examining the effective use of hl7v3 messaging “ where the rubber meets the road” introduction...

Examining the Effective Use of Examining the Effective Use of HL7v3 MessagingHL7v3 Messaging

““Where the Rubber Meets the Road”Where the Rubber Meets the Road”

Introduction for an Open Dialogue on:Introduction for an Open Dialogue on:Issues in Communicating the Real Meaning of Issues in Communicating the Real Meaning of

Data and Information in Data and Information in Citizens’ Electronic Health SystemsCitizens’ Electronic Health Systems

The 4The 4thth Conference for Conference for Semantic Interoperability for Semantic Interoperability for

E-GovernmentE-GovernmentFebruary 9-10, 2006February 9-10, 2006

McLean, VAMcLean, VA

The Semantic Web and Ontology The Semantic Web and Ontology for Healthcare for Healthcare

Use of Semantic Web technologies and practices are designed Use of Semantic Web technologies and practices are designed and used to improve collaboration, research and and used to improve collaboration, research and development and innovation adoption in Healthcare.development and innovation adoption in Healthcare.

Success depends on a foundation of semantically rich system, Success depends on a foundation of semantically rich system, process and information interoperability.process and information interoperability.

Key to Success for communicating real accurately data and Key to Success for communicating real accurately data and information across diverse information across diverse e-e-hhealth systems:alth systems:

Core vocabularies and ontologies to support cross-Core vocabularies and ontologies to support cross-community data integration and collaborative efforts. community data integration and collaborative efforts.

Guidelines and Best Practices for Resource Identification to Guidelines and Best Practices for Resource Identification to support integrity and version control. support integrity and version control.

Better integration of Scientific Publication with people, data, Better integration of Scientific Publication with people, data, software, publications, and clinical trials .software, publications, and clinical trials .

For Interoperability You Must be Communicating For Interoperability You Must be Communicating Real Information with Real Meaning -AccuratelyReal Information with Real Meaning -Accurately

The lack of immediate access to patient healthcare information is the source of one-fifth of medical errors.

Americans need a connected system of electronic healthcare information available to all doctors and patients whenever and wherever necessary.

In 2000, the Institute of Medicine (IoM) estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors.

One of every seven primary care visits is affected by missing medical information.

In a recent study, 80 percent of errors were initiated by miscommunication, including missed communication between physicians, misinformation in medical records, mishandling of patient requests and messages, inaccessible records, mislabeled specimens, misfiled or missing charts, and inadequate reminder systems.

Action is needed to achieve an interoperable Action is needed to achieve an interoperable health information technology system in health information technology system in

the United Statesthe United StatesLives Are in The Balance: Interoperable healthcare information

enhances the quality of care for all Americans.

Interoperability creates convenience by allowing doctors and other health care providers to share medical history, lab results, and other pertinent information in a more timely and accurate way.

Backups of data easier to maintain, so catastrophic data loss is more easily remedied

Provides improved support for adults who care for aging parents, especially from far away.

Enhance and ease post-diagnosis and post-treatment contact with doctors via on-line services.

By more effectively limiting unauthorized access, and tracking who views personal healthcare information, interoperability provides patients with more security and confidentiality.

The FY 2007 Priority for Health The FY 2007 Priority for Health Information TechnologyInformation Technology

The President launched the initiative to make The President launched the initiative to make electronic health records (EHRs) available to most electronic health records (EHRs) available to most Americans by 2014:Americans by 2014:

A national coordinator for health IT was A national coordinator for health IT was appointed, DHHS Office of the National HIT appointed, DHHS Office of the National HIT Coordinator (ONC)Coordinator (ONC)

$100 million allocated to fund projects: $100 million allocated to fund projects: harmonizing standards; harmonizing standards; addressing privacy and security issues; addressing privacy and security issues; and developing models for a national web-based and developing models for a national web-based

health IT system.health IT system.

The FY 2007 Priority for Health The FY 2007 Priority for Health Information Technology, cont.Information Technology, cont.

The President proposes to develop nationwide The President proposes to develop nationwide standards to:standards to:

accelerate patient access to EHRs;accelerate patient access to EHRs; develop web-based health records systems develop web-based health records systems

accessed only with a citizen-users consent;accessed only with a citizen-users consent; use electronic medication history and lab test use electronic medication history and lab test

results; andresults; and utilize health information tools to monitor disease utilize health information tools to monitor disease

outbreaksoutbreaksThis year’s budget requests $169 million, an This year’s budget requests $169 million, an

increase of $58 to continue this initiative.increase of $58 to continue this initiative.

Examining Issues with HL7v3Examining Issues with HL7v3

HL7 Generally DefinedHL7 Generally Defined: is a standard protocol for : is a standard protocol for packaging and sending messages in terms that packaging and sending messages in terms that diverse computer systems can interpret and diverse computer systems can interpret and understand for the end-users.understand for the end-users.

““Health Level 7” - The application level addresses Health Level 7” - The application level addresses definition of the data to be exchanged, the timing definition of the data to be exchanged, the timing of the interchange, and the communication of of the interchange, and the communication of certain errors to the application. The seventh certain errors to the application. The seventh level supports such functions as security checks, level supports such functions as security checks, participant identification, availability checks, participant identification, availability checks, exchange mechanism negotiations and, most exchange mechanism negotiations and, most importantly, data exchange structuring. importantly, data exchange structuring.

Examining Issues with HL7v3, cont.Examining Issues with HL7v3, cont.

Rationale of HL7:Rationale of HL7:

To ensure that health information To ensure that health information systems can communicate their systems can communicate their information in the form of messages information in the form of messages which will be understood in exactly which will be understood in exactly the same way by both sender and the same way by both sender and recipientrecipient


In HL7v2:In HL7v2:

The realization of this task required an The realization of this task required an ad hoc ad hoc interpretation of the standards by each sending interpretation of the standards by each sending or receiving institution.or receiving institution.

The data created for any particular purpose (e.g., The data created for any particular purpose (e.g., conveying biochemistry results) would often be conveying biochemistry results) would often be implemented differently by different vendors, implemented differently by different vendors, with the consequence that vendor products were with the consequence that vendor products were never properly interoperable…never properly interoperable…

and always required the use of mapping and always required the use of mapping software.software.


HL7v3:HL7v3: Is an attempt to design a replacement, in

which the “optionality” in the version 2 standard was removed in a way that health information messages for each functional area could be created in a single, uniform way.

The intention: Interpretation of version 3 could be carried out uniformly by all health IT developer organizations.


The pillars of HL7v3 are as follows:The pillars of HL7v3 are as follows:

1.1. The reference Information Model (RIM), claimed as a The reference Information Model (RIM), claimed as a master model of all health information, and universally master model of all health information, and universally used within HL7v3.used within HL7v3.

2.2. An HL7 custom method of creating predefined message An HL7 custom method of creating predefined message definitions via refinement of the RIM into message schemas definitions via refinement of the RIM into message schemas for each functional area.for each functional area.

3.3. Extensive use of HL7-defined vocabularies and external Extensive use of HL7-defined vocabularies and external terminology such as LOINC and Snomed-ct to provide the terminology such as LOINC and Snomed-ct to provide the semantics of message definitions.semantics of message definitions.


Key questions -- to examine the pillars of HL7v3:Key questions -- to examine the pillars of HL7v3:

1. Does the RIM uphold the basic rules of both good ontological design and object-oriented modeling, and prove to be efficient to use in practice for representing heath information?

2. Does the HL7 approach to message refinement create difficulties for those who need to build generic, maintainable, extensible software in the future?

3. Are HL7 mechanisms adequate for ensuring that the vast number of combinations of coded terms within actual messages can be controlled in such a way that messages will be understood in the same way by designers, senders and receivers?


An objective and neutral examination of issues, inAn objective and neutral examination of issues, in

““communicating the real meaning of data and communicating the real meaning of data and

information in citizens information in citizens ee-health systems,” may -health systems,” may

affect multi-billion dollar investments in healthcare affect multi-billion dollar investments in healthcare

information infrastructure as well as impact patient information infrastructure as well as impact patient

safety.safety.


An objective dialogue on HL7v3 would An objective dialogue on HL7v3 would need to:need to:

establish what a messaging standard is,establish what a messaging standard is,

define criteria for assessing the suitability of define criteria for assessing the suitability of messaging standards for clinical communication, messaging standards for clinical communication, and,and,

assess current messaging standards and assess current messaging standards and alternative technologies against these criteria.alternative technologies against these criteria.

Examining Issues with HL7v3Examining Issues with HL7v3

Discussion and DialogueDiscussion and Dialogue

examining the effective use of hl7v3 messaging “ where the rubber meets the road” introduction...

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