Spacelabs Mcare 300 Patient Monitor Service Manual Full.17

[Mariam Obregon]

Thischapter describes the transaction set required for sending structuredpatient-oriented clinical data from one computer system to another. A commonuse of these transaction sets will be to transmit observations and results ofdiagnostic studies from the producing system (e.g., clinical laboratory system,EKG system) (the filler), to the ordering system (e.g., HIS order entry,physician's office system) (the placer). However, the transaction set is notlimited to such transactions. Observations can be sent from producing systemsto archival medical record systems (not necessarily the order placer) and fromsuch medical record systems to other systems that were not part of the orderingloop, e.g., an office practice system of the referring physician for inpatienttest results ordered by an inpatient surgeon. This chapter also providesmechanisms for registering clinical trials and methods for linking orders andresults to clinical trials and for reporting experiences with drugs anddevices.
These transaction sets permit the transmission of any kind of clinicalobservations including (but not limited to) clinical laboratory results, theresults of imaging studies (excluding the image), EKG pulmonary functionstudies, measures of patient status and condition, vital signs, intake andoutput, severity and/or frequency of symptoms, drug allergies, problem lists,diagnostic lists, physician and nursing history, physicals, progress notes,operative notes and so on. These transaction sets carry information that isreported as text, numeric or categorical values. These messages do not carrythe images themselves. (See ACR NEMA Publication 300-1988 Digital Imagingand Communications Standard, for image standards, and ASTM E1467.91Standard specification for transferring digital neurophysiological databetween independent computer systems, for transmitting EEG, EMGtracings).
An observation can be one of many data types. The main ones are text, numbersand codes. This provides the flexibility needed to transmit observations thatare recorded as continuous values (e.g., glucose, diastolic blood pressure), ascategorical values, e.g., patient position (sitting, reclining or standing),VDRL (reactive, weakly reactive or nonreactive), or as text. An entire Historyand Physical could be transmitted as an observation whose value is one largechunk of formatted text.
This chapter provides mechanisms for transmitting structured,record-oriented reports. This means that individual observations aretransmitted as separate logical entities (objects), and within this entity,separate fields are defined for identifying the observation, its values, itsunits, normal ranges, etc., such that the receiving system can "understand,"reorganize and/or react to the contents of these messages. Structured reportsare to be distinguished from text-oriented reports which can also betransmitted via HL7 using the UDM message described in Chapter 2. The latterare ASCII images of nonstandard printed reports intended for display to humans.For practical purposes their contents are not understandable to the computer.
Observations may be transmitted in a solicited (in response to a query) orunsolicited mode. In the solicited mode, a user requests a set of observationsaccording to criteria transmitted by the user. The sending system responds withexisting data to satisfy the query (subject to access controls). Queries donot elicit new observations by the target system, they simply retrieve oldobservations. (See Chapter 2 for full discussion of the querytransmission.)
The unsolicited mode is used primarily to transmit the values of newobservations. It is the mode used by producing services to return the values ofobservations requested by an ordering system. A laboratory system, forexample, would usually send the results of an AM electrolytes to the orderingHIS via the unsolicited mode. An intensive care system would send the bloodpressures to the same HIS by the same mode. Calling such transactionsunsolicited may sound like a misnomer, but is not. The placing servicesolicits the producing service to make the observation. It could also (througha query) solicit the value of that observation after it has been made.However, such an approach would demand continuous polling of the producingsystem until the result was produced. Using the unsolicited mode, theproducing service returns the value of an observation as soon as it isavailable. The unsolicited mode can also be used to transmit new results to asystem (e.g., an archival medical record system) that did not order theobservation. The transactions that define these modes are more fully describedin Section 7.2, "MESSAGE DEFINITIONS."
Observations are usually ordered and reported as sets (batteries) of manyseparate observations. Physicians order electrolytes (consisting of sodium,potassium, chloride, bicarbonate) or vitals (consisting of diastolic bloodpressure, systolic blood pressure, pulse, and temperature). Moreover, teststhat we may think of as single entity, e.g., cardiac echo, usually yieldmultiple separate measurements, e.g., left ventricular diameter, left atrialdiameter, etc. Moreover, observations that are usually reported as text (e.g.,the review of systems from the history and physical) can also be considered aset of separately analyzable units (e.g., cardiac history, pulmonary history,genito-urinary history, etc.). We strongly suggest that all text clinicalreports be broken down into such separate analyzable entities and that theseindividual entities be transmitted as separate OBX segments. Because manyattributes of a set of observations taken at one time will be identical, oneOBR segment serves as a header for the report and carries the information thatapplies to all of the individual observations in the set. In the case ofordered observations, the OBR segment is a "turn-around document" like themanual request forms it replaces. It carries information about the order tothe producing service; a copy of the OBR with additional fields completed isreturned with the observations to the requesting service.
Not all observations are preceded by an order. However, all observationswhether explicitly ordered or initiated without an order are reported with anOBR segment as the report header.
The major segments (OBR, OBX) defined in this chapter, their fields, and thecode tables have been defined in collaboration with ASTM E31.11 with the goalof keeping HL7 observation transmission the same as ASTM E1238 in pursuit ofthe goals of ANSI HISPP and the Message Standards Developers Subcommittee.(Some sections of this chapter have been taken with permission directly fromthe E1238-91 document and vice versa in pursuit of those goals).
The OBR segment provides information that applies to all of the observationsthat follow. It includes a field that identifies a particular battery (orpanel or set) of observations (e.g., electrolytes, vital signs or AdmissionH&P). For simplicity we will refer to the observation set as the battery.The battery usually corresponds to the entity that is ordered or performed as aunit. (In the case of a query, observation sets may be a more arbitrarycollection of observations.) The OBX segment provides information about asingle observation, and it includes a field that identifies that singleobservation (e.g., potassium, diastolic blood pressure or admission diagnosis).Both of these fields assume master tables that define coding systems (theuniverse of valid identifying codes) for batteries and observations,respectively. These tables will usually be part of the producing and sendingservices application and (usually) include many other useful pieces ofinformation about the observation or battery. Segments for transmitting suchmaster file information between systems that produce and systems that useclinical information are described in Chapter 8.
This Standard does not require the use of a particular coding system toidentify either batteries or single observations In the past, localinstitutions tended to invent their own unique code systems for identifyingtest and other clinical observations because standard codes were not available.Such local code systems sufficed for transmitting information within theinstitutions but presented high barriers to pooling data from many sources forresearch or for building medical record systems. However, standard code systemssuch as LOINC and SNOMED now exist for many of these purposes, and we stronglyencourage their use in observation reporting. These codes can be sent either asthe only code or they can be sent along with the local historic code as thesecond code system in a CE code.
In past versions of the HL7 standard, Appendix A to Chapter 7 presentedsuggestions for constructing clinical codes from existing procedure codesystems such as CPT4. Appendix A is now part of the Implementation Guide andcontains LOINC codes for most laboratory tests and many common clinicalvariables (e.g., vital signs, intake and output, cardiovascular measurementsand others). The most recent version of the LOINC database, which includesrecords for more than 7,000 observations and includes codes, names, synonymsand other attributes (such as the molecular weights of chemical moieties) foreach observation, is available from the HL7 file server at . TheImplementation Guide provides construction rules for many variables that arenot yet covered by LOINC. Codes for Neurophysiologic variables (EEG, EMG,Evoked potentials) are provided in Appendix X2 of ASTM E1467.
Some parts of this document (the discussion and tables defining units, thediscussion of the rules of mapping observations to OBX segments, and some ofthe examples at the end of the chapter have been copied (with permission) fromASTM E1238.
As is true throughout this Standard, the emphasis should be on the abstractmessages, defined without regard to the encoding rules. The example messages,however, are based upon the HL7 encoding rules.

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