Thursday 31 January 2013

ADT A06 Change Outpatient to Inpatient

In hospitals,there might be a need to admit an outpatient as inpatient. This happens when patient comes as outpatient and after diagnosis, doctor decides to admit patient.

This is also required when an inpatient is admitted as outpatient by mistake and records need to be corrected.

HL7 has provided this trigger event (ADT A06 Outpatient to Inpatient) to perform this task.
This trigger event (A06 outpatient to inpatient) signals receiving system to change patient's status from outpatient to inpatient.

I will provide basic details of implementing A06 into your system, but please contact source system administrator before implementing your interface.

There could be many fields in HL7 message or in your system which can distinguish an inpatient  & an outpatient (This depends on your EMR configuration or system which mangaes your Admission/Discharge/Transfer).

Common fields are PatientClass, PatientType, AccountStatus, AssignedPatientLocation etc. and all of these values would be very meaningful for Healthcare Systems.

Let me start with a scenario where we need to change an outpatient to inpatient

Suppose Patient A is registered in a system as outpatient.
We will assume that while registration (A04) we have received following values in PV1 segment of HL7 message
PatientClass (PV1.2) - O (Important & Requred field)
PatientType (PV1.18) - OPE
AccountStatus (PV1.41) - REG
So, when our system receives this registration message it will register a new patient and data in database will look like this
(I have only mentioned fields which are required to describe A06)

PV1.2 AssignedPatientLocation PV1.3 PV1.18 PV1.41 AccomodationCode PV2.2 PV2.3
PatientClass PointOfCare Room Bed PatientType AccountStatus Id Text AdmitReason

Now, let's assume that we have received an A06 HL7 message for same patient with following values in PV1 segment

PatientClass (PV1.2) - I (Important & Requred field)
PatientType (PV1.18) - INE
AccountStatus (PV1.41) - ADM

Note: There will also be other fields for inpatient like Admitting Physician, Hospital Service etc, but I don't want to include these in this article

So when we process this message, system will change the values in database as following

PV1.2 AssignedPatientLocation PV1.3 PV1.18 PV1.41 AccomodationCode PV2.2 PV2.3
PatientClass PointOfCare Room Bed PatientType AccountStatus Id Text AdmitReason
I IR 101 1 IPE ADM S-P Semi-Private Appendicitis

You can see, now, the system will identify same patient as an Inpatient. And very importantly we haven't changed episode of care. So, patient can continue receiving care services in this same episode as inpatient.


Please get clarification from your source system administrator on following:
What should be done if AssignedPatientLocation is not availalbe in A06 message? Usually while admitting a patient as inpatient, patient should be allocated a physical location.


ADT messages always contain current information except MRG segments
Process all the fieds in PID & PV1 & other segments in message as normal A08 upate message unless specified by source system.
It is recommended not to send any updated fields except required ones in A06. A08 should be used to update any other fields.
Patient's Current Physical Location will be in PV1.3 & prior location will be in PV1.6

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