PowerScribe® 360 V4.0 RadBridge - Nuance

880805 January 8, 2019

PowerScribe® 360 V4.x RadBridge REFERENCE GUIDE

Nuance PowerScribe® 360 v4.0 RadBridge Reference Guide

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Contents PS360 v4.0 RadBridge with Default Settings ..................................................................................................................... 2 RadBridge Inbound Options .............................................................................................................................................. 3 RadBridge Option Descriptions ......................................................................................................................................... 4 Send Timezone Qualifier – UTC ....................................................................................................................................... 11

Inbound Messages ....................................................................................................................................................... 11 Outbound Messages .................................................................................................................................................... 11

OBX Result Format .......................................................................................................................................................... 13 Paragraph Example ...................................................................................................................................................... 13 Formatted Example ..................................................................................................................................................... 13


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PS360 v4.0 RadBridge with Default Settings


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RadBridge Inbound Options Below highlights the settings that impact Inbound messages to PS360. All other settings impact outbound.


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RadBridge Option Descriptions I = Inbound Messages to PS360 O = Outbound Messages from PS360 Feature I / O Description Bridge link Displays the General Name value General Name Since a Site may have more than one interface, name the interface General Description Description of the interface. For example, the RIS vendor/engine or purpose of the

interface. General Site Select appropriate Site Interface Options:

HL7 – most common XML File –proprietary format to import PS 4.x/5.0 reports only Text File –

• Import fixed length file for Exams only • Exports report file as “acc# .MDS” ASCII text file only, file name is the accession

DICOM – import DICOM Structured Reports Inbound If HL7 or DICOM, enter Listen Port

XML and Text file interfaces required path name Outbound HL7 enter Transmit Port and Transmit IP

Text interfaces require path name(s) and template HIS Type If IDXRad v9.9, enter IDXRad – otherwise leave blank Sending Application O Enter value to be sent in MSH 3 Receiving Application

O Enter value to be sent in MSH 5

Sending Facility O Enter value to be sent in MSH 4 Receiving Facility O Enter value to be sent in MSH 6 Send dictated status updates

O Sends “D” in OBR 25 and OBX 11. OBX segments not sent. Options: Never Immediately for new reports When saving as Draft Always excluding Draft

Send pending correction reports

O Sends “D” or “P” in OBR 25 and OBX 11. Options: Never Dictated status (no text) - OBX segments not sent – sends “D” status Preliminary result (with text) - OBX segments sent – sends “P” status Note: The Send pending correction reports option takes precedence over Send dictated status updates option. For example, even if Send dictated status updates is set to Never, a status update will be sent for Pending Correction reports if Send pending correction reports option is set to Dictated status (no text)


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Feature I / O Description Maximum line length

O Maximum characters sent in OBX 5 0 - 65536 (if Px2008 is formatting OBX segments, set to 0)

Interpret Sending Facility as

I Defines purpose of MSH 4 Options: Nothing - MSH 4 not used

Site Identifier – Allows a single inbound interface to insert the ORM, ADT, or ORU to the appropriate Site. Requires MSH 4 to match Site Names. Location Identifier* - creates multiple locations within a single site – ability to browse by Location in RadPortal Explorer or Client, create a Worklist by Location, Location Merge Field in the Dictation Client

Trigger Event Code O PowerScribe360 automatically sends ORU Outbound. If customer requires R01 event, insert R01

Log file directory I/O Not required if using Bridge global log folder under System or Bridge, Configuration OBX result format O Options:

Paragraph – sends blank OBX to indicate paragraph break, no \.br\ Formatted – sends \.br\ as line feed, also sends \H\ to indicate start bold, \N\ to end bold, and \X09\ for tab Epic RTF – RTF format specifically formatted for Epic Radiant RIS

Send formatted report as embedded document:

O Sends standard ASCII report plus the last OBX contains an embedded RTF encoded using Base64. PS360 v3.0 used a different RTF format than PS360 v3.5 SP 1. PS360 v3.5 SP2 added options for WordPad which is the v3.0 RTF format. Options: None RTF Wordpad RTF (PS360 v3.5 SP2 or higher) PDF RTF with Print Template Wordpad RTF with Print Template (PS306 v3.5 SP2 or higher) PDF with Print Template If one of Print Template options is selected, PS360 uses the print template format for the embedded report. Print template is configured in Word. Can add headers/footers to the print template. PS360 Administrative Guide provides instructions on creating/installing a print template. WordPad options sends the PS360 v2.5/3.0 RTF format. Note: Wordpad does not support headers/footers.

Accept results I Should results be accepted from the RIS? Options: All Final Only On Status Change – if PS360 already has a final, a second final will be ignored.


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Feature I / O Description Import location from PV1-3 component

I Options: None Point of Care (PV1 3.1) Room (PV1 3.2) Bed (PV1 3.3) Facility (PV1 3.4) Building (PV1 3.7) Floor (PV1 3.8) Location Status (PV1 3.5) Location Description (PV1 3.9) Person Location Type (PV1 3.6) When “Interpret Sending Facility as:” has Location selected and you want to use a PV1 3.x value instead of value sent in MSH 4. Stores both the original value in MSH 4 and PV1 3.X value selected as Locations. Here’s an example of a single Site – ORM contains: MSH 4 = STMARYS PV1 3.1 = EMPIRE When you use the browse option for location, STMARYS and EMPIRE are both listed. If you search under STMARYS no orders appear. If you search under EMPIRE, the order appears. Caution - may confuse end user if they try to search under the original value. When “Interpret Sending Facility as: ”Site Identifier”, the Site ID is not added to the Location list.

Processing ID O MSH 11 value Options: Blank Debugging (D) Production (P) Training (T)

Send timezone qualifier

O Options: None All Timestamps Header Only (MSH-7)

Note: UTC is based on the PS360 server time unless the data was not stored in a non-date/time field in SQL.


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Feature I / O Description Send follow-up recommendations

O Options: None Epic Cerner - NA Epic Radiant - Example Follow-up recommendations: OBX|3|ST|LRR1^CRITICAL RESULT - ACUITY / FINDING ID|1|12345|||||||||||| OBX|4|ST|LRR2^CRITICAL RESULT - ACUITY STATUS|1|OPEN|||||||||||| OBX|5|ST|LRR3^CRITICAL RESULT - ACUITY|1|Critical|||||||||||| OBX|6|ST|LRR7^CRITICAL RESULT - RECOMMENDATION ID|1|12345|||||||||||| OBX|7|ST|LRR8^CRITICAL RESULT - GENERAL RECOMMENDATION|1|CT Neck between 90 and 180 days|||||||||||| OBX|8|ST|LRR9^CRITICAL RESULT - RECOMMENDATION BEGIN/END USER|1|JOEA^^|||||||||||| OBX|9|ST|LRR10^CRITICAL RESULT - RECOMMENDATION BEGIN/END INSTANT|1|20160516113004|||||||||||| OBX|10|ST|LRR1^CRITICAL RESULT - ACUITY / FINDING ID|2|12346|||||||||||| OBX|11|ST|LRR2^CRITICAL RESULT - ACUITY STATUS|2|OPEN|||||||||||| OBX|12|ST|LRR3^CRITICAL RESULT - ACUITY|2|Critical|||||||||||| OBX|13|ST|LRR7^CRITICAL RESULT - RECOMMENDATION ID|2|12346|||||||||||| OBX|14|ST|LRR8^CRITICAL RESULT - GENERAL RECOMMENDATION|2|MRI Brain within 365 days|||||||||||| OBX|15|ST|LRR9^CRITICAL RESULT - RECOMMENDATION BEGIN/END USER|2|JOEA^^|||||||||||| OBX|16|ST|LRR10^CRITICAL RESULT - RECOMMENDATION BEGIN/END INSTANT|2|20160516113004||||||||||||

Separator for multi-choice custom fields

O A Custom Field may be configured to allow multiple selections. A comma is the default separator. OBX|3|CE|12345^Description||CustomField1^Export1, Export2, Export 3

Unassigned signer ID O If Site Preference/Permissions feature called “Allow unassigned attending” is enabled, the Unassigned signer ID value in the Bridge is sent in OBR 32.1 as the principal interpreter where “Unassigned” is selected as the Attending.

Send addenda O Options: Standalone – addended text only After original – original at top followed by addendum(s)

Before original (chronological) – addendums at top followed by the original – if multiple addendums, oldest on top 1st, 2nd, 3rd … Before original (reverse chronological) - addendums on top followed by the original – if multiple addendums, newest on top 3rd, 2nd, 1st …

Match existing visits by visit number

I True – ADT PV1 segment updates all orders with the same PV1 19 Visit Number. ORM messages with same PV1 19 Visit Number updates entire PV1 segment as well as Site Location and patient location (MSH 4 or PV1 3) For example, if Site Location is a department within a hospital, it’s possible the department changes but the visit stays the same. False - each order received gets a new visit entry in PS360 database even though it may be the same visit

Match physicians by name

I Inbound ORU messages – OBR 32, 33, and 35 False - attempts to find existing account with the same ID. If ID does not exist, PS360 creates an inactive account with a role of Fellow. True – attempts to find existing account with the same ID or name (exact match). If ID or name does not exist, PS360 creates an inactive account with a role of Fellow. The login ID of the inactive account is a combination of the person’s last name and ID number. If no last or first name sent, name will be N/A


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Feature I / O Description Ignore Physicians without ID:

I PV1 7, 8, 9, 17 and OBR 16 False – do not ignore providers without an ID True – ignore providers without an ID

Interpret patient external ID as MPI

I False – PID 2 is ignored True – PID 2 is processed as the MPI and is available to be returned in the ORU MPI (master patient index) is a single patient identifier. The patient may have different local MRNs (PID 3). In the dictation client, allows end user to see patient’s history even though the patient has different MRNs. Note: End user needs access to the Sites. Starting with v2.5, an MPI supports multiple MRN in a single Site or across Sites. PS360 versions below v2.5 only supported MPI across Sites.

Escape non-printable characters

O False – extended ASCII sent as is – exception: bold \H\ and stop bold \N\ True - Escapes extended ASCII characters to appropriate escape sequence. If this feature is disabled, receiving system may convert the value to a ? Example: Radiologist copies the degree symbol into the report body. Depending on the setting, PS360 will either send ° or replace it with \XB0\. All extended ASCII escape sequences start with \X and end with \. Exceptions: start bold \H\, stop bold (back to normal) \N\, and line feed \.br\.

Import escaped text as RTF

I False – Ignores bold and stop bold. If \E\ sent, inserts \E\. PS360 versions vary, some versions insert \.br\ rather than displaying a line feed. True – PS360 recognizes \.br\ (new line), \E\ (backslash) \H\ (highlight), and \N\ (normal) escape sequences in the OBX 5 result. All others are discarded.

Send original signer as addendum observer*

O False – original signer is not sent with the addendum True - original signer is sent with the addendum in OBX 16 Default Bridge settings sends the ID only

Send preliminary results

O False – do not send preliminary reports True - Sends “P” in OBR 25 and OBX 11. Preliminary reports may be sent at resident approval, transcriptionist/editor finishes report, or manual request. - System/Site Permissions preferences: “Resident control of approved reports:” “Editor control of corrected reports:” Determines if a preliminary report is sent when a resident approves or an editor finishes correcting a report. Notes: -Even if this feature is disabled in the Bridge, it’s possible for users to “Send Now” in RadPortal or Client.

Send preliminary addenda

O False – do not send preliminary addendums True - sends preliminary addendums outbound - “PA” is sent in OBR 25 and OBX 11 Note: Even if this feature is disabled in the Bridge, it’s possible for users to “Send Now” in RadPortal or Client.

Send combined results

O True - sends single ORU with multiple ORC/OBR pairs False – sends one ORU per Accession, same Message Control ID (MSH 10)

Send results for scheduled orders

O False – does not allow final ORU sent with an order status of “scheduled” True – allows final ORU manually forced sent from RadPortal with an order status of “scheduled” Note: Some RIS vendors may not support this feature.


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Feature I / O Description Send results for entered orders:

O True – Order Entry results are sent outbound False – Order Entry results are not sent outbound

Send extended data with results*

O False – do not send last and first name True - Includes Radiologist, Resident, and Transcriptionist name in OBR 32, OBR 33~1, OBR 35. Example: 007^Bond^James

Send timestamps in interpreter fields*

O False – do not include time stamps True - Send timestamps in OBR 32.3, OBR 33.3~1, and OBR 35.3 If “Send extended data with results” is enabled, format changes to: ID&Last&First&Middle&Suffix&Prefix&Degree^^20150120080000

Send diagnosis segments

O False – do not send DG1 (diagnosis codes) outbound True – send DG1 (diagnosis codes - ICD 9/10 codes) DG1|1||D43.1^Neoplasm of uncertain behavior of brain, infratent^ICD10^71023844HB^^|||F DG1|2||G46.3^Brain stem stroke syndrome^ICD10^71023844HB^^|||F

Send custom field segments

O False – do not send Custom Fields outbound True – send Custom Fields outbound if configured as exportable – sent in OBX coded element segment(s) In the RadPortal, under Sites, Custom Fields, select “E” (Exportable) on any Custom Field(s) that should be sent outbound. OBX|3|CE|329^Mammography Surgical||BIRAD^2||||||F|||20120329152216|||

Send ZBR and ZBO segments

O False – do not send ZBR/ZBO segments True – sends ZBR/ZBO segments - intended for PowerScribe 4.x/5.x customer conversions – also includes Job ID, Workstation ID, and date/time stamps in ORC 7.1 dictate, 7.2 transcribe, and 7.3 signed If final ORU, only ZBR is sent for the original final. If addendum, ZBR is the last addendum and ZBO is the original ZBR (final ORU). ZBR||528667|007^Bond^James^^^^^Y^Y^^^|007^Bond^James^^^^^Y^Y^^^||007^Bond^James^^^^^Y^Y^^^|||NOR|Signed^F^N^|20170310091343^20170310091607^20170310091343^0^Radiology^|007^Sign^20170310091343^^20170310091343^Prelim~007^Signed^20170310091607^PS360-VM35GA^20170310091607^Signed|Signed^N| ZBO uses the same format as ZBR.

Send BI-RADs segment

O False – do not send built-in bi-rad code outbound True – send built-in bi-rad code outbound in an OBX coded element. Built-in Bi-Rads are defined in the RadPortal under System, BI-RAD. Limited to a single code per report. If require more than one code, use Custom Fields. Sends OBX coded element with BIRAD in OBX 13. When Radiologist signs report, PS360 automatically adds the code selected to the end of the report body and sends an OBX coded element: BI-RADS 2 – benign findings HL7 Example: OBX|3|CE|329^Mammography Surgical Specimen||2^benign findings^BIRAD||||||F||BIRAD|20120329152216|||

Send wet reads O False – does not send wet reads outbound True - sends wet reads outbound with “W” in OBR 25 and OBX 11

Uppercase results O False – does not convert case size True - converts result body to all uppercase

Accept addenda I False – do not accept inbound addendums where OBR 25 = A True - accept inbound addendums where OBR 25 = A


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Feature I / O Description Addendum header O If Original report sent with addendum, define header

Note: can add Merge Fields and \n to make a line break Addendum report separator:

O If Original report sent with addendum, define separator

*If “Send extended data with results” and “Send timestamps in interpreter fields” are disabled, only the ID is sent in OBR 32, 33, and 35. If “Original Signer” is enabled, it will send the ID only too. Does not impact contributor(s) format in OBR 33~2, 33~3…33~6. If “Send extended data with results” and “Send timestamps in interpreter fields” are enabled, the “Send timestamps in interpreter fields” format is sent. Does not impact contributor(s) format in OBR 33~2, 33~3…33~6.


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Send Timezone Qualifier – UTC PS360 RadPortal and client application displays time using the user's workstation time zone setting. Both HL7 v2.x and v3.x support complex date structures (YYYYMMDDHHMMSS+/-ZZZZ). UTC does not change with a change of seasons, but local time may change if a time zone jurisdiction observes daylight saving time (summer time). For example, local time on the east coast of the United States is five hours behind UTC during winter, but four hours behind while daylight saving is observed there. Inbound Messages The UTC time zone qualifier is supported inbound by default. If time zone offsets are sent inbound to PS360, the time zone offset reflects the time displayed from the portal and clients. Assumption: RIS vendor sends the appropriate offset for standard vs daylight savings time in MSH 7. In the following example, the time is 12:43:00 EST (Eastern Standard Time). MSH|^~\&|||||20150130124300-0500||ORMÔ01|14|P|2.3|||||||| In the following example, the time is 12:43:00 EDT (Eastern Daylight Savings Time). MSH|^~\&|||||20150130124300-0400||ORMÔ01|14|P|2.3||||||||

Outbound Messages RadBridge feature called “Send timezone qualifier” allows the UTC value sent in MSH 7 or all valid date/time fields.

-None is the default setting -Header Only (MSH-7) sends time zone qualifier in MSH-7 only on outbound results -All Timestamps - sends the time zone qualifier in all timestamps fields on outbound results*

If the “Send timezone qualifier is enabled, the PS360 Web Server local time zone offset will be sent in the ORU messages.. With MSH 7 only set in Bridge – Sample Outbound ORU MSH|^~\&|PS360|TR|CCH|TR|20131024134259-0400||ORU|183|P|2.3| PID|||39124||ZZTESTÛLRADTHIRTEEN^^^^||19570201|M|||1113 RADIANT LANE^^TRACY^CA^95376ÛSA^||(555)555-5555||||||200001919|| PV1|1|O|CVTRERDAÊD RM1^1^CVTR^R^^^^||||||||||||||||57431|||||||||||||||||||||||||20110722000000|| ORC|RE||||||20131024133831^20131024133831^20131024134016||| OBR|1|171228337ÊPC|ET-622|RAD0084^CT NECK SOFT TISSUE W CONTRAST|||20131024133831||||||OBR 7 = 20131024120000|||CBHYMD^HYBRID^CB^^MD^^||||TZ Sent as East||20131024134016|||F||^^^20131024120000^^|||||1234&Holmes&Sherlock&&&&^^20131024134016^||||| OBX|1|TX|RAD0084&BODY^CT NECK SOFT TISSUE W CONTRAST||Testing TZ offsets for Eastern Time\.br\\.br\||||||F|||20131024134016||| OBX|2|TX|RAD0084&IMP^CT NECK SOFT TISSUE W CONTRAST||IMPRESSION: Hopeful\.br\||||||F|||20131024134016|||


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With All timestamps set in Bridge MSH|^~\&|PS360|TR|CCH|TR|20131024135227-0400||ORU|187|P|2.3| PID|||39124||ZZTESTÛLRADTHIRTEEN^^^^||19570201|M|||1113 RADIANT LANE^^TRACY^CA^95376ÛSA^||(555)555-5555||||||200001919|| PV1|1|O|CVTRERDAÊD RM1^1^CVTR^R^^^^||||||||||||||||57431|||||||||||||||||||||||||20110722000000-0400|| ORC|RE||||||20131024133831-0400^20131024133831-0400^20131024134016-0400||| OBR|1|171228337ÊPC|ET-622|RAD0084^CT NECK SOFT TISSUE W CONTRAST|||20131024133831-0400||||||OBR 7 = 20131024120000|||CBHYMD^HYBRID^CB^^MD^^||||TZ Sent as East||20131024134016-0400|||F||^^^20131024120000-0400^^|||||1234&Holmes&Sherlock&&&&^^20131024134016-0400^||||| OBX|1|TX|RAD0084&BODY^CT NECK SOFT TISSUE W CONTRAST||Testing TZ offsets for Eastern Time\.br\\.br\||||||F|||20131024134016-0400||| OBX|2|TX|RAD0084&IMP^CT NECK SOFT TISSUE W CONTRAST||IMPRESSION: Hopeful\.br\||||||F|||20131024134016-0400||| ZBR||511795|1234^Holmes^Sherlock^^^^^Y^Y^^^|1234^Holmes^Sherlock^^^^^Y^Y^^^||1234^Holmes^Sherlock^^^^^Y^Y^^^|||NOR|Signed^F^N^|20131024133831-0400^20131024134016-0400^20131024133831-0400^0^Radiology^|^^^MEL-SHOLMES^|Signed^N| Note: If d/t stamp is stored in a field that is not designated as a time stamp like OBR 18, 19, 20, or 21, UTC value will not be added in the ORU.


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OBX Result Format Both examples use a 0 Maximum Line Length.

Paragraph Example OBX|1|FT|JRD7360339&BODY^CHEST PORTABLE||REASON FOR EXAM: Shortness of breath||||||F|||20140214170813|||||| OBX|2|FT|JRD7360339&BODY^CHEST PORTABLE||||||||F|||20140214170813|||||| OBX|3|FT|JRD7360339&BODY^CHEST PORTABLE||COMPARISON: 1 August||||||F|||20140214170813|||||| OBX|4|FT|JRD7360339&BODY^CHEST PORTABLE||||||||F|||20140214170813|||||| OBX|5|FT|JRD7360339&BODY^CHEST PORTABLE||FINDINGS: CHEST PORTABLE, Nov 25, 2013 10:47:00 AM:||||||F|||20140214170813|||||| OBX|6|FT|JRD7360339&BODY^CHEST PORTABLE||A single view of the chest is submitted.||||||F|||20140214170813|||||| OBX|7|FT|JRD7360339&BODY^CHEST PORTABLE||||||||F|||20140214170813|||||| OBX|8|FT|JRD7360339&BODY^CHEST PORTABLE||The heart and pulmonary vasculature are grossly unremarkable. The lungs are clear. No pleural based abnormalities are seen.||||||F|||20140214170813|||||| OBX|9|FT|JRD7360339&BODY^CHEST PORTABLE||||||||F|||20140214170813|||||| OBX|10|FT|JRD7360339&IMP^CHEST PORTABLE||IMPRESSION: ||||||F|||20140214170813|||||| OBX|11|FT|JRD7360339&IMP^CHEST PORTABLE||No active heart or lung disease is identified.||||||F|||20140214170813||||||

Formatted Example OBX|1|FT|70221155&BODY^XR TIBIA/FIBULA 3 VIEWS||EXAM: XR TIBIA/FIBULA 3 VIEWS \.br\\.br\HISTORY: Prior trauma. Evaluate for healing fracture. \.br\\.br\COMPARISON: Right tibia/fibular radiographs 1/19/2014.\.br\\.br\TECHNIQUE: Frontal, oblique, and lateral views of the right tibia/fibula.\.br\\.br\FINDINGS: \.br\\.br\Again noted is questionable buckling of the anterior cortex of the proximal metaphysis of the right tibia associate with questionable slight increased sclerosis which suggests a healing fracture. Otherwise, there is no acute or healing fracture, malalignment, or radiopaque foreign body. The soft tissues are unremarkable. \.br\\.br\||||||F|||20140204074149|||||| OBX|2|FT|70221155&IMP^XR TIBIA/FIBULA 3 VIEWS||IMPRESSION: \.br\\.br\Question healing buckle fracture of the proximal tibia as described. Clinical correlation recommended.\.br\\.br\ ||||||F|||20140204074149||||||

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