This document provides an overview of HL7 standards. It discusses HL7 version 2 and version 3 messaging standards. HL7 version 2 is the most commonly used standard for healthcare information exchange, using a pipe-delimited format. HL7 version 3 adds semantic capability and uses XML formatting and the Reference Information Model. The document also discusses other HL7 standards like Clinical Document Architecture and different levels of interoperability that standards support.
Presentation given at HL7 Norway on april 1st, 2014. Subjects are: why a new standard? what are the basic building blocks of FHIR? What are profiles? How do we make documents out of resources? Also contains some example architectures.
Presentation given at HL7 Norway on april 1st, 2014. Subjects are: why a new standard? what are the basic building blocks of FHIR? What are profiles? How do we make documents out of resources? Also contains some example architectures.
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
In this tutorial participants will learn the history of the RIM, the method by which the RIM is maintained, and key characteristics of the RIM that make it the premier information model in healthcare.
Topics Covered:
1. Introduction to HL7: who, what, and why
2. Introduction to HL7 v3: what and why
3. History of the HL7 Reference Information Model
4. HL7 RIM Subjects, Core Classes, and Structural Attributes
5. State Machines of RIM Core Classes
6. HL7 v3 Datatypes
7. HL7 v3 Vocabulary
This tutorial will assist in preparation for the HL7 v3 Certification exam.
The presentation talks about the components of FHIR, its distribution and use. Scenarios for the introduction of FHIR in the country using HL7 V3 are also offered.
Shannon Labout has more than 17 years of experience in healthcare technologies, project management and clinical research. She is the past Senior Director of Education at CDISC, and has developed and delivered training on CDISC standards for audiences in North America, Europe and Asia since 2007. She has been involved in CDASH since the beginning of the project in 2006, co-led the CDASH team for the past 3-1/2 years, and has been a contributing member of the SDS team since 2007. She has participated in CRF standardization for the past fourteen years, and been involved in data standards development, harmonization and implementation at several CROs and global pharmaceutical companies. She has managed clinical data management teams in both the U.S. and Europe, and is currently the Director Data Management at Statistics & Data Corporation based in Tempe, Arizona.
Source: http://www.arena-international.com/ecdm/shannon-labout/3038.speaker
Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
In this tutorial participants will learn the history of the RIM, the method by which the RIM is maintained, and key characteristics of the RIM that make it the premier information model in healthcare.
Topics Covered:
1. Introduction to HL7: who, what, and why
2. Introduction to HL7 v3: what and why
3. History of the HL7 Reference Information Model
4. HL7 RIM Subjects, Core Classes, and Structural Attributes
5. State Machines of RIM Core Classes
6. HL7 v3 Datatypes
7. HL7 v3 Vocabulary
This tutorial will assist in preparation for the HL7 v3 Certification exam.
The presentation talks about the components of FHIR, its distribution and use. Scenarios for the introduction of FHIR in the country using HL7 V3 are also offered.
Shannon Labout has more than 17 years of experience in healthcare technologies, project management and clinical research. She is the past Senior Director of Education at CDISC, and has developed and delivered training on CDISC standards for audiences in North America, Europe and Asia since 2007. She has been involved in CDASH since the beginning of the project in 2006, co-led the CDASH team for the past 3-1/2 years, and has been a contributing member of the SDS team since 2007. She has participated in CRF standardization for the past fourteen years, and been involved in data standards development, harmonization and implementation at several CROs and global pharmaceutical companies. She has managed clinical data management teams in both the U.S. and Europe, and is currently the Director Data Management at Statistics & Data Corporation based in Tempe, Arizona.
Source: http://www.arena-international.com/ecdm/shannon-labout/3038.speaker
Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
Presented at the 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on September 15, 2016
Presented at the 8th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 21, 2018
FHIR is the latest standard to be developed under the HL7 organization. Pronounced 'Fire' , FHIR stands for Fast Healthcare Interoperability Resources. I think it's the most interesting standard to have come out of HL7 since the original HL7 protocol.
Open Insights Harvard DBMI - Personal Health Train - Kees van Bochove - The HyveKees van Bochove
In this talk, the Personal Health Train concept will be introduced, which enables running personalized medicine workflows as trains visiting data stations (e.g. hospital records, primary care records, clinical studies and registries, patient-held data from e.g. wearable sensors etc.) The Personal Health Train is a very powerful concept, which is however dependent on source medical data to be coded with appropriate metadata on consent, license, scope etc. of the data, and the data itself to be encoded using biomedical data standards, which is an ever growing field in biomedical informatics. In order to realize the Personal Health Train biomedical data will need to be FAIR, i.e. adopt the FAIR Guiding Principles. This talk will cover the emerging GO-FAIR international movement, and provide examples of how several European health data networks currently are adopting open standards based stacks, to enable routine health care data to be come accessible for research.
How do HL7 standards help secure data exchange for Digital Healthcare.pptxMocDoc
Learn about HL7 standards and how they help secure data exchange for digital healthcare. Discover the primary and other standards of HL7, their benefits, and their impact on patient care.
An overview of the interoperability standard - Health Level 7
In partial fulfillment of the requirements for
MI 224: Coding, Classification, and Terminology in Medicine
MS Health Informatics
UP Manila College of Medicine
Full lecture with narration: https://www.youtube.com/watch?v=hjUy6k328gk
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Hl7 Standards
1. 1
HL7 Standards
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Certified HL7 CDA Specialist
Some slides reproduced & adapted with permission from
Dr. Supachai Parchariyanon
November 2, 2014
2. 2
Some Slides Reproduced with
Permission from
Dr. Supachai Parchariyanon
@supachaiMD
»Profile:
Dr. Supachai Parchariyanon is a medical doctor
who’s passionate about information technology and
turn himself to be informatician and serial
entrepreneurs.
He’s also earned Business Management degree
from Ramkamhaeng university and Biomedical
Informatics degree from the US. He led the team to
certify both HL7 Reference Information Model (RIM)
and Clinical Document Architecture (CDA). His
interest is now on standards and interoperability,
clinical informatics and project management.
»Keep in touch
»supachaimd@gmail.com
»http://www.facebook.com/supachaiMD
Slide reproduced/adapted from Dr. Supachai Parchariyanon
3. 3
Thailand’s HL7
Certified Specialists
Kevin
Asavanant
HL7 V3 RIM (2009)
Supachai
Parchariyanon
HL7 CDA (2010)
Nawanan
Theera-Ampornpunt
HL7 CDA (2012)
Sireerat
Srisiriratanakul
HL7 V3 RIM (2013)
5. 5
Standards: Why?
• The Large N Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950
6. 6
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
7. 7
Why Health Information Standards?
Objectives
• Interoperability
• Inter-operable
systems
Ultimate Goals
• Continuity of Care
• Quality
Safety
Timeliness
Effectiveness
Equity
Patient-Centeredness
Efficiency
8. 8
What is interoperability?
It is the ability of two or more systems
or components to exchange information,
and to use the information that has been
exchanged predictably (IEEE Standard
Computer Dictionary)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
9. 9
Levels of Interoperability
Functional
Semantic
Syntactic
10. 10
Goal of interoperability
• HL7’s key goal of interoperability has
two aspects:
– Syntactic interoperability has to do with
structure
– Semantic interoperability has to do with
meaning
Slide reproduced/adapted from Dr. Supachai Parchariyanon
11. 11
Things that can go wrong in
message exchange
Slide reproduced/adapted from Dr. Supachai Parchariyanon
12. 12
Standards are not equal
Interoperability
Standards only create the opportunity
for interoperability and are not equal to
interoperability
Slide reproduced/adapted from Dr. Supachai Parchariyanon
13. 13
Various Kinds of Standards
• Unique Identifiers
• Standard Data Sets
• Vocabularies & Terminologies
• Exchange Standards
– Message Exchange
– Document Exchange
• Functional Standards
• Technical Standards: Data Communications,
Encryption, Security
14. Functional Standards (HL7 EHR
Functional Specifications)
Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 v.3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Unique ID
Exchange Standards (HL7 v.2,
HL7 v.3 Messaging, HL7 CDA,
14
How Standards Support Interoperability
Functional
Semantic
Syntactic
DICOM)
Technical Standards
(TCP/IP, encryption,
security)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
15. 15
What is HL7?
• HL7 is an ANSI-accredited Standards
Development Organization (SDO)
operating in the healthcare arena.
• It is a non-profit organization made up of
volunteers – providers, customers,
vendors, government, etc.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
16. 16
What is HL7? (Cont.)
• HL7 is an acronym for Health Level Seven
– Seven represents the highest, or “application”
level of the International Standards
Organization (ISO) communications model for
Open Systems Interconnection (OSI) networks.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
17. 17
OSI Model
Slide reproduced/adapted from Dr. Supachai Parchariyanon
18. 18
What HL7 does?
• HL7 focuses on the clinical and administrative
data domains.
• It defines data exchange standards for these
domains called messages or messaging
specifications (aka HL7 messages)
– Messages are developed by technical committees and
special interest groups in the HL7 organization.
• HL7 organization defines 2 versions of the
messaging standard:
– HL7 v2.x (syntactic only)
– HL7 v3.0 (semantic capability added)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
19. 19
What HL7 does?
Slide reproduced/adapted from Dr. Supachai Parchariyanon
20. 20
HL7 Standards
• HL7V2.x
– Defines electronic messages supporting hospital
operations
• HL7V3
• HL7 Clinical Document Architecture
(CDA) Releases 1 and 2
• HL7 Arden Syntax
– Representation of medical knowledge
• HL7 EHR & PHR Functional Specifications
• Etc.
21. 21
The Industry Standard
HL7 version 2 (HL7 v2)
• Not “Plug and Play” - it provides 80 percent of the
interface and a framework to negotiate the remaining 20
percent on an interface-by-interface basis
• Historically built in an ad hoc way because no other
standard existed at the time
• Generally provides compatibility between 2.X versions
• Messaging-based standard built upon pipe and hat
encoding
• In the U.S., V2 is what most people think of when people
say “HL7″
Slide reproduced/adapted from Dr. Supachai Parchariyanon
22. 22
HL7 version2
• HL7 v2 is still the most commonly used HL7
standard
– Over 90% of US hospitals have implemented some
version of 2.x HL7 messages
• The HL7 v2 messaging standard is considered:
– The workhorse of data exchange in healthcare
– The most widely implemented standard for healthcare
information in the world
• HL7 v2.5 was approved as an ANSI standard in
2003
Slide reproduced/adapted from Dr. Supachai Parchariyanon
23. 23
Part of Sample HL7 v.2 Message
(Lab Result)
OBX|1|NM|10839-9^TROPONIN-I^LN||5|ng/ml|
0-1.3|H||H|F|19980309…
Slide reproduced/adapted from Dr. Supachai Parchariyanon
24. 24
HL7 v2 Message
• Messages composed of
– Segments composed of
• Fields composed of
– Components
• Delimiters
– Field separator: |
– Component separator: ^
– Repetition separator: ~
– Escape character:
– Subcomponent: &
– Segment terminator: <cr>
Slide reproduced/adapted from Dr. Supachai Parchariyanon
25. 25
Message Header Segment - MSH
Sending
Unit
Receiving
Unit Date
Time
Message
type
Trigger
ID
MSH|^~|&|SMS|OR2|TMR|SICU|201010191535|password|ADT^A01|MSG1632|P|2.7<cr>
Sending
Place Receiving
Place
Message
Number
version
Delimiters
production
Slide reproduced/adapted from Dr. Supachai Parchariyanon
26. 26
PID Segment – 1/3
Check digit
Patient ID
Method
Last name
First name
Middle
Initial
Suffix
PID|Z12345^5^M11||||PATIENT^JOSEPH^M^IV|
Patient name
Null fields
Data field
Field delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
27. 27
PID Segment – 2/3
Mother’s
maiden name
Date of birth Race
MAIDEN|19610605|M||C|1492 OCEAN STREET^
Gender
Street
address
Data component Component
delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
28. 28
PID Segment – 3/3
City
State
Zip Code
County
Telephone
DURHAM^NC^27705|DUR|(919)684-6421<cr>
Segment terminator
Slide reproduced/adapted from Dr. Supachai Parchariyanon
29. 29
PV1 Segment
PV1|1|1|N2200^2200|||OR^02|0846^WELBY^MARCUS^G||SUR<cr>
Patient location
Attending
Service
Sequence
number
Patient
class
Slide reproduced/adapted from Dr. Supachai Parchariyanon
30. 30
OBR Segment
Placer order
number
Filler order
number
Universal
service ID
Text
order Local set
OBR|1|330769.0001.001^DMCRES|0000514215^RADIS1|77061^U/S PEVLIC^L
||201010211145|||||||||||||0491909||||U999|M||||||^FIBROIDS, R/O|207484^
CARROLL&BARBARA&A|||089657&BROWN&JOANNE<CR>
Requested
date-time of
service
Reason for
study
Principal results
interpreter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
31. 31
Typical Result Message -
ORU
MSH|^~&|||||19981105131523||ORU^R01<cr>
PID|||100928782^9^M11||Smith^John^J<cr>
OBR||||Z0063-0^^LN<cr>
OBX||XCN|Z0063-0^^LN||2093467^Smits^J^<cr>
OBX||Z0092-0^^LN||203BE0004Y^^X12PTX<cr>
Data field
Data component
segment
Again, this slide shows a typical order result message. In this case, the
segments include the header, the patient identifier, the order request,
and two result segments. The OBX segment is examined in detail in
the next slide. The last OBX shows the hierarchical nature of the
segment. The test ID data field is broken into the triplet of code (with
check-digit), text name, and vocabulary source (LOINC).
Slide reproduced/adapted from Dr. Supachai Parchariyanon
32. 32
Problems with HL7v2
• HL7 v2 cannot support all this!
– Ad Hoc design methodology
– Ambiguous – lacking definition
– Complicated, esoteric encoding rules.
– Artifacts left to retain backward compatibility
– Too much optionality
– Can’t specify conformance
– No standard vocabulary
Slide reproduced/adapted from Dr. Supachai Parchariyanon
33. 33
What’s Different About v3?
• Conceptual foundation
– A single, common reference information model to be used across
HL7
• Semantic foundation
– Explicitly defined concept domains drawn from the best
terminologies
• Abstract design methodology
– That is technology-neutral
– Able to be used with whatever is the technology de jour
• XML, UML, etc.
• Maintain a repository
– Database of the semantic content
– Ensures a single source and enable development of support
tooling
Slide reproduced/adapted from Dr. Supachai Parchariyanon
34. 34
How is v3 different than v2?
• v3 is approaching “Plug and Play”
• v2 uses pipe and hat messaging, while v3
uses the Reference Information
Model(RIM) and XML for messaging
• v3 is a brand new start – it is NOT
backward compatible with v2
Slide reproduced/adapted from Dr. Supachai Parchariyanon
36. 36
HL7 V3 Standards
• A family of standards based on V3
information models and development
methodology
• Components
– HL7 V3 Reference Information Model (RIM)
– HL7 V3 Messaging
– HL7 Development Framework (HDF)
37. 37
How HL7 V3 Works
• Message sent from sending application to
receiving application
• Mostly triggered by an event
• Typical scenario portrayed in a storyboard
• Message in XML with machine-processable
elements conforming to messaging
standard
• Data elements in message conform to RIM
• Not designed for human readability
38. 38
v3 Messaging Standard
• Based on an object information
model, called the Reference
Information Model, (RIM)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
39. 39
HL7 V3 Messaging
• V3 provides messaging standards for
– Patient administration
– Medical records
– Orders
– Laboratory
– Claims & Reimbursement
– Care provision
– Clinical genomics
– Public Health
– Etc.
40. 40
HL7 v3 Reference
Information Model
Act
Relationship
• Referral
• Transportation
• Supply
• Procedure
• Consent
• Observation
• Medication
• Administrative act
• Financial act
• Organization
• Place
• Person
• Living Subject
• Material
• Has component
• Is supported by
0..* 1
• Patient
• Member
• Healthcare facility
• Practitioner
• Practitioner assignment
• Specimen
• Location
Entity
0..*
1
Role
1
0..*
1
0..*
1..*
1
Participation Act
• Author
• Reviewer
• Verifier
• Subject
• Target
• Tracker
Slide reproduced/adapted from Dr. Supachai Parchariyanon
41. 41
HL7 v3 Components and Process: RIM UML Instance
Scenario
Entity Role Participation Act
John Doe Patient Subject
Dr. Smith
Classes are color coded:
Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message
controller.
HealthCare
Provider Surgeon
John Doe Patient Subject
Has Pertinent
Act Relationship Information
(Clinical Trial Act)
Protocol ECOG
1112
XYZ
Hospital
HealthCare
Facility Location
(Procedure Act)
Prostectomy
Slide reproduced/adapted from Dr. Supachai Parchariyanon
43. 43
V3 Messaging Concerns
• Difficult to implement
• No one understands v3
• Overhead too much
– 1% of message is payload compared to v2 (delimiters)
is about 90-95%
• No one understands what implementation of v3
messaging means
• Need stability, clarity, definition of v3 messaging
Slide reproduced/adapted from Dr. Supachai Parchariyanon
44. 44
Additional Information
• Health Level Seven
– www.hl7.org
• HL7 Reference Information Model
– https://www.hl7.org/library/data-model/RIM/C30202/rim.htm
• HL7 Vocabulary Domains
– http://www.hl7.org/library/data-model/
RIM/C30123/vocabulary.htm
• HL7 v3 Standard
– http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
• HL7v3:
– “Driving Interoperability & Transforming Healthcare Information
Management” by Charles Mead, MD, MSc.
– http://www.healthcare-informatics.com/webinars/05_20_04.htm
Slide reproduced/adapted from Dr. Supachai Parchariyanon
45. 45
HL7 Clinical Document
Architecture (CDA)
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Certified HL7 CDA Specialist
Some slides reproduced & adapted with permission from
Dr. Supachai Parchariyanon
November 2, 2014
46. 46
Exchange Standards
Message Exchange
• Goal: Specify format
for exchange of data
• Internal vs. external
messages
• Examples
HL7 v.2
HL7 v.3 Messaging
DICOM
NCPDP
Document Exchange
• Goal: Specify format
for exchange of
“documents”
• Examples
HL7 v.3 Clinical Document
Architecture (CDA)
ASTM Continuity of Care
Record (CCR)
HL7 Continuity of Care
Document (CCD)
47. 47
Exchange Standards
Messages
• Human Unreadable
• Machine Processable
Clinical Documents
• Human Readable
• (Ideally) Machine
Processable
48. 48
Message Exchange
Message
Message
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message
Message Message
49. 49
Clinical Document Exchange
Message containing
Referral Letter
Message containing
Claims Request
Message containing
Communicable
Disease Report
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message containing
Lab Report
Message containing
Patient Visit Summary
50. 50
What Is HL7 CDA?
• “A document markup standard that
specifies structure & semantics of “clinical
documents” for the purpose of exchange”
[Source: HL7 CDA Release 2]
• Focuses on document exchange, not
message exchange
• A document is packaged in a message
during exchange
• Note: CDA is not designed for document
storage. Only for exchange!!
51. 51
What is CDA?
• CDA is based on XML
• XML is eXtensible Markup Language
• In XML, structure & format are conveyed
by markup which is embedded into the
information
Slide reproduced/adapted from Dr. Supachai Parchariyanon
53. 53
A Clinical Document (1)
• A documentation of clinical observations
and services, with the following
characteristics:
Persistence - continues to exist in an
unaltered state, for a time period defined by
local and regulatory requirements
Stewardship - maintained by an organization
entrusted with its care
Potential for authentication - an assemblage
of information that is intended to be legally
authenticated Source: HL7 CDA R2
54. 54
A Clinical Document (2)
• A documentation of clinical observations
and services, with the following
characteristics:
Context - establishes the default context for its
contents; can exist in non-messaging contexts
Wholeness - Authentication of a clinical
document applies to the whole and does not
apply to portions of the document without full
context of the document
Human readability - human readable
Source: HL7 CDA R2
55. 55
A Clinical Document (3)
• A CDA document is a defined & complete
information object that can include
Text
Images
Sounds
Other multimedia content
Source: HL7 CDA R2
56. 56
CDA & HL7 Messages
• Documents complement HL7 messaging
specifications
• Documents are defined and complete information
objects that can exist outside of a messaging
context
• A document can be encoded within an HL7
message
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
57. 57
CDA & Message Exchange
• CDA can be payload (or content) in any kind of
message
– HL7 V2.x message
– HL7 V3 message
– EDI ANSI X12 message
– IHE Cross-Enterprise Document Sharing (XDS)
message
• And it can be passed from one kind to
another
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
58. 58
CDA & Message Exchange
Clinical Document
(Payload)
HL7 V3 Message
(Message)
HL7 V2 Message
(Message)
Source: Adapted from “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
59. 59
CDA As Payload
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
60. 60
Major Components of a
CDA
Slide reproduced/adapted from Dr. Supachai Parchariyanon
61. 61
CDA Model
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
62. Human Readable Part
Machine Processable Parts
62
A Closer Look at a CDA Document
<ClinicalDocument> ... CDA Header ...
<structuredBody> <section> <text>... Single
Narrative Block ...</text>
<observation>...</observation>
<substanceAdministration>
<supply>...</supply>
</substanceAdministration> <observation>
<externalObservation>...
</externalObservation> </observation>
</section> <section> <section>...</section>
</section> </structuredBody>
</ClinicalDocument>
Source: HL7 CDA R2
63. 63
Rendering CDA Documents (1)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
64. 64
Rendering CDA Documents (2)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
65. 65
CDA & Document Management
• CDA focuses on document exchange, not
storage or processing
• Clinical documents are used for various reasons
– Clinical care
– Medico-legal reasons (as evidence)
– Auditing
– Etc.
• Clinical documents may contain errors or need
data updates (e.g. preliminary lab results vs. final
results)
66. 66
CDA & Document Management
• CDA supports appending and replacement of
documents through use of Document ID, setID,
versionNumber & parent document
– Supports version control of documents
– Both old (replaced) and new versions of documents
can be stored in and retrieved from document
management systems depending on situation
– Addendum is possible through append
– Addendum itself can also be replaced with same
version control mechanism
– Document management system (not CDA) is
responsible for keeping track of most up-to-date
documents
67. 67
Document Management Examples
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
68. 68
Some Possible Use Cases of CDA
Intra-institutional
Exchange of parts of medical records (scanned or
structured electronic health records)
Lab/Imaging requests & reports
Prescriptions/order forms
Admission notes
Progress notes
Operative notes
Discharge summaries
Payment receipts
Other forms/documents (clinical or administrative)
69. 69
Some Possible Use Cases of CDA
Inter-institutional
Referral letters
Claims requests or reimbursement documents
External lab/imaging reports
Visit summary documents
Insurance eligibility & coverage documents
Identification documents
Disease reporting
Other administrative reports
70. 70
Achieving Interoperability
CDA is a general-purpose, broad standard
Use in each use case or context requires
implementation guides to constrain CDA
Examples
Operative Note (OP)
Consultation Notes (CON)
Care Record Summary (CRS)
Continuity of Care Document (CCD)
CDA for Public Health Case Reports (PHCRPT)
Quality Reporting Document Architecture (QRDA)
71. 71
CDA Summary
CDA is a markup standard for document
exchange
Not message exchange
CDA is a general-purpose standard
Use in specific context requires
Implementation Guides (and possibly
Extensions)
72. 72
CDA Summary
CDA is XML-based and RIM-based
CDA documents can be exchanged as
encapsulated data (payload) in any message
(HL7 V2, HL7 V3, etc.)
CDA is not dependent on using HL7 V3
messages
Most likely early use cases for CDA
Referrals
Claims & Reimbursements
Lab/imaging Reports
Electronic Health Records Documents
73. 73
Q/A
Slide reproduced/adapted from Dr. Supachai Parchariyanon