2. HL7 crash course
National efforts and applications (Finland)
Choice of Techology
3. 20 year old (since 1987), non-profit
organisation
National standard in the US (ANSI) since
1994
Open, consensus based development
process
In use?
◦ CHIME-study 2000 (153 Hospital CIOs in US)
80% using HL7, 13.5% planning
Hospitals over 400 beds: 95%
For interoperability
4. Process level
Ability to adapt to work flow
Semantic level
Ability to exchange information
Operational level
Ability to exchange data
5. Messaging standards
◦ HL7 v2.x (v2.5 ANSI-standard 2006)
◦ HL7 versio 3 RIM
CDA (clinical document architecture) R1
and R2
HL7 data types to become ISO standard
CCOW (clinical context management)
Arden syntax (represents medical
algorithms in clinical information) + GLIF +
Gello
+ small Working Groups
Recommendations, implementation guides
6. Data model (or information model)
◦ RIM (Reference Information Model) and D-MIM,
R-MIM, HMD
◦ Refine by constraining
Vocabulary
Data types
Domain models
ITS (Implementation Technology
Specification)
◦ XML ITS currently available
7. Information Model
Spec Define classes,
Develop Scope
attributes, and
Use Case Model relationships
Identify actors and
Use Cases RIM Spec
Spec
Class Diagram State Diagram Define vocabulary
domains and codes
Associate Actors
UCM Spec
and Use Cases Use Case Diagram Define states,
transitions and
triggers
Define
Application Roles
Message Design
Interaction Model Develop Refined
Message Information
Define Spec 2-nd Order h//mt:50”d” Model
Interactions 1 choice of …
0-n Drug … Specify CMET
Define
Inter Spec 0-1 Nursing …
Conformance Interaction Diagram
Specify HMD &
Criteria METs with
constraints
Source: HL7 Training, Scandinavia Tour, 2002
8.
9. Relationship Act
Link Relationship
0..* 0..* 0..* 0..*
1 1 1 1
0..* 0..* 1
Entity 1
Role 1
Participation 0..*
Act
Patient Referral
Organization
Employee Transportation
Living Subject
Practitioner Supply
Material
Assigned Procedure
Place
Practitioner Condition Node
Health Chart
Specimen Consent
Observation
Medication
Act complex
(Source: G.W. Beeler) Financial act
10. Medication
(Act/ substance
Administation)
Is related to
(ActRelationship)
Dr Phil Doctor Performer
(Person) (Role) (Participation)
Visit
(Act/ Encounter)
Pasi Leino Patient Target
(Entity/ Person) (Role) (Participation)
Is related
(ActRelationship)
Study,
other action
11. Entities in Green
◦ Organisations, persons, devices,
locations ...
Roles in yellow
◦ professionals, patients, roleLinks
Participation in Cyan
Activities (act), in Red
◦ Observations, Events, medication,
Encounters, ...
Relations in activities
12.
13. RIM DMIM RMIM
Dynaamic model:
Use cases, application roles, interactions
The static model an dynamic behavior is linked by interactions
XML HMD
Schema
14. HL7 affilicate since 1995
Has earned status of respect
Receives funding from the Ministry of social
affair and health
Finland is an early adopter of any technology
CDA –centric approach
15. CDA is defined by the RIM
CDA RMIM is a constraint on the RIM
Classes “cloned” (replicated, renamed, constrained with
vocabulary, datatypes)
CDA is Persistence, stewardship, is Potential for authentication,
Whole, Human readable
16. CDA document
Header and context to describe the document
Body
Narrative, Structured
Human readable Machine readable
Structurd
data
text
text
text
17. Forms used everywhere: patient core data,
health status, drivers license, leave of
absence...
Very simple to define and implement
However, a single concept (diagnosis etc.)
could be defied differently in different forms.
Seemingly simplistic?
In strict sence CDA document is not designed
for forms
18. kentän pituus
pakollisuus
tietotyyppi
toistuma
max
min
rivi tietokenttätunnus oid tunnus tietotyyppi koodisto huom. kentän nimi
1 1.2.246.537.6.12.2006.3 Label LB K lomake lomake HEN
2 1.2.246.537.6.12.2006.3. 1 Label LB K pääotsikko
Päivitystiedot
3 1.2.246.537.6.12.2006.3. 2 Coded Value CV K Henkilötietojen käy
4 1.2.246.537.6.12.2006.3. 3 Point in Time TS K Henkilötiedot on p
5 1.2.246.537.6.12.2006.3. 4 Character String ST K Henkilötietojen päi
6 1.2.246.537.6.12.2006.3. 5 Label LB K pääotsikko
Perustiedot
7 1.2.246.537.6.12.2006.3. 6 Instance Identifer II Henkilötunnus
8 1.2.246.537.6.12.2006.3. 7 Instance Identifer II Väliaikainen henki
9 1.2.246.537.6.12.2006.3. 8 Instance Identifer II Muut tunnisteet
10 1.2.246.537.6.12.2006.3. 9 Person Name PN Sukunimi, etunime
11 1.2.246.537.6.12.2006.3. 10 Person Name PN T Entinen sukunimim
12 1.2.246.537.6.12.2006.3. 11 Point in Time TS Syntymäaika
19. Patient centric services, which promote
continuity of care
Interoperability
Electronic archiving or EPR, prescriptions,
centralised image repositories
National services for codes, classifications,
archiving
20. Scheduling-domain
◦ Regional shared scheduling
ePrescription
◦ Medical Records messages
◦ CDA R2 based content- prescription, delivery, locking, etc.
Death notice message
◦ V3 messaging spesifications for automatic reporting of
death to National citizen registy.
eArchive messages
◦ V3 Messages, CDAR2 payload + W3C signature
Diagnostic imaging patient records and reports
CDA R2 implementation guidelines
◦ See: www.hl7.fi
◦ See: www.hl7.co.uk
21. YHDIS-
TELMÄ
LPSY
PSY
HENKILÖ- KIR
TIEDOT SIS Summary
YLE
documents
SOS LÄÄ KUUMEKU
LAB PSY LÄHETE
RAD ANS PSY HOSU
OPER RR HOSU
VEREN- DIA TAUDIN-
SIIRTO KULKU JA
HOITO
Service units Care programs Care episodes
22. Structured and standardised core data
Use of national codes and OID
CDAR2 documents
Open interface to exchange CDAR2
documents
Ability to interface to national EPR archive,
ePrescription, code services
Desktop integration, SSO
User authentication, electronic signing,
concent management, referrals
23.
24. Several Duodecim
providers Stakes
TEO
VRK Decision Public Health I. Stakes
Content Codes, Authentication support Consumer Healthcare
OID- Person service
providers classifications, codes of healthcare Consumer health
professionals identifier statistics
vocabularies health
Content
User
Code OID-code authentication Person Decision Enabling
service service & eSignature identifier support
service service services
service
National
EPR Medical EPR Service
Health ePre- Core
Service forms &
Portal scription (Active) (Long-term)
services
certificates Registry
Service Service Repository Archive
service
Secure Network &
Messaging Service
Enterprise
applications
25. Information model to be updated according to
”structured core patient date definitions”
Use of Codes and OID’s
Use of CDA R2 for document generation
Open interfaces for interchange of CDA R2
documents
Access to decision support services
Ability to use of the EPR, ePrescription etc. services
Functionality to filter user tailored views from
retrieved patient documents
Desktop integration & SSO
User authentication, signature, consent
management
26. XML is nothing alone
◦ SOAP
◦ Custom schemas
◦ XML RPC
Decision points: the developer does not need
to know what goes in the wire
Acid test of spesification: can this be done
using general purpose development tools?
Caché, Enseble –objects
eXtc, DOM model
Example document
27. author
cdaBody
AD cdaHeader
component
BL custodian
CS dataComponent
documentationOf
CV encompassingEncounter
externalLink
ED externalObservation
toCDA(..
II localHeader Construct(...
paragraphComponent
INT textComponent
Generate(...
patient
IVL patientSubject
MO relatedPatient
performer
PN qualifier
rtgENVEntry
rtgRQOEntry
rtgOBSEntry
Section