HL 7 Standard
Dr. Der-Ming Liou
Institute of Health Informatics
National Yang-Ming University
Health Care Industry Standards
• Components vary with
platforms, modalities, and
manufactures
• HL7 for textual data
– standard textual data format
• ACR-NEMA and DICOM for
image data
– include data format and communication
protocols
2003/5/3 Dr. Der-Ming Liou 2
Health Level 7 Standard
• Established in March 1987
– organized by a user-vendor committee
– to develop a standard for electronic data
exchange in health care environments
• Goal
– to simplify the interface implementation
between computer applications from
multiple vendors
2003/5/3 Dr. Der-Ming Liou 3
Health Level 7 Example
HIS RIS
ADT VAX
Patient IBM VMS
VM
TCP/IP
SUN
UNIX
PACS
2003/5/3 Dr. Der-Ming Liou 4
HL7 Message
• The basic unit is a message
– comprise multiple segments in a defined sequence
– each segment contains multiple data fields
– identified by a unique, predefined three-character code
• A typical message contain the following
segments
MSG message header segment
EVN event type segment
PID patient identification segment
NKI next of skin segment
PVI patient visit segment
2003/5/3 Dr. Der-Ming Liou 5
Example of A Surgery Transactions
• Message header segment
MSH||STORE|MISSION|MIME|LAUREL|19801181007|secur
ity|ADT|MSG00201|||<CR>
• Event type segment
EVN|01|199801181005||<CR>
• Patient identification segment
PID|||PATID1234567||Doe^John^B^II||197470701|M||C|371
MAIN AVE^SAN FRANCISCO^CA^94122-0619||415-681-
2888||||||||<CR>
• Next of kin segment
NK1|Doe^Linda^E||wife|<CR>
• Patient visit segment
PV1|1|I|100^345^01||||00135^SMITH^WILLIAM^K|||SUR|A
DM|<CR>
2003/5/3 Dr. Der-Ming Liou 6
Message Flow Example
• An ADT event occur
– HIS automatically send a broadcast message to
RIS
– RIS parse this message and
• insert, update, and organize patient demographic data in its
database
– RIS send
• an HL7-formatted ADT message
• the examination reports
• the procedural descriptions to PACS
2003/5/3 Dr. Der-Ming Liou 7
The HL7 Demo
• Standards
• Connectivity
• Functionality: four clinical
scenarios
2003/5/3 Dr. Der-Ming Liou 8
The HL7 Information Exchange Demo
• Standards
– Version 2.x (“pipe & hat”)
– Version 3 messages (prototype)
– Version 3 Clinical Document Architecture
• now ANSI-certified: ANSI/HL7 CDA R1.0-2000
– Version 2.XML
• first time in demo
• canonical XML-ification of Version 2.x
• transitional strategy for those who have
implemented Version 2.x and want XML now!
2003/5/3 Dr. Der-Ming Liou 9
Connectivity
MDinTouch
Knowledgebase
Remote Physicians Office
Care
Epic Data Killdara
Systems
affinitex
McKessonHBOC Eclipsys
NetFish Internet
NeoTool LAN
ftp
mllp
http w/pki
http servers located on LAN and in Michigan Ontario,
CORBA And Florida
2003/5/3 Dr. Der-Ming Liou 10
Clinical scenario #1: OP reg
in-patient encounter office registration
Epic
Create Record/Order Lab Care Data
Register patient, collect
repository
NeoTool
NetFish,
Pseudo-lab
Eclipsys,
remote lab
Care Data,
Killdara Killdara
McKessonHBOC Connectivity, Routing, Translation Remote pseudo-lab,
PKI
Register patient
Create assessment
distribute results
College of
American affinitex MDinTouch
Pathology Secure remote access using
strong authentication, virtual
PDA, cell, thin client, secure, remote
access to dictated CDA patient
vocabulary patient record, flexible message records, vocabulary service
delivery
CDA
2003/5/3
V3 msg V2.XML V2 msg
virtual electronic
Dr. Der-Ming Liou health record
11
Clinical scenario #2: home health
Epic
Create Record/Order Lab
Care Data
in-house lab Register patient, collect
repository
NeoTool
NetFish,
Pseudo-lab
Eclipsys,
Care Data,
home registration Killdara Killdara
McKessonHBOC Connectivity, Routing, Translation Remote pseudo-lab,
PKI
Register patient
Create assessment
distribute results
College of
American affinitex MDinTouch
Pathology Secure remote access using
strong authentication, virtual
PDA, cell, thin client, secure, remote
access to dictated CDA patient
vocabulary patient record, flexible message records, vocabulary service
delivery
CDA
2003/5/3
V3 msg V2.XML V2 msg
virtual electronic
Dr. Der-Ming Liou health record
12
Clinical scenario #3: remote sign
Epic
Create Record/Order Lab
Care Data
Register patient, collect
repository
NeoTool
NetFish,
Pseudo-lab
Eclipsys,
Care Data,
Killdara Killdara
McKessonHBOC Connectivity, Routing, Translation Remote pseudo-lab,
PKI
Register patient
Create assessment
distribute
document
College of
American affinitex MDinTouch
Pathology Secure remote access using
strong authentication, virtual
PDA, cell, thin client, secure, remote
access to dictated CDA patient
vocabulary patient record, flexible message records, vocabulary service
delivery
2003/5/3
transcribe,
Dr. Der-Ming Liou
sign document;13
CDA V3 msg V2.XML V2 msg
access vocabulary service
Clinical scenario #4: coded query
code ICD diagnosis
SNOMED RT “is a” Parent-Child hierarchy
Epic
Create Record/Order Lab Disease,Care Data
DF-00000
Register
Metabolic patient,
Disease, collect
D6-00000
repository
NeoTool
Disorder of carbohydrate metabolism, D6-50000
NetFish, Disorder of glucose metabolism, D6-50100
Pseudo-lab
Eclipsys,
ICD-9-CM, 250.00
Diabetes Mellitus, DB-61000
Care Data,
code ICD diagnosis Killdara
Type 1, DB-61010
Killdara
McKessonHBOC Connectivity, Routing, Translation RemoteCarpenter
pseudo-lab,
Syndrome,
ICD-9-CM, 250.1 PKI DB-02324
Register patient
Create assessment Neonatal, DB75110
Neonatal, DB75110 Insulin dependant
ICD-9-CM, 775.10 type IA, DB-61020
College of
American affinitex MDinTouch
Pathology Secure remote access using
strong authentication, virtual
PDA, cell, thin client, secure, remote
access to dictated CDA patient
vocabulary patient record, flexible message records, vocabulary service
delivery
2003/5/3
query against SNOMED diagnosis
Dr. Der-Ming Liou 14
HL7 Information Exchange
• Bottom Line
– secure, distributed, virtual electronic health
record
– based on Internet and established healthcare
standards and model
– NOW
• Standards are the fastest, most
effective path to cross-application,
distributed functionality
2003/5/3 Dr. Der-Ming Liou 15
Information Exchange Demo Vendors
2003/5/3 Dr. Der-Ming Liou 16
HL7 Information Exchange
• Where we are/where we are going
• Today’s limitations:
– mix of production software and software
modified to comply with draft specifications
– not yet a uniformly fine-grained EHR, but the
basis for one
– vocab is standard, but application contingent on
local policy
• Tomorrow’s direction:
– continue to fill out fine-grained EHR
– evolve to increasingly precise data exchange
2003/5/3 Dr. Der-Ming Liou 17
Health Level Seven’s
Clinical Document Architecture
The HL7 Structured Documents Technical
Committee
Clinical Document Architecture
• ANSI/HL7 CDA R1.0-2000
– first nationally-certified XML specification in
healthcare
– CDA-compliant applications are available, more
coming
– CDA-compliance is required, more coming
• In development since 1996
– was Patient Record Architecture (PRA)
– was Kona Architecture
2003/5/3 Dr. Der-Ming Liou 19
Clinical Document Architecture
• CDA does simple things simply
• RIM metadata header +
generic clinical body =
portable display, retrieval
• Lays basis for extensibility:
– domain-specific document types
– fine-grained definitions
2003/5/3 Dr. Der-Ming Liou 20
Clinical Document Architecture
CDA Level One DTD shown in “XML
Authority” from Extensibility
CDA Level One document shown in
“Internet Explorer” from Microsoft
2003/5/3 Dr. Der-Ming Liou 21
Clinical Document Architecture
2003/5/3 Dr. Der-Ming Liou 22
Clinical Document Architecture
2003/5/3 Dr. Der-Ming Liou 23
Clinical Document Architecture
2003/5/3 Dr. Der-Ming Liou 24
Clinical Document Architecture
• Implementation: US
• affinitex, Care Data Systems, Epic
Systems, MDinTouch
– Mayo Clinic (30,000 notes/week)
– IDX (document management)
– CareFlow Net (transcription)
• In evaluation:
– by major providers and suppliers, as well as start-
ups and government projects
2003/5/3 Dr. Der-Ming Liou 25
Clinical Document Architecture
• Implementation: Germany
– SCIPHOX
• Standardization of Communication between
Information Systems in Physician Offices and
Hospitals using XML
– Phase I: Discharge letter from hospital to
physician office system
– Phase II: Referral information
– Status: supported by multiple national
organizations; first implementation
documents Q101
2003/5/3 Dr. Der-Ming Liou 26
Clinical Document Architecture
• Implementation: Canada
– HealthNet/BC, part of Ministry of Health in
British Columbia
– CDA to provide clinical documentation in
national claims attachment project
• In evaluation:
– by major providers and suppliers, as well as
start-ups and government projects
2003/5/3 Dr. Der-Ming Liou 27
Clinical Document Architecture
3 ballots; 108 votes; all negatives reconciled; unanimous final ballot
3M Health Information Systems McKessonHBOC
Akron General Medical Center Medic Computer Systems, LLC
Care Data Systems Medical Center of Boston Intl
Medical Informatics Project, UCSF
CareScience, Inc. Medical Manager Research & Development, Inc.
Danica Biomedical AB MedicaLogic, Inc.
Electronic Data Systems Corporation Netfish Technologies, Inc.
Epic Systems Corporation Oacis Healthcare Systems, Inc.
Figler Consulting Oracle Corporation
Partners HealthCare System, Inc.
Health Network Ventures PBM Micro, Inc.
Healtheon/WebMD Corporation Per-Se Technologies, Inc.
HL7 Australia Pitt County Mem. Hospital /University Systems
HL7 Canada QuadraMed Corporation
HL7 Germany Queensland Health
Saint Vincent Hospital and Health Center
HL7 Japan scheduling.com
HL7 United Kingdom Shafarman Consulting
IDX Systems Corporation Shared Medical Systems (SMS)
Intermountain Health Care St. Alphonsus Regional Medical Center
Kaiser Permanente SUNY Stony Brook
Sutter Health
Labtest.com, Inc. the BREENs
Lanier Worldwide, Inc. The Word Electric
LifeGard Technologies U.S. Department of Veterans Affairs
Los Alamos National Laboratory University of California Arthur ASHE Student
University of Chicago Hospitals & Health Systems
2003/5/3
Magnolia Technologies Dr. Der-Ming Liou 28
Washoe Medical Center
Mayo Foundation
