HL7 101
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The document provides an overview of HL7 (Health Level Seven), which is a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. HL7 aims to standardize how systems exchange key sets of clinical and administrative data, such as medical records, patient registration information, laboratory results, and medication orders. The document discusses HL7's origins, organization, messaging framework, common message types, segments, trigger events, and use of acknowledgement messages to confirm receipt of HL7 messages.
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HL7 101
- 1. Linda Sabatini MA, RN
- 2. Agenda Origin & Background Standardization & Affiliation HL7 Basics How to read HL7 Common Events Examples from JCMC
- 3. Why is HL7 Necessary • Interfaces had to be custom designed per institution and were costly and time consuming • Each system was tailored - What information to send - How it should be formatted
- 4. How was HL7 Created? • HL7 was created by the users of applications and clinical interface specialists • The group of clinical interface specialists from hospitals and software vendors formed a volunteer group called Health Level 7, or HL7 • The goal of creating an easier, more standardized way of building healthcare interfaces to substantially reduce programming costs.
- 5. Organization • HL7 was founded in 1987 to produce a standard for hospital information systems • HL7 is ANSI accredited standards developing organization (SDO)
- 6. What is HL7 • HL7 is a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. • These standards define how information is packaged and communicated from one party to another, setting the language, structure and data types for seamless integration between systems
- 7. What is HL7
- 8. HL7 stands for Health Level Seven, the seven refers to the seventh layer of the ISO communications Model. This is the application layer which HL7 formatting and structure of information is exchanged.
- 9. Time Line HL7 V 2.0 Version 1: 1987 Minimally useful “proof of concept” Hosp Univ of Pennsylvania Dr. Sam Shultz Verzion 2 1988 Version 2.0 1998 Version 2.1 1990 Version 2.2 1994 Version 2.3 1997 Most widely used Version 2.31 1999 Messaging Standard MU Version 2.4 2001 Version 2.5 2003 Messaging Standard MU Version 2.6 2007 Version 2.7 2011
- 10. What is HL7 Version 2? Send HL7 message Receive HL7-ACK System A Receive HL7 message Send HL7-ACK System B network Trigger event
- 11. Common Message Types Message Types in red represent the respective EHR – MU Public Health Objectives, Surveillance, ELR, and Immunization according to applicable CDC’s PHIN Messaging Guides The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
- 12. Common Data Types The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
- 13. Trigger Events • An Event in the real world of healthcare creates the need for data to flow among systems • Real World Event is the trigger event Patient Registration- Admission, Transfer, Discharge Observation- e.g. CBC result Pharmacy Order- Order Cancellation- Patient Referral-
- 14. Trigger Events - ADT A01: Admit notification A02: Transfer notification A03: Discharge notification A04: Patient registration notification A05: Pre-admit a patient notification A08: Update patient information notification A11: Cancel Admit notification A12: Cancel discharge notification A40: Merge patient identifier list notification
- 15. ADT - Hospital Administrative System (HIS) The messages are sent to all ancillary systems enabling them to synchronize their application databases with the latest information available in the main administrative system
- 16. Abstract message syntax definition table Segments Description MSH Message Header [{ SFT }] Software Segment { UAC } User Authentication EVN Event Type PID Patient Identification [PD1] Additional Demographics [{ ARV }] Access Restrictions [{ ROL }] Role [ { NK1 } ] Next of Kin /Associated Parties PV1 Patient Visit [ PV2 ] Patient Visit - Additional Info. [ { ARV } ] Access Restriction [ { ROL } ] Role [ { DB1 } ] Disability Information [ { OBX } ] Observation/Result [ { AL1 } ] Allergy Information [ { DG1 } ] Diagnosis Information [ DRG ] Diagnosis Related Group [ { --- PROCEDURE begin PR1 Procedures [{ROL}] Role } ] --- PROCEDURE end [ { GT1 } ] Guarantor [ { --- INSURANCE begin IN1 Insurance [ IN2 ] Insurance Additional Info. [ {IN3} ] Insurance Additional Info. - Cert. [ {ROL} ] Role } ] --- INSURANCE end [ { ACC } ] Accident Information [ { UB1 } ] Universal Bill Information [] Optional, e.g. [AL1] allergy segment optional {} May repeat, e.g. {AL1} may repeat if needed No bracket= R Segments must be in specified order for each message type Table indicates usage for all segments that legally appear in a standard HL7 message This abstract defines MSH, EVN, PID and PV1 as required segments for an ADT event
- 17. Message Parts • Segment- grouping of data fields (highest level of message hierarchy) Each segment has a three character name, e.g. MSH • Data Field- string of characters that occur at depth 2 • Component & Subcomponent- data within data fields, component and subcomponents can repeat within the same field MSH Segment Segment Field Subfield Subfield
- 18. HL7 Message Structure of ADT^A01 MSH|^~&|PAS|HBE|RAD||2008040112149||ADT^A01|20080401112149 |P|2.5|||AL|NE| <cr> EVN|A01|200804010800|20080401112149|||<cr> PID||""|8005069^^^HBE^PI~24109642356^^^F-NUM^NPNO| |Haugen^^Terje^^^L||19961024|M||| Jonas Storm vei 23^^Bergen^^5022^^HP|| 70555366|""||""|||||||""|""|||| <cr> MSH Segment Segment Field Subfield Subfield A message is the atomic unit of data transferred between systems. It is comprised of a group of segments in a defined sequence. ) Message Type defines the purpose
- 19. HL7 Message Framework Segment ID MSH Message Header EVN Event Type PID Patient Visit Information AL1 Patient Allergy Information DG1 Diagnosis PR1 Procedures Fields: contain information Related to the patient encounter or event
- 20. HL7 Message Forms Flat Files XML
- 21. Segments have (fields) separated by delimiter Delimiter Suggested Value Encoding Character Position Segment Terminator <cr> marks the end of a segment - Field Separator | - Component Separator ^ 1 Subcomponent Separator & 4 Repetition Separator ~ 2 Escape Character 3 MSH ^~&
- 22. Segment Table Defines an HL7 Segment MSH|^~&|MegaReg|XYZHospC|SuperOE|XYZImagCter|20060529090131-0500|| ADT^_A01^ADT|01052901|P|2.5 Sequence Value OPT Details 0 R Segment ID=MSH 1 (field Separator) | R 2 (encoding characters) ^~& R 3 Sending application megareg O 4 Sending Facility xyzhospc 5 Receiving Application superoe 6 xyzimgcter 7 Date Time of Mess 200060529090131- 8 Security [empty] MSH 9 ADT^A01^A DT_A01 Message Type ADT & Trigger Event A01 10 Message Control ID 01052901 11 Processing ID P 12 Version ID 2.5 Version of HL7 Field position Segment= Zero Field Separator | =1 Encoding Char = 2 MSH 9 is significant, it contains the message type and Event
- 23. General Order Message - ORM • There is only one ORM message – ORM Event 01 ORM is any request for materials or services, e.g.,EKG lipid panel • ORM Trigger Events involve changes to an order such as: New Order Cancellation Information Updates Discontinuation • ORM Message is composed of Segments MSH- Message Header PID - Patient Identifier PV1 - Patient Visit ORC - Common Order- “order identifiers to note” OBR - Observation Request (order detail)
- 24. ORC – Common Order Segment Table Sequence Opt Element Name 0 R Segment ID = "ORC" 1 R Order control 2 R Placer order number (initiating order) 3 O Filler order number (filler of order) 4 O Placer group number 5 O Order status 6 O Response flag 7 O/R Timing / Quantity (Required for ORM messages) 8 O Parent 9 R Transaction date/time 10 O Entered by 11 O Verified by 12 O Ordering provider 13 O Location for enterer 14 O Call back phone number 15 O Order effective date/time 16 O Order control reason 17 O Entering organization 18 O Entering device Order Control Codes Value Event Description New Orders NW O01 New order OK O02 Order accepted OK UA O002/ORR Unable to accept Cancel Orders CA Cancel order CR Cancel Request OC Order Canceled UC Unable to cancel XO Change/update order Hold Orders HD Hold order request Etc.
- 25. ORM Messages HL7 Placer Filler
- 26. ORM Messages Definitions: Order- a request for materials or services Observation- performance of the service including result data Placer- application initiating the order Filler- application that provides the observation Identifiers: Place Order # – identifies the order from placer’s perspective Filler Order #- identifies the order from filler’s perspective Placer Group #- identifies a group of orders
- 27. ORM Message MSH|^~&|CPX-RIS|Example Hospital|PACS||20050701||ORM^O01|71200517353359|P|2.3||||||| PID|1|807|ETH0809||Johnson^Karen||12130919120000|F||0|4708 Indian Paint^^Example^Texas^77777|Williamson|||0|0|0|ETH0809||^0^20050701120000| ||||||||| PV1|1|O|||||3^Jack^Johnson|162^SPEED^JOHN|||||||||||EN01156||||||||||||| ||||||||||||20050701174500|| |||||| ORC|NW|EX01369|EX01369||||^^^20050701174500||20050701|2^frontdesk||||| |||| OBR|1|EX01369|EX01369|1299^CT abd/pelvis w/o contrast & 3d recon||||||||||||||||||||CT|||^^^20050701174500|||||||||20050701174500||| ||||
- 28. OBR
- 29. OBX & NTE MSH|^~&|LCS|LCA|LIS|TEST9999|199807311532||ORU^R01|3630|P|2.2 PID|3|2161348473|20923085580|01572633|20923085580^TESTPAT||19730204| M|||^^^^00000-0000|||||||86427531^^^03|SSN# HERE PV1||I|^802^1||||8625^Physician^Michael|86-7468^||xxx|||||||||V1001 ORC|NW|8642753100013^LIS|20923085580^LCS||||||19980728000000|||PEED OBR|1|8642753100013^LIS|20923085580^LCS|083824^PANEL083824^L|||19980728083600||| ||| CH13380|19980728000000||||||20923085580||19980730041800|||F OBX|1|NM|150001^HIV-1 ABS-O.D. RATIO^L|||||||N|X OBX|2|CE|001719^HIV-1 ABS, SEMI-QN^L||HTN|||||N|F|19910123|| 19980729155700|BN NTE|1|L|Result: NEGATIVE by EIA screen. NTE|2|L|No antibodies to HIV-1 detected. OBX|3|CE|169999^.^L||SPRCS|||||N|F|||19980728130600|BN NTE|1|L|NOTE: Submission of serum NTE|2|L|separator tube recommended NTE|3|L|for this test. Thank you NTE|4|L|for your cooperation if you NTE|5|L|are already doing so. OBX|4|CE|169998^.^L||SPRCS|||||N|F|||19980728130600|BN ZPS|1|BN|LABCORP HOLDINGS|1447 YORK COURT^^BURLINGTON^NC^272152230|8007624344
- 30. Message Acknowledgement Send HL7 message Receive HL7-ACK System A Receive HL7 message Send HL7-ACK System B 123 network 123-OK ACK Messages are sent to indicate the receiving application was able to: Parse message, decode message, assume responsibility for message, process message contents, successfully commit to storage
- 31. MSA Acknowledgement Segment Abstract Syntax of General Acknowledgment Message ACK^A01 General Acknowledgement MSH Message Header MSA Message Acknowledgement {[ERR]} Error MSA Segment Table Sequence Opt Element Name 0 R Segment ID = "MSA" 1 R Acknowledgment Code (AA, AE, AR) Message ACK Codes AA Application Accept AE Application Error AR Application Reject (AA, AE, AR) 2 R Message Control ID Control ID in MSH Field 10 3 O Text Message If neg ACK (AE), then contains text desc 4 O Expected Sequence Number 5 O Delayed Acknowledgment Type 6 O Error Condition
- 32. ACK General Acknowledgement Message MSA Segment – indicates what message is being acknowledged and weather the processing of the message was successful HL7 Acknowledgement MSH|^~&|RIS|JCMC|SoarianEMR|JCMC|20141019172717||ACK^ 001|MSGID12349876|p|2.3 MSA|AA|MSGID12349876 AA-Application Accept AE- Application Error AR-Application Reject
- 33. Order Message / Acknowledgement Message HL7 Order Message: MSH|^~&|RIS|JCMC|SoarianEMR|JCMC|20141019172717|| ORM^001|MSGID12349876|p|2.3 HL7 Acknowledgment: MSH|^~&|RIS|JCMC|SoarianEMR|JCMC|20141019172717|| ACK^001|MSGID12349876|p|2.3 MSA|AA|MSGID12349876
- 34. Soarian Interface Error Viewer (SIEV)
- 35. OBX & NTE MSH|^~&|LCS|LCA|LIS|TEST9999|199807311532||ORU^R01|3630|P|2.2 PID|3|2161348473|20923085580|01572633|20923085580^TESTPAT||19730204| M|||^^^^00000-0000|||||||86427531^^^03|SSN# HERE PV1||I|^802^1||||8625^Physician^Michael|86-7468^||xxx|||||||||V1001 ORC|NW|8642753100013^LIS|20923085580^LCS||||||19980728000000|||PEED OBR|1|8642753100013^LIS|20923085580^LCS|083824^PANEL 083824^L|||19980728083600|||||| CH13380|19980728000000||||||20923085580||19980730041800|||F OBX|1|NM|150001^HIV-1 ABS-O.D. RATIO^L|||||||N|X OBX|2|CE|001719^HIV-1 ABS, SEMI-QN^L||HTN|||||N|F|19910123|| 19980729155700|BN NTE|1|L|Result: NEGATIVE by EIA screen. NTE|2|L|No antibodies to HIV-1 detected. OBX|3|CE|169999^.^L||SPRCS|||||N|F|||19980728130600|BN NTE|1|L|NOTE: Submission of serum NTE|2|L|separator tube recommended NTE|3|L|for this test. Thank you NTE|4|L|for your cooperation if you NTE|5|L|are already doing so. OBX|4|CE|169998^.^L||SPRCS|||||N|F|||19980728130600|BN ZPS|1|BN|LABCORP HOLDINGS|1447 YORK COURT^^BURLINGTON^NC^272152230|8007624344
- 36. JCMC Examples • Soarian RIS • Soarian Mammography Reporting System • Soarian CBORD Dietary
- 38. Radiology Charge Master SIMCD FIMCD EXAMCD EXAMDESC CHG HCPCS MOD 1016 82001016 1016 US VASCULAR VENOUS EXTREMITY &IPG 1071 93965US 1017 82001017 1017US DOP CAROTIDS 900 93880US 1018 82001018 1018 US ABD ABDOMEN COMPLETE 771 76700US 1019 82001019 1019 US VASCULAR ARTERIAL EXTRM.& IPG 1071 93922US 1016 82001016 1016 US VASCULAR VENOUS EXTREMITY &IPG 1071 93965US 1017 82001017 1017US DOP CAROTIDS 900 93880US
- 39. Order Message: Radiology from RIS Live Environment MSH:;~&:ST01:J:HMI:J:20110725073755::ORM;O01:10335431:P:2.2:10335431::AL:::::::2.2b PID:1:00000000:000000000;;;ST01J;MR~00490279;;;ST01;PI:PROD,PATIENT;"";"":PROD,PATIENT,:000000: M::0:18-20 DUCKLING AVE APT00;;JERSEY CITY;NJ;07306;USA;P;0000::(201)000-000::ENG; ENGLISH;HL70296;ENG; ENGLISH;99CLAN:M:ISL:1120100729;;;ST01J:137-72- 9807::::EGYPT:N:::N:0;NO,NOT SPAN/HISP/LA;99NAT::N:N:::::::::::::::::::N PV1:1:I:J5I;020;02;J;OCC:1:::1396;CHANDAK;RITU;"";;;MD;HL70010::"":PSY:::N:1:::1396;CHANDAK;RITU;" ";;;MD;HL70010:JPI::R:::::::::::::::::::J::0:::201107211240::: 28070.45::: ORC:SC:27051203;HBOC:0001799468J1018;HBOX:27J1120100729;HBOC:SC:N:1;;;201107221701;;3:270 51202&HBOC:201107250737:PESA6185::1396;CHANDAK;RITU;"";;;MD;HL70010:JOU;5 PSYCH 2;99H26;JOU;5 PSYCH 2;99CRT::201107221701:::JOU;5 PSYCH 2;99H26;JOU;5 PSYCH 2;99CRT::;;HL70339:::::: OBR:1:27051203;HBOC:0001799468J1018;HBOX:1018&JRA;US ABD ABDOMEN COMPLETE;99STBB:::::::L:::::1396;CHANDAK;RITU;"";;;MD;HL70010:::::::::S::1;;;201107221701;;3:1396;CH ANDAK;RITU;"";;;MD;HL70010:27051202&HBOC:AMB:;-:::::::::::::;;HL70088:::: NTE:"":"":""
- 40. Result Message: Radiology from RIS Live Environment MSH|^~&||J|STAR|J|20110912075519||ORU^R01|767492663|P|2.3| PID|||0001789355^||TEST^PTROD^||000011122|M|||000 JERSEY CITY.APT.3^^JERSEY CITY^NJ^0000^USA^||(201)0000-000^|000)000-0000^||||00000000^| PV1|1|E|JJER^^^J^^^^^JJER^||||9999^EMERGENCY^PHYSICIAN^|9999^EMERGENCY^PHYSI CIAN^|||||||||9999^EMERGENCY^PHYSICIAN^|||||||||||||||||||||||||||201109112318 00| ORC|RE| OBR|1|1817800^|1817800^|J5040^CT HEAD WO^|||20110912010437|||||||||9999^EMERGENCY^PHYSICIAN^||||||20110912075104| ||F||^^^20110911233000^||||HEAD INJ^|BIES6206^|~LEVC3086^| OBX|1|TX|J5040&BODY^CT HEAD WO^||EXAM: CT HEAD WITHOUT CONTRAST||||||F|||20110912075104| OBX|2|TX|J5040&BODY^CT HEAD WO^||||||||F|||20110912075104| OBX|3|TX|J5040&BODY^CT HEAD WO^||CLINICAL INDICATION: HEAD INJ||||||F|||20110912075104| OBX|4|TX|J5040&BODY^CT HEAD WO^||||||||F|||20110912075104| OBX|5|TX|J5040&BODY^CT HEAD WO^||TECHNIQUE: Contiguous axial sections were obtained from the skull base||||||F|||20110912075104| OBX|6|TX|J5040&BODY^CT HEAD WO^||through the vertex for evaluation of the brain without intravenous||||||F|||20110912075104| OBX|7|TX|J5040&BODY^CT HEAD WO^||contrast. No pertinent prior studies have been submitted for||||||F|||20110912075104| OBX|19|TX|J5040&BODY^CT HEAD WO^||See associated CT of the facial bone report.||||||F|||20110912075104|
- 41. Message to Mammography Reporting System (MRS) originating from Soarian The following are messages to MRS originating from Soarian MSH|^~&|SPC|J|PACS|J|201209060802||ORM|10708525|P|2.3.1|10708525 PID||00720544|0001750097^^^J||TEST^SUE^||19520817|F||1|200 C COLUMBUS DR A3^ ^JERSEY CITY^NJ^07302|USA|(201)721-6311|(201)761-6143| ENGLISH^ENG^|||1225000001 ^^^J|555-90-0434 PV1|||||||8246^MARKI^RICHARD|^^|||||||||8246^MARKI^RICHARD^E.^^^MD^ ORC|SC|222447|1954006||IP|||||||8246^MARKI^RICHARD^E.||| OBR||222447|1954006|9402^||||||||||||8246^MARKI^RICHARD^E. MSH|^~&|SPC|J|PACS|J|201209060810||ORM|10708531|P|2.3.1|10708531 PID||00720544|0001750097^^^J||TEST^SUE^||1900000|F||1|200 DONALD DUCK DR A3^ ^JERSEY CITY^NJ^07302|USA|(201)721-2000|(201)721-2000| ENGLISH^ENG^|||1200000001 ^^^J|000-000-0000 PV1|||||||8246^MARKI^RICHARD|^^|||||||||8246^MARKI^RICHARD^E.^^^MD^ ORC|SC|222447|1954006||IP|||||||8246^MARKI^RICHARD^E.||| OBR||222447|1954006|9402^||||||||||||8246^MARKI^RICHARD^E.
- 42. Message to MRS originating from Soarian TEST I see that a new order message was sent out on this order: MSH:;~&:SPC:J:PACS:J:201209171332::ORM;O01;44:10741529:P:2.2:10741529::AL:: PID::00717642:0001747488;;;J:7845230;J46281090:TEST;ANGIE;;:TEST,TEST:19670101:F ::1:115 TEST TEST;;JERSEY CITY;NJ;07302;US;C;0906:0906:(201)444-1111:: ENGLISH;E NG;:I:UNK;;:1226100478;;;J:: PV1::O:MOBM;;;J;;;:3:::826;DIGIOIA;JULIA;M;;;MD;;;;;PRI&Hall-DiGioia Surgical As c;33 OVERLOOK ROAD;STE 205;SUMMIT;NJ&NEW JERSEY;07901;(908)522-3200;908-522-1222 ;N;;&;(973)214-1124&;20120917 :826;DIGIOIA;JULIA;M;;;MD;;;;;PRI&Hall-DiGioia Surgical Asc;33 OVERLOOK ROAD;STE 205;SUMMIT;NJ&NEW JERSEY;07901;(908)522-3200;908-522-1222;N;;&;(973)214-1124&;2 0120917:JMM;;J:1226100478;;;J:O:::::::::::::::::::J:::::201209171326::::: ORC:NW:274245;SOARIAN:1958306:9999997845230J46281090;SPC:IP:N:1;;;201209171332;; 3;;;::201209171332:::826;DIGIOIA;JULIA;M;;;MD:::201209171332:::: OBR:1:274245;SOARIAN:NC;SPC:9402;ZIC MAMMO BILAT SCREENING DIGITAL;JRA:::::::::: ::826;DIGIOIA;JULIA;M;;;MD;;;;;PRI&Hall-DiGioia Surgical Asc;33 OVERLOOK ROAD;ST E 205;SUMMIT;NJ&NEW JERSEY;07901;(908)522-3200;908-522-1222;N;;&;(973)214-1124&; 20120917::: :::201209171332:; :MG:ORDERED::1;;;201209171332;;3;;;:::AMB;AMBULATORY;JRA:;Enl arged Lymph Nodes::::: DG1:99:I9::;Enlarged Lymph Nodes::WORKING::::::::
- 43. CBORD (Dietary) MSH|^~&|SPC|J|CBORD|J|20131210113638||ORM^O01|6866885|D|2.2|6866885 PID|||0001788821^^^J^MR||RELAY^FINALTEST1||197802010000|F||||||||||13311 00012^^^J PV1||I|J6E^007^01|||||||MED||||||N||||||||||||||||||||||||||||20131107144 500 ORC|NW|1274861|||||1^^^201312101136^^7|||^Sabatini, RN^Linda^^^^^^^^^^DN|||||201312101136 ODS|D||3233 ODT|RS ORC Order Control NW = New Order CA = Cancel Order DC = Discontinue RP = Replace Order ODT =Tray Type: RS= Room Service Late=Late Tray NoRS=No Room Service Early= Early Tray PMN= Personal Menu Note MSG=Tray Ticket Message ODS Segment = Cond Req for NW D= Diet or S= Supplement 3233= CHO60/2snack
- 44. Diet Modifiers Table in Open Link / Built in Soarian 3230 = CHO45/snack 3231 = CHO60/snack 3232 = CHO65/snack 3233 = CHO60/2snack 3234 = CHO60/3snack 3235 = GDM60+2 3236 = GDM60+3
- 46. Basic Principles of HL7 Messaging Messaging Services TCP/IP IN TCP/IP IN HL7_OPL HL7 To XML XML_OPL OUT Inbound Connectivity COMEPR3 EXE Soarian Clinicals Interface Engine External Endpoint System HL7_OPL HL7 To XML XML_OPL OUT Inbound Connectivity Soarian Clinicals
- 47. Challenges of HL7 V 2 HL7 Official Standard HL7 HL7 HL7 HL7 Vendor Standard Vendors do not strictly adhere to the HL7 Standard. As a result, HL7 messages may lack specific segments, lack required fields or even contain unexpected segments. You may also find data contained in different fields or segments
- 48. Challenges of HL7 V 2 Substantial Cost & time to construct interfaces • 80% standard 20% custom-- V2 called “Non-standard” HL7 Standard • Versions 2.4- 2.7 have increase # of data elements and messages • V2 is backwards compatibility- version are compatible, but the implementation can be challenging • HL7 v3 XML based, is not backwards compatible with 2.x version
- 49. Challenges of HL7 V 2 Gap analysis required for interfacing due to • Segments and fields are customizable: field length, data types • Required vs Optional • Data constraints and rules are not followed
- 50. Challenges of HL7 V 2 Functional Semantic Syntactic Functional Standards (HL7) Vocabularies, Terminologies, Coding Systems (ICD-10, CPT, SNOMED LOINC Information Models HL7 v3 RIM, CCD Exchange Standards HL7 v2,
- 51. Questions! Additional small educational sessions can be arranged
Editor's Notes
- Before HL7 was developed, vendors of information systems needing to communicate between each other had to get together and work out what information was going to be sent between each system, and how it should be formatted. This would then require the creation of a new interface mechanism to handle this information flow. Naturally, this was an expensive and time-consuming process. Health organizations use different applications and systems, billing, EMR, Labs, Pharmacy all must exchange data, when you have multiple systems to interface the demand for standards was required.
- Interfaces were expensive because there was no standard collection of patient attributes or set of standard set of events Interface specialists saw a need to create standards to reduce the cost Hospitals were incurring A small volunteer group formed for the purpose of creating an easier more standard way of interfacing systems.
- American National Standards Institute (ANSI)
- HL& is a messaging protocol specifically developed to exchange health / medical / patient information between information systems. HL7 is used in hospitals and medical organizations in the USA, Europe, Australasia. HL7 standards support clinical practice and the management, delivery, and evaluation of health services, and are recognized as the most commonly used in the world (currently used in 35 countries
- HL7 was originally designed for intra HOSPITAL use only, NOW, provides INTEROPERABILIY, the back and forth exchange of patient health data among other health facilities. Interoperability has been one of the MAIN focuses within Health Information Technology. Allowing data transfer among EHR systems and Other Healthcare facilities, which is required to meet meaningful use. Examples of MU : 1. Michele- Patient Portal 2. 3
- HL7 stands for Health Level Seven. The Level Seven refers to the seventh layer of the ISO communications model. This is the application layer, and basically means that HL7 is only interested in the formatting or structure of the information, not the technical details of how the information is passed from one system to another. The Open Systems Interconnection model (OSI) is a conceptual model that characterizes and standardizes the internal functions of a communication system by partitioning it into abstraction layers. The model is a product of the Open Systems Interconnection project at the International Organization for Standardization (ISO), maintained by the identification ISO/IEC 7498-1. The model groups communication functions into seven logical layers. A layer serves the layer above it and is served by the layer below it. For example, a layer that provides error-free communications across a network provides the path needed by applications above it, while it calls the next lower layer to send and receive packets that make up the contents of that path. Two instances at one layer are connected by a horizontal connection on that layer.
- Verzion 1 of HL& was developed in 1987 and immediately deployed on a limited basis as a minimally useful proof of concept. Version 2.0 of HL7 followed shortly thereafter in 1988. Through the 1990’s, subsequent version of HL7 included version 2.1 in 1990, version 2.2Version 1: 1987 Minimally useful “proof of concept Verzion 2 1988 Version 2.0 1998 Version 2.1 1990 Version 2.2 1994 Version 2.3 1997 Most widely used Version 2.31 1999 Messaging Standard MU Version 2.4 2001 Version 2.5 2003 Messaging Standard MU Version 2.6 2007 Version 2.7 2011
- Version 2 is a standard series of predefined logical formats for packaging healthcare data in the form of messages to be transmitted among computer systems
- There are dozens of message types. Listed here are some common message types. Please take note that there are message types for various situations. The message types in red are the ones associated with meaningful use. ADT messages will be used for surveillance messages. ORU messages will be used for electronic laboratory reporting messages, and VXU messages will be used for immunization messages.
- A trigger event creates the need for the flow of data to other systems, examples include a patient being admitted to the hospital, or a CBC result
- Patient Administration (ADT) messages are used to exchange the patient state within a healthcare facility. HL7 ADT messages keep patient demographic and visit information synchronized across healthcare systems. ADT is the most commonly used HL7 messaging type, with most clinical applications enabled to receive key ADT messages. ADT messages within the HL7 standard are typically initiated by the Hospital Information Systems (HIS), or a registration application, to inform ancillary systems that a patient has been admitted, discharged, transferred, merged, that other demographic data about the patient has changed (name, insurance, next of kin, etc.) or that some visit information has changed (patient location, attending doctor, etc.). The patient class for any visit related information must be specified in PV1-2-patient class in order to enable each system to handle the transaction properly. if an ADT system allows the transfer function of the patient’s medical service and attending doctor to be changed, the ADT system should send two HL7 messages. It should send an A02 to reflect the location change, followed by an A08 to reflect the change in the medical service and the attending doctor.
- Even though the standard itself doesn’t explicitly define a sequence in which these trigger events occur, it seems clear that normally a patient has to be admitted (A01) before he or she can be transferred (A02) and discharged (A03). HL7 ADT messages (Admission, Discharge and Transfer) are implemented by almost all applications used within a hospital setting. The ADT trigger events typically occur in the administrative system of the hospital (Hospital Information System - HIS or Patient Administrative System - PAS). The resulting messages are sent to all ancillary systems enabling them to synchronize their application database with the latest information as available in the main administrative system.
- Each trigger event is associated with an abstract message that defines the type of data that the message needs to support the trigger event. The abstract message is a collection of segments, and includes rules of repetition and inclusion for thos segments. This abstract is defining the MSH, EVN and PID and PV1 required, items in brackets are optional and items in curly bracket may repeat.
- An HL7 Message contains the following parts: segments, data fields, components and optionally subcomponents.
- Messages are comprised of two or more segments that act as the building blocks for each message MSH – Message Header segment identifies the event type. The example above is an ADT^A01 The message header MSH is a mandatory and will be present in all transactions
- This HL7 message Contains the following segments:
- Most up to date technologies convert HL7 to XML Virtually any universal standards are converted to communicate with formal standards between your EMR, HIS, RIS, PAS, LIS, EHR and more and also between various vendors. Includes interface standard conversions between HL7 to XML, HL7 2.x to HL7 3.x or HL7 to XML or HL7 to web services and many more. HL7 is converted to communicate with formal standards between your EMR, HIS, RIS, PAS, LIS, EHR, and more and also between various vendors.
- HL7 uses delimiters to define the segment, field, and subcomponent levels of the flat files. The following table lists the default delimiters used by HL7 flat files
- This is an MSH Segment Table, which defines the order of each data field. The segment ID (MSH) is not counted, the field separator is One and the encoding characters are in the second field. For all MSH segments, data field Nine (9) will have your message type and trigger event. MSH segments are required for all HL7 Messages. This message is an ADT^A01 which is an admission
- Order messages in HL7 require two segment in order to communicate general order information. One is the ORC segment, used for all order messages , this contains order identifiers. The other is the “order detail segment or OBR
- ORC is used for three kinds of communication: a request b. acknowledgement c. information
- ORM Messages segments
- Placer is the application initiating the Order Filler is the application that provides the observation
- ORM^01 = order message The ORC 1 segment specifies it’s a NW, new order ‘ ORC 2 is the placer order number ORC 3 is the filler order number
- What MSH Type is this message? The OBX segment is part of multiple message types that transmit patient clinical information. However this segment is most commonly utilized in ORU (Observational Report – Unsolicited) messages, and is sometimes utilized in ORM (Order) and ADT (Admit Discharge Transfer) messages. The OBX segment transmits a single observation or observation fragment, and can be used more than once in the message. NTE – Notes Segment The Notes Segment (NTE) is a common format for sending notes and comments. For the details of this segment, please refer to Appendix P. The fields in the OBX segment are as follows:
- The HL7 protocol specifies that when an application receives an HL7 message, it must return a message of type ACK (general acknowledge) to the sender. Before generating the ACK message, the receiving application must first check the original HL7 message that it received for formatting errors, missing data and other errors. Then, the receiving application generates the ACK message according to the results Acknowledgement messages confirm the message is received and that it is in the agreed upon format. Otherwise, the receiving application will return an error message which will be sent to the sending application.
- This MSH message header is informing in data field 9 that this message is an Acknowledgement message MSA- acknowledgement segment first data filed indicates AA, application accept
- MSA Indicates the application accepted the message, The order number
- Error Messages will be pushed to the SIEV You will see the XML version in Soarian Interface Error Viewer (SIEV)
- What MSH Type is this message? The OBX segment is part of multiple message types that transmit patient clinical information. However this segment is most commonly utilized in ORU (Observational Report – Unsolicited) messages, and is sometimes utilized in ORM (Order) and ADT (Admit Discharge Transfer) messages. The OBX segment transmits a single observation or observation fragment, and can be used more than once in the message. NTE – Notes Segment The Notes Segment (NTE) is a common format for sending notes and comments. For the details of this segment, please refer to Appendix P. The fields in the OBX segment are as follows:
- Today hospitals have multiple applications or modules that have to be interoperable to provide efficiency and the quality of care that is safe. So to make a hospital efficient using Health Information Technology, they must have the ability to exchange information and to use the information that has been exchanged. This is defined as interoperability.
- 8/16/2011- Therese obtained this from IT department to determine what to use for the interface code., here we have the OBR segment, but not the obx Standard Segments Processed from ORM Messages (Order Messages) Segment Description MSH Message Header PID Patient Identification PV1 Patient Visit ORC Common Order OBR Order Detail
- 10/27/11 Joy obtained this message from IT department, which contains the correct segments, to determine the Order interface Code Standard Segments Processed from ORU Messages (Result Messages) Segment Description MSH Message Header PID Patient Identification PV1 Patient Visit ORC Common Order OBR Order Detail OBX Observation / Result
- Radiology to Mammography Reporting System (MRS) TEST System: IIC mammo Bilat Screening Digital sent Doug confirmed the order passed to MRS, I am on the phone with him now. I sent a second order IC US Breast Bilateral, this crossed as well.
- Order Control- These are the fileds that CBORD uses for Order Control, NW, CA, DC and RP, there are many more available, but not used. Some other may include
- The Diet Modifier goes across the order interface using Model Elements that carry the data dictionary elements
- Backwards capability means the a newer application can process a message from an older application. If you have version 2.3 and you need to interface with v2.1, your version will be able to accommodate the difference. However, if you have V2.3 and yo need to interface with someone using v2.5, they will have to accommodate to your version. The XML based HL7 V 3 is not backwards compatible with the 2.x versions of the standard, so existing v2 interfaces would not be avle to communicate with interfaces using v3 without considerable modification
- In most healthcare system dealing with HL7, we are facing this partial list of common challenges: Each system could interpret the meaning of each data piece. Also the context and workflows can influence the semantic. I saw some systems using the account number (PID.18) or visit number (PV1.19) to identify the patient to be compliant to some clinical workflows. That type of semantic gap will probably have some impacts on how the system receive this data deals with it. Required vs. Optional: Because a piece of data can be exchanged to achieve several goals in several different contexts, most segments and fields are documented as optional in the official documentation (and some parsers). However, to satisfy specific workflows, healthcare products would probably add data constraints rules and relax some others. Most of the time, a case by case analysis need to occur to identify them. Tables: HL7 provides some list of suggested values for some fields. For instance, the suggested value list for gender is 6 long... Obviously, most systems don’t implement all 6 but what is your mapping strategy if you receive one you don’t support upfront? Segments and fields can be customized: Field length, data types and other definition attributes can be customized. You need to map it to some data structure you know without loosing important information. jlmorin
- Semantics are not explicit in HL7 V2.0, The ability of two or more computer systems to communicate information and have that information properly interpreted by a receiving system in the same sense as was intended by the transmitting system Version 3.0 is based on model, RIM has the ability to better achieve semantic interoperability. Data models are used to established the meaning, such as the RIM model in HLs V3 SNOMED, HL7 Semantic Interoprability