Examining the Effective Use of HL7v3 Messaging “ Where the Rubber Meets the Road” Introduction for an Open Dialogue on: Issues in Communicating the Real Meaning of Data and Information in Citizens’ Electronic Health Systems The 4 th Conference for Semantic Interoperability for E-Government February 9-10, 2006 McLean, VA

The Semantic Web and Ontology for Healthcare Use of Semantic Web technologies and practices are designed and used to improve collaboration, research and development and innovation adoption in Healthcare. Success depends on a foundation of semantically rich system, process and information interoperability. Key to Success for communicating real accurately data and information across diverse e-halth systems: Key to Success for communicating real accurately data and information across diverse e-health systems: Core vocabularies and ontologies to support cross- community data integration and collaborative efforts. Core vocabularies and ontologies to support cross- community data integration and collaborative efforts. Guidelines and Best Practices for Resource Identification to support integrity and version control. Guidelines and Best Practices for Resource Identification to support integrity and version control. Better integration of Scientific Publication with people, data, software, publications, and clinical trials. Better integration of Scientific Publication with people, data, software, publications, and clinical trials.

For Interoperability You Must be Communicating Real Information with Real Meaning -Accurately The lack of immediate access to patient healthcare information is the source of one-fifth of medical errors. Americans need a connected system of electronic healthcare information available to all doctors and patients whenever and wherever necessary. In 2000, the Institute of Medicine (IoM) estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors. One of every seven primary care visits is affected by missing medical information. In a recent study, 80 percent of errors were initiated by miscommunication, including missed communication between physicians, misinformation in medical records, mishandling of patient requests and messages, inaccessible records, mislabeled specimens, misfiled or missing charts, and inadequate reminder systems.

Action is needed to achieve an interoperable health information technology system in the United States Lives Are in The Balance: Interoperable healthcare information enhances the quality of care for all Americans. Interoperability creates convenience by allowing doctors and other health care providers to share medical history, lab results, and other pertinent information in a more timely and accurate way. Backups of data easier to maintain, so catastrophic data loss is more easily remedied Provides improved support for adults who care for aging parents, especially from far away. Enhance and ease post-diagnosis and post-treatment contact with doctors via on-line services. By more effectively limiting unauthorized access, and tracking who views personal healthcare information, interoperability provides patients with more security and confidentiality.

The FY 2007 Priority for Health Information Technology The President launched the initiative to make electronic health records (EHRs) available to most Americans by 2014: A national coordinator for health IT was appointed, DHHS Office of the National HIT Coordinator (ONC) A national coordinator for health IT was appointed, DHHS Office of the National HIT Coordinator (ONC) $100 million allocated to fund projects: harmonizing standards; harmonizing standards; addressing privacy and security issues; addressing privacy and security issues; and developing models for a national web-based health IT system. and developing models for a national web-based health IT system.

The FY 2007 Priority for Health Information Technology, cont. The President proposes to develop nationwide standards to: accelerate patient access to EHRs; accelerate patient access to EHRs; develop web-based health records systems accessed only with a citizen-users consent; develop web-based health records systems accessed only with a citizen-users consent; use electronic medication history and lab test results; and use electronic medication history and lab test results; and utilize health information tools to monitor disease outbreaks utilize health information tools to monitor disease outbreaks This year’s budget requests $169 million, an increase of $58 to continue this initiative.

Examining Issues with HL7v3 HL7 Generally Defined: is a standard protocol for packaging and sending messages in terms that diverse computer systems can interpret and understand for the end-users. “Health Level 7” - 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. “Health Level 7” - 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.

Examining Issues with HL7v3, cont. Rationale of HL7: To ensure that health information systems can communicate their information in the form of messages which will be understood in exactly the same way by both sender and recipient To ensure that health information systems can communicate their information in the form of messages which will be understood in exactly the same way by both sender and recipient

Examining Issues with HL7v3, cont. In HL7v2: The realization of this task required an ad hoc interpretation of the standards by each sending or receiving institution. The realization of this task required an ad hoc interpretation of the standards by each sending or receiving institution. The data created for any particular purpose (e.g., conveying biochemistry results) would often be implemented differently by different vendors, with the consequence that vendor products were never properly interoperable… The data created for any particular purpose (e.g., conveying biochemistry results) would often be implemented differently by different vendors, with the consequence that vendor products were never properly interoperable… and always required the use of mapping software. and always required the use of mapping software.

Examining Issues with HL7v3, cont. HL7v3: Is an attempt to design a replacement, in which the “optionality” in the version 2 standard was removed in a way that health information messages for each functional area could be created in a single, uniform way. The intention: Interpretation of version 3 could be carried out uniformly by all health IT developer organizations.

Examining Issues with HL7v3, cont. The pillars of HL7v3 are as follows: 1. The reference Information Model (RIM), claimed as a master model of all health information, and universally used within HL7v3. 2. An HL7 custom method of creating predefined message definitions via refinement of the RIM into message schemas for each functional area. 3. Extensive use of HL7-defined vocabularies and external terminology such as LOINC and Snomed-ct to provide the semantics of message definitions.

Examining Issues with HL7v3, cont. Key questions -- to examine the pillars of HL7v3: Does the RIM uphold the basic rules of both good ontological design and object-oriented modeling, and prove to be efficient to use in practice for representing heath information? Does the HL7 approach to message refinement create difficulties for those who need to build generic, maintainable, extensible software in the future? Are HL7 mechanisms adequate for ensuring that the vast number of combinations of coded terms within actual messages can be controlled in such a way that messages will be understood in the same way by designers, senders and receivers?

Examining Issues with HL7v3, cont. An objective and neutral examination of issues, in “communicating the real meaning of data and information in citizens e-health systems,” may affect multi-billion dollar investments in healthcare information infrastructure as well as impact patient safety.

Examining Issues with HL7v3, cont. An objective dialogue on HL7v3 would need to: establish what a messaging standard is, establish what a messaging standard is, define criteria for assessing the suitability of messaging standards for clinical communication, and, define criteria for assessing the suitability of messaging standards for clinical communication, and, assess current messaging standards and alternative technologies against these criteria. assess current messaging standards and alternative technologies against these criteria.

Examining Issues with HL7v3 Discussion and Dialogue