England Pathology and Laboratory Medicine (PaLM) Technical Framework
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HL7 v2.5.1 Segments and Data Types

This page defines the HL7 v2.5.1 segments used by the LAB transactions, localised for England. Each field lists its FHIR equivalent; the element-level mappings are also on each profile's Mappings tab (HL7 v2.5.1 (England PaLM)).

Conventions

  • Version - HL7 v2.5.1. Messages SHALL follow the HL7 v2.5.1 standard; deprecated (B) fields SHOULD NOT be used where a 2.5.1 replacement exists (for example use SPM, not OBR-15; TQ1, not ORC-7 / OBR-27).
  • Optionality - R required, RE required if known (send it if you have it), C conditional, O optional, X not used. This guide's optionality is for England and may be tighter than the HL7 base.
  • Sources - the field rules follow the Digital Health and Care Wales HL7 ORU_R01 2.5.1 IG (DHCW) and the NW GMSA HL7 v2 standards, with English identifiers in place of NHS Wales OIDs.
  • Escape characters - \F\ \S\ \T\ \R\ \E\ and \.br\ (new line) SHALL be supported. HL7 null "" means delete this value.
  • Codes - every coded field (CWE / CE) SHALL have a code, display text and coding system (CWE-1, CWE-2, CWE-3). Local codes SHALL use coding system L (or a registered local system name) and SHOULD also carry a national code in CWE-4 to CWE-6 - see Terminology.
  • Transport - MLLP over TLS within a network, or HTTPS (agreed per interface).

MSH

Message Header. MSH SHALL NOT be used to derive patient, clinician or patient identifier information (for example the assigning authority of PID-3).

Field Name DT Opt Example England rule FHIR
MSH-1 Field Separator ST R |   -
MSH-2 Encoding Characters ST R ^~\&   -
MSH-3 Sending Application HD R LIMS Agreed per interface MessageHeader.source.name
MSH-4 Sending Facility HD R R0A ODS code of the sending organisation MessageHeader.sender.identifier
MSH-5 Receiving Application HD R GPSYSTEM   MessageHeader.destination.name
MSH-6 Receiving Facility HD R A12345 ODS code of the receiving organisation MessageHeader.destination.receiver.identifier
MSH-7 Date/Time of Message TS R 20261103160530 Time of sending, not a clinical time Bundle.timestamp
MSH-9 Message Type MSG R ORU^R01^ORU_R01   MessageHeader.eventCoding (MSH-9.2)
MSH-10 Message Control ID ST R LIMS-MSG-000987 Unique per message (up to 20 characters) Bundle.identifier
MSH-11 Processing ID PT R P P production, T training, D debugging - (environment)
MSH-12 Version ID VID R 2.5.1   -
MSH-15 Accept Acknowledgment Type ID R AL AL - always acknowledge MessageDefinition.responseRequired = always

PID

Patient Identification.

Field Name DT Opt Example England rule FHIR
PID-1 Set ID SI O 1   -
PID-3 Patient Identifier List CX R 633^^^R0A^MR~9449305552^^^NHS^NH NHS Number with CX-4 NHS, CX-5 NH. Local identifiers with CX-4 the ODS code of the assigning trust and CX-5 MR. Identifiers without an assigning authority SHALL NOT be sent. Only verified identifiers Patient.identifier
PID-5 Patient Name XPN R CHISLETT^Octavia^^^Miss Family and given name required Patient.name
PID-7 Date/Time of Birth TS R 20080920   Patient.birthDate
PID-8 Administrative Sex IS R F Table 0001 Patient.gender - ConceptMap
PID-11 Patient Address XAD RE 1 RAVENSFIELD GARDENS^^EPSOM^SURREY^KT19 0ST First repeat is the home address Patient.address
PID-13 Phone Number - Home XTN O 07700900123^PRN^CP XTN-2 and XTN-3 required on each repeat Patient.telecom
PID-29 Patient Death Date and Time TS O     Patient.deceasedDateTime
PID-32 Identity Reliability Code IS RE 01 NHS Number verification status (01 present and verified … 08 trace postponed) NHS Number verification status extension (UK Core) - not profiled here (Open)

PV1

Patient Visit. Used to identify where the report goes and who requested it.

Field Name DT Opt Example England rule FHIR
PV1-1 Set ID SI O 1   -
PV1-2 Patient Class IS R O Table 0004 (I, O, E, N not applicable) Encounter.class
PV1-3 Assigned Patient Location PL R ^^^^^^^^Example Surgery^A12345 The requesting location - GP practice (ODS code) or ward / clinic. PL-9 description, PL-10 identifier ServiceRequest.requester (Organization) or Encounter.location
PV1-8 Referring Doctor XCN R G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN The responsible clinician the report returns to ServiceRequest.requester (PractitionerRole)
PV1-19 Visit Number CX RE     Encounter.identifier, DiagnosticReport.encounter.identifier

ORC

Common Order. SHALL be sent in OML_O21. In ORU_R01 it SHOULD be sent where there was an electronic order.

Field Name DT Opt Example England rule FHIR
ORC-1 Order Control ID R NW Table 0119 ServiceRequest.status - ConceptMap
ORC-2 Placer Order Number EI C GP-ORD-000123^GPSYSTEM Required for electronic orders ServiceRequest.identifier (PLAC)
ORC-3 Filler Order Number EI C 26H012345^LIMS Required from the Order Filler ServiceRequest.identifier (FILL)
ORC-4 Placer Group Number EI RE GP-REQ-000045^GPSYSTEM All orders on one request ServiceRequest.requisition
ORC-5 Order Status ID O CM Table 0038 ServiceRequest.status
ORC-8 Parent EIP C   Required for sub-orders [LAB-35] ServiceRequest.basedOn
ORC-9 Date/Time of Transaction TS R 20261103091000 When the order was placed ServiceRequest.authoredOn
ORC-10 Entered By XCN O   The user who entered the order, not the clinician Provenance.agent - not mapped
ORC-12 Ordering Provider XCN R G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN Same as OBR-16 ServiceRequest.requester → PractitionerRole.practitioner
ORC-16 Order Control Code Reason CWE O   Reason for a cancellation ServiceRequest.note (Open)
ORC-21 Ordering Facility Name XON RE Example Surgery^^^^^^^^^A12345 XON-10 the ODS code ServiceRequest.requester → PractitionerRole.organization

TQ1

Timing/Quantity. Send only for a non-routine priority (no TQ1 means routine).

Field Name DT Opt Example England rule FHIR
TQ1-7 Start Date/Time TS O   Earliest time to perform ServiceRequest.occurrencePeriod.start
TQ1-9 Priority CWE R S^Stat^HL70485 Table 0485 ServiceRequest.priority - ConceptMap

OBR

Observation Request. In OML_O21 it is the requested test; in ORU_R01 it is the report header, populated by the Order Filler.

Field Name DT Opt Example England rule FHIR
OBR-1 Set ID SI R 1   -
OBR-2 Placer Order Number EI C GP-ORD-000123^GPSYSTEM Same as ORC-2. Required if the order was electronic ServiceRequest.identifier (PLAC); DiagnosticReport.basedOn
OBR-3 Filler Order Number EI C 26H012345^LIMS Required in ORU_R01. The laboratory (report) number users quote - the same on every OBR of one report DiagnosticReport.identifier
OBR-4 Universal Service Identifier CWE R 1022441000000101^FBC - full blood count^SCT The test group or test: the PaLM requestable (SNOMED CT UK, refset 1853561000000109) in CWE-1 to CWE-3, the laboratory's own code as the alternate (CWE-4 to CWE-6) ServiceRequest.code; the test group Observation.code
OBR-7 Observation Date/Time TS C 20261103091500 Required in ORU_R01 - the specimen collection time DiagnosticReport.effectiveDateTime
OBR-13 Relevant Clinical Information ST O   Prefer NTE ServiceRequest.note
OBR-16 Ordering Provider XCN R G1234567^GREEN^Alex^^^Dr^^^GMP^^^^DN Same as ORC-12 ServiceRequest.requester
OBR-22 Results Rpt/Status Chng - Date/Time TS C 20261103160500 Required in ORU_R01 - when the report was released. Used for alerts downstream DiagnosticReport.issued
OBR-24 Diagnostic Serv Sect ID ID RE HM Table 0074 (CH, HM, MB, IMM, BLB, SR, VR, …) DiagnosticReport.category
OBR-25 Result Status ID C F Required in ORU_R01. Table 0123 DiagnosticReport.status - ConceptMap
OBR-29 Parent EIP C   Required for sub-order results [LAB-36] ServiceRequest.basedOn
OBR-31 Reason for Study CWE O ^Tiredness   ServiceRequest.reasonCode
OBR-32 Principal Result Interpreter NDL RE 7654321&HUGHES&Sam&&&Dr&&&GMC The authorising clinician DiagnosticReport.resultsInterpreter

NTE

Notes and Comments. Position gives the meaning: after PID - patient comments; after OBR - order or report comments; after OBX - result comments.

Field Name DT Opt Example England rule FHIR
NTE-1 Set ID SI O 1   -
NTE-2 Source of Comment ID RE L L filler (laboratory), P placer (for example clinical details), O other. Default L Annotation author
NTE-3 Comment FT R Mild anaemia ... One NTE per paragraph; \.br\ for line breaks ServiceRequest.note (after OBR in OML), DiagnosticReport.conclusion (after OBR in ORU), Observation.note (after OBX)
NTE-4 Comment Type CWE O RE Table 0364 -

DG1

Diagnosis (OML_O21 only).

Field Name DT Opt Example England rule FHIR
DG1-3 Diagnosis Code CWE R   SNOMED CT or ICD-10 ServiceRequest.reasonCode

OBX

Observation / Result.

Field Name DT Opt Example England rule FHIR
OBX-1 Set ID SI R 1 Starts at 1 for each OBR -
OBX-2 Value Type ID C NM Table 0125 - see OBX-2 Value Type type of Observation.value[x]
OBX-3 Observation Identifier CWE R 1022431000000105^Haemoglobin estimation^SCT^718-7^Hemoglobin [Mass/volume] in Blood^LN SNOMED CT UK (PaLM) observable entity; LOINC as the alternate code where known; local code with L only if there is no national code Observation.code
OBX-4 Observation Sub-ID ST C   Groups related OBX (for example an organism and its sensitivities) Observation.hasMember
OBX-5 Observation Value varies C 112 Typed by OBX-2. Empty only with OBX-11 = X, N, D or I Observation.value[x]
OBX-6 Units CWE C g/L^^UCUM Required for NM and SN. UCUM code in CWE-1 valueQuantity.unit, .system, .code
OBX-7 References Range ST RE 115-165 low-high, >low or <high Observation.referenceRange
OBX-8 Abnormal Flags IS RE L Table 0078 Observation.interpretation - ConceptMap
OBX-11 Observation Result Status ID R F Table 0085 Observation.status - ConceptMap
OBX-14 Date/Time of the Observation TS RE 20261103091500 Clinically relevant time (specimen collection) if different OBX have different times; otherwise OBR-7 Observation.effectiveDateTime
OBX-16 Responsible Observer XCN O     Observation.performer
OBX-17 Observation Method CWE O     Observation.method
OBX-18 Equipment Instance Identifier EI O   Analyser Observation.device
OBX-19 Date/Time of the Analysis TS O     Observation.issued (Open)
OBX-23 Performing Organization Name XON RE Manchester University NHS Foundation Trust^^^^^^^^^R0A XON-10 ODS code. SHALL be sent for subcontracted results Observation.performer (Organization)

OBX Type ED (Embedded Documents)

A report PDF is sent as an OBX of type ED, OBX-5 = ^application^pdf^Base64^<data> (ED-2 type of data, ED-3 data subtype, ED-4 encoding, ED-5 data). Where the data is too large for one field (DHCW limit 32K), it is split across consecutive ED OBX with the same OBX-3, and the receiver joins them. For large documents an OBX of type RP (reference pointer, a URL) MAY be used instead, by agreement. FHIR: DiagnosticReport.presentedForm - see Mapping.

SPM

Specimen. SHOULD be sent wherever a specimen was tested.

Field Name DT Opt Example England rule FHIR
SPM-1 Set ID SI O 1   -
SPM-2 Specimen ID EIP RE GP-SPC-000123&GPSYSTEM^26H012345&LIMS EIP-1 placer (label) number, EIP-2 filler (accession) number Specimen.identifier (PLAC), Specimen.accessionIdentifier
SPM-3 Specimen Parent IDs EIP C   For aliquots Specimen.parent
SPM-4 Specimen Type CWE R 119297000^Blood specimen^SCT SNOMED CT specimen Specimen.type
SPM-7 Specimen Collection Method CWE O     Specimen.collection.method
SPM-8 Specimen Source Site CWE O   SNOMED CT body structure Specimen.collection.bodySite
SPM-14 Specimen Description ST O     Specimen.note
SPM-17 Specimen Collection Date/Time DR R 20261103091500   Specimen.collection.collectedDateTime (or collectedPeriod)
SPM-18 Specimen Received Date/Time TS RE 20261103134000 Required in ORU_R01 Specimen.receivedTime
SPM-21 Specimen Reject Reason CWE C   When the specimen was rejected Specimen.condition / Specimen.status = unsatisfactory
SPM-27 Container Type CWE O     Specimen.container.type

MSA

Message Acknowledgment (ACK, ORL).

Field Name DT Opt Example England rule FHIR
MSA-1 Acknowledgment Code ID R AA AA accept, AE error (resend after an agreed period), AR reject (do not resend) MessageHeader.response.code: ok, transient-error, fatal-error
MSA-2 Message Control ID ST R LIMS-MSG-000987 MSH-10 of the message being acknowledged MessageHeader.response.identifier
MSA-3 Text Message ST O     MessageHeader.response.details → OperationOutcome

Data Types

CX

Extended Composite ID - patient identifiers.

Component Name England rule FHIR Identifier
CX-1 ID Number   value
CX-4 Assigning Authority NHS for the NHS Number; the trust ODS code for a hospital number system (NHS Number: https://fhir.nhs.uk/Id/nhs-number), assigner.identifier (ODS)
CX-5 Identifier Type Code Table 0203: NH NHS Number, MR medical record number, PI patient internal identifier type

EI

Entity Identifier - order numbers.

Component Name England rule FHIR Identifier
EI-1 Entity Identifier   value
EI-2 Namespace ID The assigning organisation (ODS code) or application assigner.identifier (ODS); and system through an agreed table
EI-3 / EI-4 Universal ID / Type Not used - the FHIR Identifier.system URI is not known to the LIMS at this stage of the pipeline; the receiver assigns it -

XCN

Extended Composite ID Number and Name for Persons - clinicians.

Component Name England rule FHIR
XCN-1 ID Number Professional registration number Practitioner.identifier.value
XCN-2 / XCN-3 Family Name / Given Name   Practitioner.name
XCN-6 Prefix   Practitioner.name.prefix
XCN-9 Assigning Authority GMC, NMC, HCPC, GPHC, GMP (GP national code); L for local codes Practitioner.identifier.system - see Terminology
XCN-13 Identifier Type Code DN doctor number, NP nurse practitioner, RN registered nurse -

XON

Extended Composite Name and ID for Organizations.

Component Name England rule FHIR
XON-1 Organization Name   Organization.name
XON-10 Organization Identifier ODS code Organization.identifier (https://fhir.nhs.uk/Id/ods-organization-code)