Thursday, 31 January 2013

ADT A07 Change Inpatient to Outpatient

In hospitals,there might be a need to change an Inpatient to Outpatient. This happens when patient admitted as inpatient is no longer admitted but still receiving care/services.

This is also required when an outpatient is admitted as inpatient by mistake and records need to be corrected.
HL7 has provided this trigger event (ADT A07 Inpatient to Outpatient) to perform this task.
This trigger event (A07 Inpatient to Outpatient) signals receiving system to change patient's status from Inpatient/admitted to Outpatient/Pre admitted/Not admitted.
I will provide basic details of implementing A07 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 Inpatient to Outpatient
Suppose Patient A is registered in a system as Inpatient.
We will assume that while admitting (A01) we have received following values in PV1 segment of HL7 message
PatientClass (PV1.2) - I (Important & Requred field)
PatientType (PV1.18) - IPE
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 those in this discussion

So, when our system receives this registration message it will admit a new patient and data in database will look like this
(I have only mentioned fields which are required to describe A07)
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

Now, let's assume that we have received an A07 HL7 message for same patient with following values in PV1 segment
PatientClass (PV1.2) - P (Important & Requred field)
PatientType (PV1.18) - XX
AccountStatus (PV1.41) - PRE
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

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


Please get clarification from your source system administrator on following:
What should be done if AssignedPatientLocation is not availalbe in A07 HL7 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 A07. 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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