|
The summary of differences assumes use of the PH (Public Health) data type components, as defined in the Draft Laboratory Standard, which does not define the data type when the usage of a field is optional. This leaves the field underspecified which could be a problem if any system for any reason needs to populate it, and may result in messages that are not HL7 compliant nor ELR conformant. Differences omitted from the table are those that the task force perceived as having no impact on central registry messaging including differences in fields where usage is defined as “Not Supported” in the Current Registry Standard.
The differences are described by all of the characteristics of each field in which there is a difference.
The characteristics documented are:
1) Field description;
2) Cardinality (identifies which segments within an HL7 standard are allowed to repeat and to what extent);
3) Data type (various data types are supported by HL7, those referred to in this document are listed in Appendix A);
4) Usage (identifies whether a sending system is required to populate a particular data item if the data are available, and whether a receiving system is required to be capable of processing the data, if contained in a message). Usage values referred to in this document are: R (Required), RE (Required or empty), O (Optional), CE (Conditional or empty), and X (Not supported);
5) Vocabulary (in HL7 it defines the meaning of data by specifying which code systems and value sets should be used), and
6) Data values.
There are 3 levels of differences (Minor, Significant, and Critical) in the table below:
Minor (M) - Items that will not necessitate any significant change, or modifications to the system to allow the registry to continue normal operation. No changes are required by the sender or receiver.
Significant (S) - Incur some change and inconvenience on both the sender and the receiver. May result in conformance violations, but the registry can still perform functions, albeit with difficulty.
Critical (C) - The Draft Laboratory Standard is missing support for a required data item, and the registry cannot perform one or more functions.
Summary of Differences Between NAACCR Standards Volume V Version 4.0 and the ELR DSTU Specification
MSH (Message Header) Segment
|
Element ID
|
Element Name
|
Location of difference
|
Description of difference
|
Level of Difference (M, S, C )
|
Notes
|
MSH-1
|
Field separator
|
Field Description
|
ELR has ‘SHALL’ vs 'Recommended'
|
M
|
|
MSH-3
|
Sending application
|
Cardinality
|
ELR has [1..1] vs [0..1]
|
M
|
Due to using the PH component.
|
MSH-3
|
Sending application
|
Data Type
|
ELR has HD_GU vs HD
|
S
|
An OID is required here as per the ELR. It can be a significant expense to obtain a valid OID, in addition to other expenses that come with sending and receiving OIDs. There can be two levels of OID, application OID, or the application instance. Does the OID identify the product or does it identify the specific installation of the product? This is not clearly stated in the ELR.
|
MSH-4
|
Sending facility
|
Data Type
|
ELR has HD_GU-PH. Vol V has HD.
|
C
|
The 2nd and 3rd components of the HD are R in the ELR and must be OID or CLIA numbers vs. Vol V where they are CE and any type of universal ID or universal ID type. OID or CLIA numbers cannot be enforced in Canada.
|
MSH-4
|
Sending facility
|
Field Description
|
ELR mentions OIDs, which Vol V does not. Both allow CLIA, does not look like either require it.
|
C
|
|
MSH-5
|
Receiving application
|
Data Type
|
ELR has HD_GU vs HD
|
C
|
An OID is required here as per the ELR. It can be a significant expense to obtain a valid OID, in addition to other expenses that come with sending and receiving OIDs. There can be two levels of OID, application OID, or the application instance. Does the OID identify the product or does it identify the specific installation of the product? This is not clearly stated in the ELR.
|
MSH-5
|
Receiving application
|
Usage
|
ELR has Varies vs RE. R for PH component, O for others; neither matches Vol V.
|
M
|
|
MSH-5
|
Receiving application
|
Cardinality
|
ELR has [1..1] vs [0..1]
|
S
|
Due to using the PH component.
|
MSH-6
|
Receiving facility
|
Data Type
|
ELR has HD_GU vs HD
|
C
|
The cancer registry would need to have an OID assigned as per the ELR for the PH component.
|
MSH-7
|
Date/time of message
|
Data Type
|
ELR has Varies vs TS. Non PH component usage has TS_1. It isn’t clear in Vol V how many of the TS parts are required.
|
M
|
Vol V would permit a TS that is less granular than a second where the ELR would not (but we have never seen this).
|
MSH-11
|
Processing ID
|
Field Description
|
Vol V appears to limit to P (production), T (training),
D (debugging). ELR does not have a value set for this field.
|
M
|
Vol V 2nd component for data type PT is RE and the ELR is silent on this issue.
|
MSH-12
|
Version ID
|
Field Description
|
ELR is constrained to 2.5.1
|
M
|
Vol V does not explicitly constrain it to 2.5.1. (Perhaps it should?)
|
MSH-13
|
Sequence number
|
Data Type
|
ELR does not define as Usage is O.
|
M
|
|
MSH-13
|
Sequence number
|
Usage
|
ELR has O vs RE
|
M
|
|
MSH-13
|
Sequence number
|
Cardinality
|
ELR does not define as Usage is O
|
M
|
|
MSH-14
|
Continuation pointer
|
Data Type
|
ELR does not define as Usage is O.
|
M
|
The use of this field is under specified in both specs (ELR vs. Vol V).
|
MSH-14
|
Continuation pointer
|
Usage
|
ELR has O vs CE
|
M
|
|
MSH-14
|
Continuation pointer
|
Cardinality
|
ELR does not define as Usage is O
|
M
|
|
MSH-17
|
Country code
|
Data Type
|
ELR does not define as Usage is O.
|
S
|
The ELR is explicitly for use in the U.S. and Vol V is for use in the U.S. and Canada.
|
MSH-17
|
Country code
|
Vocabulary
|
ELR does not define as Usage is O vs 0399
|
S
|
|
MSH-17
|
Country code
|
Cardinality
|
ELR has O vs RE
|
S
|
|
MSH-17
|
Country code
|
Data Type
|
ELR does not define as Usage is O.
|
S
|
|
MSH-19
|
Principal language of message
|
Data Type
|
ELR does not define as Usage is O.
|
S
|
The ELR is explicitly for use in the U.S. and Vol V is for use in the U.S. and Canada.
|
MSH-19
|
Principal language of message
|
Usage
|
ELR has O vs RE
|
S
|
|
MSH-19
|
Principal language of message
|
Cardinality
|
ELR does not define as Usage is O.
|
S
|
|
MSH-21
|
Message Profile Identifier
|
Data Type
|
ELR has EI_GU vs EI
|
C
|
An OID is required and there is no OID for Vol V.
|
MSH-21
|
Message Profile Identifier
|
Usage
|
ELR has R vs RE
|
M
|
|
MSH-21
|
Message Profile Identifier
|
Cardinality
|
ELR has [1..*]
|
M
|
|
Summary of Differences Between NAACCR Standards Volume V Version 4.0 and the ELR DSTU Specification
PID (Patient Identification) Segment
|
Element ID
|
Element Name
|
Location of difference
|
Description of difference
|
Level of Difference (M, S, C)
|
Notes
|
PID-2
|
Patient ID (External)
|
All
|
This field is excluded from the ELR.
|
M
|
|
PID-3
|
Patient identifier list
|
Data Type
|
ELR uses CX_GU, Vol V uses CX
|
M
|
The ELR requires an OID for the assigning authority, since the data type is HD_GU, while Vol V accepts strings.
|
PID-3
|
Patient identifier list
|
Cardinality
|
ELR is [1..*] vs. [1..8].
|
M
|
|
PID-5
|
Patient name
|
Cardinality
|
ELR is [1..*] vs. [1..8].
|
M
|
|
PID-7
|
Date/time of birth
|
Data Type
|
ELR varies, Vol V is TS. ELR common component: TS_2. Newborn Screening Profile: TS_3. PH Component: Patient's date of birth. Note that the granularity of the birth date may be important. For a newborn, birth date may be known to the minute, while for adults it may be known only to the date. Note: If a birth date is not provided in the PID, then the patient age must be reported as an observation associated with the Order.
|
M
|
|
PID-8
|
Sex
|
Data Values
|
ELR refers to HL7 table and Vol. V has 2 additional codes that do not appear in the HL7 table.
|
M
|
|
PID-8
|
Sex
|
Usage
|
ELR is R, Vol V is RE.
|
M
|
|
PID-8
|
Sex
|
Cardinality
|
ELR is [1..1] vs. [0..1].
|
M
|
|
PID-9
|
Patient alias
|
All
|
This field is excluded from the ELR.
|
M
|
|
PID-10
|
Race
|
Data Type
|
ELR varies, Vol V is CE
|
M
|
|
PID-10
|
Race
|
Data Values
|
ELR refers to the HL7 table with no distinction.
|
M
|
The ELR does not specify the code set, while the CDC Race/Ethnicity code set is recommended in Vol V.
|
PID-15
|
Primary language
|
Usage
|
ELR is optional. No other information for this field is available within the ELR. Vol V has RE.
|
M
|
|
PID-16
|
Marital status
|
Usage
|
ELR is optional. No other information for this field is available within the ELR. Vol V has RE.
|
M
|
|
PID-17
|
Religion
|
Usage
|
ELR is optional. No other information for this field is available within the ELR. Vol V has RE.
|
M
|
|
PID-18
|
Patient account number
|
Usage
|
ELR is optional. No other information for this field is available within the ELR. Vol V has CE.
|
M
|
|
PID-19
|
SSN number – patient
|
Usage
|
This field is excluded from the ELR. Vol V has CE.
|
C
|
In the U.S., if this field is not populated some central registries will not be able to obtain the SSN.
|
PID-22
|
Ethnic group
|
Data Type
|
ELR is CWE_CRE, Vol V is CE.
|
M
|
|
PID-22
|
Ethnic group
|
Vocabulary
|
ELR uses the HL7 single character codes; Vol V uses a larger more detailed set based on the CDC Race/Ethnicity codes.
|
S
|
|
PID-22
|
Ethnic group
|
Cardinality
|
ELR is [0..*] vs. [0..4].
|
M
|
|
PID-23
|
Birth place
|
Usage
|
ELR is optional. No other information for this field is available within the ELR. The Vol V is RE.
|
M
|
|
PID-31
|
Identity unknown indicator
|
Usage
|
This field is excluded from the ELR, Vol V is RE.
|
M
|
|
PID-32
|
Identity reliability code
|
Usage
|
ELR is optional, Vol V is RE. No other information for this field is available within the ELR.
|
M
|
|
PID-39
|
Tribal citizenship
|
Usage
|
ELR is not supported, Vol V is RE.
|
S
|
For those registries that need to collect tribal information this is a significant difference.
|
Summary of Differences Between NAACCR Standards Volume V Version 4.0 and the ELR DSTU Specification ORC (Common Order) Segment
|
Element ID
|
Element Name
|
Location of difference
|
Description of difference
|
Level of Difference (M, S, C)
|
Notes
|
ORC-21
|
Ordering facility name
|
Usage
|
ELR varies (see below):
PH Component Usage: ‘R’
All other profiles Usage: ‘O’
PH Component:
This field should contain the name of the facility where the order was originally placed by the provider (even if a sample is being referred by the filler lab to another lab). If the order was placed in a single provider office, the value in this field may be the same as in ORC-12.
Vol V is C
|
M
|
|
ORC-21
|
Ordering facility name
|
Cardinality
|
ELR is [1..1] vs. [1..4]
|
M
|
|
ORC-22
|
Ordering facility address
|
Usage
|
ELR varies (see below):
PH Component Usage: ‘R’
All other profiles Usage: ‘O’
PH Component:
The address of the ordering facility identified in ORC.21.
Vol V is RE
|
M
|
|
ORC-22
|
Ordering facility address
|
Cardinality
|
ELR is [1..1] vs. [1..4]
|
M
|
|
ORC-23
|
Ordering facility phone number
|
Usage
|
ELR varies (see below):
PH Component Usage: ‘R’
All other profiles Usage: ‘O’
PH Component:
The address of the ordering facility identified in ORC.21.
Vol V is RE
|
M
|
|
ORC-23
|
Ordering facility phone number
|
Cardinality
|
ELR is [1..*] vs. [1..4]
|
M
|
|
ORC-24
|
Ordering provider address
|
Usage
|
ELR varies (see below):
PH Component Usage: ‘RE’
All other profiles Usage: ‘O’
PH Component:
This should be the address associated with the original ordering provider identified in OBR.16 / ORC 12.
Vol V is RE
|
M
|
|
ORC-24
|
Ordering provider address
|
Cardinality
|
ELR 0..*. Vol V is 1..4
|
M
|
|
Summary of Differences Between NAACCR Standards Volume V Version 4.0 and the ELR DSTU Specification OBR (Observation Request) Segment
|
Element ID
|
Element Name
|
Location of difference
|
Description of difference
|
Level of Difference (M, S, C)
|
Notes
|
OBR-2
|
Placer order number
|
Data Type
|
ELR is EI_GU; Vol V is EI.
|
C
|
The ELR requires an OID.
|
OBR-3
|
Filler order number
|
Data Type
|
ELR is EI_GU; Vol V is EI.
|
C
|
The ELR requires an OID.
|
OBR-4
|
Universal service ID
|
Data Type
|
ELR is CWE_CR; Vol V is CE.
|
S
|
|
OBR-4
|
Universal service ID
|
Vocabulary
|
ELR requires a specific value set of LOINC codes; Vol V uses LOINC and others.
|
S
|
|
OBR-7
|
Observation
|
Data Type
|
ELR is TS_4 vs. regular HL7 TS.
|
S
|
The ELR says that IF you have a valid year, you must have mm (month), dd (day), and minutes.
|
OBR-10
|
Collector identifier
|
Usage
|
ELR is O; Vol V is RE.
|
M
|
|
OBR-10
|
Collector identifier
|
Cardinality
|
ELR does not define cardinality, Vol V has repeats allowed 4 times.
|
M
|
|
OBR-13
|
Relevant clinical information
|
Usage
|
ELR is RE; Vol V is X (not supported), but it probably should be.
|
M
|
|
OBR-13
|
Relevant clinical information
|
Data Type
|
ELR is CWE_CRE, Vol V is ST.
|
M
|
|
OBR-14
|
Specimen received date/time
|
Usage
|
ELR is not supported, Vol V is RE. HL7 is B.
|
M
|
|
OBR-15
|
Specimen source
|
Usage
|
ELR is not supported, Vol V is RE. HL7 is B.
|
S
|
|
OBR-16
|
Ordering provider
|
Usage
|
ELR is O, Vol V is C.
|
S
|
|
OBR-16
|
Ordering provider
|
Data Type
|
ELR is XCN_GU, Vol V is XCN.
|
S
|
|
OBR-16
|
Ordering provider
|
Cardinality
|
ELR allows for only one, Vol V allows four repeats.
|
M
|
|
OBR-17
|
Order callback phone number
|
Cardinality
|
ELR allows for up to two repeats, Vol V allows four repeats.
|
M
|
|
OBR-22
|
Results rpt/status change-date/time
|
Usage
|
ELR is R, Vol V is RE.
|
M
|
|
OBR-22
|
Results rpt/status change-date/time
|
Data Type
|
ELR is TS_6; Vol V is TS.
|
M
|
The ELR requires that it be populated to the second.
|
OBR-26
|
Parent result
|
Usage
|
Conditional on OBR-11 (Specimen Action Code); i.e., it being valued "G" (Generated Order/reflex order). Specifically, usage is in ELR is C(R/RE), vs. CE in Vol V.
|
M
|
|
OBR-29
|
Parent
|
Usage
|
ELR is C(R/RE); Vol V is CE.
|
M
|
|
OBR-29
|
Parent
|
Data Type
|
ELR is EIP_GU; Vol V is EIP.
|
M
|
|
OBR-31
|
Reason for study
|
Data Type
|
ELR is CWE_CRE, Vol V is CE.
|
M
|
|
Summary of Differences Between NAACCR Standards Volume V Version 4.0 and the ELR DSTU Specification
OBX (Observation Result) Segment
|
Element ID
|
Element Name
|
Location of difference
|
Description of difference
|
Level of Difference (M, S, C)
|
Notes
|
OBX-3
|
Observation identifier
|
Vocabulary
|
ELR has a fixed value set of LOINC codes; Vol V uses LOINC and others.
|
S
|
|
OBX-5
|
Observation value
|
Vocabulary
|
ELR states that SCT is used for all coded results if the code exists (we use ICDO, and cKeys, among other coding systems). Cancer registry reporting may suggest using SCT in addition to the primary cancer reporting code systems.
|
S
|
|
OBX-5
|
Observation value
|
Usage
|
ELR is RE, but there is no explanation of the rule (if different from the base HL7 rule) for leaving it unpopulated. Vol V requires a value here in OBX-5.
|
M
|
|
OBX-5
|
Observation value
|
Cardinality
|
OBX-5 is not permitted to repeat for multipart results, whereas Vol V allows up to 12 repeats, as virtually ALL cancer reporting systems break up the lines or paragraphs or sections of the report into OBX-5 repeats.
|
S
|
|
OBX-8
|
Abnormal flags
|
Data Type
|
Vol V has IS data type for this field. ELR changed the datatype for messages that are part of the “PH Component” to be a constrained CWE (CWE_CRE); this would not be supported in current path lab systems and would likely break all state registry receiving systems.
|
S
|
|
OBX-15
|
Producer’s reference
|
Usage
|
ELR is optional, with no cardinality constraint defined
|
S
|
|
OBX-16
|
Responsible observer
|
Usage
|
ELR is optional, with no cardinality constraint defined
|
S
|
|
OBX-17
|
Observation method
|
Cardinality
|
ELR looks a bit strange; Usage is “varies” and cardinality is “RE”.
|
S
|
Typo in the ELR in Cardinality column.
|
OBX-17
|
Observation method
|
Vocabulary
|
ELR says uses HL7 V3 or SNOMED but allows other code systems to be used; Vol V defines a NAACCR code system.
|
M
|
|
OBX-23
|
Performing organization name
|
Data Type
|
ELR is the customized XON_GU, while Vol V is XON.
|
S
|
|
OBX-23
|
Performing organization name
|
Usage
|
ELR is R; Vol V is RE
|
S
|
|
OBX-24
|
Performing organization address
|
Usage
|
ELR is R; Vol V is CE
|
S
|
|
OBX-29
|
Observation type
|
Field Definition
|
ELR has added four fields to the OBX segments, fields which do not exist in any of the earlier releases of HL7. Three of the four are optional: 1) OBX-26 (Patients results release category; 2) OBX-27 (Root cause); and 3) OBX-28 (Local process control). These are not included in this table. The fourth field OBX-29 (Observation type), is also pre-adopted from HL7 version 2.8.1. It is a Required field.
|
S
|
|
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