Presented at the 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on September 15, 2016
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
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
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 presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
This presentation was the work of Ileana Lulic and Ivor Kovic. It was presented by Ivor Kovic as a final student assignment at Summerschool Health Informatics: The Role of Informatics in Health Care, held at University of Amsterdam, Academical Medical Center, Amsterdam.
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.
A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
This presentation was the work of Ileana Lulic and Ivor Kovic. It was presented by Ivor Kovic as a final student assignment at Summerschool Health Informatics: The Role of Informatics in Health Care, held at University of Amsterdam, Academical Medical Center, Amsterdam.
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.
Explains about how to Enhance knowledge transfer among all of stakeholders including healthcare providers. For more information visit: http://www.transformhealth-it.org/
A presentation by Dr. Shailendra Kumar, Delhi University, during National Workshop on Library 2.0: A Global Information Hub, Feb 5-6, 2009 at PRL Ahmedabad
Social Media Use by Doctors: Advice for Safety and for Effectiveness (Februar...Nawanan Theera-Ampornpunt
Presented at the 10th Ramathibodi GI and Liver Annual Review 2017, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University on February 4-5, 2017
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.
Importance of data standards and system validation of software for clinical r...Wolfgang Kuchinke
We present our evaluation of existing data standards for clinical trials. For this purpose a survey about the importance of data standards for clinical trials centers and EDC software companies were conducted. Electronic data capture in clinical trials uses a computerized system designed for the collection of clinical data in electronic form in Case Report Forms (CRF). It also covers medical data captured during clinical trials, safety data related to clinical trials, and patient reported outcome. The degree of implementation of standards, like CDISC ODM in available EDC software products was evaluated. Failure to establish data standards will make it difficult or impossible to connect data between different systems for efficient clinical study execution. The next step after purchasing a software solution is the computer system validation. Validation is about bringing computerized systems into regulatory compliance and making them compliant with GCP, GLP and GMP and other regulations (e.g. data protection). The basis standard for validation is provided by the GAMP Good Practice Guide, which provides a framework of best practices to ensure that computer systems are suitable for use and compliant with the legislation. The newest version uses a risk-based approach to computer system validation A system is evaluated and assigned to a predefined category based on its intended use and complexity. For validation one should define how all elements of the computer system are supposed to work (functional requirements), develop corresponding scripts and test routines to validate it is functioning as it should.
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.
Similar to Hl7 Standards (September 15, 2016) (20)
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
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
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:
Professor Orazio Schillaci, Minister of Health, Italy
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
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
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.
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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
September 15, 2016
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
Supachai Parchariyanon
@supachaiMD
Slide reproduced/adapted from Dr. Supachai Parchariyanon
3. 3
Nawanan Theera-Ampornpunt
2003 M.D. (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
Former Deputy Chief, Informatics Division
Deputy Executive Director for Informatics,
Chakri Naruebodindra Medical Institute
Faculty of Medicine Ramathibodi Hospital
nawanan.the@mahidol.ac.th
http://groups.google.com/group/ThaiHealthIT
Research interests:
• EHRs & health IT applications in clinical settings
• Health IT adoption
• Health informatics education & workforce development
4. 4
Outline
• Introduction to Standards & Interoperability
• What is Health Level Seven (HL7)?
• What HL7 does?
• HL7 Version 2
• HL7 Version 3 Messaging Standard
• Reference Information Model (RIM)
• Clinical Document Architecture (CDA)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
6. 6
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
10. 10
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
11. 11
Functional
Semantic
Syntactic
How Standards Support Interoperability
Technical Standards
(TCP/IP, encryption,
security)
Exchange Standards (HL7 V2,
HL7 V3 Messaging, HL7 CDA,
DICOM)
Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 V3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 V3, HL7 CCD
Unique ID
12. 12
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
13. 13
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
15. 15
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
17. 17
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.
18. 18
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
19. 19
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
• HL7 is currently working on version 2.7
Slide reproduced/adapted from Dr. Supachai Parchariyanon
20. 20
HL7 V2 Message
• Composed of reusable segments, each
identified by a 3-letter mnemonic
• All messages must start with header segment
MSH which includes sender, receiver, date-
time, message identifier, message type, and
trigger event
• Segments used in a message are determined
by message type
Slide reproduced/adapted from Dr. Supachai Parchariyanon
21. 21
Part of Sample HL7 V2 Message
(Lab Result)
OBX|1|NM|10839-9^TROPONIN-I^LN||5|ng/ml|
0-1.3|H||H|F|19980309…
22. 22
HL7 Basic Transaction Model
send
HL7 ADT
A01 msg
receive HL7
ACK msg
ADT system
Lab system
Receive A01,
send ACK
(external) admit
event
trigger event
network
Slide reproduced/adapted from Dr. Supachai Parchariyanon
23. 23
Patient Admission Scenario,
Inform Lab System
• Trigger event is admission : A01
• Message type is: ADT
• Messages composed of:
– MSH (message header)
– PID (patient identification)
– PV1 (visit data)
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
32. 32
Problems with HL7 v2
• 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
35. 35
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)
36. 36
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
37. 37
V3 Messaging Standard
• Based on an object information model, called the
Reference Information Model, (RIM)
– This model is “abstract,” that is, it is defined without
regard to how it is represented in a message “on the
wire” or in a “service architecture” method or in a
“clinical document”
– In fact, each of these representations can contain the
same “instance” of information
• Consequently, can be extended incrementally
when new clinical information domains need to
be added, in a way that doesn’t require changing
what has already been created
Slide reproduced/adapted from Dr. Supachai Parchariyanon
38. 38
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
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
44. 44
The HL7 V3 Solution
• Approaching “Plug and Play” - less of a
“framework for negotiation”
• Utilizes RIM for data model
• Utilizes XML as transport method
• HL7 V3 is not the next release of HL7 V2 -
It is a paradigm shift
Slide reproduced/adapted from Dr. Supachai Parchariyanon
45. 45
The HL7 V3 Solution (Cont.)
• HL7 V3 addresses the problems of HL7 V2
by:
– Reducing HL7 V2 optionality
– Including testable conformance rules
• HL7 V3 is based on a formal development
methodology:
– Follows an Object Oriented (OO) approach
– Uses Universal Modeling Language (UML) principles
• Most importantly, HL7 V3 supports
semantic interoperability
Slide reproduced/adapted from Dr. Supachai Parchariyanon
46. 46
Interoperability in HL7 V3
• The Four Pillars of Semantic
Interoperability in HL7 V3
– A common Reference Information Model (RIM) which
spans the entire patient care, administrative and
financial healthcare universe
– A well-defined and tool-supported process for deriving
data exchange specifications ("messages") from the
RIM
– A formal and robust Data Type Specification upon
which to ground the RIM
– A formal methodology for binding concept-based
terminologies (vocabulary) to RIM attributes
Slide reproduced/adapted from Dr. Supachai Parchariyanon
47. 47
HL7 Model Repository
• Database holding the core of HL7
semantic specifications
– RIM
– Storyboards
– Vocabulary domains
– Interaction models
– Message designs
– Message constraints
Slide reproduced/adapted from Dr. Supachai Parchariyanon
49. 49
Navigating the V3 Ballot
Publication
Slide reproduced/adapted from Dr. Supachai Parchariyanon
50. 50
Navigating the V3 Ballot
Publication
• Domains: The Functional Content of the
Publication
– Universal Realm Domains
• Administration Domains
• Health and Clinical Practice Domains
• Common Use Domains
– US Realm domains
• Medicaid Information Technology Architecture
(MITA)
– Other realm specific domains..
Slide reproduced/adapted from Dr. Supachai Parchariyanon
51. 51
Domain Publication
Structure
Each Realm contains a collection of
Domains. Domains are further divided into
Topics
• Domain
• Topic
Slide reproduced/adapted from Dr. Supachai Parchariyanon
52. 52
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
53. 53
The Future of HL7
• FHIR: Fast Healthcare Interoperability
Resources
– Pronounced “Fire”
• FHIR defines a set of “Resources” that
represent granular clinical concepts, which
can be managed in isolation, or
aggregated into complex documents
• Resources are based on simple XML or
JSON structures, with an http-based
RESTful protocol
http://wiki.hl7.org/index.php?title=FHIR
54. 54
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
55. 55
Message Exchange
• Goal: Specify format
for exchange of data
• Internal vs. external
messages
• Examples
HL7 V2
HL7 V3 Messaging
DICOM
NCPDP
Document Exchange
• Goal: Specify format
for exchange of
“documents”
• Examples
HL7 V3 Clinical Document
Architecture (CDA)
ASTM Continuity of Care
Record (CCR)
HL7 Continuity of Care
Document (CCD)
Exchange Standards
56. 56
Messages
• Human Unreadable
• Machine Processable
Clinical Documents
• Human Readable
• (Ideally) Machine
Processable
Exchange Standards
57. 57
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message Exchange
Message
Message
Message
Message
Message
58. 58
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
59. 59
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!!
60. 60
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
62. 62
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
63. 63
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
64. 64
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
65. 65
CDA Releases
• CDA Release 1 (ANSI-approved in 2000)
– First specification derived from HL7 RIM
• CDA Release 2 (2005) - Current Release
– Basic model essentially unchanged from R1
• Document has a header & a body
• Body contains nested sections
• Sections can be coded using standard vocabularies and can
contain entries
– Derived from HL7 RIM Version 2.07
Source: HL7 CDA R2
66. 66
Key Aspects of CDA
• CDA documents are encoded in XML
When alternative implementations are feasible,
new conformance requirements will be issued
• CDA documents derive their machine
processable meaning from HL7 RIM and
use HL7 V3 Data Types
• CDA specification is richly expressive &
flexible
Templates can be used to constrain generic
CDA specifications
Source: HL7 CDA R2
67. 67
Scope of CDA
• Standardization of clinical documents for
exchange
• Data format of clinical documents outside
of exchange context (such as data format
used to store clinical documents) is
out-of-scope
Source: HL7 CDA R2
68. 68
Scope of CDA
• CDA doesn’t specify creation or
management of documents and messages
related to document management
• Instead, HL7 V3 Structured Documents
WG provides specifications on standards
for document exchange within HL7 V3
messages (where CDA clinical documents
can become contents of the messages)
Source: HL7 CDA R2
69. 69
Scope of CDA
Lab Technician Physician
Lab Report
Create
document
Process &
Store
document
Transmit
document
CDA
70. 70
Scope of document content
• Clinical content of the documents is
defined by the RIM and not by CDA.
• CDA only standardizes the structure and
semantics required to exchange
documents.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
71. 71
Goals of CDA (1)
• Give priority to delivery of patient care
• Allow cost effective implementation across
as wide a spectrum of systems as possible
• Support exchange of human-readable
documents between users, including those
with different levels of technical
sophistication
• Promote longevity of all information
encoded according to this architecture
Source: HL7 CDA R2
72. 72
Goals of CDA (2)
• Enable a wide range of post-exchange
processing applications
• Be compatible with a wide range of document
creation applications
• Promote exchange that is independent of the
underlying transfer or storage mechanism
• Prepare the design reasonably quickly
• Enable policy-makers to control their own
information requirements without extension to this
specification
Source: HL7 CDA R2
73. 73
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 a MIME-encoded payload
within an HL7 message
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
74. 74
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
75. 75
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
76. 76
CDA As Payload
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
77. 77
MIME
• Multipurpose Internet Mail Extensions
• An Internet standard that extends the format of e-
mail to support
– Text in non-ASCII character sets
– Non-text attachments
– Message bodies with multiple parts
– Etc.
• Often used in e-mails & some HTTP data
• Encoding: e.g. base64 (converting bits into
64 ASCII characters
Source: http://en.wikipedia.org/wiki/MIME
80. 80
Major Components of a CDA
• A CDA document is wrapped by the
<ClinicalDocument> element, and contains a
header and a body.
• The header lies between the <ClinicalDocument>
and the <StructuredBody> elements and identifies
and classifies the document and provides
information on authentication, the encounter, the
patient, and the involved providers.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
86. 86
Rendering CDA Documents (1)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
87. 87
Rendering CDA Documents (2)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
88. 88
Rendering CDA Documents (3)
• Different recipients may use different style sheets
to render the same CDA document, and thus may
display it differently (but the same content is
presented)
• This can help facilitate display of CDA documents
with specific preferences or local requirements
89. 89
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)
90. 90
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)
91. 91
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
92. 92
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)
93. 93
CDA Summary
CDA is a markup standard for document
exchange
Not message exchange
Not document storage or processing
CDA is a general-purpose standard
Use in specific context requires
Implementation Guides (and possibly
Extensions)
94. 94
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
95. 95
HL7: Take Home Message
• HL7 is not panacea and so does other standards
• People and processes matter most
• Do not aim to build HIS to comply with HL7
specification but do aim to let it be able to
communicate to another systems via HL7
• Most specifications in standards and
interoperability provide framework but not
implementation guide, at times you need experts
Slide reproduced/adapted from Dr. Supachai Parchariyanon
96. 96
Additional Information
• Health Level Seven http://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
• FHIR: http://www.hl7.org/implement/standards/fhir/
Slide reproduced/adapted from Dr. Supachai Parchariyanon