HL7 Electronic Data Exchange in Health Care

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HL7 Electronic Data Exchange in Health Care

• W. Ed Hammond, Ph.D.
• President, AMIA
• Vice-chair, Technical Steering Committee, HL7
• Co-chair, Vocabulary Technical Committee, HL7
• Co-chair, EHR SIG, HL7
• Convenor, ISO TC 215, WG2
• Professor, Community Family Medicine, Duke
  University

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Why standards in health care?

• There is an assumed and inherent need to share
  data in the health care setting. The data are of
  many types and form and will be used for multiple
  purposes.
• We must share both data and knowledge for both
  improved health care and for economic reasons.
• Sharing becomes economically possible only if
  interoperability exists.
• Interoperability occurs only if a full set of
  standards in health care exist.

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Inpatient setting

• Inpatient systems consist of many heterogeneous
  systems that must be integrated for efficient and
  effective care.
• Service requirements that are essential parts of
  hospital information systems require
  communication between the requestor of a service
  and the supplier of the service.
• Automated capture of data is most economical,
  most accurate, and most complete.
• Patient safety and improved quality of care
  require the integration of data without the loss
  of information among many systems.

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Steps to making a standard

• Awareness of need for standard
• Critical mass of technical expertise to create
  standard
• Must insure fairness and not competitive
  advantage to a single vendor
• Expertise must be both technical and domain
• MUST involve vendors, providers, consultants,
  government
• Global acceptance of standard
• Requires education, balanced voting
• Vendor implementation of standard usually driven
  by consumer pressure to implement
• Visible reduction in cost and effort of
  interfaces as a result of standard

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Different Kinds of Standards

• Company
• Dos
• Windows
• Consortium
• Unix
• Linux
• Industry
• DICOM

• Government
• NIST
• CMS (UB92)
• HIPAA
• Voluntary consensus
• ASTM
• HL7
• NCPDP

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Consensus Standards

• Volunteer-driven
• Not full-time commitment
• Uneven levels of participation
• Uneven levels of understanding
• Required resolution of negatives
• Prone to compromise, often leading to ambiguity
• Specialized balloting process (ANSI requires 90
  approval at membership level)

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Multiple talents required for success

• Administrative structure that supports the
  process but does not get in its way.
• Political process that removes barriers to
  acceptance and implementation
• Technical process that produces technically sound
  standard
• Open process that does not slow or hinder
  production of standard
• Funding process to create a standard in shortest,
  reasonable time
• Commitment to life cycle of maintenance and update

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A bit of history

• HL7 began in 1987 to permit the creation of an
  affordable Hospital Information System from a
  best of breed approach.
• Standard was based on an implicit model based
  purely on the experience of the developers.
• Limitations in technology defined the
  characteristics of the standard
  character-based, character delimiters,
  position-defined.
• First efforts addressed most important and
  frequent requirements.
• Speed was important.
• Acceptance took time.

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Health Level Seven - Standards

• Messaging Standard V2.4
• Messaging Standard V2.4, XML Syntax
• Messaging Standard V 3.0
• Reference Information Model
• Data Types
• Clinical Document Architecture
• Common Clinical Objects Working Group
• Arden Syntax
• Vocabulary
• Clinical Guidelines
• Decision Support
• Clinical templates
• Electronic Health record

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Functional and Semantic Interoperability

• Defined process for creating data interchange
• Reference Information Model
• Common Data Types
• Common Terminologies
• Common content specification at complex levels
  a.k.a. clinical templates
• Clinical document architectures
• Conformance requirements
• Document standards
• Trigger Events

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MDF Model Relationships
Analysis
Design
Requirements Analysis Use
Case Model (UCM)
Domain Analysis Domain Information
Model (DIM)
Interaction Design Interaction Model (IM
)
Message Design HierarchicalMessageDescr
iptions (HMD)
2-nd Order 1 choice of 0-n Drug
0-1 Nursing
Reference Model Repository
RIM
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Interoperability Standards

• Reference Information Model
• Object Model that provides framework for the
  exchange and sharing of health data. EHR model
  must be based on this model.
• HL7 has created such a model, accepted
  internationally, that is now becoming stable
• HL7 model is high level requiring subsequent
  refined models for communications and storage of
  data.

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HL7 RIM 1.15
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HL 7 RIM Core Classes
Entity
Participation
Act
Role
Referral Transportation Supply Procedure Condition
Node Consent Observation Medication Act
complex Financial act
Patient Employee Practitioner Assigned
PractitionerSpecimen
Organization Living Subject Material Place Health
Chart
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V3 Coded Data Types
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Clinical Document Architecture

• XML-based definition of clinical documents such
  as discharge summaries, op notes, progress notes,
  radiology reports, etc.
• HL7 has ANSI approved standards. Work is based on
  3 levels (1) header (2) header plus body
  structure and section headings (3) element
  content specification and identification

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Interoperability Standards (Concepts)

• Clinical Data Model
• Defines detail clinical object structures
• Examples
• CEN GPICS
• HL7 3M Clinical Data Models
• HL7 Common Message Element Types
• HL7 Clinical Templates
• GEHR Archetypes
• ISO TC 215 WG2 has work item to harmonize these
  common conceptual elements (CHICS)
• Require registry

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Implementation/Conformance

• Most frequently, ambiguity and options remain in
  standards at all levels. Total interoperability
  requires a precise definition of what will be
  sent to whom under what circumstances.
• One example of this approach is DEEDS.
• NEDSS will also provide this level of
  specification.

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Methods

• Work can be performed by a knowledgeable few
  then get buy-in from group
• Require use of standards by law
• Sell value of standards create a market
• Demonstrations to prove standards work and to get
  publicity
• Give publicity to vendors that use standards
• Convince users to demand standards
• Buy from vendors who use standards
• Reduce confusion in market place caused by
  multiple, competing standards.

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Final advice

• Total adherence to standard is most economical
  approach
• Mapping of your standard to the standard is
  inefficient, expensive, out of date, and wrong.
• A business case must be made for switching to the
  standard. Then the switch must be made in a
  timely fashion.
• Governments must support standards.
• If you know what must be done, do it now!