The document provides an overview of HL7 (Health Level Seven) standards for exchanging healthcare information and testing HL7 interface functionality in Eclipsys systems. It introduces HL7 components like message types, segments, and versions. It also explains how to set up HL7 dictionaries, define applications and processes, install interfaces, and use testing utilities like Interfaceslite and HL7Test to validate HL7 message exchange.

1. Eclipsys Interfaces Integration Presentation Eclipsys Baroda , India Part I Jan 25 th 2007 Presented by Monisha Ghuman

2. Introductions

3. Our Demo Objectives-Session One Introduction and Purpose of HL7 Body of an HL7 Message Different Hl7 Versions Eclipsys Test Utilities- Interfaceslite and HL7 Test Using HL7 test to test the communications and interfaces sub systems Importance of HL7 Data mapping Setting up Dictionary entries, applications and communication processes Installing Interfaces and HL7 Connections Interfaces Template Eclipsys -Interfaces testing Utilities

4. What are Interfaces? General Definition - “A point of intersection or communication at which independent systems interact” From Healthcare Industry perspective – “A point of intersection or communication at which various ancillaries (ADT, PRX, LAB), HIM or any system involved in Clinical Patient Care and Management interact”. HL7 is used as a standard for communicating between these systems.

5. Prior to HL7 !!! Where do we start ?

6. HL7 Background and Information… Health Level Seven is both an American National Standards Institute (ANSI)-accredited standards organization and a standard. The HL7 Organization was founded at the University of Pennsylvania in 1987 and is headquartered in Ann Arbor,MI . Started with an original committee of 14 people, now numbers nearly 2,400 members including healthcare providers, vendors and consultants. HL7 standard does not specify how messages will be delivered between the applications nor how the data is passed between the computers or networks. The term ?Level Seven? refers to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI (Open Systems Interconnection ) model of the International Standards Organization (ISO). Health Level Seven has been actively working with XML technology .

7. Introduction and Purpose of Health Level Seven(HL7) HL7 is a standard for information exchange between medical applications. HL7 simplifies interfaces between computer applications by standardizing the format and protocol for the exchange of essential set of patient data among health care computer applications. HL7 standard is written from the assumption that an event in the real world of healthcare creates the need for data to flow among systems. HL7 specifies the way data exchange between applications will be accomplished. It does not specify how applications store or process this data. Usually a TCP/IP connection or FTP file transfers are used to deliver a message. HL7 main aim is to establish a common language among medical applications regardless of platform, architecture or programming language. Sunrise Clinical manager uses 2.3.1 version of HL7.

8. HL7 Benefactors … HL7’s endeavors are sponsored, in part, by the support of its benefactors. Few of its benefactors are : Booz Allen Hamilton IBM Intel Corporation GE Healthcare Integrated IT Solutions; Oracle Corporation Quest Diagnostics Inc Accenture Wyeth Pharmaceuticals

9. International Affiliations International affiliates have also been established in 26 countries throughout the globe including Argentina, Australia, Brazil, Canada, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, India, Ireland, Italy, Japan, Korea, Mexico, The Netherlands, New Zealand, Spain, Sweden, Switzerland, Taiwan, Turkey and the United Kingdom, and Uruguay.

10. Different HL7 Versions HL7 version 2.1 and 2.2 are the older versions of HL7. Both of these versions are used today by some health applications. HL7 Version 2.1 and 2.2 covered the following: HL7 Patient Master Index PMI HL7 Admissions Discharge and Transfers ADT HL7 Radiology orders and results HL7 Pathology orders and results HL7 Medication prescribing and drug administration

11. Different HL7 Versions cont… HL7 Version 2.3 was approved as an ANSI standard standard in May 1997 developed by SDO (Standard Development Organization) and introduced: HL7 document management messages HL7 appointment servicing messages HL7 patient referrals messages HL7 track patient goals messages

12. Different HL7 Versions cont… HL7 Version 2.3.1 - Approved as an ANSI standard in April 1999. HL7 version 2.3.1 included updates to: HL7 Pathology orders and results messages and HL7 Radiology orders and results messages HL7 Medication prescribing and drug administration messages HL7 Patient Master Index PMI messages. These changes where particularly relevant to HL7 messaging for Enterprise Master Patient Index including the treatment of Multiple Patient Identifiers

13. Different HL7 Versions cont… HL7 Version 2.4 HL7 Version 2.4 was approved as an ANSI standard in October 2000. Extension of 2.3.1 version. HL7 Version 2.5 HL7 Version 2.5 was approved as an ANSI standard in June 2003. Extension of 2.4 version.

14. Different HL7 Versions cont… HL7 Version 3.0 HL7 Version 3.0 is being refined and is expected to gradually replace HL7 version 2 implementations. Significant Australian and international effort is currently focused on HL7 version 3.0. HL7 Version 3.0 is a complete redefinition of the HL7 standard to try and overcome some of the issues with the current standard Still a work in progress

15. Why isn't HL7 Plug and Play? Missing fields - Some vendors tend to omit fields in the message instead of leaving them empty. This will change the number of every subsequent field from the start of the message. Same data in different fields - Same information may be located in different fields and even in different segments in different HL7 implementations. Same data in different formats - Same data may come in different formats. For example, time stamp information should appear as following: 19991231100000.000 but some vendors divide date and time to different sub-fields 19991231^100000.000. Different versions - Existence of a number of different versions will allow data exchange only between applications that support same version of HL7. Missing values (including mandatory fields) - Although the standard requires only a limited set of values to be present, (95% of the fields are optional), some vendors omit even those with required values.

16. Message Type, Events ,Segments and Fields Message Type Each message has a message type that defines its purpose. ADT = patient administration message ORU = result message ORM = order messages MDM = medical document message RAS = pharmacy administration RDE = pharmacy response

17. Message Type, Events , Segments and Fields cont.. Trigger Events- The Trigger events are events in the real world of healthcare which create a need for data to flow among systems. For e.g. A trigger event a patient is admitted may cause the need for the data about that patient to be sent to a number of other systems. -A01-Admit a patient -A02-Transfer a patient -A03-Discharge a patient -A04-Register a patient The message type ADT could have the following events- Message Type Trigger Events Description ADT A01 Admit a patient ADT A02 Transfer a patient ADT A03 Discharge a patient ADT A04 Register a patient

18. Message Type, Events ,Segments and Fields cont.. Segments Messages are comprised of segments. Every line in a message is called a 'segment'. Segments are the units that comprise a message. Each segment is identified by a unique three character code known as the segment ID . Each segment has its own semantic purpose .This means that it contains information of a specific type. For example- MSH segment contains information about the sender and receiver of the message, type of the message, time stamp etc. EVN contains information about event type PID contains the demographic information about the patient such as name,id codes, address and so on. PV1 contains the information regarding the patient stay in the hospital such as location assigned, referring doctor etc.

19. Data Mapping/Translations Importance of Data mappings: The purpose of data mapping is to perform a check on whether the two systems can communicate and exchange data in a consistent manner. Data mapping is a means of matching up events ,segments and fields between systems. ( Refer HL7 Reference Mapping Guide). In many cases, mapping is just confirming that field data is OK to be supplied as is. Some fields may need to be translated from one system to another. E.g., O = Outpatient or F=Female. Interface Mapping worksheets are used to describe needed manipulation / translation. Translating the data so that differing values can be sent between SXA Clinical Manager and ancillaries.

20. Data Mapping cont..

21. Data Mapping cont… In the example below PID-8 “F” is translated to “Female” in SXA(PCS) ;client,VCRNTTEST29,7231 ;client,VCRNTTEST29,7230 ;HL7ADT ;pcs //A01 MSH|^~\&|HL7ADT||PCS||2003101910501530||ADT^A01|323922|P|2.3|%seq%| EVN|A01|20031018| PID|||6668889^^^MRN||monishaGhuman1019^^^||| F |||||(267)978-2678|(610)722-3250|E|STAYSINGLE|""||443138127|443128128||||||Indian|Q PV1||Inpatient|1A^^^NGH|||||||||||||||AcuteCare|9888^^^Visit|||||||||||||||||||||||||20031003115000|

22. Defining Applications Define applications in the application dictionary that communicate with Sunrise XA Clinical Manager. Identifies applications that can send messages to or receive messages from SXA Clinical Manager. Applications can receive/send messages

23. Defining Communication Process Define communication processes for the different ancillary applications. Define what must be done with data being sent from SXA Clinical Manager to another application. Communication Type = Electronic. Receiving Application = Value defined in the application dictionary (e.g.ADT,LAB…). Connection Name=HL7 Connections (ADT_OUT,LAB_OUT…). Coding standard=OBR-4 and OBX-3 as defined in the Ancillary Coding Standard dictionary.

24. Defining Communication Process Defined in application dictionary Communication Process

25. HL7 Example showing the Comm. Process ;client,10.138.50.2,8889 Receive from SXA(InterfacesLite does not use this ) ;client,10.138.50.2,8888 Send to SXA (Interfaceslite does not use this) ;HL7LAB Sending App (MSH-3 Comm. Process Name) ;PCS Receiving App (MSH-5 Envprofile/HL7Interfaces/CVApplicationName) // CommProcess – Test MSH|^~\&|HL7LAB|Main Hospital|PCS||%date%%time%||ORU^R01|0029|P|2.2|| PID |||20030424LAB1 ^^^MRN||Lab^Result^O^^^|Jones|19710101|M|Pat|3|1313 Mockingbird Lane^^Anywhere^ST^99999^USA|USA|(770) 555-1234~(404) 555-12356|(770) 555-1237~(404) 555-1238|Arameic|S|P|555774444|123-45-6789|AZ0000111 |||||||||||||| PV1||Inpatient|1EST^100^A^GH||0001|ACUTE^2^2|32556^Bundie^James|MTAN^Tan^Max|WATSON^Waston^Maria|Surgical|TEMP^TEMP||||||0003^Julip^Mint^Dr^PhD|IP|555774444^^^Visit|A||||||||||||||||||VE|CH|H|AA|||200304231000|| OBR|||LABCP00003^|0100520^Electrolytes|||200304231000||^|^^^^^^|||||^^^^|32556^Bundie^James|||||||||||&^&^^^^^^|||||||| OBX|1|ST|0100270^Sodium Level||147|mEq/L|140-150||||F||||| OBX|2|ST|0100280^Potassium Level||4.9|mEq/L|3.7-5.0||||F||||| OBX|3|ST|0100284^Chloride||107|mg/dl|95-105|H|||F|||| OBX|4|ST|0100282^Carbon Dioxide, Total||30|mEq/L|20-30||||F||||| OBX|5|ST|0100286^Anion Gap||10||||||F|||| MSH-3 Sending Application-Communication Process MSH-5 Receiving Application

26. Outbound Configuration (Orders/Tasks) Configuration Tools/Item Catalog/Ordering Info. Select appropriate Transmission policy, Disc Transmission policy. Select appropriate Ancillary Info. Configuration Tools/Dictionary/Catalog Information/Transmission policy. Configure Transmission policy for patients location/Priority and Communication Process. Configuration Tools/Dictionary/Catalog Information/Communication Process. Configure Communication Process (specifying Communication Type, Receiving application , Connection name).

27. Outbound Configuration (Orders/Tasks) Comm. Process attached to the location(transmission policy defined)

28. HL7 Interfaces Dictionaries (Environment profile) MSH-3 Sending app(Outbound Messages) MSH-5 Receiving app (Inbound Messages)/

29. HL7 Interfaces Dictionaries (Environment profile) cont… MSH-4 Outbound Messages

30. HL7 Interfaces Dictionaries (Environment profile) cont… MSH-12 Outbound Messages

31. HL7 Interfaces Dictionaries (Environment profile) cont… Client Id Type “MRN”attached to the facility(Outbound)

32. Interfaces Express Load File Express load is a fast means of inserting configuration rows into an SXA Clinical Manager database. HVCTemplate.blk used to define what outbound messages SXA Clinical Manager is to send. Outbound messages can include orders message(ORM), Pharmacy Task completion (RAS) and patient updates (ADT). HVCTemplate.blk is located in the \EclipsysSunrise\Clinical Manager client\version\Entdata directory.

33. Interface Express Load File Template Message Type Event Type Application Name

34. Interfaces Log showing HVC Template Error HVC Template Error

35. HL7 Interfaces testing HL7 interface testing is part of the overall HL7 interfaces planning process which includes HL7 interface analysis, HL7 interfaces requirements, HL7 interfaces specifications and HL7 Interfaces Testing .

36. Eclipsys-Test Utilities Interfaceslite and HL7Test Interfaceslite: The Interfaceslite program allows the user to load a data file created by an ancillary department and edit and transmit one or more messages from the file into Sunrise. Interfaceslite is installed as part of the application installation. Utility to test the integrity of the HL7 messages and the configuration of SXA Clinical Manager. Mimics the HL7 Worker. Delivers HL7 into the database bypassing the Interfaces sub system. It does not accept HL7 messages from SunriseXA Clinical Manager (not for outbound testing). Will show the ACK message from SXA Clinical Manager. Do not use the first two header lines in the HL7 push file .Used as placeholder. To use, log as a SXA Clinical Manager user with rights to write to the database. Must have local admin rights on machine.

37. Interfaceslite Executable Path

38. Invoking Interfaceslite To open, double click interfaceslite.exe in the client install folder ( C:\Program Files\Eclipsys Sunrise\Clinical Manager Client\build version). Login to Interfaces Lite with the appropriate user and password. Click the ‘Open’ button and browse for an HL7 message. Send the message by clicking the send button.

39. Using Interfaceslite to test Inbound data to SXA MESSAGE ACKNOWLEGMENT FROM SXA THAT IT RECEIVED THE MESSAGE HL7 message field counter Helper. Shows You the HL7 field your cursor is at Application Accept

40. FAQ-Interfaceslite How do I debug existing HL7 message? The best resource for debugging an HL7 message is the Sunrise Clinical Manager HL7 Mapping Interfaces Reference Guide. This guide describes about all the segments and structure of an HL7 message, their possible values and format. When you are trying to send a message and are getting “AE” application error, read the description of the error message and try to map the context of the error message in the reference guide. How can I save an existing HL7 message after modification using interfaceslite? Just click ‘Save’ in InterfacesLite. If you are modifying the message in Notepad, make sure you save it with .hl7 extension, otherwise InterfacesLite will not identify the message. Also, one HL7 file can have any number of messages as far as they have message header and are separated by a semi-colon (‘;’). How do I know that my HL7 message has been sent successfully through interfaceslite? “ AA” is the acknowledgement code for a successful HL7 message transmission. When you click the send button in InterfacesLite, the code is displayed in the ‘Received’ frame. This is the acknowledgment, which SCM has sent back to InterfacesLite that it has received the data and accepts it successfully. If SCM has some errors in receiving the message, it sends an acknowledgment with “AE” code and a reason where the error occurred.

41. HL7 Test Utility Mimics an Integration Engine. Tests messages by delivering them through the interfaces sub-system to the primary active database. Used to test the communication of the Interfaces Sub-system. Used for Inbound and Outbound Testing. It uses the first two header lines in the HL7 push file .Interfaces Lite does not. Errors and warnings generated when a message is processed through HL7Test are logged in the normal interface logs. Drag the prepared HL7 file on top of the hl7 test.exe and the utility opens up

42. HL7Test Utility Executable Path HL7Test Utility is installed as part of the Clinical Manager Interfaces installation

43. HL7Test File Format ;client, 192.87.14.210, Port Number (Outbound) ;client, The Server Name, Port Number (Inbound) ;HL7ADT ;PCS //first msg MSH|||||| EVN||||| PID||||| PV1||||| //second msg xxxxx Receiving from SXA (Outbound) TCP/IP info Sending to SXA (Inbound) TCP/IP info

44. HL7 Test GUI Outbound Message

45. Time to grab a bite ..!!!