Correction of historical ADT Data in HL7 V2

Question

Just out of curiosity

How do you transmit corrections of historic ADT Data in HL7 V2, e.g. patient transfer, if you do not have a ZBE segment for historic movements as in Germany?
Do you cancel all relevant events and build a new patient history or do you use some of the already defined fields of the segments of ADT messages to mark the event, that should be corrected?
How do you deal with multiple transfers wardA --> wardB --> wardA -->wardB ?

Answer 1

ADT^A02 would be the "correct" way to transfer a patient from one room/bed to another. However, as @Sid stated I cannot recall a time where I've ever seen an ADT^A02 implemented in the real world.

This is most likely due to changing status/demographics while transferring a patient - Most of the time there will be a specific reason as to why the transfer is happening - moving from an outpatient/inpatient(or vice-versa), change in facility, etc. It's much easier to bunch up this information into one ADT^A08 then to send both an ADT^A02 and an ADT^A08 to satisfy these constraints.

If the transfer information is erroneous, like you've stated in the above comment, then a transfer cancellation will need to be triggered ADT^A12 - Again, this is another one that I've seen rarely used - but if the transfer was done accidently or wrong, you wouldn't want to keep that information in the system. You'd want to get rid of it, and only have the correct information updated.

Since your Health/Hospital Information System(HIS) is usually the same system in which your Patient Census is done, blasting this cancellation message out to every individually connected system isn't usually worth doing because most specialty applications attached to the HIS could careless about previous room/bed for patients, only the most current information. Because of this, again, an ADT^A08 is more widely used.

Previous Room/Bed information is usually kept up by the HIS from the application standpoint. When a patient room/bed is updated, it will write the current PatientRoom or PatientBed information in the database columns to something like PreviousRoom or PreviousBed. I've seen this implemented down to the "Previous-Previous" Room and Bed. It will then write the new room/bed to the PatientRoom or PatientBed.

This is done so that the HIS can locally process cancellations of transfers. Most of the time these cancellations are done directly in the HIS by a user, and then an ADT^A08 is sent out to the appropriate interoperable applications using the new Room/Bed, with the connected applications being none-the-wiser what the previous room and bed was, or that it may have been cancelled and retransferred. If they were to cancel this transfer in the HIS, it would revert back to the database columns for PreviousRoom or PreviousBed, and update accordingly.

Hope this didn't confuse you too much.

TL;DR - The HIS is predominately the only system that cares about previous room/bed data. ADT^A08 is what's used the majority of the time to update patient room/bed information, even though it's standard-wrong.