HL7 What’s hot and what’s not Dr David Hay Chair New Zealand HL7 Users Group healthAlliance Enterprise Architect

What’s hot and what’s not

Agenda HL7 and interoperability SAEAF IHE What’s hot and what’s not Last words

HL7 and interoperability

SAEAF

IHE

What’s hot and what’s not

Last words

Interoperability “ Ability of two or more systems or components to exchange information and to use the information that has been exchanged ” [IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] Functional Interoperability - message structure - eg HL7 v2 / CDA Semantic Interoperability - meaning - eg SNOMED, LOINC Functional interoperability Semantic interoperability

“ Ability of two or more systems or components to exchange information and to use the information that has been exchanged ”

[IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]

Interoperability needs standards Each/every end of the conversation needs to know what the other is saying Structural standards physical construction of the message Semantic standards what does the sender mean? Standards are really common: Mobile phones WiFi CD’s ATM’s The ‘Great Baltimore Fire’ of 1907

Each/every end of the conversation needs to know what the other is saying

Structural standards

physical construction of the message

Semantic standards

what does the sender mean?

Standards are really common:

Mobile phones

WiFi

CD’s

ATM’s

The ‘Great Baltimore Fire’ of 1907

Everyone knows that Standards are important...

HL7 Organisation Central Organisation (US Based) with 32 International affiliates International aspect increasing in importance Many different standards driven by members / user well defined process to update standards Collaborations with other SDO LOINC IHTSDO (SNOMED) OMG (Object Management Group) IHE (Integrating the Healthcare Enterprise) openEHR 3 Working Group Meetings per year develop standards and training 2 in the US and one International Separate Educational summits focused on training

Central Organisation (US Based) with 32 International affiliates

International aspect increasing in importance

Many different standards

driven by members / user

well defined process to update standards

Collaborations with other SDO

LOINC

IHTSDO (SNOMED)

OMG (Object Management Group)

IHE (Integrating the Healthcare Enterprise)

openEHR

3 Working Group Meetings per year

develop standards and training

2 in the US and one International

Separate Educational summits

focused on training

Why Health Level “Seven”? 1 Physical (hardware, Ethernet, RS232) 2 Data Link (MAC& LLC) 3 Network (switching & routing) 4 Transport (error recovery & flow control) Communication 6 Presentation (encryption) 5 Session (session set-up & termination) Function 7 Application (clinical) 7-layer ISO Communication Model

HL7 Mission To provide standards for the exchange , management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services. Specifically, to create flexible , cost effective approaches, standards, guidelines, methodologies, and enable healthcare information system interoperability and sharing of electronic health records .” global

To provide standards for the exchange , management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.

Specifically, to create flexible , cost effective approaches, standards, guidelines, methodologies, and enable healthcare information system interoperability and sharing of electronic health records .”

the Stages of HL7 Stage 1 simple messaging - v2 multi domain Stage 2 standards in other areas decision support (arden gello) ccow ehr, phr Stage 3 common information model - v3 RIM, D-MIM, R-MIM, CMET (and all that jazz...) defined processes Stage 4 unified theory SAEAF One process to rule them all...

Stage 1 simple messaging - v2

multi domain

Stage 2 standards in other areas

decision support (arden gello)

ccow

ehr, phr

Stage 3 common information model - v3

RIM, D-MIM, R-MIM, CMET (and all that jazz...)

defined processes

Stage 4 unified theory

SAEAF

One process to rule them all...

Stage 1 - the beginning Started 1987 - v1 1988 - v2.x (currently 2.6) Clinical input from domain experts ie knowledgeable users now have many domains lab, pharmacy, emergency care and many others point to point solutions participants agree on detailed meaning Z segments ‘ bottom up’ solution ‘ on the wire’

Started 1987 - v1

1988 - v2.x (currently 2.6)

Clinical input from domain experts

ie knowledgeable users

now have many domains

lab, pharmacy, emergency care and many others

point to point solutions

participants agree on detailed meaning

Z segments

‘ bottom up’ solution

‘ on the wire’

V2 Messaging The standard assumes that the transport will: have error free transmission will perform any character conversion not limit the message length Message Ack HL7-enabled system Receiver Data Network HL7-enabled system Sender Data HL7 Message Creation E n c o d i n g HL7 Message Parsing E n c o d i n g HL7 V2.5 Standard HL7 2.5 Standard

The standard assumes that the transport will:

have error free transmission

will perform any character conversion

not limit the message length

Segments and Fields MSH|^~&|PATH||GP123||20070625||ORU^R01|101|P|2.5^AUS|||AL|NE|AUS||en<cr> PID|||KNEE123||Knees^Nobby^J^^Mr||19601130|M|||23 Shady Lane^LIGHTNING RIDGE^NSW^2392||||||||219171803<cr> OBR|1|PMS66666|956635.9|LFT^LIVER FUNCTION TEST^N2270<cr> OBX|1|NM|1751-7^S Albumin^LN||38|g/L|35-45||||F<cr> OBX|2|NM|1779-8^S Alkaline Phosphatase^LN||52|U/L|30-120||||F<cr> Town/Suburb DOB ID Name Gender Street Address

MSH|^~&|PATH||GP123||20070625||ORU^R01|101|P|2.5^AUS|||AL|NE|AUS||en<cr>

PID|||KNEE123||Knees^Nobby^J^^Mr||19601130|M|||23 Shady Lane^LIGHTNING RIDGE^NSW^2392||||||||219171803<cr>

OBR|1|PMS66666|956635.9|LFT^LIVER FUNCTION TEST^N2270<cr>

OBX|1|NM|1751-7^S Albumin^LN||38|g/L|35-45||||F<cr>

OBX|2|NM|1779-8^S Alkaline Phosphatase^LN||52|U/L|30-120||||F<cr>

Stage 2 - beyond messaging Standards beyond simple messaging Conceptual EHR/PHR Functional standards SOA standards EA standards Application CCOW (Clinical Context Object Workgroup) Arden Syntax GELLO Exchange standards (V2 & V3)

Standards beyond simple messaging

Conceptual

EHR/PHR Functional standards

SOA standards

EA standards

Application

CCOW (Clinical Context Object Workgroup)

Arden Syntax

GELLO

Exchange standards

(V2 & V3)

Stage 3 - version 3 & the RIM Main purpose was to address deficiencies in v2 and promote semantic interoperability. V2 has: No defined development process Fields and events are described using natural language Massive reuse of segments and events leading to a lot of optionality and ambiguity V3 has: A Reference Information Model (RIM), with messages and other artifacts derived from the model A standard development methodology Story boards / Use Cases Interaction diagrams State diagrams

Main purpose was to address deficiencies in v2 and promote semantic interoperability.

V2 has:

No defined development process

Fields and events are described using natural language

Massive reuse of segments and events leading to a lot of optionality and ambiguity

V3 has:

A Reference Information Model (RIM), with messages and other artifacts derived from the model

A standard development methodology

Story boards / Use Cases

Interaction diagrams

State diagrams

The v3 RIM Don’t Panic!

v3 document: CDA Most successful v3 standard has been CDA (Clinical Document Architecture) Many implementations internationally Even in New Zealand! Why? people understand documents clearly defined Implementation Guides don’t have to be an expert to use It took 2 weeks for pharmacy vendors to produce CDA dispensing documents Business focussed deals with problem domains not covered by existing messaging (eg CCD) v3 messaging is hard! do have to be an expert to use

Most successful v3 standard has been CDA (Clinical Document Architecture)

Many implementations internationally

Even in New Zealand!

Why?

people understand documents

clearly defined Implementation Guides

don’t have to be an expert to use

It took 2 weeks for pharmacy vendors to produce CDA dispensing documents

Business focussed

deals with problem domains not covered by existing messaging (eg CCD)

v3 messaging is hard!

do have to be an expert to use

© Alschuler Associates, LLC, 2008 12 The CDA document defined CDA Release 2 , section 2.1: A clinical document ... has the following characteristics: Persistence Stewardship Potential for authentication Context Wholeness Human readability therefore, CDA documents are not: data fragments, unless signed birth-to-death aggregate records electronic health records

CDA Release 2 , section 2.1:

A clinical document ... has the following characteristics:

Persistence

Stewardship

Potential for authentication

Context

Wholeness

Human readability

therefore, CDA documents are not:

data fragments, unless signed

birth-to-death aggregate records

electronic health records

CDA: R-MIM

From RMIM to V3 Message (CDA) Prescription classCode* <= SBADM moodCode* <= RQO id*: II [1..1] text: ED [0..1] statusCode: CS CNE [1..1] <= active Person classCode*: <= PSN determinerCode*: <= PSN id: II [1..1] name: EN [0..*] birthTime: TS [0..*]… Patient classCode*: <= PAT id*: II [1..1] addr: AD [0..1] telecom: TEL [0..*] CMET (Assigned) R_AssignedPerson [identified] (COCT_MT090101) 1..1 patient 1..1 patientLivingSubject 1..1 assignedEntity <clinicalDocument> <id extension=&quot;3000201&quot; root=&quot;2.16.840.1.113... <statusCode code=&quot;active&quot;/> <recordSubject> <Patient> <id extension=&quot;7658456&quot; root=&quot;2.16.840... <addr>... <Person> <name use=&quot;L&quot;> <given>Kevin</given> <family>de Boer</family> <birthtime value= &quot; 19551216 &quot; /> </name> </Person> </Patient> </subject> <author> <time value=&quot;20040427090010&quot;/> <AssignedPerson> <id extension=&quot;120450&quot; root=&quot;2.16... </AssignedPerson> </author>... Person Patient recordSubject typeCode*: <= SBJ author typeCode*: <= AUT time IVL<TS> EntryPoint Clinical Document id

CDA: Templates A key concept in re-usability Able to ‘mark’ a document or sections of a document to indicate that they meet a particular business requirement eg what is in a problem list, a medication list etc... Use a globally unique identifier (OID) Can ‘mix and match’ sections in a document to meet specific requirements Can freely re-use between documents Will have a template registry available in 6 months

A key concept in re-usability

Able to ‘mark’ a document or sections of a document to indicate that they meet a particular business requirement

eg what is in a problem list, a medication list etc...

Use a globally unique identifier (OID)

Can ‘mix and match’ sections in a document to meet specific requirements

Can freely re-use between documents

Will have a template registry available in 6 months

Stage 4 - SAEAF It’s still not quite right... v3 (apart from CDA) not widely adopted actually, v3 messaging is hard! actually, interoperability (especially semantic) is hard! but, having a common model is needed for semantic interoperability... within HL7 committees, there is some duplication and disconnect There are always ignore new technologies to accommodate - eg services - SOA It’s hard to ignore real-life architectures and real-life implementations SAEAF is a new initiative to address these issues.

It’s still not quite right...

v3 (apart from CDA) not widely adopted

actually, v3 messaging is hard!

actually, interoperability (especially semantic) is hard!

but, having a common model is needed for semantic interoperability...

within HL7 committees, there is some duplication and disconnect

There are always ignore new technologies to accommodate - eg services - SOA

It’s hard to ignore real-life architectures and real-life implementations

SAEAF is a new initiative to address these issues.

SAEAF - Working Interoperability Services Aware Enterprise Architecture Framework It’s not just SOA Messages, Documents, Services A Framework for creating Enterprise Architecture specifications It’s not a specification in and of itself - it’s a way to create an architecture about a particular topic Initiative to bring Enterprise Architecture disciplines to: internal HL7 standards development external users of the standards Working Interoperability Make things explicit

Services Aware Enterprise Architecture Framework

It’s not just SOA

Messages, Documents, Services

A Framework for creating Enterprise Architecture specifications

It’s not a specification in and of itself - it’s a way to create an architecture about a particular topic

Initiative to bring Enterprise Architecture disciplines to:

internal HL7 standards development

external users of the standards

Working Interoperability

Make things explicit

The ‘Lens’ of SAEAF It’s drawing on many other standards in the software industry

Stairway to Heaven

Specification Stack Why What How Where

IHE Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise

Standards: Necessary…Not Sufficient Standards are Foundational - to interoperability and communications Broad - varying interpretations and implementations Narrow - may not consider relationships between standards domains Plentiful - often redundant or disjointed Focused - standards implementation guides focus only on a single standard IHE provides a standard process for implementing multiple standards

Standards are

Foundational - to interoperability and communications

Broad - varying interpretations and implementations

Narrow - may not consider relationships between standards domains

Plentiful - often redundant or disjointed

Focused - standards implementation guides focus only on a single standard

An Incremental Multi-Year Project Launched in 1998 Goal: Enhance the Access to Clinical Information Ensure Continuity and Integrity of Patient Information Speed Up the Integration in Healthcare Environments Fosters Communication Between Vendors of Medical Information Technology Prove that Integration is Attainable Based on Standards Participants: Representatives of Healthcare Providers Information Systems Vendors Imaging Systems Vendors Standardization Groups The IHE Initiative

An Incremental Multi-Year Project Launched in 1998

Goal:

Enhance the Access to Clinical Information

Ensure Continuity and Integrity of Patient Information

Speed Up the Integration in Healthcare Environments

Fosters Communication Between Vendors of Medical Information Technology

Prove that Integration is Attainable Based on Standards

Participants:

Representatives of Healthcare Providers

Information Systems Vendors

Imaging Systems Vendors

Standardization Groups

Stakeholder Benefits Healthcare providers and support staff Improved workflows Information whenever and wherever needed Fewer opportunities for errors Fewer tedious tasks/repeated work Improved report turnaround time Vendors Align product interoperability with industry consensus Decreased cost and complexity of interface installation and management Focus competition on functionality/service space not information transport space SDOs Rapid feedback to adjust standards to real-world Establishment of critical mass and widespread adoption

Healthcare providers and support staff

Improved workflows

Information whenever and wherever needed

Fewer opportunities for errors

Fewer tedious tasks/repeated work

Improved report turnaround time

Vendors

Align product interoperability with industry consensus

Decreased cost and complexity of interface installation and management

Focus competition on functionality/service space not information transport space

SDOs

Rapid feedback to adjust standards to real-world

Establishment of critical mass and widespread adoption

9 IHE Organizational Structure USA Canada Japan Korea Taiwan China Global Development Regional Deployment Contributing & Participating Vendors IHE North America IHE Asia ACC ACCE ACEP JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors ACP GMSIHIMSS IHE International Board Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye Care Radiation Oncology Public Health, Quality and Research IHE Asia-Pacific New Zealand Australia Malaysia IHE Europe France Netherlands Spain Sweden UK Italy Germany Norway Austria

International Growth of IHE 10 Local Deployment National Extensions Promotional & Live Demonstration Events Funding France USA Germany Italy Japan UK Canada Korea Taiwan Norway Netherlands Spain China Austria 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Pragmatic global standards harmonization + best practices sharing Australia

Local Deployment

National Extensions

Promotional & Live Demonstration Events

Funding

IHE Technical Frameworks Implementation Guide for each Integration Profile An Integration Profile : A Set of Actors Exchanging Transactions Use cases Process Flows For each transaction: Std referenced Options specified Mapping required Actors Transactions

An Integration Profile :

A Set of Actors

Exchanging Transactions

For each transaction:

Std referenced

Options specified

Mapping required

IHE Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed acquisition completed images printed Acquisition Modality

IHE Connectathon Cross-vendor, live, supervised, structured tests All participating vendors’ products tested together in the same place/time Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! Each vendor tests with multiple trading partners (actual product to actual product) Testing of real-world clinical scenarios using IHE Integration Profiles

Cross-vendor, live, supervised, structured tests

All participating vendors’ products tested together in the same place/time

Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!!

Each vendor tests with multiple trading partners (actual product to actual product)

Testing of real-world clinical scenarios using IHE Integration Profiles

XDS (Cross Enterprise Document Sharing

What’s hot and what’s not? Hot HL7 v2 v3 RIM CDA and CCD Templates SAEAF IHE archetypes Not v3 messaging Not following a standard!

Hot

HL7 v2

v3 RIM

CDA and CCD

Templates

SAEAF

IHE

archetypes

Not

v3 messaging

Not following a standard!

A shameless plug NZHUG represents the HL7 organisation in New Zealand We want to be a source of assistance for anyone developing in HL7 What help do you want ? Is there a need for training? If so, then in what? In 2011 (probably January) there will be an HL7 working group in Australia This is a wonderful opportunity to meet and greet with the international experts We can raise New Zealands profile internationally There will be training and certification opportunities

NZHUG represents the HL7 organisation in New Zealand

We want to be a source of assistance for anyone developing in HL7

What help do you want ?

Is there a need for training? If so, then in what?

In 2011 (probably January) there will be an HL7 working group in Australia

This is a wonderful opportunity to meet and greet with the international experts

We can raise New Zealands profile internationally

There will be training and certification opportunities

Thank you! [email_address]