HL7 MDM Messages: Medical Document Management
HL7 MDM (Medical Document Management) messages communicate document lifecycle events — creation, updates, addenda, and status changes — between transcription systems, document management platforms, and EHRs. The most common trigger event is MDM^T02 (Original Document Notification & Content), which delivers a complete clinical document like an operative note, discharge summary, or consultation report.
MDM Message Structure
Section titled “MDM Message Structure”| Segment | Name | Required | Purpose |
|---|---|---|---|
| MSH | Message Header | Yes | Sender, receiver, message type, version |
| EVN | Event Type | Yes | Document event code and timestamp |
| PID | Patient Identification | Yes | Patient demographics and identifiers |
| PV1 | Patient Visit | Yes | Visit context for the document |
| TXA | Transcription Document Header | Yes | Document type, author, status, unique ID |
| OBX | Observation/Result | Conditional | Document content (text or embedded file) |
TXA is the defining segment of MDM messages — it carries the document metadata (type, author, authentication status), while OBX segments carry the actual content. Messages with content (T02, T06, T10) require OBX; notification-only events (T01, T03, T09) omit it.
MDM Event Types
Section titled “MDM Event Types”Document Creation Events
Section titled “Document Creation Events”| Event | Name | Has Content | Description |
|---|---|---|---|
| T01 | Original Document Notification | No | Notification that a document was created |
| T02 | Original Document Notification & Content | Yes | Document created with full content |
Document Status Events
Section titled “Document Status Events”| Event | Name | Has Content | Description |
|---|---|---|---|
| T03 | Document Status Change Notification | No | Status changed (e.g., dictated → authenticated) |
| T04 | Document Status Change Notification & Content | Yes | Status change with updated content |
Document Modification Events
Section titled “Document Modification Events”| Event | Name | Has Content | Description |
|---|---|---|---|
| T05 | Document Addendum Notification | No | Addendum created |
| T06 | Document Addendum Notification & Content | Yes | Addendum with full text |
| T08 | Document Edit Notification & Content | Yes | Document edited (corrections) |
| T09 | Document Replace Notification | No | Document replaced |
| T10 | Document Replace Notification & Content | Yes | Replacement with full content |
| T11 | Document Cancel Notification | No | Document cancelled/retracted |
TXA-17: Document Completion Status
Section titled “TXA-17: Document Completion Status”The document lifecycle progresses through these status codes:
| Code | Status | Description |
|---|---|---|
| DI | Dictated | Initial dictation recorded, not yet transcribed |
| DO | Documented | Transcribed/entered, awaiting review |
| IP | In Progress | Document being actively edited |
| IN | Incomplete | Missing required content |
| AU | Authenticated | Reviewed and signed by author |
| LA | Legally Authenticated | Full legal signature applied |
Status Lifecycle
Section titled “Status Lifecycle”Each status transition generates an MDM^T03 or MDM^T04 event. The transition from DO to AU represents the physician’s electronic signature — a critical compliance step for CMS and Joint Commission requirements.
TXA-2: Document Type Codes
Section titled “TXA-2: Document Type Codes”| Code | Document Type |
|---|---|
| OP | Operative Note |
| DS | Discharge Summary |
| HP | History and Physical |
| CN | Consultation Note |
| PN | Progress Note |
| RA | Radiology Report |
| PA | Pathology Report |
| PR | Procedure Note |
| ED | Emergency Department Note |
| AN | Anesthesia Note |
Sample MDM^T02 Message
Section titled “Sample MDM^T02 Message”A transcribed operative note with full content:
| Field | Name | Value | Note |
|---|---|---|---|
MSH-3 | Sending Application | TRANS_SYS | Transcription system |
MSH-5 | Receiving Application | EPIC | EHR document repository |
MSH-9 | Message Type | MDM^T02^MDM_T02 | Original Document Notification & Content |
| Field | Name | Value | Note |
|---|---|---|---|
EVN-1 | Event Type Code | T02 | Original Document with Content |
EVN-2 | Recorded Date/Time | 202603021000 | March 2, 2026 at 10:00 AM |
| Field | Name | Value | Note |
|---|---|---|---|
PID-3 | Patient Identifier List | MRN12345^^^MAIN_HOSP^MR | |
PID-5 | Patient Name | DOE^JOHN^ALEXANDER |
| Field | Name | Value | Note |
|---|---|---|---|
TXA-2 | Document Type | OP^Operative Note^HL70270 | Operative note document |
TXA-3 | Document Content Presentation | TX^Text^HL70191 | Plain text format |
TXA-5 | Activity Date/Time | 202603011600 | Procedure performed March 1 at 4:00 PM |
TXA-10 | Document Author | SUR5678^WILLIAMS^MARK^^^MD | Dr. Mark Williams |
TXA-14 | Unique Document Number | DOC54321 | Document ID for versioning and linking |
TXA-17 | Document Completion Status | AU^Authenticated^HL70271 | Reviewed and signed by author |
TXA-22 | Authentication Date/Time | 202603021000 | Signed March 2 at 10:00 AM |
| Field | Name | Value | Note |
|---|---|---|---|
OBX-2 | Value Type | TX | Text — line breaks encoded as \.br\ |
OBX-3 | Observation ID | OP_NOTE^Operative Note^LOCAL | |
OBX-5 | Observation Value | Procedure: Laparoscopic cholecystectomy... | Full operative note text |
OBX-11 | Result Status | F | Final — document complete |
Key Implementation Considerations
Section titled “Key Implementation Considerations”Document Authentication Workflow
Section titled “Document Authentication Workflow”Clinical documents must be authenticated (signed) before they become part of the permanent medical record. The typical workflow:
- MDM^T02 — Transcriptionist creates the document (status: DO)
- MDM^T03 — Physician reviews and signs (status: AU)
- MDM^T03 — Legal authentication applied (status: LA, if required by policy)
Integration engines must track document status transitions and ensure downstream systems update accordingly. Documents in DO status may be displayed with a “Pending Signature” indicator.
OBX Content Formats
Section titled “OBX Content Formats”MDM documents can be delivered in two primary formats:
- TX (Text): Plain text with
\.br\line breaks. Simple to parse but limited formatting. Most common for clinical notes. - ED (Encapsulated Data): Base64-encoded PDF, RTF, or image files. Used when document formatting must be preserved exactly (letterhead, tables, signatures).
The value type in OBX-2 tells the receiving system how to handle the content. Systems should support both TX and ED to handle documents from different sources.
Document Versioning
Section titled “Document Versioning”TXA-13 (Parent Document Number) links addenda and replacements to the original document:
- Addendum (T06): TXA-13 points to original DOC ID. Both documents remain active.
- Replacement (T10): TXA-13 points to replaced DOC ID. Old document is superseded.
- Cancellation (T11): Document is retracted. Clinical record should show cancellation reason.
Receiving systems must maintain the document chain — each version linked to its predecessors — for complete audit trails.