FIM Technical Manuals

FIM Technical Manuals Functional Independence Measurement (FIM) Technical Manual and Security Guide Version 1.0 May 2003 Department of Veterans Affairs VistA System Design and Development Revision History Date Description 2/26/2003 Updates from John Owczarzak 3/31/2003 Updates from John Owczarzak 4/14/2003 Updates from John Owczarzak 4/22/2003 Updates from John Owczarzak 5/02/2003 Updates from John Owczarzak May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 TABLE OF CONTENTS INTRODUCTION ....................................................................................... 1 Recommended Users............................................................................ 2 Related Manual ..................................................................................... 2 Online Help ........................................................................................... 2 ORIENTATION ......................................................................................... 2 Screen Displays and Text Notes .......................................................... 2 Software and Manual Retrieval ............................................................. 4 VistA Intranet ........................................................................................ 4 Assumptions about the Reader ............................................................ 5 IMPLEMENTATION AND MAINTENANCE ................................................ 6 System Log In ....................................................................................... 6 Configuration File Management ........................................................... 7 FILE DIAGRAM ........................................................................................ 8 PROTOCOLS ........................................................................................... 8 FILES ....................................................................................................... 9 ROUTINES ............................................................................................... 9 EXPORTED OPTIONS ............................................................................ 10 XINDEX ............................................................................................... 11 Callable Routines/Entry Points/APIs .................................................. 11 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 iii BROKER CONTEXT MENU OPTION ASSIGNMENT ............................... 11 EXTERNAL INTERFACES ...................................................................... 12 Exported Remote Procedure Calls (RPC) ........................................... 12 EXTERNAL RELATIONS ........................................................................ 13 Data Base Agreements (DBIAs) .......................................................... 13 SOFTWARE SECURITY ......................................................................... 14 Mail Groups ........................................................................................ 14 Remote Systems ................................................................................. 14 Archiving and Purging ....................................................................... 15 Contingency Planning ........................................................................ 15 Interfacing Software ........................................................................... 15 Security Keys ..................................................................................... 15 Equipment .......................................................................................... 16 APPENDIX A - DATABASES .................................................................. 16 APPENDIX B – HEALTH LEVEL SEVEN (HL7) SPECIFICATIONS .......... 23 INTRODUCTION ..................................................................................... 23 GENERAL SPECIFICATIONS ................................................................. 23 Communication Protocol .................................................................... 23 Application Processing Rules ............................................................ 23 HL7 Concepts and Definitions ............................................................ 24 Messages ........................................................................................................ 24 Segments ........................................................................................................ 24 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 iv Fields ............................................................................................................. 24 Position (sequence within the segment) ............................................................ 24 Maximum length ............................................................................................. 25 Data type ........................................................................................................ 25 Optionality ..................................................................................................... 25 Repetition ...................................................................................................... 26 Message Delimiters ......................................................................................... 26 Data Types ..................................................................................................... 27 Use of Escape Sequences in Text Fields ........................................................... 31 Specification Conventions ................................................................. 31 Segment Tables Definitions ............................................................................. 31 HL7 MESSAGES .................................................................................... 32HL7 Message Definition ...................................................................... 32 ORU – Unsolicited transmission of an observation (Event type R01).................. 32 HL7 Segment Definitions and Specifics ............................................. 33 MSH Attributes .............................................................................................. 33 MSH field definitions...................................................................................... 34 PID Attributes ................................................................................................ 37 PID field definitions ....................................................................................... 38 PV1 Attributes ................................................................................................ 41 PV1 Field Definitions .......................................................................... 44 PV1 – Admission Type .................................................................................... 44 NTE – Notes and Comments Segment – Attributes ............................ 46 NTE field definitions ...................................................................................... 46 OBR Attributes ............................................................................................... 47 OBR Field Definitions .................................................................................... 49 OBX Attributes ............................................................................................... 49 OBX field definitions ...................................................................................... 50 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 v Introduction The Functional Independence Measures (FIM) Version 1.0 provides an integration of FIM assessments into the Computerized Patient Record System (CPRS) and into the Functional Status and Outcomes Database (FSOD) at the Austin Automation Center (AAC). The FIM is an 18-item 7-level functional assessment designed to evaluate the amount of assistance required by a person with a disability to perform basic life activities safely and effectively. There are five types of FIM assessments: admission, goals, interim, discharge, and follow-up. The FIM assessments are used clinically to monitor the outcomes of rehabilitative care, as required by the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) and the Commission on the Accreditation of Rehabilitative Facilities (CARF). According to VHA Directive 2000-16, medical centers are mandated to measure and track rehabilitation outcomes on all new stroke, lower-extremity amputees, and traumatic brain injury (TBI) patients using the FIM. Finally, the Performance Measurement Workgroup of the Department of Veterans Affairs Central Office (VACO) approved a Network Director Performance Measure for rehabilitation for FY03 that requires the collection of FIM data. FIM Version 1.0 should greatly ease the burden placed on rehabilitation professionals in the field who are working to comply with the new performance measure. Functional Independence provides a Graphic User Interface (GUI) front end programmed in Delphi to allow multiple clinicians to input FIM data for a given patient. This documentation will then be available in CPRS as a progress note with addendums and/or a completed consults. The GUI front end will also gather demographic data, as well as other required data by FSOD from VistA, eliminating the need for the clinician search of VistA for the information and re-enter for FIM. The FIM data will be placed in a VistA FileMan file for Health Level Seven (HL7) transmission to the FSOD at ACC. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 1 Recommended Users Information in this manual is technical in nature and is developed for the following individuals who are responsible for the installing, supporting, maintaining, and testing this software: Information Resource Management (IRM) Clinical Coordinators National VistA Support (NVS) Related Manual Functional Independence Measurement (FIM) Installation Guide, V.1.0 Functional Independence Measurement (FIM) User Manual, V.1.0 Online Help Instructions, procedures, and other information are available from the FIM online help file. You may access the help file by clicking on Help|Contents from the menu bar or by pressing the F1 key while you have any FIM screen dialog open. Orientation Screen Displays and Text Notes The user’s response in this manual is in bold type, but does not appear on the screen as bold. The bold part of the entry is the letter or letters that you must type so that the computer can identify the response. In most cases, you need only enter the first few letters. This increases speed and accuracy. Every response you type must be followed by pressing the return key (or enter key for some keyboards). Whenever the return or enter key should be pressed, you will see the symbol . This symbol is not shown but is implied if there is bold input. Within the roll and scroll part of the system, help frames may be accessed from most prompts by entering one, two, or three question marks (?, ??, ???). May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 2 Within the examples representing actual terminal dialogues, the author may offer information about the dialogue. You can find this information enclosed in brackets, for example, [type ward name here], and will not appear on the screen. Various symbols are used throughout the documentation to alert the reader to special information. The following table gives a description of each of these symbols: Symbol Description Used to inform the reader of general information including references to additional reading material. See example Used to caution the reader to take special notice of critical information. Table 1: Documentation Symbol Descriptions May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 3 Software and Manual Retrieval The VistA FIM software files and Installation and Implementation Guide (i.e., RMIM1_0IG.PDF) are available on the following Office of Information Field Offices (OIFOs) ANONYMOUS SOFTWARE directories. OIFO FTP Address Directory ftp.fo-albany.med.va.gov anonymous.software Albany Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake City ftp.fo-slc.med.va.gov anonymous.software VistA FIM software and documentation are distributed as the following set of files: File Name Contents Retrieval Format File Size RMIM1_0.KID KIDS build ASCII 219,648 bytes RMIM1_0.ZIP FIM Executable BINARY 1,121,792 bytes RMIM1_0IG.pdf Installation Guide BINARY 1,350 bytes RMIM1_0IG.doc 28,570 bytes RMIM1_0TM.pdf Technical Manual and BINARY 2,460 bytes RMIM1_0TM.doc Security Guide 17,530 bytes RMIM1_0UM.pdf Users Manual BINARY 19,350 bytes RMIM1_0UM.doc 29,130 bytes VistA Intranet Online Documentation for this product is available on the intranet at the following address: www.va.gov/vdl. This address takes you to the VistA Documentation Library (VDL), which has a listing of all the clinical software manuals. Click on the Clinical Case Registries link and it will take you to the FIM documentation. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 4 Assumptions about the Reader This manual is written with the assumption that the reader is familiar with the following: , VistA computing environment , (e.g., Kernel Installation and distribution System [KIDS]) , VA FileMan data structures and terminology , Microsoft Windows , M programming language May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 5 Implementation and Maintenance Please refer to the Functional Independence Measures (FIM) Installation Guide for additional information about installing and implementing this software. There are three ways to run the FIM.exe: 1. If site chooses to pass parameters within the Tools menu of CPRS, Patient Selection will be controlled by CPRS only.* 2. If site chooses to hang the software within the Tools menu of CPRS without passing parameters, Patient Selection will be controlled by FIM. FIM will run as a stand-alone. 3. If site chooses to initiate FIM through other means (i.e. desktop shortcut), Patient Selection will be controlled by FIM. FIM will run as a stand-alone. *If site chooses to launch FIM from the CPRS Tools menu using parameter passing (s=%SRV p=%PORT d=%DFN): 1. Patient Selection will be controlled by CPRS. 2. No Patient Selection will be allowed in FIM 3. If FIM has an active patient record open, and CPRS changes patient, users will be informed that all current input data will be ignored. 4. FIM will shut down. System Log In The system will display the same Broker Server list that you see in CPRS if your site has server lists installed. If you wish to make changes to the list, use the ServerList program that was distributed with the RPCBroker. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 6 Configuration File Management The RMIM FIM SITE PARAMETERS file (#783.9) stores the system parameter data. The settings in this file are critical to the proper operation of the Functional Independence Measurement. Incorrect or missing setting will cause unpredictable results. The following fields are provided in this file: .01 FACILITY NAME .02 HIGHEST CASE NUMBER .03 MAIL GROUP .04 FSOD NOTE TITLE .05 NON FSOD NOTE TITLE .06 CONSULT TITLE 10 FACILITY CODE (multiple) The following is an explanation of the individual entries: FACILITY NAME Name of your site HIGHEST CASE NUMBER Internal use MAIL GROUP Receives messages when a record that goes to FSOD gets created or edited FSOD NOTE TITLE Used for progress notes when data is sent to FSOD NON FSOD NOTE TITLE Used for progress note when data is not sent to FSOD CONSULT TITLE Used for consults when data is sent to FSOD FACILITY CODE (multiple) Code(s) assigned to your site by FSOD May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 7 File Diagram POINTER (#) FILE FILE (#) TYPE POINTER FIELD POINTER FIELD FILE POINTED TO L=Laygo S=File not in set C=Xref. N=Normal Ref. *=Truncated m=Multiple v=Variable Pointer 783 FUNCTIONAL * PATIENT - > PATIENT PROG NOTE IEN - > TIU DOCUMENT EMAIL ID - > MESSAGE Protocols RMIM DRIVER FIM – FSOD EVENT DRIVER RMIM SUBSCRIBER RMIM FIM – FSOD SUBSCRIBER May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 8 Files The FIM.exe file is associated with the Functional Independence Measurement and must be placed on an End-User Workstation or a Consolidated Network Location. The following files are installed on the VistA server: File Description Functional Independence This file holds all the information that is Measurement Record file transmitted to Austin. This file is populated by the Functional Independence Measurement (FIM) Delphi template Functional Independence Site Parameter for FIM. Measurement Parameter file Routines Review the listing below to learn the routines installed on your site's VistA Server during the installation of RMIM V. 1.0. The first line of each routine briefly describes its general information. You can use the Kernel First line Routine Print option to print a list containing the first line of each routine. The following list contains the routines included in RMIM Version 1.0 Routine Checksum Values RMIMHL 5598302 RMIMRP 7242673 RMIMU 3354346 RMIMU1 2235473 RMIMV 8374421 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 9 Exported Options Option Name Descriptions RMIM EDIT SITE FIM Site Parameter Edit Option to edit the RMIM PARAMETER FIM SITE PARAMETER file (#783.9). RMIM MAIL SERVERRMIM Mail Server Server option used to populate information in file #783 (RMIM FIM FSOD RECORD), fields AUSTIN STATUS (ACK or ERR) and ERROR DESCRIPTION (if one exists). This server option processes the AAC mail message back to site. RMIM MAIL SERVER Austin Error Report for Report for coordinators to REPORT FSOD Transmission observe if Austin had an error processing an entry. RMIM NIGHTLY FIM to FSOD Transmission This task should be TRANSMISSION Task scheduled nightly to send all edited cases to FSOD Austin. RMIM REPORTS FIM Repots Menu to hold FIM coordinator reports. RMIMCOORD MENU FIM Coordinators Menu Menu consisting of an option to edit the FIM Site parameter and Reports. RMIMFIM RMIM FIM Context version CONTEXT needed to run 1.0 the FIM template (Delphi form). RMIMIT FIM Retransmit all records An option not on any to Austin menu. This option is for Information Management staff to use if all cases need to be re-transmitted to Austin FSOD. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 10 Option Name Descriptions RMIMXMIT FIM to FSOD by Patient Report sorted by patient to view all cases sent to FSOD and the status of that transmission. RMIMXMIT DATE FIM to FSOD by Report sorted by Transmission Date transmission date for all cases transmitted to Austin. XINDEX XINDEX is a routine that produces a report called the VA Cross-Reference. This report is a technical and cross-reference listing of one routine or a group of routines. XINDEX provides a summary of errors and warnings for routines that do not comply with VA programming standards and conventions, a list of local and global variables and what routines they are referenced in, and a listing of internal and external routine calls. XINDEX is invoked from programmer mode: D ^XINDEX. When selecting routines, select RMIM*. Callable Routines/Entry Points/APIs There are no callable routines in this package. Files and databases should be included in your network saves. Broker Context Menu Option Assignment If you have the @ sign, you will not need these Broker Menus to see these menus. We created options for each type of user to avoid us having to remove the @ sign from ourselves. For Employees who can run FIM, assign the Broker Context Menu [RMIM FSOD] to these employees secondary menu. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 11 External Interfaces There is a unidirectional interface from the FIM to the AAC based upon HL7 V2.3.1 messaging standards. The function of the message is to pass information relating to local FIM patient data to a centralized database. A two-phased process is required for message transactions. VistA will send a batch HL7 message and receive a commit acknowledgment from the AAC over the same link. This tells VistA the message was received correctly. After the message has been processed, the AAC will connect back to the sending VistA site (using the standard listener on the port 5000) and send an application acknowledgment. See Appendix B for HL7 information Exported Remote Procedure Calls (RPC) RMIM distributes the following RPCs: RPC Name Line Tag Routine RMIM AUTHOR LOOKUP AL RMIMR RMIM CHECK DUPLICATE DUP RMIMV RMIM CONSULT LIST CON RMIMV RMIM CONVERT DATE DTFMT RMIMRP RMIM FIM PARAMETER PRM RMIMRP RMIM GET CASES LC RMIMRP RMIM GET DFN DFN RMIMRP RMIM GET FORM FRM RMIMRP RMIM GET PATIENT DME DME RMIMRP RMIM GET SELECTED CASE GC RMIMRP RMIM GET USER INFO DUZ RMIMRP RMIM LOCATION LOOKUP LL RMIMRP RMIM LOCK PATIENT PT L RMIMRP RMIM PATIENT INFO PI RMIMRP May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 12 RPC Name Line Tag Routine RMIM PATIENT LOOKUP PL RMIMRP RMIM RESTRICTED RECORD RRN RMIMRP RMIM SAVE FSOD SAV RMIMRP RMIM SEND EMAIL XM RMIMRP RMIM VERSION RPC RMIMVP External Relations Before installing FIM, make sure that your system includes the following VistA software applications and versions (those listed or higher). Application Name Minimum Version Kernel V. 8 Kernel Toolkit V. 7.3 VA FileMan V. 22 RPC Broker V. 1.1 TIU V.1.0 OERR V.3.0 HL7 V.1.6 MailMan V.8 Data Base Agreements (DBIAs) The following is a list of DBIAs requested for FIM: Name DBIA Number ORQQCN LIST 1671 ORWD DT 1824 ORWU DT 3363 TIU SIGN RECORD 1790 TIU UPDATE RECORD 1799 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 13 Name DBIA Number TIU REQUIRES COSIGNATURE 1800 TIU CREATE ADDENDUM RECORD 1805 Software Security The Functional Independence Measures transmits data to the national database through the VA network; this network has security protection in place. Local coordinators will have their profile within Computerized Patient Record System (CPRS) amended by a local IRM to allow them to have access to the local FIM functionality. No other users will be able to access the local FIM unless they are set up in this method. All patients Social Security Numbers (SSN) and names are encrypted before transmission to an agreed upon standard. The fields sent to the AAC become readable upon receipt of the data, however only high-level users have access to the unencrypted fields when viewing the national database. Mail Groups The FIM Coordinators Mail Group RMIM FSOD is used for communication between users of the FIM template and the Coordinators. When a record that goes to FSOD gets created or edited, the FIM template will send a message to this group. The RMIM FSOD TRANSMISSION Mail Group is used for the transmission of FIM data to the FSOD database in Austin. No members need to be in this group. The mail group should have REMOTE MEMBER: XXX@Q-FIM.MED.VA.GOV, which was created by the FIM install. The RMIM MAIL SERVER mail group may be used in the future for better communication between Facility System and the Austin Automation Center in regards to ACK or ERR status. No members need to be in this group. Remote Systems As a Broker aware product written in Delphi 5, FIM connects to the M server from a client workstation. This connection is subject to authentication, as any normal logon requires. If the user is present in the new person file, successfully logs on to the VistA Server, and has the RMIMFIM option, they will have the ability to run the application. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 14 The Functional Independence Measurement can be anywhere on the VA’s TCP/IP network. Encryption is used when a user’s access, verify, and electronic signature codes are sent from the client to the server. See RPC Broker V. 1.1 Technical Manual page 31-32 for further information on RPC Broker’s security features. Archiving and Purging There are no archiving or purging functions necessary with FIM. Contingency Planning Sites utilizing the Functional Independence Measurement software should develop a local contingency plan to be used in the event of product problems in a live environment. The facility contingency plan must identify the procedure for maintaining functionality provided by this package in the event of system outage. Field station Information Security Officers (ISOs) may obtain assistance from their Regional Information Security Officer (RISO). Interfacing Software The interface software is HL7. This will transmit FIM data to the AAC. Security Keys There are two keys associated with this software. 1. RMIM COORD This key is given to a user(s) who coordinate the Functional Status and Outcomes Database (FSOD) at the Austin Automation Center (AAC). The key allows the FSOD coordinator to edit any part of the FIM record within the template prior to sending to Austin. 2. RMIM FSOD This key is given to user(s) who are allowed to send updates via the FIM Template to the Functional Status and Outcomes Database (FSOD) at the Austin Automation Center (AAC). May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 15 Equipment Default PC Printer: Reports require that the personal computer have a valid default printer specified. See Microsoft operating system documentation for details on setting up default printers. Appendix A - Databases RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 0.01 ENTRY NUMBER n/a 0.02 SITE CASE NUMBER n/a 0.03 PATIENT n/a 0.04 PT ID PATIENT_CODE/PATIENT_ID n/a FIRST_NAME n/a LAST_NAME n/a MIDDLE_INITIAL 0.05 PT DOB BIRTH_DATE 0.06 FACILITY CODE FACILITY_ID 0.07 TYPE OF CARE CARE_CLASS_CODE 0.08 IMPAIRMENT GROUP IMPAIRMENT_CODE 0.09 ONSET DATE ONSET_DATE 0.1 ADMIT DATE ADMIT_DATE 0.11 DSCHG DATE DISCHARGE_DATE n/a THERAPY_START_DATE n/a THERAPY_END_DATE 0.12 EDIT DATE ASSESSMENT_DATE 0.13 XMIT DATE n/a May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 16 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 0.14 OP CODE n/a 0.15 READY FOR XMIT n/a 0.16 PROG NOTE IEN n/a 0.17 EMAIL ID n/a 0.2 AUSTIN STATUS n/a 0.21 ERROR DISCRIPTION n/a 1.01 STREET STREET 1.02 CITY CITY 1.03 STATE STATE 1.04 POSTAL CODE POSTAL_CODE 1.05 TELEPHONE TELEPHONE 1.06 GENDER CODE GENDER_CODE 1.07 ETHNIC CODE ETHNICITY_CODE 1.08 MARITAL CODE MARITAL_CODE 1.09 ACTIVE MIL IND ACTIVE_MIL_IND 2.01 ADMIT CLASS ADMIT_CLASS_CODE 2.03 INTERRUPTION CODE INTERRUPTION_CODE 2.04 TRANSFER 1 DATE TRANSFER1_DATE 2.05 RETURN 1 DATE RETURN1_DATE 2.06 TRANSFER 2 DATE TRANSFER2_DATE 2.07 RETURN 2 DATE RETURN2_DATE 2.08 TRANSFER 3 DATE TRANSFER3_DATE 2.09 RETURN 3 DATE RETURN3_DATE 2.1 ETIOLOGIC CODE ETIOLOGIC_CODE 2.11 ASIA CODE ASIA_CODE 3.01 DIAGNOSIS1 DIAGNOSIS1_CODE May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 17 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 3.02 DIAGNOSIS2 DIAGNOSIS2_CODE 3.03 DIAGNOSIS3 DIAGNOSIS3_CODE 3.04 DIAGNOSIS4 DIAGNOSIS4_CODE 3.05 DIAGNOSIS5 DIAGNOSIS5_CODE 3.06 DIAGNOSIS6 DIAGNOSIS6_CODE 3.07 DIAGNOSIS7 DIAGNOSIS7_CODE 4.01 A EAT EAT_FIM 4.02 A GROOM GROOM_FIM 4.03 A BATH BATH_FIM 4.04 A DRESS UP DRESS_UP_FIM 4.05 A DRESS LO DRESS_LO_FIM 4.06 A TOILET TOILET_FIM 4.07 A BLADDER BLADDER_FIM 4.08 A BOWEL BOWEL_FIM 4.09 A TRANS CHAIR TRANS_CHAIR_FIM 4.1 A TRANS TOILET TRANS_TOILET_FIM 4.11 A TRANS TUB TRANS_TUB_FIM 4.12 A LOCOM WALK LOCOM_WALK_FIM 4.13 A LOCOM STAIR LOCOM_STAIR_FIM 4.14 A COMPREHEND COMPREHEND_FIM 4.15 A EXPRESS EXPRESS_FIM 4.16 A INTERACT INTERACT_FIM 4.17 A PROBLEM PROBLEM_FIM 4.18 A MEMORY MEMORY_FIM 4.19 A WALK MODE WALK_MODE 4.2 COMPREHEND_MODE A COMPREHEND May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 18 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL MODE 4.21 A EXPRESS MODE EXPRESS_MODE 5.01 D EAT 5.02 D GROOM 5.03 D BATH 5.04 D DRESS UP The FIM fields repeat for each type of 5.05 D DRESS LO assessment 5.06 D TOILET 5.07 D BLADDER 5.08 D BOWEL 5.09 D TRANS CHAIR 5.1 D TRANS TOILET 5.11 D TRANS TUB 5.12 D LOCOM WALK 5.13 D LOCOM STAIR 5.14 D COMPREHEND 5.15 D EXPRESS 5.16 D INTERACT 5.17 D PROBLEM 5.18 D MEMORY 5.19 D WALK MODE D COMPREHEND 5.2 MODE 5.21 D EXPRESS MODE 6.01 I EAT 6.02 I GROOM May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 19 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 6.03 I BATH 6.04 I DRESS UP 6.05 I DRESS LO 6.06 I TOILET 6.07 I BLADDER 6.08 I BOWEL 6.09 I TRANS CHAIR 6.1 I TRANS TOILET 6.11 I TRANS TUB 6.12 I LOCOM WALK 6.13 I LOCOM STAIR 6.14 I COMPREHEND 6.15 I EXPRESS 6.16 I INTERACT 6.17 I PROBLEM 6.18 I MEMORY 6.19 I WALK MODE I COMPREHEND MODE 6.2 6.21 I EXPRESS MODE 7.01 F EAT 7.02 F GROOM 7.03 F BATH 7.04 F DRESS UP 7.05 F DRESS LO 7.06 F TOILET May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 20 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 7.07 F BLADDER 7.08 F BOWEL 7.09 F TRANS CHAIR 7.1 F TRANS TOILET 7.11 F TRANS TUB 7.12 F LOCOM WALK 7.13 F LOCOM STAIR 7.14 F COMPREHEND 7.15 F EXPRESS 7.16 F INTERACT 7.17 F PROBLEM 7.18 F MEMORY 7.19 F WALK MODE F COMPREHEND MODE 7.2 7.21 F EXPRESS MODE 8.01 G EAT EAT_FIM_GOAL 8.02 G GROOM GROOM_FIM_GOAL 8.03 G BATH BATH_FIM_GOAL 8.04 G DRESS UP DRESS_UP_FIM_GOAL 8.05 G DRESS LO DRESS_LO_FIM_GOAL 8.06 G TOILET TOILET_FIM_GOAL 8.07 G BLADDER BLADDER_FIM_GOAL 8.08 G BOWEL BOWEL_FIM_GOAL 8.09 G TRANS CHAIR TRANS_CHAIR_FIM_GOAL 8.1 G TRANS TOILET TRANS_TOILET_FIM_GOAL May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 21 RMIM FIM FSOD RECORD FSOD LOCAL FIM DATABASE FSOD DATABASE NUMBER LABEL LABEL 8.11 G TRANS TUB TRANS_TUB_FIM_GOAL 8.12 G LOCOM WALK LOCOM_WALK_FIM_GOAL 8.13 G LOCOM STAIR LOCOM_STAIR_FIM_GOAL 8.14 G COMPREHEND COMPREHEND_FIM_GOAL 8.15 G EXPRESS EXPRESS_FIM_GOAL 8.16 G INTERACT INTERACT_FIM_GOAL 8.17 G PROBLEM PROBLEM_FIM_GOAL 8.18 G MEMORY MEMORY_FIM_GOAL 8.19 G WALK MODE G COMPREHEND MODE 8.2 8.21 G EXPRESS MODE May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 22 Appendix B – Health Level Seven (HL7) Specifications Introduction This document describes a unidirectional interface from the VistA FIM database to the FSOD database based upon HL7 V2.3.1 messaging standards. General Specifications Communication Protocol The HL7 protocol defines only the seventh level of the Open System Interconnect (OSI) Model. This is the application level. Levels one through six involve primarily communication protocols. The TCP/IP network standard will be used to support the Transport layer and Network layer of the interface. The Minimal Lower Layer Protocol (MLLP) will be used to support the Presentation layer protocol for the interface and will encapsulate the HL7 V2.3.1 messages with start and end markers. One link only will be required for message transactions. VistA will send a batch HL7 message and receive acknowledgments over the same link. Application Processing Rules The HL7 protocol itself describes the basic rules for application processing by the sending and receiving systems. Information contained in the protocol will not be repeated here. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 23 HL7 Concepts and Definitions Messages A message is the atomic unit of data transferred between systems. It is comprised of a group of segments in a defined sequence. Each message has a message type that defines its purpose. A three-character code contained within each message identifies its type. The real-world event that initiates an exchange of messages is called a trigger event. These codes represent values such as a patient is admitted or an order event occurred. There is a one-to-many relationship between message types and trigger event codes. The same trigger event code may not be associated with more than one message type. Segments A segment is a logical grouping of data fields. Segments of a message may be required or optional. They may occur only once in a message or they may be allowed to repeat. Each segment is given a name. Each segment is identified by a unique three-character code known as the Segment ID. Fields A field is a string of characters. HL7 does not care how systems actually store data within an application. When fields are transmitted, they are sent as character strings. Except where noted, HL7 data fields may take on the null value. Sending the null value, which is transmitted as two double quote marks (“”), is different from omitting an optional data field. The difference appears when the contents of a message will be used to update a record in a database rather than create a new one. If no value is sent, (i.e., it is omitted) the old value should remain unchanged. If the null value is sent, the old value should be changed to null. Please note that at this time there will be no null values sent. Position (sequence within the segment) Defines the ordinal position of the data field within the segment. This number is used to refer to the data field in the text comments that follow the segment definition table. In the segment attribute tables, this information is in a column labeled SEQ. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 24 Maximum length Defines the maximum number of characters that one occurrence of the data field may occupy. It is calculated to include the component and sub component separators. Because the maximum length is that of a single occurrence, the repetition separator is not included in calculating the maximum length. In the segment attribute tables, this information is in a column labeled LEN. Data type Defines the restrictions on the contents of the data field. There are a number of data types defined by HL7. The data types used in this specification are described in the next section titled Data Types. This information is in a column labeled DT in the segment attribute tables. Optionality Defines whether the field is required, optional, or conditional in a segment. The designations are: Value Description B Left in for backward compatibility with previous versions of HL7. The field definitions following the segment attribute table should denote the optionality of the field for prior versions. C Conditional on the trigger event, or some other field. O Optional R Required X Not used with this trigger event In the segment attribute tables, this information is in a column labeled OPT. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 25 Repetition Defines whether the field may repeat. The designations are: Value Description N No repetition permitted Y The field may repeat an indefinite or site- determined number of times Y/IntegThe field may repeat up to the number specified er by the integer Each occurrence may contain the number of characters specified by the field’s maximum length. In the segment attribute tables, this information is in a column labeled RP/#. Message Delimiters In constructing a message certain special characters are used. They are the segment terminator, the field separator, the component separator, subcomponent separator, repetition separator, and escape character. The segment terminator is always a carriage return (in ASCII, a hex 0D). The other delimiters are defined in the MSH segment, with the field delimiter in the 4th character position, and the other delimiters occurring as in the field called Encoding Characters, which is the first field after the segment ID. The delimiter values used in the MSH segment are the delimiter values used throughout the entire message. The Clinical Registries interface uses the HL7 standard values, found in the table below: Delimiter Usage Suggested Encoding Value Character Position Segment Terminates a segment record. Terminator Implementers cannot change this value. hex 0D Field Separates 2 adjacent data fields within a Separator I segment. It also separates the segment ID stfrom the 1 data field in each segment Component ^ 1 Separates 2 adjacent components of data May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 26 Delimiter Usage Suggested Encoding Value Character Position Separator fields, where allowed SubcomponSeparates adjacent subcomponents of data ent & 2 fields, where allowed. If there are no Separator subcomponents, it may be omitted Repetition Separates multiple occurrences of a field, ~ 3 Separator where allowed Escape Escape Character for use with any field Character represented by an ST, TX or FT data type, \ 4 or for use with the data component of the ED data type. Data Types Data Type Name Notes/Format Data Type Category/ Data type Alphanumeric ST String TX Text data FT Formatted text Numerical CQ Composite ^ quantity with units NM Numeric SI Sequence ID Identifier ID Coded values for HL7 tables IS Coded value for user-defined tables May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 27 Data Type Name Notes/Format Data Type Category/ Data type HD Hierarchic ^ ^ Used only as part of EI and other data types. EI Entity identifier ^ ^ ^ PL Person location ^ ^ ^ ^ < location status (IS )> ^ ^ ^ ^ PT Processing type ^ Date/Time DT Date YYYY[MM[DD]] TM Time HH[MM[SS[.S[S[S[S]]]]]][+/-ZZZZ] TS Time stamp YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]] ]]][+/-ZZZZ] ^ Code Values CE Coded element ^ ^ ^ ^ ^ CX Extended ^ ^ ^ < assigning authority (HD)> ^ ^ < assigning facility (HD) XCN Extended In Version 2.3, use instead of the CN composite ID data type. ^ & ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ Generic CM Composite No new CM’s are allowed after HL7 Version 2.2. Hence there are no new CM’s in Version 2.3. Demographics XAD Extended address In Version 2.3, replaces the AD data type. ^ ^ ^ ^ ^ ^ < address type (ID)> ^ ^ ^ ^

XPN Extended person In Version 2.3, replaces the PN data name type. ^ & ^ ^ ^ ^ ^ ^ XON Extended ^ composite name ^ May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 29 Data Type Name Notes/Format Data Type Category/ Data type and ID number ^ ^ ^ ^ ^ ^ XTN Extended In Version 2.3, replaces the TN data type. [NNN] [(999)]999-9999 [X99999] telecommunicatio ns number [B99999] [C any text] ^ ^ ^ ^ ^ ^ ^ ^ Time Series: TQ Timing/quantity For timing/quantity specifications for orders, see Chapter 4, Section 4.4. ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 30 Use of Escape Sequences in Text Fields When a field of type TX, FT, or CF is being encoded, the escape character may be used to signal certain special characteristics of portions of the text field. The escape character is whatever display ASCII character is specified in the Escape Character component of MSH-2-encoding characters. The character \ must be used to represent the character so designated in a message. An escape sequence consists of the escape character followed by an escape code ID of one character, and another occurrence of the escape character. The following escape sequences are used by the Hepatitis C HL7 interface: Value Description \S\ Component separator \T\ Subcomponent separator \R\ Repetition separator \E\ Escape character Specification Conventions Segment Tables Definitions Column Description SEQ Ordinal position of the data field within the segment LEN Maximum length of a field DT HL7 data type OPT Required, Optional, Conditional, or Backward compatible RP/# Repeating field (Y/N/#) ELEMENT Field description NAME COMMENTS Set to ‘See Notes’, if the field is used in this interface May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 31 HL7 Messages HL7 Message Definition The message is sent as a batch message. Each patient will be transmitted as an individual record. ORU Observational Results (Unsolicited) MSH Message Header PID Patient Identification [PV1] Patient Visit {NTE} Notes and Comments { OBR Observations Report ID { [OBX] Observation/Result } ORU – Unsolicited transmission of an observation (Event type R01) The function of this message is to initiate the transmission of information about a report. With the observation segment (OBX), and the OBR, one can construct almost any clinical report as a three-level hierarchy, with the PID segment at the upper level, an order segment (OBR) at the next level and one or more observation segments (OBX) at the bottom. One result segment (OBX) is transmitted for each component of a diagnostic report, such as a series of Diagnosis codes or an Admission’s scores. Segment Order Message HL7 Chapter MSH Message header 2 Patient PID 3 identification May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 32 Segment Order Message HL7 Chapter OBR Order detail 4 OBX Observation/Result 7 HL7 Segment Definitions and Specifics MSH Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 1 1 ST R Field Separator See Notes 2 4 ST R Encoding Characters See Notes 3 180 HD O Sending Application See Notes 4 180 HD O Sending Facility See Notes 5 180 HD O Receiving Application See Notes 6 180 HD O Receiving Facility See Notes 7 26 TS O Date/Time Of Message See Notes 8 40 ST O Security NV 9 7 CR Message Type See Notes M 10 20 ST R Message Control ID See Notes 11 3 PT R Processing ID See Notes 12 8 ID R Version ID See Notes 13 15 NO Sequence Number NV M 14 180 ST O Continuation Pointer NV 15 2 ID O Accept NV Acknowledgment Type 16 2 ID O Application NV Acknowledgment Type 17 2 ID O Country Code See Notes 18 6 ID O Y/Character Set NV 3 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 33 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 19 60 CE O Principal Language Of NV Message MSH field definitions MSH – Field Separator <1>/<1>/ Definition: This field contains the separator between the segment ID and the first real field, MSH-2-encoding characters. As such, it serves as the separator and defines the character to be used as a separator for the rest of the message. Recommended value is |, (ASCII 124). MSH – Encoding Characters <2>/<4>/ Definition: This field contains the four characters in the following order: the component separator, repetition separator, escape character, and subcomponent separator. Recommended values are ^~\&, (ASCII 94, 126, 92, and 38, respectively). MSH – Sending Application <3>/<180>/ Definition: This field uniquely identifies the sending application among all other applications within the network enterprise. The network enterprise consists of all those applications that participate in the exchange of HL7 messages within the enterprise. Entirely site defined. MSH – Sending Facility <4>/<180>/ Definition: This field contains the address of one of several occurrences of the same application within the sending system. Entirely user-defined. MSH – Receiving Application <5>/<180>/ Definition: This field uniquely identifies the receiving application among all other applications within the network enterprise. The network enterprise consists of all those applications that participate in the exchange of HL7 messages within the enterprise. Entirely site-defined. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 34 MSH – Receiving Facility <6>/<180>/ Definition: This field identifies the receiving application among multiple identical instances of the application running on behalf of different organizations. See comments: MSH-4-sending facility. Entirely site-defined. MSH – Date/Time Of Message <7>/<26>/ Definition: This field contains the date/time that the sending system created the message. If the time zone is specified, it will be used throughout the message as the default time zone. Format: YYYYMMDDHHMMSS MSH – Message Type <9>/<7>/ Components: ^ Definition: This field contains the message type and trigger event for the message. VistA sends an ORM message type with the trigger event O01 for orders from Radiology/Nuclear Medicine and TIU. An ORU message type with the trigger event R01 for unsolicited observation results is sent to VistA. MSH – Message Control ID <10>/<20>/ Definition: This field contains a number or other identifier that uniquely identifies the message. The receiving system echoes this ID back to the sending system in the Message acknowledgment segment (MSA). MSH – Processing ID <11>/<3>/ Components: ^ Definition: This field identifies the status of the interface. The processing mode component is not used. Value Description P Production D Debugging T Training May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 35 MSH – Version ID <12>/<8>/ Definition: This field is matched by the receiving system to its own version to be sure the message will be interpreted correctly. The VistA TIU Connection interface currently uses version 2.3 of the HL7 standard. However, future versions will be implemented as needed. MSH – Country Code <17>/<2>/ Definition: This field contains the country of origin for the message. Example: MSH|^~\&|RMIM SITE|FIM|RMIM AAC|FSOD|20021009123935- 0500||ORU^R01^ORU_R01|54823249|T|2.4|||NE|AL|US May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 36 PID Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 1 4 SI O Set ID - Patient ID NV 2 20 CX O Patient ID (External See Notes ID) 3 20 CX R Y Patient ID (Internal See Notes ID) 4 20 CX O Y Alternate Patient ID - See Notes PID 5 48 XPN R Y Patient Name See Notes 6 48 XPN O Mother’s Maiden Name NV 7 26 TS O Date/Time of Birth See Notes 8 1 IS O Sex See Notes 9 48 XPN O Y Patient Alias NV 10 1 IS O Race See Notes 11 106 XAD O Y Patient Address See Notes 12 4 IS B County Code NV 13 40 XTN O Y Phone Number - Home See Notes 14 40 XTN O Y Phone Number - NV Business 15 60 CE O Primary Language NV 16 1 IS O Marital Status See Notes 17 3 IS O Religion NV 18 20 CX O Patient Account NV Number 19 16 ST O SSN - Patient See Notes 20 25 DLN O Driver's License NV Number - Patient 21 20 CX O Y Mother's Identifier NV May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 37 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 22 3 IS O Ethnic Group NV 23 60 ST O Birth Place NV 24 2 ID O Multiple Birth NV Indicator 25 2 NM O Birth Order NV 26 4 IS O Y Citizenship NV 27 60 CE O Veterans Military See Notes Status 28 80 CE O Nationality NV 29 26 TS O Patient Death Date and NV Time 30 1 ID O Patient Death Indicator NV PID field definitions PID – Patient ID (external ID) <2>/<20>/ Components: ^ ^ Definition: When the patient is from another institution, outside office, etc., the identifier used by that institution can be shown in this field. This contains the patient SSN. PID – Patient ID (internal ID) <3>/<20>/ Components: ^ ^ Definition: This field contains the primary identifier, or other identifiers used by the facility to identify a patient uniquely. This will be VistA DFN. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 38 PID – Alternate patient ID <4>/<20>/ Components: ^ ^ ^ ^ ^ Definition: This field contains the IEN and local Case number. PID – Patient Name <5>/<48>/ Components: ^ ^ Definition: This field contains the legal name of the patient. PID – Date/Time of Birth <7>/<26>/ Definition: This field contains the patient’s date of birth. Format: YYYYMMDD PID – Sex <8>/<1>/ Definition: This field contains the patient’s sex. Value Description 2 Female 1 Male PID – Race <10>/<1>/ Definition: This field refers to the patient’s ethnic code. 1-White 2-Black 3-Asian 4-Native American 5-Other 6-Hispanic May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 39 PID – Patient Address <11>/<106>/ Components: ^ ^ ^ ^ ^ ^ < address type (ID)> ^ ^ ^ Definition: This field contains the mailing address of the patient. PID – Telephone <13>/<40>/ Definition: This field contains the patient’s Telephone Number. PID – Marital Code <16>/<1>/ Definition: This field contains the patient’s Marital Code. 1-Never Married 2-Married 3-Widowed 4-Separated 5-Divorced PID – SSN – Patient <19>/<16>/ Definition: This field contains the patient’s social security number. Format: [555555555] or [555555555P] Note: PID does not include the “-“ in this field. PID – Veterans Military Status <27>/<16>/ Definition: This field contains the patient’s Active Military Indicator. A-Active Military N-Not Active Military Example PID segment PID||000001640|2604|8^25|TEST^SAM^ONE||19400516|1|||NONE^^LONGLY^^12345^USA||(561)123-1234||||||000001640||||||||N May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 40 PV1 Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 1 4 SI O Set ID - PV1 NV 2 1 IS R Patient Class See Notes 3 80 PL O Assigned Patient NV Location 4 2 IS O Admission Type See Notes 5 20 CX O Preadmit Number NV 6 80 PL O Prior Patient NV Location 7 60 XCO Y Attending Doctor NV N 8 60 XCO Y Referring Doctor NV N 9 60 XCO Y Consulting Doctor NV N 10 3 IS O Hospital Service NV 11 80 PL O Temporary Location NV 12 2 IS O Preadmit Test NV Indicator 13 2 IS O Readmission NV Indicator 14 3 IS O Admit Source NV 15 2 IS O Y Ambulatory Status NV 16 2 IS O VIP Indicator NV 17 60 XCO Y Admitting Doctor NV N 18 2 IS O Patient Type NV 19 20 CX O Visit Number NV 20 50 FC O Y Financial Class NV 21 2 IS O Charge Price NV May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 41 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# Indicator 22 2 IS O Courtesy Code NV 23 2 IS O Credit Rating NV 24 2 IS O Y Contract Code NV 25 8 DT O Y Contract Effective NV Date 26 12 NM O Y Contract Amount NV 27 3 NM O Y Contract Period NV 28 2 IS O Interest Code NV 29 1 IS O Transfer to Bad NV Debt Code 30 8 DT O Transfer to Bad NV Debt Date 31 10 IS O Bad Debt Agency NV Code 32 12 NM O Bad Debt Transfer NV Amount 33 12 NM O Bad Debt Recovery NV Amount 34 1 IS O Delete Account NV Indicator 35 8 DT O Delete Account Date NV 36 3 IS O Discharge NV Disposition 37 25 CM O Discharged to NV Location 38 2 IS O Diet Type NV 39 2 IS O Servicing Facility NV 40 1 IS B Bed Status NV 41 2 IS O Account Status NV 42 80 PL O Pending Location NV May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 42 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP /# 43 80 PL O Prior Temporary NV Location 44 26 TS O Admit Date/Time See Notes 45 26 TS O Discharge Date/Time See Notes 46 12 NM O Current Patient NV Balance 47 12 NM O Total Charges NV 48 12 NM O Total Adjustments NV 49 12 NM O Total Payments NV 50 20 CX O Alternate Visit ID NV 51 1 IS O Visit Indicator NV 52 60 XCO Y Other Healthcare NV N Provider May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 43 PV1 Field Definitions PV1 – Admission Type PV1 – Patient Class <2>/<1>/ Care Class Code 1= Acute Rehab Inpatient 2= Sub Acute Rehab Inpatient 3= Continuum of Care PV1 – Admission Type <4>/<2>/ Admit Class Code 1= Initial Rehab 2= Short Stay 3= Readmission PV1 – Admit Date/Time <44>/<26>/ Definition: This field contains the admit date/time. It is to be used if the event date/time is different than the admit date and time, i.e., a retroactive update. This field is also used to reflect the date/time of an outpatient/emergency patient registration. Note: Date could be a Therapy Start Date depending on the admit class code. PV1 – Discharge Date/Time <45>/<26>/ Definition: This field contains the discharge date/time. It is to be used if the event date/time is different than the discharge date and time, that is, a retroactive update. This field is also used to reflect the date/time of an outpatient/emergency patient discharge. Note: Date could be a Therapy Start Date depending on the admit class code. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 44 Example PV1 segment PV1| |CLASS| |ADMIT| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |20020801|20020801 May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 45 NTE – Notes and Comments Segment – Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP/ # 1 4 SI O Set ID – NTE NV 2 8 ID O Source of Comment NV 3 245 FT O Y Comment See Notes 4 60 CE O Comment Type NTE field definitions NTE-3 Comment Definition: This field contains the transfer/return dates. Transfer 1 date – Return 1 date – Transfer 2 date – Return 2 date – Transfer 3 date – Return 3 date Example: CCCCMMDD Example NTE segment NTE|1|L|20020923^20020923^20020923^20020923^20020923^20020923| May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 46 OBR Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP/ # 1 4 SI C Set ID - OBR NV 2 75 EI C Placer Order Number NV 3 75 EI C Filler Order Number + NV 4 200 CE R Universal Service ID See Notes 5 2 ID B Priority NV 6 26 TS B Requested Date/time NV 7 26 TS C Observation Date/Time # See Notes 8 26 TS O Observation End NV Date/Time # 9 20 CQ O Collection Volume * NV 10 60 XCN O Y Collector Identifier * NV 11 1 ID O Specimen Action Code * NV 12 60 CE O Danger Code NV 13 300 ST O Relevant Clinical Info. See Notes 14 26 TS C Specimen Received NV Date/Time * 15 300 CM O Specimen Source * NV 16 80 XCN O Y Ordering Provider NV 17 40 XTN O Y/2 Order Callback Phone NV Number 18 60 ST O Placer field 1 NV 19 60 ST O Placer field 2 NV 20 60 ST O Filler Field 1 + NV 21 60 ST O Filler Field 2 + NV 22 26 TS C Results Rpt/Status Chng - NV Date/Time + 23 40 CM O Charge to Practice + NV May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 47 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP/ # 24 10 ID O Diagnostic Serv Sect ID NV 25 1 ID C Result Status + NV 26 400 CM O Parent Result + NV 27 200 TQ O Y Quantity/Timing NV 28 150 XCN O Y/5 Result Copies To NV 29 150 CM O Parent NV 30 20 ID O Transportation Mode NV 31 300 CE O Y Reason for Study NV 32 200 CM O Principal Result NV Interpreter + 33 200 CM O Y Assistant Result NV Interpreter + 34 200 CM O Y Technician + NV 35 200 CM O Y Transcriptionist + NV 36 26 TS O Scheduled Date/Time + NV 37 4 NM O Number of Sample NV Containers * 38 60 CE O Y Transport Logistics of NV Collected Sample * 39 200 CE O Y Collector’s Comment * NV 40 60 CE O Transport Arrangement NV Responsibility 41 30 ID O Transport Arranged NV 42 1 ID O Escort Required NV 43 200 CE O Y Planned Patient Transport NV Comment May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 48 OBR Field Definitions OBR – Universal Service ID <4>/<200>/ This will be the fields required separated by ^SSN^DOB^Care Class^ Onset Date^Impairment Group^ Admit Date^Facility Code OBR – Observation Date/time # <7>/<26>/ Assessment Date (length/size 10) OBR – Relevant Clinical Info. <13>/<300>/ Etiologic Code (length/size 10) Example OBR segment OBR||||000001640^19400516^1^20020826^17.51^20020828^1433|||20020916||||||250.0 OBX Attributes SEQ LEN DT OPT ELEMENT NAME COMMENTS RP/ # 1 10 SI O Set ID - OBX See Notes 2 2 ID C Value Type See Notes 3 590 CE R Observation See Notes Identifier 4 20 ST C Observation Sub-ID NV 15 245 * C Y Observation Value See Notes 6 60 CE O Units NV 7 10 ST O References Range NV 8 5 ID O Y/5 Abnormal Flags NV 9 5 NM O Probability NV 10 2 ID O Y Nature of Abnormal NV Test 11 1 ID R Observ Result Status See Notes 12 26 TS O Date Last Obs NV 1 May repeat for multipart, single answer results with appropriate data types, e.g., CE, TX, and FT data types. May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 49 SEQ LEN DT OPT ELEMENT NAME COMMENTS RP/ # Normal Values 13 20 ST O User Defined Access NV Checks 14 26 TS O Date/Time of the NV Observation 15 60 CE O Producer's ID NV 16 80 XCN O Responsible NV Observer 17 60 CE O Y Observation Method NV OBX field definitions OBX – Set ID – OBX <1>/<10>/ Defined as array number. OBX – Value Type <2>/<2>/ Defined as NM = Assessment Type Data CE = Diagnoses Data FT= Case Notes TX= DME Items OBX – Observation Identifier <3>/<590>/>CE> A= Admission, D= Discharge, I= Interim, F= Follow-up and G= Goals Diagnoses Case Notes DME Items May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 50 OBX – Observation Value <5>/<65536>/<> ASIA Impairment Scale A-Complete B-Sensory Preserved C-Motor Nonfunctional D-Motor Functional E-Normal The value of the Results 0-9 on scores for different assessment types or the ASIA code followed by the 7 Diagnoses codes. Will be based on Observation Identifier OBX – Observ Result Status <11>/<1>/ Always an F – used by HL7 Example OBX segment OBX|1|NM|ADMISSION| |1^^1^^^^2^^^^^1^^^^4^^^^3| | | | | |F OBX|2|CE|DIAGNOSES CODE| |A^610.1^^410.0^^^^750.1| | | | | |F OBX|nn|FT|CASE NOTES| |test of the note| | | | | |F OBX|nn|TX|DME ITEMS| |item^cost| | | | | |F May 2003 Functional Independence Measurement (FIM) Technical Manual and Security Guide, Version 1.0 51