hl7 - 1 cse 5095 hl7: organization, standards, and implementation brendan heckman cse 5095 5/2/2011

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HL7 - 1 CSE5 095 HL7: Organization, HL7: Organization, Standards, and Standards, and Implementation Implementation Brendan Heckman Brendan Heckman CSE 5095 CSE 5095 5/2/2011 5/2/2011

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No Slide TitleBrendan Heckman
CSE 5095
Fragmentation of healthcare systems
Lots of data, no knowledge
Must abstract the problem above the system level
Provide a means for interoperability
HL7 - *
CSE5095
HL7 Use in EHRs/PHRs
The Term “HL7” stands for “Health Level Seven”
Reference to 7th layer in OSI Model
Open Systems Interconnection Model
7th layer = Application Layer
The name “HL7” is commonly used in two ways…
To represent the organization
SDO – Standards Development Organization
Intro to HL7: The Organization
Founded and started work in March 1987 at a conference at University of Pennsylvania, USA
Officially accredited as an SDO in 1994 by ANSI
Headquarters located in Ann Arbor Michigan
All volunteer Non Profit Organization
Worldwide presence
Local organizations in over 30 countries and members in over 55 countries
Members referred to as the “Working Group”
ANSI – American National Standards Association
*
Argentina
Australia
Brazil
Columbia
Canada
China
Chile
Denmark
Finland
France
Germany
India
Ireland
Italy
Japan
Korea
Lithuania
Mexico
Romania
Spain
Switzerland
Turkey
Mission statement
Improve care delivery
Exhibit…
Timeliness
Original goal, exchange between hospital systems
Important to note: standards and protocols not software or hardware.
Tackle interface requirements through common language
Try to implement standards on a fast track
Consider the requirements of preexisting systems
Overall goal is to achieve interoperability in healthcare
HL7 - *
CSE5095
OSI – Levels 1-6
Essential for benefits
Just to give you an idea…
Most widely implemented healthcare data messaging system in the world
Approximately 1500 healthcare facilities (~2006, Shortliffe)
> 93% of organizations with Health IT systems use HL7
HL7 - *
CSE5095
HL7 - *
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1.0 – September 1987
2.0 – September 1988
2.2 – December 1994
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2.3 – March 1995
2.4 – October 2000
Makes HL7 web enabled
2.5 – 2003
3.0 – (~ 2004)
HL7 - *
CSE5095
Human readable* ASCII format
Unreadable without prior knowledge
Each segment has its own line of text (120 types)
Specific category of information, 3 character marker
MSH – Message Header, info about message
PID – Patient Information, demographic info
NK1 – Next of Kin, contact info of relatives
PV1 – Patient Visit, describes hospital stay
HL7 - *
CSE5095
Primitive data types (character, string, number) or other composites
Denoted by delimiters
Located in the “MSH” segment (9th field)
Also determines what types of segments are availible
Example…
HL7 - *
CSE5095
Provide a layer of HL7 message management
Eliminate the need to replace existing systems
Interpret and parse HL7 Messages
Examples include…
Collection of subjects, scenarios, classes, attributes, use cases, action, and triggers
Designed to depict information to specify HL7 messages
Information model not a data model, for HL7 development
Cornerstone of HL7 version 3.0
Goal is to merge standard notions of…
Terminology
Representation
Expressed in UML modeling language
The model is split into four components
Classes
Relationships
Attributes
6 categories of Classes
HL7 - *
CSE5095
Participation
Role
Entity
Object in the model that can act or be acted upon
Act-relationship
Role-link
Ex > A1 patient visits pediatrician
A2 administration of a vaccine
Relation A2 occurs in the setting of A1
high level of abstraction makes RIM very robust and comprehensive
Subclasses also exist
Generalization Relationships
Occur between subclasses of the model
HL7 - *
CSE5095
Hierarchical in nature
Inherited such that children have attributes of parents
Children may add additional attributes
Structure removes inappropriate attributes
The HL7 RIM: Vocabulary Domains
RIM attempts to accounts for high degree in varying terminology in healthcare
Defines vocabulary domain that are specific at class level
Terminology unification is one of the biggest hurdles in electronic healthcare information interoperability
Standard libraries exist however…
Adoption less than nominal
Arden Syntax
Rules can be formulated independent of computer systems
Later applied to systems being used in healthcare
Aims to facilitate the sharing of knowledge to generate a knowledge base
CCOW (Clinical Context Object Workgroup)
Interoperability specification for user experience
Users experience integrated user session on the desktop
Enables “single sign on” experience
HL7 - *
CSE5095
Clinical Document Architecture (CDA)
Augments success of electronic medical records
Utilizes XML, HL7 RIM, and coded vocabularies
Documents are human and machine readable
Using XML brings the CDA into the mobile scope
HL7 - *
CSE5095
HL7 provides a standard for EHRs/PHRs
Reference of functions that may be present in an EHR system
List described from a user prospective to enable consistent expression of system functionality
Guidelines for exchange …
Standard is currently in draft status
Despite this it is being used in some instances
HL7 - *
CSE5095
Study from Kansas State University
Problem
Doctors need secure and standardized way to access this date
Goal Solution
Implement a home monitoring system that uses secure HL7 to communicate between a home data base and a remote database (at the hospital).
HL7 - *
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HL7 - *
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HL7 used to transmit from local DB to remote DB
Command from doctor packed into HL7 messages
Direct effect on home monitoring system
Doctors can alter monitoring parameters remotely
Monitoring becomes active rather than passive
Greater flexibility
Can interface with Java, C++, VB, Etc.
Encrypts data before sending
Research from National Taiwan University Hospital
Studied implementation of HL7 in a collaborative health information system
Prototype was implemented in outpatient registration
Implemented a set of web- services that directly map to HL7 standard message events
Message management acts as HL7 - IE
Event driven web services…
HL7 - *
CSE5095
HL7 based physiological monitoring system for mobile consumer devices
Implement HL7 standard EHR with a trigger for video conferencing
To be used on mobile device platform
Automatically enable mobile video conference
Promotes telemedicine
Founded 1898, chartered 1902
First healthcare data interchange standard (1984)
Recently worked on Continuity of Care Record standards (CCR)
Served as a basis for HL7
IEEE (Institute of Electrical and Electronic Engineers)
MEDIX – standard for exchange between HIS
Merged into HL7 activities
Medical Information Bus (MIB)
Defines entire 7-layer requirements set
HL7 - *
CSE5095
National Council for Prescription Drug Programs
Create/promote data interchange standards for the pharmacy industry
Provide resources to educate the industry
American Dental Association (ADA)
Health Industry Business Communications Council
Health industry bar code standard
Regulates bar code specifications for products in the healthcare industry
HL7 - *
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HL7 - *
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Final Thoughts
HL7 is currently the best solution to interoperability in healthcare information systems
Can only get better with time and adoption
Although it very large and complex, it is out of necessity
The problem is equally large and complex
While there are other standards out there
None as generalized as HL7