HL7
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HL7 AS A COMMON HEALTHCARE COMMUNICATION FORMAT Andy Stopford, Technical Director, Havas Lynx Andy Stopford has over 16 years experience leading teams to deliver pioneering software solutions that enable business goals to be achieved. With experience drawn from the e-commerce, financial, insurance, banking and healthcare sectors he is committed to creating quality software that adheres to best practices and delivers solutions that are robust and help clients achieve business goals. Andy is a software engineer by trade and is a published book author and keen writer with 200 magazine and journal articles over his career. He has a great depth and breadth of knowledge in a variety of technologies and is passionate about all things software engineering. Andy leads the HAVAS HEALTH SOFTWARE team of software engineers to develop solutions that focus on the best possible outcome for the end user that ensure the business needs are met. @andystopford
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HL7
- 1. HL7
- 2. Agenda − Intro − HL7 − HL7 v2.* − HL7 v3.* − HL7 CDA − HL7 FHIR − Challenges − Questions
- 3. Introduction
- 4. Andy Stopford – Technical Director − Oversee HAVAS Health Software − Software Engineer by trade − 18 years in the software industry − Experience built in the E-commerce, Insurance & Financial sectors − Author & Writer − Technical advisory at Microsoft − Member of HL7 UK charter
- 5. Our partners
- 6. The company we keep
- 7. Healthcare Installations − UK − NHS Guys & St Thomas Foundation Trust − NHS Buckinghamshire Healthcare Trust − NHS Southend Clinical Commissioning Group − USA − Henry Ford Health System
- 9. HL7 − HL7 International was founded in 1987 − Standards Body − HL7 defines a common method of structured data exchange in healthcare − Very common to find in healthcare IT systems − EHR systems − Patient appointment booking systems − HL7 is used in over 35 countries
- 10. HL7 v2 − Started life in 1988 with version 1 − 2.1 was the first usable standard and arrived in 1991 − 2.2 to 2.7 − In 2010 2.1 was still used in over 32 countries − Very common to see 2.1/2.5 in the NHS − Subject domains − Patient demographics − Clinical observations − Scheduling of patient appointments Resources − Etc.
- 11. HL7 v2 structure − Aunit of data that is transferred between systems − Each information exchange is initiated by a trigger event and consists of one or more messages − Amessage is composed of segments in a defined sequence − Segments hold fields (data types) − The first segment of each message defines the message type and the type of trigger event that caused the message to be sent − Each segment is a sequence of data fields, separated by special data field separators (usually the pipe ‘|’ symbol) − Each data field has a data type, which may be compound – made up of components which are separated by a component separator (usually the carat ‘^’ symbol) − Structure is modelled onANSI X.12 and UN/EDIFACT
- 12. HL7 v2ADT − Some trigger messages can be classified underAdmission, Discharge, Treatment (ADT) − CodedA01 toA62 − A01 –Admit − A05 – Pre-Admit − A02 – Transfer − A08 – Change patient information − etc
- 13. HL7 v2 sequence ENCOUNTER REGISTRATION PLANNED ENC. TRANSFER TRANSFER TRANSFER DISCHARGE ADMIT ADT^A04 ADT^A03 ADT^A02 ADT^A12 ADT^A02ADT^A01ADT^A05
- 14. HL7 v2 Segments − Each message structure varies depending on the trigger − Every message holds segments − MSH – Message Header − EVN – Event Type − PID – Patient Identification − PV1 – Patient Visit
- 15. HL7 v2 PID fields (sample) Name Required Length Set ID No 4 Patient ID No 0 Patient Identifier List Yes 250 Alternate Patient ID No 0 Patient Name Yes 250 Mother's Maiden Name No 250 Date/Time of Birth No 24
- 16. HL7 v2 - Example
- 17. HL7 v3 − Newer definition of the HL7 standard − First developed in 2005 − XML based − Addresses some of the v2 issues − Schema − Structure − Extension − “Semantic Interoperability” − Spec is huge (1.2 gig in size)
- 18. HL7 v3 - RIM − Primary object model (RIM) − Accounting & Billing − Pharmacy − PatientAdmission − Medical Records − Laboratory − …My own…. − Etc.
- 19. HL7 v3 - RIM − Domain − Story boards − Trigger events − Domain information model (D-MIM) − Refined information models (R-MIM) − Hierarchical Message Descriptions − CMET
- 20. HL7 v3 - Reference Information Model (RIM)
- 21. HL7 v3 - RIM − Red: The central block and represents an action, − Blue: Defines a participant, − Pink: Represents an act relationship to describe how acts are related, − Yellow: Describes the role of the participant, − Green: Represents the entity playing the role
- 22. HL7 v3 - RIM If I have an inpatient visit for a surgery at a hospital − The surgery is an act (red) that is a Procedure − I am participating (blue) as a Record Target − My surgeon is participating (blue) as the Performer − My role (yellow) is as a Patient, and − I am the entity (green) of a Person.
- 23. HL7 v3 - D-MIM/R-MIM − Domain Message Information Model (D-MIM) − D-MIM is based on the RIM − Models a given domain but is not the implementation − Refined Message Information Model (R-MIM) − R-MIM is derived from the parent D-MIM − Information model, shows data for a particular message
- 24. HL7 v3 - PatientAdmission D-MIM
- 25. HL7 V3 -Activate Patient R-MIM
- 26. HL7 v3 - Wrapper − Wraps a message to support the transport from sender to receiver − Transmission Wrapper − ControlAct Wrapper − Payload (the actual domain message)
- 27. HL7 v3 – Transmission Wrapper − Required − Date/Time − Identifies the sender and receiver (ID) − Identifies when acks are required for the message − Upper level and wraps − ControlAct Wrapper − Payload
- 28. HL7 v3 – ControlAct Wrapper − Used to communicate information to an interaction that triggered a message. − Message ControlAct (basic) − Query Infrastructure − Master File/Registry − Domain messages have different uses of the control act wrappers
- 29. HL7 v3 - CMET − Common Message Element Type − Reusable part of a message − E.g. Patient − Included in the domain − Isolated from the domain − Vulnerable to change − E.g. Lab states patient needs IQ then pharmacy also has it − Hides the true size of a message
- 30. HL7 v3 - Transport − Big XML messages that we need to move − MLLP (Minimum Lower Layer Protocol) − Used with v2 a lot − Limited − SOAP − The most common − XML payload − ebXML (yuck) − Standard includes a payload spec
- 31. HL7 v3 - Example
- 32. HL7 CDA − Clinical DocumentArchitecture − Represent any clinical document – e.g. Discharge Summary − Built on the HL7 Reference Information Model (RIM) − CDAHeader − CDABody
- 33. HL7 CDAHeader − Document Information − ID of the document, confidentiality & relationship to other documents. − Encounter data − Describes where the encounter took place, time & setting. − Service actors − Describes who interacted with service being described − Service targets − Include the patient, family members etc.
- 34. HL7 CDABody − Describes the body of the document − Adocument structure will vary, so too must a CDAbody − CDABody gives you structures to capture this − Structures − Sections − Paragraphs − Lists − Tables
- 35. HL7 CCR − Joint HL7/ASTM standard − Facilitate better cross communication between systems − CDABody can vary in structure − CCR defines templates that fix this structure
- 36. HL7 tools − Server − InterSystems Ensemble − InterfaceWare Iguana − Microsoft BizTalk − Mirth Connect − Tools − HL7 Inspector (OSS) − 7Edit (commercial
- 37. HL7 FHIR − Fast Health Interoperable Resources − The future of HL7… − Free and open! − Combines parts of v2, v3 and CDAto create a new standard − Supports XML and JSON − RESTful − Working draft available by the end of 2013 with a working process through 2014 and 2015
- 38. FHIR Resources − Clinical − General -AdverseReaction, CarePlan, FamilyHistory etc − Medications - Medication, MedicationPrescription etc − Diagnostics – Observation, DiagnosticReport − Administrative − Attribution – Patient, RelatedPerson, Practictioner − Resources – Device, Location − Workflow – Encounter,Alert − Bundles − Combined resources
- 39. FHIR REST − Resources expose certain logical interactions − Create (POST) − Read (GET) − Update (PUT) − Delete (DELETE) − Bundles − History (GET) − Search (GET)
- 40. FHIR Security − HTTPS/SSL − OAuth − Authorization/Access control − HL7 Healthcare Classification System − Access/data segmentation − Audit − Security events − Provenance
- 41. So all good?
- 42. The protection of patient data is critical − Thus it’s not truly open − Access is limited − Data is limited − Storage is almost impossible − Security is paramount − HIPAA
- 43. How best to work with patient data − Agree with the trust what you need and what you can see − Caldicott Guardian − ISO 27001 − Point to point − SSL 256 − Accredited data storage (or just don’t do it) − Encrypt the storage, not the data. − 256 at minimum
- 44. More information − Web − HL7 international (http://www.hl7.org) − HL7 UK charter (http://www.hl7.org.uk/) − Books − Principles of Health Interoperability HL7 and SNOMED (Tim Benson)
- 45. QUESTIONS?