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1 Page Intentionally Blank Publication History of Previous Versions: Implementation Guide for Immunization Data Transactions using Version of the Health Level Seven (HL7) Standard Protocol Version Date Version June 1999 Version September 2003 Version June 2006 Revision history Revision Date Author Release 5/1/2010 Rob Savage For information about HL7, contact: Health Level Seven 3300 Washtenaw Avenue, Suite 227 Ann Arbor, MI 48104-4250 Phone: (734) 677-7777 Fax: (734) 677-6622 E-Mail: Website: For information about the American Immunization Registry Association, visit For information about this Guide, contact: Rob Savage Warren Williams Immunization Information Systems Support Branch, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Phone: (404) 639-8245 Fax: (404) 639-8171 Website: Table of Contents 1.

2 INTRODUCTION ..1 INTENDED AUDIENCE .. 1 SCOPE .. 2 ORGANIZATION AND FLOW .. 3 INTRODUCTION TO DIAGRAMS AND MODELS .. 5 ACTOR AND USE CASE DIAGRAMS AND TABLES .. 5 SEQUENCE DIAGRAMS .. 6 ACTIVITY 7 2. ACTORS, GOALS, AND MESSAGING TRANSACTIONS ..9 ACTORS AND GOALS .. 9 HIGH-LEVEL VIEW OF USE CASES .. 12 USE CASE DESCRIPTIONS .. 14 USE CASE 1 SEND IMMUNIZATION HISTORY .. 14 USE CASE 2 RECEIVE IMMUNIZATION HISTORY .. 15 USE CASE 3 REQUEST IMMUNIZATION HISTORY .. 15 USE CASE 4 RETURN IMMUNIZATION HISTORY .. 17 USE CASE 4A FIND CANDIDATE CLIENTS .. 17 USE CASE 5--ACCEPT REQUESTED HISTORY: .. 20 USE CASE 6 SEND DEMOGRAPHIC DATA .. 21 USE CASE 7 ACCEPT DEMOGRAPHIC DATA .. 21 USE CASE 8--ACKNOWLEDGE RECEIPT .. 22 USE CASE 9 REPORT ERROR .. 23 MESSAGING IN THE CONTEXT OF THE BUSINESS PROCESS .. 23 3. HL7 MESSAGING INFRASTRUCTURE .. 26 HL7 DEFINITIONS .. 26 BASIC MESSAGE CONSTRUCTION RULES .. 28 ENCODING RULES FOR SENDING.

3 28 ENCODING RULES FOR RECEIVING .. 29 IMPLICATIONS OF THE ENCODING RULES .. 29 DETERMINING USAGE OF SEGMENTS, FIELDS AND COMPONENTS .. 30 MESSAGE ATTRIBUTES COMMON TO ALL MESSAGES .. 35 SEGMENT ATTRIBUTES COMMON TO ALL SEGMENTS .. 36 4. HL7 DATA TYPES .. 38 DATA TYPES FOR IIS USE .. 38 CE -- CODED ELEMENT (MOST USES) .. 39 CE -- CODED ELEMENT (TEXT ONLY IN RXA-9) .. 41 CQ -- COMPOSITE QUANTITY WITH UNITS .. 41 CWE -- CODED WITH EXCEPTIONS .. 42 CX -- EXTENDED COMPOSITE ID WITH CHECK DIGIT .. 44 DT -- DATE .. 45 DTM -- DATE/TIME .. 46 EI -- ENTITY IDENTIFIER .. 46 ERL -- ERROR LOCATION .. 47 FC -- FINANCIAL CLASS .. 49 FN -- FAMILY 49 HD -- HIERARCHIC DESIGNATOR .. 50 ID -- CODED VALUES FOR HL7 TABLES .. 51 IS -- CODED VALUES FOR USER DEFINED TABLES .. 52 LA2 -- LOCATION WITH ADDRESS VARIATION 2 .. 52 MSG -- MESSAGE TYPE .. 53 NM -- NUMERIC .. 54 PT -- PROCESSING TYPE .. 54 SAD -- STREET ADDRESS.

4 55 SI -- SEQUENCE ID .. 55 ST STRING .. 56 TS -- TIME STAMP .. 56 VID -- VERSION ID .. 56 XAD -- EXTENDED ADDRESS .. 57 XCN - EXTENDED COMPOSITE ID NUMBER AND NAME FOR PERSONS .. 59 EXTENDED PERSON NAME (XPN) .. 61 XTN - EXTENDED TELECOMMUNICATION NUMBER .. 63 5. SEGMENTS AND MESSAGE DETAILS .. 65 BHS BATCH HEADER SEGMENT .. 71 BHS FIELD DEFINITIONS .. 71 BTS BATCH TRAILER SEGMENT .. 72 BTS FIELD DEFINITIONS .. 72 ERR ERROR SEGMENT .. 72 ERR FIELD DEFINITIONS: .. 74 EVN - EVENT TYPE SEGMENT .. 75 EVN FIELD DEFINITIONS .. 75 FHS FILE HEADER SEGMENT .. 76 FHS FIELD DEFINITIONS .. 76 FTS FILE TRAILER SEGMENT .. 77 IN1 INSURANCE SEGMENT (IN2, IN3) .. 77 MSA MESSAGE ACKNOWLEDGEMENT SEGMENT .. 78 MSA FIELD DEFINITIONS .. 78 MSH MESSAGE HEADER SEGMENT .. 79 MSH FIELD DEFINITIONS .. 80 NK1 NEXT OF KIN SEGMENT .. 85 NK1 FIELD DEFINITIONS .. 88 NTE NOTE SEGMENT .. 89 NTE FIELD DEFINITIONS .. 89 OBX OBSERVATION RESULT SEGMENT.

5 89 OBX FIELD DEFINITIONS .. 92 ORC ORDER REQUEST SEGMENT .. 94 ORC FIELD DEFINITIONS .. 97 PD1 PATIENT DEMOGRAPHIC SEGMENT .. 99 PD1 FIELD DEFINITIONS .. 101 PID PATIENT IDENTIFIER SEGMENT .. 103 PID FIELD DEFINITIONS .. 107 PV1 PATIENT VISIT SEGMENT .. 110 PV1 FIELD DEFINITIONS .. 113 QAK QUERY ACKNOWLEDGEMENT SEGMENT .. 114 QAK FIELD DEFINITIONS .. 114 QPD QUERY PARAMETER DEFINITION .. 115 QPD FIELD DEFINITIONS .. 115 RCP RESPONSE CONTROL PARAMETER SEGMENT .. 116 RCP FIELD DEFINITIONS .. 117 RXA -- PHARMACY/TREATMENT ADMINISTRATION 118 RXA FIELD DEFINITIONS .. 121 RXR-- PHARMACY/TREATMENT ROUTE SEGMENT .. 125 RXR FIELD DEFINITIONS .. 125 6. MESSAGES FOR TRANSMITTING IMMUNIZATION INFORMATION .. 127 INTRODUCTION .. 127 SEND IMMUNIZATION HISTORY--VXU .. 127 REQUESTING INFORMATION (IMMUNIZATION HISTORY) QBP .. 129 RESPOND TO REQUEST FOR INFORMATION RSP .. 130 REQUESTING AN IMMUNIZATION HISTORY FROM ANOTHER SYSTEM VXQ.

6 131 THE USE OF VXQ IS NOT SUPPORTED FOR IMMUNIZATION MESSAGING.. 131 ACKNOWLEDGING A MESSAGE--ACK .. 131 SENDING DEMOGRAPHIC INFORMATION VXU OR ADT .. 132 SENDING MESSAGES IN A BATCH .. 133 7. QUERY AND RESPONSE PROFILE (QBP/RSP) .. 135 REQUEST IMMUNIZATION HISTORY QUERY PROFILE Z34^CDCPHINVS .. 135 RETURN A LIST OF CANDIDATES PROFILE -- Z31^CDCPHINVS .. 147 INTRODUCTION: .. 147 USE CASE: .. 148 STATIC DEFINITION .. 149 SEGMENT LEVEL PROFILE .. 151 FIELD LEVEL PROFILE .. 151 DYNAMIC DEFINITION .. 152 ACKNOWLEDGEMENT RESPONSIBILITIES .. 152 RETURN AN IMMUNIZATION HISTORY Z32^CDCPHINVS .. 153 INTRODUCTION: .. 153 USE CASE: .. 153 STATIC DEFINITION .. 155 SEGMENT LEVEL PROFILE .. 156 FIELD LEVEL PROFILE .. 157 DYNAMIC DEFINITION .. 157 APPENDIX A: CODE TABLES ..1 APPENDIX B GUIDANCE ON USAGE AND EXAMPLE MESSAGES ..1 IMMUNIZATION HISTORY DEFINITION .. 1 SEND IMMUNIZATION HISTORY (VXU).

7 2 BUSINESS PROCESS .. 2 SUPPORTED MESSAGE SEGMENTS .. 5 EXAMPLE VXU # 1-BASIC MESSAGE: .. 6 EXAMPLE VXU #2 - INDICATE VACCINE FUNDING SOURCE AND CLIENT ELIGIBILITY STATUS: .. 7 ELIGIBILITY STATUS: .. 7 FUNDING SOURCE:.. 8 EXAMPLE VXU #3 - INCLUDE IMMUNIZATION HISTORY EVALUATION AND FORECAST IN VXU .. 10 INDICATING THE SCHEDULE THAT WAS USED: .. 14 INDICATING VACCINE GROUP ASSOCIATED: .. 15 REPORTING THE ORDINAL POSITION IN A SERIES: .. 16 REPORTING THE NUMBER OF DOSES IN A SERIES: .. 16 REPORTING NEXT DOSE RECOMMENDATION DATES: .. 16 REPORTING RECOMMENDATION REASONS: .. 17 USING THE NTE SEGMENT ASSOCIATED WITH AN OBX TO PROVIDE MORE INFORMATION: .. 18 EXAMPLE VXU #4 - SEND CLIENT SPECIFIC 18 EVIDENCE OF IMMUNITY: .. 18 CONTRAINDICATIONS TO IMMUNIZATION: .. 19 FACTORS WHICH INDICATE THE NEED FOR AN IMMUNIZATION OR A CHANGED RECOMMENDATION: .. 19 EXAMPLE VXU #5 SEND IMMUNIZATIONS ASSOCIATED WITH REACTIONS (ADVERSE EVENTS).

8 19 EXAMPLE VXU #6 DELETE AN IMMUNIZATION RECORD .. 20 VXU EXAMPLE #7--SEND INFORMATION ABOUT VACCINE INFORMATION STATEMENT (VIS) .. 21 VXU EXAMPLE #8 SEND INFORMATION ABOUT IMMUNIZATION REFUSAL .. 22 VXU EXAMPLE #9 SEND TWO LOT NUMBERS IN RXA .. 22 VXU EXAMPLE #10 RECORDING BIRTH INFORMATION .. 23 VXU EXAMPLE #11 RECORDING AN INCOMPLETELY ADMINISTERED DOSE OR A NON-POTENT DOSE.. 23 SEND ACKNOWLEDGEMENT ACK IN RESPONSE TO VXU .. 24 SEND ACKNOWLEDGEMENT OF SUCCESS IN ACK .. 24 SEND ERROR IN ACK .. 24 SEND REQUEST FOR VACCINE HISTORY (QBP/RSP) .. 26 PROCESS FOR REQUESTING IMMUNIZATION HISTORY .. 26 DESCRIPTION OF THE VXQ/VXX/VXR PROCESS FROM VERSION .. 26 USING QBP QUERY TO REPLICATE VXQ/ 28 RETURNING A LIST OF CANDIDATE CLIENTS IN RESPONSE TO QBP^Q11 QUERY .. 31 RETURNING AN IMMUNIZATION HISTORY IN RESPONSE TO A REQUEST FOR IMMUNIZATION HISTORY QUERY .. 32 ACKNOWLEDGING A QUERY THAT FINDS NO CANDIDATE CLIENTS.

9 32 USING A TWO-STEP PROCESS TO REQUEST AN IMMUNIZATION HISTORY .. 33 RETURNING A LIST OF CANDIDATE CLIENTS IN RESPONSE TO PDQ QUERY .. 37 RECEIVING SYSTEM DETERMINES THAT MESSAGE HAS ERRORS .. 38 MALFORMED MESSAGE .. 38 NO MATCH IS FOUND .. 39 Table of Figures Revision 3 Figure 1-1 Simple Use Case Diagram .. 6 Figure 1-2-Simple Sequence Diagram .. 7 Figure 1-3 Simple Activity Diagram .. 8 Table 2-1 Actors and Goals for Messaging .. 10 Figure 2-1 Use Case Diagram .. 13 Figure 2-2 Finding a Client .. 14 Figure 2-3-Use Cases 1 and 2: Send and Receive Immunization History .. 15 Figure 2-4-Use Cases 3, 4 and 5: Request Immunization History, Respond to Request and Accept Requested History .. 17 Figure 2-5--Using PDQ to Resolve Identity Prior to Request for Immunization History .. 18 Figure 2-6--Implicit Identity Resolution in Response to a Request for Immunization History When One High-confidence Match Is Found.

10 19 Figure 2-7--Implicit Identity Resolution in Response to a Request for Immunization History When Lower Confidence Candidates Are Found .. 20 Figure 2-8--Send Demographic Data Via VXU or ADT .. 22 Figure 2-9--VXU Process Model .. 25 Table 3-1 Outcome of Encoding Rule Breaches .. 29 Table 3-1--Usage Code Interpretations for Fields, Components and Sub-components .. 31 Table 3-2--Usage Code Interpretation for Segments .. 34 Table 3-3--Message Attributes .. 35 Table 3-4--Segment Attributes .. 36 Table 4-1-- Data Types .. 39 Table 4-2 Coded Element (CE) .. 40 Table 4-3 Coded Element (CE) for Text Only RXA-9 .. 41 Table 4-4 Composite Quantity with Units (CQ) .. 42 Table 4-5 Coded with Exceptions (CWE) .. 43 Table 4-6 Extended Composite ID with Check Digit(CX) .. 44 Table 4-7 Date (DT) .. 45 Table 4-8 Date/Time (DTM) .. 46 Table 4-9 Entity Identifier (EI) .. 46 Table 4-10 Error Location (ERL).