1 HL7 Version 3 at NCICB Overview Session Details Introduction Reference Information Model (RIM) HL7 Modeling Conventions HL7 Process & Artifacts,

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HL7 Version 3 at NCICB Overview

Session Details

Introduction

Reference Information Model (RIM)

HL7 Modeling Conventions

HL7 Process & Artifacts, Vocabulary & Data Types

HL7 Version 3 at NCI

Web Resources

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Session Details

Target Audience:– Developers and Analysts– Adopters

Prerequisites:– Modeling concepts

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Session Details:

Presenters and Participants

<Presenter’s name here>

Who is in attendance?– Name– Title– Cancer Center– Reason for Attending

Note:

This training can also be used as a self-paced training. (See notes for each slide)

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Session Details:Training Objectives

Objectives of this training are to:– Provide an overview of HL7 version 3– Define terms and concepts used in HL7– Describe the HL7 modeling methodology– Introduce reason for HL7 version 3 at NCICB

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Introduction

In this section, we will:– Introduce the HL7 organization and the version 3 standard– Discuss the goal of HL7

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Introduction:

What is HL7?

Heath Level Seven (HL7) is an ANSI-accredited Standards Developing Organization (SDO) operating in healthcare arena

Provides standards for data exchange to allow interoperability between healthcare information systems

HL7 focuses on the clinical and administrative data domains

It is a not-for-profit organization made up of volunteers – providers, payers, vendors, government

Key goal is syntactic and semantic interoperability

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Introduction:

4 Pillars of Semantic Interoperability

The 4 pillars of semantic interoperability are:

1. A common Reference Information Model (RIM) spanning the entire clinical, administrative and financial healthcare universe

2. A well-defined and tool-supported process for deriving data exchange specifications ("messages") from the RIM

3. A formal and robust Data Type Specification upon which to ground the RIM

4. A formal methodology for binding concept-based terminologies to RIM attributes.

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Reference Information Model (RIM)

In this section, we will:– Discuss the modeling concepts used in HL7 Version 3– Describe the Backbone Classes of the HL7 RIM

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Reference Information Model (RIM):

Overview

Reference Information Model (RIM):

Follows object oriented developmental methodology based on a UML model

The fundamental model from which all v3 messages are derived is referred to as the Reference Information Model (RIM)

The RIM is a generic, abstract model that expresses the information content of all the areas of healthcare

Defines all the information from which the data content of HL7 messages are drawn

Forms a shared view of the healthcare domain and is used across all HL7 messages independent of message structure

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Reference Information Model (RIM):

Backbone Classes

A physical thing, group of physical things or an organization capable of participating in Acts, while in a role.

A physical thing, group of physical things or an organization capable of participating in Acts, while in a role.

A record of something that is being done, has been done, can be done, or is intended or requested to be done.

A record of something that is being done, has been done, can be done, or is intended or requested to be done.

A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role.

A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role.

An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance.

An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance.

Entity Role Participation Act

A connection between two roles expressing a dependency between those roles.

A connection between two roles expressing a dependency between those roles.

A directed association between a source act and a target act.

A directed association between a source act and a target act.

Role Link Act Relationship

0..1

0..n

1

0..n

0..n

1

0..1

0..n

0..n 0..n

1 1

0..n 0..n

1 1

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Reference Information Model (RIM)

Backbone Class: Entity

Entity

classCode : CSdeterminerCode : CSid : SET<II>code : CEquantity : SET<PQ>name : BAG<EN>desc : EDstatusCode : SET<CS>existenceTime : IVL<TS>telecom : BAG<TEL>riskCode : CEhandlingCode : CE

Entity: a person, animal, organization or thing

A collection of classes related to the Entity class, its specializations and related qualifying classes. The classes represent health care stakeholders and other things of interest to health care.

Entity has the following sub-classes:ContainerDeviceLanguageCommunicationLivingSubjectManufacturedMaterialMaterialNonPersonLivingSubjectOrganizationPersonPlace

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Reference Information Model (RIM):

Backbone Class: Role

Role

classCode : CS

id : SET<II>code : CEnegationInd : BLaddr : BAG<AD>

telecom : BAG<TEL>statusCode : SET<CS>effectiveTime : IVL<TS>

certificateText : ED

quantity : RTOpositionNumber : LIST<INT>...

Roles:

A responsibility or part played by an entity (e.g. Person in a role of patient, employee, etc.) – different faces of an Entity

A collection of classes related to the Role class and its specializations. These classes focus on the roles participants may play in health care.

Role has the following sub-classes:AccessEmployeeLicensedEntityPatient

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Reference Information Model (RIM): Backbone Class: RoleLink

RoleLink

typeCode : CS

effectiveTime : IVL<TS>

Role

0..n outboundLink

0..nsource

0..n

inboundLink0..n

RoleLink:

A connection between two roles expressing a dependency between those roles.

RoleLink has no sub-classes.

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Reference Information Model (RIM):

Backbone Class: Participation

Participation

typeCode : CSfunctionCode : CDcontextControlCode : CS...

sequenceNumber : INTnegationInd : BLnoteText : EDtime : IVL<TS>modeCode : CEawarenessCode : CEsignatureCode : CE

signatureText : EDperformInd : BLsubstitutionConditionCode : CE

Participation:

An association between an Act and a Role with an Entity playing that Role.

Participation has the following sub-class:

ManagedParticipation

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Reference Information Model (RIM):

Backbone Class: Act

Act

classCode : CS

moodCode : CS

id : SET<II>code : CDnegationInd : BLderivationExpr : ST

text : EDtitle : STstatusCode : SET<CS>effectiveTime : GTS

activityTime : GTS

availabilityTime : TSpriorityCode : SET<CE>confidentialityCode : SET<CE>repeatNumber : IVL<INT>interruptibleInd : BLlevelCode : CEindependentInd : BL

uncertaintyCode : CEreasonCode : SET<CE>languageCode : CE

Act:

A collection of classes including the Act class and its specializations. These relate to the actions and events that constitute health care services. A record of something that is being done, has been done, can be done, or is intended or requested to be done.

Act has the following sub-classes:AccountControlActDeviceTaskDiagnosticImageDietFinancialContractFinancialTransactionInvoiceElement

ObservationParticipationPatientEncounterProcedurePublicHealthCaseSubstanceAdministrationSupplyWorkingList

Note: Sub-classes also include Core Infrastructure, Message Communications Control and Structured Documents classes not shown here.

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Reference Information Model (RIM): Backbone Class: ActRelationship

ActRelationship

typeCode : CSinversionInd : BL

contextControlCode : CS

contextConductionInd : BL

sequenceNumber : INTpriorityNumber : INTpauseQuantity : PQ

checkpointCode : CS

splitCode : CSjoinCode : CSnegationInd : BLconjunctionCode : CS

localVariableName : ST

seperatableInd : BL

Act

0..n

outboundRelationship0..n

source

inboundRelationship

0..n

target1

ActRelationship:

A directed association between a source Act and a target Act. A point from a later instance to a earlier instance OR point from collector instance to component instance.

ActRelationship has no sub-classes.

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Reference Information Model (RIM): The Complete RIM

11

11

Observation

...

SubstanceAdministration

routeCode : CE...

Procedure

...

Supply

...

Diet

...

Document

...

ContainercapacityQuantity : PQheightQuantity : PQdiameterQuantity : PQcapTypeCode : CE...

AccessapproachSiteCode : CD......

DevicemanufacturerModelName : SCsoftwareName : SClocalRemoteControlStateCode : CE......

EmployeejobCode : CEjobTitleName : SCjobClassCode : CEsalaryTypeCode : CE...

LivingSubjectadministrativeGenderCode : CE...birthTime : TSdeceasedInd : BLdeceasedTime : TS...

MaterialformCode : CE...

LicensedEntityrecertificationTime : TS...Place

mobileInd : BLaddr : ADdirectionsText : ED......

ManufacturedMateriallotNumberText : ST...

NonPersonLivingSubject...

Patient...

Organization...

Account

...

Person

addr : BAG<AD>...maritalStatusCode : CE......

WorkingList

ownershipLevelCode : CE...

PublicHealthCase

...

PatientEncounterpreAdmitTestInd : BLadmissionReferralSourceCode : CElengthOfStayQuantity : PQdischargeDispositionCode : CEspecialCourtesiesCode : SET<CE>...

Other

Acts

Infrastructure (Structured documents)

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL VERSION 1.23 (RIM_0123)

Reflects changes to RIM in RIM Harmonization Meeting 03/20/2003.

Bi l l board produced by:Rochest er O ut door Advert i si ng

Roles

DiagnosticImage

subjectOrientationCode : CE...

QueryAck

...

QueryContinuation

...

Table

summary : ST......

TableStructure

...

TableColumnStructure

span :

TableCell

scope : CS...

LocalAttr

...

LocalMarkup

...

LinkHtml

...

ContextStructure

localId : ST

Infrastructure (Structured documents)

Infrastructure (Communications)

Enitites

Message Control

FinancialTransaction

...

InvoiceElement

modifierCode : SET<CE>......

FinancialContract

paymentTermsCode : CE...

RoleHeir

EntityHeir

SortControlsequenceNumber : INT......

QuerySpecmodifyCode : CSresponseElementGroupId : SET<II>...responseModalityCode : CSresponsePriorityCode : CS...

0..n

1

0..n

1

RelationalExpression

...

QueryBySelection SelectionExpression0..n

1

0..n

1

LogicalExpression

relationalConjunctionCode : CS...

0..n

0..1

user AsRight

0..n

r ightSide 0..1

0..n

0..1

user AsLeft0..n

leftSide0..1

QueryByParameter

ParameterList

Parameter

id : II0..n 0..10..n 0..1

0..1

0..n

0..1

0..n

Parameter Item

...

DeviceTask

parameterValue : LIST<ANY>...

ManagedParticipation...

ActHeir

ActRelationship

typeCode : CSinversionInd : BL...contextControlCode : CS...contextConductionInd : BL......

Act

classCode : CSmoodCode : CSid : SET<II>code : CDnegationInd : BLderivationExpr : ST......

0. . n1

inboundRelat ionship

0. . n

t ar get

1

0. . n1

out boundRelat ionship

0. . n

sour ce

1

ParticipationtypeCode : CSfunctionCode : CDcontextControlCode : CSsequenceNumber : INTnegationInd : BLnoteText : EDtime : IVL<TS>modeCode : CE...

0. . n1

0. . n1

RoleLink...

RoleclassCode : CSid : SET<II>code : CEnegationInd : BLaddr : BAG<AD>telecom : BAG<TEL>statusCode : SET<CS>...

0. . n1

0. . n1

0. . n1

out boundLink

0. . n

sour ce

1

0. . n1

inboundLink

0. . n

t ar get

1

LanguageCommunicationlanguageCode : CEmodeCode : CE...

AttentionLine...

BatchreferenceControlId : IIname : SC...

EntityclassCode : CSdeterminerCode : CSid : SET<II>code : CEquantity : SET<PQ>name : BAG<EN>desc : EDstatusCode : SET<CS>...

0. . n0. . 1

playedRole

0. . n

player

0. . 1

0. . n0. . 1

scopedRole

0. . n

scoper

0. . 1

10..n 10..n

Transmissionid : II...

0..n

1

0..n

1

0..1

0..n

0..1

0..n

CommunicationFunction

typeCode : CStelecom : TEL

1..n

0..*

1..n

0..*1..*

0..*

1..*

0..* InfrastructureRoot

...QueryEvent

...

ControlAct

...

0..1

1

0..1

1

MessageversionId : STinteractionId : IIprofileId : SET<II>processingCode : CSprocessingModeCode : CSacceptAckCode : CSapplicationAckCode : CS...

0. . 1

0. . n

0. . 1

payload

0. . n

Acknowledgement

...

0. . n

1

ack nowledgedBy0. . n

acknowledges1

0. . 1

1

conveyedAcknowledgem ent0. . 1

conveyingM essage1

AcknowledgementDetail

...

1

0..n

1

0..n

Domain Related

Infrastructure Related Structured Documents

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Reference Information Model (RIM):

RIM-UML Instance Scenario

John DoeJohn Doe PatientPatient SubjectSubject

Entity Role Participation Act

Dr. SmithDr. SmithHealthCare

ProviderHealthCare

ProviderSurgeon*Surgeon*

John DoeJohn Doe PatientPatient SubjectSubject

Has Pertinent InformationHas Pertinent InformationAct Relationship

(Clinical Trial Act)

Protocol ECOG 1112(Clinical Trial Act)

Protocol ECOG 1112

XYZ HospitalXYZ HospitalHealthCare

Facility*HealthCare

Facility*LocationLocation

(Procedure Act)

Prostectomy(Procedure Act)

Prostectomy

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HL7 Version 3 Process & Artifacts

In this section, we will discuss:– Domain Message Information Model (DMIM)– Refined Message Information Model (RMIM)– Hierarchal Message Definitions (HMDs) – Message Type (MT)

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HL7 Version 3 Process & Artifacts:

Overall Process

RIM D-MIM R-MIM

1..* 1..*

1..*HMD MT

1..*

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Entry points

HL7 Version 3 Process & Artifacts:Examples

Arrows

Color-coding

Labeling

Directional

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Reference Information Model (RIM): HL7 Modeling Conventions

Color-coding – colors of classes in the model denote the type of backbone class to which it belongs

Arrows – Participations, ActRelationships and RoleLinks are directional arrows that have rather than being lines that connect classes like in UML

Entry points – where to start reading the model; DMIMs have one or more entry points, RMIMs have one

RMIMs are directional – all associations flow out from the entry point to the remaining parts of the model

Labeling – associations in RMIMs are labeled on the distal end only

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HL7 Process & Artifacts:

Domain Message Information Model (DMIM)

A DMIM is a refined subset of the RIM that includes a set of class clones, attributes and relationships that can be used to create messages for a particular domain (a particular area of interest in healthcare).

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HL7 Process & Artifacts:

Refined Message Information Model (RMIM)

The RMIM is a subset of a DMIM that is used to express the information content for a message or set of messages with annotations and refinements that are message specific.

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HL7 Process & Artifacts:

Hierarchal Message Definitions (HMDs)

A Hierarchal Message Definition (HMD) is a serialized version of the RMIM in a specific order.

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HL7 Process & Artifacts:

Message Type (MT)

The Message Type elements and attributes in an XML message instance correspond to the sequence of data in the HMD

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Vocabulary & Data Types

In this section, we will discuss:– HL7 Standard Vocabulary

• Structural Attributes – prescribed HL7 vocabulary

• Non-Structural Attributes – vocabulary chosen by organization– Robust Data Types

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Vocabulary & Data Types:

Structural Attributes

Structural attributes are used to specify type and state of each RIM

class and what it means when used in a message. They use a standard vocabulary defined and controlled by HL7.

An Act of the Class Observation (OBS) with a Mood of Event (EVN).

classCode and moodCode are both Structural Attributes

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Vocabulary & Data Types :

Non-Structural Attributes

Other attributes don’t have an assigned vocabulary

Organizations can choose any industry standard vocabulary

For example, commonly used ones for Observation Acts are LOINC, SNOMED, MedDRA, etc.

Must specify more than just the code value, other data is needed for semantic interoperability…this is where data types come in

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Vocabulary & Data Types :

Data Types

What is a data type?

lengthOfStayQuantity is attribute of the EncounterProcess class.

lengthOfStayQuantity has a data type of Physical Quantity (PQ).

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Vocabulary & Data Types :

Data Types

Data types in HL7 version 3 are complex

Each data type has attributes

Each attribute has a data type of its own

<lengthOfStayQuantity value=“10” unit=“hours"/>

Physical Quantity (PQ) example

The attributes ‘value’ and ‘unit’ are part of the complex data type Physical Quantity (PQ). Value is expressed as the data type of integer (int).

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HL7 Version 3 at NCICB

In this section, we will discuss:– Why HL7 at NCICB?– NCICB Clinical Architecture Vision – caAdapter

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HL7 Version 3 at NCICB:

Why HL7?

Recommended by the Health and Human Service (HHS) as the messaging standard for electronic exchange of clinical data.

Over 90% of US hospitals have implemented some version of 2.x HL7 messages.

Support for translational research requires integration of research data with the clinical data. – V3 offers the syntactic and semantic interoperability to make this

possible

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HL7 Version 3 at NCICB:

NCICB Clinical Architecture Vision

HL7 version 3 supports messaging within the NCICB Clinical Architecture Vision.

etc.TissuesLabs

JDBC 2

Analytical ApplicationsAnalytical and

Reporting Tools (SAS, WebSDM, ToxViewer, I-

Review, etc.)

Ad HocQueryTool

BIO-gopher

Master Index

MessageExchangeServices(ebXML)

Translation Service(CAM/caAdapter)

ElectronicMedical

Record (EMR)

HL7 v3

Excel, Text,HL7 v2,

etc.

HL7 v3HL7 v3

HL7 Transactional

Database (HTB)

Extensions(CDUS/CTMS)

Base Janus Model

BRIDG

Clinical/Clinical Trials Applications

C3DcaMATC

H C3PR SAE

Study Specific Analysis Data

ClinicalData Sources

Patient Identifiable Clinical Environment

caGRID

caBIG

HL7 v3

SecureTransportBetween

Sites

caBIO/CTOM

HL7 RIM

BRIDG

caBIO/CTOM

HL7 RIM

FDA

SPONSOR

CTEP

DCP

Other

ExternalAgencie

s

HL7 v3

HL7 v3

Common Security Module (CSM) Enterprise Vocabulary Service (EVS) Data Standards Repository (caDSR)

SecureTransportBetween

Sites

Excel, Text,

HL7 v1, v2, etc.

De-Identification/Re-Identification

Service

HL7 v3

eCTD,Excel, Text,HL7 v2,etc.

Translation Service(CAM/caAdapter)

HL7 v3

caPRI

FIREBIRD

CRIX Data Repository

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HL7 Version 3 at NCICB:

Highlights of the NCICB Clinical Architecture Vision

caAdapter – Open source toolkit which facilitates v3 message building, parsing and validation

Message Exchange – Service supporting message transmission and routing

HL7 Transactional Database - HL7 RIM-based transactional database and data access service

De-identification Service – Service for de-identifying patient information from HL7 messages

Analytical Applications - Applications for querying, reporting, mining clinical data

Cancer Data Standards Repository (caDSR) - Shared metadata repository

Enterprise Terminology Services (EVS) - Terminology service for hosting controlled vocabulary, including HL7 registered terminology

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HL7 Version 3 at NCICB:

caAdapter

Facilitates the building, parsing, and validation of HL7 v3 messages

Components include:– HL7 v3 Message Parser – parses HL7 version 3 messages to RIM object

graph– HL7 v3 Message Builder – builds HL7 version 3 messages from the RIM

object graph– HL7 v3 Artifacts – implements RIM objects, data types and metadata

objects– Metadata Loader – represents HL7 version 3 metadata in-memory– Validation Services – integrates with NCICB caCORE components such as

Enterprise Vocabulary Service (EVS) and W3C XML schema validation services

– Mapping Tool – maps clinical data to the HL7 version 3 message specification currently, with extensible mapping and data transformation in the near future

– caAdapter API – uses mappings to generate HL7 version 3 messages– Message Service – integrates with message exchange services (future

plans)

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HL7 Version 3 at NCICB:

caAdapter

A platform to enable clinical applications to build and parse HL7 v3 messages based on specific schema definitions.

Capability to perform vocabulary validation of the RIM structural attributes.

An open source solution for implementing an international messaging standard allowing data to be exchanged between disparate systems.

Integration with NCI metadata repository (caDSR) and terminology services (EVS)

Facilitating the building and parsing of HL7 v3 messages from source clinical systems will promote data exchange in a standards based common format.

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Recommended Resources

Health Level Seven www.hl7.org

HL7 Reference Information Model https://www.hl7.org/library/data-model/RIM/C30202/rim.htm

HL7 Vocabulary Domains http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm

HL7 Version 3 Standard http://www.hl7.org/v3ballot/html/welcome/environment/index.htm

NCICB caAdapter Project Site trials.nci.nih.gov/projects/infrastructureProject/caAdapter

HL7 Version 3: Driving Interoperability & Transforming Healthcare Information Management - Charles Mead, MD, MSc NIHSeminar_Charlie Mead.ppt