HL7 Activities and Experiences in the Republic of Croatia

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HL7 Activities and Experiences in the Republic of
Croatia

• Miroslav Koncar
• HL7 Croatia
• HL7 Inc. International Affiliate Committee
  Technical Co-Chair
• Ericsson Nikola Tesla d.d.

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Contents

• Croatian Healthcare in 21st century - vision
• Introduction to HL7
• Ongoing projects and HL7 implementation
  experiences
• HL7 Croatia Affiliate activities
• Summary

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Croatian Healthcare Vision
Nurse
Physician
Patient
Pharmacy
Ministry of Health
Hospital Information System
Healthcare Enterprise Information System
Insurance Company
You have to have standards!!!
Certificate Authority
Public Health
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HL7 Inc. mission

• To provide standards for the exchange,
  management and integration of data that support
  clinical patient care and the management,
  delivery and evaluation of healthcare services

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Why HL7 version 3 standard?

• The process for building HL7v2.x messages is
  entirely ad hoc
• No formal guidelines when constructing messages
• Most data fields are optional
• Result interoperability of HL7v2.x
  implementations from different vendors is not
  guaranteed and practically impossible!!!

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HL7v3 standard

• Explicitly documented methodology
• Greatly limited optionality
• Supported by training classes and computerized
  tools
• Reference Information Model (RIM)
• Static model of health and health care
  information within the scope of HL7 standards
  development activities
• Application Roles concept
• Basis for HL7v3 conformance testing

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HL7v3 methodology
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How to implement HL7v3 standard?

• Specification of allowed localization methods
• Appearance constraints
• Element is or is not included from the base model
• Cardinality constraints
• Number of repetitions of the given element
• Type constraints
• Limit the structure of element in question
• Value set constraints
• Limit the set of values applicable for the
  element
• Any other constraints
• Stated as text to establish local business rules

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Healthcare invoice and HL7 models localization
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HL7 methodology in use
Acquire Work Permission Message Information
Model
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HL7v3 messaging implementation
HL7v3 Transmission Wrapper

• HL7v3 composite message consists of
• Transport Wrapper (mandatory)
• ControlAct Wrapper (optional)
• Payload (optional)

HL7v3 ControlAct Wrapper
HL7v3 Payload
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HL7v3 and XML digital signature

• XML Signatures provide
• Integrity
• Message authentication
• Signer authentication and non-repudiation
• W3C XML Digital Signature Specifications
• Enveloping mechanism HL7v3 composite message
  within the ltSignaturegt element
• Enveloped mechanism requires changes in the
  HL7v3 XML schemas or datatypes definition
• Detached signature transferred outside signed
  XML content

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HL7v3 and detached XML digital signature
Detached W3C XML digital signature
Signature Reference
Signed HL7v3 XML payload
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CEN/TC 251 ENV 13606 standard

• Worlds leading standard for electronic
  healthcare record communication
• Four part standard consisting of
• 1. Extended Architecture
• 2. Domain Term List
• 3. Distribution Rules
• 4. Messages for the Exchange of Information
• Accepted by the State Office for Standardization
  and Metrology of Republic of Croatia

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Knowledge models in patient record
Archetype
Domain Knowledge - Prescription
CEN ENV 13606 Reference Architecture
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CEN/TC 251 ENV 13606 Messaging

• Fourth part of the standard
• Messages for the exchange of information
• Unable to meet the requirements of a loosely
  coupled environment!
• Solution
• HL7v3 transmission infrastructure for application
  level transaction management
• Local interactions codes

HL7v3 Transmission Wrapper
HL7v3 ControlAct Wrapper
ENV 13606 Payload
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Croatian Primary Care Project and HL7

• Decisions made at the start of the project
• Go directly to HL7v3!
• For electronic healthcare records use CEN ENV
  13606
• Every transaction needs to be digitally signed
• Healthcare system environment
• Loosely coupled systems with various types of
  communication capabilities
• Highly heterogeneous
• GPs applications are from 5 different vendors
• Insurance Company
• Public Health Institute

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Primary Healthcare Information System
HL7v3/ENV 13606
HL7v3
HL7v3
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HL7v3 in Croatian primary healthcare

• Reference HL7v3 ballot4 package
• More than 70 localized HL7v3 models
• More than 30 coding systems in use
• NOTE some of the models in ballot4 had obvious
  mistakes
• Models from most recent ballots
• Locally developed models

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Experiences from the Croatian pilot operation
(June and July, 2003)

• 30 GPs offices and 20000 registered patients
• Total 9.515 examinations completed
• Total of 12.386 prescriptions and 4.463 referrals
  issued
• Financials
• Prescribed medications(total value) 1,55 M HRK
• Medical procedures(total value) 178,600 HRK
• The most frequent diseases circulatory system
  (I00 I99)
• 25 of all diagnoses
• 21.5 of total cost

Screenshot from ? application
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HL7 Croatia Affiliate history

• Formed in October, 2001
• Founders are Croatian Society for Medical
  Informatics (CSMI) and Croatian Society for
  Medical and Biological Engineering (CROMBES)
• From October 2002 officially excepted in the HL7
  International Affiliates group
• 4 major events with international participation
• Module HL7 International Communication
  Standard in Healthcare, within the 6th
  International HIT Conference Biotechnology and
  Public Health in Cavtat, October 2003

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Summary and further actions

• HL7v3 to become Croatian standard
• HL7 Croatia Affiliate efforts
• Election of a Croatian representative to the HL7
  International Affiliate Committee
• Education programs
• HL7 standard in the context of ongoing projects
• Early implementers of HL7v3 standard in specific
  environment
• HL7v3 and CEN/TC ENV 13606 standards
  interoperability

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Thank You!Any Questions?
Email miroslav.koncar_at_ericsson.com