Wednesday 13 February 2013

ADT A11 - Cancel Admit/Visit Notification

In hospitals, there might be a need to cancel an admission for admitted patients (Admitted patients are one for whom we have received and A01). This happens when hospital/doctor decides not to admit a patient. This can also happen when a patient is admitted by mistake and records need to be corrected.

We can also cancel visit notification of non-admitted patients (Outpatients) for whom we have received an A04 message earlier.

HL7 has provided this trigger event (ADT A11 Cancel Admit/Visit Notification) to
Cancel A01 for admitted patients
Cancel A04 for non admitted patients

This trigger event (A11 Cancel Admit/Visit Notification) signals receiving system to cancel admission or close visit. But implementation depends on receiving system. One can
  • Mark the patient/visit as inactive
  • Remove the patient/visit from database (Not preferred)

I will provide basic details of implementing A11 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 identify visit status (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 cancel a visit notification (I will let users think about cancel admission based on this)
Suppose we have received a visit notification for Patient A using A04 message & we have received following values in PV1 segment
PatientClass (PV1.2) - O (Important & Requred field)
AccountStatus (PV1.41) - REG
So, when our system receives this registration message it will create a new patient visit and data in database will look like this

(I have only mentioned fields which are required to describe A11)
PV1.2 PV1.41
PatientClass AccountStatus

Now, let's assume that we have received an A11 message for same patient with following values in PV1 segment
PatientClass (PV1.2) - P (Important & Requred field)
AccountStatus (PV1.41) - CAN

So when we process this message, system will change the values in database as following
PV1.2 PV1.41
PatientClass AccountStatus

You can see, now, the system will identify same patient as an Pre-Admit patient and AccountStatus is changed to CAN. (Different systems could use different codes & fields to identify cancelled/inactive visit)
Depending on these fields, application which displays the data to end users can filter the patients with active visits.


Please get clarification from your source system administrator on following:
How will you process messages recieved after A11 with same account & visit details?
Usually when we cancel a visit, we assume that episide of care is over & new visit has to be created using A04/A01 for this patient.


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 A11. A08 should be used to update any other fields.

Sample Immunization Records Blockchain using Hyperledger Composer

This is basic and sample Blockchain implementation of Immunization Records using Hyperledger Composer.  Source Code available at:  https...