CDC Message Development Using HL7 Version 3 Principles

CDC Message Development Using HL7 Version 3 Principles

Mead WalkerJanuary 8, 2002

Presentation Outline

• Introduce CDC Projects

• Using national standardsHL7 in particular

• Review progress so far

• Consider impacts on V3 development

• What about impacts on other government work?

2002-01-08 3CDC Version 3 Messaging

Messaging Projects

• Notificationmanaging notificable disease reports

• Vital StatisticsBirth and Death information

• Anti-Microbial ResistanceReporting on antibiotic susceptibility and pharmacy drug use

The context for these

projects is provided

by something called

“NEDSS”


A Vision for National Electronic Disease Surveillance System (NEDSS)

• Gathers health data automatically from a variety of sources on a real-time basis

• Monitors the health of communities

• Assists in ongoing analyses of trends and detection of emerging public health problems

• Provides information for setting public health policies

• Is a system of interoperable systems like the Internet is a network of interoperable networks – is not a software program


NEDSS “at-a-glance”

• NEDSS is a broad initiative using national data and information system standards for development of efficient, integrated, and interoperable surveillance systems at the state and local levels

– Data standards—Conceptual data model, http://www.cdc.gov/cic– Harmonizing with HL7 Reference Information Model– NEDSS System Architecture http://www.cdc.gov/cic

• Includes tools for electronic data transfer to health department from health care system:

– Eg from multi-jurisdictional clinical labs

• Architecture built on Integrated Data Repository; data from health care to health department sent via

– single “pipeline”: single format, receiving point, security

• Security standards (HIPAA compliant) to maintain public health track record in protecting sensitive data

• Starts with focus—infectious disease—but keeps big picture in mind

http://www.cdc.gov/cic


“Standards and Derived Specifications”

National Standards

•“true” standards• needed for sharing• “conceptual”• not specific enough

Design Specifications

• standards?• “physical”• risk of proprietary nature• need national underpinning



National Standards


Design Specifications


• Use national standards wherever possible

• Use and publish “design specifications” in order to do the work

• Have a very high bar to change vs. derive

• Be prepared to follow the refinement of standards



National Standards


DesignSpecifications


• See that public health issues are represented in national standards

• Document specification development activities

• Use opportunities to promote the sometimes more difficult approach of using standards


A Philosophy for CDC Messaging Projects

• Develop HL7 Version 3 messages. – Use the RIM and the Message Development Framework. – Use HL7 vocabulary domains– Create a consistent set of work products across the projects.

• Influence HL7– Suggest RIM changes and vocabulary items– Plan to submit message formats for standardization

• Work within the technical architecture developed by NEDSS


Using the MDF - CDC Style

• Document messaging requirements

• Map relevant data to the RIM. Use data mapping as a source for the RMIM. (These two can be documented together with simple source data.)

• HL7 tooling supports definition of HMDs, message types, and XML schemas.

• Create mappings between message elements and source and target databases

• Address vocabulary issues by looking at HL7 domains first, but not last.


Current CDC Projects

• Notification Messaging– Communicate notifiable disease reports from states to CDC.– This is a core component of the NEDSS Base System.

• Vital Statistics– Provide a specification for Birth and Death information.– There is also a need to support “verification/certification”.

• Antimicrobial Use Reporting– Periodic (monthly) reporting of antibiotics use and organism

susceptibility from providers to CDC.– This is expected to be expanded to support reporting on

individual isolates.


Messaging Analysis

• Statement of RequirementsWe did not do formal use case analysis. This would be important for a “new” area.

• Messaging ScenariosThis documents needs for communication, and the discussion around those needs.

• Interaction DiagramA record of the interactions to be supported

• Interaction GridDocuments Trigger events, and message dependencies.


Notification Messaging Scenarios

I. Condition NotificationState or other reporting base system sends a notification to CDC. CDC will acknowledge receipt. A negative acknowledgement will be sent if the message that has been received cannot be processed.

II. Change/Retraction of Prior NotificationState or other reporting base system sends a notification update/change/retraction. This message will always provide a reference to the earlier notification that is being updated, changed, or retracted. CDC will acknowledge receipt. A negative acknowledgement will be sent if the message that has been received cannot be processed.

III. Summary NotificationState or other reporting base system provides total amounts for the reporting, during a specified time period, of a specific disease or condition to CDC. CDC will acknowledge receipt. A negative acknowledgement will be sent if the message that has been received cannot be processed.

IV. Notification ResponseCDC will provide a response to the state or other reporting base system once the CDC base system has processed the message. This message will indicate that the message was successfully processed by the interface engine. The state or other reporting base system will acknowledge receipt. A negative acknowledgement will be sent if the message that has been received cannot be processed


ID Interaction Name

Trigger Event

Event Precondition

Sender Receiver Receiver Responsibility

CDCNND1 Condition Notification

Notification Criteria Met

Relevant observations in hand

Base System

CDC Base System

Send # 4 Case Notification Acceptance Report

CDCNND 2 Change/ Retraction or Prior Notification

Modified Case Information Available

Error or omission detected in previously sent message

Base System

CDC Base System


CDCNND 3 Summary Notification

Summary notification criteria met

Request for summary data, or other reason for sending summary data

Base System

CDC Base System


CDCNND 4 Case Notification Acceptance Report

Case Notification Accepted

Receipt of notification message from base system.

CDC Base System

Base System

None

Interaction Specification

1: Condition Notification

Base System

CDC Base System

3: Summary Notification 4: Notification Response

2: Change/Retraction of Prior Notification


Diagram Based MappingActmood: eventclass cd: notificaitontype cd: RCTTYPEtype cd: SYSVERcritical date time: YEAR,WEEKstatus code: REPSTATUS

Participationtype_cd: author

Roleclass cd:jurisdictiontype_cd reportingentity:

EntityClass cd: Placetype cd: netss stateplace name: STATE

EntityClass cd: living subjectentity id: SUBJECTIDbirth date: DOBsex cd: SEXrace cd: HISPANIC,ASIAN, BLACK, AMIND,NAHAQ, WHITE, ORACErace modf: : OTH_SPEC

Actmood:: eventClass cd: casetype cd: EVENTactivity id: REPORTIDcritidal date time:ONSETDATEclassification status cd:CASE STATUSdisease imported code:IMPORTED

Participationtype_cd: location

Roleclass cd:jurisdictiontype_cd reportingentity:

EntityClass cd: Placetype cd: netss siteentity id: SITE

Actmood:: eventclass cd: obsvobsv value: RCDCOUNT

Act_relationshiptype_cd: pertains

EntityClass cd: placetyppe cd: netss countyplace name: COUNTY

Participationtype_cd: subjecttarget

Roleclass cd:residence

Participationtype_cd: location

Roleclass cd:jurisdictiontype_cd :reporting entity

Actmood: eventclass cd: obsvtype cd: AGETYPEvalue: AGE

Actmood: eventclass cd: obsvtype cd: AGETYPEvalue: AGE CAT

Locatorclass cd: postal addresstype cd: NETSS zip codestreeet address: POSTCD

Actmood: eventclass cd: obsvtype cd:: netss educationvalue: EDUC

EntityClass cd: Entity Grouptype cd: adultgroup count: ADLTHOUSE

Roleclass cd:: grouptype cd:membership inhouushold

EntityClass cd: Entity Grouptype cd: adultgroup count: CHILDHOUS

Roleclass cd: grouptype cd:membership inhouushold

Actmood: eventclass cd: diagmpsistype cd::actv date time: DIAGDATE

Actmood: eventclass cd: HRAtype cd:: : specimen collectionactv date time: SPECDATE

Roleclass_cd :specimen

EntityClass cd: materialtype cd: SPECTYPE

Actmood: eventclass cd: notificaitontype cd: first report to publichealthactivity date time: PHDATE

Actmood: eventclass cd: notificaitontype cd: first report to CDCactivity date time:FSTMXDATE

Actmood: eventclass cd: obsvtype cd:: netss observationindiccatorvalue:: OUTBREAKIND

Actmood: eventclass cd: outbreakidentifier: OUTBREAKID

Actmood: eventclass cd: obsvtype cd:: LABTESTactivity date time: LABDATEvalue: LABRESULT

Actmood: eventclass cd: obsvtype cd:: netss outcomevalue: OUTCOME

Actmood: eventclass cd: obsvtype cd:: netsshospitilazation indicatorvalue: HOSPITAL














Participationtype_cd:specimen

Locator_relationshiptype_cd: case relevant

• Can be constructed in a group session.

• Becomes an education on the HL7 RIM.

• Leads naturally into RMIM construction.


Mapping from Source DataNEDSS

VARIABLE NAME

DESCRIPTION/ DEFINITION

NEDSS NAME (RIM-

DERIVED)

VOCABULARY DOMAIN NAME

(SOURCE)

ACCEPTED VALUES

COMMENTS

MMWR_Week

MMWR week for which case information is counted for MMWR publication

Public_health_ case.effective_ time

The field includes the value for the MMWR week (as a number out of 52) prefaced by the literal WOY (for week of year; e.g., WOY37)

MMWR_Year

4-digits for year for which case information is counted for MMWR publication

Public_health_ case.effective_ time

The field includes the value for the MMWR year (4 digits), prefaced by the literal Y (e.g., Y2001); the value for MMWR year will be separated from the value for MMWR week by a comma

Record_Type

The type of record used for reporting.

MI_Notification. id

CDCInteractions (NEDSS)

Condition notification, change/retraction of prior notification, summary notification, notification response

This will be treated as a coded field, even though it is an instance identifier in the RIM

NETSS_ Version

Represents version of NETSS-2 or NETSS record is formatted in

Message.version_id

There is a clear need to identify the message version.

NND_Report_Type

NETSS record type M (MMWR or case record) or S (summary record)

MI_Notification.id

CDCInteractions (NEDSS)

Note, this data is highly intertwined with the message type.

NND_ Reporting_ State

State reporting case R_Reporter.addr AddressPartType (HL7 Data Types)

The address part type used for this data will be STA (state)

NND_ Reporting_ County

County name R_Reporter.addr AddressPartType (HL7 Data Types)

The address part type used for this data will be CPA (county/parish)

NND_ Reporting_City

City name R_Reporter.addr AddressPartType (HL7 Data Types)

The address part type used for this data will be CTY (city)

NND_ Reporting_ Zipcode

Zip Code of reporting location

R_Reporter.addr AddressPartType (HL7 Data Types)

The address part type used for this data will be ZIP (postal code)

• The detailed tabular mapping:– Covers a wealth of data– Includes domain information– Allows room for comments.


Notification RMIM (Rose UML model)

is_scoped_by

Living_subjectbirth_time : TSdeceased_ind : BLdeceased_time : TS

Personeducation_level_cd : CVethnic_group_cd : SET<CV>marital_status_cd : CVrace_cd : SET<CV>

E_ReportingPartycd : CEclass_cd : CSnm : SET<EN>determiner_cd : CS

E_NotificationRecipientcd : CEclass_cd : CSnm : SET<EN>determiner_cd : CS

R_Reporteraddr : SET<AD>cd : CEclass_cd : CSid : SET<II>

0..1played_by0..1

R_ReceivingJurisdictioncd : CEclass_cd : CS

0..10..1

played_by

P_NotificationInitiatortype_cd : CS

1..11..1has_as_participant

P_NotificationRecipienttype_cd : CS

1..1

has_as_participant

1..1

Messagecreation_time : TSid : SET<II>interaction_id : IIprocessing_cd : CVprocessing_mode_cd : CVprofile_id : SET<OID>receiving_application_id : SET<II>sending_application_id : IIversion_id : ST

MI_Notificationcd : C Vclass_cd : CSid : SET<II>mood_cd : CSpriority_cd : SET<CV>txt : EDactivity_time : GTS

1..*1..*has

1..11..1has

0..1

has_payload

0..1

AR_ObservationRelationshiptype_cd : CS

Proc_SpecimenCollectioncd : C Vclass_cd : CSmood_cd : CStxt : EDactivity_time : GTStarget_site_cd : SET<CD>

P_Specimentype_cd : CS

0..*

has

0..*

E_Specimencd : CEclass_cd : CSdeterminer_cd : CS

P_SpecimenHandlingtype_cd : CS

0..*0..*

has

Obsv_CaseObservationvalue : ANYcd : C Vclass_cd : CSmood_cd : CSinterpretation_cd : SET<CS>method_cd : SET<CV>activity_time : GTSeffective_time : GTS

0..*

1..1

has_target0..*

is_target_for

1..1 1..1

0..*

is_source_for

1..1

has_source0..*

P_ObservationParticipanttype_cd : CS

0..*

has

0..*

R_Specimenclass_cd : CS

1..11..1

has_as_participant

1..1

played_by

1..1

R_SpecimenResponsibilityclass_cd : CS

1..11..1has_as_participant

R_PartyRelationshipcd : CEclass_cd : CSeffective_time : IVL<TS>

R_CaseRelatedPartycd : CEclass_cd : CS

1..1

participates_in

1..1

E_CaseRelatedPartyclass_cd : CSdeterminer_cd : CSid : SET<II>

0..1

is_scoped_by

0..1

0..10..1played_by

0..1

0..*

plays0..1 played_by

0..*

0..*0..1 0..*

scopes

0..1

0..1

played_by

0..1

A_AssociatedNotificationactivity_time : GTSclass_cd : CSid : SET<II>mood_cd : CScd : C V

AR_Casetype_cd : CS

0..1

+is_target_for

0..1

AR_CaseObservationtype_cd : CS

1..11..1

has_source

AR_SpecimenCollectiontype_cd : CS

1..1

has_source

1..1

P_CaseParticipanttype_cd : CS

1..11..1

has_as_participant

AR_AssociatedNotificationtype_cd : CS

1..11..1

has_source

Public_health_casedetection_method_cd : CEdisease_imported_cd : CEtransmission_mode_cd : CEcd : C Vclass_cd : CSeffective_time : GTSid : SET<II>mood_cd : CSstatus_cd : SET<CS>activity_time : GTS

1..1has_source

1..1

0..*is_target_for

0..*

0..*has_target

0..*

0..*

has

0..*

0..*0..*

is_target_for

AR_PatientEncountertype_cd : CS

0..*0..*is_target_for

Patient_encounteractivity_time : GTSclass_cd : CSmood_cd : CS

1..1

has_source

1..1

Placeaddr : Set<AD>


Message Artifacts: HMD FragmentR

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(Attribute or Association) Rim Source Class

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3 hmd C13_ RIM_ 0108_ 001 NND Notification 07.16.01

NND 00.16.01 NND_ CaseReport NND_ CaseReport_ 080201

Common {35AB457E-ACCE-4059-B395-D85FC7A5BBB1}

4 class Message Message Message Messg NND_ CaseReport Messg N 0..15 attr creation_ time Message creation_ time creatnTime Messg TS D 0..1 M6 attr id Message id id Messg SET <II> D 1..1 M7 attr interaction_ id Message interaction_ id intrctnId Messg II D 1..18 attr processing_ cd Message processing_ cd procssng Messg CV D 0..1 ProcessingID CWE9 attr processing_ mode_ cd Message processing_ mode_ cd procssngMode Messg CV D 0..1 ProcessingMode CWE

10 attr profile_ id Message profile_ id profleId Messg SET <OID> D 0..111 attr receiving_ application_ id Message receiving_ application_ id recvngApplctnId Messg SET <II> D 1..1 M12 attr sending_ application_ id Message sending_ application_ id sendngApplctnId Messg II D 1..1 M13 attr version_ id Message version_ id versnId Messg ST D 0..1

14 assoc has_ payload Message has_ payload_ MI_ Notification hasPayld_ MI_ Notfctn

Messg MI_ Notfctn N 0..1

15 attr cd Act cd cd MI_ Notfctn CV D 0..1 ActCode CWE ####16 attr class_ cd Act class_ cd class MI_ Notfctn CS D 1..1 ActClass CNE M #### ######17 attr id Act id id MI_ Notfctn SET <II> D 0..118 attr mood_ cd Act mood_ cd mood MI_ Notfctn CS D 1..1 ActMood CNE M #### ######19 attr priority_ cd Act priority_ cd priorty MI_ Notfctn SET <CV> D 0..1 ActPriority CWE20 attr txt Act txt txt MI_ Notfctn ED D 0..121 attr activity_ time Act activity_ time actvtyTime MI_ Notfctn GTS D 0..122 assoc has Act has_ SetList_ P_ NotificationInitiator has_ P_ Notfctnn MI_ Notfctn SET <P_ Notfctnn> N 1..*23 item Act _ item_ P_ NotificationInitiator _ P_ Notfctnn SET <P_ Notfctnn> P_ Notfctnn N 124 attr type_ cd Participation type_ cd type P_ Notfctnn CS D 1..1 ParticipationType CNE M #### ######

25 assoc has_ as_ participant Participation has_ as_ participant_ R_ Reporter hasAsPartcpnt_ R_ Reprtr

P_ Notfctnn R_ Reprtr N 1..1

26 attr addr Role addr addr R_ Reprtr SET <AD> D 0..127 attr cd Role cd cd R_ Reprtr CE D 0..1 RoleCode CWE28 attr class_ cd Role class_ cd class R_ Reprtr CS D 1..1 RoleClass CNE M29 attr id Role id id R_ Reprtr SET <II> D 0..1

30 assoc played_ by Role played_ by_ E_ ReportingParty playdBy_ E_ Reprtngy

R_ Reprtr E_ Reprtngy N 0..1

31 attr cd Entity cd cd E_ Reprtngy CE D 0..1 EntityCode CWE32 attr class_ cd Entity class_ cd class E_ Reprtngy CS D 1..1 EntityClass CNE M33 attr nm Entity nm nm E_ Reprtngy SET <EN> D 0..134 attr determiner_ cd Entity determiner_ cd detrmnr E_ Reprtngy CS D 1..1 Determiner CNE M #### ######35 assoc has Act has_ P_ NotificationRecipient has_ P_ Notfctnt MI_ Notfctn P_ Notfctnt N 1..136 attr type_ cd Participation type_ cd type P_ Notfctnt CS D 1..1 ParticipationType CNE M #### ######

37 assoc

38 attr39 attr

40 assoc

41 attr42 attr43 attr44 attr

45 assoc

46 attr ######

47 assoc

48 attr49 attr50 attr51 attr52 attr53 attr54 attr CWE55 attr CWE56 attr CWE57 attr


Message Artifacts II: Schema Fragment• <?xml version="1.0" encoding="UTF-8" standalone="no"?>• • • <xsd:schema targetNamespace="urn::hl7.org/NTF_V1_001.01" xmlns="urn::hl7.org/NTF_V1_001.01" xmlns:v3dt="urn::hl7.org/v3dt" xmlns:hl7="urn::hl7.org" xmlns:xsd="http://www.w3.org/2001/XMLSchema"

elementFormDefault="qualified">• <xsd:annotation>• <xsd:documentation/>• <xsd:appinfo>• <hl7:hmdName>Notification Report</hl7:hmdName>• <hl7:hmdID>NEDSSNTF_V1_001</hl7:hmdID>• <hl7:messageID>NTF_V1_001.01</hl7:messageID>• <hl7:rmimID>NND 00.16.01</hl7:rmimID>• </xsd:appinfo>• </xsd:annotation>• • <xsd:import namespace="urn::hl7.org/v3dt" schemaLocation="v3dt.xsd"/>• <xsd:import namespace="urn::hl7.org/IMCO_MC_MT00001" schemaLocation="IMCO_MC_MT00001.xsd"/>• <xsd:element name="MI_Notfctn" type="NTF_V1_001.01">• <xsd:annotation>• <xsd:appinfo>• <hl7:rowType>Class</hl7:rowType>• <hl7:METsource>N</hl7:METsource>• <hl7:hmdClass>Message_interaction</hl7:hmdClass>• <hl7:hmdProperty>MI_Notification</hl7:hmdProperty>• <hl7:hmdRowID>NEDSSNTF_V1_001-NEDSSNTF_V1_001-MI_Notfctn-hmd</hl7:hmdRowID>• </xsd:appinfo>• </xsd:annotation>• </xsd:element>


Lessons Learned and to be Worked on

• The process for creating message specifications works

• XML has wide credibility, and becomes a major selling point. However XML implementation skills are just developing. (Specifically the implementation of XML as a messaging format.)

• The tooling to support schema creation is still evolving.

• HL7 datatypes can provide a shock. This needs to be cushioned by agreed on methods for simplification.


Item for Discussion

• What about impacts on other government work?

Any More Questions?

Mead WalkerHealth Data & Interoperability Consulting

T: 610-518-6259F: 509-357-7983E: [email protected]