The incoming messages had errors that caused the IIS systems to reject them. The ACK messages used the MSA and ERR fields to indicate the errors: - MSA-1 was AE to show the message was processed but errors were reported - ERR-1,2 provided the error location in the message - ERR-3 specified the HL7 error code like "Required field missing" - ERR-4 had a severity like E for Error - ERR fields 7,8 sometimes included a diagnostic message. The IIS systems expect the EHRs to correct the errors and resubmit the messages.

1. ACK Response Messages
HL7 User Group Meeting
8/13/2015

2. Agenda
• Quick Review of the CDC IG Release 1.5 ACK Message
• Read actual ACK messages from IIS
• Provide a summary of current ACK analysis

3. The ACK per CDC IG
Segments

4. The ACK per CDC IG – Cont’d
MSA Segment

5. The ACK per CDC IG – Cont’d
ERR Segment

6. The ACK per CDC IG – Cont’d
In Summary
• MSA – Required (1..1)
• Field 1 – R – (Ack Code - AA, AE, AR)
• Field 2 – R – (ID from EHR-submitted MSH)
• Field 3 – X – (Textual Message)
• ERR – RE (0..*)
• Field 1 – X – (Error Code and Location)
• Field 2 – RE – (Error Location in Submitted Message)
• Field 3 – R – (HL7 Error Code – Table 0357)
• Field 4 – R – (Severity of Error – I, W, E)
• Field 5 – RE – (Application Error Code – SISC defined this table)
• Field 6 – O – (Application Error Parameter – Not defined in CDC IG)
• Field 7 – O – (Diagnostic Information – Not defined in CDC IG)
• Field 8 – RE – (User Message – Locally specified informative text)

7. Key Coded Values in an ACK
• MSA-1 Acknowledgement Code
• AA – Application Accept
• Message was accepted without error.
• AE – Application Error
• Message was processed and errors are
being reported.
• AE is sent whenever an error is detected.
This may range from data that are ignored
because they are not wanted to rejection
of the entire message.
• AR – Application Reject
• Message was rejected because one of the
following occurred:
• Unsupported message type
• Unsupported event code
• Unsupported processing ID
• Unable to process for reasons unrelated to
format or content
• ERR-4 Severity
• I – Information
• Transaction successful, but includes
returned information.
• W – Warning
• Transaction successful, but there may be
issues. These may include non-fatal errors
with potential for loss of data.
• E – Error
• Transaction was not successful. The
application rejected data that it views as
important. This could include required
fields or the entire message. The sender
should be alerted to review and correct the
message.

8. AIRA Interop Testing Project
ACK Analysis
• Two messages were submitted to 20 IIS participating in the AIRA
Interop Testing Project.
• AIRA first submitted a message which was accepted by the IIS.
• Simple, clean message
• 3 Immunizations
• Then AIRA removed data from one field and resubmitted.
• Same Simple message, one field changed from populated to empty.

9. Our Job Today
• Pretend we are the EHR processing the ACK returned by the IIS
• For Each ACK Example, Ask yourself
• What was wrong with the incoming message?
• Did the IIS accept the message?
• What MSA and ERR fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

10. The ACKs
Example 1 of 9
MSH|^~&||System C|TEST||20150715183728||ACK^V04^ACK_V04|7802135|P|2.5.1|||||||||
MSA|AA|2778764-I.02.05504.4872|Message had been sent to queue for updates.
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AA – Application Accept
MSA-3 X – Not Supported Message had been sent to queue for updates.
ERR RE No ERR Segment
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

11. The ACKs
Example 2 of 9
MSH|^~&|^^|^^|^^|^^|20150715200933||ACK^|6616739034.100006979|P|2.5.1|
MSA|AA|6164186-I.02.05504.8715|Patient 6164186-I.02.05504 "Pembroke Madison" with 3 vaccinations accepted into vaccination staging table
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AA – Application Accept
MSA-3 X – Not Supported Patient 6164186-I.02.05504 "Pembroke Madison" with 3 vaccinations accepted into
vaccination staging table
ERR RE No ERR Segment
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

12. The ACKs
Example 3 of 9
MSH|^~&||||XX-XXXXXX|20150723102057||ACK^V04^ACK|20150723102057|P|2.5.1
MSA|AE|4765640-I.02.05504.7451|message failed validation
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AE
MSA-3 X – Not Supported message failed validation
ERR RE No ERR Segment
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

13. The ACKs
Example 4 of 9
MSH|^~&|System A||||20150722142244||ACK^V04^ACK|2671551-I.02.05504.3847a|P|2.5.1|
MSA|AA|2671551-I.02.05504.3847a|
ERR|^^^1&WARNING: Missing Vaccine ID AND Text. One of these values is required. (RXA-5.1 and RXA-5.2 in HL7). Value: ID='null'. Text='null'. Coding
System='null'~^^^2&WARNING: Unknown patient primary language (PID-15 in HL7). Value='eng'~^^^3&WARNING: Unknown Administered Code/Vaccine Type
(RXA-5 in HL7). Value=''.|
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AA
ERR-1 X – Not Supported ^^^1&WARNING: Missing Vaccine ID AND Text. One of these values is required. (RXA-5.1 and RXA-5.2 in HL7). Value:
ID='null'. Text='null'. Coding System='null'~^^^2&WARNING: Unknown patient primary language (PID-15 in HL7).
Value='eng'~^^^3&WARNING: Unknown Administered Code/Vaccine Type (RXA-5 in HL7). Value=''.
ERR-2 RE – Error Location <Empty>
ERR-3 R – HL7 Error Code <Empty>
ERR-4 R – Severity of Error <Empty>
ERR-5 RE – Application Error Code <Empty>
ERR-8 RE – User Message <Empty>
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

14. The ACKs
Example 5 of 9
MSH|^~&|SYSTEM D|SYSTEM D||AIRA|20150722174737||ACK|2312702-I.02.05504.6800|P|2.5.1
MSA|AA|2312702-I.02.05504.6800|Error Code - 026: Record Rejected. You must supply at least ONE immunization identifying code
ERR||RXA^1^5|101^Required field missing^HL70357
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AA
MSA-3 X – Not Supported Error Code - 026: Record Rejected. You must supply at least ONE immunization identifying code
ERR-1 X – Not Supported <Empty>
ERR-2 RE – Error Location RXA^1^5
ERR-3 R – HL7 Error Code 101^Required field missing^HL70357
ERR-4 R – Severity of Error <Empty>
ERR-5 RE – Application Error Code <Empty>
ERR-8 RE – User Message <Empty>
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

15. The ACKs
Example 6 of 9
MSH|^~&|SYSTEM G|SYSTEM G||DEFAULT2|20150722163628.296||ACK|2788163-I.02.05504.3006|P|2.5.1
MSA|AA|2788163-I.02.05504.3006|WARNING: No client financial class values specified. PV1 segment ignored.
ERR||PV1^1^20|102^Data type error^HL70357
MSA|AA|2788163-I.02.05504.3006|WARNING: Inaccurate or missing observation value. No value stored.
ERR||OBX^2^3^0|204^Unknown key identifier^HL70357
… <cut for brevity> …
MSA|AA|2788163-I.02.05504.3006|Error: Record Rejected. You must supply at least ONE immunization identifying code.
ERR||RXA^1^5|101^Required field missing^HL70357
MSA|AA|2788163-I.02.05504.3006|WARNING: No insurance verification date sent for new administered immunization. Please verify insurance.
ERR|||^^HL70357
MSA|AA|2788163-I.02.05504.3006|DED_INV_FUNDING_SRC_EMPTY
ERR|||^^HL70357
Field CDC IG Standard IIS Actual
MSA Segment is Required, but only 1 10 MSAs (Below is MSA and ERR of Interest)
MSA-1 Required – AA, AE, or AR AA
MSA-3 X – Not Supported Error: Record Rejected. You must supply at least ONE immunization identifying code.
ERR-1 X – Not Supported <Empty>
ERR-2 RE – Error Location RXA^1^5
ERR-3 R – HL7 Error Code 101^Required field missing^HL70357
ERR-4 R – Severity of Error <Empty>
ERR-5 RE – Application Error Code <Empty>
ERR-8 RE – User Message <Empty>
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

16. The ACKs
Example 7 of 9
MSH|^~&||||NIST|20150730121603||ACK^V04^ACK|20150730KS0000074624|P|2.5.1|||||||||||9999
MSA|AE|6638200I.02.05504.68
ERR||Rxa^0^5^1|101^Required field missing^HL70357|W|||RXA-5 (AdministeredCode) : Missing required value.|RXA-5 (AdministeredCode) : Missing required
value.
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AE
ERR-1 X – Not Supported <Empty>
ERR-2 RE – Error Location RXA^0^1^5
ERR-3 R – HL7 Error Code 101^Required field missing^HL70357
ERR-4 R – Severity of Error W
ERR-5 RE – Application Error Code <Empty>
ERR-7 O – Diagnostic Information RXA-5 (AdministeredCode) : Missing required value.
ERR-8 RE – User Message RXA-5 (AdministeredCode) : Missing required value.
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

17. The ACKs
Example 8 of 9
MSH|^~&|SYSTEM F|SYSTEM F||ATEST|20150722020716.727||ACK|5129720-I.02.05504.846|P|2.5.1
MSA|AE|5129720-I.02.05504.846
ERR||RXA^1^5|101^Required field missing^HL70357|E||||Record rejected. You must supply at least ONE immunization identifying code
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AE
ERR-1 X – Not Supported <Empty>
ERR-2 RE – Error Location RXA^1^5
ERR-3 R – HL7 Error Code 101^Required field missing^HL70357
ERR-4 R – Severity of Error E
ERR-5 RE – Application Error Code <Empty>
ERR-8 RE – User Message Record rejected. You must supply at least ONE immunization identifying code
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

18. The ACKs
Example 9 of 9
MSH|^~&|SYSTEM I|SYSTEM I||RI88150325|20150722045601||ACK^V04^ACK|7009322-I.02.05504.7354|P|2.5.1|||NE|AL|
MSA|AE|7009322-I.02.05504.7354|
ERR||RXA^1^5^1^1|101^REQUIRED FIELD MISSING^HL70357|E|7^REQUIRED DATA MISSING^HL70533|||RXA-5 ADMINISTRATION CODE IS MISSING|
Field CDC IG Standard IIS Actual
MSA-1 Required – AA, AE, or AR AE
ERR-1 X – Not Supported <Empty>
ERR-2 RE – Error Location RXA^1^5^1^1
ERR-3 R – HL7 Error Code 101^REQUIRED FIELD MISSING^HL70357
ERR-4 R – Severity of Error E
ERR-5 RE – Application Error Code 7^REQUIRED DATA MISSING^HL70533
ERR-8 RE – User Message RXA-5 ADMINISTRATION CODE IS MISSING
• What was wrong with the incoming message?
• Was it accepted?
• What fields did you use to determine that?
• Does the IIS expect the EHR to correct/resubmit?

19. Current Analysis (RXA-5 Empty) – MSA
Segment
20 IIS
MSA Segment Missing 1 MSA Multiple
R (1..1) 0 17 3
MSA-1 AA AE AR
R - Ack Code 9 6 5
MSA-3 Valued Empty
X - Textual Message 11 9

20. Current Analysis (RXA-5 Empty) – ERR
Segment
20 IIS
ERR Segment Yes No
RE (0..*) 12 8
ERR-1 Valued Empty
X - Err Code & Loc. 2 10
ERR-2 Empty RXA^0^5^1 RXA^5^1 RXA^1^5 RXA^1^5^1^1
RE - Error Location 2 1 1 6 2
ERR-3 Empty 101 102
R - HL7 Error Code 2 9 1
ERR-4 Empty I W E
R - Severity 7 0 1 4
ERR-5 Empty Valued - No Code 4 7
RE - App Error Code 9 1 1 1
ERR-6 Empty Valued
O - App Error Param 12 0
ERR-7 Empty Valued
O - Diagnostic Info 11 1
ERR-8 Empty Valued
RE - User Message 6 6

21. Current Analysis – Key ACK Fields by IIS
20 IIS
Key ACK Fields Used by IIS Number of IIS Conforms to CDC IG
MSA-1; MSA-3 5
- NO -
Uses MSA-3
MSA-1; ERR-1 2
- NO -
Uses ERR-1;
Missing ERR-3 and ERR-4
MSA-1; ERR-2; ERR-3 1
- NO -
Missing ERR-4
MSA-1; MSA-3; ERR-2; ERR-3 4
- NO -
Uses MSA-3;
Missing ERR-4
MSA-1; MSA-3; MSA-6 2
- NO -
Uses MSA-3 and MSA-6
MSA-1 1 - Yes -
MSA-1; ERR-2; ERR-3; ERR-4 2 - Yes -
MSA-1; ERR-2; ERR-3; ERR-4; ERR-5 3 - Yes -

22. Current Analysis – Structurally
Conformant IIS
6 IIS
MSA-1 ERR-2 ERR-3 ERR-4 ERR-5
System 1 AE RXA^0^5^1 101 W Empty
System 2 AR RXA^1^5^1^1 101 E Valued - No Code
System 3 AE RXA^5^1 102 E 4
System 4 AE RXA^1^5 101 E Empty
System 5 AE RXA^1^5^1^1 101 E 7
System 6 AE

23. National IG
• Current Processing Rules (Table 3-1) Needs more freedom for receiving systems
• Currently all Required fields are treated with equal importance
• PID-1 (HL7 Set ID) and PID-7 (Date of Birth) are both equally important.
• The ACK has some ambiguities in the description
• The word “Error” when written in various sections can mean several different things
• ERR Segment
• Application Error (AE) in MSA-1
• Error (E) Severity in ERR-4
• The general English term error unrelated to HL7 Specifics
• What does “raise an error” really mean?
• The ACK has some limitations
• In the example used today, The best ACKs noted that RXA-5 was missing.
• What about the rest of the RXA?
• What about the entire Order Group?
• What about the two good immunization in the message?
• AA, AE, AR and I, W, E have a limited set of combinations and sometimes make it difficult to
discern what really occurred during processing.

24. Next Steps
• IIS
• Come up to release 1.5
• 1 and only 1 MSA Segment per ACK
• Stop using MSA-3 and ERR-1
• Always use ERR-3 and ERR-4 when sending an ERR Segment
• AIRA
• Work with SISC to develop best practice guidance on ACKs which meets 1.5
conformance