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Arkansas WebIZ Immunization RegistryHL7 Interface SpecificationArkansas Department of HealthDocument Version 0.9.1January, 2013
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013Table of ContentsChange Log . 3Overview . 4Significant Design Decisions . 5Business Rules . 6Request for Vaccination Record . 6Update a Patient’s Vaccination Record in the Registry . 7Business Rules for Parsing Messages . 7Security for Submitting a Message to the Registry . 7Data Definition. 8Delimiters . 8Implemented Message Types . 8Accessing the HL7 Interface . 9VXQ - Query for Vaccination Record. 9VXX - Response to Vaccination Query Returning Multiple PID Matches (VXX) . 18VXR - Response to Vaccination Query Returning the Vaccination Record (VXR) 27VXU - Unsolicited Vaccination Record Update (VXU) . 45ACK - Acknowledgement Message (With Errors) . 68QCK - Query General Acknowledgement Message . 70Additional Items for Rollout . 73Envision Technology Partners, Inc.Page 2
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013Change LogThe following table captures the progression of this document over ptionDRAFT version of documentUpdating ADH to the latest version of the coredocument (but still DRAFT pending ADH review)Envision Technology Partners, Inc.AuthorRay SeggelkeRay SeggelkePage 3
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013OverviewThere are numerous providers across Arkansas who will use the Arkansas WebIZStatewide Immunization Registry directly as they administer vaccinations to theirpatients. The Registry can be a valuable tool to these providers by offering significantfunctionality not available to them in their current systems.ADH desires to offer the benefits of the Registry to all providers in Arkansas. For thoseproviders already using a full-featured electronic management records system or a clinicmanagement system that is adequately assisting them with the daily operations of theirpractice, Arkansas WebIZ can still serve as the single, consolidated repository of apatient’s immunization history.The goal of the HL7 Interface is to provide the ability for a provider’s system tocommunicate with the Registry via a standardized set of messages. This allows theprovider to retrieve the vaccination history of a patient from the Registry and to updatethe Registry with additional vaccination data.Envision Technology Partners, Inc.Page 4
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013Significant Design DecisionsIn most cases, this interface has been defined to follow the standards andrecommendations from the CDC. More specifically, the following standards have beenselected as the foundation of these interfaces: Health Level Seven (HL7) Standard Protocol, version 2.3.1 The CDC’s Implementation Guide for Immunization Data Transactions, version2.2, dated June, 2006o This guide also incorporates some minor updates to various messagesand code sets that are included in version 2.4 of the HL7 protocol.Any significant deviations from these guidelines are documented here. Whereapplicable, “lessons learned” from select previously implemented projects have alsobeen addressed.In most cases, the tables contained in the CDC’s Implementation Guide will be used asthe set of valid values for many of the fields in the messages. Every effort has beenmade to accommodate these values as much as possible in order to minimize thenumber modifications necessary for a system to interface with the Registry. Anydeviations from these values have been documented within the relevant field(s).All providers using the HL7 interfaces will be setup in Arkansas WebIZ with nonintegrated inventory control. This will allow the Registry to track inventory informationabout the vaccines administered, but it will not manage the number of doses on-hand.As a result, these providers will not be able to use the inventory reconciliation featuresavailable in the Registry, and they will not be able to report their monthly inventorystatus electronically via the Registry.While evaluating the interface definition, it is expected that a technical assessment willbe made by representatives of other systems (in use at the various provider locationsaround the state) in order to identify what, if any, modifications will be necessary to theirsystem in order to successfully communicate with the Registry. Each vendor is highlyencouraged to contact the ADH Immunization Program to request and/or discuss anymodifications to the interface that would assist them to minimize the modificationsnecessary to their system.Envision Technology Partners, Inc.Page 5
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013Business RulesWhen defining these interfaces, the general approach has been to consider the Registryas a repository of information. The idea is for systems utilizing these interfaces tosubmit requests for information from the Registry or messages that contain updates torecords within the Registry. The primary scenarios are: The Registry receives a query and responds with the results of the query. The Registry receives an update message and responds with anacknowledgement indicating success or failure of persisting the data in theRegistry. The Registry receives a file (consisting of batch VXU messages) and processesthe file during non-peak hours (e.g., overnight). The Registry receives a request to generate a file (consisting of batch VXUmessages) and processes the request during non-peak hours (e.g., overnight)At this time, it is not anticipated that the Registry will initiate the exchange of informationwith other systems. (This is something that can be revisited in the future at such timethat Arkansas WebIZ begins interfacing with other Registries or systems at the nationallevel.) The Registry will only respond to messages submitted to it.There are several common interactions that will occur between provider systems andthe Registry. The following sections describe these exchanges in terms of themessages that are transmitted between the systems involved. (Detailed informationregarding these messages can be found in the “Data Definition” section later in thissection of the document.)Request for Vaccination RecordOne of the key benefits of an immunization registry is the ability for a provider to gainaccess to the consolidated vaccination history of a patient. In today’s highly mobilesociety, it is common for a person to receive immunizations from multiple providers. Aregistry allows a provider to review vaccinations a person has received from otherproviders in order to more accurately identify any immunizations they may need. As aresult, when a patient presents at a provider’s facility for a vaccination, a commonrequest will be to obtain the available vaccination history for that person from theRegistry.Providers who need access to a person’s vaccination record will submit a VXQ (Queryfor Vaccination Record) message to Arkansas WebIZ to obtain this information. TheRegistry will respond in one of the following ways: If there is no record in the Registry that matches the information provided in theQuery, the Registry will respond with a QCK (Query General Acknowledgement)message indicating no matching record was found. If there is a single matching record found, the Registry will respond with a VXR(Response to Vaccination Query) message containing the relevant information.Envision Technology Partners, Inc.Page 6
Arkansas WebIZHL7 Interface Specification Version 0.9.1January, 2013If there are multiple matching records found, the Registry will respond with a VXX(Response to Vaccination Query Returning Multiple PID Matches) messagecontaining the list of possible matches.o Typically, the provider’s system will then send another VXQ messageindicating the specific record from the VXX response that represents theirpatient.If there is an issue processing the message, the Registry will respond with anACK (General Acknowledgement) message containing the applicable errormessage.Update a Patient’s Vaccination Record in the RegistryObviously, the only way for a Registry to be able to make available a patient’simmunization history is for providers who are physically administering the vaccinationsto notify the Registry in a timely fashion of each vaccination they have administered.This immunization information is then consolidated with similar information from otherproviders to produce the full vaccination record for a person.To this end, providers desiring to submit vaccination information to the Registry will usethe VXU (Unsolicited Vaccination Record Update) message. The Registry will respondwith an ACK (General Acknowledgement) message indicating the success or failure ofthe update. In the case of failure, this message will include the applicable errormessage.Business Rules for Parsing MessagesThe HL7 interfaces defined for Arkansas WebIZ are based on version 2.3.1 of the HL7standards protocol (with some variances to support the related changes made inversion 2.4 of the same protocol). The “Data Definition” section documents the specificmessages that will be accepted. Systems submitting a properly formatted message canexpect the Registry to accept the message. Any minor issues will be reported as errorsvia the ACK (General Acknowledgement) message. In these cases, the Registry willprocess as much of the message as possible.Significant deviations from the message definitions will prevent the Registry from beingable to process the message. This situation will be reported as rejections via the ACK(General Acknowledgement) message. In these cases, the Registry will not process thecontents of the message.All incoming messages and associated responses are logged by the Registry.Security for Submitting a Message to the RegistryRefer to the Arkansas WebIZ Immunization Registry HL7 Engine Design Document forthe detailed web service definition for the real-time HL7 interface.Envision Technology Partners, Inc.Page 7
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013Data DefinitionAll messages sent to Arkansas WebIZ should be properly formatted as described in theCDC’s Implementation Guide for Immunization Data Transactions, version 2.2, datedJune, 2006 (which is based on the Health Level Seven (HL7) Standard Protocol, version2.3.1). This document also describes the possible codes and/or values that can beincluded in various data fields in the document.The following sections contain detailed information for each message, includingindications when a field will always have a set value, which fields are required(highlighted in bold font), which fields in the standard message definition will be ignored,etc. Where applicable, information is also included on what makes a value valid and/orinvalid.DelimitersArkansas WebIZ expects and will use the CDC recommended delimiters for allmessages. These include:DELIMITERMEANINGCharacterDescription CR Carriage ReturnSegment Terminator PipeField Separator CaratComponent Separator&AmpersandSub-ComponentSeparator TildeRepetition Separator\Back SlashEscape CharacterTable 1: HL7 Interface DefinitionImplemented Message TypesArkansas WebIZ will accept the message types and corresponding event types definedin Table 2. Any other message types will generate an ACK general acknowledgementresponse indicating a rejection.MESSAGE TYPESACCEPTED BY REGISTRYVXQVXUSUPPORTED EVENTTYPES (BY MESSAGETYPE)V01V04Table 2: Message Types accepted by Arkansas WebIZSimilarly, the Registry will send the message types and corresponding event types asdefined in Table 3. At the current time, the Registry will only send these messages inresponse to a message received from a provider’s system. It will not initiate anyexchange of data.Envision Technology Partners, Inc.Page 8
Arkansas WebIZHL7 Interface SpecificationVersion 0.9.1January, 2013MESSAGE TYPESSENT BY REGISTRYACKQCKVXXVXRSUPPORTED EVENTTYPES (BY MESSAGETYPE)V02V03Table 3: Message Types Sent by Arkansas WebIZAccessing the HL7 InterfaceRefer to the Arkansas WebIZ Immunization Registry HL7 Interface Design Documentfor details on how to access the HL7 interface.VXQ - Query for Vaccination RecordThe VXQ message is used by a provider to submit a request for a person’s vaccinationrecord. As mentioned previously, the message should be formatted as specified in thereferenced documentation.Table 4 contains notes for various fields as they pertain to the Registry. The followingconventions have been used: Required fields are in bold type and are marked appropriately in the REQ/OPTcolumn Shaded cells will not be used by the ARKANSAS WEBIZ Registry. The REQ/OPT column will contain one of 2 values:o O – OptionalOptional fields may be left as NULL (i.e., no value supplied). These fieldsare not necessary for effectively searching the Registry. However, if avalue is specified, it must be a valid value and format as specified below.Otherwise, an acknowledgement message of type ‘AE’ may be returned.o R - RequiredAll required fields must contain a valid value and format as specifiedbelow. If a valid value is not submitted or if the value submitted is not in avalid format, an acknowledgement message of type ‘AR’ will typically bereturned. An instruction to leave a field NULL means no value needs to be provided in thatfield. It would look like when constructing the message.Envision Technology Partners, Inc.Page 9
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRVersion 0.9.1January, 2013FIELDLENGTHFIELDTYPEFIELD FORMAT EXAMPLEREQ/OPTNOTES on VALID VALUESMSH Segment Registry expects that incoming messages will use the pipecharacter (“ ”) as the field separator for all messages. In all other cases, the Registry will return an ACK message withan Acknowledgement Code of “AR” indicating the message hasbeen rejected. Registry expects that incoming messages will contain therecommended value of “ \&” in this field. In all other cases, the Registry will return an ACK message withan Acknowledgement Code of “AR” indicating the message hasbeen rejected.Field Separator11ST REncodingCharacters24ST \&RSendingApplication3 Registry will ignore the contents of this field.Sending Facility4 The ADH Immunization Program will assign a unique ID to eachprovider system interfacing with the Registry. This ID should beincluded in this field. Registry will include the ID provided here in the “ReceivingFacility” field of the MSH segment of the response message. If an invalid ID is included, the Registry will not process themessage and will return an ACK message with anAcknowledgement Code of “AR” indicating the message hasbeen rejected.ReceivingApplication5 Registry will ignore the contents of this field.6180HDR Registry will allow two values in this field:o Leave NULLo A value of “AR0000” Any other value will be considered invalid, and the Registry willnot process the message. It will return an ACK message with anAcknowledgement Code of “AR” indicating the message hasbeen rejected.726TSO Registry will archive this in the message log.ReceivingFacility180HDThe ADH ImmunizationProgram unique IDassigned to the providerLeave NULL or use avalue of AR0000RDate/Time ofMessageSecurity8Message Type97CMVXQ V01RMessage ControlID1020STa unique ID generated bythe system sending themessageREnvision Technology Partners, Inc.YYYYMMDD Registry will ignore the contents of this field. Registry expects this to always be “VXQ V01” for this type ofmessage. Registry will ignore any value in the Message Structurecomponent of this field. If an unsupported message type is indicated, the Registry willnot process the message and will return an ACK message withan Acknowledgement Code of “AR” indicating the message hasbeen rejected. Should be a unique ID (within each system sending messages tothe Registry) and is generated by the system sending themessage. Registry will archive this in its message log.Page 10
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRVersion 0.9.1January, 2013FIELDLENGTHFIELDTYPEProcessing ID113PTVersion ID1260VIDSequenceNumberContinuationPointerFIELD FORMAT EXAMPLEOne of the following:D, P, or T2.3.1REQ/OPTRRNOTES on VALID VALUES Registry will include the ID provided here in the “MessageControl ID” field of the MSA segment of the response message. If no value is supplied, the Registry will return an ACK messagewith an Acknowledgement Code of “AR” indicating the messagehas been rejected. Registry will use the indicated system to generate the results forthe query. Valid values are represented HL7- defined Table 0103. If an invalid Processing Id is included, the Registry will notprocess the message and will return an ACK message with anAcknowledgement Code of “AR” indicating the message hasbeen rejected. Registry will ignore the contents of the second component as itdoes not impact how the Registry will process the request. Registry expects all messages to use version 2.3.1. If an unsupported version is indicated, the Registry will notprocess the message and will return an ACK message with anAcknowledgement Code of “AR” indicating the message hasbeen rejected. NOTE: Additional versions may be made available as the needarises. Please contact the ADH Immunization Program to discussany specific needs for other versions.13 Registry will ignore any value in this field.14 Registry will ignore any value in this ledgementType162IDLeave NULL or use a value ofNEO Registry does not support enhanced acknowledgement mode. Registry will only respond using the original acknowledgement mode(i.e., a value of NULL or “NE”). Registry will ignore any other value in this field and will process themessage using the original acknowledgement mode. Registry will ignore any value in this field.Country Code173IDUSA or leave NULLOCharacter Set1810IDASCII or leave NULLOPrincipalLanguage ofMessage1960CEEN or leave NULLOAlternate20Envision Technology Partners, Inc. Registry expects all messages will originate in the USA (i.e., this fieldhas a value of either “USA” or is NULL). Registry will ignore any other value in this field and will process themessage as if it originated in the USA. Registry expects all messages will use the ASCII character set (i.e.,this field has a value of “ASCII” or is NULL). Registry will ignore any other value in this field and will process themessage using the ASCII character set. Registry expects all messages will use English as the principallanguage (i.e., this field has a value of “EN” or is NULL). Registry will ignore any other value in this field and will process themessage in English. Registry expects all messages submitted to it will not be usingPage 11
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRVersion 0.9.1January, 2013FIELDLENGTHFIELDTYPEFIELD FORMAT EXAMPLEREQ/OPTCharacter SetHandlingQRD SegmentQuery Date/Timecharacter set switching (i.e., this field is empty). Registry will ignore any other value in this field and will process themessage without using alternate character sets.1Query FormatCode21IDRRQuery Priority31IDIRQuery ID410STa unique ID generated by thesystem sending the messageRDeferredResponse TypeDeferredResponseDate/TimeNOTES on VALID VALUES5 Registry will ignore any value in this field. Registry will only return result in the record-oriented-format (i.e.,a value of “R” in this field). Registry will ignore any other value in this field and will returnthe results in the record-oriented format. Since the Registrytreats all records as type ”R”, the Registry will accept any valuein the field and the Registry will NOT return a rejectedAcknowledgement code of “AR” in the ACK message Registry will only return results immediately (i.e., a value of “I” inthis field). Registry will ignore any other value in this field and will processthe message with a query priority of immediate. Since theRegistry treats all records as type ”I”, the Registry will acceptany value in the field and the Registry will NOT return a rejectedAcknowledgement code of “AR” in the ACK message Should be a unique ID (within each system sending messages tothe Registry) and is generated by the system sending themessage. Registry will include the ID provided here in the “Query ID” fieldof the QRD segment of the corresponding VXX or VXR responsemessage. If no value is supplied, the Registry will return an ACK messagewith an Acknowledgement Code of “AR” indicating the messagehas been rejected. Registry will ignore any value in this field and will return the resultsimmediately. Registry will ignore any value in this field and will return the resultsimmediately.6Quantity LimitedRequest710CQNumber of Records UnitsRWho Subjectfilter860XCNIDnumber Lastname Firstname Middle Suffix Prefix REnvision Technology Partners, Inc. Registry will return up to 100 records or the Number of Recordsvalue indicated in this field, whichever is less. The Registryexpects that the Units will be “RD”. For example, “25 RD” willreturn up to 25 records. Registry will use the indicated unit values to generate the resultsfor the query. Only the valid value, RD from the HL7- definedTable 0126. If an invalid number of records or units is included, the Registrywill not process the message and will return an ACK messagewith an Acknowledgement Code of “AR” indicating the messagehas been rejected. Registry will ignore values in the following components of thisfield as they will have no impact on the search results:Page 12
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRVersion 0.9.1January, 2013FIELDLENGTHFIELDTYPEFIELD FORMAT EXAMPLEREQ/OPTNOTES on VALID VALUESDegree SourceTable AssigningAuthority NameType IdentifierCheckDigit CodeIdentifyingtheCheckDigitSchemeEmployed IdentifierType AssigningFacilityID NameRepresentationCode What SubjectFilterWhat DepartmentData CodeWhat Data CodeValue QualifierQuery ResultsLevel960CEVXI VACCINEINFORMATION HL70048R o Source Tableo Assigning Authorityo All Name Types except: Legal AliasNOTE: Name values will be parsed by the Registry to ensure astandardized format prior to searching for or updating apatient’s record. This may result in slight variations of namessubmitted versus names returned.o Identifier Check Digito Code Identifying the Check Digit Scheme Employedo All Identifier Types except: Medicaid number Medicare number Medical Record Number Patient Internal Identifier Social Security Number (This field must include 9 digits afterthe system removes all non-numeric characters such as adash (-), forward slash (/), spaces, etc. If 9 digits are notfound, the system will ignore the value in this field. It will try tocontinue processing the message, but it will return anacknowledgement of type ‘AE’.) State Registry ID (This field must only contain numeric digits.If any non-numeric characters are found, the system willignore the value in this field. It will try to continue processingthe message, but it will return an acknowledgement of type‘AE’.) MCI (Master Client Index)o Assigning Facility IDo Name Representation CodeExample Simpson Bart Thomas L SS123456789 If no value is supplied, the Registry will return an ACKmessage with an Acknowledgement Code of “AR” indicatingthe message has been rejected.Registry will only return vaccine information for a patient (i.e., avalue of “VXI VACCINE NFORMATION HL70048” in this field).Specifying any other value (including no value) will result in theRegistry returning an ACK message with an AcknowledgementCode of “AR” indicating the message has been rejected.10 Registry will ignore any value in this field.11 Registry will ignore any value in this field.12 Registry will only return vaccine information for a patient. Therefore,the value of this field has no impact on the query results, and theRegistry will ignore it.Envision Technology Partners, Inc.Page 13
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRVersion 0.9.1January, 2013FIELDLENGTHFIELDTYPEFIELD FORMAT EXAMPLEREQ/OPTNOTES on VALID VALUESQRF SegmentWhere SubjectFilter120STAR0000RWhen Data StartDate/Time226TSYYYYMMDDOWhen Data EndDate/Time326TSYYYYMMDDOWhat UserQualifier4Other QuerySubject Filter560Envision Technology Partners, Inc.STPatientSocialSecurityNumber PatientBirthdate PatientBirthState PatientMedicare Number PatientMedicaid Number O Registry expects incoming VXQ messages are intended for theRegistry in an attempt to receive vaccine information for apatient. Therefore, this field should always be valued as“AR0000”. Any other value in this field will cause the Registry to ignore therequest and return an ACK message is returned with anAcknowledgement Code of “AR” indicating the message hasbeen rejected. Registry will only use the YYYYMMDD portion of this field (i.e., alltime-related data will be ignored) Registry expects that, if populated, the field will contain a fullyspecified, valid date (i.e., not just a year or month/year value) Registry will ignore any value that is not valid date. It will attempt tocontinue processing the message, but it will return anacknowledgement of type ‘AE’. If supplied and the:o “When Data End Date/Time” field is empty, then all of the patient’svaccinations on or after this date will be returned.o “When Data End Date/Time” field has a value equal to or greaterthan this field, then all of the patient’s vaccinations beginning withthis value and ending with the End Date value will be returned.o “When Data End Date/Time” field is less than this date, then novaccination records will be returned. Registry will only use the YYYYMMDD portion of this field (i.e., alltime-related data will be ignored) Registry expects that, if populated, the field will contain a fullyspecified, valid date (i.e., not just a year or month/year value). Registry will ignore any value that is not valid date. It will attempt tocontinue processing the message, but it will return anacknowledgement of type ‘AE’. If supplied and the:o “When Data Start Date/Time” field is empty, then all of the patient’svaccinations before or on this date will be returned.o “When Data Start Date/Time” field has the a value equal to or lessthan this field, then all of the patient’s vaccinations beginning withthe Start Date/Time value and ending with this value will bereturned.o “When Data Start Date/Time” field is greater than this date, then novaccination records will be returned. Registry will not filter the results based on this field; therefore thevalue of this field will be ignored. Registry locally defines the following search keys for use in this field:Position ComponentData Description / ExamplesTypePage 14
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRFIELDLENGTHVersion 0.9.1January, 2013FIELDTYPEFIELD FORMAT EXAMPLEMother’sLastName Mother’sFirstname Mother’sMiddleName Mother’sSuffix Mother’sPrefix Mother’sDegree Mother’sMaidenName PatientState Registry ID Father’sLastName Father’sFirstname Father’sMiddleName Father’sSuffix Father’sPrefix Father’sDegree PatientIdentifierREQ/OPTNOTES on VALID VALUES1Patient SocialSecurity Number ST2Patient Birth Date DT3Patient BirthState ID4Patient MedicareNumber Patient MedicaidNumber Mother’s Name STThis field must include 9digits after the systemremoves all non-numericcharacters such as dash(-), forward slash (/),spaces, etc. If 9 digitsare not found, thesystem will ignore thevalue in this field. It willtry to continueprocessing the message,but it will return anacknowledgement oftype ‘AE’.Example: 123456789YYYYMMDDIf a valid date is notfound, the system willignore the value in thisfield. It will try to continueprocessing the message,but it will return anacknowledgement oftype ‘AE’.Example: July 4, 1976 19760704Use 2-letter postal code.If a valid state code isnot found, the system willignore the value in thisfield. It will try to continueprocessing the message,but it will return anacknowledgement oftype ‘AE’.When applicableSTWhen applicablePN family name givenname middle name orinitial suffix prefix degree Family name of motherbefore marriageExample: 123456Note that leading zeroes5678Envision Technology Partners, Inc.Mother’s MaidenName Patient StateRegistry ID STSTPage 15
Arkansas WebIZHL7 Interface SpecificationFIELD NAMEFIELDNBRWhich Date/TimeQualifier6Which Date/TimeStatus Qualifier7Date/TimeSelection Version 0.9.1January, 2013FIELDTYPEFIELD FORMAT EXAMPLEREQ/OPTNOTES on VALID VALUES9Father’s Name PN10Local PatientIdentifierSTshould not be inc
The goal of the HL7 Interface is to provide the ability for a provider's system to communicate with the Registry via a standardized set of messages. This allows the . Refer to the Arkansas WebIZ Immunization Registry HL7 Engine Design Document for the detailed web service definition for the real-time HL7 interface. Arkansas WebIZ Version 0.9.1
