This document provides an overview of HL7 standards. It begins with introducing Thailand's certified HL7 specialists and then discusses why standards are important for health information exchange. The document explains different levels of interoperability and describes various HL7 standards including HL7 v2, HL7 v3, and CDA. It highlights key differences between HL7 v2 and v3 and provides examples of HL7 message segments.
HL7
Health level 7
What is HL7?
What does it stand for
HL7 Mission
HL7 contains message standards
HL7 in HealthcareManagement System
Standards
Limitations of HL7
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
HL7
Health level 7
What is HL7?
What does it stand for
HL7 Mission
HL7 contains message standards
HL7 in HealthcareManagement System
Standards
Limitations of HL7
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
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.
The Biggest Barriers to Healthcare InteroperabilityHealth Catalyst
Improving healthcare interoperability is a top priority for health systems today. Fundamental problems around improving interoperability include standardization of terminology and normalization of data to those standards. And, the volume of data healthcare IT systems produce exacerbates these problems.
While interoperability regulations focus on trying to make it easy to find and exchange patient data across multiple organizations and HIEs, the legislation’s lack of fine print and aggressive implementation timelines nearly ensures the proliferation of existing interoperability problems. This article discusses the biggest barriers to interoperability, possible solutions to interoperability problems, and why it matters.
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.
This is for doctors, nurses, or anyone in the medical profession, also for engineers and managers in IT. Start learning #digitalhealth with #HL7 #FHIR!
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.
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.
The Biggest Barriers to Healthcare InteroperabilityHealth Catalyst
Improving healthcare interoperability is a top priority for health systems today. Fundamental problems around improving interoperability include standardization of terminology and normalization of data to those standards. And, the volume of data healthcare IT systems produce exacerbates these problems.
While interoperability regulations focus on trying to make it easy to find and exchange patient data across multiple organizations and HIEs, the legislation’s lack of fine print and aggressive implementation timelines nearly ensures the proliferation of existing interoperability problems. This article discusses the biggest barriers to interoperability, possible solutions to interoperability problems, and why it matters.
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.
This is for doctors, nurses, or anyone in the medical profession, also for engineers and managers in IT. Start learning #digitalhealth with #HL7 #FHIR!
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.
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.
The Logical Model Designer - Binding Information Models to TerminologySnow Owl
This presentation demonstrates the functionality provided by the Logical Model Designer (LMD) and Snow Owl tools, which enables terminology to be bound to the Singapore Logical Information Model.
Abstract:
A critical enabler in the journey towards semantic interoperability in Singapore is the Singapore "˜Logical Information Model' (LIM). The LIM is a model of the healthcare information shared within Singapore, and is defined as a set of reusable "˜archetypes' for each clinical concept (e.g. Problem/Diagnosis, Pharmacy Order). These archetypes are then constrained and composed into "˜templates' to support specific use cases.
The Singapore LIM harmonises the semantics of the information structures with the terminology, using multiple types of terminology bindings, including semantic, value domain and constraint bindings. Value domain bindings are defined to both national "˜reference terminology' (used for querying nationally-collated data), as well as to a variety of "˜interface terminologies' used within local clinical systems (required to enforce conformance-compliance rules over message specifications generated from the LIM). To support the diversity of pre-coordination captured in local interface terms, "˜design patterns' are included in the LIM, based on the SNOMED CT concept model. These design patterns represent a logical model of meaning for a specific concept, and allow more than one split between the information model and the terminology model to be represented in a semantically-consistent manner.
This presentation will demonstrate the "˜Logical Model Designer' (LMD) - an Eclipse-based tool that is being used to maintain Singapore's Logical Information Model. A number of features of the LMD tooling will be demonstrated, with a specific focus on how the information structure is bound to the terminology via an interface to the Snow Owl platform. Value Domains are defined as reference sets within Snow Owl and then linked to the information structures defined in the LMD.
Please see our website http://b2i.sg for further information.
Standards Driven Healthcare Information Integration InfrastructureAbdul-Malik Shakir
Healthcare information exchange, integration, and analytic capabilities are critical to safe, cost-effective, high-quality health care.
The technical infrastructure that serves as an enabler for these capabilities is a complex array of data exchange standards, clinical terminologies, and infrastructure technologies.
This presentation provides an overview of this technical infrastructure and relevant current and emerging technologies:
1. Data Exchange Standards: HL7, X12, IEEE, ASTM, NCPDP, and DICOM;
2. Clinical Terminologies: ICD, SNOMED, LOINC, RxNORM, and CPT;
3. Infrastructure Technologies: integration engines, terminology servers, standards conformance validators, integrated data repositories, and business intelligence tools.
Next generation electronic medical records and search a test implementation i...lucenerevolution
Presented by David Piraino, Chief Imaging Information Officer, Imaging Institute Cleveland Clinic, Cleveland Clinic
& Daniel Palmer, Chief Imaging Information Officer, Imaging Institute Cleveland Clinic, Cleveland Clinic
Most patient specifc medical information is document oriented with varying amounts of associated meta-data. Most of pateint medical information is textual and semi-structured. Electronic Medical Record Systems (EMR) are not optimized to present the textual information to users in the most understandable ways. Present EMRs show information to the user in a reverse time oriented patient specific manner only. This talk discribes the construction and use of Solr search technologies to provide relevant historical information at the point of care while intepreting radiology images.
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An average of 7.8 out of the 10 highest rated reports showed a similar case highly related to the present case. The best search showed 10 out of 10 cases that were good examples and the lowest match search showed 2 out of 10 cases that were good examples.The talk will highlight this specific use case and the issues and advances of using Solr search technology in medicine with focus on point of care applications.
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
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Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
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There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
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Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
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 8, 2015
2. 2
»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
Some Slides Reproduced with
Permission from
Dr. Supachai Parchariyanon
@supachaiMD
Slide reproduced/adapted from Dr. Supachai Parchariyanon
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
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
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. 14
Functional
Semantic
Syntactic
How Standards Support Interoperability
Technical Standards
(TCP/IP, encryption,
security)
Exchange Standards (HL7 v.2,
HL7 v.3 Messaging, HL7 CDA,
DICOM)
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
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID
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
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
20. 20
HL7 Standards
• HL7 V2.x
– Defines electronic messages supporting hospital
operations
• HL7 V3
• 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
MSH|^~|&|SMS|OR2|TMR|SICU|201010191535|password|ADT^A01|MSG1632|P|2.7<cr>
Sending
Unit
Receiving
Unit Date
Time
Message
type
Trigger
ID
Sending
Place Receiving
Place
Message
Number
version
Delimiters
production
Slide reproduced/adapted from Dr. Supachai Parchariyanon
26. 26
PID Segment – 1/3
PID|Z12345^5^M11||||PATIENT^JOSEPH^M^IV|
Patient ID
Check digit
Method
Last name
First name
Middle
Initial
Suffix
Patient name
Null fields
Data field
Field delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
27. 27
PID Segment – 2/3
MAIDEN|19610605|M||C|1492 OCEAN STREET^
Mother’s
maiden name
Gender
Date of birth Race
Street
address
Data component Component
delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
28. 28
PID Segment – 3/3
DURHAM^NC^27705|DUR|(919)684-6421<cr>
City
State
Zip Code
County
Telephone
Segment terminator
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
Slide reproduced/adapted from Dr. Supachai Parchariyanon
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).
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
• Referral
• Transportation
• Supply
• Procedure
• Consent
• Observation
• Medication
• Administrative act
• Financial act
• Organization
• Place
• Person
• Living Subject
• Material
• Patient
• Member
• Healthcare facility
• Practitioner
• Practitioner assignment
• Specimen
• Location
Entity
0..*
1
Role
1
0..*
1
0..*
Act
Relationship
1..*
10..*
1
Participation Act
• Author
• Reviewer
• Verifier
• Subject
• Target
• Tracker
• Has component
• Is supported by
Slide reproduced/adapted from Dr. Supachai Parchariyanon
41. 41
HL7 v3 Components and Process: RIM UML Instance
Scenario
Classes are color coded:
Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message
controller.
John Doe Patient Subject
Entity Role Participation Act
Dr. Smith
HealthCare
Provider
Surgeon
John Doe Patient Subject
Has Pertinent
InformationAct Relationship
(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
• HL7 v3:
– “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
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)
Exchange Standards
47. 47
Messages
• Human Unreadable
• Machine Processable
Clinical Documents
• Human Readable
• (Ideally) Machine
Processable
Exchange Standards
48. 48
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message Exchange
Message
Message
Message
Message
Message
49. 49
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Clinical Document Exchange
Message containing
Referral Letter
Message containing
Claims Request
Message containing
Lab Report
Message containing
Patient Visit Summary
Message containing
Communicable
Disease Report
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
61. 61
CDA Model
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
62. 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
Human Readable Part
Machine Processable Parts
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
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