Electronic Pathology Reports and the Use of HL7 Messaging Workbench

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Electronic Pathology Reports and the Use of HL7
Messaging Workbench

• 2008 NAACCR Conference
• Ken Gerlach, MPH, CTR
• CDC-National Program of Cancer Registries
• June 10, 2008

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Outline

• Overview - NAACCR Pathology Tools
• HL7 Introduction
• Need for Conformance Testing
• HL7 Messaging Workbench (MWB)
• Overview High Level
• Usages
• Advantages

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NAACCR Volume V

• NAACCR Pathology Data Work Group
• Electronic Transmission of Reports from Pathology
  Laboratories to Cancer Registries
• Chapter 6 in Volume II, Version 9.1 Published
  March 2001
• Version 2.0 release - November 2005
• Version 2.1 release - December 2007
• Next Step -- HL7 Version 2.5.1

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Two Standard Formats

• Pipe-Delimited Format
• Less sophisticated (less technically challenging)
• Retained for legacy e-path reporting systems
• Health Level Seven (HL7)
• http//www.hl7.org/
• Flexible and robust protocol widely utilized for
  electronic data transmissions by medical
  facilities and pathology Laboratories

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Health Level Seven (HL7)

• Volunteer, not for profit organization
• International community
• American National Standards Institute (ANSI)
• Widely used in US hospital information systems
• HL7 refers to standards
• Transmission of data between systems

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We Have a Standard, but?

• High degree variability - HL7 implementations
• Optionality and other degrees of freedom
• If youve seen one HL7 message, youve seenone
  HL7 message.
• Variability Impact
• Custom-modifications for each laboratory
• Ongoing maintenance cost for these many slightly
  different formats

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MSH\HLSHITECK PATH LAB-ATLANTA3D9328409CLI
ASTJ20031124122230ORUR01200311241222300023
P2.3.12.0 ltCRgt PID197
810430PIHITECK PATH LAB-ATLANTA
3D9328409CLIA00466144PTST
JOSEPHS3932CMA3270686987PNUS
HEALTHCARESAMPLE30ALLAN19530621M112
BROAD STREETAPT 10ATLANTAGA30301
ltCRgt PV11ATTENDINGIDATTENDINGDRMANAGINGR
EFERRINGIDREFERRERFOLLOWUPDR
ltCRgt ORCREATLANTA CANCER
SPECIALISTSSTREET ADDRESS 1SUITE
ATLANTAGA30303ltCRgt OBR19781043011529-5SUR
GICAL PATH REPORTLNPATHOLOGY
REPORTL20030922EMLOYEEIDPHLEBOTOMISTPAMEL
A164341SURGEONHANNAHDRF
109772PATHOLOGISTQUINCY ltCRgt OBX1TX22637-3F
INAL DIAGNOSISLNDIAGNOSISL1LEFT INGUINAL
LYMPH NODE - GRANULOMATOUS LYMPHADENITISFltCR
gt OBX2TX22637-3FINAL DIAGNOSISLNDIAGNOSISL
1/ljm ltCRgt OBX3TXClinical HistoryL2?
lymphoma Quick SectionFltCRgt OBX4TX22633-2
Nature of SpecimenNSTissue SubmittedL3Left
inguinal nodeFltCRgt OBX5TX22634-0Gross
PathologyLNGross PathologyL4The specimen is
received fresh labelled lymph node. The specimen
consists of two nodes 2.3 and 2.2. cm each. The
cut surface is bulky tan to pink in colour and
fleshy.FltCRgt OBX6TX22634-0Gross
PathologyLNGross PathologyL4QP/jlmFltCR
gt OBX7TX11529-5SURGICAL PATHLNMicroscopicL
5Sections of left inguinal lymph node
demonstrated an encapsulated node which is
largely replaced by epithelioid granulomata
without necrosis. Special stains do not reveal
the presence of organisms. The background
lymphocytes are both B and T lymphocytes and
include macrophages and occasional neutrophils
and plasma cells. Reed-Sternberg cells are not
demonstrated.FltCRgt OBX8TX22639-9Suppleme
ntal Reports/AddendumLNSupplements/AddendaL6
Material was requested by Dr. D. Consult, Saint
Josephs Hospital for review. CltCRgt OBX9TX
22639-9Supplemental Reports/AddendumLNSupplem
ents/AddendaL6A report from Dr. C. Darwin was
received.CltCRgt OBX10TX22639-9Supplementa
l Reports/AddendumLNSupplements/AddendaL6DIA
GNOSIS Consistent with peripheral T-cell
lymphoma with epithelioid histocytes (Lennert's
lymphoma), see description and comment - lymph
node, left inguinal (biopsy from November 24,
1997). (See attached report). /HMBCltCRgt OBX
11TX22639-9Supplemental Reports/AddendumLNS
upplements/AddendaL6Tissue was submitted for
lymph node protocol. A report from Dr. B. Study,
Sunnybrook Health Science Center was
received.CltCRgt OBX12TXSupplements/Add
endaL7DIAGNOSIS (See attached report). LYMPH
NODE INGUINAL REGION, BIOPSY. NON-NECROTIZING
GRANULOMATOUS LYMPHADENITIS. /hmbCltCRgt OBX1
3SN21612-7Reported PatientAgeLNPat_ageL1
050YFltCRgt
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HL7 Messaging Workbench (MWB)

• Conformance Testing Software
• Tool for standardizing HL7 Version 2.x messages
• Tool allows messages to be validated against the
  developed profile
• Can handle precise, explicit, specifications
• Publicly available through the HL7 website
• Under HL7 Conformance SIG
• Developed by Peter Rontey of the VA

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Terms and Concepts

• MS Word software
• Opens Reads
• A file
• Minutes
• Start new file

• Messaging Workbench software
• Opens Reads
• A profile
• NAACCR Volume V
• Start new profile

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MWB Usage

• Use in US internationally
• Key tool measuring enforcing conformance - HL7
  Version 2
• Integrates with the HL7 Profile Registry
• MWB - generates profiles in a standard form
• MWB - can read published standard profiles

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Message Structure
Conformance Rules
HL7 Message Segments
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Individual Message Fields
Individual Message Fields
Implementation Notes And Definition
Table
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Test File Import
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Easy to Find Data in the Test
Message Using Parse Tree
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Validation result
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MWB Advantages

• All laboratories and registries have access to
  the same profile (specifications)
• Software eliminates variability - due to
  interpretation of text guidance
• Messages may be machine-tested for conformance to
  specification
• Explicit identification of differences from the
  standard eases implementation issues
• Eases task of reading HL7 messages during testing
  and debugging
• Standard form for publishing specifications

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Final Thoughts

• Cancer Abstracts vs. Pathology Reports
• Tradition of Electronic Cancer Abstract
  Submissions - 1988
• E-Pathology Reports - New
• Work in Progress
• Primary Use Patient Care
• Secondary Use - Public Health, QC, etc.
• Flexible
• MWB A tool for senders and receivers

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For More Information

• Tutorials Pete Rontey at Veterans
  Administration (monthly and web-cast)
• Introductory
• Advanced
• HL7 Meetings (www.hl7.org)
• In person training
• NAACCR Standards Web-site
• NAACCR web tutorial August 21, 2008?

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Thank you

• Ken Gerlach
• kgerlach_at_cdc.gov

Acknowledgements Ted Klein, Klein
Consulting Sanjeev Baral, Northrop Grumman
The findings and conclusions in this presentation
are those of the author(s) and do not necessarily
represent the official position of the Centers
for Disease Control and Prevention The findings
and conclusions in this report are those of the
author(s) and do not necessarily represent the
official position of the Centers for Disease
Control and Prevention."
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Thank you

• Ken Gerlach
• kgerlach_at_cdc.gov

Acknowledgements Ted Klein, Klein
Consulting Sanjeev Baral, Northrop Grumman
The findings and conclusions in this presentation
are those of the author(s) and do not necessarily
represent the official position of the Centers
for Disease Control and Prevention
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Why 7?

• Communication Protocols
• International Standards Organization (ISO)
• Open Systems Interconnections (OSI) Levels