Tutorial: Introduction To Health Level Seven International (HL7) Organization & Process

Tutorial:
Introduction to
Health Level Seven International (HL7)
Organization & Process
John Quinn (HL7 International CTO)

Chicago, Illinois, US
September 14, 2014
© 2014 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.
ORGANIZATION
© 2014 Health Level Seven ® International. All Rights Reserved. September, 2014
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. 2
HL7 International
is a Consensus Driven
Standards Development
Organization (SDO)
Consensus Driven Standards
 Are:
 Volunteer-driven
 Not a full-time commitment by most
 Marked by uneven levels of participation
 Participant developers have unequal levels of
understanding
 Balloted with required resolution of negative ballots
 Therefore they are also prone to compromise
which often leads to ambiguity
36 HL7 International Affiliates / Countries
Argentina Romania Puerto Rico Philippines Pakistan Norway
Australia
Russia
And growing New Zealand
Uruguay
Malaysia
Austria Singapore
Bosnia and
Herzegovina United States Japan
South Korea
Spain Italy
Brazil
Sweden United Kingdom

India
Canada
Switzerland The Turkey
Taiwan
Netherlands Hong
5 Kong
Greece
China Croatia France
Czech Republic Finland Germany
© 2014 Health Level Seven ® International. All Rights Reserved. Updated 09/14/14
Examples of Influencers &
Drivers
 Governments (US ONC, Canada Health Infoway,
Australia’s NEHTA, UK’s NHS CfH, …)
 American National Standards Institute (ANSI)
 Vendors
 International Affiliates
 Clinical users & Consultants
 Healthcare Ontology/Terminology SDOs (e.g.,
IHTSDO (SNOMED), Regenstrief (LOINC), WHO
(ICD), etc.)
 Other International Standards Organization
(ISO, DICOM, GS/1, CEN TC 251, etc.)
 Other US Healthcare related SDOs
(e.g., X12N, NCPDP, etc.)
What is an Affiliate?
 An Affiliate is an independent legal entity that:

 Represents its members at Hl7 International and within its country/
territory on HL7 matters;
 Participates in HL7 International’s standards development and
governance processes;
 Promotes the relevance and fitness of the HL7 Protocol Specifications,
HL7 Educational Material and Other HL7 Material in its country/territory;
 Distributes, translates and localizes the HL7 Protocol Specifications as
appropriate;
 Administers and proctors HL7 Certification tests within its Territory when
suitable and authorized to do so as provided below; and
 Promote HL7 standards, educates, informs and supports current and
potential users within the Territory to promote consistent and widespread
usage of the standards.
The Users
 Our current four major stakeholder-users (imho):

 ONC/US Federal Health Architecture
 CDA Community
 Canada Health Infoway
 NHS Connecting for Health (CfH)
 HL7 V3 (or V2) is not being applied to any two stakeholders in the
same way. No two of the stakeholders have the same problem-set or
the same approach and use of HL7. Typical approach to using HL7 is:
 A manageable problem when integration is within an organization (intra-organizational)
 Less manageable when integration is in a large complex organization
 Large IDN
 Reference Lab Network (e.g., Quest, LabCorp)
 Unacceptable when organization is large geographic areas that have little formal
healthcare organizational governance (e.g., countries, states, counties, etc.)
In short
 Interoperability beyond a single point to point

interface requires:
 A profile that includes all of the related SDOs’ elements (e.g.,
terminologies), and other directed references within the primary
SDO product (e.g., state names & abbreviations).
 A resolution of all pre-coordinated decisions to remove all
optionality;
 Full specification from Layers 1-7 (not just Level 7)
 The publication of an implementation guide that is used by all
communicating parties.
 A published governance and update process that supports
needed fixes and related updates.
HL7 International Products
• HL7 International has a number of major

product lines:
– Version 2.x
– Version 3 Reference Information Based Products
• Version 3 Messaging
• Version 3 Clinical Document Architecture (CDA)
• CDA Implementation Specifications or IGs (e.g., CCD)
• Version 3 Services (near-term future)
• Gello
• Attachments
• Structured Product Labeling
– EHR-S & PHR-S Set of Standards
– CCOW
– Arden Syntax
A project to create Product-Line Management and coordinate common elements and

better define “backward-break” issues is now being formulated in the Technical Steering
Committee.
The Users
 V3 products (e.g., messaging, CDA, SPL, etc.)

are now much more widely used around the
world than even a few years ago.
 Users include governments and government
funded entities (e.g., NHS, CHI, Turkey,
Argentina, Uruguay, Malaysia, US, etc.)
 The exact forms of use varies as well:
 messaging, electronic documents or services
 the approach and methodology
 processes automated and terminologies applied
What the Market Wants
 Faster implementations
 Conformance & Conformability testing
 Computable Semantic Interoperability
 Better Quality, Methodology & Tools
 Confidentiality/Security
 Harmonization with other standards
 Support of the latest communication
technologies
HL7 INTERNATIONAL
WHAT IT IS &
HOW IT IS ORGANIZED?
HL7 – Health Level Seven
International
HL7 International is an ANSI accredited standards
organization (ASO) for clinical & operational EDI.
Members include: user (hospital, physicians

ISO’s Open Systems practices, physician group practices, academic faculty
Interconnect (OSI) model: practice plans, health maintenance organizations
(HMO), preferred provider organizations (PPO),
Application Level” – level 7 independent practice affiliations (IPA), utilization
review (UR) companies, fiscal intermediaries, third-
party administrators (TPA), peer review organizations
(PRO), insurers and payers, manufacturers
(pharmaceuticals, medical devices, etc.), professional
associations and societies, industry consortia,
regulators, and government agencies.
There are also now 34 countries that participate in HL7
What is HL7 International?
 HL7 International is one of several American

National Standards Institute (ANSI) accredited
Standards Developing Organizations (SDOs)
operating in the healthcare arena. Most SDOs
produce standards (sometimes called specifications
or protocols) for a particular healthcare domain
such as pharmacy, medical devices, imaging or
insurance (claims processing) transactions.
 HL7 International’s domain is clinical and

administrative data.
 Many of our Standards are also ISO TC-215
Standards.
 ISO TC-215 both adopts specific HL7
International Standards and also works with
HL7 International to jointly develop
standards.
Where & Who is HL7 International?
 Headquartered in Ann Arbor, MI, HL7 International

is like many other SDOs in that it is a not-for-profit
volunteer organization. HL7 International also has
an office in Brussels, Belgium.
 Its members (providers, vendors, payers,
consultants, government groups and others who
have an interest in the development and
advancement of clinical and administrative
standards for healthcare) develop HL7’s standards.
 Like all ANSI-accredited SDOs, HL7 International adheres
to a strict and well-defined set of operating procedures that
ensures consensus, openness and balance of interest.
 A frequent misconception about HL7 International (and

presumably about the other SDOs) is that it develops
software. While some small amount of software is
developed (e.g., tools), what we actually develop are
standards specifications. Our most widely used standards
specifications enable disparate healthcare IT applications to
exchange keys sets of clinical and administrative data.
 Members of Health Level Seven International are

known collectively as the “Working Group”, which
is organized into individual work groups.
 The work groups are directly responsible for the
content of the our products.
 Work groups can also serve as a source for
exploring new areas that need to be covered by
HL7 International’s published standards.
HL7 INTERNATIONAL’S
VISION
To create the best and most widely

used standards in healthcare.
THE MOST HELPFUL SINGLE
PIECE OF INFORMATION?
http://www.hl7.org
HL7 International’s Mission
HL7 International 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.
What is the Origination
of the name HL7?
"Level Seven" refers to the highest level

of the International Standards
Organization (ISO) communications
model for
Open Systems Interconnection (OSI)
(i.e., the Application Layer).
What is the Origination
of the name HL7?
The application level addresses definition of

the data to be exchanged, the timing of the
interchange, and the communication of
certain errors to the application. The seventh
level supports such functions as security
checks, participant identification, availability
checks, exchange mechanism negotiations
and, most importantly, data exchange
structuring.
The OSI Model
HL7
7 Application Logical Connection Application
6 Presentation Logical Connection Presentation
5 Session Logical Connection Session
4 Transport Logical Connection Transport
3 Network Logical Connection Network
2 Data Logical Connection Data
1 Physical Physical Connection Physical
Application 1 Application 2
HL7 Subject Domains
 ADT  Mobile Computing
 Order entry  Adverse event reporting
 Result reporting  Automated waveforms
 Clinical Guidelines  Medical transcriptions
 Clinical Observations  Referrals
 Scheduling  Consultations
 Patient care  Clinical trials
 Immunizations  Nursing care plans
 Discharge summaries  Data Warehousing
… And Growing …
HL7 Subject Domains
 SGML, (now XML)  Personnel Management
 Terminology/Vocabulary/  Arden Syntax
Ontology  Component Based
 Certification Messaging (i.e., Java)
 Conformance  Visual/Context Integration
 Security transactions  Government Projects
 Claims attachment  Master Patient Index
 Accountability, Quality,  SOA
Assurance  Image Management
 Blood Bank
… And Growing …
HL7 International’s Work Groups
HL7 Work Groups:
 Affiliate Due Diligence  Financial Management  Policy Advisory

 Anatomic Pathology  Governance and Operations  Process Improvement
 Anesthesia  Health Care Devices  Project Services
 Application Implementation and  Imaging Integration  Public Health and Emergency
Design  Implementable Technology Response
 Architecture Board Specifications  Publishing
 Arden Syntax  Infrastructure and Messaging  Recognition and Awards
 Attachments  International Council  Regulated Clinical Research
 Child Health  International Mentoring Information Management (RCRIM)
 Clinical Decision Support  Marketing  Security
 Clinical Genomics  Mobile Health  Services Oriented Architecture
 Clinical Interoperability Council  Modeling and Methodology  Strategic Initiative Committee
 Clinical Quality Information  Nomination  Structured Documents
 Clinical Statement  Orders and Observations  Technical Steering Committee
 Community Based Collaborative  Organizational Relations  Templates
Care  Outreach Committee for Clinical  Tooling
 Conformance & Guidance for Research  Vocabulary
Implementation/Testing  Patient Administration
 Education  Patient Care
 Electronic Health Record s  Patient Safety
 Electronic Services  Pharmacy
 Emergency Care
(19) (15)
(19)
Updated: 01/14 53 Total
HL7 Organization
Two Representatives
HL7 Board of
Directors
Executive
Advisory International Council
Committee
Council & HL7 Affiliates
(BoD Officers)
CEO
Chuck Jaffe MD PhD
COO CTO
Mark McDougall Wayne Kubick
Technical Steering
Operations
Committee (TSC)
AMG
Chair: Ken McCaslin
Other Members
Steering Division: Steering Division:
International Steering Division: Steering Division: ARB Co-Chairs:
Foundation & Technical &
Representatives Structure & Domain Experts Anthony Julian &
Technology Support
Giorgio Cangioli Semantic Design Melva Peters & Lorraine Constable
Russ Hamm Sandra Stuart &
& Jean Duteau Calvin Beebe & Gora Datta John Roberts Ad-Hoc: Austin Kreisler
& Paul Knapp Andy Stechishin
& Freida Hall
Work Groups
TSC Structure
 Technical Steering Committee -

 6 elected voting representatives, 4 appointed voting members
 TSC-elects their Chair; CTO is ex-officio co-chair
 Foundation & Technologies Steering Division
 9 existing workgroups
 2 Elected SD Co-Chairs plus Co-Chairs of workgroups in SD
 Structure & Semantic Design Steering Division
 Domain Experts Steering Division
 Technical & Support Services Steering Division
TSC – Mission
HL7 International’s Technical Steering Committee’s Mission

 This group supports the HL7 International mission to create and promote its
standards by:
 Overseeing and coordinating the technical efforts contributed by the HL7 International
participants, who make up the HL7 International Working Group, and assuring that the efforts
of the Working Group are focused on the overall HL7 mission.
 The Technical Steering Committee and the HL7 International Working Group
operate in such a way so as to:
 Respect the contributions and ideas of the talented individuals who make up the Working
Group;
 Maintain an effective focus on the goals of HL7 International;
 Assure that the all major decisions are based on consensus of the stakeholders;
 Maximize sharing and "re-use" of work products between elements of the Working Group;
 Use project management to assure that project goals are articulated and met;
 Reduce competition and conflict between the elements of the Working Group; and
 Assure that HL7 International Standards are developed on a solid architectural foundation that
assures consistency and interoperability.
Steering Divisions
 Foundation & Technologies
Provides fundamental tools and building blocks
 Conformance
 Infrastructure & Messaging
 Implementable Technology Specifications (ITS)
 Java
 Modeling & Methodology
 Security
 Service Oriented Architecture (SOA)
 Templates
 Vocabulary
Steering Divisions (con’t)
 Structure & Semantic Design Steering Division Focuses on
creation of basic patterns and common messages that could
exist on their own, but are mostly used by others:
 Arden Syntax
 Clinical Decision Support
 Electronic Health Record (EHR)
 Financial Management
 Imaging Integration
 Orders & Observations
 Patient Administration
 Personnel Management
 Scheduling & Logistics
 Structured Documents
 Domain Experts Steering Division
Focuses on creation of messages, services, documents using many of the
common structures in place
 Anatomic Pathology
 Anesthesiology
 Attachments
 Cardiology
 Clinical Genomics
 Clinical Guidelines
 Community Based Health Services
 Emergency Care
 Government Projects
 Health Care Devices
 Laboratory
 Patient Care
 Patient Safety
 Pediatrics Data Standards
 Public Health Emergency Response (PHER)
 Pharmacy
 Regulated Clinical Research Information Management (RCRIM)
Technical & Support Services Steering Division
 The primary feature of these work groups is to support the Technical
Steering Committee and work groups of the Working Group.
 Education
 Electronic Services
 Implementation
 Marketing Committee
 Process Improvement Committee (PIC)
 Project Services -- a new group that will take responsibility for the Project
Life Cycle and will serve as the primary support for the PMO
 Publishing
 Tooling
U.S. Health Messaging Standards
Development Efforts
HL7 International
(Health Level 7)
ACR/NEMA (DICOM)
(American College of Radiologists / National
Electrical Manufacturers Association)
(Digital Image Communications)
X12 (X12N)
ASTM (E31)
ASTM International
(was American Society of Testing Materials)
IEEE
(Institute of Electrical and Electronic Engineers)
NCPDP
(National Council of Prescription Drug
Producers)
ADA
(American Dental Association)
HL7—Country and International
Standards
TC 215
Other Countries /
HL7 Affiliates
TC 251
September, 2014
38
HL7 International Diversifies
 HL7 International Started with and is traditionally thought of as
“messaging”. For most of its life, however, HL7 International has also
produced more than messaging standards.
 Electronic Data Exchange in Healthcare Environments (i.e. “messaging”)
 Version 2 & Version 3
 Arden Syntax
 GELLO
 Visual / Context Integration (CCOW)
 Version 2.x XML (XML encoding of HL7 International messages)
 Clinical Document Architecture (CDA)
 Clinical Context Document Implementation Guide (CCD)
 Electronic Health Record System (EHR-S) Functional Model
 Personal Health Record System (PHR-S) Functional Model
 Services (i.e., Services as related to a Services Oriented Architecture)
History of HL7
(Through 2012)
Version 1.0 Implementation Version 2.2 Version 2.2
Published Support Guide Published ANSI Version 2.3.1
published Published PRA
and ANSI (CDA 1.0)
1987 88 89 90 91 92 93 94 95 96 97 98 99 2000 01 02 03 04
Version 2.0 Arden

Charter member of Syntax
Published 2.4 2.5
ANSI HISPP 2.0
First Meeting
Hospital Version 3.0
Version 2.3
University of PA Version 2.1 1st published
Published
Published and ANSI
CCOW
2005 06 07 08 09 10 11 12 13 14
Reorganizes
V2.6
First work on SOA Hires CEO & CTO & V2.7 V2.7.1
(Services) w/HSSP starts work on SAIF
Pub-
lished
V3 20xx Normative Editions

HL7 INTERNATIONAL
PROCESS
MEETINGS, BALLOTS & LIFE

CYCLE
HL7 International Meetings
 Working Group Meetings occur three times a year.

 September meeting is designated a “plenary”
meeting.
 Monday AM is a special program dedicated to
business and reporting state of the organization.
 Most (if not all) HL7 International work groups have
face-to-face meetings during a working group
meeting.
 Workgroups set agendas for the “next” meeting at

the end of the last meeting.
 Agenda usually progresses work with time
allocated to:
 Version 2
 Version 3
 Joint meetings with related work groups
 Current ballots normally take priority.
 Work Groups have defined decision making

processes that specify how they run
meetings, debate and vote on issues
discussed in a meetings.
 HL7 International Process Improvement
Committee (PIC) has default template
procedures
 Work Groups can customize their decision

making processes. However:
 PIC guidelines constrain the framework.
 HL7 International’s By-Laws and Policy and
Procedures take precedence
 Default conduct is Robert’s Rules of Order.
Ballots
 The end product of a ballot process is a

document. The document could stand on its
own. However, most balloted documents are
a part of a published Standards Document
(e.g., HL7 2.6, HL7 3.0, etc.)
Ballots
 Documents can be:

 Informative
 An Informative Document is the product of a Work Group that is not currently
deemed normative, but nonetheless is intended for general publication. It
explains or supports the structure of the HL7 Protocol Specifications, or
provides detailed information regarding the interpretation or implementation of
an HL7 Protocol Specification. The TSC shall approve the issuance of an
informative document ballot.
 Draft Document for Comment Only

 A Work Group, with the concurrence of the TSC, may submit proposed
content or requirements documents, such as a Domain Analysis Model
(DAM), to comment-only review. The intent is to gather input from members
outside of the Work Group on the viability and clarity of the proposed content
or requirements document. The review of proposed content or requirements
documents does not seek a vote, per se, but will capture all comments.
Ballots
 Draft Standards for Trial Use (DSTU)
 Content is balloted by the general membership as the draft of a future
standard which will, following a pre-specified period of evaluation and
comment (usually 2 years), be expeditiously incorporated into normative
standard. DSTU’s require at least two verified implementations that
demonstrate the standard’s use.
 Normative Standard
 Content is balloted by the general membership and is considered a
structural component of the HL7 Standard. Negative ballots must be
resolved. Normative Standards are typically registered with ANSI.
Ballots
 Ballots normally progress through two or
more cycles of ballots.
 Ballot pool is limited to declared interested
members;
 Negative votes must be accompanied with a
specific reason justifying the negative vote;
 Affirmative w/edit change; Abstention with
comment.
ALL HL7 Balloted Standards are introduced first as a
DSTU and must show some successful implementations
before being advanced as a Normative Standard.
Ballots
 Work Groups must resolve negative votes:
 Accept the voters comment and recommended solution.
 Negotiate with the voter and get them to agree to

withdraw their negative.
 Declare the vote non-persuasive.
 Voters may appeal to the TSC and Board. They can also
re-vote their same negative vote on the next round of
balloting.
 Substantive changes to a ballot (either to fix a negative
or add new material) merit another round of balloting.
Ballots
 When 75% (for normative documents) of

the responses are registered as
affirmatives…and hopefully all negatives
withdrawn, a document is ready for
publication as an HL7 International
Standard.
HL7 Products and Projects
 Project Lifecycle relies on the concept of HL7

International Products.
 Examples:
 Product Brand
 Messaging, Arden Syntax, CCOW, CDA, XML,….
 Version
 V2, V3, R1, R2, R3, …
 Multiple projects may be required to create viable

‘product’
HL7 Project Criteria
 Be consistent with HL7 strategic direction
 Include appropriate project documentation - project charter, scope,
resources, timelines, assumptions, constraints, planned
deliverables, etc. per PMO methodology
 Be aligned with market demand
 Be sponsored by stakeholders intending to implement the product
produced by the project
 Define a reasonable balloting strategy to meet market demand
and implementation timelines
 Define how the project will engage with other impacted work
groups
 Follow project approval protocols to ensure appropriate project
socialization and sign-off has taken place
HL7 Project Life Cycle for
Product Development
QVSD
Training Materials Request to Project
Implementation Guides HL7 Protocol enhance Yes
COMPLETE Request
Publish Standard Specifications or create Approved
Initiation
(.21) (.1) product (.2) (.5)
No QVSD
Yes
No Pass
(.18) START Request to
QVSD Sunset
Product No Move
Normative Finalize Cancel or
Ballot Specification
END Forward
Withdraw (.3)
(.17) (.16) (.6)
Yes
Request No
Industry Use
(.15) Approved Requirements
(.2) Analysis
Yes (.7)
QVSD
No
Go Specification
QVSD
Normative and Training Sunset
(.14) Product
(.20)
Yes (.4) Logical
QVSD Design
DSTU (.8)
Ballot END
(.13) QVSD
Normative
Yes
QVSD
Review
Informative Ballot Comment Yes Seek Draft
No DSTU
Document Type Only Comments Specification
(.12) (.11)
Ballot (.19) Ballot (.10) (.9)
No QVSD
HL7 INTERNATIONAL
VERSION 2.X
HL7 International Version 2.x
 First widely used version 2.1 published in 1991

 Used in 90%+ provider organizations in the US and widely supported by
vendors.
 Generally requires bi-lateral negotiations between communicating
parties.
 Backwards-fitted (imperfectly to HL7 International Reference Information
Model (RIM))
 Not well normalized.
 Segments & Data Elements moved to a single location (Chapter 2) only in 2.5 in 2003.
 Makes no formal attempt to define process
 Most implementations are a mix of versions ranging from 2.1 to 2.3
(even though current version is 2.7)
Version 2.7 Chapters*
1. Introduction 12. Patient Care
2. Control / Data Types / 13. Clinical Laboratory Automation
Conformance & Code Tables
14. Application Management
3. Patient Administration
15. Personnel Management
4. Orders
16. Non-US eClaims (new to 2.6)
5. Queries
17. Materials Mgmt. (new to 2.6)
6. Financial Management
7. Observations
Appendices:
8. Master Files A. Data Definition Tables
9. Medical Records / Information Mgmt B. Lower Layer Protocol
C. BNF Definitions
10. Scheduling D. Glossary
11. Patient Referral E. Index
2.7 is available on the HL7 “Standards” section of the HL7 web site. CDs are also available.
HL7 INTERNATIONAL
VERSION 3
Some HL7 International
Version 3 Terms
 Use-case Models
 Reference Information Model (RIM)
 Domain Message Information Model (DMIM)
 Refined Message Information Model (RMIM)
 Message Implementation Manual (MIM-UK term for
spec)
 Message Object Diagram
 Hierarchical Message Description (HMD)
 Common Message Element Types (CMET)
HL7
International
Version 3
First approved for
publication and pro-
motion to ANSI as an
HL7 Standard in
September, 2004.
Current Version: 2010
Published July 2010
HL7 International Version 3
HL7 International Version 3
Appendices
Acronyms
Glossary
Some Acronyms*
 ADA American Dental Association
 ACR American College of Radiology
 AHA American Hospital Association
 AHIC American Health Information Community (an advisory board within DHHS)
 AHIMA American Healthcare Information Management Association
 AHRQ Agency for Health Research and Quality
 AMA American Medical Association
 AMIA American Medical Informatics Association
 ANA American Nursing Association
 ANSI American National Standards Institute
 ASC X12 Accredited Standards Committee X12 – for business transactions
 ASC X12N Accredited Standards Committee X12N – for insurance and reimbursement data
interchange
 ASC Z80 Accredited Standards Committee Z80 – for Optometry
 ASN.1 Abstract Syntax Notation One
 ASTM American Society for Testing and Machinery—A US based SDO
 CAP College of American Pathologists
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
Some Acronyms*
 CCHIT Certification Commission for Health Information Technology
 CCOW HL7 Clinical Context Object Workgroup (now Clinical Context Management)
 CDC Centers for Disease Control and Prevention
 CEN Comité Européen de Normalisation (EU Standards Body)
 CENELEC European ` for Electrotechnical Standardization
 CHIA Canadian Health Informatics Association
 CIHI Canadian Institution for Health Information
 CMA Context Management Architecture
 CMET HL7 Common Message Element Type—reusable message components such as data
types
 CMS DHHS Centers for Medicare and Medicaid Services (was HCFA)
 COM Component Object Model
 CORBA Common Object Request Broker Architecture
 CorbaMed OMG group working on health related projects
 CPRI Computer-based Patient Record Institute
 CPT Common Procedural Terminology. A systematic listing and coding of procedures and
services performed by physicians. A five-digit code with modifiers, used
for Billing Owned & maintained by AMA.
 CTS HL7 Common Terminology Services
Some Acronyms*
 DAM HL7 Domain Analysis Model (see HL7 HDF)
 DCOM Distributed Component Object Model
 DES Data Encryption Standard
 DHHS Department of Health and Human Services
 DICOM Digital Imaging and Communications in Medicine. Standard for transferring images.
Owned by ACR
 DIM Domain Information Model
 DIN German standards organization
 DISA Data Interchange Standards Organization. The secretariat for ASC X12.
 DMIM Domain Message Information Model
 DOD Department of Defense
 DRG Diagnostic Related Group
 DSM-IV Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Assoc.
 EPA Environmental Protection Agency. Has data registry.
 EU European Union
 EWG UN/EDIFACT Working Group
 FDA Food and Drug Administration
 FDIS ISO Final Draft International Standard
 GEHR Good European Health Record
Some Acronyms*
 HCFA Health Care Financing Administration (now CMS)
 HCPCS HCFA Procedure Coding System
 HDF HL7 Healthcare Development Framework
 HEDIS Health Employers Data and Information Set
 HHCC Home Health Care Classification. Virginia Saba’s code set for home care.
 HHS Health and Human Services (sometimes used instead of DHHS)
 HIBCC Health Industry Business Communications Council
 HIMA Health Industry Manufacturers Association
 HIMSS Healthcare Information and Management Systems Society (a trade group)
 HIPAA Health Insurance Portability and Accountability Act of 1996
 HIT Health Information Technology
 HITSP Healthcare Information Technology Standards Panel (owned and organized under ANSI
 HL7 Health Level Seven International
 HMD HL7 Hierarchical Message Definition
 HMO Health Maintenance Organization
 HOST Healthcare Open Systems and Trials
 HPCC High Performance Communications and Computing
 HTML Hyper-Text Markup Language
Some Acronyms*
 ICD International Classification of Disease
 ICD9 Diagnostic and procedure codes, current version in the US is ICD9-CM
 ICD9-CM ICD9 with Clinical Modification
 ICD10 Latest version of ICD implemented in most countries
 IDL Interface Definition Language
 ICNP International Classification for Nursing Practice
 IEC International Electrotechnical Commission
 IEEE Institute of Electronic and Electrical Engineers
 IETF Internet Engineering Task Force
 IHS Indian Health Service
 IMIA International Medical Informatics Association
 IOM Institute of Medicine
 ISSB Information Systems Standards Board
 ISO International Standards Organization (part of the UN in Geneva Switzerland)
 ITSEC Information Technology Security Evaluation Criteria
 ITU International Telecommunication Union
Some Acronyms*
 JAHIS Japanese Association for Medical Informatics
 JCAHO Joint Commission on Accreditation of Healthcare Organizations
 JIRA Japan Industries Association of Radiation Apparatus
 LOINC Logical Observations, Identifiers, Names and Codes
 MDF Message Development Framework
 MEDCIN Nomenclature for healthcare. Produced by Medicomp.
 MEDINFO World Medical Informatics Conference; every 3 years; sponsored by IMIA.
 MEDIX Medical Data Interchange Standard (IEEE)[P1157]
 MEDRA Medical Dictionary for Drug Regulatory Affairs
 MeSH Medical Subject Heading
 MGMA Medical Group Management Association
 MIB Medical Informatics Bus (IEEE)
 MOU Memorandum Of Understanding
 MPI Master Patient Index or Master Person Index
 MPL Master Patient (Person) Locator
 MSHUG Microsoft Healthcare User Group
Some Acronyms*
 NANDA North American Nursing Diagnoses Association
 NCHS National Center for Health Statistics
 NCCLS National Committee for Clinical Laboratory Standards
 NCPDP National Council for Prescription Drug Programs
 NCVHS National Committee for Vital and Health Statistics
 NDC National Drug Codes. Produced by the FDA.
 NEMA National Electrical Manufacturers Association
 NHS National Health Service – UK
 NHS CT National Health Service Clinical Terms (formerly Read Codes)
 NIC Nursing Intervention Classification
 NILT Nursing Intervention Lexicon and Taxonomy
 NIST National Institute of Standards and Technology
 NLM National Library of Medicine
 NOC Nursing Outcomes Classification
 NPRM Notice of Proposed Rule Making
 NUBC National Uniform Billing Committee
 NUCC National Uniform Claims Committee
Some Acronyms*
 OMAHA System Nursing Codes
 OMG Object Management Group
 ORB Object Request Broker
 PACS Picture Archiving and Communication System
 PCDS Patient Care Data Set. Judy Ozbolt, Vanderbilt.
 PHS Public Health Service
 PRA Patient Record Architecture
 PSRO Professional Standards Review Organization
 READ Classification System:
Clinical codes with a bias for primary care. Now part of NHS SNOMED CT.
 RIM Reference Information Model
 RMIM Refined Message Information Model
 RSA Algorithm for encrypting / decrypting data. Developed by Ronald Rivest,
Adi Shamir, and Leonard Adleman
 RSNA Radiological Society of North America
 SCAR Society for Computer Applications in Radiology
 SDO Standards Development Organization
 SGML Standard Generalized Markup Language
Some Acronyms*
 SCAR Society for Computer Applications in Radiology
 SDO Standards Development Organization
 SGML Structured Graphical Markup Language
 SNOMED RT Systematized Nomenclature of Medicine Reference Terminology
 SNOP Systematized Nomenclature of Pathology
 SQL Structured Query Language
 TC 215 ISO Technical Committee 215 – Healthcare Information
 TC 215 WG1 Working Group 1: Modeling Coordination and Health Records
 TC 215 WG2 Working Group 2: Messaging and Communications
 TC 215 WG3 Working Group 3: Health Concept Representation
 TC 215 WG4 Working Group 4: Security
 TC 215 WG5 Working Group 5: Health Cards
Some Acronyms*
 TC 251 CEN Technical Committee for Medical Informatics
 TC 251 WG1 Healthcare Information Modeling and Medical Records
 TC 251 WG2 Healthcare Terminology, Semantics and Knowledge Bases
 TC 251 WG3 Healthcare Communications and Messages
 TC 251 WG4 Medical Imaging and Multimedia
 TC 251 WG5 Communication with Medical Devices
 TC 251 WG6 Healthcare Security, Privacy, Quality and Safety
 TC 251 WG8 Intermittently Connected Devices (including Cards)
 TCP/IP Transmission Control Protocol/Internet Protocol
 Terminfo An HL7 International General Approach to resolving issues related to the interface
between HL7 International Information Model and terminologies or code systems
 TR ISO Technical Report
 TS ISO Technical Specification
 UCC Uniform Code Council
 UCDS Uniform Clinical Data System
 UMDNS Universal Medical Device Nomenclature System
 UML Unified Modeling Language
 UMLS Unified Medical Language System
Some Acronyms*
 UN/EDIFACT United Nations Electronic Data Interchange For Administration, Commerce and Transport
 UNIX Open Systems Operating system
 UPC Universal Product Code. From UCC.
 URL Universal Resource Locator (e.g., http://www.hl7.org)
 USHIK US Health Information Knowledgebase; Data Registry
 US/TAG United States Technical Advisory Committee
 VA Veterans Administration
 WEDI Workgroup on Electronic Data Interchange
 WHO World Health Organization
 WS-I Web Services Interoperability Organization
 www World Wide Web
 W3C World Wide Web Consortium. Definers of HTML & XML among other things
 XML Extensible Markup Language
HL7 V 2.7 Glossary
HL7 V3 Glossary
HL7 Healthcare Development
Framework (HDF)
ISO TC 215 Joint Initiative for Global Standards
Harmonization Health Informatics Document
Registry and Glossary
http://www.skmtglossary.org/
Note, this web site requires registration

but no fee.
If you have interest, you can use this link to obtain a
username & password and then access to the above ISO
Document Registry and Glossary.
Glossary
Here are some definitions of organizations that have been mentioned in

this presentation.
 American National Standards Institute (ANSI) :
 The Institute oversees the creation, promulgation and use of thousands of norms
and guidelines that directly impact businesses in nearly every sector: ANSI is also
actively engaged in accrediting programs that assess conformance to standards –
including globally-recognized cross-sector programs such as the ISO 9000
(quality) and ISO 14000 (environmental) management systems.
 Standards Development Organizations (SDOs)—not healthcare

specific :
 Any organization whose primary activities are developing, coordinating,

promulgating, revising, amending, reissuing, interpreting, or otherwise maintaining
technical standards that address the interests of a wide base of users outside the
standard-developing organization*.
*wikipedia
Glossary
 ONC
 The Office of the National Coordinator for Health Information Technology is an organization in the US Department
of Health and Human Services reporting to the DHHS Secretary. ONC is designated in several laws by the US
Congress to distribute funds and manage initiatives to meet requirements for the development, deployment and
use of health information technology by providers, and public health agencies through inducement of financial
incentives and, eventually, financial penalties.
 International Standards Organization (ISO) Technical Committee (TC) 215 (Health Informatics):
 ISO is an organization of the United Nations headquartered in Switzerland. Its governance structure is similar to
the UN’s where each country has one vote. The secretariat for ISO TC 215 is held by the American National
Standards Institute (ANSI).
 ITC 215’s domain of work is standardization in the field of information for health, and Health Information and
Communications Technology (ICT) to promote interoperability between independent systems, to enable
compatibility and consistency for health information and data, as well as to reduce duplication of effort and
redundancies.
 The domain of ICT for health includes but is not limited to:
− Healthcare delivery;
− Disease prevention and wellness promotion;
− Public health and surveillance;
− Clinical research related to health service.
Glossary
 EU’s CEN (Comité Européen de Normalisation) TC251

 (CEN Technical Committee 251) is a workgroup within the European Union
working on standardization in the field of Health Information and
Communications Technology (ICT) in the European Union. The goal is to
achieve compatibility and interoperability between independent systems and to
enable modularity in Electronic Health Records systems.
 Workgroups establish requirements for health information structure in order to
support clinical and administrative procedures, technical methods to support
interoperable systems. In addition they establish requirements regarding safety,
security and quality.*
*wikipedia

Tutorial: Introduction To Health Level Seven International (HL7) Organization & Process

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John Quinn (HL7 International CTO)

© 2014 Health Level Seven ® International. All Rights Reserved.

Argentina Romania Puerto Rico Philippines Pakistan Norway

Sweden United Kingdom

 An Affiliate is an independent legal entity that:

 Our current four major stakeholder-users (imho):

 Interoperability beyond a single point to point

• HL7 International has a number of major

A project to create Product-Line Management and coordinate common elements and

 V3 products (e.g., messaging, CDA, SPL, etc.)

Members include: user (hospital, physicians

There are also now 34 countries that participate in HL7

 HL7 International is one of several American

 HL7 International’s domain is clinical and

 Headquartered in Ann Arbor, MI, HL7 International

 A frequent misconception about HL7 International (and

 Members of Health Level Seven International are

To create the best and most widely

HL7 International provides standards for

"Level Seven" refers to the highest level

The application level addresses definition of

 Affiliate Due Diligence  Financial Management  Policy Advisory

 Technical Steering Committee -

HL7 International’s Technical Steering Committee’s Mission

Version 2.0 Arden

V3 20xx Normative Editions

MEETINGS, BALLOTS & LIFE

 Working Group Meetings occur three times a year.

 Workgroups set agendas for the “next” meeting at

 Work Groups have defined decision making

 Work Groups can customize their decision

 The end product of a ballot process is a

 Documents can be:

 Draft Document for Comment Only

 Negotiate with the voter and get them to agree to

 When 75% (for normative documents) of

 Project Lifecycle relies on the concept of HL7

 Multiple projects may be required to create viable

 First widely used version 2.1 published in 1991

Note, this web site requires registration

Here are some definitions of organizations that have been mentioned in

 American National Standards Institute (ANSI) :

 Standards Development Organizations (SDOs)—not healthcare

 Any organization whose primary activities are developing, coordinating,

 EU’s CEN (Comité Européen de Normalisation) TC251

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