A13 is used to trigger cancellation of previous discharge message. This could happen if it is decided that patient need more care after discharging or discharge message was trigger by mistake.
In HL7, ADT A13 event is used to trigger cancellation of dischange for an admitted patient. This can alos cancel end visit notification fro non-admitted patients.
Let's understand the scenario:
Patient A was admitted to a hospital and assigned some physical location
When we receive an A03 HL7 message, we record patients discharge date & allocated physical location becomes available for other patients.
When we receive an A13 HL7 message, we cancel the discharge.
There could be many fields in HL7 message or in your system which can identify patient's discharge (This depends on your EMR configuration or system which mangaes your Admission/Discharge/Transfer).
Common fields are PatientClass(PV1.2), AssignedPatientLocation(PV1.3), AccountStatus, DischargeDate etc. and all of these values would be very meaningful for Healthcare Systems.
In real world, a hospital system would receive many messages for a patient before A13, but to understand A03 scenario we will discuss two important one - A01 (Admission) and A03 (Discharge)
I will include only those fields in example which are required to describe the A13 cancel discharge message.
Suppose, we have received an A01 hl7 message for a patient with following details
PatientClass (PV1.2) - E (Important & Requred field)
AssignedLocation (PV1.3) - PointOfCare - IR, Room - 101, Bed - A
AccountStatus (PV1.41) - REG
AdmissionDate (PV1.44) - 1/1/2012
after processing this A01 message, we have following details in our system:
| PV1.2 | AssignedPatientLocation PV1.3 | PV1.41 | PV1.44 | PV1.45 | ||
| PatientClass | PointOfCare | Room | Bed | AccountStatus | AdmissionDate | DischargeDate |
| I | IR | 101 | A | REG | 1/1/2012 | |
Now suppose, patients has received care & need to be discharged from facility.
Now, we have received a discharge request by A03 hl7 message with following details
PatientClass (PV1.2) - E (Important & Requred field)
AssignedLocation (PV1.3) - PointOfCare - IR, Room - 101, Bed - A
AccountStatus (PV1.41) - DIS
AdmissionDate (PV1.44) - 1/1/2012
DischargeDate (PV1.45) - 1/5/2012
after processing this we have following details in our system:
| PV1.2 | AssignedPatientLocation PV1.3 | PV1.41 | PV1.44 | PV1.45 | ||
| PatientClass | PointOfCare | Room | Bed | AccountStatus | AdmissionDate | DischargeDate |
| I | IR | 101 | A | DIS | 1/1/2012 | 1/5/2012 |
Now, suppose it was decided to cancel the discharge & contiue with this episode of care and we have recieved an A13 message with following details:
PatientClass (PV1.2) - E (Important & Requred field)
AssignedLocation (PV1.3) - PointOfCare - IR, Room - 101, Bed - A
AccountStatus (PV1.41) - REG
AdmissionDate (PV1.44) - 1/1/2012
DischargeDate (PV1.45) - ""
after processing this message, we will have following details in our system:
| PV1.2 | AssignedPatientLocation PV1.3 | PV1.41 | PV1.44 | PV1.45 | ||
| PatientClass | PointOfCare | Room | Bed | AccountStatus | AdmissionDate | DischargeDate |
| I | IR | 101 | A | REG | 1/1/2012 | |
You can see that after processing A13, patient is registered again in facility & will continue receiving care.
Important:
Patiet's location hould be in PV1.3 & this could be different than what it was before discharge.
A13 will be important for billing system to notify that patient's billing period is still valid
Note:
ADT messages always contain current information except MRG segments
Process all the fieds in PID & PV1 & other segments in message as normal A08 upate message unless specified by source system.
It is recommended not to send any updated fields except required ones in A13. A08 should be used to update any other fields.
