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ADT A08 - Event Type Matching

ADT^A08: Update an Encounter

Status

In specification. API spec subject to change.

Case for change

An A08 currently creates an 'Updated information for <name>' event within 'Events and Messages'.  Feedback has indicated that it is not always clear what this relates to.

- An A08 'Updated Information' event can be orphaned within 'Events and Messages'.  If an A08 is sent in relation to a previous event (e.g. transfer) and then that previous event is cancelled (i.e. A12 - cancel transfer) then the main event is removed from 'Events and Messages' but the 'Updated Information' panel remains and can not be removed from the encounter.

- An A08 sent for a historical update - e.g. a change out of sequence - is displayed within 'Events and Messages' but it is not clear what it relates to.  E.g. if an A08 is sent with the intention of correcting the admitting location then an 'Updated Information' panel is displayed but the admission event is not updated.

Overview

This message can be used to update a previously received encounter.

Key changes:

- An A08 will default to updating the most recent event on the encounter rather than creating its own event.  All PV1 segment information supported by PKB can be updated.  

- An A08 will be ignored if the encounter does not already exist within PKB.

- The source system will optionally have a means to specify a specific event to apply the update to using a bespoke ZVN segment.  This will override the default behaviour of updating the most recent event.

Relevant Entities

Please click through to the Data Model to explore the presentation of these entities in the web interface.


Update Behaviour

Message Entity Matching Criteria Behaviour (Matched) Behaviour (Not Matched)
A08 [[Encounter]] [[Encounter.External Encounter ID]] as derived from PV1-19.1
The [[Encounter Event]] and any linked [[Appointment]] will be handled as indicated below. No action.
  [[Encounter Event]] The most recent [[Encounter Event]] on the [[Encounter]] will be updated by default.

The default matching can be overridden by including a custom ZVN segment.  In this case [[Encounter Event.Type]] is derived from ZVN-1.1 with matching rules:

ZVN-1.1 = A01 (Type = ADMIT)
ZVN-1.1 = A02 (Type = TRANSFER)
ZVN-1.1 = A03 (Type = DISCHARGE)
ZVN-1.1 = A05 (Type = PRE_ADMIT)
ZVN-1.1 = A14 (Type = PENDING_ADMIT)

If ZVN-1.1 is A02 then the matched [[Encounter Event.Type]] is TRANSFER.  In this instance ZVN-6 will be used to match to a specific transfer on [[Encounter Event.Timestamp]].  If ZVN-6 is not provided then the most recent transfer will be updated instead.
The matched [[Encounter Event]] is updated with the information in this message if it differs from the details already held.

If there is an existing admission [[Encounter Event]] or discharge [[Encounter Event]] then these will be updated separately if PV1-44.1 and PV1-45.1 are provided in the message and they differ from the timestamps already held.
No action.
  [[Appointment]] PKB maintains an internal link joining the [[Encounter Event]] to the [[Appointment]]. No additional external IDs required. If the matched [[Encounter Event.Type]] is a PRE_ADMIT or PENDING_ADMIT then the associated [[Appointment]] will be updated.
 No action.

Definition

This is identical in format to the ADT^A01, except that a ZVN segment can be used to match a specific [[Encounter Event]], 
and PV1-44 and PV1-45 will be checked only for updates to the timestamp of admission and/or discharge [[Encounter Event]]s, where they exist.  This is shown below:

Segment Field Component Description Example Data Model
PV1          

[ PV1-44 ]
Admit datetime. Timestamp of admission for the entire Encounter.
 

PV1-44.1 Admit timestamp 201902011200 [[Encounter Event.Timestamp]] : Admission Event

If not provided, no update is performed.
  [ PV1-45 ]   Discharge datetime. Timestamp of discharge for the entire Encounter.    
    PV1-45.1 Discharge timestamp 201902031200 [[Encounter Event.Timestamp]] : Discharge Event

If not provided, no update is performed.
[ ZVN ]

Bespoke PKB segment used to match the update to a previously received encounter event.

Example usage for a ZVN:
- Your source A08 messages track the original event and you want that association to be communicated to PKB. E.g. the source knows that the A08 is an update to the admission and the A08 should thus specifically update the admission event in PKB.  Set ZVN-1.1 to ‘A01’.

 
   [ZVN-1]   Event Type Code    
     ZVN-1.1 Event code.  

This field is used to match this update to a specific event.  Options: A01, A02, A03, A05, A14
 A01Matched to [[Encounter Event.Type]]
  [ ZVN-6 ]   Transfer Event Occurred    
    ZVN-6.1 Transfer Event Occurred

This field can be used to match this update to a specific transfer event. If ZVN-1.1 is 'A02' then this field will be checked to determine if there is a transfer event matching the timestamp provided.
201902011200 [[Encounter Event.Timestamp]] : Transfer Event

If not provided or not matched this field is ignored

Examples

Typical A08 message.  Updates the most recent event on the encounter.  Additionally the admission date on the admission event is updated if the supplied PV1-44.1 is different.

MSH|^~\&|SendingApp|SendingFacility|HL7API|PKB|20190201100000||ADT^A08|ABC0000000001|P|2.4
PID|||9555555555^^^NHS^NH||Smith^John^Joe^^Mr||19700101|M|||My flat name^1, The Road^London^London^SW1A 1AA^GBR|||||||||||||||||||N|
PV1|1|I|^^^^^^^^My Ward||||^Jones^Stuart^James^^Dr^|^Smith^William^^^Dr^|^Foster^Terry^^^Mr^||||||||||enctrId|||||||||||||||||||||||||201902011000|

Customised A08 message.  This will update the transfer event from 01/02/2019 10:15.  Additionally the admission date on the admission event is updated if the supplied PV1-44.1 is different.

MSH|^~\&|SendingApp|SendingFacility|HL7API|PKB|20190201113000||ADT^A08|ABC0000000003|P|2.4
PID|||9555555555^^^NHS^NH||Smith^John^Joe^^Mr||19700101|M|||My flat name^1, The Road^London^London^SW1A 1AA^GBR|||||||||||||||||||N|
PV1|1|I|^^^^^^^^My Ward Corrected||||^Jones^Stuart^James^^Dr^|^Smith^William^^^Dr^|^Foster^Terry^^^Mr^||||||||||enctrId|||||||||||||||||||||||||201902011000| ZVN|A02|||||201902011015

Customised A08 message.  This will update the admission event on the encounter.  E.g. this A08 may reflect a correction to previous admission details or a historical update event.

MSH|^~\&|SendingApp|SendingFacility|HL7API|PKB|20190201113000||ADT^A08|ABC0000000003|P|2.4
PID|||9555555555^^^NHS^NH||Smith^John^Joe^^Mr||19700101|M|||My flat name^1, The Road^London^London^SW1A 1AA^GBR|||||||||||||||||||N|
PV1|1|I|^^^^^^^^My Ward Corrected||||^Jones^Stuart^James^^Dr^|^Smith^William^^^Dr^|^Foster^Terry^^^Mr^||||||||||enctrId|||||||||||||||||||||||||201902011000|
ZVN|A01

Customised A08 message.  This will update a pre admission event on the encounter.  E.g. the pre admission is rescheduled.  The associated [[Appointment]] will also be updated.

MSH|^~\&|SendingApp|SendingFacility|HL7API|PKB|20190201113000||ADT^A08|ABC0000000003|P|2.4
PID|||9555555555^^^NHS^NH||Smith^John^Joe^^Mr||19700101|M|||My flat name^1, The Road^London^London^SW1A 1AA^GBR|||||||||||||||||||N|
PV1|1|I|^^^^^^^^Main Outpatient||||^Jones^Stuart^James^^Dr^|^Smith^William^^^Dr^|^Foster^Terry^^^Mr^||||||||||enctrId2|||||||||||||||||||||||||201908091000|
ZVN|A05

Workflow

Response

PKB will respond with a standard HL7 acknowledgement.

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