hl7 daniel c. russler, m.d. hl7 version 3-- the clinical model tutorial hl7 version 3-- the clinical...
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HL7
Daniel C. Russler, M.D.
HL7 Version 3--
the clinical model tutorial
HL7 Version 3--
the clinical model tutorial
VP Medical DirectorMcKessonHBOC
HL7 Know the Market Know the Market for Healthcare Standardsfor Healthcare Standards
HIPAA RegulationsHIPAA Regulations• Privacy & SecurityPrivacy & Security• Administrative--eligibility, claims submissionAdministrative--eligibility, claims submission• Clinical--vocabulary, claims attachmentsClinical--vocabulary, claims attachments
Cost and Quality Improvement NeedsCost and Quality Improvement Needs• Service line methodologyService line methodology
- Condition management orientationCondition management orientation
- Risk ManagementRisk Management
• Workflow managementWorkflow management- Increasing task volumeIncreasing task volume
- Preventing errorsPreventing errors
- Decreasing low-value proceduresDecreasing low-value procedures
- Increasing high-value proceduresIncreasing high-value procedures
HL7 A Mega-use-case---A Mega-use-case---Modeling the ConditionModeling the Condition
EnrollmentEpisodeBegins
Doctor'sOffice
Specialist
DiagnosticTesting
Relative HealthRelative HealthHealthHealth
Certification
Admission
Surgery
Discharge
Rehab
Follow-upDoctor'sVisit
Chest Pain
r/o Angina
Angina
ASHD s/p CABG
HL7 Typical Service LineTypical Service LineTask Force OrganizationTask Force Organization
Perinatal Task Force--Full-Term Delivery
Cardiac Task Force--Congestive Heart Failure
Orthopedics Task Force--Hip Replacement
Pulmonary Task Force--Asthma
Primary Care Task Force--Health Maintenance
Other Task Forces
Chief Medical Officer Chief Information OfficerChief Nursing Officer
Medical Director Clinical Informatics
Nursing Director Clinical Informatics
IS Support Staff
HL7 HL7 Mission StatementHL7 Mission Statement
To provide To provide standards forstandards for the the exchange, exchange, management and integration of datamanagement and integration of data that support that support clinical patient careclinical patient care and the and the management, management, delivery and evaluationdelivery and evaluation of healthcare services. of healthcare services. Specifically, to create flexible, cost effective Specifically, to create flexible, cost effective approaches, standards, guidelines, methodologies, approaches, standards, guidelines, methodologies, and related services for interoperability between and related services for interoperability between healthcare information systems.healthcare information systems.
HL7 Clinical Modeling GoalsClinical Modeling Goals Standards for dataStandards for data
• IntegrationIntegration- Reference Information Model(RIM)Reference Information Model(RIM)
• ManagementManagement- Vocabulary & rule version controlVocabulary & rule version control
• ExchangeExchange- Message formats: Version 2.x; Version 3Message formats: Version 2.x; Version 3
SupportingSupporting• Clinical patient careClinical patient care
- Service Service managementmanagement--workflow guidelines--workflow guidelines
- Service Service deliverydelivery--context & relationship tracking--context & relationship tracking
- Service Service evaluationevaluation--cost & quality tracking--cost & quality tracking
HL7 Version 3 HighlightsVersion 3 Highlights
New message syntax--XMLNew message syntax--XML Support for XML document transmissionSupport for XML document transmission Support for an explicit information modelSupport for an explicit information model Support for multiple published Support for multiple published
vocabulariesvocabularies Support for composite datatypesSupport for composite datatypes First model message drafts September, First model message drafts September,
19991999
HL7 Alert Messages & Alert Messages & Information ModelingInformation Modeling
Dog!
HL7/CORBA/DCOM
HL7 Clinical Classes Clinical Classes Modeling AssumptionsModeling Assumptions
Healthcare is a series of service actionsHealthcare is a series of service actions Each action contributes to cost and qualityEach action contributes to cost and quality All actions have a context of:All actions have a context of:
- Prior actionsPrior actions
- Current actors, things, & contractsCurrent actors, things, & contracts
- Future goalsFuture goals
Each action consists of:Each action consists of:- Action nameAction name
- Action methodologyAction methodology
- Action result valuesAction result values
Action descriptions will change over time and Action descriptions will change over time and must be versionedmust be versioned
HL7 Explaining the RIM--Explaining the RIM--Context of an ActionContext of an Action
Service Event
Action Name:
When?
Who?
Whom?Why?
Where?
How?
HL7Unified Modeling Language Unified Modeling Language
Action HierarchyAction Hierarchy
Service Event
Service EventRelationship
Action Name:Dates:Cost:Privacy Level:ActionValues:
Observation
UniqueAction Values:
Procedure
UniqueAction Values:
Condition node
UniqueAction Values:
Goal
UniqueAction Values:
Future classes
UniqueAction Values:
HL7 List-Link CollectionsList-Link Collections
Service EventList-Link
Service EventRelationship
Action Name:Dates:Cost:Privacy Level:
Observation
Action Value:
HL7 Conditional-Link CollectionsConditional-Link Collections
Service EventConditional-Link
Service EventRelationship
Action Name:Dates:Cost:Privacy Level:
Observation
Action Value:
Timeline
CBC U/A X-Ray ?
HL7 Judgement CollectionsJudgement Collections
Service EventJudgement
Service EventRelationship
Action Name:Dates:Cost:Privacy Level:
Observation
Action Value:
Timeline
hasReason
CBC U/A X-Ray Pay
HL7 Judgement CollectionsJudgement Collections
Service EventJudgement
Service EventRelationship
Action Name:Dates:Cost:Privacy Level:
Observation
Action Value:
hasReason
CBC U/A X-Ray Pay
HL7 Vocabulary ModelingVocabulary ModelingCompromisesCompromises
Pre-coordination e.g. LOINC
Composition(needs composition datatype)e.g. SNOMED Conceptual Graphs;
Mayo Metaphrase
Information ModelingExtreme--Value = Present/
Not Present
Vocabulary ModelingExtreme--
One Class/One Attribute
HL7 Vocabulary ModelingVocabulary ModelingCompromisesCompromises
Pre-coordination e.g. LOINC
Composition(needs composition datatype)e.g. SNOMED Conceptual Graphs;
Mayo Metaphrase
Diabetes
Asthma
CHF
Value:Not
Present
Pneumonia
Value:Any
SNOMEDCode
HealthcareThing
HL7 Vocabulary ModelingVocabulary ModelingCompromisesCompromises
F-xxxxx = chest pain radiating to left arm
(F-xxxx = pain(T-xxxx = chest)(F-xxxx = radiating to(T-xxxx = arm(M-xxxx = left))))
Diabetes
Asthma
CHF
Value:Not
Present
Pneumonia
Value:Any
SNOMEDCode
HealthcareThing