What’s Next? Why HL7 Messages and HL7 CDA Documents are in our Future Sondra Renly IBM Research and Jack Krueger APHL

Introductions Sondra R Renly John (Jack) Krueger File Name Here.ppt 02/10/10 03:37 Introductions Sondra R Renly MLS(ASCP)CM, MS Computer Sciences IBM Research, Healthcare Interoperability John (Jack) Krueger MS ChE Retired State of Maine Laboratory Director Informatics Consultant and SME to APHL and CSC 2

Health Level 7 CDA R2 2005

HL7 Messages http://www.ringholm.de/docs/04200_en.htm File Name Here.ppt 02/10/10 03:37 HL7 Messages http://www.ringholm.de/docs/04200_en.htm Messages are generally used to support an ongoing process in a real-time fashion. They convey status information and updates related to one and the same dynamic business object. Messages are about "control" - they can represent requests that can be accepted or refused by the system and there are clear sets of expectations about what the receiver must do. In such situations the latest version of the data is of importance to support an ongoing process, historic versions of one and the same object are generally not of importance apart from regulatory (e.g. auditing) purposes. Messages by and large contain “current” data. The more interactive and tightly coupled your communication process is, the more the use of messages is applicable. 4

Laboratory Use Case Messages Orders Results * child orders File Name Here.ppt 02/10/10 03:37 Laboratory Use Case Messages Orders Results * child orders * status updates * reflex tests * preliminary results MSH|^~\&|LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO|US WHO Collab Labsys^2.16.840.1.114222.4.3.3.7^ISO|CDC-EPI Surv Branch^2.16.840.1.114222.4.1.10416^ISO|20111212201328+1900||ORU^R01|20111212201328-000014085|P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^2.16.840.1.114222.4.10.3^ISO PID|1||1038239^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO^PI||^^^^^^S||19980926|M|||304 W 37TH ST^^Wilmington^DE^19802^^^^10003|||||||||||2135-2^Non-Hispanic^CDCREC^NON_HISP^Non Hispanic^L ORC|RE||14085^DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^6515658 OBR|1||31804^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|243365003^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^6515658|||||20111108161839+1900|||F OBX|1|CE|38379-4^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L||260373001^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||20111108161839+1900 OBR|2||14085^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO||||||F|||20111108161640+1900 TB Sample from the 2012 HIMSS Interoperability Showcase UC3 5

HL7 Documents http://www.ringholm.de/docs/04200_en.htm File Name Here.ppt 02/10/10 03:37 HL7 Documents http://www.ringholm.de/docs/04200_en.htm Documents are persistent in nature, have “static” content and tend to be used “post occurrence”, i.e. once the actual process is done. Documents are about persisting "snapshots" as understood at a particular time. Documents contain data “as it was” when the document was originally created. For documents such as referrals and discharge summaries, it may be more appropriate to see the data as it was understood at the time the referral or summary was constructed rather than viewing the data as it exists now. Documents are "passive". They capture information and allow that information to be shared, but do not in and of themselves drive any activity. Documents can be superseded and corrected, but they are still "static documents" rather than dynamic objects. The more passive and loosely coupled your communication process is, the more the use of documents is applicable. 6

Laboratory Use Case Messages Documents Orders Results Final Report File Name Here.ppt 02/10/10 03:37 Laboratory Use Case Messages Orders Results Documents Final Report Summaries MSH|^~\&|LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO|US WHO Collab Labsys^2.16.840.1.114222.4.3.3.7^ISO|CDC-EPI Surv Branch^2.16.840.1.114222.4.1.10416^ISO|20111212201328+1900||ORU^R01|20111212201328-000014085|P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^2.16.840.1.114222.4.10.3^ISO PID|1||1038239^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO^PI||^^^^^^S||19980926|M|||304 W 37TH ST^^Wilmington^DE^19802^^^^10003|||||||||||2135-2^Non-Hispanic^CDCREC^NON_HISP^Non Hispanic^L ORC|RE||14085^DE.Smyrna.SPHL^2.16.840.1.114222.4.1.44596^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^6515658 OBR|1||31804^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|243365003^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^6515658|||||20111108161839+1900|||F OBX|1|CE|38379-4^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L||260373001^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||20111108161839+1900 OBR|2||14085^LABWARE.DE.STAG^2.16.840.1.114222.4.3.3.2.23.2^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND|||20111108154032+1900|||||||20111108154030+1900|LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG&2.16.840.1.114222.4.3.3.2.23.2&ISO||||||F|||20111108161640+1900 TB Sample from the 2012 HIMSS Interoperability Showcase UC3 7

ONC EHR Certification http://onc-chpl.force.com/ehrcert File Name Here.ppt 02/10/10 03:37 ONC EHR Certification Public Health Surveillance Electronically record, modify, retrieve, submit v2.3.1 or v2.5.1 Reportable Lab Results Electronically record, modify, retrieve, submit v2.5.1 Submission to Immunization Registries http://onc-chpl.force.com/ehrcert 8

ONC EHR Certification http://onc-chpl.force.com/ehrcert File Name Here.ppt 02/10/10 03:37 ONC EHR Certification Exchange clinical information and patient summary record Electronically receive and display CCR or CCD Electronically transmit CCR or CCD * diagnostic test results * problem list * medication list * medication allergy list Ambulatory certified systems = 869 Inpatient certified systems = 282 http://onc-chpl.force.com/ehrcert 9

Continuity of Care Problems* Family History Social History Alerts* File Name Here.ppt 02/10/10 03:37 Continuity of Care Problems* Family History Social History Alerts* Medications* Results Section* Procedures Encounters Plan of Care Immunizations Vital Signs Medical Equipment Functional Status Advance Directives Payors Purpose 10

Continuity of Care Record Lab Result … <Test> <CCRDataObjectID>8b3fa370-67a5-11db-bd13-0800200c9a66</CCRDataObjectID> <DateTime> <Type><Text>Assessment Time</Text></Type> <ExactDateTime>2000-04-07T14:30Z</ExactDateTime> </DateTime> <Description> <Text>WBC</Text> <Code><Value>33765-9</Value><CodingSystem>LOINC</CodingSystem></Code> </Description> <Status><Text>Final Results</Text></Status> <Source><Actor><ActorID>8a54f393-8015-460c-abd2-f29aad15481c</ActorID></Actor></Source> <TestResult> <Value>6.7</Value><Units><Unit>10+3/ul</Unit></Units> </TestResult> </Test>

Continuity of Care Document Lab Result … <component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.31"/> <id root="8b3fa370-67a5-11db-bd13-0800200c9a66"/> <code code="33765-9" codeSystem="2.16.840.1.113883.6.1" displayName="WBC"/> <statusCode code="completed"/> <effectiveTime value="200003231430"/> <value xsi:type="PQ" value="6.7" unit="10+3/ul"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> </observation> </component>

Continuity of Care Document Immunization … <substanceAdministration classCode="SBADM"> <templateId root="2.16.840.1.113883.10.20.1.24"/> <id root="1.3.6.1.4.1.19376.1.3.4" extension="3331"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS" value="20110810102500+0500"/> <routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Intramuscular injection"/> <consumable> <manufacturedProduct> <manufacturedMaterial> <code code="88" codeSystem="2.16.840.1.113883.6.59" codeSystemName="CVX" displayName="Influenza Virus Vaccine, NOS"/> <name>Influenza Virus Vaccine</name> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration>

Continuity of Care >> Case Report File Name Here.ppt 02/10/10 03:37 Continuity of Care >> Case Report Problems Family History Social History Alerts Medications Results Section Procedures Encounters Plan of Care Immunizations Vital Signs Medical Equipment Functional Status Advance Directives Payors Purpose 14

CDA Public Health Case Report File Name Here.ppt 02/10/10 03:37 CDA Public Health Case Report Social History Section Clinical Information Section Treatment Information Section Encounters Section Relevant Diagnostics and Laboratory Section Immunizations Section TB Sample from the 2012 HIMSS Interoperability Showcase UC3 15

CDA Case Report Pilot Team File Name Here.ppt 02/10/10 03:37 CDA Case Report Pilot Team Participants Observers MAY 2012 16

BODY L3 MACHINE PROCESSABLE CDA Primer <ClinicalDocument ...> <templateId root="2.16.840.1.113883.10.20.15"/> <recordTarget><patientRole/></recordTarget> <author/> <custodian/> <legalAuthenticator/> HEADER <structuredBody> <section> <templateId root="2.16.840.1.113883.10.20.1.15"/> <templateId root="2.16.840.1.113883.10.20.15.2.22"/> <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" displayName="Social History"/> <title>Social History</title> <text><list><item>Occupation: Healthcare Support Occupations</item></list></text> BODY L2 HUMAN READABLE <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.15.3.7"/> <code code="11341-5" codeSystem="2.16.840.1.113883.6.1" displayName="History of Occupation"/> <statusCode code="completed"/> <effectiveTime value="20110810102500-0500"/> <value xsi:type="CD" code="31-0000" codeSystem="2.16.840.1.113883.6.243" codeSystemName="Occupation (SOC 2000)" displayName="Healthcare Support Occupations"/> BODY L3 MACHINE PROCESSABLE

CDA Primer Human Readable … Machine Processable … HL7 CDA R2 xml File Style-sheet Machine Processable … HL7 CDA R2 xml File

What’s Next? Messages & Documents File Name Here.ppt 02/10/10 03:37 What’s Next? Messages & Documents Questions? 19