HL7 Attachments

The HIPAA Attachments display in the RELMA program is a tool for users to browse the LOINC terms used in attachments. From the main attachments viewer, four sub-sections are available: Documents with implementation guide (previously called "STRUCTURED"), Documents without implementation guide (previously called "UNSTRUCTURED"), Valid attachment requests, and Request Modifier Codes.

The Documents with implementation guide tab presents the attachment types for which clinically-relevant HL7 implementation guides that use the U.S. Realm Header have been developed. In the LOINC database, these terms have a value of "IG Exists" (previously "STRUCTURED") in the HL7_ATTACHMENT_STRUCTURE field.

The dropdown menu on the upper left hand side selects the specific implementation guide of interest. On the left side of the screen, for each implementation guide, the set of allowed LOINC document codes in that document type are listed under the Attachment Name. For each attachment document type, the most generic LOINC code (i.e. the one that is approved for use as an attachment request) is indicated with a star icon. When a document code is selected, the set of allowed section and entry-level codes for that implementation guide are shown on the right side of the display under CDA Recommended Sections and Entries.

You can view the details of a LOINC code by double-clicking any of the rows that show a LOINC number. Alternately, you can use the "View Details" right-click actions to display the currently highlighted panels.

Note: the LOINC terms listed under CDA Recommended Sections and Entries are not to be used in requesting a document. They do however elucidate the potential contents of the response.

The Documents without implementation guide tab lists all of the LOINC codes that are approved by the HL7 Attachments WG for use in requesting as an unstructured attachment. These codes represent documents that may be needed by payers but for which an implementation guide that explicitly enumerates the expected contents has not yet been developed. In the LOINC database, these terms have a value of "No IG Exists" (previously "UNSTRUCTURED") in the HL7_ATTACHMENT_STRUCTURE field.

The Valid attachment requests tab contains the complete set of LOINC codes that can be used by payers as attachment requests. This set consists of a) the "top level" (i.e. preferred) document codes from clinically-relevant HL7 implementation guides that use the U.S. Realm Header, and b) the document codes without implementation guides that have been approved by the HL7 Attachment WG.

The Request Modifier Codes tab lists all the LOINC codes that can be used as request modifiers. For more information, see the HL7 Attachment Specification.

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