Hi Mr. Ramon,
I´ll explain you how I worked: I use Mirth for read from database (I have HIS/RIS without HL7 funcionality). Then I create ORM with ORC.1 = NW and send to DCM4CHEE.
This creates a MWL record for this patient and procedure. When the modality asks for MWL, DCM4CHEE sends all records and the status of record changed to 'IN PROGRESS'. In every change made in the modality, it sends a message to DCM4CHEE updating the status, and DCM4CHEE send a HL7 message to Mirth with this information.
When I receive in Mirth the messsage with ORC.1 = SC and ORC.5 = CM, implies that the procedure is ended. At this time is when I send from MIRTH a HL7 message with the same information about patient and procedure (the same message), but with ORC.1 = CA to DCM4CHEE.
This HL7 "CA"ncel the record on the MWL for this patient, but no create a new one. It simply delete the record. In this way, when the modality re-orders the MWL, that study is not forwarded again.
I don't know if this is helpful for you, I hope so
Regards