Myriad HL7 ORM/ORU Message Standards

Myriad uses HL7 version 2.3
Myriad results include an embedded PDF, base64 encoded in an OBX segment in the ORU message.
Myriad prefers to exchange messages via LLP over a VPN, and supports all the following connectivity methods:
- LAN-2-LAN IPsec VPN
- Client Based Remote Access VPN
- SFTP/FTPS over public internet
- FTP (over VPN Tunnel)
- API calls

In the specification below, 'R' refers to Required field, 'C' refers to Conditional, 'O' refers to Optional.

Myriad HL7 Order Message Format

Order Message Structure (ORM)

These segments are sent in the following order:

MSH - required
PID - required
PV1 - optional

INSURANCE

IN1 - conditional
GT1 - optional
DG1 - required

The IN1 is required if insurance needs to be billed. If neither an IN1 segment nor GT1 segment is received, we assume that the billing option is bill-to-clinic.

ORDER

ORC - required
OBR - required
DG1 - required
OBX - optional

MSH Segment - Message Header

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
MSH-0	Segment Type IDUse: To identify the segment 'MSH'	R	3	\|
MSH-1	Field DelimiterUse: To separate fields '\|'	R	1	\|
MSH-2	Encoding CharactersUse: To separate components, repeating fields, sub-components '^~&`	R	4	\|
MSH-3	Sending ApplicationUse: ID to identify EMR system. Mutually agreed upon between Myriad and Vendor Alpha, Numeric characters	R	15	\|
MSH-4	Sending FacilityUse: unique clinic ID, sent by Myriad to vendor to identify practice location Alpha, Numeric characters	R	15	\|
MSH-5	Receiving ApplicationUse: to identify the lab system receiving the orders 'Myriad'	R	15	\|
MSH-6	Receiving Facility 'Myriad'	R	10	\|
MSH-7	Date/Time of Message	R	12	\|
MSH-9	Message Type 'ORM^O01'	R	3	\|
MSH-10	Message Control ID	O	N/A	\|
MSH-11	Processing ID 'P'	O	1	\|
MSH-12	Version of HL7 '2.3'	R	3	CR

PID Segment - Patient Identification

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
PID-0	Segment Type IDUse: To identify the segment 'PID'	R	3	\|
PID-1	Sequence Number	O	20	\|
PID-2	External Patient ID	O		\|
PID-3	Internal Patient ID	O		\|
PID-4	Alternate Patient ID	O		\|
PID-5	5.1 Patient Last Name	R	30	^
	5.2 Patient First Name	R	30	^
PID-7	Date of Birth Formatted as YYYYMMDD	R		^
PID-8	Patient Gender 'F' - Female 'M' - Male 'U' - Unknown 'U' is accepted but we need gender to appear with sample	R		\|
PID-10	Patient RaceCan also be provided as part of the AOE answers	R	15	\|
PID-11	11.1 Patient Address	R	35	^
PID-13	13.1 Patient Home Phone Number	R	10	^
PID-14	Patient Business Phone Number	C (required if PID-13 is empty)	10	\|
PID-16	16.1 Marital status Not null=married	O	10	\|

PV1 Segment

Optional Segment

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
PV1-0	Segment Type IDUse: To identify the segment 'PV1'	R	3	\|
PV1-1	Set ID	R	4	\|
PV1-3	Assigned Patient Location(Can be used to distinguish sites)	O		\|

IN1 Segment - Insurance

The IN1 segment is required for third party billing and preferred for other billing options with the IN1-47 segment populated. When multiple IN1 segments are sent we bill to the first one. If we receive neither an IN1 nor a GT1, we bill to clinic.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
IN1-0	Segment Type IDUse: To identify the segment 'IN1'	R	3	\|
IN1-1	Sequence NumberUse: To identify the number of the IN1 segment	O	4	\|
IN1-2	2.2 Plan name	O		\|
IN1-4	Insurance Company Name4.1 Carrier name	R	30	\|
IN1-5	5.1 Insurance Company Address	R	35	\|
	5.3 Insurance Company City	R	16	^
	5.4 Insurance Company State	R	2	^
	5.5 Insurance Company Zip Code	R	9	^
IN1-8	Group Number of Insured Patient	R	15	\|
IN1-16	16.1 Insured's last name16.2 Insured's first name	R	15	\|
IN1-17	Insured's Relationship to Patient '1' - Self '2' - Spouse '3' - Other	R	1	\|
IN1-18	Insured's DOB	O		\|
IN1-19	Insured's Address	O		\|
IN1-31	Type of Agreement	O	1	\|
IN1-36	Policy Number (Insurance Number/Member ID)	R	25	\|
IN1-47	Coverage type 'P' = Bill to patient 'C' = Bill to clinic 'T' = Bill to Insurance	R	1	CR

GT1 Segment - Guarantor

Send the GT1 if the guarantor's address is to override the IN1 address.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
GT1-0	Segment Type IDUse: To identify the segment 'GT1'	R	3	\|
GT1-1	Sequence Number	R	4	\|
GT1-3	3.1 Guarantor Last Name	R	25	^
	3.2 Guarantor First Name	R	15	^
GT1-5	Guarantor Address(If a GT1 is provided, and GT1[11] is not 'Self', the GT1's address overrides the address in the IN1.)	R	35	^
GT1-6	Guarantor Home Phone Number	O	10	\|
GT1-11	Guarantor Relationship to Patient '1' - Self '2' - Spouse '3' - Other	R	1	\|

DG1 Segment - Diagnosis

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
DG1-0	Segment Type IDUse: To identify the segment 'DG1'	R	3	\|
DG1-1	Sequence Number	R	4	\|
DG1-2	Diagnosis Coding Method 'I10' - ICD10	R	2	\|
DG1-3	Diagnosis Code Identifier	R	8	^

ORC Segment - Common Order Segment

ORC and OBR segments are paired. Some ORC fields are duplicated in the OBR.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
ORC-0	Segment Type IDUse: To identify the segment ORC'	R	3	\|
ORC-1	Order Control Code NW'	R	2	\|
ORC-2	2.1 Unique Foreign Accession or Specimen or Requisition ID Alphanumeric Values in ORC-2 and OBR-2 must match	R	30	^
ORC-9	Date/Time of Transaction	R	12	\|
ORC-12	12.1 Ordering Provider ID Number NPI of the ordering provider	R	10	^
	12.2 Ordering Provider Last Name	R	25	^
	12.3 Ordering Provider First Name	R	15	^
	12.8 Source Table 'N' - NPI number	O	1	~ or \|

OBR Segment - Observation Order

ORC and OBR segments are paired. Some OBR fields are duplicated in the ORC.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
OBR-0	Segment Type IDUse: To identify the segment 'OBR'	R	3	\|
OBR-1	Sequence Number	R	4	\|
OBR-2	2.1 Unique Foreign Accession or Specimen or Requisition ID Alphanumeric Values in ORC-2 and OBR-2 must match	R	30	^
OBR-4	4.1 Observation Test Identifier	R	15	\|
	4.2 Observation Test Text	R	10	^
	4.3 Name of Coding System	O	25	^
OBR-7	Observation/Specimen Collection Date/Time	R	15	^
OBR-13	13.2 Comments on test order	O	64	^
OBR-15	Source of Specimen	C	26	\|
OBR-16	16.1 Ordering Provider ID Number	R	20	^
	16.2 Ordering Provider Last Name	R	25	^
	16.3 Ordering Provider First Name	R	15	^
	16.8 Source Table	O	1	\|
OBR-18	Alternate Foreign Accession/Specimen ID	O	11	\|

OBX Segment

AOE (ask-on-order-entry) questions and answers are sent in OBX segments. One question and one answer are transmitted per OBX.

Below are some examples of our AOEs. We will send compendia with the specific AOEs for each clinic, if supported.

Example OBX transmission in an ORM

(format is OBX|indexed number|ST|Question Code^Question||Option^Option Code|):

OBX|1|ST|Question0001^Is the patient currently pregnant||Yes^Yes|

OBX|3|ST|Question0003^Ethnicity||East Asian^ea|

OBX|8|ST|Question0050^Email Address||rogerrabbit@gmail.com^|

Example AOE Compendium format:

Question Code	Question	Tips	Required	Fieldtype
QUESTION0001	Is the patient currently pregnant		O	DD
QUESTION0003	Ethnicity	Please select the closest match if patient is of a mixed ethnicity.	R	DD
QUESTION0050	Patient Email Address	Necessary for more efficient handling of billing, status and results.	O	FT

ID	OBX Code	Option	Option Code
1	QUESTION0001	Yes	Yes
2	QUESTION0001	No	No
5	QUESTION0003	Northern European	ne
6	QUESTION0003	Southern European	so
7	QUESTION0003	French Canadian	cj
8	QUESTION0003	Ashkenazi Jewish	aj
9	QUESTION0003	Finnish	fi
10	QUESTION0003	Other Caucasian	co
11	QUESTION0003	East Asian	ea
12	QUESTION0003	South Asian	sa
13	QUESTION0003	Southeast Asian	se
14	QUESTION0003	African-American	af
15	QUESTION0003	Hispanic	hi
16	QUESTION0003	Middle Eastern	me
17	QUESTION0003	Native American	na
18	QUESTION0003	Pacific Islander	pi
19	QUESTION0003	Unknown	uk

Myriad HL7 Result Message Format

Result Message Structure (ORU)

The ORU comprises of the following messages.

MSH
PID
ORC (ORC and OBR are paired, and sent once per disease panel ordered)
OBR
NTE (accompanies OBR where necessary)
OBX (repeated for every observation)
NTE (accompanies OBX where necessary)

MSH Segment - Message Header

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
MSH-0	Segment Type IDUse: To identify the segment 'MSH'	R	3	\|
MSH-1	Field DelimiterUse: To separate fields '\|'	R	1	\|
MSH-2	Component DelimiterUse: To separate components '^'	R	1	\|
	Repeat Delimiter Use: To identify repeating fields '\'	R	1	\|
	Sub-component delimiterUse: To create sub-components '&'	R	1	\|
MSH-3	Sending Application 'Myriad'	R	15	\|
MSH-4	Sending Facility 'Myriad'	R	15	\|
MSH-5	Receiving Application Code provided by clinic or Myriad	R	15	\|
MSH-6	Receiving Facility - Alphanumeric values Clinic ID, provided by Myriad	R	15	\|
MSH-7	Date/Time of Message	R	12	\|
MSH-9	9.1 Message Type 'ORU'	R	3	\|
	9.2 'R01'
MSH-10	Message Control ID	R	20	\|
MSH-11	Processing ID 'P'	R	1	\|
MSH-12	Version of HL7 '2.3'	R	3	CR

PID Segment - Patient Identification

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
PID-0	Segment Type IDUse: To identify the segment 'PID'	R	3	\|
PID-1	Sequence Number	O	20	\|
PID-5	5.1 Patient Last Name	R	15	^
	5.2 Patient First Name	R	15	^
PID-7	Date of Birth	R		^
PID-8	Patient Gender	R		\|
PID-11	11.1 Patient Address	R	35	^
	11.3 Patient City	R	16	^
	11.4 Patient State	R	2	^
	11.5 Patient Zip Code	R	9	^

ORC Segment - Common Order Segment

ORC and OBR segments are paired. Some ORC fields are duplicated in the OBR.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
ORC-0	Segment Type IDUse: To identify the segment 'ORC'	R	3	\|
ORC-1	Order Control Code 'RE'	R	2	\|
ORC-2	2.1 Unique Foreign Accession or Specimen or Requisition ID Alphanumeric Values in ORC-2 and OBR-2 must match	R	30	^
ORC-6	'F'	R	1	\|
ORC-9	Date/Time of Transaction	R	12	\|
ORC-12	12.1 Ordering Provider ID Number NPI of the ordering provider	R	10	^
	12.2 Ordering Provider Last Name	R	25	^
	12.3 Ordering Provider First Name	R	15	\|

OBR Segment - Observation Order

ORC and OBR segments are paired. Some OBR fields are duplicated in the ORC.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
OBR-0	Segment Type IDUse: To identify the segment 'OBR'	R	3	\|
OBR-1	Sequence Number	R	4	\|
OBR-2	Unique Foreign Accession or Specimen or Requisition ID Alphanumeric	R	30	\|
OBR-3	3.1 Requisition number. Identical to OBR-2	\|	^
OBR-4	4.1 Observation Test Identifier	R	15	^
	4.2 Observation Test Text	R	50	\|
OBR-6	Requisition time (datetime order was placed)	O	25	\|
OBR-7	Observation/Specimen Collection Date/Time	R	12	\|
OBR-8	Observation End Date/Time	O	12	\|
OBR-14	Observation/Specimen Collection Date/Time	R	15	\|
OBR-15	Source of Specimen	C	26	\|
OBR-16	16.1 Ordering Provider ID Number	R	10	^
	16.2 Ordering Provider Last Name	R	25	^
	16.3 Ordering Provider First Name	R	15	\|
OBR-22	Test completion date	R	12	\|
OBR-25	Order Result Status P = Preliminar F = Final C = Corrected	R	1	\|

OBX Segment - Result Observation Segment

OBX segments will be sent with every specimen reported.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
OBX-0	Segment Type IDUse: To identify the segment 'OBX'	R	3	\|
OBX-1	Sequence Number	R	4	\|
OBX-2	Use: to identify the type of data being sent (eg: TX, ED, etc.)	R	2	\|
OBX-3	3.1 Observation Test Identifier	R	15	\|
	3.2 Observation Test Text	R	50	^
OBX-5	Observation Value	C	21	\|
OBX-8	Abnormal Flags N = Normal HH = Abnormal Blank = No result or abnormal flag does not apply	R	3	\|
OBX-11	Observation Result Status P = Preliminary F = Final C = Corrected	R	1	\|
OBX-15	15.1 'Myriad'	R		^
	15.2 'Myriad'	R		^
	15.3 '180 Kimball Way'	R		^
	15.4 'South San Francisco'	R		^
	15.5 'CA'	R		^
	15.6 '94080'	R		^
	15.7 '<Medical Director Name + Title>'	R		^
	15.8 '(888)268-6795'	R		\|

We also use an OBX segment to send an encapsulated base64 PDF.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
OBX-0	Segment Type IDUse: To identify the segment 'OBX'	R	3	\|
OBX-1	Sequence Number	R	4	\|
OBX-2	Use: to identify the type of data being sent 'ED' - Encapsulated Data	R	2	\|
OBX-3	3.1 Observation Test Identifier 'PDFReport1'	R	15	^
	3.2 Observation Test Text 'PDF Report'	R	50	\|
OBX-5	5.1 'PDF'	R	79	\|
	5.4 PDF value in base64	R		\|
OBX-11	Observation Result Status	R	1	\|

NTE Segment

Multiple NTEs may be associated with a single OBX and/or OBR.

Field Mnemonic	Use/Value Field	Required Field?	Length	Field or Segment Delimiter
NTE-0	Segment Type IDUse: To identify the segment 'NTE'	R	3	\|
NTE-1	Sequence Number	R	4	\|
NTE-3	Comment Text	R	78	CR

HL7 Detailed Results OBX