HL7 V3 – the Medication HL7 V3 – the Medication Information/Pharmacy Information/Pharmacy

DomainDomainJulie JamesJulie James

Blue Wave InformaticsBlue Wave Informatics

HL7 V3HL7 V3

• What (or who) is HL7?What (or who) is HL7?

• Why is it important?Why is it important?

• What is V3?What is V3?

• How does V3 apply to Medication How does V3 apply to Medication Information?Information?

• How does HL7 V3 relate to UKCPRS?How does HL7 V3 relate to UKCPRS?

What is HL7?What is HL7?

• International Standards Developing International Standards Developing Organisation (SDO) Organisation (SDO)

• Producing standards (or specifications) for Producing standards (or specifications) for messaging of clinical and administrative data messaging of clinical and administrative data between systems in healthcarebetween systems in healthcare

• Modelling and sending medical messages is Modelling and sending medical messages is equated to the top layer of the ISO equated to the top layer of the ISO Communications modelCommunications model

HL7 Mission StatementHL7 Mission Statement

• ““To provide standards for the exchange, To provide standards for the exchange, management and integration of data that management and integration of data that support clinical patient care and the support clinical patient care and the management, delivery and evaluation of management, delivery and evaluation of healthcare services. Specifically, to create healthcare services. Specifically, to create flexible, cost effective approaches, standards, flexible, cost effective approaches, standards, guidelines, methodologies and related guidelines, methodologies and related services for interoperability between services for interoperability between healthcare information systems”healthcare information systems”

Why is HL7 Important?Why is HL7 Important?

• To the NHSTo the NHS

• To the Healthcare IT IndustryTo the Healthcare IT Industry

• To patientsTo patients

For the NHS?For the NHS?

• In early summer 2002, HL7 Version 3 In early summer 2002, HL7 Version 3 was designated as a “strategic was designated as a “strategic direction” for NHS Standards by the direction” for NHS Standards by the Information Standards BoardInformation Standards Board

• Works in co-operation with ISO (the Works in co-operation with ISO (the International Standards Organisation) International Standards Organisation) and CEN (the European Standards and CEN (the European Standards Organisation)Organisation)

For the Healthcare IT For the Healthcare IT IndustryIndustry

• Domain is messaging of “clinical and Domain is messaging of “clinical and administrative data in healthcare”administrative data in healthcare”

• Membership includes healthcare Membership includes healthcare providers, health insurance companies, providers, health insurance companies, clinicians, academics and government clinicians, academics and government representativesrepresentatives

• Putting one’s own home in order!Putting one’s own home in order!

For Patients?For Patients?• Focussed around unambiguous Focussed around unambiguous

messaging of patient care interactionsmessaging of patient care interactions• Volunteer organisation with strict operating Volunteer organisation with strict operating

procedures for development to ensure procedures for development to ensure openness, consensus and balance of openness, consensus and balance of interest interest

• International – wide body of expertise and International – wide body of expertise and experienceexperience

• Safe Communication about Life Critical Safe Communication about Life Critical InformationInformation

What is V3?What is V3?

• What was/is V2?What was/is V2?

• Why is V3 needed?Why is V3 needed?

• V3 Principles V3 Principles – the Static Corethe Static Core– the Dynamic Componentsthe Dynamic Components

What was/is V2?What was/is V2?

• Initial development (late 1980s) produced V2Initial development (late 1980s) produced V2• Widely used in US, particularly in Secondary Widely used in US, particularly in Secondary

Care sectorCare sector• Also used internationallyAlso used internationally• Based on structured, segmented, coded Based on structured, segmented, coded

messagesmessages• Not intuitive, flexible only at the cost of clarityNot intuitive, flexible only at the cost of clarity

Why is V3 Needed?Why is V3 Needed?

• Stronger methodology to support true Stronger methodology to support true interoperability of systemsinteroperability of systems

• Reflecting development of messaging, Reflecting development of messaging, including new technologiesincluding new technologies

• Allowing more sensible Allowing more sensible internationalisationinternationalisation

V3 Core – the Static ModelV3 Core – the Static Model• Reference Information Model (RIM)Reference Information Model (RIM)

– Uses UML like methodology and notationUses UML like methodology and notation– 6 core classes and relationships6 core classes and relationships– Gives a consistently ordered set of classes and attributes Gives a consistently ordered set of classes and attributes

foundational for unambiguous messagingfoundational for unambiguous messaging

• Domain Information Model (D-MIM)Domain Information Model (D-MIM)– ““Specialises” RIM classes for a particular domain area Specialises” RIM classes for a particular domain area

(e.g. Pharmacy, Billing etc.)(e.g. Pharmacy, Billing etc.)

• Refined Message Information Model (R-MIM)Refined Message Information Model (R-MIM)– ““Constrains” the D-MIM for a particular set of messages Constrains” the D-MIM for a particular set of messages

(e.g. prescribing)(e.g. prescribing)

V3 – the Dynamic V3 – the Dynamic ComponentComponent

• StoryboardsStoryboards

• Application RolesApplication Roles

• Interactions (State Transitions)Interactions (State Transitions)

• Trigger EventsTrigger Events

• Message TypesMessage Types

V3 Medication InformationV3 Medication Information• Focussed on dealing with messages to Focussed on dealing with messages to

support the Supply and Administration of support the Supply and Administration of therapeutic substances to patientstherapeutic substances to patients

• Initially:Initially:– Bare bones systemsBare bones systems

• PrescribingPrescribing• DispensingDispensing• AdministrationAdministration

– More complex messagingMore complex messaging• Master file updateMaster file update• Knowledge ManagementKnowledge Management

Messaging about Messaging about MedicinesMedicines

• Primary CarePrimary Care– ETPETP– GP2GP RecordsGP2GP Records

• Secondary CareSecondary Care– Prescribing system to Pharmacy SystemPrescribing system to Pharmacy System– Pharmacy system to Robotic DispenserPharmacy system to Robotic Dispenser– Prescribing system to Administration SystemPrescribing system to Administration System

• Primary to Secondary Care (& V/V)Primary to Secondary Care (& V/V)

0..10..*

AR_Administertype_cd*: <= FLFS

0..10..*

AR_Dispensetype_cd*: <= FLFS

AR_Admin_order_fulfills0..1

0..*

type_cd*: <= FLFS

AR_Sup_ord_fulfills0..1

0..*

type_cd*: <= FLFS

AR_Prop/Ord/Int_Plan_detail

0..*

type_cd*: <= COMPsequence_nbr*: INT [1..1]priority_nbr: INTpause_qty: PQ (e.g. 1s)split_cd:join_cd:

AR_Sup_Ord/Int_revision 0..*

0..*

type_cd*: <= RVSN

AR_Admin_Ord/Int_revision 0..*

0..*

type_cd*: <= RVSN

Constraint:cd and value or txt mustnot be null

Constraint:Either 'qty' or'expected_use_period'must be present.

Constraint:must have at leastdose_qty or txt

A_Other_admin_ord

class_cd* <= SBADMmood_cd*: <= ORDid*: [1..*]

A_Substance_admin_Prop/Ord/Int_dose

class_cd* <= SBADMmood_cd*: <= PRP, ORD, INTtxt*: STeffective_time: (SIG timing)repeat_nbr:dose_qty: IVL<PQ>rate_qty: IVL<PQ> (e.g. 1 s)dose_check_qty: SET<RTO<PQ,PQ>>max_dose_qty: SET<RTO<PQ,PQ>>

A_Prescription

class_cd* <= ACTmood_cd*: <= ORDid*:

A_Observation_indication

class_cd* <= OBSmood_cd*: <= EVNid: (used for future maintenance)cd*: [1..1] <= DiagnosisCodes (admitting Dx, Billing Dx, family Hx, etc.)status_cd: (Complete, Superceded)effective_time:confidentiality_cd:value*: UVP<CD> CWE (e.g. ICD9)target_site_cd:

A_Formulary

class_cd* <= SPLYmood_cd*: <= DEFid*: [1..*] (catalogue #)

A_Sub_admin_Prop/Ord/Int

class_cd* <= SBADMmood_cd*: <= PRP, ORD,INTid: SET<II> (sub-order id)cd: <= drugTreatmenttxt:priority_cd:independent_ind: "FALSE"

A_Observation_criteria

class_cd* <= OBSmood_cd*: <= EVN.CRTcd: CE <= ObservationTypetxt*:effective_time:value: ANY

A_Substance_admin_master

class_cd* <= SBADMmood_cd*: <= DEFid*: [1..*] (catalogue #)

A_Other_admin_Ord/Int

class_cd* <= SBADMmood_cd*: <= ORD, INTid*: [1..*]

A_Substance_administration_Proposal/Order/Intent

class_cd* <= SBADMmood_cd*: <= PRP, ORD. INTid*: SET<II> (placer number, etc.)cd*: <= (Manufactured) drugTreatment (clinical drug)txt: EDstatus_cd*: "ACTIVE"priority_cd:confidentiality_cd: "N"substitution_cd:

independent_ind: "FALSE"

A_Substance_administration_eventnegation_ind*: "False" (not administered)...status_cd: = COMPLETEDeffective_time*: (Admin. time)...cd:repeat_nbr:dose_qty*: PQrate_qty: PQ (e.g. 1 s)...

A_Sub_administrationmood_cd*: <= EVNcd*: <= ManufactureddrugTreatmentnegation_ind*: "False" (not administered)txt: EDeffective_time*: (admin. time)priority_cd:repeat_nbr:dose_qty*: PQrate_qty: PQ (e.g. 1 s)

A_Supply_Prop/Ord/Int

class_cd* <= SPLYmood_cd*: <= PRP, ORD, INTid: (defaults to Sub_admin_order.id)cd: <= ActPharmacySupplyType (partial, trial, etc. - this would be used to indicate authorization for trial/partial dispense)txt: (pharm. instructions)effective_time: (Earliest/last allowed dispense, frequency restrictions, etc.)confidentiality_cd:repeat_nbr: INT "1" (# refills + 1)qty*: PQ [1..1]expected_use_time: (days supply ordered)

A_Other_supply_Ord/Int

class_cd* <= SPLYmood_cd*: <= ORD, INTid*: [1..*]

Pharmacy Administration Proposal/Order/Intent(N/A)

Used as an entry-point when creatingor otherwise manipulating a pharmacyproposal, order or intent.

Supply(N/A)

PROPOSALUsed as an entry-point for messagesthat propose the revision or replacementof a supply order, independent of anadministration order. Generally usedfor requests to extend prescriptionend date or number of renewals

ORDERUsed as an entry-point for messagesthat revise or create a supply order,independent of an administration order.

NOTE: This message is NOT used forbulk-supply scenarios

INTENTUsed as an entry-point for messagesthat revise or create a supply intent,independent of an administration intent.

EVENTUsed as an entry-point for messagesrelating to dispense (supply) events

Note:E.g. radioactive substance mustbe administered in secured location,oral morphine in pharmacy

Note:This Act represents the dosageinstructions for a substanceadministration order.

Note:Used to refererencepharmacy protocolsgoverning how a drugshould be prescribed/administered.

Note:Administration instructions providedat time of dispensing

Note:Body weight,Surface Area,Allergies,Medical conditions

Note:For 'change' orders:If Substance_admin_order.id is null,P_subject and Substance_admin_order.cdmust be specified.Otherwise, this information is notrequired. If specified, it mustcorrespond with the specifiedSubstance_admin_order.id.

0..1

AR_Fulfill_admin_ord_reftype_cd*: <= FLFS

0..*

AR_Confirmationtype_cd*: <= PERT

0..*

AR_Alertstype_cd*: <= TRIG

0..* 0..1

AR_Prescriptiontype_cd*: <= COMP

0..*

AR_Annotationtype_cd*: <= PERT

0..*

AR_Encountertype_cd*: <= COMP

0..*AR_Encountertype_cd*: <= COMP

0..*

AR_Instantiates_supplytype_cd*: <= INST

0..*

AR_Indicationstype_cd*: <= RSON

0..*

AR_Routing*type_cd*: <= OPTN + COMP

0..*

AR_PRN_conditiontype_cd*: <= PRCN+OUTCcheckpoint_cd: CSnegation_ind: BLconjunction_cd: CS

0..*

AR_Propl/Ord/Int_plan_detailtype_cd*: <= COMPsequence_nbr*: INT [1..1]priority_nbr: INTpause_qty: PQ (e.g. 1s)split_cd:join_cd:

0..*

AR_Succeeding_admin_Ord/Inttype_cd*: <= SUCC

0..*

AR_Succeeds_admin_Ord/Inttype_cd*: <= SUCC

0..*

AR_Clinical_infotype_cd*: <= PERT

0..*

AR_PRN_conditiontype_cd*: <= PRCN+OUTCcheckpoint_cd: CSnegation_ind: BLconjunction_cd: CS

0..*

AR_Instantiates_admintype_cd*: <= INST

0..*

AR_Encountertype_cd*: <= COMP

0..*

AR_Annotationtype_cd*: <= PERT

0..*

AR_Succeeding_supply_Ord/Inttype_cd*: <= SUCC

0..*

AR_Succeeds_supply_Ord/Inttype_cd*: <= SUCC

0..1

AR_Admin_Prop/Ord/Int_dose*type_cd*: <= OPTN

0..1

AR_Sub_admin_Prop/Ord/Int_dose*type_cd*: <= OPTN

0..10..*

AR_Fulfill_proposal/order/Intenttype_cd*: <= FLFS

0..*

AR_Confirmationtype_cd*: <= PERT

0..*

0..*

AR_Dispense_Prop/Ord/Inttype_cd*: <= COMP

0..10..*

AR_Fulfill_dispense_Proposal/Order/Intnettype_cd*: <= FLFS

0..1

AR_Dispense_instructionstype_cd*: <= TRIG

R_Assigned_practitioner_or_device

R_Assigned_practitioner

R_Assigned_practitioner

R_Assigned_practitioner

R_Assigned_practitionerR_Assigned_practitionerR_Assigned_practitioner

R_Agent

R_Assigned_practitioner_or_device

R_Assigned_practitioner

R_Assigned_practitioner_or_device

R_Assigned_practitioner_or_device

R_Assigned_practitioner_or_deviceR_Assigned_practitioner_or_device

R_Assigned_practitionerR_Assigned_practitioner

R_Assigned_practitioner_or_device

CMET: (PAT) R_Patient(COCT_RM050000)

CMET: (AUTH) A_Confirmation(COCT_RM270000)

CMET: (ALRT) A_Alerts(COCT_RM260000)

CMET: (OBS) A_Observation_annotation(COCT_HD120400)

CMET: (OBS) A_Observation_annotation(COCT_HD120400)

CMET: (ENC) A_Encounter_identified(COCT_HD010100)

CMET: (SBADM) A_Route_substance(COCT_HD170100)

CMET: (CONT) R_Material_med_prod(COCT_RM230000)

0..*

CMET: (OBS) A_Observation_supporting(COCT_HD120200)

CMET: (MANU) R_Material_med_pkg(COCT_RM220000)

CMET: (PRSN) R_Location_located(COCT_HD070100)

0..*

CMET: (ENC) A_Encounter_identified(COCT_HD010100)

CMET: (ENC) A_Encounter_identified(COCT_HD010100)

CMET: (ASSIGNED) R_Assigned_practitioner_identified(COCT_HD091100)

CMET: (PRSN) R_Location_located(COCT_HD070100)

0..*

CMET: (ASSIGNED) R_Assigned_practitioner_identified(COCT_HD091100)

CMET: (ASSIGNED) R_Assigned_practitioner_identified(COCT_HD091100)

CMET: (ASSIGNED) R_Assigned_person_identified(COCT_HD090700)

CMET: (ASSIGNED) R_Assigned_practitioner_identified(COCT_HD091100)

CMET: (ASSIGNED) R_Assigned_device_identified(COCT_HD090900)

CMET: (ASSIGNED) R_Assigned_practitioner_identified(COCT_HD091100)

CMET: (ASSIGNED) R_Assigned_device_identified(COCT_HD090900)

CMET: (PAT) R_Patient(COCT_RM050000)

CMET: (AUTH) A_Confirmation(COCT_RM270000)

1..*

P_Subjecttype_cd*: <= SBJtime: (availability time)

0..*

P_Deliver_totype_cd*: <= DST

0..*

P_Responsible_partiestype_cd*: <= VRF+SPV +AST+WITtime*: (verification or attestation)mode_cd:signature_cd:signature_txt:

0..*

P_Performertype_cd*: <= PRFsignature_cd:signature_txt:

0..*

P_Authortype_cd*: <= AUT +PRFtime*: (time of creation)mode_cd:signature_cd:signature_txt:

1..*

P_Author*type_cd*: <= AUTtime*: (time of creation)mode_cd:signature_cd:signature_txt:

0..*

P_Receivertype_cd*: <= RCV

0..*

P_Data_entrytype_cd*: <= ENTtime: (time recorded)

0..*

P_Call_backtype_cd*: <= CBCtime: (availability time)

0..*

P_Delivery_locationtype_cd*: <= DST

1..*

P_Subject*type_cd*: <= SBJtime: (availability time)

0..*

P_Responsible_partiestype_cd*: <= VRF+SPV +ASS+WITtime*: (verification or attestation)mode_cd:signature_cd:signature_txt:

0..*

P_Data_entrytype_cd*: <= ENTtime: (time recorded)

0..*

P_Call_backtype_cd*: <= CBCtime: (availability time)

0..*

P_Administer_producttype_cd*: <= CSM

0..*

P_Admin_loctype_cd*: <= LOC

1..*

P_Supply_product*type_cd*: <= PRD

Note:Need to figure out howto represent proposalsto supercede/revise anorder.

Note:Order only

Note:Order/Intent only

Note:Order only

Constraint:Proposal OnlyEither 'qty' or'expected_use_period'must be present.

Note:Proposal & Order only

0..*

P_Dispense_loctype_cd*: <= ORG+DST

How does HL7 V3 relate to How does HL7 V3 relate to UKCPRS?UKCPRS?

• Medication Messages must use a Medication Messages must use a “Vocabulary” to describe medicines“Vocabulary” to describe medicines

• Represented in the Pharmacy D-MIM by two Represented in the Pharmacy D-MIM by two CMETs (modelled data)CMETs (modelled data)– Medicinal Product (VMP/AMP)Medicinal Product (VMP/AMP)– Packaged Medicinal Product (VMPP/AMPP)Packaged Medicinal Product (VMPP/AMPP)– Also Route of AdministrationAlso Route of Administration

• International understanding and International understanding and harmonisation where appropriateharmonisation where appropriate

Want to know more???Want to know more???

• HL7 UK WebsiteHL7 UK Website• HL7 UK membership/trainingHL7 UK membership/training• HL7 UK Technical Committee meetingHL7 UK Technical Committee meeting• UK Medication Information group (!)UK Medication Information group (!)• Main HL7 Pharmacy List ServerMain HL7 Pharmacy List Server• Main HL7 WebsiteMain HL7 Website• Holidays in the US three times a year…….Holidays in the US three times a year…….