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HL7 Version 3
HL7 Version 3
HL7 Version 3
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
HL7’s Version 3
Standards:
The Essence of Model-
driven Standards
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Mission
HL7 provides standards for interoperability that
improve care delivery, optimize workflow,
reduce ambiguity and enhance knowledge
transfer among all of our stakeholders, including
healthcare providers, government agencies, the
vendor community, fellow SDOs and patients. In
all of our processes we exhibit timeliness,
scientific rigor and technical expertise without
compromising transparency, accountability,
practicality, or our willingness to put the needs
of our stakeholders first.
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
HL7 Mission (2)
Interoperability
“Ability of two or more systems or components to
exchange information and to use the information
that has been exchanged”
¾ [IEEE Standard Computer Dictionary: A
Compilation of IEEE Standard Computer
Glossaries, IEEE, 1990] Semantic
Functional interoperability
interoperability
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Core requirements for standard
exchanges
Nouns –items we communicate about
¾ Typically actions and physical things (persons,
places, etc.)
Phrases - the essential bindings between
nouns
¾ An action happens to a person
¾ One action causes another
¾ A person performs an action
Vocabulary & model – common definitions
¾ Assure common perspective
¾ Prescribe the nouns and phrases we can use
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
How is Version 3 “better”?
Conceptual foundation – a single, common reference
information model to be used across HL7
Semantic foundation – in explicitly defined concept
domains drawn from the best terminologies
Abstract design methodology that is technology-
neutral – able to be used with whatever is the preferred
technology: documents, messages, services,
applications
Maintain a repository of the semantic content to
assure a single source, and enable development of
support tooling
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Class Diagram – Normative RIM
Release 1
Participation
ActRelationship
typeCode : CS Act
typeCode : CS
functionCode : CD classCode : CS
1 0..n inversionInd : BL
Entity Role RoleLink contextControlCode : CS moodCode : CS source outboundRel ationship
target inboundLink contextControlCode : CS
classCode : CS classCode : CS sequenceNumber : INT id : SET<II>
1 0..n typeCode : CS 0..n contextConductionInd : BL
determinerCode : CS id : SET<II> negationInd : BL code : CD 1
player source outboundLi nk effectiveTime : IVL<TS> sequenceNumber : INT
LanguageCommunication playedRole noteText : ED negationInd : BL
id : SET<II> code : CE priorityNumber : INT
Participation
languageCode : CE code : CE 0..1 0..n negationInd : BL time : IVL<TS> derivationExpr : ST
target inboundRelationshi p pauseQuantity : PQ
modeCode : CE quantity : SET<PQ> addr : BAG<AD> 1 0..n modeCode : CE 0..n
1
text : ED
checkpointCode : CS
proficiencyLevelCode : CE 0..n 1 name : BAG<EN> scoper scopedRole telecom : BAG<TEL> awarenessCode : CE statusCode : SET<CS> 1 0..n
splitCode : CS
preferenceInd : BL desc : ED 0..1 0..n statusCode : SET<CS> signatureCode : CE effectiveTime : GTS
joinCode : CS
statusCode : SET<CS> effectiveTime : IVL<TS> signatureText : ED activityTime : GTS
negationInd : BL
existenceTime : IVL<TS> certificateText : ED performInd : BL availabilityTime : TS
conjunctionCode : CS
telecom : BAG<TEL> quantity : RTO substitutionConditionCode : CE priorityCode : SET<CE>
localVariableName : ST
riskCode : CE positionNumber : LIST<INT> confidentialityCode : SET<CE>
seperatableInd : BL
handlingCode : CE repeatNumber : IVL<INT>
interruptibleInd : BL
levelCode : CE
ManagedParticipation independentInd : BL
id : SET<II> uncertaintyCode : CE
statusCode : SET<CS> reasonCode : SET<CE>
languageCode : CE
LivingSubject
administrativeGenderCode : CE Organization Employee
Material jobCode : CE Patient
birthTime : TS addr : BAG<AD>
Entity Role
deceasedInd : BL formCode : CE jobTitleName : SC confidentialityCode : CE
standardIndustryClassCode : CE
deceasedTime : TS jobClassCode : CE veryImportantPersonCode : CE
multipleBirthInd : BL salaryTypeCode : CE
multipleBirthOrderNumber : INT salaryQuantity : MO LicensedEntity
organDonorInd : BL hazardExposureText : ED
protectiveEquipmentText : ED recertificationTime : TS Supply Procedure
Place ManufacturedMaterial Observation SubstanceAdministration
PatientEncounter quantity : PQ methodCode : SET<CE> Account
mobileInd : BL lotNumberText : ST value : ANY routeCode : CE InvoiceElement
expectedUseTime : IVL<TS> approachSiteCode : SET<CD> name : ST
addr : AD expirationTime : IVL<TS> preAdmitTestInd : BL interpretationCode : SET<CE> approachSiteCode : SET<CD> modifierCode : SET<CE>
Access targetSiteCode : SET<CD> balanceAmt : MO
directionsText : ED stabilityTime : IVL<TS> admissionReferralSourceCode : CE methodCode : SET<CE> doseQuantity : IVL<PQ> unitQuantity : RTO<PQ,PQ>
approachSiteCode : CD lengthOfStayQuantity : PQ targetSiteCode : SET<CD> currencyCode : CE
positionText : ED rateQuantity : IVL<PQ> unitPriceAmt : RTO<MO,PQ>
targetSiteCode : CD dischargeDispositionCode : CE interestRateQuantity : RTO<MO,PQ>
gpsText : ST doseCheckQuantity : SET<RTO> netAmt : MO
gaugeQuantity : PQ specialCourtesiesCode : SET<CE> allowedBalanceQuantity : IVL<MO>
maxDoseQuantity : SET<RTO> factorNumber : REAL
specialAccommodationCode : SET<CE> pointsNumber : REAL
acuityLevelCode : CE
WorkingList
Person ownershipLevelCode : CE FinancialContract
addr : BAG<AD> Device
NonPersonLivingSubject Container paymentTermsCode : CE
maritalStatusCode : CE manufacturerModelName : SC
educationLevelCode : CE strainText : ED softwareName : SC capacityQuantity : PQ
raceCode : SET<CE> genderStatusCode : CE heightQuantity : PQ
Acts
localRemoteControlStateCode : CE DeviceTask FinancialTransaction
diameterQuantity : PQ ControlAct Diet
disabilityCode : SET<CE> alertLevelCode : CE PublicHealthCase amt : MO
livingArrangementCode : CE capTypeCode : CE energyQuantity : PQ parameterValue : LIST<ANY>
lastCalibrationTime : TS detectionMethodCode : CE creditExchangeRateQuantity : REAL
religiousAffiliationCode : CE separatorTypeCode : CE carbohydrateQuantity : PQ
transmissionModeCode : CE DiagnosticImage debitExchangeRateQuantity : REAL
ethnicGroupCode : SET<CE> barrierDeltaQuantity : PQ
bottomDeltaQuantity : PQ diseaseImportedCode : CE subjectOrientationCode : CE
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Action – the focus of health care
communication & documentation
The reason we want to automate health care data is
to be able to document the actions taken to treat a
patient:
¾ A request or order for a test is an action
¾ The report of the test result is an action
¾ Creating a diagnosis based on test results is an action
¾ Prescribing treatment based on the diagnosis is an action
In simple terms, a medical record is a record of each
of the individual actions that make up the
diagnosis, treatment and care of a patient.
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Five core concepts of the RIM
Every happening is an Act
¾ Procedures, observations, medications, supply,
registration, etc.
Acts are related through an ActRelationship
¾ composition, preconditions, revisions, support, etc.
Participation defines the context for an Act
¾ author, performer, subject, location, etc.
The participants are Roles
¾ patient, provider, practitioner, specimen, employee etc.
Roles are played by Entities
¾ persons, organizations, material, places, devices, etc.
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
RIM Core Classes
Role Act
Link Relationship
0..* 0..* 0..* 0..*
1 1 1 1
0..*
1 plays 0..* 1
Entity 0..*
Role 1
Participation 0..*
Act
1 scopes
Organization Procedure
Patient
Living Subject Observation
Employee
Person Patient Enc’nt’r
LicensedEntity
Material Substance Adm
Access
Place Supply
Referral
Financial act
Noun Phrase Working list
Account
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
“Rules” for HL7 Designs
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Domain–Value Set Binding Example
Binding
Definition
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Tools – for developers and
implementers
Enabled by the presence of “processable”
representations of V3 standards – data bases and
XML representations
Tools for defining, refining and documenting these
designs
¾ Enforce the “rules” for refinement and localization
¾ Draw their starting content from RIM, Vocabulary and
previous models
¾ Produce processable aritfacts that allow this cycle to repeat
Designed to allow rapid deployment and application
of the specifications to particular locale
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
The problem
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
RIM Core Classes
ObservationDefinition
Role Act
classCode*: <= OBS
moodCode*: <= DEF
HealthCareOrganization
Link Relationship
id: SET<II>
SET<II> [0..*]
[0..*]
code: CD CWE [0..1] <= ActCode
classCode*: <= ORG
determinerCode*: <= INSTANCE 0..* 0..* definition
0..* 0..* 0..* obs
id: SET<II> [0..*] typeCode*: <= INST
name: BAG<EN> [0..*] 0..1 representedHealthCareOrganization
1 1 1 1
0..*
0..* healthCareProvider ObservationRequest
1 plays AssignedPractitioner author 0..* 1
Entity Role
classCode*: <= ASSIGNED
0..* id: SET<II> [0..*] 1 typeCode*: <= Participation
AUT 0..*
classCode*:
moodCode*: <= RQO Act
<= OBS
Organization Procedure
Patient
Living Subject Observation
Employee
Person Patient Enc’nt’r
LicensedEntity
Material Substance Adm
Access
Place Supply
Referral
Financial act
Working list
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Account
Assembling content – relational
phrase
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Demo
Order
Example – POLB_RM992100
Author
Physician
Performer
Laboratory
Subject
Specimen
Record target
Patient
Definition
Ordered test
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
The essence of Version 3
A family of specifications
Built upon a single model of
¾ How we construct our messages
¾ The domain of discourse
¾ The attributes used
Constructed in a fashion to rapidly develop
a comprehensive, fully constrained
specification in XML
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Bringing it together
One Reference Model, one set of tools, one
process produce
¾ The mundane – a Common element for patient
¾ The complex – a specification to communicate
annotated ECGs for clinical trials
¾ Large, rich sets – electronic claims, clinical trial
data
¾ The esoteric – clinical genomics
¾ The basics – message control (headers)
All taken from RIM to schemas, and
published with a single set of effective tools
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Version 3 Normative Editions
After HL7 ballots individual Version 3 standards
¾ Under our consensus process
¾ Ballot until you satisfy your own toughest critics – your self
These are registered as ANSI specifications
Grouped informally as:
¾ Domains – topic of healthcare interest
¾ Common – Content shared by/across domains
¾ Infrastructure – enables communication
¾ Foundation – the basis for the V3 family of standards
And bundled into a comprehensive Normative
Edition
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Content of V3 Normative Editions
Final publication form of all Normative
Specifications (ANSI registered)
Supporting Reference Material –
methodology guide, readers guides, etc.
Processable representations of all
content – data bases, XML interchange
format, schemas, etc.
Documented dependency hierarchy
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Table of Contents
Help for readers
CDA
Public Health Messaging
Clinical studies
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Foundation
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Infrastructure, Implementation &
Services
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Array of Specific Domains
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Version 3 - where is it being used?
As CDA documents, as SOA designs, as
interchanged Messages
In large-scale projects deriving from
governmental mandates
For communications between multiple,
independent, “non-integrated” entities
Whereever there are requirements to
communicate parts of an EHR and to
maintain the integrity of the EHR data
relationships
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
The power of HL7 and Version 3
Consensus standards, developed by volunteers
who come from countries around the world to
undertake “practical” informatics
Welcoming new participants, and their ideas
Founded on solid principles of system design,
focusing on models & terminology
Models that emphasize clinical concepts, and
the supporting context needed for decision
support, clinical decision making and just plain
“solid patient care”
Thank you!
© 2010 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.