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RFQ: Develop Phase I EHR Query-Response Message Set
The system components will be assembled from existing open source implementations, the initial components of which are: Transport/encryption/data integrity - candidate
CDC PHIN-MS Phase I EHR Query-Response Message Set-
developed within NLM project by modifying existing messages
Contract: how quick & how dirty is quick & dirty?
5 weeks “120” hours Lightweight Find and retrieve baseline, human-readable
information
Objectives How easy can we make it to request and receive
human-readable information? What HL7 components are available?
Identify Implement
Major deliverables: Operational prototype, proof-of-concept software and
implementation guide Report on what works as-is, what requires modification,
constraint or extension, where gaps lie and recommendations on best direction moving forward
Input into the standards development and refinement process
Scenario:
Client: requestor, low-end, small office, low-cost, simple, web-enabled
Server: data source, high-end, large facility, more sophisticated technically
Client can request, receive documents; Server can respond to query, supply documents
Server backend database has mix of data sources including non-CDA reports, CDA, V2 and V3 lab results
Primary components CDC’s Version 2 PHINMS messaging system MS SQL Server database development license
used locally by CommerceNet, other participants, including HL7, to supply own license
Version 3 query/response messages: Shared Messages, Medical Records
Utility to transform unstructured documents into CDA R1 (non-XML body): Webify
Client application for query definition and viewing of retrieved documents: Webify
Style sheet for displaying CDA R1 documents: adapted from one developed for CDA Claims Attachments (ASIG stylesheet)
Final report
Infrastructure Messages Data
Final report: Infrastructure
PHIN-MS Required addition of asp message handler
CDC had not implemented message handler talking to asp page; this was in the functional spec, but undocumented, so it took a bit of time
Now developed and working, will be deliverable back to CDC
Input into standards process: Should review with security and accountability
SIG
Final report: Messaging Candidate areas of V3: V3 messages to be considered: (from RFQ) Transport Specifications: ebXML, Release 1 DSTU - Pending Board Approval Webservices SOAP/WSDL Profile, Release 1 DSTU - Pending Board Approval MLLP, Release 1 ( Membership #1 ) Common Domains: Shared Messages: Act Status Topic Act Reference Topic QUMT (document query and query response) Infrastructure Management: Transmission Infrastructure: Generic Message Transmission Polling Message Transmission Infrastructure Management: Query Infrastructure: Query Control Act Topic Infrastructure Management: Master File/Registry Infrastructure: Master File Registry Topic Health and Clinical Management: Clinical Document Architecture Laboratory: Result Topic Medical Records: Document Topic RCMR (document request & retrieve) Public Health Reporting: ICSR Topic other, as desired (eg, Pharmacy, Blood Bank and so on)
Final report: Messaging
Input into standards process: Query messages: QUMT (document query and response)
-- CQ/OO/MRM: Review query parameters Review document parameters in query response
Retrieve messages: RCMR (document request and retrieve) – MRM/SDTC Accelerate creation of MRM query-by-parameter message Future consideration: query-by-example (new MRM/SDTC
project), constrained for implementation Promote use of MRM retrieve messages, possibly open
issue with OO as well
Final report: Clinical content
4 types of native data format: CDA
Henry Levin 7th (Release 1 Membership ballot sample) MS Word
CCR sample by Dr. Tom Sullivan Transform to CDA
V2 lab result Result sample provided by Mike Henderson Transform to CDA
V3 lab result Result in development (HIMSS 2004 as basis)
Final report: Clinical content
Input into standards process: CDA R1 sample: no issues Word to CDA: no issues V2 lab to CDA: rich source of issues to bring
forward within SDTC, in conjunction with O&O
Lab2CDA Transformation Issues
1. document ID: for every transform or every source document?
2. timestamp: time of source report creation? transmission? time of transform?
3. document type code: no LOINC scale=doc
4. provider: CDA assumes role in encounter; relationship to lab unclear
5. referring physician: anticipates an encounter
6. lab tech: no such role
7. order status: no such status
8. authentication: who is the authenticator?
Final report: clinical content Input into standards process:
CDA R1 sample: no issues Word to CDA (show): no issues V2 lab to CDA: rich source of issues to bring
forward within SDTC & O&O, many resolved in R2
V3 lab to CDA: in progress… input to O&O: Sample generation non-trivial because in active
development Cross-enterprise interaction modeling an incremental
challenge beyond V2 Schema generation complex (multiple CMETs) Sample available from HIMSS demo 2004 courtesy
Epic systems
Functional description Client: Invoke Send Query GUI, enter query parameters
(patient ID; optional: document type, provider, date range) Completed query, packaged in PHINMS and sent to Server. Server unpacks query, searches for corresponding artifacts,
formats response per guidelines, and sends response to Client listing matching data.
Client (requesting system) receives response, unpacks message, and renders response as HTML list in browser.
User selects one or more records to retrieve, sends request to Server.
Server unpacks request, identifies records to be retrieved; if needed, transforms them to CDA R1, packages in message and sends back to Client.
One or more documents received, can be displayed by Client using CDA R1 style sheet on Client java-enabled web browser.
Client Server
Client Sends HL7 Query
Server gets data from db and creates a HL7 V3 response
Server sends HL7 Response with a list of document metadata
Client parses HL7 V3 response and displays it on screen
Client Sends HL7 Query with specific document ID Server transforms/gets CDA document
from db and creates a HL7 V3 response
Server sends HL7 Response with a CDA document
Client parses CDA document response and displays it on screen
Do you have a referral for
Zsazsa from June ’03?
patientID=x123docType=LOINCxxxdate=YYYYmmDD
Yes, several
I’ll take that one
Okay, here it is
Thanks!
Application overview
Requesting a document
Showing what’s available
… and delivery
CDA Creation and Database Insertion
For More Information
Contact for technical InfoGary Griffin
Technical Consultant
Rainbow Builders Intl
[email protected] Downloads
Phase I Deliverable (2c) - Implementation Guide
http://hl7.org/nlmcontract/ehrfiles.cfm
Thank you!
Questions?