ASTM E1238-97
Standard Specification for Transferring Clinical Observations Between Independent Computer Systems

Standard No.

ASTM E1238-97

Release Date

1997

Published By

American Society for Testing and Materials (ASTM)

Status

Withdraw 2002-01

Latest

ASTM E1238-97

Scope

1.1 General Approach—This specification covers the twoway digital transmission of requests for, and results of, tests, diagnostic studies, and care-provider observations between requestors (for example, hospital information systems, clinical workstations, office practice computers) and producers (for example, clinical laboratory systems, radiology systems, EKG machines, nursing care systems). It specifies the logical format and encoding rules for messages needed to interchange any clinical information that can be reported in a textual form. It enables any two systems to establish a link for communicating text to send result or request information in a standard and interpretable form. It deals not only with general information about diagnostic testing, but specific details useful for clinical practice, administration, and research in a comprehensive, but flexible, convention. 1.2 The major topics are found in the following sections: Section Information Requirements in Diagnostic Studies and Clinical Observations 5 Distinction Between the Logical Contents and the Encoding Rules in This Specification 5.1 General Approach 5.2 Maximum Line Length 5.3 Network Protocols and Transmission Media 5.4 Relation to Specifications E 1394 and E 1381E 1394E 1381 5.5 Negotiating Required and Optional Fields in Segments 5.6 Acknowledgment of Messages 5.7 Message General Content Considerations 6 Character Representation 6.1 Standard Character Set 6.1.1 Range and Case Insensitivity 6.1.2 Segment and Field Lengths 6.2 Maximum Line Length 6.3 Delimiters 6.4 Segment Delimiter 6.4.1 Field Delimiter 6.4.2 Repeat (subfield) Delimiter 6.4.3 Component (sub-subfield) Delimiter 6.4.4 Specification of Delimiters 6.4.5 Delimiters for Null Fields 6.4.6 Fields of No Concern to the Receiving System 6.4.7 Changing Fields to Null Values 6.4.8 Segment Types 6.5 Message Header Segment (H) 6.5.1 Patient Identifying Segment (P) 6.5.2 Observation Order Segment (OBR) 6.5.3 Observation Segment (OBX) 6.5.4 Comment Segment (C) 6.5.5 Error Checking Segment (E) 6.5.6 Request Results Segment (Q) 6.5.7 Scientific Segment (S) 6.5.8 Addendum Segment (A) 6.5.9 Field Data Types 6.6 1 This specification is under the jurisdiction of ASTM Committee E-31 on Healthcare Informatics and is the direct responsibility of Subcommittee E31.13 on Clinical Laboratory Systems. Current edition approved Aug. 10, 1997. Published March 1998. Originally published as E 1238 – 94. Last previous edition E 1238 – 94. 1 Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States. NOTICE: This standard has either been superseded and replaced by a new version or withdrawn. Please contact ASTM International (www.astm.org) for the latest information. AD Addresses 6.6.1 CE Coded Entry 6.6.2 CK Composite ID With Check Digit 6.6.7 CM Composite Miscellaneous 6.6.8 CNA Provider and User IDs 6.6.9 CQ Fixed Measurements and Units 6.6.10 Reserved for Future Use 6.6.11 Reserved for Future Use 6.6.12 Reserved for Future Use 6.6.13 ID String that Represents an ID 6.6.14 NM Numeric 6.6.15 PN Person Name 6.6.16 ST String 6.6.17 TN Telephone and Beeper Number 6.6.18 TS (Time Stamp)—Previously Date-Time 6.6.19 TX Bulk Text 6.6.20 Examples of Messages Using This System 6.7 Rules About Retransmission of Results 6.8 Orders that Spawn Multiple Orders 6.9 Producer Generated Orders 6.10 DETAILED STRUCTURE OF EACH SEGMENT TYPE Message Header 7 General Approach 7.1 Segment Type ID 7.2 Delimiter Definition 7.3 Message Control ID 7.4 Security (previously Access Password) 7.5 Sender Name or ID 7.6 Sender Street Address 7.7 Message Type (new) 7.8 Sender Telephone Number 7.9 Characteristics of Sender 7.10 Receiver ID 7.11 Comment or Special Instructions 7.12 Processing ID 7.13 Version 7.14 Date and Time of Message 7.15 Patient Identifying Segment 8 General Approach 8.1 Segment Type ID 8.2 Transmission Sequence Number 8.3 Requestor (Practice) Assigned Patient ID 8.4 Producer (Diagnostic Service) Assigned Patient ID 8.5 Alternate Patient ID 8.6 Patient Name 8.7 Mother’s Maiden Name 8.8 Birthdate 8.9 Patient Sex 8.10 Patient Race or Ethnic Origin 8.11 Patient Street Address, City, State, Country, and Zip/Postal Code 8.12 Not used 8.13 Patient Telephone Number 8.14 Attending Physician ID 8.15 Special Field 1 8.16 Special Field 2 8.17 Patient Height 8.18 Patient Weight 8.19 Patient’s Known or Suspected Diagnosis 8.20 Patient Active Medications, or Medications Suspected in Overdose Situations 8.21 Patient’s Diet 8.22 Practice Field 1 8.23 Practice Field 2 8.24 Admission Date/Time and Discharge Date/Time 8.25 Admission Status 8.26 Location 8.27 Diagnostic Classification 8.28 Patient Religion 8.29 Marital Status 8.30 Isolation Status 8.31 Language 8.32 Confidentiality Status (new) 8.33 Date and Time Registration Changed 8.34 Death date/time 8.35 Observation Order Segment (OBR) 9 General Approach 9.1 Segment Type ID 9.9 Sequence Number 9.10 Observation Requestor Accession or Specimen ID 9.11 Observation Producer Accession ID 9.12 Producer ID for Generated or Exploded Orders 9.13 Observation Battery ID 9.14 Priority 9.15 Requested Date and Time 9.16 Observation Date-Time/Specimen Collection Date-Time 9.17 Collection End Time 9.18 Collection Volume 9.19 Collector ID 9.20 Action Code 9.21 Danger Code 9.22 Relevant Clinical Information 9.23 Date and Time of Specimen Receipt in the Laboratory 9.24 Source of Specimen 9.25 Ordering Physician 9.26 Physician’s Telephone Number 9.27 Requestor Field 1 9.28 Requestor Field 2 9.29 Producer (Diagnostic Service) Field 1 9.30 Producer (Diagnostic Service) Field 2 9.31 Date-Time Observations Reported or Order Status Changed 9.32 Producer’s Charge 9.33 Producer’s Section ID 9.34 Order Result Status (previously report type) 9.35 Link to “Parent” Result 9.36 Quantity/Timing (previously Frequency) 9.37 Send Copies to (new) 9.38 Link to Parent Order (new) 9.39 Transportation Mode (new) 9.40 Reason for Study (new) 9.41 Principal Interpreter of Study (new) 9.42 Assisting Interpreter of Study (Resident) (new) 9.43 Observer/Technician (new) 9.44 Transcriptionist Identity (new) 9.45 Date-Time Scheduled (new) 9.46 Observation Segment 10 Background 10.1 Changes 10.2 Each Component of a Narrative Report Is Sent as a Separate OBX 10.3 Diagnostic Impressions (IMP) 10.4 Recommendations (REC) 10.5 Confirming Procedure (CNP) 10.6 Procedure Medication (MED) 10.7 Anatomic Site (ANT) 10.8 Devices (DEV) 10.9 Gross or General Description (GDT) 10.10 Secondary or Microscopic Description (MDT) 10.11 Procedure Comment (TCM) 10.12 Addendum Note (ADT) 10.13 Diagnosis (problem) Onset Date-Time (IMT) 10.14 Diagnosis (problem) Resolution Date-Time (RMT) 10.15 Comparison study (CMS) 10.16 Comparison Date-time (CMT) 10.17 Comparison Results (CMR) 10.18 Comparison Change (CMC) 10.19 Predicted (PRD) 10.20 Percent of Predicted (PPR) 10.21 After Drug Observed (AFD) 10.22 Predicted Value After Drug (ADP) 10.23 Percent Predicted After Drug (APP) 10.24 Expanded AS4 Codes 10.25 Segment Type ID 10.26 Sequence Number 10.27 Value Type (new) 10.28 Observation Identifier 10.29 Observation SubID 10.30 Observation Value 10.31 Representation 10.32 Reporting Logically Independent Observations 10.33 Multiple OBX Segments With The Same Observation ID and Sub ID 10.34 Coded Values 10.35 Bacterial Names as Values 10.36 Units of Measure 10.37 ISO and ANSI Customary Units Abbreviations 10.38 E 1238 – 97 2 NOTICE: This standard has either been superseded and replaced by a new version or withdrawn. Please contact ASTM International (www.astm.org) for the latest information. Local Codes 10.39 Reference Ranges 10.40 Upper and Lower Limits 10.40.1 Physiologic and Therapeutic Range 10.40.2 Abnormal Flags 10.41 Probability (new) 10.42 Nature of Abnormal Checking 10.43 Observation Result Status 10.44 Date/Time of Last Change in Normal Values or Units 10.45 Interpretive Report Segment 10.46 Error Checking Segment 11 General Approach 11.1 Segment Type ID 11.1.5.1 Sequence Number 11.1.5.2 Error Check, Byte Count 11.1.5.3 Check Code 11.1.5.4 Comment Segment 12 General Approach 12.1 Segment Type ID 12.1.1 Sequence Number 12.1.2 Comment Source 12.1.3 Comment Text 12.1.4 Request Results Segment 13 General Approach 13.1 Segment Type ID 13.1.1 Sequence Number 13.1.2 Practice (Requester) Assigned Patient ID 13.1.3 Observation Producer Assigned Patient ID 13.1.4 Observation Battery ID 13.1.5 Nature of Request Time Limits 13.1.6 Beginning Request Results Date and Time 13.1.7 Ending Request Results Date and Time 13.1.8 Requesting Physician 13.1.9 Requesting Physician Telephone Number 13.1.10 User Field 1 13.1.11 User Field 2 13.1.12 Message Terminator 14 General Approach 14.1 Segment Type ID 14.1.1 Sequence Number 14.1.2 Not used (for compatibility with Specification E 1394E 1394) 14.1.3 Patient Count (NM) 14.1.4 Line Count (NM) 14.1.5 Batch Number 14.1.6 Scientific Segment 15 General Approach 15.1 Segment Type ID 15.1.1 Sequence Number 15.1.2 Analytical Method 15.1.3 Instrumentation 15.1.4 Reagents 15.1.5 Units of Measure 15.1.6 Quality Control 15.1.7 Specimen Source 15.1.8 Body Site 15.1.9 Container 15.1.10 Specimen ID 15.1.11 Analyte 15.1.12 Result 15.1.13 Result Units 15.1.14 Collection Date and Time 15.1.15 Result Date and Time 15.1.16 Analytical Preprocessing Steps 15.1.17 Patient Diagnosis 15.1.18 Patient Birthdate 15.1.19 Patient Sex 15.1.20 Patient Race 15.1.21 HL7 Patient Visit Segment 16 HL7 Guarantor Segment 17 Background 17.1 Billing Information 17.1.1 Segment Type ID 17.2 Sequence Number 17.3 Guarantor Number 17.4 Guarantor Name 17.5 Guarantor Spouse Name 17.6 Guarantor Address 17.7 Guarantor Phone Number—Home 17.8 Guarantor Phone Number—Work 17.9 Guarantor Date of Birth 17.10 Guarantor Sex 17.11 Guarantor Type 17.12 Guarantor Relationship to Patient 17.13 Guarantor Universal ID Number 17.14 Guarantor Date/Time—Begin 17.15 Guarantor Date/Time—End 17.16 Guarantor Priority 17.17 Guarantor’s Employer Name 17.18 Guarantor’s Employer Address 17.19 Guarantor’s Employer Telephone Number 17.20 Guarantor Employee ID Number 17.21 Guarantor Employment Status 17.22 HL7 Insurance Segment for Billing 18 Background 18.1 Segment Type ID 18.2 Sequence Number 18.3 Insurance Plan ID 18.4 Insurance Company 18.5 Insurance Company Name 18.6 Insurance Company Address 18.7 Insurance Company Contact Person 18.8 Insurance Company Phone Number 18.9 Group Number 18.10 Group Name 18.11 Insured’s Group Employer ID 18.12 Insured’s Group Employer Name 18.13 Plan Effective Date/Time 18.14 Plan Expiration Date/Time 18.15 Authorization Information 18.16 Plan Type 18.17 Name of Insured 18.18 Insured’s Relationship to Patient 18.19 Insured’s Date/Time of Birth 18.20 Insured’s Address 18.21 Assignment of Benefits 18.22 Coordination of Benefits 18.23 Primary Payer 18.24 Notice of Admission Code 18.25 Notice of Admission Date/Time 18.26 Report of Eligibility Code 18.27 Report of Eligibility Date/Time 18.28 Release Information Code 18.29 Preadmit Certification 18.30 Verification Date/Time 18.31 Verification By 18.32 Type of Agreement 18.33 Billing Status 18.34 Lifetime Reserve Days 18.35 Delay Before Lifetime Reserve Days 18.36 Company Plan Code 18.37 Policy Number 18.38 Policy Deductible 18.39 Policy Limit—Amount 18.40 Policy Limit—Days 18.41 Room Rate—Semiprivate 18.42 Room Rate—Private 18.43 Insured’s Employment Status 18.44 Insured’s Sex 18.45 Insured’s Employer Address 18.46 Insured’s Telephone Number—Home 18.47 Insured’s Telephone Number—Work 18.48 Insured’s Universal ID Number 18.49 Test/Observation Master Segments 19 General Approach 19.1 General Test Observation Master Segment 19.2 Segment Type ID 19.2.1 Sequence Number 19.2.2 Producer’s Test/Observation ID 19.2.3 Permitted Data Types 19.2.4 Specimen Required 19.2.5 Producer ID 19.2.6 Observation Description 19.2.7 Other Test/Observation IDs for the Observation 19.2.8 Other Names 19.2.9 Preferred Report Name for the Observation 19.2.10 Preferred Short Name or Mnemonic for the Observation 19.2.11 E 1238 – 97 3 NOTICE: This standard has either been superseded and replaced by a new version or withdrawn. Please contact ASTM International (www.astm.org) for the latest information. Preferred Long Name for the Observation 19.2.12 Orderability 19.2.13 Identity of Instrument Used to Perform This Study 19.2.14 Coded Representation of Method 19.2.15 Portable Device 19.2.16 Observation Producing Department/Section 19.2.17 Telephone Number of Department/Section 19.2.18 Nature of Test/Observation 19.2.19 Report Subheader 19.2.20 Report Display Order 19.2.21 Date-Time Stamp for Any Change in Definition Attribute for the Observation 19.2.22 Effective Date-Time of Change in Test Procedure That Makes Results Noncomparable 19.2.23 Typical Turn-Around Time from Receipt of Specimen/Subject to Result Produced 19.2.24 Processing Time 19.2.25 Processing Priority 19.2.26 Reporting Priority 19.2.27 Outside Site(s) Where Observation May be Performed 19.2.28 Address of Outside Site(s) 19.2.29 Phone Number of Outside Site(s) 19.2.30 Confidentiality Code 19.2.31 Observations Required to Interpret This Observation 19.2.32 Interpretation of Observations 19.2.33 Contraindications to Observations 19.2.34 Reflex Tests/Observations 19.2.35 Rules That Trigger Reflex Testing 19.2.36 Fixed Canned Message 19.2.37 Patient Preparation 19.2.38 Procedure Medication 19.2.39 Factors That May Affect the Observation 19.2.40 Test/Observation Performance Schedule 19.2.41 Description of Test Methods 19.2.42 Charge by Producing Service 19.2.43 Price Modifiers 19.2.44 Numeric Test/Observation Segment 19.3 Segment Type ID 19.3.1 Sequence Number 19.3.2 Units of Measure 19.3.3 Range and Decimal Precision 19.3.4 Corresponding SI Units of Measure 19.3.5 SI Conversion Factor or Formula 19.3.6 Reference (Normal) Range for Ordinal and Continuous Observations 19.3.7 Critical Range for Ordinal and Continuous Observations 19.3.8 Absolute Range for Ordinal and Continuous Observations 19.3.9 Delta Check Criteria 19.3.10 Minimum Meaningful Increments 19.3.11 Categorical Test/Observation Master Segment 19.4 Segment Type ID 19.4.1 Sequence Number 19.4.2 Preferred Coding System 19.4.3 Text/Codes for Categorical Observations 19.4.4 Normal Text/Codes for Categorical Observations 19.4.5 Abnormal Text/Codes for Categorical Observations 19.4.6 Critical Abnormal Text/Codes for Categorical Observations 19.4.7 Data Type 19.4.8 Observations That Require Specimens 19.5 Segment Type ID 19.5.1 Sequence Number 19.5.2 Derived Specimen 19.5.3 Container Description 19.5.4 Container Volume 19.5.5 Container Units 19.5.6 Specimen 19.5.7 Additive 19.5.8 Preparation 19.5.9 Special Handling Requirements 19.5.10 Normal Collection Volume 19.5.11 Minimum Collection Volume 19.5.12 Specimen Requirements 19.5.13 Specimen Priorities 19.5.14 Specimen Retention Time 19.5.15 Test/Observation Master Segment for Observation Batteries 19.6 Segment Type ID 19.6.1 Sequence Number 19.6.2 Tests/Observations Included Within an Ordered Test Battery 19.6.3 Observation ID Suffixes 19.6.4 Test/Observation Master Segment for Calculated Observations 19.7 Segment Type ID 19.7.1 Sequence Number 19.7.2 Derivation Rule 19.7.3 Observations Used to Compute Value 19.7.4

ASTM E1238-97 Referenced Document

• ASTM E1381 Standard Specification for Low-Level Protocol to Transfer Messages Between Clinical Laboratory Instruments and Computer Systems
• ASTM E1384 Standard Guide for Content and Structure of the Electronic Health Record (EHR)*， 1999-04-19 Update
• ASTM E1394 Standard Specification for Transferring Information Between Clinical Instruments and Computer Systems
• ASTM E1460 
• ASTM E1467 
• ASTM E1633 Standard Specification for Coded Values Used in the Electronic Health Record*， 2024-04-19 Update
• ISO 2022:1986 Information processing; ISO 7-bit and 8-bit coded character sets; Code extension techniques
• ISO 2955:1983 Information processing; Representation of SI and other units in systems with limited character sets
• ISO 4217:1990 Codes for the representation of currencies and funds
• ISO 8072:1986 Information processing systems; Open Systems Interconnection; Transport service definition
• ISO 8601:1988 Data elements and interchange formats — Information interchange — Representation of dates and times

ASTM E1238-97 history

• 1997 ASTM E1238-97 Standard Specification for Transferring Clinical Observations Between Independent Computer Systems