HL7 <ul><ul><li>What’s hot and what’s not </li></ul></ul>Dr David Hay Chair New Zealand HL7 Users Group healthAlliance Ent...
Agenda <ul><li>HL7 and interoperability </li></ul><ul><li>SAEAF </li></ul><ul><li>IHE </li></ul><ul><li>What’s hot and wha...
Interoperability <ul><li>“ Ability of two or more systems or components to exchange information and to use the information...
Interoperability needs standards <ul><li>Each/every end of the conversation needs to know what the other is saying </li></...
Everyone knows that Standards are important...
HL7 Organisation <ul><li>Central Organisation (US Based) with 32 International affiliates  </li></ul><ul><ul><li>Internati...
Why Health Level “Seven”? 1  Physical  (hardware, Ethernet, RS232) 2  Data Link  (MAC& LLC) 3  Network  (switching & routi...
HL7 Mission <ul><li>To provide standards for the  exchange ,  management  and  integration  of data that supports clinical...
the Stages of HL7 <ul><li>Stage 1  simple messaging - v2 </li></ul><ul><ul><ul><li>multi domain </li></ul></ul></ul><ul><l...
Stage 1 - the beginning <ul><li>Started 1987 - v1 </li></ul><ul><li>1988  - v2.x (currently 2.6) </li></ul><ul><li>Clinica...
V2 Messaging  <ul><li>The standard assumes that the transport will: </li></ul><ul><li>have error free transmission </li></...
Segments and Fields <ul><li>MSH|^~&|PATH||GP123||20070625||ORU^R01|101|P|2.5^AUS|||AL|NE|AUS||en<cr> </li></ul><ul><li>PID...
Stage 2 - beyond messaging <ul><li>Standards beyond simple messaging </li></ul><ul><ul><li>Conceptual </li></ul></ul><ul><...
Stage 3 - version 3 & the RIM <ul><li>Main purpose was to address deficiencies in v2 and promote semantic interoperability...
The v3 RIM Don’t Panic!
v3 document: CDA <ul><li>Most successful v3 standard has been CDA (Clinical Document Architecture) </li></ul><ul><ul><li>M...
© Alschuler Associates, LLC, 2008 12 The CDA  document  defined <ul><li>CDA Release 2 ,  section 2.1: </li></ul><ul><li>A ...
CDA: R-MIM
From RMIM to V3 Message (CDA)  Prescription classCode*  <= SBADM moodCode*  <= RQO id*:  II [1..1] text: ED [0..1] statusC...
CDA: Templates <ul><li>A key concept in re-usability </li></ul><ul><li>Able to ‘mark’ a document or sections of a document...
Stage 4 - SAEAF <ul><li>It’s still not quite right... </li></ul><ul><ul><li>v3 (apart from CDA) not widely adopted </li></...
SAEAF - Working Interoperability <ul><li>Services  Aware  Enterprise Architecture Framework </li></ul><ul><ul><li>It’s not...
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 <ul><li>Integrating the Healthcare Enterprise </li></ul>
Standards: Necessary…Not Sufficient <ul><li>Standards are </li></ul><ul><ul><li>Foundational - to interoperability and com...
<ul><li>An Incremental Multi-Year Project Launched in 1998 </li></ul><ul><li>Goal: </li></ul><ul><li>Enhance the Access to...
Stakeholder Benefits <ul><li>Healthcare providers and support staff </li></ul><ul><ul><li>Improved workflows </li></ul></u...
9 IHE Organizational Structure USA Canada Japan Korea Taiwan China Global Development Regional Deployment Contributing & P...
International Growth of IHE 10 <ul><li>Local Deployment </li></ul><ul><li>National Extensions </li></ul><ul><li>Promotiona...
IHE Technical Frameworks Implementation Guide for each Integration Profile <ul><li>An Integration Profile : </li></ul><ul>...
IHE Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Film Folder Image Manager & Archive Film Ligh...
IHE Connectathon <ul><li>Cross-vendor, live, supervised, structured tests </li></ul><ul><li>All participating vendors’ pro...
XDS (Cross Enterprise Document Sharing
What’s hot and what’s not? <ul><li>Hot </li></ul><ul><ul><li>HL7 v2 </li></ul></ul><ul><ul><li>v3 RIM </li></ul></ul><ul><...
A shameless plug <ul><li>NZHUG represents the HL7 organisation in New Zealand </li></ul><ul><ul><li>We want to be a source...
Thank you! [email_address]
Upcoming SlideShare
Loading in …5
×

HL7 - Whats Hot and Whats Not

1,915 views

Published on

David Hay
NZ HL7 Users Group
www.hl7.org.nz
(2/10/09, Forum, 3.20)

Published in: Health & Medicine, Technology
  • Be the first to comment

HL7 - Whats Hot and Whats Not

  1. 1. HL7 <ul><ul><li>What’s hot and what’s not </li></ul></ul>Dr David Hay Chair New Zealand HL7 Users Group healthAlliance Enterprise Architect
  2. 2. Agenda <ul><li>HL7 and interoperability </li></ul><ul><li>SAEAF </li></ul><ul><li>IHE </li></ul><ul><li>What’s hot and what’s not </li></ul><ul><li>Last words </li></ul>
  3. 3. Interoperability <ul><li>“ Ability of two or more systems or components to exchange information and to use the information that has been exchanged ” </li></ul><ul><ul><li>[IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] </li></ul></ul>Functional Interoperability - message structure - eg HL7 v2 / CDA Semantic Interoperability - meaning - eg SNOMED, LOINC Functional interoperability Semantic interoperability
  4. 4. Interoperability needs standards <ul><li>Each/every end of the conversation needs to know what the other is saying </li></ul><ul><li>Structural standards </li></ul><ul><ul><li>physical construction of the message </li></ul></ul><ul><li>Semantic standards </li></ul><ul><ul><li>what does the sender mean? </li></ul></ul><ul><li>Standards are really common: </li></ul><ul><ul><li>Mobile phones </li></ul></ul><ul><ul><li>WiFi </li></ul></ul><ul><ul><li>CD’s </li></ul></ul><ul><ul><li>ATM’s </li></ul></ul><ul><ul><li>The ‘Great Baltimore Fire’ of 1907 </li></ul></ul>
  5. 5. Everyone knows that Standards are important...
  6. 6. HL7 Organisation <ul><li>Central Organisation (US Based) with 32 International affiliates </li></ul><ul><ul><li>International aspect increasing in importance </li></ul></ul><ul><li>Many different standards </li></ul><ul><ul><li>driven by members / user </li></ul></ul><ul><ul><li>well defined process to update standards </li></ul></ul><ul><li>Collaborations with other SDO </li></ul><ul><ul><ul><li>LOINC </li></ul></ul></ul><ul><ul><ul><li>IHTSDO (SNOMED) </li></ul></ul></ul><ul><ul><ul><li>OMG (Object Management Group) </li></ul></ul></ul><ul><ul><ul><li>IHE (Integrating the Healthcare Enterprise) </li></ul></ul></ul><ul><ul><ul><li>openEHR </li></ul></ul></ul><ul><li>3 Working Group Meetings per year </li></ul><ul><ul><li>develop standards and training </li></ul></ul><ul><ul><li>2 in the US and one International </li></ul></ul><ul><li>Separate Educational summits </li></ul><ul><ul><li>focused on training </li></ul></ul>
  7. 7. 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
  8. 8.
  9. 9. HL7 Mission <ul><li>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. </li></ul><ul><li>Specifically, to create flexible , cost effective approaches, standards, guidelines, methodologies, and enable healthcare information system interoperability and sharing of electronic health records .” </li></ul>global
  10. 10. the Stages of HL7 <ul><li>Stage 1 simple messaging - v2 </li></ul><ul><ul><ul><li>multi domain </li></ul></ul></ul><ul><li>Stage 2 standards in other areas </li></ul><ul><ul><ul><li>decision support (arden gello) </li></ul></ul></ul><ul><ul><ul><li>ccow </li></ul></ul></ul><ul><ul><ul><li>ehr, phr </li></ul></ul></ul><ul><li>Stage 3 common information model - v3 </li></ul><ul><ul><li>RIM, D-MIM, R-MIM, CMET (and all that jazz...) </li></ul></ul><ul><ul><li>defined processes </li></ul></ul><ul><li>Stage 4 unified theory </li></ul><ul><ul><li>SAEAF </li></ul></ul><ul><ul><li>One process to rule them all... </li></ul></ul>
  11. 11. Stage 1 - the beginning <ul><li>Started 1987 - v1 </li></ul><ul><li>1988 - v2.x (currently 2.6) </li></ul><ul><li>Clinical input from domain experts </li></ul><ul><ul><li>ie knowledgeable users </li></ul></ul><ul><ul><li>now have many domains </li></ul></ul><ul><ul><ul><li>lab, pharmacy, emergency care and many others </li></ul></ul></ul><ul><li>point to point solutions </li></ul><ul><ul><li>participants agree on detailed meaning </li></ul></ul><ul><ul><li>Z segments </li></ul></ul><ul><li>‘ bottom up’ solution </li></ul><ul><ul><li>‘ on the wire’ </li></ul></ul>
  12. 12. V2 Messaging <ul><li>The standard assumes that the transport will: </li></ul><ul><li>have error free transmission </li></ul><ul><li>will perform any character conversion </li></ul><ul><li>not limit the message length </li></ul>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
  13. 13. Segments and Fields <ul><li>MSH|^~&|PATH||GP123||20070625||ORU^R01|101|P|2.5^AUS|||AL|NE|AUS||en<cr> </li></ul><ul><li>PID|||KNEE123||Knees^Nobby^J^^Mr||19601130|M|||23 Shady Lane^LIGHTNING RIDGE^NSW^2392||||||||219171803<cr> </li></ul><ul><li>OBR|1|PMS66666|956635.9|LFT^LIVER FUNCTION TEST^N2270<cr> </li></ul><ul><li>OBX|1|NM|1751-7^S Albumin^LN||38|g/L|35-45||||F<cr> </li></ul><ul><li>OBX|2|NM|1779-8^S Alkaline Phosphatase^LN||52|U/L|30-120||||F<cr> </li></ul>Town/Suburb DOB ID Name Gender Street Address
  14. 14. Stage 2 - beyond messaging <ul><li>Standards beyond simple messaging </li></ul><ul><ul><li>Conceptual </li></ul></ul><ul><ul><ul><li>EHR/PHR Functional standards </li></ul></ul></ul><ul><ul><ul><li>SOA standards </li></ul></ul></ul><ul><ul><ul><li>EA standards </li></ul></ul></ul><ul><ul><li>Application </li></ul></ul><ul><ul><ul><li>CCOW (Clinical Context Object Workgroup) </li></ul></ul></ul><ul><ul><ul><li>Arden Syntax </li></ul></ul></ul><ul><ul><ul><li>GELLO </li></ul></ul></ul><ul><ul><li>Exchange standards </li></ul></ul><ul><ul><ul><li>(V2 & V3) </li></ul></ul></ul>
  15. 15. Stage 3 - version 3 & the RIM <ul><li>Main purpose was to address deficiencies in v2 and promote semantic interoperability. </li></ul><ul><li>V2 has: </li></ul><ul><ul><li>No defined development process </li></ul></ul><ul><ul><li>Fields and events are described using natural language </li></ul></ul><ul><ul><li>Massive reuse of segments and events leading to a lot of optionality and ambiguity </li></ul></ul><ul><li>V3 has: </li></ul><ul><ul><li>A Reference Information Model (RIM), with messages and other artifacts derived from the model </li></ul></ul><ul><ul><li>A standard development methodology </li></ul></ul><ul><ul><ul><li>Story boards / Use Cases </li></ul></ul></ul><ul><ul><ul><li>Interaction diagrams </li></ul></ul></ul><ul><ul><ul><li>State diagrams </li></ul></ul></ul>
  16. 16. The v3 RIM Don’t Panic!
  17. 17. v3 document: CDA <ul><li>Most successful v3 standard has been CDA (Clinical Document Architecture) </li></ul><ul><ul><li>Many implementations internationally </li></ul></ul><ul><ul><li>Even in New Zealand! </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>people understand documents </li></ul></ul><ul><ul><li>clearly defined Implementation Guides </li></ul></ul><ul><ul><ul><li>don’t have to be an expert to use </li></ul></ul></ul><ul><ul><ul><li>It took 2 weeks for pharmacy vendors to produce CDA dispensing documents </li></ul></ul></ul><ul><ul><li>Business focussed </li></ul></ul><ul><ul><ul><li>deals with problem domains not covered by existing messaging (eg CCD) </li></ul></ul></ul><ul><ul><li>v3 messaging is hard! </li></ul></ul><ul><ul><ul><li>do have to be an expert to use </li></ul></ul></ul>
  18. 18. © Alschuler Associates, LLC, 2008 12 The CDA document defined <ul><li>CDA Release 2 , section 2.1: </li></ul><ul><li>A clinical document ... has the following characteristics: </li></ul><ul><li>Persistence </li></ul><ul><li>Stewardship </li></ul><ul><li>Potential for authentication </li></ul><ul><li>Context </li></ul><ul><li>Wholeness </li></ul><ul><li>Human readability </li></ul><ul><li>therefore, CDA documents are not: </li></ul><ul><li>data fragments, unless signed </li></ul><ul><li>birth-to-death aggregate records </li></ul><ul><li>electronic health records </li></ul>
  19. 19. CDA: R-MIM
  20. 20. 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
  21. 21. CDA: Templates <ul><li>A key concept in re-usability </li></ul><ul><li>Able to ‘mark’ a document or sections of a document to indicate that they meet a particular business requirement </li></ul><ul><ul><li>eg what is in a problem list, a medication list etc... </li></ul></ul><ul><li>Use a globally unique identifier (OID) </li></ul><ul><li>Can ‘mix and match’ sections in a document to meet specific requirements </li></ul><ul><li>Can freely re-use between documents </li></ul><ul><li>Will have a template registry available in 6 months </li></ul>
  22. 22. Stage 4 - SAEAF <ul><li>It’s still not quite right... </li></ul><ul><ul><li>v3 (apart from CDA) not widely adopted </li></ul></ul><ul><ul><ul><li>actually, v3 messaging is hard! </li></ul></ul></ul><ul><ul><ul><li>actually, interoperability (especially semantic) is hard! </li></ul></ul></ul><ul><ul><ul><li>but, having a common model is needed for semantic interoperability... </li></ul></ul></ul><ul><ul><li>within HL7 committees, there is some duplication and disconnect </li></ul></ul><ul><ul><li>There are always ignore new technologies to accommodate - eg services - SOA </li></ul></ul><ul><ul><li>It’s hard to ignore real-life architectures and real-life implementations </li></ul></ul><ul><li>SAEAF is a new initiative to address these issues. </li></ul>
  23. 23. SAEAF - Working Interoperability <ul><li>Services Aware Enterprise Architecture Framework </li></ul><ul><ul><li>It’s not just SOA </li></ul></ul><ul><ul><li>Messages, Documents, Services </li></ul></ul><ul><li>A Framework for creating Enterprise Architecture specifications </li></ul><ul><ul><li>It’s not a specification in and of itself - it’s a way to create an architecture about a particular topic </li></ul></ul><ul><li>Initiative to bring Enterprise Architecture disciplines to: </li></ul><ul><ul><li>internal HL7 standards development </li></ul></ul><ul><ul><li>external users of the standards </li></ul></ul><ul><li>Working Interoperability </li></ul><ul><li>Make things explicit </li></ul>
  24. 24. The ‘Lens’ of SAEAF It’s drawing on many other standards in the software industry
  25. 25. Stairway to Heaven
  26. 26. Specification Stack Why What How Where
  27. 27. IHE <ul><li>Integrating the Healthcare Enterprise </li></ul>
  28. 28. Standards: Necessary…Not Sufficient <ul><li>Standards are </li></ul><ul><ul><li>Foundational - to interoperability and communications </li></ul></ul><ul><ul><li>Broad - varying interpretations and implementations </li></ul></ul><ul><ul><li>Narrow - may not consider relationships between standards domains </li></ul></ul><ul><ul><li>Plentiful - often redundant or disjointed </li></ul></ul><ul><ul><li>Focused - standards implementation guides focus only on a single standard </li></ul></ul>IHE provides a standard process for implementing multiple standards
  29. 29. <ul><li>An Incremental Multi-Year Project Launched in 1998 </li></ul><ul><li>Goal: </li></ul><ul><li>Enhance the Access to Clinical Information </li></ul><ul><li>Ensure Continuity and Integrity of Patient Information </li></ul><ul><li>Speed Up the Integration in Healthcare Environments </li></ul><ul><li>Fosters Communication Between Vendors of Medical Information Technology </li></ul><ul><li>Prove that Integration is Attainable Based on Standards </li></ul><ul><li>Participants: </li></ul><ul><li>Representatives of Healthcare Providers </li></ul><ul><li>Information Systems Vendors </li></ul><ul><li>Imaging Systems Vendors </li></ul><ul><li>Standardization Groups </li></ul>The IHE Initiative
  30. 30. Stakeholder Benefits <ul><li>Healthcare providers and support staff </li></ul><ul><ul><li>Improved workflows </li></ul></ul><ul><ul><li>Information whenever and wherever needed </li></ul></ul><ul><ul><li>Fewer opportunities for errors </li></ul></ul><ul><ul><li>Fewer tedious tasks/repeated work </li></ul></ul><ul><ul><li>Improved report turnaround time </li></ul></ul><ul><li>Vendors </li></ul><ul><ul><li>Align product interoperability with industry consensus </li></ul></ul><ul><ul><li>Decreased cost and complexity of interface installation and management </li></ul></ul><ul><ul><li>Focus competition on functionality/service space not information transport space </li></ul></ul><ul><li>SDOs </li></ul><ul><ul><li>Rapid feedback to adjust standards to real-world </li></ul></ul><ul><ul><li>Establishment of critical mass and widespread adoption </li></ul></ul>
  31. 31. 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
  32. 32. International Growth of IHE 10 <ul><li>Local Deployment </li></ul><ul><li>National Extensions </li></ul><ul><li>Promotional & Live Demonstration Events </li></ul><ul><li>Funding </li></ul>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
  33. 33. IHE Technical Frameworks Implementation Guide for each Integration Profile <ul><li>An Integration Profile : </li></ul><ul><li>A Set of Actors </li></ul><ul><li>Exchanging Transactions </li></ul>Use cases Process Flows <ul><li>For each transaction: </li></ul><ul><li>Std referenced </li></ul><ul><li>Options specified </li></ul><ul><li>Mapping required </li></ul>Actors Transactions
  34. 34. 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
  35. 35. IHE Connectathon <ul><li>Cross-vendor, live, supervised, structured tests </li></ul><ul><li>All participating vendors’ products tested together in the same place/time </li></ul><ul><li>Experts from each vendor available for immediate problem resolution… fixes are done in minutes, not months!! </li></ul><ul><li>Each vendor tests with multiple trading partners (actual product to actual product) </li></ul><ul><li>Testing of real-world clinical scenarios using IHE Integration Profiles </li></ul>
  36. 36. XDS (Cross Enterprise Document Sharing
  37. 37. What’s hot and what’s not? <ul><li>Hot </li></ul><ul><ul><li>HL7 v2 </li></ul></ul><ul><ul><li>v3 RIM </li></ul></ul><ul><ul><li>CDA and CCD </li></ul></ul><ul><ul><li>Templates </li></ul></ul><ul><ul><li>SAEAF </li></ul></ul><ul><ul><li>IHE </li></ul></ul><ul><ul><li>archetypes </li></ul></ul><ul><li>Not </li></ul><ul><ul><li>v3 messaging </li></ul></ul><ul><ul><li>Not following a standard! </li></ul></ul>
  38. 38. A shameless plug <ul><li>NZHUG represents the HL7 organisation in New Zealand </li></ul><ul><ul><li>We want to be a source of assistance for anyone developing in HL7 </li></ul></ul><ul><ul><li>What help do you want ? </li></ul></ul><ul><ul><ul><li>Is there a need for training? If so, then in what? </li></ul></ul></ul><ul><li>In 2011 (probably January) there will be an HL7 working group in Australia </li></ul><ul><ul><li>This is a wonderful opportunity to meet and greet with the international experts </li></ul></ul><ul><ul><li>We can raise New Zealands profile internationally </li></ul></ul><ul><ul><li>There will be training and certification opportunities </li></ul></ul>
  39. 39. Thank you! [email_address]

×