CDC Message Development Using HL7 Version 3 Principles Mead Walker January 8, 2002
Jan 07, 2016
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 th
ese
projects is provided
by something called
“NEDSS”
2002-01-08 4CDC Version 3 Messaging
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
2002-01-08 5CDC Version 3 Messaging
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
2002-01-08 6CDC Version 3 Messaging
“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
2002-01-08 7CDC Version 3 Messaging
“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
• 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
2002-01-08 8CDC Version 3 Messaging
“Standards and Derived Specifications”
National Standards
•“true” standards• needed for sharing• “conceptual”• not specific enough
DesignSpecifications
• standards?• “physical”• risk of proprietary nature• need national underpinning
• 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
2002-01-08 9CDC Version 3 Messaging
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
2002-01-08 10CDC Version 3 Messaging
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.
2002-01-08 11CDC Version 3 Messaging
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.
2002-01-08 12CDC Version 3 Messaging
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.
2002-01-08 13CDC Version 3 Messaging
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
2002-01-08 14CDC Version 3 Messaging
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
Send # 4 Case Notification Acceptance Report
CDCNND 3 Summary Notification
Summary notification criteria met
Request for summary data, or other reason for sending summary data
Base System
CDC Base System
Send # 4 Case Notification Acceptance Report
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
2002-01-08 15CDC Version 3 Messaging
Diagram Based Mapping
Actmood: 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
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
Act_relationshiptype_cd: pertains
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.
2002-01-08 16CDC Version 3 Messaging
Mapping from Source Data
NEDSS 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.
2002-01-08 17CDC Version 3 Messaging
Notification RMIM (Rose UML model)
is_scoped_by
Living_subject
birth_time : TSdeceased_ind : BLdeceased_time : TS
Person
education_level_cd : CVethnic_group_cd : SET<CV>marital_status_cd : CVrace_cd : SET<CV>
E_ReportingParty
cd : CEclass_cd : CSnm : SET<EN>determiner_cd : CS
E_NotificationRecipient
cd : CEclass_cd : CSnm : SET<EN>determiner_cd : CS
R_Reporter
addr : SET<AD>cd : CEclass_cd : CSid : SET<II>
0..1played_by0..1
R_ReceivingJurisdiction
cd : CEclass_cd : CS
0..10..1
played_by
P_NotificationInitiator
type_cd : CS1..11..1
has_as_participantP_NotificationRecipient
type_cd : CS1..1
has_as_participant
1..1
Message
creation_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_Notification
cd : C Vclass_cd : CSid : SET<II>mood_cd : CSpriority_cd : SET<CV>txt : EDactivity_time : GTS
1..*1..*
has1..11..1
has
0..1
has_payload
0..1
AR_ObservationRelationship
type_cd : CS
Proc_SpecimenCollection
cd : C Vclass_cd : CSmood_cd : CStxt : EDactivity_time : GTStarget_site_cd : SET<CD>
P_Specimen
type_cd : CS
0..*
has
0..*
E_Specimen
cd : CEclass_cd : CSdeterminer_cd : CS
P_SpecimenHandling
type_cd : CS0..*0..*
has
Obsv_CaseObservation
value : 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_ObservationParticipant
type_cd : CS
0..*
has
0..*
R_Specimen
class_cd : CS1..11..1
has_as_participant
1..1
played_by
1..1
R_SpecimenResponsibility
class_cd : CS1..11..1
has_as_participantR_PartyRelationship
cd : CEclass_cd : CSeffective_time : IVL<TS>
R_CaseRelatedParty
cd : CEclass_cd : CS
1..1
participates_in
1..1
E_CaseRelatedParty
class_cd : CSdeterminer_cd : CSid : SET<II>
0..1
is_scoped_by
0..1
0..10..1
played_by
0..1
0..*
plays0..1 played_by
0..*
0..*0..1 0..*
scopes
0..1
0..1
played_by
0..1
A_AssociatedNotification
activity_time : GTSclass_cd : CSid : SET<II>mood_cd : CScd : C V
AR_Case
type_cd : CS
0..1
+is_target_for
0..1
AR_CaseObservation
type_cd : CS1..11..1
has_source
AR_SpecimenCollection
type_cd : CS1..1
has_source
1..1
P_CaseParticipant
type_cd : CS
1..11..1
has_as_participant
AR_AssociatedNotification
type_cd : CS
1..11..1
has_source
Public_health_case
detection_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..1
has_source
1..1
0..*
is_target_for
0..*
0..*has_target
0..*
0..*
has
0..*
0..*0..*
is_target_for
AR_PatientEncounter
type_cd : CS0..*0..*
is_target_for
Patient_encounter
activity_time : GTSclass_cd : CSmood_cd : CS
1..1
has_source
1..1
Place
addr : Set<AD>
2002-01-08 18CDC Version 3 Messaging
Message Artifacts: HMD FragmentR
ow
Nu
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Ro
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Class or Property of Class
(Attribute or Association) Rim Source Class
InsertColumn Message Element Name
Message Element Short Name in
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InsertRow
3 hmd C13_ RIM_ 0108_ 001NND Notification 07.16.01
NND 00.16.01 NND_ CaseReportNND_ 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_ NotificationhasPayld_ 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_ ReporterhasAsPartcpnt_ 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_ ReportingPartyplaydBy_ 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 attr
39 attr
40 assoc
41 attr
42 attr
43 attr
44 attr
45 assoc
46 attr ######
47 assoc
48 attr
49 attr
50 attr
51 attr
52 attr
53 attr
54 attr CWE55 attr CWE56 attr CWE57 attr
2002-01-08 19CDC Version 3 Messaging
Message Artifacts II: Schema Fragment
• <?xml version="1.0" encoding="UTF-8" standalone="no"?>
• <!-- edited with XML Spy v4.1 U (http://www.xmlspy.com) by MeadWalker (Computer Sciences Corporation) -->
• <!--
• This schema document has been automatically generated
• from NEDSSNTF_V1_001.xml by hmd2xsd.xsl,
• version 0.3.
• Other than the value of the default NS decl and any NS decls for
• CMETs, this schema document should NOT be hand edited; rather, the
• original HMD should be modified in RoseTree, serialized as XML and
• then this schema document should be regenerated.
• -->
• <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>
• <!--
• import the schemas for other namespaces, i.e., V3DT and any
• CMETs needed
• -->
• <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>
2002-01-08 20CDC Version 3 Messaging
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.
2002-01-08 21CDC Version 3 Messaging
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]