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

E. Della Valle – http://emanueledellavalle.org - @manudellavalle

Interoperability and Semantic Technologies 2015-16HL7: from syntax (v.2) to semantics (v.3)

Emanuele Della ValleDEIB - Politecnico di Milanohttp://emanueledellavalle.org - @manudellavalle


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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

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

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*ADT: Admission Discharge Transfer

*


HL7 v2 enables bi-later integrations

Complementary application

[…]

Organizationalboundaries

application

[…]

adapter!

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The Type of a message is identified by a threedigit 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|DonorÊyes~Donor^Heart~Donor^Lungs

ZCH|ADE^DO NOT RECESITATE

… … what’s the meaning of a Z code !?!what’s the meaning of a Z code !?!

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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.

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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.

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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.

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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

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AdmittanceAdmittance

WardWard

LaboratoryLaboratory

AdministrationAdministration

Message brokerMessage broker

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The main limit related to a message-only architecture (even when a The main limit related to a message-only architecture (even when a using a bus) is that information remain confined inside all the single using 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

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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.

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Limitations of HL7 v.2.x in XML

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HL7 - Version 3

• Initial HL7 standards (Version 2) were based on apragmatic ‘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

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HL7 version 3 intent

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[…]

[…]

[…]

[…]

[…]

[…]

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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.

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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.

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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

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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

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Positioning HL7

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Interoperability and Semantic Technologies 2015-16HL7: from syntax (v.2) to semantics (v.3)

Emanuele Della ValleDEIB - Politecnico di Milanohttp://emanueledellavalle.org - @manudellavalle

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

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