Ist16-02 HL7 from v2 (syntax) to v3 (semantics)

E. Della Valle – http://emanueledellavalle.org - @manudellavalle
Interoperability and Semantic Technologies 2015-16
HL7: from syntax (v.2) to semantics (v.3)
Emanuele Della Valle
DEIB - Politecnico di Milano
http://emanueledellavalle.org - @manudellavalle

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2

Health Level 7
• Founded in 1987, Health Level Seven International is one of
several American National Standards Institute (ANSI) -
accredited Standards Developing Organizations (SDOs)
operating in the healthcare arena. Most SDOs produce
standards (sometimes called specifications or protocols) for a
particular healthcare domain such as pharmacy, medical
devices, imaging or insurance (claims processing)
transactions. Health Level Seven's domain is clinical and
administrative data.
• HL7 develops:
• conceptual standards (e.g., HL7 RIM)
• document standards (e.g., HL7 CDA)
• messaging standards (e.g., HL7 v2.x and v3.0).
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HL7 v.2.x principles
Message Description
ACK General acknowledgment message
ADR ADT response
ADT ADT message
BAR Add/change billing account
CRM Clinical study registration message
CSU Unsolicited study data message
DFT Detail financial transactions
DOC Document response
DSR Display response
HL7 v.2.x roots are to
be found in situations
like where two
systems need to align
their data
Trigger events
 Actions or Events
Messages
 Contains the actual
information
Segments
 Reusable structures
Data elements
 Data representation
4
*ADT: Admission Discharge Transfer
*

HL7 v2 enables bi-later integrations
Complementary application
[…]
Organizational
boundaries
application
[…]
adapter
!
5

6
The Type of a message is identified by a three
digit code, and the Event that starts a
communication is called Trigger
Message Description
ACK General acknowledgment message
ADR ADT response
ADT ADT message
BAR Add/change billing account
CRM Clinical study registration message
CSU Unsolicited study data message
DFT Detail financial transactions
DOC Document response
DSR Display response
Code samples
and their
meaning New codes can be
defined using Z as the
first code character

ZCH|Donor^Eyes~Donor^Heart~Donor^Lungs
ZCH|ADE^DO NOT RECESITATE
…… whatwhat’’s the meaning of a Z code !?!s the meaning of a Z code !?!
7

HL7 v.2.4 example
MSH|^~&|GHH LAB|ELAB-3|GHHOE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P|
2.4<cr>
PID|||555-44-4444||EVERYWOMANÊVEÊ^^^^L|JONES|19620320|F|||153 FERNWOOD
DR.^^STATESVILLEÔH^35292||(206)3345232|(206)752-121||||AC555444444||67-
A4335ÔH^20030520<cr>
OBR|1|845439^GHH OE|1045813^GHH LAB|15545^GLUCOSE|||200202150730|||||||||
555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444-44-
4444^HIPPOCRATES^HOWARD H^^^^MD<cr>
OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|mg/dl|
70_105|H|||F<cr>
Completion of a serum glucose laboratory result of 182 mg/dL authored by
Howard H. Hippocrates. The laboratory test was ordered by Patricia Primary for
patient Eve E. Everywoman. The use case takes place in the US Realm.
8

HL7 v.2.4 example (2)
MSH|^~&|GHH LAB|ELAB-3|GHHOE|BLDG4|200202150930||ORU^R01|CNTRL-
3456|P|2.4<cr>
The MSH (Message Header) segment contains the message type, in this case,
ORU^R01, which identifies the message type and the trigger event. The sender is
the GHH Lab in ELAB-3. The receiving application is the GHH OE system located
in BLDG4. The message was sent on 2002-02-15 at 09:30. The MSH segment is the
initial segment of the message structure.
PID|||555-44-4444||EVERYWOMANÊVEÊ^^^^L|JONES|19620320|F|||153
FERNWOOD DR.^^STATESVILLEÔH^35292||(206)3345232|(206)752-121||||
AC555444444||67-A4335ÔH^20030520
The PID (Patient Identification) segment contains the demographic information of
the patient. Eve E. Everywoman was born on 1962-03-20 and lives in Statesville OH.
Her patient ID number (presumably assigned to her by the Good Health Hospital) is
555-44-4444.
9

HL7 v.2.4 example (3)
OBR|1|845439^GHH OE|1045813^GHH LAB|15545^GLUCOSE|||
200202150730||||||||| 555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444-
44-4444^HIPPOCRATES^HOWARD H^^^^MD<cr>
The OBR (Observation Request) segment identifies the observation as it was
originally ordered: 15545^GLUCOSE. The observation was ordered by Patricia
Primary MD and performed by Howard Hippocrates MD.
OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|
mg/dl|70_105|H|||F<cr>
The OBX (Observation) segment contains the results of the observation: 182
mg/dl.
10

Limitations of HL7 v.2.x
• Implicit data model (i.e., positional)
• Events are difficult to be linked to their respective business
processes
• Optional fields (see |||||)
• A single message support only one coding system
• No support for
 object technologies
 XML and Web technologies
• No support for security
11

AdmittanceAdmittance
WardWard
LaboratoryLaboratory
AdministrationAdministration
Message brokerMessage broker
12

13

The main limit related to a message-only architecture (even when aThe main limit related to a message-only architecture (even when a
using a bus) is that information remain confined inside all the singleusing a bus) is that information remain confined inside all the single
applications deployed in a companyapplications deployed in a company
Application 1
messagesWhere’s the right
patient’s address ?
Application 2
Application 3
By just using messages, different applications can
interact, but no coherent information base can be created
14

HL7 v.2.x in XML
• Adoption of XML
• Element Naming
Convention
• message name and
trigger event ORM_O01,
ADT_A01,
• Segment element MSH,
PID, OBX, etc.
• Datatype name and
component number
CE.2, HD.1, XAD.3, etc.
15

Limitations of HL7 v.2.x in XML
16

HL7 - Version 3
• Initial HL7 standards (Version 2) were based on a
pragmatic ‘just do it’ approach to standards
• HL7 saw the need to revise and formalize the process
• to assure consistency of the standards
• to meet plug’n’play demands
• to be able to adopt and leverage new technologies for both HL7 and
its users
• Adopted the new methodology in 1997
• based on best development & design practices
• supports ‘distributed’ development across committees
• It is technology neutral
17

HL7 version 3 intent
18
[…]
[…]
[…]
[…]
[…]
[…]
[…]

HL7 - Version 3
• Methodology based on shared models
• Reference Information Model (RIM) of the health care information
domain
• Defined vocabulary domains
• Drawn from the best available terminologies directly linked to the RIM
• Supported by robust communication techniques
• Harmonization process that
• Assures each member and committee a voice in the process, yet
• Produces a single model as the foundation for HL7 standards
• Continuous balloting - begun in 2009 – produces a new
release each year.
19

The essence of Version 3
• Apply the ‘best practices’ of software development to
developing standards - a model-based methodology
• Predicate all designs on two semantic foundations
• a reference information model (RIM) and
• a complete, carefully-selected set of terminology domains
• Require all Version 3 standards to draw from these two
common resources
• Use software-engineering style tools to support the
process.
20

The essence of Version 3
• A family of specifications
• Built upon a single model of
• How we construct our messages
• The domain of discourse
• The attributes used
• Constructed in a fashion to rapidly develop a comprehensive,
fully constrained specification in XML
21

How is Version 3 “better”?
• Conceptual foundation
• a single, common reference information model to be used across HL7
• Semantic foundation
• in explicitly defined concept domains drawn from the best
terminologies
• Abstract design methodology
• technology-neutral
• able to be used with whatever is the preferred technology: documents,
messages, services, applications
• Maintain a repository of the semantic content
• to assure a single source, and enable development of support tooling

Version 3 - where is it being used?
• As
• Clinical Document Architecture (CDA) documents,
• SOA designs
• interchanged Messages
• In
• large-scale projects deriving from governmental mandates
• For
• communications between multiple, independent, “non-integrated”
entities
• Wherever there are requirements to communicate parts of an
Electronic Health Record (EHR) and to maintain the integrity of the
EHR data relationships
23

Positioning HL7
24

Ist16-02 HL7 from v2 (syntax) to v3 (semantics)

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