HL7 for ultrasound orders and reports

Ultrasound looks like radiology until measurements, worksheets, and narrative reports all need to agree.

Ultrasound often uses the same HL7 shape as radiology: orders arrive as ORM_O01 or imaging-specific order messages, and reports return as ORU_R01. The difference is the content. Ultrasound workflows may include measurements, worksheet findings, images in PACS, a narrative report, and sometimes DICOM Structured Report conversion.

Use OBR to preserve study context and accession identity. Use OBX for measurements, impressions, narrative sections, and report flags according to the local profile.

MSH|^~\&|ULTRASOUND|CITYHOSP|EHR|CITYHOSP|20260715152000||ORU^R01^ORU_R01|US000501|P|2.5.1 PID|1||123456^^^CITYHOSP^MR||Smith^Jane^Anne^^Ms^^L||19800314|F ORC|RE|US4488^EHR|USF7788^RIS OBR|1|US4488^EHR|USF7788^RIS|30745-4^Ultrasound abdomen complete^LN|||20260715143000|||||||||67890^Sonographer^Sam^^^^^^NPI||||ACCUS7788||20260715151500|||F OBX|1|NM|11884-4^Liver length by US^LN||14.2|cm|10.0-15.0|N|||F|||20260715150000 OBX|2|TX|18782-3^Radiology study observation^LN||No gallstones. Common bile duct is not dilated.||||||F|||20260715151000

This is synthetic sample data for learning and testing. Open it in HL7 Soup Web before mapping it so the segment groups, repeated fields, and coded values are visible.

Measurements Are Not The Same As The Report

An ultrasound result may contain structured measurements and a narrative interpretation. A receiving EHR may want the final report text, while research, registry, or specialty systems may care about each measurement. Decide which OBX values are display text, which are discrete measurements, and which are workflow metadata.

When DICOM SR is involved, treat the conversion to HL7 as a designed mapping. Do not rely on screen-scraped report text if the measurement semantics matter.

  • Keep accession and order identifiers consistent with RIS/PACS.
  • Separate preliminary worksheet data from final radiologist or clinician interpretation.
  • Preserve units for every numeric measurement.

Specialty Ultrasound Needs Local Agreement

Obstetric, vascular, cardiac, and point-of-care ultrasound can all look like ultrasound from the outside while using different measurements and reporting rules. Link observations to the correct order and encounter, and be careful not to assume every ultrasound result is a single radiology-style paragraph.

Referral PDFs Are A Separate Question

Ultrasound orders are often created from referral documents, and those referrals may arrive as PDFs before the HL7 order exists. That can work well, but the conversion should be explicit: extract or map procedure, urgency, destination, clinical details, referrer details, provider identifiers, and order identifiers into the ORM/OBR structure first. Then decide whether the PDF itself needs to travel onward.

Do not assume the receiving ultrasound system can process an embedded PDF just because the HL7 message can carry one. Some receivers support the order but not the document payload. When the PDF is required, test whether the receiver wants an ED datatype in OBX-5, a separate document feed, or a file reference. Use HL7 Soup Web to inspect the message structure and Integration Soup to keep the order mapping and document-handling branch visible.

A Practical Integration Soup Workflow

In Integration Soup, route ultrasound orders and results by facility, modality, procedure code, accession, and report status. If converting DICOM SR measurements into OBX rows, use the DICOM SR to HL7 ORU tutorial as the pattern and keep the mapping rules visible.

The Test Pack I Would Ask For

Ask for a normal order, cancelled order, final report, amended report, structured measurement report, narrative-only report, obstetric report if relevant, and a report where measurements and impression both exist.