HL7 ADT

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The Discovery Data Service (DDS) takes HL7 ADT messages from a number of suppliers, transforms the data into FHIR, and makes this available for subscriber use. This page explains the HL7 ADT message types, structure, transform process, and the ADT -> FHIR -> Compass2 mappings.

Message Types

Publisher Message Type Message Name
Barts Health

Homerton

ADT^A01 Admit / visit notification
Barts Health

Homerton

ADT^A02 Transfer a patient
Barts Health

Homerton

ADT^A03 Discharge/end visit
Barts Health

Homerton

ADT^A04 Register a patient
Homerton ADT^A05 Pre-admit a patient
Homerton ADT^A06 Change an outpatient to an inpatient
Homerton ADT^A07 Change an inpatient to an outpatient
Barts Health

Homerton

ADT^A08 Update patient information
Barts Health ADT^A11 Cancel admit/visit notification
Barts Health

Homerton

ADT^A12 Cancel transfer
Barts Health

Homerton

ADT^A13 Cancel discharge/end visit
Homerton ADT^A14 Pending admit
Homerton ADT^A17 Swap patients
Barts Health

Homerton

ADT^A23 Delete a patient record
Homerton ADT^A27 Cancel pending admit
Barts Health

Homerton

ADT^A28 Add person information
Barts Health

Homerton

ADT^A31 Update person information
Barts Health

Homerton

ADT^A34 Merge patient information - patient ID only
Barts Health

Homerton

ADT^A35 Merge patient information - account number only
Barts Health

Homerton

ADT^A44 Move account information - patient account number

Message Structures

The messages types are grouped by their structure for transformation to FHIR, since this avoids a large amount of code repetition.

When saving FHIR to the Discovery store there are variations in handling of message types within the message structure groups.

The structures are as follows:

Structure A – Patient level messages

Applies to Standard segments Cerner custom segments
  • ADT^A01 (Admit/visit notification)
  • ADT^A02 (Transfer a patient)
  • ADT^A03 (Discharge/end visit)
  • ADT^A04 (Register a patient)
  • ADT^A05 (Pre-admit a patient)
  • ADT^A06 (Change an outpatient to an inpatient)
  • ADT^A07 (Change an inpatient to an outpatient)
  • ADT^A08 (Update patient information)
  • ADT^A11 (Cancel admit/visit notification)
  • ADT^A12 (Cancel transfer)
  • ADT^A13 (Cancel discharge/end visit)
  • ADT^A14 (Pending admit)
  • ADT^A23 (Delete a patient record)
  • MSH [1..1] Message header
  • EVN [1..1]  Event information
  • PID [1..1] Patient information
  • PD1 [0..1] Additional demographics
  • NK1 [0..*] Next of kin / associated parties
  • PV1 [1..1] Patient visit information
  • PV2 [0..1] Patient visit additional
  • OBX [0..*] Obs (used by Homerton for misc. admin data)
  • AL1 [0..*] Allergies
  • ACC [0..*] Accident information
  • DG1 [0..*] Diagnosis information
  • NTE [0..*] Notes and comments
  • ZAL [0..*] Additional allergy information
  • ZQA [0..1] Questionnaire information
  • ZPI [0..1] Additional person information
  • ZVI [0..1] Additional visit information

Structure B – Person level messages (without encounter information)

Applies to Standard segments Cerner custom segments
  • ADT^A28 (Add person information)
  • ADT^A31 (Update person information)
  • MSH [1..1] Message header
  • EVN [1..1] Event information
  • PID [1..1] Patient information
  • PD1 [0..1] Additional demographics
  • NK1 [0..*] Next of kin / associated parties
  • OBX [0..*] Obs (used by Homerton for misc. admin data)
  • AL1 [0..*] Allergies
  • NTE [0..*] Notes and comments
  • ZAL [0..*] Additional allergy information
  • ZPI [0..1] Additional person information

Structure C – Swap patients

Applies to Standard segments Cerner custom segments
  • ADT^A17 (Swap patients)
  • MSH [1..1] Message header
  • EVN [1..1] Event information
  • PID [1..1] Patient information
  • PV1 [1..1] Patient visit information
  • PV2 [0..1] Patient visit additional
  • OBX [0..*] Obs (used by Homerton for misc. admin data)
  • ZPI [0..1] Additional person information
  • ZVI [0..1] Additional visit information

Structure D – Merge patient information

Applies to Standard segments
  • A34 (Merge patient information)
  • A44 (Move account information)
  • MSH [1..1] Message header
  • EVN [1..1] Event information
  • PID [1..1] Patient information
  • PD1 [0..1] Additional demographics
  • MRG [1..1] Merge information

Structure E – Merge account number

Applies to Standard segments
  • A35 (Merge account number)
  • MSH [1..1] Message header
  • EVN [1..1] Event information
  • PID [1..1] Patient information
  • PD1 [0..1] Additional demographics
  • PV1 [1..1] Patient visit information
  • MRG [1..1] Merge information

Transformation

The diagram below shows a simplified view of the HL7 to FHIR transform for structure A with the source HL7 segments on the left and target FHIR resources on the right.

Barts Health Homerton
HL7 ADT Transformation Overview.jpg Transformation Overview Homerton V2.jpg
As Barts Health plus NK1 and ZVI

The following sections show each transformation in detail, including field mappings.

Message Header

Barts Health Homerton
MSH Overview.jpg MSH EVN Overview.jpg
Message Header (MSH) Message Header (MSH) & Even Type (EVN)
MSH field mapping
Publisher Field# FieldName FHIR Mapping Extension Compass Schema Table Field
Barts Health

Homerton

MSH.3 Sending application MessageHeader.source.software
Barts Health

Homerton

MSH.4 Sending facility MessageHeader.source.name
Barts Health

Homerton

MSH.5 Receiving application MessageHeader.destination.extension message-header-destination-software-extension
Barts Health

Homerton

MSH.6 Receiving facility MessageHeader.destination.name & MessageHeader.responsible
Barts Health

Homerton

MSH.7 Message date/time MessageHeader.timestamp
Barts Health

Homerton

MSH.9 Message type MessageHeader.event.code
Barts Health

Homerton

MSH.10 Message control id MessageHeader.extension message-header-message-control-id-extension
Barts Health

Homerton

MSH.12 Version ID MessageHeader.event.version
Homerton MSH.13 Sequence number MessageHeader.extension message-header-sequence-number-extension
EVN field mapping
Publisher Field# FieldName FHIR Mapping Compass Schema Table Field
Homerton EVN.5 Operator ID MessageHeader.enterer & Practitioner.identifier & Practitioner.name

Patient

Barts Health

Patient Identification (PID), & Patient Additional Demographic (PD1)



OR

Homerton

PID PD1 NK1 segments.jpg

Patient Identification (PID), Patient Additional Demographic (PD1), & Next of Kin (NK1) segments

PID field mapping
Publisher Field# FieldName FHIR Mapping Extension Compass Schema Table Field
Barts Health

Homerton

PID.2 Patient ID Patient.identifier patient nhs_number
Barts Health

Homerton

PID.3 Patient Identifier List Patient.identifier
Barts Health - PID.3.1 ID Patient.identifier.value
Barts Health - PID.3.4 Assigning authority Patient.identifier.system Patient organization_id
Homerton PID.4 Alternate PatientIidentifier Patient.identifier
Barts Health

Homerton

PID.5 Patient Name Patient.name Patient first_names

last_name

Barts Health - PID.5.1 Family Name Patient.name.family Patient last_name
Barts Health - PID.5.2 Given Name Patient.name.given Patient first_names
Barts Health - PID.5.3 Middle Name Patient.name.given Patient first_names
Barts Health - PID.5.5 Prefix Patient.name.prefix Patient title
Barts Health - PID.5.7 Name Type Code Patient.name.use
Barts Health

Homerton

PID.7 Date/Time Of Birth Patient.birthDate & Patient.extension primarycare-contact-birth-time-extension Patient date_of_birth
Barts Health

Homerton

PID.8 Sex Patient.gender Patient gender_concept_id
Barts Health

Homerton

PID.9 Patient Alias Patient.name
Barts Health

Homerton

PID.11 Patient Address Patient.address patient current_address_id
Barts Health - PID.11.1 Street Address Patient.address.line patient_address address_line_1
Barts Health - PID.11.2 Other Designation Patient.address.line patient_address address_line_2
Barts Health - PID.11.3 City Patient.address.city patient_address city
Barts Health - PID.11.5 Zip Or Postal Code Patient.address.postalCode patient_address postcode
Barts Health - PID.11.7 Address Type Patient.address.use patient_address use_concept_id
Barts Health - PID.11.8 Other Geographic Designation Patient.address.line patient_address address_line_3
Barts Health - PID.11.9 County/Parish Code Patient.address.district patient_address ward_code

local_authority_code

Barts Health

Homerton

PID.13 Phone Number - Home Patient.telecom patient_contact type_concept_id
Barts Health - PID.13.1 Patient Number Patient.telecom.value patient_contact value
Barts Health - PID.13.2 Telecommunication Use Code Patient.telecom.use patient_contact use_concept_id
Barts Health

Homerton

PID.14 Phone Number - Business Patient.telecom patient_contact type_concept_id
Barts Health - PID.14.1 Patient Number Patient.telecom.value patient_contact value
Barts Health - PID.14.2 Telecommunication Use Code Patient.telecom.use patint_concept use_concept_id
Barts Health

Homerton

PID.15 Primary Language Patient.communication.language
Barts Health

Homerton

PID.16 Marital Status Patient.maritalStatus
Barts Health

Homerton

PID.17 Religion Patient.extension primarycare-religion-category-extension
Barts Health

Homerton

PID.18 Patient Account Number Patient.identifier
Barts Health

Homerton

PID.22 Ethnic Group Patient.extension primarycare-ethnic-category-extension Patient ethnic_code_concept_id
Barts Health

Homerton

PID.29 Patient Death Date and Time Patient.deceased Patient date_of_death
Barts Health

Homerton

PID.30 Patient Death Indicator Patient.deceased
PD1 field mapping
Publisher Field# FieldName FHIR Mapping Compass Schema Table Field
Barts Health

Homerton

PD1.3 Patient primary facility Patient.careProvider& Organization
Barts Health - PD1.3.3 ID number Organization.identifier.value
Barts Health

Homerton

PD1.4 Patient primary care provider Patient.careProvider& Practitioner
Barts Health - PD1.4.1 ID number Practitioner.identifier.value
Barts Health - PD1.4.2 Family name Practitioner.name.family
Barts Health - PD1.4.3 Given name Practitioner.name.given
Barts Health - PD1.4.9 Assigning authority Practitioner.identifier.system
NK1 field mapping
Publisher Field# FieldName FHIR Mapping Extension Compass Schema Table Field
Homerton NK1.2 Name Patient.contact.name
Homerton NK1.3 Relationship Patient.contact.relationship
Homerton NK1.4 Address Patient.contact.address
Homerton NK1.5 Phone number Patient.contact.telecom.value
Homerton NK1.6 Business phone number Patient.contact.telecom.value
Homerton NK1.7 Contact role Patient.contact.extension primarycare-contact-role-category-extension
Homerton NK1.20 Primary language Patient.contact.extension primarycare-contact-main-language-category-extension

Encounter

Barts Health

PV1 PV2 EVN Segments.jpg

Patient Visit (PV1), Patient Visit - additional (PV2), & Event Type (EVN)



OR

Homerton

PV1 PV2 ZVI segments.jpg

Patient Visit (PV1), Patient Visit - additional (PV2), & Additional Visit Information (ZVI) segments

Note - Each ADT message containing a PV1 segment (i.e. Structure A messages) results in a new FHIR Encounter resource being created.

The newly created FHIR Encounter is linked to an EpisodeOfCare resource based on the PV1’s Visit Number (this is carried in the Attendance Number field).

If the PV1 Visit Number is new – i.e. has not previously been seen by Discovery – this causes a new EpisodeOfCare resource to be created.

If the PV1 Attendance Number has previously been seen by Discovery, then the Encounter is linked to the existing EpisodeOfCare.

PV1 field mapping
Publisher Field# FieldName FHIR Mapping Extension Compass Schema Table Field
Barts Health

Homerton

PV1.2 Patient class Encounter.class
Barts Health PV1.3 Assigned patient location Encounter.location

& Location

Barts Health - PV1.3.1 Point of Care Encounter.location
Barts Health - PV1.3.2 Room Encounter.location
Barts Health - PV1.3.3 Bed Encounter.location
Barts Health - PV1.3.4 Facility Encounter.location

Encounter.location

Barts Health - PV1.3.7 Building Encounter.location
Homerton PV1.4 Admission type Encounter.extension encounter-admission-type
Homerton PV1.6 Prior patient location Encounter.location& Location
Barts Health

Homerton

PV1.7 Attending doctor Encounter.participant & Practitioner
Barts Health - PV1.7.1 ID number Practitioner.identifier.value practitioner id
Barts Health - PV1.7.2 Family name Practitioner.name.family practicioner name
Barts Health - PV1.7.3 Given name Practitioner.name.given practicioner name
Barts Health - PV1.7.9 Assigning authority Practitioner.identifier.system practicioner organization_id
Barts Health

Homerton

PV1.8 Referring doctor Encounter.participant & Practitioner
Barts Health - PV1.8.1 ID number Practitioner.identifier.value practicioner id
Barts Health - PV1.8.2 Family name Practitioner.name.family practicioner name
Barts Health - PV1.8.3 Given name Practitioner.name.given practicioner name
Barts Health - PV1.8.9 Assigning authority Practitioner.identifier.system practicioner organization_id
Homerton PV1.9 Consulting doctor Encounter.participant& Practitioner
Barts Health

Homerton

PV1.10 Hospital service Encounter.serviceProvider& Organization
Homerton PV1.14 Admit source Encounter.hospitalization.origin encounter_additional value_id
Homerton PV1.17 Admitting doctor Encounter.participant & Practitioner
Barts Health

Homerton

PV1.18 Patient type Encounter.type
Barts Health

Homerton

PV1.19 Visit number EpisodeOfCare.identifier episode_of_care id
Barts Health

Homerton

PV1.36 Discharge disposition Encounter.hospitalization.dischargeDisposition
Barts Health

Homerton

PV1.37 Discharged to location Encounter.hospitalization.destination
Homerton PV1.39 Servicing facility Encounter.managingOrganization encounter service_provider_organization_id
Barts Health

Homerton

PV1.41 Account status Encounter.status
Barts Health

Homerton

PV1.44 Admit date/time Encounter.statusHistory.start encounter

encounter_event

clinical_effective_date

clinical_effective_date

Barts Health

Homerton

PV1.45 Discharge date/time Encounter.statusHistory.end
Homerton PV1.50 Alternate visit ID Encounter.identifier
Homerton PV1.52 Other healthcare provider Encounter.participant& Practitioner
PV2 field mapping
Publisher Field# FieldName FHIR Mapping Compass Schema Table Field
Barts Health

Homerton

PV2.3 Admit reason Encounter.reason
Homerton PV2.4 Transfer reason Encounter.reason
Barts Health

Homerton

PV2.8 Expected admit date/time Encounter.statusHistory.start
Homerton PV2.9 Expected discharge date/time Encounter.statusHistory.end
EVN field mapping
Publisher Field# FieldName FHIR Mapping Extension Compass Schema Table Field
Barts Health EVN.2 Recorded date/time Encounter.extension primarycare-recorded-date-extension encounter date_recorded
Homerton EVN.5 Operator ID MessageHeader.enterer & Practitioner.identifier & Practitioner.name
ZVI field mapping
Publisher Field# FieldName FHIR Mapping Compass Schema Table Field
Homerton ZVI.9 Admit mode Encounter.hospitalization.admitSource
Homerton ZVI.15 Assign to location date/time Encounter.location.period
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