HL7 Version 3 in Europe A Standard in Practice HL7...HL7 Version 3 in Europe A Standard in Practice Strategies & Concepts to Real Implementations BALTIC IT&T 2006 FORUM: eBaltics –

HL7 Version 3 in Europe A Standard in Practice

Strategies & Concepts toReal Implementations

BALTIC IT&T 2006 FORUM: eBaltics – Riga (LV) April 5-7, 2006

Dr. Kai U. Heitmann M.D.Managing Consultant, Heitmann Consulting and Services (The Netherlands)Institute for Medical Statistics, Informatics & Epidemiology, University of Cologne (Germany)

Director International Affiliates - Board of Directors HL7 USAChair HL7 Germany


eHealth Questions (and answers):What is HL7? And why do we need it?

How to start?

HL7 “Europe” and Worldwide:What happened so far?

How to conclude?

3

eHealth Concepts - Questions

• Applications?– Prioritize functionality for patients & providers

• Communication?– Facilitate electronic data exchange– Allow cross-sectoral communication

• Infrastructure?– Highway for healthcare information– Dealing with Transport & Security

• Plan and Vision?– Analysis of Care Processes– Strategy and steps towards an EHR

4

Health Level Seven - The Organization

• HL7, founded 1987

• ANSI-accreditedStandards DevelopmentOrganization

• Approx. 2200 members

• First non-US country„joined“ early 90s

• Official first affiliates in 1992 (Germany,Canada, the Netherlands)

ISO’s Open SystemsInterconnect (OSI) model:Application Level” – level 7

5

Who is HL7?

• Over 500 organizational members, about 2200total members

• Up to 500 attend Working Group Meetings -including about 20% international attendees at

• International: 33 countries– US– Affiliates in Canada, Europe, Asia-Pacific, Latin

America, Africa

6

HL7 International (more than 30 countries)

FinlandFinland

United StatesUnited States

CanadaCanada

FranceFranceJapanJapanIndiaIndia

PolandPolandDenmarkDenmark

ArgentinaArgentina

CroatiaCroatia

AustraliaAustralia

UnitedUnitedKingdomKingdom

TurkeyTurkey TaiwanTaiwan

SwitzerlandSwitzerland

New ZealandNew Zealand

The NetherlandsThe NetherlandsGermanyGermany

KoreaKorea

Southern AfricaSouthern Africa

MexicoMexico

ChinaChina

LithuaniaLithuania

BrazilBrazil

GreeceGreece

IrelandIrelandItalyItaly

Czech RCzech R

SpainSpainBulgariaBulgaria

MalaysiaMalaysia

UruguayUruguay

ChileChile

7

UK2000

Ireland2003

Netherlands1996

Germany1995

France2004

Spain2003

Finland1996

Poland2003

Czech Republic2001

Lithuania2002

Denmark2003

Italy2003Switzerland

2000

Croatia2001

Latvia2006?

HL7 in Europe

• Starting point (1995) of International Activities / Affiliates

• 16 European Affiliates

Portugal2006? Bulgaria

2005

Austria2006?

Sweden2006

8

HL7 Version 3

• Basically– HL7 Version 3 is a family of object-oriented

communication standards, based on theHL7 Reference Information Model (RIM)

– The RIM is a worldwide accepted model for healthinformation

– Also basis for other SDOs (CEN, ISO)– Used in many projects and real world environments for

more than 3 1/2 years now (Early Implementers)

• Models as a base of all products within HL7 V3– Symbolic structured representation of parts of the reality– UML (Universal Modeling Language) used

9

Version 3 is based on models

• Models are the “common” language to expresscontent, structure and interactions forcommunication– Content: Data types, Vocabulary– Structures and Semantics of the information– Interactions between communicating parties

• Messages are the result when putting together– The static model– The dynamic model

• Answers the question: When do Iexchange/share what?

10

Role Participation ActEntity

HL7 Version 3

• „Building bricks“ forcommunication models– Reference Information Model RIM– All objects, activities and their

relationship in ONE generichealthcare model

11

What‘s exciting about HL7 Version 3?

• Supports cross-sectoral cross-sectoral Care Process ChainsCare Process Chains• Reflects internationalinternational contributions/standards• Reflects expert knowledgeexpert knowledge collected over decades

General Pract

Patient Aftercare

Hospital Surg

Rad

Lab

Specialist

Healthcare System

Information flow

12

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 that istechnology-neutral– able to be used with whatever is the technology de jour

(e.g. XML, UML, etc.)

13

How is Version 3 “better”?

• Maintain a repository (database) of thesemantic content– assure a single source– enable development of support tooling

• Tools to auto-generate XML schemas– for messages once the semantic content is final (via

ballot and conformance constraints)

• Tools for documentation of constraints– for both message definition and conformance

specifications



How to start?

HL7 in “Europe”:What happened so far?

How to conclude?

15

“proprietary” CDAHL7 v3 …“payload”content

HL7 |^~ XML …exchangeformat

Starting V3

MLLP ebXML WS-* FTP/S S/MIME HTTP/S …transportsecurity

• Starting real life project means...dealing with all these challenges & layers– Content– Exchange Format (=XML..., what else!?)– Transport & Security (Infrastructure / Framework,

International solutions / standards, Legal requirements)

16

“Layers” of activities in Europe

• XML encoding and applicationbuilding

• V3 messaging standard– early implementor projects

• V3 based documents

• Infrastructure and Framework

• Education

XML

InfrastructureSecurity

CDA

HL7 v3

Training

17

Drivers for v3 adoption

•• Need of support for large scale integrationNeed of support for large scale integration

• V3 has “built-in” support for ComplexDatatypes– “universally unique” instance identifiers for persons,

places, organizations, practitioners, URL’s, orders,observations, etc.

– internationally feasible name datatype (persons andorganizations)

– time and date-related datatype forms– codes (binding standard vocabularies to RIM attributes)

18

Drivers for v3 adoption

• V3 has “built-in” support for large scaleintegration (city, region, province, nationwide,international)– a coherent set of (structures) models guaranteeing

semantic interoperability and re-usability– identifier strategy supporting wide integration– models and tools based design and implementation

• Support of decision support and rules-basedprocessing



How to start?


How to conclude?

20

Short Trip through Europe

• Visiting some EU Activities and Activists

• HL7 Version 3 in Practice

UK

NetherlandsGermany

Finland

Croatia

Lithuania

HL7 Activities in…

Croatia

22


HL7 v3 TrainingCroatia

• HL7 Croatia in September 2002– Croatian Society for Medical Informatics (CSMI) and

Croatian Society for Medical and Biological Engineering(CROMBES)

– Supported by• Ministry of Health of the Republic of Croatia• Croatian State Office for Standardization and Metrology• Croatian Public Health Institute

– Education

• National Infrastructure Project• WebService Based Infrastructure for the Exchange of

Information• Large Mobile Phone vendor


Finland

24

Finland

• Use of HL7‘s Clinical Document Architecture– Start of activities around 2000– Connection implementation within four health districts in

Finland

• HL7 Finland defined application level protocol– Based on ebXML

• Currently: exchange of other documents likereferrals, prescriptions and health certificates


CDA

25

Finland

• CDA Release 2– specifications started 2004– funded by MoHSW and HL7 FI (together 260 k€)– standarization activites build in a broad sense around

HL7 TC (formal mandate)

• areal funding for 2004-2005 towards 2007– MoSHW will distribute 20 + 10 M€ for the areas– one technical requirement is to use HL7 CDA...


CDA

26

Specialized care epicrisis


United Kingdom

28

United Kingdom

• GP 2 GP Project– Early Implementor Project based on Version 3

• Infrastructure Framework– Support by NHS

• NHS in England:– Funding for several years– Many bn‘s of money– aims to connect more than 30,000 GPs and 270 acute,

community and mental NHS Trusts in a single nationalsystem.


HL7 v3


Germany

30

Germany

• Content: SCIPHOX Project (CDA)

• Infrastructure Framework– Project by Ministry of Health

– Consortium of 5 vendors/organisations– Introduction of the Health card for patients– Health professional card for providers

• HL7 Version 3 messaging (Dialysis, Lab)


CDAHL7 v3

31

Germany: Cards as the key

For a Telematic Infrastructure

32

The SCIPHOX project and CDA

• uses CDA R1 model as a start

• framework for basic sharedinformation (CDA Header)– sender, recipient, patient, event etc.

• definition of structures (CDA Body)– Structure of information units based on analysis– Story boards (discharge/referral documents, long term

diabetes documentation, emergency info)

• Formal voting procedures for specifications

• Also activities in version 3 messaging

CDA

33

Care Record Summary (Arztbrief)Recent development• „discharge letter“• Based on CDA R2• Implementation

Guideline– 150 pages– Four defined use cases– Numerous examples– Implementation

rules (formalized)

• Industry Driven!


The Netherlands

35

Let us think abouthaving stable shelves...

or a stable EHR...

36

The Netherlands

• HL7 Project Office– Projects, Training (focussed on Version 3)

• National IT Institute for Healthcare

• Projects (among others)– Modelling the perinatology domain

• Domain analysis, Modelling

• Implementation guidelines

• Proof of concept: Modelling

– Medication Registry as one of the first steps to a EHRin the Netherlands

• Implementations with several vendors at large exhibition


HL7 v3 Training

37


Lithuania

39

Lithuanian eHealth

• National Infrastructure Project

• Funded by the World Bank

• HL7 Version 3– Facilitate electronic data exchange– To allow cross-sectoral communication– Implementation Guidelines

• Stepwise approach– Communication Backbone– “high priority” applications first– Preparing steps towards an EHR


HL7 v3/CDA

40

• Registries– Also designed as switch points

for communication– Patients– Providers– Generic Activities– Specific Activities– Key roles:

• A transportation infrastructureincluding security (“backbone”)

• (a network of) Integration Engines

• connecting Hospitals (h), General Practitioners (g), Specialist(s) in an interoperable way

Lithuanian eHealth Concept

h

Registry

g

h g

Registry

s



How to start?


How to conclude?

42

PublicHealthReporting

LegacySystems...

ProviderPortal

PatientPortal

DatabaseContentMaintenance

Central/National/Regional

Service PointIdentification

Authorization

Authentication

Logging

Other functions

Architecture (UK, CA, DE, NL, HR, LT)

PatientRegistry

ProviderRegistry

OrganizationRegistry

Act Repository(later: „the EHR“)

Act Reference Registry

Specialist FacilityProvider (Specialist)•Consultation Request•Medical history•Subject./Object./Ass./Plan•Referral

Lab Facility•Order•Result

Pharmacy•Prescription/Dispense

GP FacilityRegistration Office•CID/Demographics•Social Insurance Verification•Subscription to HCF•Provider Assignment •ConsentProvider (GP)•(appointment)•Medical history•Subject./Object./Ass./Plan•Referral

Hospitals/...• ...

...

43

HL7 Activities Worldwide – Conclusion

• HL7 Migration in the past several years– ...from an US „based“ standard used mainly in hospitals– ...to a globally defined suite of international standards– ...implemented locally– ...with major international contribution as a feedback to

the development process– ...ready (and proven) to support care process chains

• More than 80 implementation projects– Version 3 Messaging and Documents– Practical implementations– Feedback for the standard

44

HL7 Activities Worldwide – Conclusion

• Education required!– Modeling Methodology– Version 3 Messaging and CDA Documents

• Early implementor projects– Version 3 Messaging and CDA Documents– Practical implementations– Feedback for the standard

• Infrastructure Framework needed

• Funding– collaboration with national bodies (Ministry of Health)

45

HL7 Calendar 2006

International HL7Interoperability Conference

Cologne (Germany),August 24+25, 2006

46

Thank you -Questions?

Later? mailto: [email protected]

Paldies Tänan Achiu-

47

A word about myself

• Dr Kai U. Heitmann– Studies of medicine 1982-1988, doctor of medicine– Complementary education in Medical Informatics– Works in standards developing areas since 1995,

internationally since 1998– Board Member of HL7 International, Chair HL7

Germany Germany– Contributions to HIS of University of Cologne 1994-1997, system

introduction and integration– Deputy head of Medical Informatics Unit of the University of

Cologne (Germany) 1998-2005– Independent Healthcare IT Consultant with head office in the

Netherlands since January 2004– Involved in and finalized many communication and integration

projects in the Netherlands, Germany, Lithuania, Australia...