Question: Identifying the organisation of a referring provider (AS 4700.6)
May 8, 2012Question:
We are looking at receiving referrals REF I12. Currently they are V2.3.1 AS 4700.6-2004. In these referrals we need to be able to identify the organisation of the referring provider, preferably with an HPI-O. It seems that the only place that this can go is in PRD.4. Do we need to use HL7 V2.5 and put the values in PRD.4.10 & PRD.4.11? Is there a better place we could put this in HL7 a V2.3.1 message?
Well, PRD.4 is named “Provider Location”, with the rather confusing definition (v2.3.1):
This field contains the location of the provider as needed when a provider that may be external to a given enterprise must be referenced. For example, if this provider represented the referred-to physician, the PRD-4-provider location should identify the clinic of the physician or provider to whom this referral has been sent. The identification of the provider’s location is specified by an application and facility identifier carried in the facility field. The application ID and facility ID would be used in the same manner as their corresponding fields in the MSH segment (MSH-3-sending application, MSH-5-receiving application MSH-4-sending facility, MSH-6-receiving facility).
The facility field is PRD-4-4. This definition is… not helpful, because it confuses the physical, logical and organisational place, all of which are different perspectives. The definition is untouched through to HL7 v2.7. But given that the definition of the PL data type is quite orientated to physical location, and the definition of PRD-4 is orientated towards the logical/messaging place, I’d be wary of putting the organisational identifier there, particularly an HPI-O which is very location independent.
v2.6 provides more of an answer to this question, in the definitions of fields 10 - 14 in the PRD segment:
| 10 | Provider Organization Name and Identifier | XON : Extended Composite Name and Identification Number for Organizations | 250 |
| 11 | Provider Organization Address | XAD : Extended Address | 60 |
| 12 | Provider Organization Location Information | PL : Person Location | 60 |
| 13 | Provider Organization Communication Information | XTN : Extended Telecommunication Number | 250 |
| 14 | Provider Organization Method of Contact | CWE : Coded with Exceptions | 705 |
Given that v2.6 defines these fields, then it would be best to preadopt these in v2.3, particularly PRD-10
Pre-adopting v2 fields
This is a fairly widespread practice in Australia; it’s preferable to using a Z-segment, because the definition of the field is known - you have to look far enough forward to where the field is defined. It’s also the anointed “right place” for the information, and if you asked the relevant committee, you’d get the same answer again. Pre-adopting fields - and also lengths - can have the effect of breaking implementations, though it shouldn’t (same can be said for adding z-segments too).
In this case, you’ll have to have a trading partner negotiation whatever, and of the various choices - misusing PRD-4, using a Z-segment, and pre-adopting PRD-10, I’d