Approach to handle multiple MWL items under the same Study Instance UID

[Mohankumar Thangavel]

Hello Community,
We are setting up DCM4CHEE ARC light for a facility. We have a requirement to group studies of different orders (different views) under the same study instance uid. What is recommended approach to model HL7 messages from the EMR to create MWL items ?

Workflow:
1. Order 1 placed for Chest AP view

2. EMR sends HL7 message(ORM_O01) with Study Instance UID in ZDS

3. MWL item created 

4. Image taken and submitted by modality

5. On viewing, doctor placed linked order 2 for PA view
Now how should the HL7 message be ?

Approaches tried:

1. Tried sending the same study instance uid, or order 2, but the first MWL item gets deleted from the database

2. Tried sending HL7 message with info about both orders containing multiple OBR and ORC segments but same study instance UID, still the same problem.

Thanks for you time. 

[Vrinda Nayak]

Multiple Scheduled Procedure Steps for same Requested Procedure can be sent using an OMI^O23 order message to the archive which has extended support w.r.t. segments / fields vs. the older version of order message (ORM^O01). Eg. 

MSH|^~\&|MESA_OF|XYZ_RADIOLOGY|MESA_IM|XYZ_IMAGE_MANAGER|20220324193155||OMI^O23^OMI_O23|1001125|P|2.5.1||||||8859/1||
PID|||PID_1^^^ADT1||Smith^Lucy^Mark||20141014|F|||1100 Main St^Apt 2B^Anytown^CA^90210^USA^H||(555) 123-4567^PRN^PH^te...@example.com^1|(555) 123-4577^WPN^PH^test-b...@example.com^1|ENG^English^I10|||AdmissionIDFromPatientAccountNo1|||||||||ID^MilitaryRank^Scheme|||||||||||
NTE|||PatientComments||
PV1||E||||||^ReferringPhysicianFN^ReferringPhysicianGN^ReferringPhysicianMN^^DR^Md|||||||B6||||AdmissionIDFromVisitNo1||||||||||||||||||||||||||||||||V|
ORC|NW|PlacerOrderNumberImagingServiceRequest1|FillerOrderNumberImagingServiceRequest1||SC||^^^^^RequestedProcedurePriority||||||^^^^^^^^InstitutionalDepartmentName||||InstitutionCodeSeq.CV^InstitutionCodeSeq.CM-and-InstitutionName^InstitutionCodeSeq.CSD|ScheduledProcStepSeq.SSAET1-Fallback~ScheduledProcStepSeq.SSAET2-Fallback||||InstitutionAddress||||||ConfidentialityCode||
TQ1|||||||20220324193155||
OBR||PlacerOrderNumberImagingServiceRequest1|FillerOrderNumberImagingServiceRequest1|||||||||PatientState|MedicalAlerts|||^RequestingPhysicianFN^RequestingPhysicianGN^RequestingPhysicianMN^^DR^Md||||||||||||||PatientTransportArrangements|ReasonForRequestedProcedureCodeSeq.CV^ReasonForRequestedProcedureCodeSeq.CM-and-ReasonForTheRequestedProcedure^ReasonForRequestedProcedureCodeSeq.CSD|||ScheduledPerformingPhysicianNameFN^ScheduledPerformingPhysicianNameGN^ScheduledPerformingPhysicianNameMN^^DR^Md||||||||||RequestedProcedureCodeSeq.CV^RequestedProcedureCodeSeq.CM-and-RequestedProcedureDescription^RequestedProcedureCodeSeq.CSD|
OBX|1|ST|^Body Weight||65|kg|||||F||||||
OBX|2|ST|^Body Height||1.65|m|||||F||||||
NTE|||RequestedProcedureComments||||
IPC|AccessionNumber1|RequestedProcedureID1|1.2.392.200036.9125.0.198811291108.9|ScheduledProcStepSeq.ScheduledProcStepID1|CT|ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CV1^ScheduledProcStepSeq.ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CM1-and-ScheduledProcStepDesc1^ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CSD1|ScheduledProcStepSeq.ScheduledStationName1~ScheduledProcStepSeq.ScheduledStationName2|ScheduledProcStepSeq.ScheduledProcStepLocation1|ScheduledProcStepSeq.SSAET1~ScheduledProcStepSeq.SSAET2
IPC|AccessionNumber1|RequestedProcedureID1|1.2.392.200036.9125.0.198811291108.9|ScheduledProcStepSeq.ScheduledProcStepID2|US|ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CV2^ScheduledProcStepSeq.ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CM2-and-ScheduledProcStepDesc2^ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CSD2|ScheduledProcStepSeq.ScheduledStationName3~ScheduledProcStepSeq.ScheduledStationName4|ScheduledProcStepSeq.ScheduledProcStepLocation2|ScheduledProcStepSeq.SSAET3~ScheduledProcStepSeq.SSAET4
IPC|AccessionNumber1|RequestedProcedureID1|1.2.392.200036.9125.0.198811291108.9|ScheduledProcStepSeq.ScheduledProcStepID3|MR|ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CV3^ScheduledProcStepSeq.ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CM3-and-ScheduledProcStepDesc3^ScheduledProcStepSeq.ScheduledProtocolCodeSeq.CSD3|ScheduledProcStepSeq.ScheduledStationName5~ScheduledProcStepSeq.ScheduledStationName6|ScheduledProcStepSeq.ScheduledProcStepLocation3|ScheduledProcStepSeq.SSAET5~ScheduledProcStepSeq.SSAET6