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Healthcare Management
A Definitive Guide to HL7 Integration – Part 1

Posted in Healthcare Management

Last Updated | July 25, 2023
Different medical systems in clinics and hospitals including; hospital information
system (HIS), electronic health record (EHR), radiology information system (RIS),
electronic medical record (EMR), and lab information system (LIS) has different
communication languages. To further complicate the system, there are ever-increasing
numbers of healthcare applications being used across different functions of the
healthcare system. This means that a unified and universal inter-communication
language for different systems and applications used across all the functions of the
medical system is a necessity to ensure efficient, reliable, and quality healthcare
solutions.

That’s where HL7 comes into play.

The language was exclusively developed as a universal communication language

between medical systems and applications. The language was introduced in the
industry back in 1987. In this digital health blog, we will be looking at everything you
would want to know about the language including the HL7 software, HL7 integration,
and HL7 integration engine.
What is HL7?
As briefly discussed above, HL7 is an exclusive universal medical language that was
developed to ensure easy and consistent communication between different
applications and systems used across all the functions of the healthcare industry.
Today, the entire communication involved in the healthcare industry is being
communicated in one or more HL7 messages.

The development of HL7 needs close collaboration between the application catalyst,
system analyst, application programmer, and integration specialist.

What does HL7 stand for?

As can be guessed by the name, the HL7 language comprised of 7 different layers of
ISO communication model including;

 Physical – this communication layer is responsible to connect the medical

facility to the transmission media
 Datalink: the data link layer in HL7 is responsible to manage and minimize
errors between adjacent nodes
 Network: the HL7 network layer is responsible for routing the information
across the network
  Transport: the transport layer of the HL7 language is responsible for the end-
to-end communication control
 Session: The session layer is responsible to manage the non-communication
issues
 Presentation: the presentation layer of the HL7 language is responsible to
transform the information
 Application: lastly, the application layer of the language is responsible for
delivering services to applications
If we broadly categorized the 7 different layers that together make up the HL7 layers,
we can say that the layers 1 to 4 are responsible for communication purposes,
whereas, layers 5 to 7 are the functional layers. All of these HL7 layers are important
to complete the transfer or retrieval of medical communications between different
applications and systems.

What is the Objective of HL7?

The core vision behind the development of HL7 was to offer the healthcare industry
with a unified and universal language to promote fasters and secure medical data
sharing. Now, in order to achieve the goal of data interoperability, it is important to
have a logical and simplified workflow to ensure enhanced quality, superior accuracy,
and cost-effectiveness for healthcare providers.
What is HL7 Integration?
Today, all healthcare facilities would typically use more several HL7 enables systems
and applications. However, to be able to fully leverage the potential of the language
and achieve higher efficiency, reduce cost and ensure superior services, healthcare
facilities would require an HL7 integration engine that can assist in HL7 integration
between all of the systems and applications facilitating the benefits of integrated
healthcare systems.
Here, the HL7 integration can be accomplished by one of the two ways:

1. Point-to-Point:
The Point-to-Point interface HL7 integration is the simplest approach to ensure data
communication between different medical systems and applications. In this approach,
dedicated interfaces (point-to-point) are built to send and receive data between two
systems or applications. Since, there’s a dedicated link/interface between the two
systems/applications, the data format used for communication between them is easily
recognized. However, the downside or challenge of this approach is a large number of
interfaces/links that have to be generated between the systems/applications. For
instance, to connect 4 systems with ADT data, 4 different interfaces/links would have
to be built.
2. Interface and HL7 Integration Engine
The HL7 integration engine is a sort of middleware that is meant to connect different
systems. The HL7 integration engine is able to convert the data formats as per the
requirements of different systems, as well as, orchestrates the message workflow. The
benefit of this approach is that it removes any need for individual (point-to-point)
interfaces between systems. And while the interfaces (from point-to-point approach)
and integration engines can be difficult to differentiate, the main point of
differentiation is the range of functionalities supported by each.
When it comes to HL7 integration, the primary consideration should be your
integration strategy, irrespective of the HL7 version you choose. For instance, you
would need to understand your facility needs; whether you want to go with an HL7
integration engine or you would be better off with the point-to-point interface? What
are the integration functionalities you would require at your place? It is of utmost
important to nail down a strategy detailing the scope of integration.

Who uses the HL7 Integration Software Engine?

At present over 90% of healthcare facilities including hospitals and private clinics in
the United States have integrated the HL7. Across the world, there is over 25 HL7
organization working to make it the global standard in the healthcare industry. Now, if
we want to categorize the HL7 users, three border segments may include:

1. Clinical Interface Specialists

This segment includes specialists that are required to move clinical data. These
specialists are primarily tasked to create tools or applications that enable easy sharing
and recognition of data between medical systems/applications. Such users are
responsible for the communication of data between healthcare providers and
applications/systems.

2. Government or Regulatory Authorities

Such authorities are mainly interested in sharing the healthcare data to multiple
entities for compliance or standardization of healthcare services. There are a few
legacy systems available at present as well. such users of HL7 are more interested and
have the mandate to communicate/channel the healthcare data in between different
healthcare entities, which often isn’t covered by existing interfaces.

3. Medical informaticists
Lastly, we have the medical informaticists which are primarily related to healthcare
informatics. The healthcare informatics deals with the logic of healthcare, as well as,
studying the creation of clinical knowledge. These HL7 users are primarily interested
in creating or adapting clinical ontology.

What are the HL7 Integration Challenges?

Variance in the implementation of HL7 standards

One key challenge in the HL7 software integration is the variation in the
implementation of the HL7 standards, which leads to increase time and cost required
for the integration. In simple words, the variance in the implementation of standards
means programmers/system analysts are required to maintain multiple code base and
integration points. Also, the variation in implementation standards means more
dedicated resources are required for integration development; leaving with fewer
resources for other work processes. To even add to the agony, replacement, or
addition of interfaces influences all the related applications; subsequently impacting
the entire communication network.

Unreliable HL7 data semantics may lead to misinterpretation

The complexity of today’s healthcare industry means that it is crucial for healthcare
applications to identify and understand the data values and their real meaning. To
avoid any misinterpretations due to data semantics, the HL7 must integrate/integration
engine to communicate their interpretation of the standards being used. To give you
an example, the HL7 interface needs to interpret if “NA” means “Not Applicable” or
“No Allergies”. Similarly, the value “3” may interpret the patient as “Smoker” or
“Former Smoker” in different systems. There can be hundreds and thousands of such
cases, which all leads to the importance of communicating the right interpretation for
data semantics because this interpretation will eventually lead to the quality of the
data, as well as, may have dire consequences for healthcare delivery to patients. And
at a time when the healthcare industry is increasingly becoming regional with various
patients’ touchpoints, HL7 integrations must offer accurate and comprehensive data
interpretation.

Unplanned EHR migration may lead to legacy data loss

There is always a certain degree of challenge and risk involved during the migration
of EHR for healthcare institutes. To avoid any loss of data, many healthcare facilities
decide to go with multiple EHRs, which require doctors, physicians, and other related
staff to maintain login details for multiple platforms. In the worst cases, the healthcare
facilities may require medical and paramedic staff to maintain paper records.
Alternatively, some institutes may decide to transfer the data into a new system.
However, unplanned data migration may lead to loss of legacy data. Before the data
migration, healthcare institutes must prioritize the data (which is the most important
and which should be migrated at the first stage). Generally, the basic essential medical
data including allergies, medications, and others should be the data of choice for
initial migration. Another complicacy in this regard arises due to the incompatibility
of the data or errors after the conversion of data into other formats.

FAQs:
Can UX design help improve HL7 compliance?
HL7 standards are responsible for bridging the gap between health apps and
healthcare providers while improving interoperability. Similarly, modern healthcare
facilities are integrating HL7 standards information into healthcare apps for better
compliance. However, a well-built UX design for healthcare apps is also a must for
optimizing app usage.
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Folio3

Folio3 is a California based software solutions partner for entrepreneurs and Fortune 500 companies that specializes in digital
healthcare software solutions. With over a decade of experience and expertise in the healthcare space, we have built
groundbreaking digital transformation healthcare solutions for some of the world’s leading healthcare companies. We have the
necessary expertise and competency integral to the optimization and management of digital health processes that cater to the
needs of all important stakeholders whether they are a healthcare practitioner, physician or patient.
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