Ist16-02 HL7 from v2 (syntax) to v3 (semantics)
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The second lecture of the course I'm giving on "Interoperability and Semantic Technologies" at Politecnico di Milano in the academic year 2015-16. It discusses interoperability using HL7 v2 and v3 as examples of syntactic and semantic interoperability, respectively.
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Ist16-02 HL7 from v2 (syntax) to v3 (semantics)
- 1. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Interoperability and Semantic Technologies 2015-16 HL7: from syntax (v.2) to semantics (v.3) Emanuele Della Valle DEIB - Politecnico di Milano http://emanueledellavalle.org - @manudellavalle
- 2. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Share, Remix, Reuse — Legally This work is licensed under the Creative Commons Attribution 3.0 Unported License. Your are free: to Share — to copy, distribute and transmit the work to Remix — to adapt the work Under the following conditions Attribution — You must attribute the work by inserting “by E. Della Valle – http://emanueledellavalle.org - @manudellavalle” at the end of each reused slide To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/ 2
- 3. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Health Level 7 • Founded in 1987, Health Level Seven International is one of several American National Standards Institute (ANSI) - accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven's domain is clinical and administrative data. • HL7 develops: • conceptual standards (e.g., HL7 RIM) • document standards (e.g., HL7 CDA) • messaging standards (e.g., HL7 v2.x and v3.0). 3
- 4. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.x principles Message Description ACK General acknowledgment message ADR ADT response ADT ADT message BAR Add/change billing account CRM Clinical study registration message CSU Unsolicited study data message DFT Detail financial transactions DOC Document response DSR Display response HL7 v.2.x roots are to be found in situations like where two systems need to align their data Trigger events Actions or Events Messages Contains the actual information Segments Reusable structures Data elements Data representation 4 *ADT: Admission Discharge Transfer *
- 5. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v2 enables bi-later integrations Complementary application […] Organizational boundaries application […] adapter ! 5
- 6. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.x principles 6 The Type of a message is identified by a three digit code, and the Event that starts a communication is called Trigger Message Description ACK General acknowledgment message ADR ADT response ADT ADT message BAR Add/change billing account CRM Clinical study registration message CSU Unsolicited study data message DFT Detail financial transactions DOC Document response DSR Display response Code samples and their meaning New codes can be defined using Z as the first code character
- 7. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.x principles ZCH|Donor^Eyes~Donor^Heart~Donor^Lungs ZCH|ADE^DO NOT RECESITATE …… whatwhat’’s the meaning of a Z code !?!s the meaning of a Z code !?! 7
- 8. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.4 example MSH|^~&|GHH LAB|ELAB-3|GHHOE|BLDG4|200202150930||ORU^R01|CNTRL-3456|P| 2.4<cr> PID|||555-44-4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOOD DR.^^STATESVILLE^OH^35292||(206)3345232|(206)752-121||||AC555444444||67- A4335^OH^20030520<cr> OBR|1|845439^GHH OE|1045813^GHH LAB|15545^GLUCOSE|||200202150730||||||||| 555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444-44- 4444^HIPPOCRATES^HOWARD H^^^^MD<cr> OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182|mg/dl| 70_105|H|||F<cr> Completion of a serum glucose laboratory result of 182 mg/dL authored by Howard H. Hippocrates. The laboratory test was ordered by Patricia Primary for patient Eve E. Everywoman. The use case takes place in the US Realm. 8
- 9. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.4 example (2) MSH|^~&|GHH LAB|ELAB-3|GHHOE|BLDG4|200202150930||ORU^R01|CNTRL- 3456|P|2.4<cr> The MSH (Message Header) segment contains the message type, in this case, ORU^R01, which identifies the message type and the trigger event. The sender is the GHH Lab in ELAB-3. The receiving application is the GHH OE system located in BLDG4. The message was sent on 2002-02-15 at 09:30. The MSH segment is the initial segment of the message structure. PID|||555-44-4444||EVERYWOMAN^EVE^E^^^^L|JONES|19620320|F|||153 FERNWOOD DR.^^STATESVILLE^OH^35292||(206)3345232|(206)752-121|||| AC555444444||67-A4335^OH^20030520 The PID (Patient Identification) segment contains the demographic information of the patient. Eve E. Everywoman was born on 1962-03-20 and lives in Statesville OH. Her patient ID number (presumably assigned to her by the Good Health Hospital) is 555-44-4444. 9
- 10. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.4 example (3) OBR|1|845439^GHH OE|1045813^GHH LAB|15545^GLUCOSE||| 200202150730||||||||| 555-55-5555^PRIMARY^PATRICIA P^^^^MD^^|||||||||F||||||444- 44-4444^HIPPOCRATES^HOWARD H^^^^MD<cr> The OBR (Observation Request) segment identifies the observation as it was originally ordered: 15545^GLUCOSE. The observation was ordered by Patricia Primary MD and performed by Howard Hippocrates MD. OBX|1|SN|1554-5^GLUCOSE^POST 12H CFST:MCNC:PT:SER/PLAS:QN||^182| mg/dl|70_105|H|||F<cr> The OBX (Observation) segment contains the results of the observation: 182 mg/dl. 10
- 11. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Limitations of HL7 v.2.x • Implicit data model (i.e., positional) • Events are difficult to be linked to their respective business processes • Optional fields (see |||||) • A single message support only one coding system • No support for object technologies XML and Web technologies • No support for security 11
- 12. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Limitations of HL7 v.2.x AdmittanceAdmittance WardWard LaboratoryLaboratory AdministrationAdministration Message brokerMessage broker 12
- 13. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Limitations of HL7 v.2.x 13
- 14. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Limitations of HL7 v.2.x The main limit related to a message-only architecture (even when aThe main limit related to a message-only architecture (even when a using a bus) is that information remain confined inside all the singleusing a bus) is that information remain confined inside all the single applications deployed in a companyapplications deployed in a company Application 1 messagesWhere’s the right patient’s address ? Application 2 Application 3 By just using messages, different applications can interact, but no coherent information base can be created 14
- 15. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 v.2.x in XML • Adoption of XML • Element Naming Convention • message name and trigger event ORM_O01, ADT_A01, • Segment element MSH, PID, OBX, etc. • Datatype name and component number CE.2, HD.1, XAD.3, etc. 15
- 16. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Limitations of HL7 v.2.x in XML 16
- 17. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 - Version 3 • Initial HL7 standards (Version 2) were based on a pragmatic ‘just do it’ approach to standards • HL7 saw the need to revise and formalize the process • to assure consistency of the standards • to meet plug’n’play demands • to be able to adopt and leverage new technologies for both HL7 and its users • Adopted the new methodology in 1997 • based on best development & design practices • supports ‘distributed’ development across committees • It is technology neutral 17
- 18. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 version 3 intent 18 […] […] […] […] […] […] […]
- 19. E. Della Valle – http://emanueledellavalle.org - @manudellavalle HL7 - Version 3 • Methodology based on shared models • Reference Information Model (RIM) of the health care information domain • Defined vocabulary domains • Drawn from the best available terminologies directly linked to the RIM • Supported by robust communication techniques • Harmonization process that • Assures each member and committee a voice in the process, yet • Produces a single model as the foundation for HL7 standards • Continuous balloting - begun in 2009 – produces a new release each year. 19
- 20. E. Della Valle – http://emanueledellavalle.org - @manudellavalle The essence of Version 3 • Apply the ‘best practices’ of software development to developing standards - a model-based methodology • Predicate all designs on two semantic foundations • a reference information model (RIM) and • a complete, carefully-selected set of terminology domains • Require all Version 3 standards to draw from these two common resources • Use software-engineering style tools to support the process. 20
- 21. E. Della Valle – http://emanueledellavalle.org - @manudellavalle The essence of Version 3 • A family of specifications • Built upon a single model of • How we construct our messages • The domain of discourse • The attributes used • Constructed in a fashion to rapidly develop a comprehensive, fully constrained specification in XML 21
- 22. E. Della Valle – http://emanueledellavalle.org - @manudellavalle How is Version 3 “better”? • Conceptual foundation • a single, common reference information model to be used across HL7 • Semantic foundation • in explicitly defined concept domains drawn from the best terminologies • Abstract design methodology • technology-neutral • able to be used with whatever is the preferred technology: documents, messages, services, applications • Maintain a repository of the semantic content • to assure a single source, and enable development of support tooling
- 23. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Version 3 - where is it being used? • As • Clinical Document Architecture (CDA) documents, • SOA designs • interchanged Messages • In • large-scale projects deriving from governmental mandates • For • communications between multiple, independent, “non-integrated” entities • Wherever there are requirements to communicate parts of an Electronic Health Record (EHR) and to maintain the integrity of the EHR data relationships 23
- 24. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Positioning HL7 24
- 25. E. Della Valle – http://emanueledellavalle.org - @manudellavalle Interoperability and Semantic Technologies 2015-16 HL7: from syntax (v.2) to semantics (v.3) Emanuele Della Valle DEIB - Politecnico di Milano http://emanueledellavalle.org - @manudellavalle
Editor's Notes
- In the context of Health informatics, CCOW or Clinical Context Object Workgroup is an HL7 standard protocol designed to enable disparate applications to synchronize in real time, and at the user-interface level. It is vendor independent and allows applications to present information at the desktop and/or portal level in a unified way. CCOW is the primary standard protocol in healthcare to facilitate a process called &quot;Context Management.&quot; Context Management is the process of using particular &quot;subjects&quot; of interest (e.g., user, patient, clinical encounter, charge item, etc.) to &apos;virtually&apos; link disparate applications so that the end-user sees them operate in a unified, cohesive way.