Interconnected Health 2012
HL7 Integration: From Trial and Error to Predictable Project Outcomes
April 2012
Agenda
• HL7 is flexible• Current approach: trial & error• Proposed new approach: Interface Lifecycle
Management
© Caristix 2012. All rights reserved.2
HL7 Specification
Product A
Deployed interface
Product BDeployed interface
HL7 v2.2HL7 v2.3.1HL7 v2.4HL7 v2.5.1HL7 v2.6HL7 v2.7
GAPS:WORK REQUIRED
HL7 is Flexible – No Plug & Play
3 © Caristix 2012. All rights reserved.
Gaps: A Few Examples
• Z-segments• User-defined Data Sets
© Caristix 2012. All rights reserved.4
Z-segments
© Caristix 2012. All rights reserved.5
MSH|^~\&|SPC|R|ENG|R|200609280101|43|ADT^A08|44859646|D|2.6|44859646||AL||EVN|A08|200609280101||PID||03777168|0001754426^^^R|9960^R17400|REGISTRATION^AMY^^||19601020|F||3|123 BOOGEY AVE^^NICECITY^MN^44444^US^C^25|25|(999)555-9999|(999)555-9999|ENGLISH^E^|M|BAP^^|0627330001^^^R|569-33-8744|NK1|1|REGISTRATION^PAT|B^^|123 BOOGEY AVE^^NICECITY^MN^44444^US|(999)555-6879NK1|2|N^A|T^^|^^^^^|PV1||O|MRIR^^^R^^^|3|||16515^SMITH^JANE^S^^^DO|^REGISTRATION^MIKE^J^^^||IMG||||1||EMP|16515^SMITH^JANE^S^^^DO|OPR^^R|0627330001^^^R|S|||||||||||||||||||R|||||200609280001|||0.00||PV2|||||N|||200609280800||||OPR RAT|||||||||*|||||""|||||||20060928||||||^MRIBRAIN W/O CONTRASTAL1|||^|||DG1|0|I9||HEADACHE||A||||||||DG1|99|I9||HEADACHE||WORKING||||||||GT1|1|9960|REGISTRATION^AMY^^||123 BOOGEY AVE^^NICECITY^MN^44444^US^C^25|(999)555-9999||19601020|F||A|569-33-8744|||1|ZZHEALTH^111|1087 DENNISON AVE^^NICECITY^MN^43201^US^^25|(999)555-9999||1IN1|1|100|800|SELF PAY|^^^^^^C^||||||ZZHEALTH^111^||||C^^|REGISTRATION^AMY^||19601020||||||||||||||||||||||||1|F|1087 DENNISON AVE^^NICECITY^MN^43201^US|IN2||569-33-8744||||||||||||||||||||||||||||ACC|200609241500|3|CLEVELAND AVE/FRANKLINUB1|1|||||||||45^15||||||05^20060924~^~^~^~^|||||||ZCA|||^^^ZCD||N|||^NEW LIFE^||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||^SURGERY CASE NUMBER~^EMSTAT NUMBERZCE|15^SECRETARY^|""|111^ZZHEALTH^|1087 DENNISON AVE^^NICECITY^MN^43201^US^^25||||1||ZCI|1|SELF PAY, NO INSURANCE||S|N|569-33-8744|N||P||||""||||""|||||||||||||||||1ZCV|||||FALL||PDR|0ZCM|N|||||||||*|||||||||||||^REGISTRATION^MIKE^J
User-defined Data Sets
© Caristix 2012. All rights reserved.6
User-defined Data Sets
© Caristix 2012. All rights reserved.7
User Defined Data Sets
© Caristix 2012. All rights reserved.8
MSH|^~\&|SPC|R|ENG|R|200609280101|43|ADT^A08|44859646|D|2.6|44859646||AL||EVN|A08|200609280101||PID||03777168|0001754426^^^R|9960^R17400|REGISTRATION^AMY^^||19601020|F||3|123 BOOGEY AVE^^NICECITY^MN^44444^US^C^25|25|(999)555-9999|(999)555-9999|ENGLISH^E^|M|BAP^^|0627330001^^^R|569-33-8744|NK1|1|REGISTRATION^PAT|B^^|123 BOOGEY AVE^^NICECITY^MN^44444^US|(999)555-6879NK1|2|N^A|T^^|^^^^^|PV1||O|MRIR^^^R^^^|3|||16515^SMITH^JANE^S^^^DO|^REGISTRATION^MIKE^J^^^||IMG||||1||EMP|16515^SMITH^JANE^S^^^DO|OPR^^R|0627330001^^^R|S|||||||||||||||||||R|||||200609280001|||0.00||PV2|||||N|||200609280800||||OPR RAT|||||||||*|||||""|||||||20060928||||||^MRIBRAIN W/O CONTRASTAL1|||^|||DG1|0|I9||HEADACHE||A||||||||DG1|99|I9||HEADACHE||WORKING||||||||GT1|1|9960|REGISTRATION^AMY^^||123 BOOGEY AVE^^NICECITY^MN^44444^US^C^25|(999)555-9999||19601020|F||A|569-33-8744|||1|ZZHEALTH^111|1087 DENNISON AVE^^NICECITY^MN^43201^US^^25|(999)555-9999||1IN1|1|100|800|SELF PAY|^^^^^^C^||||||ZZHEALTH^111^||||C^^|REGISTRATION^AMY^||19601020||||||||||||||||||||||||1|F|1087 DENNISON AVE^^NICECITY^MN^43201^US|IN2||569-33-8744||||||||||||||||||||||||||||ACC|200609241500|3|CLEVELAND AVE/FRANKLINUB1|1|||||||||45^15||||||05^20060924~^~^~^~^|||||||ZCA|||^^^ZCD||N|||^NEW LIFE^||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||^SURGERY CASE NUMBER~^EMSTAT NUMBERZCE|15^SECRETARY^|""|111^ZZHEALTH^|1087 DENNISON AVE^^NICECITY^MN^43201^US^^25||||1||ZCI|1|SELF PAY, NO INSURANCE||S|N|569-33-8744|N||P||||""||||""|||||||||||||||||1ZCV|||||FALL||PDR|0ZCM|N|||||||||*|||||||||||||^REGISTRATION^MIKE^J
HL7 v2.6 suggests “2106-3”
A Few Numbers
• 60% of hospitals deal with 100+ systems.• 64% of hospitals increasing HL7 integration
over 12 months.
• In HL7 v2.6:– 370 trigger events– >500 data elements per message– >500 suggested code sets
© Caristix 2012. All rights reserved.9
Sources: HIMSS 2008 survey, Core Health Technologies 2011 survey. HL7 International.
Current Approach
Requirements based on:• Manual analysis (pipe counting)• Small data samples• Incomplete and/or outdated
documentation:– Interface specifications– Ecosystem data flow
© Caristix 2012. All rights reserved.10
Current Approach: Results
• Low-fidelity, low-trust requirements:– “What is connected here?”– “Which data structures?”– “What is optional in which scenario?”– “Which data sets? From when?”– Are the semantics consistent?”
© Caristix 2012. All rights reserved.
11
Current Approach: Results
“Let’s start with a best-guess interface and fix issues when they pop up.”
The Trial & Error loop starts...
© Caristix 2012. All rights reserved.
12
Trial & Error Outcomes
• Cannot predict effort, timeline and costs• Cannot evaluate risk• Continue iterating after go-live• Hard to capture and reuse issue discovery
– With Colleagues– With Providers/Client teams
© Caristix 2012. All rights reserved.13
Proposed New Approach
© Caristix 2012. All rights reserved.14
Interface Lifecycle Management
Interface Lifecycle Management
© Caristix 2012. All rights reserved.15
• Understand gaps early• Work with real-life messages• Predictable• Focus on automation
Scoping
• Automate as much as possible• Analyze real life data• Compare sending vs. receiving systems• Gaps found = Tasks
© Caristix 2012. All rights reserved.16
Configuration
• Configure your integration engine– Filtering– Transformation– Mapping
• Consider automation based on gaps
© Caristix 2012. All rights reserved.17
Validation
• Build reusable and repeatable test scenarios based on gaps
• Automate test scenarios• Run tests in test environment• Include real life data (de-identify if needed)• Refine test scenarios
© Caristix 2012. All rights reserved.18
Monitoring
• Keep tracking any gaps that may appear• Refine scoping results, configuration and test
scenarios
© Caristix 2012. All rights reserved.19
Evidence-based Decision-making
30-60% Time Savings
© Caristix 2012. All rights reserved.20
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Known vs. Unknown Gaps through Interfacing Project
Current Approach Proposal
Contact Information
Jean-Luc MorinVP R&D, Caristix
April 2012
