Acct = account? And account = admission. I presume. On that basis, the definition of A11 is :
For “admitted” patients, the A11 event is sent when an A01 (admit/visit notification) event is cancelled, either because of an erroneous entry of the A01 event, or because of a decision not to admit the patient after all
Well, the A11 is for either where it was an erroneous entry, or where it was a real entry that was cancelled due to real world events.
In the first case, it’s gone, and will never be heard from again. In the second case.. maybe. This is where it depends on the way the implementer of the sending system reads the spec, and their problem.
I think that having sent an A11, that should be it. No more messages on the episode, and a new one created.
But what if the A11 itself is sent erroneously? There’s no cancel a cancel message, so it’s unpredictable whether a system will use some other event to magically bring it back to life, or go with a new admission. And since there’s no real clear definition of how to use PV1-19 (Visit Number), it may not even be clear whether a new episode with the same episode details is a different episode or not.
For Account, I would be inclined to take the definition from PID-18 Patient Account Number… “This field contains the patient account number assigned by accounting to which all charges, payments, etc., are recorded. It is used to identify the patient’s account.” Searching all the instances of “account” in CH03, I can’t see anything to suggest that Account is anything other than a financial attribute.
Ironically, auditing considerations make reversing cancellations a well-worn use case in financial systems, but a tad more problematic in others. I’d be surprised if any PMS would physically delete an Admission Record, even one entered in error, but I doubt if many would attempt to look for an ‘inactive’ record that matched a new Admission Record.