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HL7 crash course
National efforts and applications (Finland)
Choice of Techology
20 year old (since 1987), non-profit organisation
National standard in the US (ANSI) since 1994
Open, consensus based development process
In use? ◦ CHIME-study 2000 (153 Hospital CIOs in US) 80% using HL7, 13.5% planning
Hospitals over 400 beds: 95%
For interoperability
Operational levelAbility to exchange data
Semantic levelAbility to exchange information
Process levelAbility to adapt to work flow
Messaging standards◦ HL7 v2.x (v2.5 ANSI-standard 2006)◦ HL7 versio 3 RIM
CDA (clinical document architecture) R1 and R2
HL7 data types to become ISO standard CCOW (clinical context management) Arden syntax (represents medical
algorithms in clinical information) + GLIF + Gello
+ small Working Groups Recommendations, implementation guides
Data model (or information model)◦ RIM (Reference Information Model) and D-MIM,
R-MIM, HMD◦ Refine by constraining
Vocabulary Data types Domain models ITS (Implementation Technology
Specification)◦ XML ITS currently available
Use Case Model
Use Case Diagram
Spec
UCM SpecAssociate Actors and Use Cases
Develop Scope
Identify actors and Use Cases
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Refined Message Information Model
Specify HMD & METs with constraints
Specify CMET
Information Model
State DiagramClass Diagram Define vocabulary domains and codes
Define states, transitions and triggers
Define classes, attributes, and relationships
Spec
RIM Spec
Interaction Model
Interaction Diagram
Define Application Roles
DefineInteractions
Define Conformance Criteria
Spec
Inter Spec
Source: HL7 Training, Scandinavia Tour, 2002
0..*
1 0..*
1Entity Participation Act
RelationshipLink
0..* 0..*
1 1
ActRelationship
1 1
0..* 0..*
ReferralTransportationSupplyProcedureCondition NodeConsentObservationMedicationAct complexFinancial act
OrganizationLiving SubjectMaterialPlaceHealth Chart
PatientEmployeePractitionerAssigned
PractitionerSpecimen
Role1
0..*
(Source: G.W. Beeler)
Study, other action
Is related(ActRelationship)
Patient(Role)
Target(Participation)
Visit(Act/ Encounter)
Pasi Leino(Entity/ Person)
Doctor(Role)
Performer(Participation)
Dr Phil(Person)
Medication(Act/ substanceAdministation)
Is related to(ActRelationship)
Entities in Green◦ Organisations, persons, devices, locations ...
Roles in yellow◦ professionals, patients, roleLinks
Participation in Cyan Activities (act), in Red◦ Observations, Events, medication, Encounters, ...Relations in activities
RIM DMIM RMIM
HMD
Dynaamic model:Use cases, application roles, interactionsThe static model an dynamic behavior is linked by interactions
XML Schema
HL7 affilicate since 1995
Has earned status of respect
Receives funding from the Ministry of social affair and health
Finland is an early adopter of any technology
CDA –centric approach
CDA is defined by the RIMCDA RMIM is a constraint on the RIMClasses “cloned” (replicated, renamed, constrained withvocabulary, datatypes)CDA is Persistence, stewardship, is Potential for authentication, Whole, Human readable
CDA document
Header and context to describe the document
Body
Narrative,
Human readable
Structured
Machine readable
texttext
text
Structurddata
Forms used everywhere: patient core data, health status, drivers license, leave of absence...
Very simple to define and implement
However, a single concept (diagnosis etc.) could be defied differently in different forms.
Seemingly simplistic?
In strict sence CDA document is not designed for forms
rivi tietokenttätunnus oid tunnus tietotyyppi tieto
tyyp
pi
ken
tän
pit
uu
s
min
max
pako
llis
uu
s
tois
tum
a
koodisto huom. kentän nimi
1 1.2.246.537.6.12.2006.3 Label LB K lomake lomake HEN
2 1.2.246.537.6.12.2006.3. 1 Label LB K pääotsikkoPäivitystiedot
3 1.2.246.537.6.12.2006.3. 2 Coded Value CV K Henkilötietojen käyttötarkoitus
4 1.2.246.537.6.12.2006.3. 3 Point in Time TS K Henkilötiedot on päivitetty
5 1.2.246.537.6.12.2006.3. 4 Character String ST K Henkilötietojen päivittäjä
6 1.2.246.537.6.12.2006.3. 5 Label LB K pääotsikkoPerustiedot
7 1.2.246.537.6.12.2006.3. 6 Instance Identifer II Henkilötunnus
8 1.2.246.537.6.12.2006.3. 7 Instance Identifer II Väliaikainen henkilötunnus
9 1.2.246.537.6.12.2006.3. 8 Instance Identifer II Muut tunnisteet
10 1.2.246.537.6.12.2006.3. 9 Person Name PN Sukunimi, etunimet
11 1.2.246.537.6.12.2006.3. 10 Person Name PN T Entinen sukunimimi, etunimet
12 1.2.246.537.6.12.2006.3. 11 Point in Time TS Syntymäaika
Patient centric services, which promote continuity of care
Interoperability
Electronic archiving or EPR, prescriptions, centralised image repositories
National services for codes, classifications, archiving
Scheduling-domain◦ Regional shared scheduling
ePrescription◦ Medical Records messages
◦ CDA R2 based content- prescription, delivery, locking, etc.
Death notice message ◦ V3 messaging spesifications for automatic reporting of
death to National citizen registy.
eArchive messages◦ V3 Messages, CDAR2 payload + W3C signature
Diagnostic imaging patient records and reports CDA R2 implementation guidelines
◦ See: www.hl7.fi
◦ See: www.hl7.co.uk
HENKILÖ-TIEDOT
YHDIS-TELMÄ
LPSYPSY
KIR
SISYLE
LÄÄPSY
ANS
RRDIA
SOSLAB
RAD
OPERVEREN-SIIRTO
KUUMEKU
LÄHETE
PSY HOSU
HOSUTAUDIN-KULKU JAHOITO
Summary
documents
Service units Care programs Care episodes
Structured and standardised core data
Use of national codes and OID
CDAR2 documents
Open interface to exchange CDAR2 documents
Ability to interface to national EPR archive, ePrescription, code services
Desktop integration, SSO
User authentication, electronic signing, concent management, referrals
Enterprise applications
National
EPR
Service
Secure Network &
Messaging Service
Core
services (Long-term)
Archive
EPR Service
(Active)
RepositoryRegistry
ePre-
scription
Service
Medical
forms &
certificates
service
Health
Portal
Service
Content
providers
VRKPerson
identifier
TEOAuthentication of healthcareprofessionals
StakesOID-
codes
Several providers
Codes,classifications,vocabularies
StakesHealthcare
servicestatistics
Content
DuodecimDecisionsupport
Consumerhealth
Public Health I. Consumer
health
Personidentifierservice
User authentication & eSignature
service
OID-codeservice
Codeservice
Decisionsupportservice
Enabling
services
Information model to be updated according to ”structured core patient date definitions”
Use of Codes and OID’s
Use of CDA R2 for document generation
Open interfaces for interchange of CDA R2 documents
Access to decision support services
Ability to use of the EPR, ePrescription etc. services
Functionality to filter user tailored views from retrieved patient documents
Desktop integration & SSO
User authentication, signature, consent management
XML is nothing alone◦ SOAP◦ Custom schemas◦ XML RPC
Decision points: the developer does not need to know what goes in the wire
Acid test of spesification: can this be done using general purpose development tools?
Caché, Enseble –objects eXtc, DOM model Example document
AD
BL
CS
CV
ED
II
INT
IVL
MO
PN
authorcdaBodycdaHeadercomponentcustodiandataComponentdocumentationOfencompassingEncounterexternalLinkexternalObservationlocalHeaderparagraphComponenttextComponentpatientpatientSubjectrelatedPatientperformerqualifierrtgENVEntryrtgRQOEntryrtgOBSEntrySection
Construct(...Generate(...
toCDA(..
Questions?
