HL7 Interface Questionnaire

(CONFIDENTIAL)

ADT INFORMATION Facility Name: ______

Question / Answer / Notes
1.  What is the name of your Hospital Information System or Practice Management information system? / If more than one system will be involved, please list all.
2.  Please indicate whether you have a training environment. / Training interfaced environment? Y/N / A training system is important for user and interface testing.
3.  Do you prefer a socket connection for ADTs and DFTs (recommended, but file drop is available)? / ADT Test Port:
ADT Prod Port:
DFT Test IP/Port:
DFT Prod IP/Port: / List port numbers to listen for ADTs in test and production.
List IP addresses and port numbers to send DFTs to in test and production.
4.  What demographic message types do you send? Please highlight in yellow the types you will send. If faxing this document please circle in pen. / ADT^A01 Y/N
ADT^A04 Y/N
ADT^A07 Y/N
ADT^A08 Y/N
ADT^A28 Y/N
ADT^A31 Y/N
SIU^S12 Y/N / Currently these are the only message types we support. SIU messages may also be configured if an account number is not sent in the ADT message types. Note that ReDoc may not accept both an account number from an ADT and a visit number from an SIU.
5.  Will you be sending pre-registration ADT (A05) message types to ReDoc? / ADT^A05 Y/N
If so, does the account number start date change with the full registration (A04) event? Y/N / The behavior of this event can be modified to only create the patient if that workflow works best. The default behavior of this event mimics the A04 event.
6.  Are you sending a medical record number? If so, please list the field this is sent in (example: PID-3) / ReDoc looks to PID-3 for this value by default.
7.  Do you need an account number or visit ID to process billing? / ReDoc looks to PID-18 for this value by default.
8.  Is there any case in which two different patients might be sent across the ADT interface with the same MRN? / Y/N / ReDoc must always have a unique value for the MRN. If two patients are sent with the same MRN, the demographics for the latter will overwrite the demographics for the former.
9.  Do you send account start dates? If so please list the field and if this info is consistently sent in all messages. / ReDoc looks to PV1-44 for this value by default.
10.  Do all disciplines (PT, OT, and Speech) share the same account number? If so, will we receive an admit message for each discipline?
11.  Does your system allow multiple cases per account number? / Multiple treatment cycles with a single account number can be managed using case numbers.
12.  Can you send a rehab discipline identifier?
If your clinic treats multiple disciplines this is a necessity to maximize ReDoc’s effectiveness. We will need to receive this identifier in every message. / Values=
Message Location=
Example (PV1-10 Hospital service, PV1-3 Assigned patient location, PV1-18 Patient type, PD1-3 Patient primary facility, or PV1-39 Servicing facility) / ReLeaf Default discipline codes are:
“PT” - Physical
“OT” - Occupational
“SP” – Speech
“PO” = Phys and occ.
“PS” = Phys and speech
“OS” = Occ and speech
“P3” = All 3 disciplines
13.  Are you sending Therapist ID and name in the ADT message? If so what is the location in the HL7 message? / The treating therapist that will be using ReDoc. Note that this data is not required.
14.  ReDoc has a ‘Referring Physician’ field. Which value should we populate this with? / ReDoc looks to PV1-8 for this value by default.
15.  ReDoc has a ‘Primary Care Physician’ field. Which value should we populate this with? / ReDoc looks to PV1-7 for this information by default.
16.  Are you going to have multiple facilities in ReDoc?
Can you Send Facility information in the HL7 message? If so, we need a translation table. / Please list facility mapping here if it is known at time of completion. / List all facilities and their corresponding interface identifiers.
Example:
General Hospital – GH1
Outpatient – OP1
17.  Are you sending the IN1 segment? If so please notate the IN1 field where each of these elements occurs in the segment. Example: (IN1-4) / Insurance Plan ID
Insurance Company ID
Insurance Company Name
Policy Number
Which of these pieces of data is your most unique insurance plan identifier aka interface ID? / ReDoc Defaults:
Insurance Plan ID IN1-2
Insurance Co. ID IN1-3
Insurance Co. Name IN1-4
Policy Number IN1-36
18.  Are you sending the IN2 segment? If so please notate what fields the Medicare and Medicaid policy numbers are sent in. Example: (IN1-4) / ReDoc looks to IN2-6 for the Medicare ID and IN2-8 for the Medicaid ID.
19.  Are you sending the NK1 segment for the contact person/next of kin? / ReDoc Contact Defaults:
Last Name NK1-3-1
First Name NK1-3-2
Phone Number NK1-5
20.  Are you sending the DG1 segment that includes an ICD9 code? / Without a DG1 segment that contains an ICD9 code all ReDoc treatment cycles will default to a diagnosis of ‘000.00 DIAGNOSIS NOT SENT TO REDOC’
21.  Will you be sending only rehab patients to ReDoc? If not can you filter the additional patients on your side? If not please provide a list of the codes ReDoc should allow through the filter. / Filtering on the ReDoc side of the interface causes additional overhead for the interface and may delay the processing of rehab patients. It is preferred that any filtering be done on the other side of the interface.
22.  Are your account numbers discharged and readmitted in a cycle or series, such as every month or every 90 days? If so do you send A03 messages to discharge these accounts? / Series Accounts? Y/N
Indicate your series account interval: Monthly, 30 day, 90 day, Other ____
ADT^A03 Y/N
23.  If sending the A03 message type, in which field do you send the discharge date? / ReDoc looks to PV1-45 in the A03 message for the end date value by default.
Note that this message type closes account numbers in ReDoc, and does not actually discharge patients.

CHARGE INFORMATION (DFT^P03)

Question / Answer / Notes
24.  When would you like production charges to be generated by ReDoc? Do you prefer single message or batch format? / ReDoc typically sends charges once a day in production, around 9pm, and real time in the test environment.
25.  How does the MSH segment need to be configured? Please notate any custom values that should be sent. / MSH field definitions
MSH-1 =
MSH-2 =
MSH-3 =
MSH-4 =
MSH-5 =
MSH-6 =
MSH-7 =
MSH-8 =
MSH-9 =
MSH-10 =
MSH-11 =
MSH-12 =
MSH-13 = / MSH field definitions
MSH-1 Field separator
MSH-2 Encoding characters
MSH-3 Sending application
MSH-4 Sending facility
MSH-5 Receiving application
MSH-6 Receiving facility
MSH-7 Date/time of message
MSH-8 Security
MSH-9 Message type
MSH-10 Message control ID
MSH-11 Processing ID
MSH-12 Version ID
MSH-13 Sequence number
26.  Please notate the charge code you look for in the FT1 segment / What charge code do you use?
CH CG CHG
27.  Do you want the treating facility sent back in the charge file? / ReDoc sends this in
FT1-16 by default.
28.  Do you want us to send DG1 Segment in your charges? If so how many do you want to receive? / We can send 1, 2, or all of the diagnosis codes on the treatment cycle.
29.  Do you want to receive the primary diagnosis in FT1-19?
30.  Do you use CPT codes for your charges or export codes? / ReDoc sends this value in FT1-7 by default.
31.  Do you want Modifiers sent in your charges? / ReDoc sends this value in FT1-26 by default.
32.  Do you have custom charge codes? (Charge Master) / Please submit the charge master file to ReDoc in an Excel format using the template provided in your initial customer documentation.
33.  Will you be using Medicare G-Codes (CMS 1590)? / Please fill out and import the G code charge master file in ReDoc Suite with either 69 or 483 charge codes that will be used.
34.  Do you need to have discipline-specific G-code modifiers in the charge message? / Can send GP, GO or GN in the message.

RESULTS INTERFACE INFORMATION (if applicable)

Question / Answer / Notes
35.  What is the name of your results interface repository if different than your Hospital Information System? / If more than one system will be involved, please list all.
36.  Per contract, what type(s) of results interfaces do you require? / A.  Exported file only (PDF, TIFF or text)
B.  Exported file with associated index file (.idx)
C.  HL7 message (MDM or ORU) with report pointer in OBX segment
D.  HL7 text results message with full report in multi-line OBX segment / Refer to the ‘Results Configuration for ReDoc Suite Customers’ document for additional detail on these formats.
37.  Will you need a specific file naming convention for an exported file? / See below for example. We can provide a list of data values that can be used for file name.
Example naming elements:
{MEDICALRECORDNUMBER}_{\ACCOUNTNUMBER}_{\LASTNAME}_{\FIRSTNAME}_{\DOCUMENTEXPORTNAME}_{\DATEOFSERVICE:yyyyMMdd}_{TIME:HHmmss}
Example of actual name filename using naming elements above:
MRN0001_ PtAcctNum001_PLastName_ PFirstName_PTPN_20110611_231655.pdf
If your system expects a different format from the one above please enter a sample filename here:
38.  Will you poll for the results files in a network folder? ReDoc uses an ‘Export’ folder in the ReDoc share for this destination by default. / Exported Results Path:
\\server\sample\path\export\ / ReDoc will generate the results files in the file share’s Export folder by default unless a different network path is provided.
39.  If you chose to receive an HL7 message, what are the IPs and ports for the Test and Production interfaces? / Results Test IP/Port:
Results Prod IP/Port: / List IP addresses and port numbers to send HL7 results to in test and production.
40.  If you chose to use an index file, does the index file need to go to a different folder than the results file? / Y/N
Index Path:
\\server\index\path\sample\ / The index file can be placed in the same folder as the results file or in a separate folder.

Feel free to additional comments or questions below for discussion during your HL7 review call.

Notes:

Statement of Confidentiality and Usage Restrictions

This document contains trade secrets and other information that are proprietary, and confidential. As a result, the reproduction, copying, or redistribution of this document or the contents contained herein, is strictly prohibited without the prior written consent of ReDoc.

1 Version 1.3 – Revision Date 12/19/2013