Infusion Segment

Justification

The Pharmacy/Treatment Segments support general infusion order parameters but do not support discrete order details for bolus, patient controlled analgesia (PCA) or syringe infusions. The information needed to support bolus PCA and syringe orders is often sent in note sections within the pharmacy treatment messages. The format and the information communicated is very site specific.

The following data elements from the pharmacy treatment segments will continue to be used:

Give code formulary item identifier

Give Amount Total volume of the solution

Give units Total volume units

Give Per Time value for Give Rate

Give Rate Rate at which the infusion is to be administered

Give rate units Units for the Give Rate.

The Pharmacy/Treatment component Order Segment will provide medication details if the bolus, PCA or syringe order contains multi-ingredients.

Proposal

To improve treatment order communication and patient safety an optional infusion order segment RXV will be added to the following Pharmacy/Treatment Messages:

MESSAGE / EVENT / DESCRIPTION
OMP / O09 / Order Message
RDE / O11 / Encoded Order
RDS / O13 / Dispense Message
RGV / O15 / Give Message

The Timing/Quantity (TQ1) following the RXV segment allowing the timing of separate infusion events within a given order.

RDE^O11^RDE_O11 / Pharmacy/Treatment Encoded Order Message / Status / Chapter
MSH / Message Header / 2
[{ SFT }] / Software / 2
[ UAC ] / User Authentication Credential / 2
[{ NTE }] / Notes and Comments (for Header) / 2
[ / --- PATIENT begin
PID / Patient Identification / 3
[ PD1 ] / Additional Demographics / 3
[{ NTE }] / Notes and Comments (for Patient ID) / 2
[ / --- PATIENT_VISIT begin
PV1 / Patient Visit / 3
[ PV2 ] / Patient Visit – Additional Info / 3
] / --- PATIENT_VISIT end
[{ / --- INSURANCE begin
IN1 / Insurance
[ IN2 ] / Insurance Additional Information / 6
[ IN3 ] / Insurance Additional Information, Certification / 6
}] / --- INSURANCE end
[ GT1 ] / Guarantor / 6
[{ AL1 }] / Allergy Information / 3
] / --- PATIENT end
{ / --- ORDER begin
ORC / Common Order / 4
[{ / --- TIMING begin
TQ1 / Timing/Quantity / 4
[{ TQ2 }] / Timing/Quantity Order Sequence / 4
}] / --- TIMING end
[ / --- ORDER_DETAIL begin
RXO / Pharmacy/Treatment Prescription Order / 4
[{ NTE }] / Notes and Comments (for RXO) / 2
{ RXR } / Pharmacy/Treatment Route / 4
[{ / --- COMPONENT begin
RXC / Pharmacy/Treatment Component (for RXO) / 4
[{ NTE }] / Notes and Comments (for each RXC) / 2
}] / --- COMPONENT end
] / --- ORDER_DETAIL end
RXE / Pharmacy/Treatment Encoded Order / 4
[{ NTE }] / Notes and Comments (for RXE) / 2
{ / --- TIMING_ENCODED begin
TQ1 / Timing/Quantity / 4
[{ TQ2 }] / Timing/Quantity Order Sequence / 4
} / --- TIMING_ENCODED end
[{ / --- INFUSION begin
RXV / Pharmacy/Treatment Infusion Segments / 4
[{ NTE }] / Notes and Comments (for RXV) / 2
{ / --- TIMING_ENCODED begin
TQ1 / Timing/Quantity / 4
[{ TQ2 }] / Timing/Quantity Order Sequence
} / --- TIMING_ENCODED end
}] / --- INFUSION end
{ RXR } / Pharmacy/Treatment Route / 4
[{ RXC }] / Pharmacy/Treatment Component (for RXE) / 4
[{ / --- OBSERVATION begin
OBX / Results / 7
[{ NTE }] / Notes and Comments (for OBX) / 2
}] / --- OBSERVATION end
[{ FT1 }] / Financial Detail / 6
[ BLG ] / Billing Segment / 4
[{ CTI }] / Clinical Trial Identification / 7
} / --- ORDER end

Note:The RXCs which follow the RXO may not be fully encoded, but those that follow the RXE must be fully encoded.

The NTE segment(s) following the PD1 segment are intended to communicate notes and comments relative to the patient.

The NTE segment(s) following the RXO segment are intended to communicate notes and comments relative to the pharmacy/treatment order.

The NTE segment(s) following the RXE segment are intended to communicate notes and comments relative to the encoded order.

The NTE segment(s) following the RXV segment are intended to communicate notes and comments relative to the encoded order.

The NTE segment(s) following the RXC segment are intended to communicate notes and comments relative to the component(s).

The NTE segment following the OBX segment is intended to communicate notes and comments relative to the results.

RXV – Pharmacy /Treatment Order Infusion Segment

The RXV segment details the pharmacy or treatment application’s encoding of specific infusion order parameters.

HL7 Attribute Table – RXV – Pharmacy/Treatment Order infusion Segment

SEQ / Length / Data Type / Opt / Rep
# / TBL
# / Item
# / Element Name / Comments
1 / (1..4) / SI / O / Set ID
2 / (2..2) / ID / R / ???? / Bolus Type / .
3 / (1..20) / NM / O / Bolus Dose Amount
4 / (1..707) / CWE / O / 9999 / Bolus Dose Amount Units
5 / (1..20) / NM / O / Bolus Dose Volume
6 / (1..707) / CWE / O / 9999 / Bolus Dose Volume Units
7 / (2..2) / ID / R / ???? / PCA Type
8 / (1..20) / NM / O / PCA Dose Amount
9 / (1..707) / CWE / O / 9999 / PCA Dose Amount Units / .
10 / (1..20) / NM / O / PCA Dose Amount Volume
11 / (1..707) / CWE / O / 9999 / PCA Dose Amount Volume Units / .
12 / (1..20) / NM / O / Max Dose Amount
13 / (1..707) / CWE / O / 9999 / Max Dose Amount Units
14 / (1..20) / NM / O / Max Dose Amount Volume
15 / (1..707) / CWE / O / 9999 / Max Dose Amount Volume Units
16 / (1..722) / CQ / R / Max Dose per Time
17 / (1..722) / CQ / O / Lockout Interval
18 / (1..707) / CWE / O / Syringe Manufacturer
19 / (1..707) / CWE / O / Syringe Model Number
20 / (1..20) / NM / C / Syringe Size
21 / (1..707) / CWE / C / Syringe Size Units

RXV – 1 Set ID (SI)

RXV –2 Bolus Type (ID)

Definition: This field identifies the type of bolus being ordered.

Bolus Type

Value / Description / Comments
C / Supplemental
L / Loading

RXV-3 Bolus Dose Amount (NM)

Definition: This field contains the ordered bolus amount.

Example: if the ordered bolus is 50 mg, this field contains the value of 50

RXV -4 Bolus Dose Amount Units (CWE)

Components: <Identifier (ST)> ^ <Text (ST)> ^ <Name of Coding System (ID)> ^ <Alternate Identifier (ST)> ^ <Alternate Text (ST)> ^ <Name of Alternate Coding System (ID)> ^ <Coding System Version ID (ST)> ^ <Alternate Coding System Version ID (ST)> ^ <Original Text (ST)>

Definition: This field indicates the amount units associated with the bolus dose amount.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263890^MDC_DIM_MILLI_G^MDC

mg^mg^UCUM

RXV-5 Bolus Dose Volume (NM)

Definition: This field defines the volume measurement for the ordered bolus amount.

Example: if the ordered bolus is 5 ml, this field contains the value of 5

RXV -6 Bolus Dose Amount Volume Units (CWE)

Definition: This field indicates the strength units associated with bolus dose strength volume.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263762^MDC_DIM_MILLI_L^MDC

mL^mL^UCUM

RXV –7 PCA Type (ID)

Definition: This field identifies the type of bolus being ordered.

Bolus Type

Value / Description / Comments
C / Continuous[GaryM1]
P / PCA Only
PC / PCA + Continuous

RXV-8 PCA Dose Amount (NM)

Definition: This field contains the order’s PCA Amount.

Example: if the ordered bolus is3 mg, this field contains the value of 3

RXV -9 PCA Dose Amount Units (CWE)

Definition: This field indicates the amount units associated with PCA dose amount.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263890^MDC_DIM_MILLI_G^MDC

mg^mg^UCUM

RXV-10 Bolus PCA Amount Volume (NM)

Definition: This field defines the volume measurement for the ordered PCA amount.

Example: if the ordered bolus is 5 ml, this field contains the value of 5

RXV -11 PCA Dose Amount Volume Units (CWE)

Definition: This field indicates the amount units associated with PCA dose amount volume.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263762^MDC_DIM_MILLI_L^MDC

mL^mL^UCUM

RXV-12 Max Dose Amount (NM)

Definition: This field contains the orders Max Amount amount.

Example: if the ordered bolus is 50 mg, this field contains the value of 50

RXV -13 Max Dose Amount Units (CWE)

Definition: This field indicates the amount units associated with the Max dose amount.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263890^MDC_DIM_MILLI_G^MDC

mg^mg^UCUM

RXV-14 Max Dose Amount Volume (NM)

Definition: This field defines the volume measurement for the ordered Max amount.

Example: if the ordered bolus is 5 ml, this field contains the value of 5

RXV -15 Max Dose Amount Volume Unit (CWE)

Definition: This field indicates the amount unit associated with RXV -12 Max dose amount volumes.

The preferred format is an MDC value; UCUM values are also acceptable.

Examples:

263762^MDC_DIM_MILLI_L^MDC

mL^mL^UCUM

RXV -16 Max Dose per Time (CQ)

Definition: This field contains the time unit expression of the lock out parameter.

Components: <Quantity (NM)> ^ <Units (CE)>

Subcomponents for Units (CE): <Identifier (ST)> & <Text (ST)> & <Name of Coding System (ID)> & <Alternate Identifier (ST)> & <Alternate Text (ST)> & <Name of Alternate Coding System (ID)>

Example: if the ordered max dose per time is 4 hours, this field format is 4^H&Hours.

RXV -17 Lockout Interval (CQ)

Definition: This field contains the length of time that must expire between delivery of PCA doses.

Components: <Quantity (NM)> ^ <Units (CE)>

Subcomponents for Units (CE): <Identifier (ST)> & <Text (ST)> & <Name of Coding System (ID)> & <Alternate Identifier (ST)> & <Alternate Text (ST)> & <Name of Alternate Coding System (ID)>

Example: if the ordered max dose per time is 10 minutes, this field format is 10^M&minutes.

RXV -18 Syringe Manufacturer (CWE)

Definition: This field contains the manufacturer of the syringe containing the ordered medication.

RXV -19 Syringe Model Number (CWE)

Definition: This field contains the model number of the syringe containing the ordered medication.

RXV -20 Syringe size (NM)

Definition: This field contains the syringe’s numeric total volume size.

RXV -21 Syringe size Units (CWE)

Definition: This field indicates the units associated with RXV -17 Syringe size.

RESOLUTION DISCUSSION

Various updates.

Check lengths

% issue on amount/amount units – separate discussion as it touches all other like segments

Is NM to CQ backwards compatible?

Received a lot of review in the devices workgroup.

Add Action Code field per new segment in first or second place.

Suggestion to add at the end, unless more logically put elsewhere.

Add PRT where needed (modeled after V2.7)

Motion: Accept as proposed (with modifications discussed) and will return for additional adjustments if the adjustments are substantive (e.g., normative lengths). Gary, Todd.

Discussion: None.

Against: 0; Abstain: 3; In Favor: 15

[GaryM1]Propose to remove this type. By default the PCA order will be continuous if the RXE rate fields are populated