1. Version 2.x Messaging Conformance Abdul-Malik Shakir Principal Consultant, Shakir Consulting HL7 Working Meeting January 2011 Sydney, AU

2.

Abdul-Malik Shakir

Principal Consultant, Shakir Consulting, La Verne, CA

HL7 Member since 1991

Principal Consultant with Shakir Consulting

Chief Technical Architect with Cal2Cal Corporation

Co-Chair of the HL7 Education Committee

Member of the HL7 Architectural Review Board

Member of the HL7 Public Health and Emergency Response Committee

Member of the HL7 Regulated Clinical Research Information Management Committee

Member of the HL7 Modeling and Methodology Committee

3. Session Outline

Part I

Background

• HL7: What, and Why

• Message Profile:Why and When

Message Profiles:

• What and How

• Concepts and Constituents

• Levels and Examples

Part II

Messaging Workbench

• What and Why

• Features and Use

• Reports and Examples

• Contacts and Help

Sample Projects

• CADHS ELR

• CA SIIS SIP

4.

Health Level Seven

What and Why

5. An HL7 Messaging Scenario:Why User Interface Program Module Dataset User Interface Program Module Dataset Message Creation Message Parsing A to B Transformation Message Parsing Message Creation B to A Transformation Order EntryApplication System LaboratoryApplication System Lab OrderTransaction Order EntryApplication System LaboratoryApplication System Lab ResultTransaction 6. Reaching the Limits of Application Interfaces Lab Order Entry ADT Pharmacy Radiology Decision Support Electronic Health Record Administrative Systems ? Enterprise Systems ? External Systems ? 7. Health Level Seven:Why

The number of interfaces between N systems is given by the formulaI = (N 2 -N)/2.

Linkingsystems only needs 1 interface,;

Linking 6 systems needs as many as 15 interfaces, (6 2 6) / 2 =15

The benefits of using the HL7 standard increase rapidly with the number of systems involved.I = N

3 (3 2- 3) / 2 = 32 (2 2- 2) / 2 = 14 (4 2- 4) / 2 = 6 8. Health Level Seven:Why Tolerable Painful Intolerable 9. Divide and Conquer / Component Reuse DATA Visit Billing Results Reporting Next of Kin( NK 1 ) Insurance( IN 1 ) Patient Visit( PV 1 ) PatientDemographics( PID ) Guarantor ( GT 1 ) NK 1 IN 1 PV 1 PID GT 1 OBR OBX Next of KIN ( NK 1 ) Patient Visit ( PV 1 ) PatientDemographics ( PID ) 10. Abstract Message Specification

MSH Message Header

EVN Event Type

PID Patient Identification

[PD1] Additional Demographics

[ { NK1 } ] Next of Kin /Associated Parties

PV1 Patient Visit

[ PV2 ] Patient Visit - Additional Info.

[ { GT1 } ] Guarantor

[

{ IN1 Insurance

[ IN2 ] Insurance Additional Info.

[ IN3 ]Insurance Add'l Info - Cert.

}

]

Segment ID Segment Name [ ] optional { } may repeat 11. MSH Segment Definition 12. MSH Segment Definition SEQ- position within segment LEN- length of field DT- data type for field OPT- optionality for field RP /# - repeatability TBL # - table number for codes ITEM # - HL7 element number ELEMENT NAME- name 13. HL7 Message Elements

An HL7message specificationis an ordered collection of one or moresegment groupswhere each segment group is an ordered collection of one or more segments.A segment may be part of more than one segment group; it can also appear more than once within the same segment group.

Asegmentis an ordered collection of fields.Eachsegment fieldis an instance of a data element.Adata elementmay appear as a field in more than one segment or as more than one field within the same segment.Each data element is assigned a data type.

Adatatypemay be simple or composite.Acomposite datatypeis an ordered collection of one or more data type components; a simple datatype has no components.Adata type componentis an instance of a data element.A data element may appear as a component of more than one composite data type or as more than one component of the same composite data type.

Segment fields and datatype components may be associated with a code table.Acode tableis a collection of code table items.Eachcode table itemis acode system termfrom some code system.Acode systemmay be HL7 defined, user defined, or defined by a third party.A code system term may be used as a code table item in more than one code table but may appear only once within the same code table.

14. HL7 v2 Message Elements 15. Sample HL7 v2.x Message

Segments

MSH: Message Header

PID: Patient Identification

OBR: Observation Request

OBX: Observation Result

Delimiters |Field^ Component & Subcomponent~RepetitionEscape Character MSH |^~&| LABGL1 || DMCRES || 199812300100 || ORU ^ R01 | LABGL1199510221838581 | P | 2.3 ||| NE | NE PID ||| 6910828 ^ Y ^ C8 || Newman ^ Alfred ^ E || 19720812 | M || W | 25 Centscheap Ave ^^ Whatmeworry ^ UT ^ 85201 ^^ P || (555)777-6666 | (444)677-7777 || M || 773789090OBR || 110801 ^ LABGL | 387209373 ^ DMCRES | 18768-2 ^ CELL COUNTS+DIFFERENTIAL TESTS (COMPOSITE) ^ LN ||| 199812292128 || 35 ^ ML ||||||| IN2973 ^ Schadow ^ Gunther ^^^^ MD ^ UPIN ||||||||||^ Once |||||| CA20837 ^ Spinosa ^ John ^^^^ MD ^ UPIN OBX || NM | 4544-3 ^ HEMATOCRIT (AUTOMATED) ^ LN || 45 || 39-49 |||| F ||| 199812292128 || CA20837 OBX || NM | 789-8 ^ ERYTHROCYTES COUNT (AUTOMATED) ^ LN || 4.94 | 10*12/mm3 | 4.30-5.90 |||| F ||| 199812292128 || CA20837 16.

Message Profiles

Why and When

17. Reveal Assumptions Revealing assumptions is an essential component of effective communication. Yes, I do play football. Do you play football? 18. Reveal Assumptions Message Profiles are an effective means of documenting our assumptions about message structures Do youuseHL7? MSH EVN PID [PD1] [ { NK1 } ] Yes, I useHL7. MSH EVN PID [ NK1 ] OBX 19. Reduce Ambiguity Message Profiles provide a language that allows us to unambiguously express our understanding and assumptions about the information in a message structure used in a particular scenario MSH EVN PID [PD1] [ { NK1 } ] 20. Highlight Conflicts Sharing message profiles providesan opportunity to identify and reconcile conflicts in our understandingand to validate our assumptions about message structures. MSH EVN PID [PD1] [ { NK1 } ] MSH EVN PID [ NK1 ] OBX 21. Consolidate Viewpoints Message Profile Message Profile Message Profile MSH EVN PID [PD1] [ { NK1 } ] MSH EVN PID [ NK1 ] OBX MSH EVN { PID } [PD1] [ { GT1 } ] MSH EVN { PID } [PD1] [ { NK1 } ] [ { GT1 } ] [ OBX ] Canonical Message Profile 22. Value of Message Profiling

Reveal Assumptions

Reduce Ambiguity

Highlight Conflicts

Consolidate Viewpoints

23.

Message Profiles

What and How

24. Message Profile Defined

Unambiguous specification of a standard HL7 message for use within a particular set of requirements

• • Prescribes a set of precise constraints upon one or more standard messages

• • Supported by use case analysis and interaction modeling

Measurable

• • What data will be passed in a message

• • The format in which the data will be passed

• • The acknowledgement responsibilities of the sender andreceiver

25. Message Profile Defined (contd)

Based on HL7, although may further constrain

• • Static structure and content of each message

• • The dynamic interactions

Parts of a valid message profile

• • Use Case Model

• • Static Definition

• • Dynamic Definition

Represented as an XML document

• • Canbe registered with HL7

• • May be reused by other HL7 users

• • May be used for documentation

of15 26. Conceptual Overview Message Profile =Static Profile+ Dynamic Profile Critical Care Unit ADT System Clinical Data Repository Response Message Initiating Message Initiating Message 27. Use Case Model

Documents the scope and requirements for an HL7Message Profile or set of Message Profiles

• May include a use case diagram or detailed text

• Provides a name that clearly and concisely defines the exchange

• Defines the actors, including the sending and receiving applications

• Defines the responsibilities of these actors

• Documents the situations in which the exchange of a particular HL7 Message Profile is required

• Documents the purpose

V3.0 Message Development Framework (MDF 99)

28. Static Definition

A specification for a message structure intended to support the use case

Based on amessage defined in HL7 Std

Defined at the message, segment, and field levels

• Follows the HL7 rules (chapter 2)

• May further constrain

• • Identifies only those specific elements used in the exchange

• • Removes all instances of optionality, defining explicitly

• • Segments, segment groups, fields and components usage rules

• • Cardinalities

• • Value sets and coding systems

• • Implementation notes

29. Static Definition Example ... ... ... NK1 MSH EVN PID NK1 NK1 NK1 NK1 PV1 PV2 OBX AL1 Message Profile

Segments/Segment Groups:

Usage (Optionality)

Cardinality (min, max)

Fields/Components: - Usage (Optionality) - Cardinality (min, max) - Value Sets/Coding system - Descriptions ... NK1 MSH EVN PID NK1 NK1 NK1 NK1 PV1 PV2 OBX AL1 HL7 Message Structure 30. Dynamic Definition

Defines interaction between the sender and receiver

• Acknowledgment mode supported

• Conditions under which an accept and/or application level acknowledgment is expected

• • Always

• • Never

• • Only on success

• • Only on error

Interaction Model

• Defines specific interactions between the applications that support message profile communication requirements

• Includes interaction diagrams that illustrate the sequence of trigger event and resulting message flows between the sending and receiving applications

Dynamic can refer one to many static definitions

31. Dynamic Interaction Critical Care UnitHIS/CIS Clinical Data Repository A/D/T System Order Filling Application Accept Ack Accept + App ACK Receiver Responsibility MSH-15,16 No ACK 32. How it all ties together 33.

Message Profiles

Concepts and Constituents

34. Profiling Concepts

Profile Types

• HL7 Standard

• Constrainable

• Implementable

Generic term message element used

• Segment groups

• Segments

• Fields

• Components

• Sub-components

Cardinality

Usage

Message Constituents 35. Profile Types

HL7 Standard Profile

• represents a specific HL7 published standard

• creation and publication limited to HL7 use

Constrainable

• May have optionality - not implementable

• Narrower profiles may be defined based on this

• Realm Specific (National, Regional, SIGs, etc.)

• Organization / Application Specific

Implementation

• Further constrained

• No optionality

36. Cardinality

Identifies minimum and maximum number of repetitions

Special values for cardinality

• Minimum number of repetitions is 0, the element may be omitted from a message

• The maximum value may have no practical limit (In this case, it may be identified as *)

37. Cardinality Examples Value Description [0..0] Element never present [0..1] Element may be omitted and it can have at most one Occurrence [1..1] Element must have exactly one Occurrence [0..n] Element may be omitted or may repeat up to n times [1..n] Element must appear at least once, and may repeat up to n times [0..*] Element may be omitted or repeat for an unlimited number of times [1..*] Element must appear at least once, and may repeat unlimited number of times [m..n] Element must appear at least m and at most n times 38. Usage

The circumstances under which an element appears in a message

• Some elements must always be present

• others may never be present

• others may only be present in certain circumstances

Rules governing the expected behavior of the sending and limited restrictions on the receiving application with respect to the element

39. Usage (continued)

R - Required

• A conforming sending application

• • populate all R elements with a non-empty value

• A conforming receiving application

• • process (save/print/archive/etc.) or ignore the information conveyed by required elements

• • must not raise an error due to the presence of a required element, but may raise an error due to the absence of a required element

• For complete compatibility with HL7, any element designated as required in a standard HL7 message definition shall also be required in all HL7 Message Profiles of that standard message

40. Usage (continued)

RE - Required but may be empty

• May be missing from the message, but must be sent by the sending application if there is relevant data

• A conforming sending application

• • must be capable of providing all RE element

• • if it knows the required values for the element, then it must send that element

• • if the conforming sending application does not know the required values, then element will be omitted

• A conforming receiving applications

• • will be expected to process (save/print/archive/etc.) or ignore data contained in the element

• • must be able to successfully process the message if the element is omitted(I.e. no error message should be generated because the element is missing

41. Usage (continued)

Optional

• This code indicates that the Usage for this element has not yet been defined

• May NOT be used in Implementation profiles (no-optionality profiles)

• Conformance cannot be tested on an Optional field

42. Usage (continued)

C - Conditional

• Predicate associated with this element that identifies the conditions under which the element must be present

• • must be testable and based on other values within the message

• • may be expressed as a mathematical expression or in text and may utilize operators such as equivalence, logical AND, logical OR and NOT

• • The conforming sending and receiving applications shall both evaluate the predicate

• If the predicate is satisfied:

• • See rules for R (Required)

• If the predicate is NOT satisfied:

• • A conformant sending application must NOT send the element

• • A conformant receiving application must NOT raise an error if the condition predicate is false and the element is not present, though it MAY raise an error if the element IS present

43. Usage (continued)

CE - Conditional but may be empty

• This usage also has an associated condition predicate similar to Conditional (C)

• If the predicate is satisfied:

• • See rules for RE (Required but may be empty)

• If the predicate is not satisfied:

• • The conformant sending application must NOT send the element

• • The conformant receiving application MAY raise an application error if the element IS present

X - Not supported

• Conformant sending applications will NOT send the element

• Conformant receiving applications MAY ignore the element if it IS present, or may raise an application error

44. Optionality / Usage Relationship

Conformance Usage codes are more specific than HL7 Optionality codes

HL7 Optionality Allowed Conformance Usage Comment R - Required R O - Optional R, RE, O*, C, CE, X O is only permitted for constrainableprofiles C - Conditional C, CE,R**, RE** ** If satisfied by use case X Not Supported X B Backward Compatibility R, RE, O*, C, CE, X O is only permitted for constrainableprofiles W Withdrawn X 45. Usage / Cardinality Relationship

Both Usage and Cardinality govern the appearance of a field in a message

Cardinality constrained by the usage code

• If Required (R), the minimum and maximum cardinality for the element shall always be >= 1

• If the usage of an element is not Required (R) (i.e. any code other than R), the minimum cardinality shall be 0 except in the following condition:

• • where an element will not always be present but, when present, must have a minimum number of repetitions greater than one, this may be indicated by specifying

• • • the non-required Usage code

• • • the minimum cardinality representing the minimum number of repetitions when the element is present.

46. Usage-Cardinality Combinations 47. Usage Within Hierarchical Elements

Messages are constructed using a hierarchy of elements

At least one lower level element must be present for the higher level element to be considered to be present

Adds an implicit conditional constraint on elements that enforce the presence of an element

Places constraints on what combinations of usage codes may be used within a hierarchy

48.

Message Profiles

Levels and Examples

49. Message Level Profile

Segment Definitions

• The set of segments and segment groups included within the message of an HL7 Message Profile shall be defined

• Any segments or segment groups that are required by HL7 shall be included

Segment Usage

Segment Cardinality

Profile does not allow for empty segment

HL7 abstract message syntax PLUS

• Usage

• Cardinality

50. Message Level Profile Example 51. Message Level Profile Example 52. Message Level Profile Example 53. Message Level Profile Example 54. Segment Level Profile

The set of fields of each instance of a segment within the Message Profile

If a segment occurs multiple times, it may be represented by different segment profiles

Field Usage

Field Cardinality

Null

Syntax (tabular HL7 segment definitions)

• Length (updated)

• Usage (new column)

• Cardinality (new column)

55. Segment Level Profile Example(PID) 56. Segment Level Profile Example(PID) 57. Field Level Profile

Field definitions

• Each individual field is completely defined to eliminate any possible ambiguity

• If HL7 2.x field descriptions are not sufficient, a precise semantic definition shall be specified

Exact allowed value set shall be specified

• Coded Values (ID and IS)

• • HL7 tables (ID) may be extended

• • User defined (IS) may be redefined and/or extended

• Coded Entry (CE, CF, CWE, and CNE)

Composite Data (CM) types

• • Appendix for 2.3.1 and 2.4 for XML encoding

• • Deprecated and all CM fields are using new data types as of 2.5

58. Message Profile Identifier

Uniquely identifies static and dynamic profile

The static profile identifier is a means to uniquely identify a message profile, expressed as an ASN.1 Object Identifier (OID)

• The sending application uses the profile identifiers to determine the specific HL7 Message Profile to send

• Branch from ISO to HL7 and Message Profile

• • 2.16.840.1.113883.9

59. MSH-21 Message Profile Identifier

Sites may use this field to assert adherence to, or reference, a message profile. Message profiles contain detailed explanations of grammar, syntax, and usage for a particular message or set of messages.

Repetition of this field allows more flexibility in creating and naming message profiles. Using repetition, this field can identify a set of message profiles that the message conforms to.

• the first repetition could reference a vendor's message profile

• The second could reference another compatible provider's profile or a later version of the first vendor profile.

As of v2.5, the HL7 message profile identifiers might be used for conformance claims.

Prior to v2.5, the field was called Conformance Statement ID. For backward compatibility, the Conformance Statement ID can be used here.

60. Compliance and Conformance

Compliance

• Messages that adhere to the rules and conventions for constructing of a specific version of a standard arecompliantto that version of the standard.

Conformance

• Messages that adhere to the constraints of a precise and unambiguous specification called amessage profileare said to beconformantto the profile.

Compliance Conformance 61. Conformance Benefits

Consistent Documentation

Reuse of Specification

Lower Cost of Integration

Similar to Version 3

• Conformance SIG is developing Implementation guide

Chaos -> order

Site Specific Profiles

• Supports specific needs

• Required of third-party application vendors

• RFP

• Simplifies introduction/acquisition of new applications

62.

Messaging Workbench

What and Why

63. The Messaging Workbench (MWB)

For those who:

• Design HL7 2.x messages

• Manage specification repositories

• Collaborate on varied messaging projects within and outside of their organizations

Free of charge from HL7 Web site ( www.hl7.org )

• HL7 -> SIG -> Conformance -> Documents

Encouraged by the Conformance SIG

Open Source Project

• Call for participation

It will continue to be supported within the VA for the foreseeable future

64. Design Features (1)

Rapid prototyping of message profiles derived from standard libraries, from profile inheritance or from scratch

Quick and easy alteration of existing profiles to meet new requirements

Design time comparison of profiles on an element by element basis

Linkage of data elements or constants to message elements for a more complete specification

65. Design Features (2)

Tools for storage and retrieval of profiles as well as updating and customizing message element libraries

The ability to capture and analyze ER7 messages

Capability to reverse engineer specifications from captured messages.

A suite of reports that document specifications and produce example messages in text, xml and html formats

Additional style sheets available for PDF

66. HL7 67. Constrainable 68. Constrainable(continued) 69. Implementation 70. Message Profile 71.

Messaging Workbench

Features and Use

72. Capture/Analyze Message 73. Reverse Engineer from Message 74. New Profile Using Libraries 75. New Profile Using Libraries (contd) 76. New Profile Using Libraries (contd) 77. New Profile Using Libraries (contd) 78. New Profile Using Libraries (contd) 79. New Profile using copy/paste 80. New Profile Copy/Paste (contd) 81. New Profile Copy/Paste (contd) 82. Modifying a Profile HL7 83. Modifying a Profile Constrainable 84. Modifying Profile Constr (contd) 85. Modifying Profile Implementation 86. Modifying Profile Impl (contd) 87. Diagram Drawing Tool 88.

Messaging Workbench

Reports and Examples

89. Reports 90. Reports(continued) 91. Reports(continued) 92. Reports(continued) 93. Reports(continued) 94. Reports(continued) 95. Producing Profile Reports 96. Producing Profile Reports (contd) 97. Producing Profile Reports (contd) 98. Producing Profile Reports (contd) Browser View 99. Producing Profile Reports (contd) 100. HL7 Message Profile 101. Register Profile with HL7 102.

Messaging Workbench

Contacts and Help

103. MWB Contacts

The Implementation/Conformance WorkGroup is interested in your feedback and suggestions for improvement of the tool

Implementation/Conformance WorkGroup list server is a good source for general information about the tool and for making improvement suggestions

For specific questions you may also contact Pete Rontey via Email at peter.rontey@med.va.gov

104. Where to Get More Information

MWB On-line help

105. Where to Get More Info (contd)

MWB On-line help (contd)

106. Where to Get More Info (cont)

MWB Updates/Downloads

107. Where to Get More Info (contd)

Conformance Tools Forum at Yahoo Groups

108. California Department of Health Services Electronic Laboratory Reporting Project 109. 110. Inbound Message Processing Outbound Message Processing Data Persistence Business Intelligence 111. Inbound Laboratory Message Inbound Message Profile Transform Translate Inbound Message Mapping Canonical Laboratory Message Canonical Message Profile Transform Translate Outbound Message Mapping Outbound Laboratory Message Outbound Lab Message Supplier Lab Message Consumer Knowledge Management Service Knowledge Management Service Object Graph Generation Laboratory Message Objects Object Relational Mapping Laboratory Message Repository Object Relational Map ELR Database Design Model CA Public Health Logical Data Model HL7 RIM & CDC PHLDM Canonical Message Profile Laboratory Message Object Model Extract, Transform, and Load Laboratory Datamart Business Intelligence Application Business Intelligence Application Business Intelligence Application Message Profile Extract, Transform, and Load Additional Data Sources 112. Message Profiles

Describe message structure and anticipated application behavior

Identify required, optional, and conditional message elements

Identify coding systems or value-sets for coded elements

Enable message validation, transformation, and persistence

Are essential for achieving system-to-system interoperability

113. Message-Level Profile

Which Segments are Supported?

Which Segments are Required?

How are Segments Grouped?

What is the order of Segments and Segment groups

Which Segments/Segment Groups are repeatable?

What is the cardinality of repeating segments/segment Groups?

114. Segment-Level Profile

Which Fields are Supported?

Which Fields are Required?

What is the order of fields within the segment?

What is the datatype of each field?

Which fields are repeatable?

What is the cardinality of repeating fields?

What maximum field length is supported?

What value tables are associated with the field?

115. Field-Level Profile

Which Field components are supported?

Which Field components are Required?

What is the order of components within a field?

What is the datatype of each field component?

Which fields components are repeatable?

What is the cardinality of repeating fields components?

What maximum length is supported for field components?

What value tables are associated with the field components?

116. CaliforniaState Immunization Information System System Interface Project 117.

The California State Immunization Information System (SIIS) is a collaboration of

• regional immunization registries,

• local health departments,

• the California Department of Health Services Immunization Branch, and

• a spectrum of key stakeholders across the state of California.

The goal of SIIS is to ensure that health care providers have rapid access to complete and up-to-date immunization records.

The objective is to eliminate both missed opportunities to immunize and unnecessary duplicate immunizations.

SIIS consists of nine regional registries and two county registries.

SIIS is a system of systems each independently managed and operated.

118. Regional and County Registries

Immunization Network of Northern California (INNC)

Shots For Tots KIDS Regional Immunization Registry (SFT)

Bay Area Regional Immunization Registry (BARR)

Imperial County (IMPL) **

Contra Costa County Automated Immunization Registry (CCAIR)**

Regional Immunization Data Exchange (RIDE)

Central Valley Immunization Information System (CVIIS)

Central Coast Immunization Registry (CCIR)

Los Angeles-Orange Immunization Network (LINK)

VaxTrack Regional Immunization Registry (VaxTrack)

San Diego Regional Immunization Registry (SDIR)

119.

The scope of the California Statewide Immunization Information System (SIIS) Systems Interface Project (SIP) is to design, construct, and implement a centralized electronic messaging hub that facilitates the automated exchange of immunization related data within the state of California.

The objective is to enable registry users to gain access to an individuals complete immunization history regardless of where that history is maintained.

Project Scope 120.

The premise behind the project is that, for many reasons, a persons immunization history data becomes fragmented over time.

The data are stored and maintained in separate state registries and immunization provider information systems.

Typical scenarios that lead to this situation are changes in a persons primary residence, changes in a persons primary healthcare provider, and ad hoc administration of immunizations such as during vacation or emergencies.

Once a persons immunization data becomes fragmented across multiple registry or provider information systems it can be difficult to ascertain their current immunization status.

This can result in over immunization or under immunization.

Problem Statement 121.

A combination of manual and automated processes are employed to address this issue.

First and foremost, providers are encouraged to enroll in regional registries and to record administered immunizations in the registry. All providers within the jurisdiction of the regional registry will then have access to the same data.

Second, a CIR (yellow card) with the persons immunization history is updated by administering providers and carried by the patient, parent, or guardian to all settings requiring an official immunization record.

Finally, immunization data may be requested from a former provider by phone, email, or fax and then entered into the immunization registry system.

Current Processes 122.

There are serious inefficiencies and limitations associated with the current processes used to address the fragmentation of a persons immunization history data.

The yellow card is often out of date, misplaced or otherwise unavailable.

Some healthcare providers operate in multiple regional registry jurisdictions and find the prospect of coordinating reporting to multiple registries to be too much of an administrative burden.

Some providers would prefer to have an automated means of exchanging data between the regional registry system and their electronic systems.These providers object to entering data into regional registries because it involves redundant data entry.

Current Limitations 123.

Today immunization information is not easily able to follow the approximately 30,000 CA children moving throughout the state each year.

SIP will address this shortcoming by enabling the electronic exchange of immunization related data.

The SIIS SIP Immunization Information Exchange System will support the electronic request and response for immunization data from one registry to another.

Regional and county registries, healthcare providers, and multi-jurisdictional provider organizations will be able to participate in a SIIS SIP information network and use electronic messages based upon HL7 messaging standards to exchange immunization data.

SIIS SIP SOLUTION 124. HL7 Message Profiling 125.

Prepare IZ messaging implementation guide

Prepare preliminary segment level profile

Prepare SIIS SIP conceptual data model

Map preliminary profile to regional IZ systems

Prepare final segment level profile

Prepare SIIS SIP logical data model

Prepare SIIS SIP phase I message level profiles

Prepare SIIS SIP vocabulary specification

126. Immunization Messaging Implementation Guide

The Centers for Disease Control and Prevention (CDC) National Immunization Program (NIP) publishes an implementation guide for immunization data messaging.

The title of the guide isImplementation Guide for Immunization Data Transactions using version 2.3.1 of the Health Level Seven (HL7) Standard Protocol.

The intent of the guide is to help familiarize developers of immunization information systems with HL7 immunization message definitions and encoding rules and provide a nationally consistent implementation of those messages.

Changes to the guide are coordinated through the Data Exchange Steering Committee of the American Immunization Registry Association (AIRA) and its associated work groups.

The members of AIRA are committed to advancing the exchange of immunization data using a common protocol.

127. Immunization Messaging Implementation Guide

The guide identifies the set of HL7 messages needed to enable information systems that maintain immunization records to transmit patient-specific immunization histories electronically to other systems to allow healthcare providers to have access to these records at the time health care is given.

The use cases detailed in the guide indicate that data transmission will occur as the result of four activities:

• a query from one system for a patients vaccination record that is held in another system using the HL7 VXQ message;

• a response to a query containing multiple patient matches to the query, but not returning vaccination records using the HL7 VXX message;

• a response to a query containing the vaccination record using the HL7 VXR message; and

• an unsolicited update to a vaccination record using the HL7 VXU message.

In addition to the messages used for the four primary activities the guide also includes specifications for transmission confirmation and exception notification messages; ACK and QCK.

128. Preliminary Segment Level Profile 129. SIIS SIP Conceptual Data Model 130. Regional System to Segment Profile Mapping 131. Regional System to Segment Profile Mapping 132. Final Segment Level Profile 133. SIIS SIP Logical Data Model 134. SIIS SIP Message Level Profiles

HL7 defines a message profile as an unambiguous specification of one or more standard HL7 messages that have been analyzed for a particular use case.It prescribes a set of precise constraints upon one or more standard HL7 messages.

A message profile eliminates ambiguity in a HL7 message specification by declaring static and semantic constraints for constituent elements of a message and the expected dynamic behavior of conformant application systems.

The SIIS SIP HL7 message profile is an extension to the NIP Implementation Guide.The profile is based upon version 2.1 of the guide published in September 2002.

The profile extends the specifications included in the guide.The profiles do not conflict with the guide; however, they are more constrained than the guide.

Messages that conform to the profile are conformant with the guide as well; although the converse may not be true.

A message profile has dynamic definition and a static definition.

135. HL7 Message Profile Dynamic Definition

The dynamic definition describes the supported use cases, interactions, and acknowledgement requirements.

• Use Case Model

• The use case portion of the message profile dynamic definition documents the scope and requirements for an HL7 message profile or set of message profiles.The use case model documents the purpose for each message exchange; defines the actors, including the sending and receiving applications; and document the situations in which the exchange of a particular HL7 message profile is required

• Interaction Model

• The Interaction Model illustrates the sequence of trigger events and resulting message flows between 2 or more systems. It may be in literal or graphical form. Graphical form should be a UML activity diagram.

• Acknowledgement Requirements

• The specific HL7 acknowledgments required and/or allowed for use with the specified static definition of the HL7 message profile is defined. Specifically, the dynamic definition identifies whether accept and application level acknowledgments are allowed or required.For any one static definition there may be one or more dynamic definitions.The dynamic definition defines the conditions under which accept and application level acknowledgments are expected.Allowed conditions include: Always, Never, Only on success, and Only on error.

136. HL7 Message Profile Static Definition

The static definition describes usage rules, cardinalities, and code systems.

• Usage Rules

• Usage refers to the circumstances under which an element appears in a message instance. Some elements must always be present, others may never be present, and others may only be present in certain circumstances. HL7 has defined a set of codes to clearly identify the rules governing the presence of a particular element. These usage codes expand/clarify the optionality codes defined in the HL7 standard.

• Cardinality

• Cardinality identifies the minimum and maximum number of repetitions for a particular element (Segment Group, Segment or Field). Cardinalities are expressed as a minimum-maximum pair of non-negative integers. A conformant application must always send at least the minimum number of repetitions, and may never send more than the maximum number of repetitions.

• Vocabulary Specification

• Vocabulary specifications declare an organized set of code systems and code system terms.Code system terms are coded concepts including concept codes, concept names, and concept relationships.Code system terms are collected into value sets declared as code tables associated with segment fields and data type components.The static definition declares the value sets for tables associated with coded message elements.Some of the value sets are HL7 defined, third party defined, or user defined.

137. SIIS SIP Use Case Diagram 138. SIIS SIP Activity Model 1 2 3 4 6 5 139. SIIP SIP Interaction Model 140. SIIS SIP Acknowledgement Requirements Message Source Destination Acknowledgment

Vaccination Record Query (VXQ)

Requester IIES Only on error

General Acknowledgement (ACK)

IIES Requester Never

Vaccination Record Query (VXQ)

IIES Responder Never

Query Acknowledgement (QCK)

Responder IIES Only on error

General Acknowledgement (ACK)

IIES Responder Never

Query Acknowledgement (QCK)

IIES Requester Never

Vaccination Query Response (VXX)

Responder IIES Only on error

General Acknowledgement (ACK)

IIES Responder Never

Vaccination Query Response (VXX)

IIES Requester Never

Vaccination Query Response (VXR)

Responder IIES Only on error

General Acknowledgement (ACK)

IIES Responder Never

Vaccination Query Response (VXR)

IIES Requester Never 141. SIIS SIP Message Profile Static Definitions

The static definition portion of the message profile declares the usage and cardinality constraints for the constituent message elements of the SIIS SIP HL7 messages.

There is a static definition for each message type (VXQ, VXX, VXR, QCK, and ACK).

Each static definition includes a message level, segment level, and field level definition.

The static definition also includes a supported elements definition.

The supported elements definition is a field level definition containing supported message elements only.

142.

The static definition portion of the message profile declares the usage and cardinality constraints for the constituent message elements of the SIIS SIP HL7 messages.

There is a static definition for each message type (VXQ, VXX, VXR, QCK, and ACK).

Each static definition includes a message level, segment level, and field level definition.

The static definition also includes a supported elements definition.

The supported elements definition is a field level definition containing supported message elements only.

SIIS SIP Message Profile Static Definitions 143. SIIS SIP Message Profile Static Definitions

The static definition portion of the message profile declares the usage and cardinality constraints for the constituent message elements of the SIIS SIP HL7 messages.

There is a static definition for each message type (VXQ, VXX, VXR, QCK, and ACK).

Each static definition includes a message level, segment level, and field level definition.

The static definition also includes a supported elements definition.

The supported elements definition is a field level definition containing supported message elements only.

144. SIIS SIP Message Profile Vocabulary Specification

The Health Level Seven (HL7) message profile vocabulary specification is a companion document to the California State Immunization Information System System Interface Project HL7 message profiles.

The specification contains the value sets for supported coded message elements identified in the profile.

The values presented in this specification are the primary code values to be used for coded message elements in the SIIS SIP message profile.

Fields with a data type of CE may include an equivalent code drawn from an alternate coding system.However, the values included in this specification must be used as the primary code.

145. SIIS SIP Message Profile Vocabulary Specification

The Health Level Seven (HL7) message profile vocabulary specification is a companion document to the California State Immunization Information System System Interface Project HL7 message profiles.

The specification contains the value sets for supported coded message elements identified in the profile.

The values presented in this specification are the primary code values to be used for coded message elements in the SIIS SIP message profile.

Fields with a data type of CE may include an equivalent code drawn from an alternate coding system.However, the values included in this specification must be used as the primary code.

146. Application Testing 147. 148. Test Themes and Scenarios

Valid message syntax, content, and flow

Valid message syntax, content, and invalid flow

Valid message syntax, invalid content

Invalid message syntax

Data content scenarios

Technical problems

149. Test Scenarios

Valid Message Syntax, Content, and Flow

This set of tests is intended to ensure that the systems produce the appropriate flow of messages, with the proper content, and in the proper syntax.These tests should not result in anything being written to the error log.

• VXQ, QCK

• This scenario is a query for a patient that is known to have no match in the remote system.The remote system is expected to respond with a QCK.

• The test data should include patients with varying ranges of matching confidence.

• VXQ, VXR

• This scenario is a query for a patient that is known to match a single patient in the remote system.The remote system is expected to respond with a VXR.

• The test data should include patients with varying ranges of matching confidence.A subset of patients should have locked records to test the locked record alerting process

150. Test Scenarios

Valid Message Syntax, Invalid Content

This set of tests is intended to ensure that message construction and validation rules are properly implemented.These test are focused on content issues not syntax errors.The message profile and vocabulary specification are the source of validation rules.

• Missing required message element

• This scenario involves the omission of required message elements (segments, fields, or components).The omitted items in this test scenario are those that are specified as optional in the standard but declared as required in the SIIS SIP Message Profile.Such an error should result in an ACK message being returned to the message originator and an entry in the error log.

• Missing conditionally required message element

• This scenario involves the omission of conditionally required message elements (segments, fields, or components).The omitted items in this test scenario are those that are specified as optional in the standard but declared as conditionally required in the SIIS SIP Message Profile.Such an error should result in an ACK message being returned to the message originator and an entry in the error log.

• The test data for this scenario must include a mixture of data values that meet the predicate conditions and others that do not meet the predicate conditions relevant for the conditional elements.

151. SIIS SIP HL7 Message Profile Links

SIIS SIP Message Profile Specification

http://www.ca-siis.org/images/docs/SIIS_SIP_HL7_MessageProfile_V1-1.pdf

SIIS SIP Vocabulary Specification

http:// www.ca-siis.org/images/docs/SIIS_SIP_HL7_Message_Profile_Vocabulary_Specification_V1-0.pdf

SIIS SIP Logical Data Model

http:// www.ca-siis.org/images/docs/SIIS_SIP_LogicalDataModel_v1-0.pdf

152. Questions 153. Thank You Abdul-Malik Shakir Principal Consultant Shakir Consulting 1407 Foothill Blvd., Suite 145 La Verne, CA 91750 Office: (909) 596-6790 Mobile: (626) 644-4491 Email:[email_address] Abdul-Malik ShakirInformation Management Strategist City of Hope 1500 East Duarte Road Duarte, CA 91010-3000 Office: (626) 256-4673 Mobile: (626) 644-4491 Email:[email_address]