PKB Questions / Responses

Owned by George Swinnerton
Last updated: Dec 07, 2020
4 min read

Questions:

  • Message Header: What's our Sending Application Name? (MSH-3.1)
  • Message Header: Sending Facilty Name (MSH-4.1). What happens if a facility name changes but not the "code"?
  • Message Header: Sending Facility Name (and teams?) (MSH-4.1). Need to known how this is to be structured.

PKB Response:

My understanding is that you will be sending data as Renal Association rather than individual sites.  The source of data is primarily identified via the HL7 credentials you connect to PKB with. These credentials will signify the source of data as the Renal Association. MSH-3 and MSH-4 can be any string value you choose as I believe we are not planning on using any aliasing to sub teams...everything will be mapped to Renal Association

PKB Response:

NHS is the primary identifier.  You can send this in PID-2 or PID-3.  Both are repeating fields so there is scope for additional local identifiers (i.e. MRNs) to be sent.  We always want a national identifier as a minimum.  There are 3 flavours of "NHS number": England & Wales / Scotland / NI. PKB requires the correct AA/TC values to be set and will reject incorrect values based on these.http://dev.patientsknowbest.com/home/hl7-api/identifiers#TOC-National-identifiers

  • Patient Identification: Should we be sending e-mail addresses from the PV Database via PID-13? Is this something we should do regularly?
  • Patient Identification: We have "Person to Contact" but not "Workplace Contact". Is this still suitable to send via PID-14 ?

PKB Response:

You can put email address in PID-13 or PID-14.  Here is an example with it set in PID-14
PID|||9468468283^^^NHS^NH{status:01}||Davies^Lydia^^^Mrs||20180819|F|||741 Gumahowo Close^^Cobuqij^Majagazu^WS458YM^GBR||07868992208^PRS|^NET^^lydia.davies.1@pkbtest.com|en||||||||||||||

  • Patient Identification: Is there a code list for Language Code (PID-15.1) ?
  • Diagnosis: Do we need a way to distinguish Primary Renal Disease from other co-morbidity diagnoses? Use "Diagnosis Alternate Code" ?

PKB Response:

No we don’t have a means to make one diagnosis more prominent than another on the UI.  It might be worth passing this one by Darryl as he is more familiar with the UI.

  • Diagnosis: Need to know/agree lookups for Diagnosis Coding Standard (DG1-3.3)
  • Diagnosis: PV XML doesn't have a timestamp for diagnoses (DG1-5.1).

PKB Response:

It is worth noting also that an individual source organisation can have only one set of allergy, diagnosis and medication information linked to an individual patient record.  So everytime you need to send a new / updated allergy, diagnosis or medication you need to send the full set of data each time.
 
Timestamp is optional on the DG1 segment.  If you don’t know when a diagnosis was first recorded we just won’t display that.

  • Medication: Confirm whether we're to send all medications or just current.
  • Medication: PV XML sends dose (ZRX-3.1) / unit (ZRX-5.1 / ZRX-5.3) / frequency (ZRX-1.2) together which is stored in medication.comments. How to handle?
  • Medication: We don't have coded drug information (ZRX-2.1 / ZRX-2.3)

PKB Response:

You need to push the full list of active medications each time.  
 
Dose, unit and frequency are all optional in our spec.  By the way the fields with square brackets around indicate they are optional...e.g. [ ZRX-3 ].  If you can work out how to parse the values into the individual fields that would be best so we have structured data.  A backup option could be to send your comment field in ZRX-7.2 ‘Instruction Text’ if appropriate?

  • Results: The PV XML doesn't include Orders/Panels. For the UKRDC we make 1 order per Sample Date. Is this okay? In the RDA King's send the actual orders.

PKB Response:

We have two content patterns for lab results….http://dev.patientsknowbest.com/home/hl7-api/messages/oru-r01/laboratory#TOC-Content-patterns.  As long as your feed corresponds to one of them it should be fine.  We should test out the permutations though to see what looks right.

We don’t mandate any coding. 

If you use LOINC codes for instance you can send in that coding.  PKB does have some LOINC codes enabled for other customers.  Using a LOINC code may result in some of your units being translated to match the mapping we have.  http://dev.patientsknowbest.com/home/hl7-api/messages/oru-r01/laboratory#TOC-Translating-units.  This allows results of the same type from different customers to be displayed on a single graph.  Here is an example OBX with LOINC:
 
OBX|1|NM|69380-4^% BCR/ABL in bloed^LOINC||0.34832638|%|||||F|||20180702082200|CHL^Centr. Hematologisch Lab.^UMCN^CHL^^UMCN||||20180702082336

Otherwise, you can send any OBX-3 id you have locally and we will display the details and units as you provide.  E.g.
 
OBX||NM|CODE_01^Serum Creatinine^||53.706|U^umol/L|50-120||||F|||20180807122835+0100
OBX||NM|CODE_02^GFR^||128.9|N^mL/min|>90||||F|||20180807122835+0100
OBX||NM|CODE_03^Potassium^||4.044|2^mmol/L|3.5-5.3||||F|||20180807122835+0100


  • Do we want to "fix" the PV data - such as where multiple test types have been submitted in a single test?


  • Issues with PKB Sending - Multiple Tests per Lab Order

The source result data in PKB has two patterns.

UKRDC data - which is held as the "real" lab orders, with results grouped in a logic way.

PV Data - where generic Lab Order structures are created by grouping the results by sample collection time (although some units will supply processed time).

We have some duplication where -

  • Because Processing Time has been used rather than Sample Collection Time the Patient has both PRE/POST results with the same apparent time. There has been an attempt to fix this by giving a suffix to the test codes to split them out (_PRE / _POST) but not all sites supply this. We also have sites who will send through a result without a PRE/POST flag initially but will then send it through when the second result is loaded. Because of the way we load PV results we then retain all three.
  • A site has two test types which are mapped to a single PV code - such as two eGFR formulae. NOTE: A site doing this can also cause data loss.