Order Type identifiers
V 2.8 HL7 Proposal
Change Request ID:
File Name:
Description:
Status:
Sponsoring Person
Sponsoring Business Unit
Date Originated:
695 order type identifier v01.doc
New Proposal
May 16, 2011
Date HL7 approved:
Backward Compatible:
Yes
Forward Compatible:
Yes
HL7 Status & Date
1 JUSTIFICATION DETAIL:
In IHE-Pharmacy, the normal flow of an order is that it is entered by a prescription placer. This is
only one specific workflow. There are other cases where, for example, the workflow begins before
a prescription is made.
Another type of cases is that a prescription is made and sent out, but only for information
purposes. This is important for the case of many applications sharing the same roles, for specific
cases. It is important to share the information, but not the work.
A chemotherapy application supports prescription, dispense and administration, but when the
doctor is using the ER prescription system, the doctor must be notified of the ongoing
prescriptions, to detect interactions, etc. All the dispensing for chemotherapy is done in the
chemotherapy software, but every software should know the complete medication record of the
patient in that hospital, when prescribing.
So, when notified by (or querying) the chemotherapy system, the pharmacy should know that
there is an ongoing prescription in chemotherapy, but no action is to be done on those items.
One example is emergency medication. In this case, the nurse gives the medication to the patient
after confirming (in a phone call) with the physician. What is expected is that in some cases the
workflow ends, but for others the physician will later submit a prescription for this medication – so
the physician will have a list of orders that he has to formally start. All data (except the
prescription) is available, and the doctor just has to enter prescription data.
The intended way to achieve status management in IHE-Pharmacy (HMW) is to state in ORC-25
that Prescription is not started, but dispensing and administration is complete. The prescription
placer will decide, according to the current set of rules, the course of action – whether a
prescription is necessary or not.
At this moment, the use of Filler Order Number is not sufficient to infer the kind of workflow used.
Some metadata is needed to identify the expected behaviour of the applications (the receiving
application must know the intended workflow).
It could make sense to explicit the kind of workflow in ORC-29 (order type). At this moment, Order
Type is an HL7 Table - 0482 with only 2 values – inpatient or outpatient. These are 2 specific
workflows. The concept that the patient’s stay type (inpatient or outpatient) is important, and it
does influence the order type, as well as other factors (legal or other rules). But other aspects do,
too.
This proposal is for using ORC-29 as a User Table that can be used to indicate conditions that
determine the workflow to be used.
This can also imply making ORC-29 repeatable, where the known variables that can influence the
order type are mentioned. (e.g. “Inpatient” + “Emergency” – which would determine different
workflow rules).
Alternatively, an exhaustive list of other workflows (besides inpatient / outpatient order) can be
defined by HL7 to add to the current values of HL7 Table 0482 (given the variance and
terminology inconsistencies, this approach would add constraints to implementations and would
take considerable effort to be complete. Maintaining a list of possible workflows seems outside
the intended scope of HL7 specifications. By making table 0482 a user table, HL7 v2.8 supports
the full complexity or workflows without enforcing specific behaviours.
2 OPEN ISSUES:
Not known.
3 CHANGE REQUEST IMPACT:
Not known.
4 DOCUMENTATION CHANGES:
User-defined Table 0482 - Order Type
Value
I
O
E
Description
Inpatient Order
Outpatient Order
Emergency Dispense
Comments