R (360X) (R2 XDR and XDM for Direct Messaging) | Type ID entry in US Realm header. |
| confidentialityCode | Identifies the confidentiality defined for the document. Implementations SHOULD NOT use codes that reveal the specific trigger causes of confidentiality (e.g., ETH, HIV, PSY, SDV) | R2 (XDR and XDM for Direct Messaging) | ConfidentialityCode in US Realm Header |
| creationTime | Defines the creation time of the document (vs. the message) | R2 (XDR and XDM for Direct Messaging) | effectiveTime in US Realm Header |
| entryUUID | Globally unique identifier UUID for the document as assigned by the message sender and used only in the XD* handling. | R (XDR and XDM for Direct Messaging) | N/A |
| eventCodeList | Contains a list of codes that reflect the clinical events occurring as the source of the information contained in the C-CDA document | R2 (360X) O (IHE) | When the 360X transaction occurs in an environment tracking eCQM measure CMS50vN, the eventCodeList SHALL contain at least one of the SNOMED CT codes from value set Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006), AND at least one of the SNOMED CT codes from value set Referral (2.16.840.1.113883.3.464.1003.101.12.1046) |
| formatCode | Globally unique identifier specifying the format of the document to allow systems to determine if / how to process. | R (360X) | Per the C-CDA specificaiton |
| healthcareFacilityTypeCode | See also practice setting type. This code represents the type of organizational setting of the clinical encounter during which the documented act occurred. Note that in context of 360X, this is the facility type of the Referral Request Initiator. | R2 (XDR and XDM for Direct) | N/A |
| languageCode | Specifies the language of the document (order / referral request) | R2 (XDR and XDM for Direct) | languageCode of US Realm Header |
| mimeType | The MIME type of the document | R (XDR and XDM for Direct Messaging) | Currently the MIME type for CDA documents is simply "text/xml" |
| patientId | See also sourcePatientId. The patientId attribute MUST be the same as the patientId in the submission set, and all document entries. Per IHE, it is the ID as known to the referral request initiator, and it MUST be the same as the sourcePatientId of the Referral Request that was sent by the referral initiator. | R (360X) (R2 XDR and XDM for Direct Messaging) | N/A |
| sourcePatientId | See also Patient ID. The sourcePatientID is the ID as known by the document submitter (in this case, the referral request recipient). This ID Shall be the same as that for the HL7v2 document entry meta data. | R2 (360X) | targetID in US Realm Header |
| sourcePatientInfo | Relevant patient demographics such as last name, first name, sex, DOB that may help in matching (electronically or by a person) if IDs are insufficient. | R2 per XDR, O per IHE | Elements in patient section of US Realm Header such as name, administrative sex, birth time, etc. |
| practiceSettingCode | Identifies the setting that created the order at a high granularity e.g., Cardiology, FamilyPractice. Should not create ambiguity as compared to healthcareFacilityTypeCode. | R2 (XDR and XDM for Direct) | Should be derived from/mapped to the information in ORC-21 through 24 |
| typeCode | Further refines classCode and should not make ambiguous. Defines the specific C-CDA document type such as <code code="34133-9" displayName="Summarization of Episode Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" /> | R (360X) | Code element from the US realm header |
| uniqueId | Globally unique identifier assigned to the document by its creator. | R (XDR and XDM for Direct Messaging) | Id element (Globally unique identifier) in US realm header |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161010142311+0000||OSU^O51^OSU_O51|20882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|SC|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO|||A|||||||34225PC^Allen^Anthony^M^III^MD^^^&1.3.6.1.4.1.21367.2016.10.1.21.10&ISO^L^^DN| |
<div class="clr-fig-caption">Figure 7.8: 360X compliant transport protocol and referral summary payload</div> |
The Document Entry metadata is usually derived from the C-CDA header, as shown in the table below:
| Attribute | Purpose within 360X | Required (Source of Requirement) | Corresponding C-CDA element |
| author | If supplied, MUST indicate the document's author, which may be different from the message sender. For the order, this is the clinician who is requesting the referral. Note that C-CDAs are often multi-authored and author may be defaulted in the document. | R2 (XDR and XDM for Direct Messaging) | Author entry in US Realm header. |
| classCode | Identifies the specific document type, in this case a C-CDA template (e.g., CCD, SOEN, Referral Note). See also typeCode which further refines the class definition and should not be ambiguous | R (360X) (R2 XDR and XDM for Direct Messaging) | Type ID entry in US Realm header. |
| confidentialityCode | Identifies the confidentiality defined for the document. Implementations SHOULD NOT use codes that reveal the specific trigger causes of confidentiality (e.g., ETH, HIV, PSY, SDV) | R2 (XDR and XDM for Direct Messaging) | ConfidentialityCode in US Realm Header |
| creationTime | Defines the creation time of the document (vs. the message) | R2 (XDR and XDM for Direct Messaging) | effectiveTime in US Realm Header |
| entryUUID | Globally unique identifier UUID for the document as assigned by the message sender and used only in the XD* handling. | R (XDR and XDM for Direct Messaging) | N/A |
| eventCodeList | Contains a list of codes that reflect the clinical events occurring as the source of the information contained in the C-CDA document | R2 (360X) O (IHE) | When the 360X transaction occurs in an environment tracking eCQM measure CMS50vN, the eventCodeList SHALL contain at least one of the SNOMED CT codes from value set Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006), AND at least one of the SNOMED CT codes from value set Referral (2.16.840.1.113883.3.464.1003.101.12.1046) |
| formatCode | Globally unique identifier specifying the format of the document to allow systems to determine if / how to process. | R (360X) | Per the C-CDA specificaiton |
| healthcareFacilityTypeCode | See also practice setting type. This code represents the type of organizational setting of the clinical encounter during which the documented act occurred. Note that in context of 360X, this is the facility type of the Referral Request Initiator. | R2 (XDR and XDM for Direct) | N/A |
| languageCode | Specifies the language of the document (order / referral request) | R2 (XDR and XDM for Direct) | languageCode of US Realm Header |
| mimeType | The MIME type of the document | R (XDR and XDM for Direct Messaging) | Currently the MIME type for CDA documents is simply "text/xml" |
| patientId | See also sourcePatientId. The patientId attribute MUST be the same as the patientId in the submission set, and all document entries. Per IHE, it is the ID as known to the referral request initiator, and it MUST be the same as the sourcePatientId of the Referral Request that was sent by the referral initiator. | R (360X) (R2 XDR and XDM for Direct Messaging) | N/A |
| sourcePatientId | See also Patient ID. The sourcePatientID is the ID as known by the document submitter (in this case, the referral request recipient). This ID Shall be the same as that for the HL7v2 document entry meta data. | R2 (360X) | targetID in US Realm Header |
| sourcePatientInfo | Relevant patient demographics such as last name, first name, sex, DOB that may help in matching (electronically or by a person) if IDs are insufficient. | R2 per XDR, O per IHE | Elements in patient section of US Realm Header such as name, administrative sex, birth time, etc. |
| practiceSettingCode | Identifies the setting that created the order at a high granularity e.g., Cardiology, FamilyPractice. Should not create ambiguity as compared to healthcareFacilityTypeCode. | R2 (XDR and XDM for Direct) | Should be derived from/mapped to the information in ORC-21 through 24 |
| typeCode | Further refines classCode and should not make ambiguous. Defines the specific C-CDA document type such as <code code="34133-9" displayName="Summarization of Episode Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" /> | R (360X) | Code element from the US realm header |
| uniqueId | Globally unique identifier assigned to the document by its creator. | R (XDR and XDM for Direct Messaging) | Id element (Globally unique identifier) in US realm header |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161012170822+0000||OSU^O51^OSU_O51|21882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|SC|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO|||CM|||||||| |
<div class="clr-fig-caption">Figure 7.9: 360X compliant transport protocol and request to cancel payload</div> |
Meaningful use content is not required for this step in the process.
| Attribute | Source | Expectations |
| sourceId | MSH-4 | R |
| patientId | PID-3 | R |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.21^ISO||^1.3.6.1.4.1.21367.2016.10.1.32^ISO|20161007092857+0000||OSU^O51^OSU_O51|23882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|CA|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO||||||||||34225PC^Allen^Anthony^M^III^MD^^^&1.3.6.1.4.1.21367.2016.10.1.21.10&ISO^L^^DN||||^Headache disappeared| |
<div class="clr-fig-caption">Figure 7.10: 360X compliant transport protocol and cancel confirmation payload</div> |
Meaningful use content is not required for this step in the process.
| Attribute | Source | Expectations |
| sourceId | MSH-4 | R |
| patientId | PID-3 | R |
| Attribute | Source | Expectations |
| creationTime | MSH-7 | R |
| classCode | MSH-9 component 1 | R |
| formatCode | MSH-9 component 3 | R |
| typeCode | MSH-9 component 2 | R |
| sourcePatientId | O (patientId as represented by the specialist) | |
| sourcePatientInfo | ||
| - patient identifier | PID-3 | R |
| - patient name | PID-5 | R |
| - patient DOB | PID-7 | O |
| - patient gender | PID-8 | R |
| - patient address | PID-11 | O |
| servicStartTime | Do not send | |
| serviceStopTime | Do not send | |
| uri | Should match the name of the hl7 file in the xdm zip |
MSH|^~\&||^1.3.6.1.4.1.21367.2016.10.1.32^ISO||^1.3.6.1.4.1.21367.2016.10.1.21^ISO|20161008110543+0000||OSU^O51^OSU_O51|24882|P|2.5.1|||NE|NE|||||360X| PID|1||T7190334^^^&1.3.6.1.4.1.21367.2016.10.1.21.5&ISO^MRN~L53HG67^^^&1.3.6.1.4.1.21367.2016.10.1.32.11&ISO^MRN||Packton^Peter^^^L||19580817|M| ORC|CR|889342^^1.3.6.1.4.1.21367.2016.10.1.21.15^ISO|||CA|||||||34225PC^Allen^Anthony^M^III^MD^^^&1.3.6.1.4.1.21367.2016.10.1.21.10&ISO^L^^DN||||^Glad to hear that| |
