HL7 Version 3.0 Mini-Tutorial Helen Stevens Senior Project Manager –Web Solutions Office McKessonHBOC - Information Technology Business

1.What is the Message Development Framework? 2.What is the Reference Information Model? 3.Why is HL7 3.x different?

HL7 Modeling Abstractions: Activities (Use Case Model) Manage Care Perform Lab Tests Review Utilization Dispense Medications Objects (Information Model) Account Patient Provider Encounter Order Communication (Interaction and Message Models) ADTPharmacy HL7 message Finance HAL

HL7 Modeling Abstractions: Activities (Use Case Model) Manage Care Perform Lab Tests Review Utilization Dispense Medications Objects (Information Model) Account Patient Provider Encounter Order Communication (Interaction and Message Models) ADTPharmacy HL7 message Finance HAL Version 2.x focused its energies at the communication level and covered the other abstractions only loosely in the specifications. By demanding analysis of the requirements and information content, Version 3 assures consistency in and enhances the value of the resulting messages.

Models developed in Phases Use Case Model Use Case Diagram Spec UCM Spec Information Model Spec DIM Spec State DiagramClass Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … Identify Actors & Events Develop Scope Create Use Cases Model new concepts Harmonize with RIM Draw initial contents from RIM Develop Message Information Model Develop Message Object Diagram Specify HMD Define Trigger Events Define Application Roles Define Interactions Create Conformance Claims Interaction Model Interaction Diagram Spec Inter Spec

Sample Use Case Model Provide Services Manage Health Plans Health Care Enterprise Manage Membership Manage Network Provide Services Manage Health Plans Order Service Treat Patient Perform Triage Treat Patient Evaluate Outcomes Administer Procedure Record Results Order Service Sign Order Create Order Status Order Manage Membership Discharge Member Enroll Member Approve Services Manage Network Market Services Evaluate Provider Schedule Service Monitor Appointment Create Appointment

Reference Information Model (RIM) Patient Encounters Scheduling Document Stakeholders Stakeholder Affiliations Data types Service Provider AppointmentsEncounterEpisode USAMServiceMessagecontrolDoc.Roles Legend Person Patient Material Organizations Location Material Material Insurance Accounting Finance

Sample State Transition Diagram Figure State diagram for Patient class. Transitions include reference to the trigger event. State diagram for Patient_encounter class

Sample Interaction Model Diagram Figure Interactions for Patient subject class.b Application Role - Role subscribed to by an application that is used to verify compliance. Interaction - Trigger Event causes a Message to be sent by a Sending role to a Receiving role for which there may be a Receiver responsibility Compliant !

Patient_encounter none Inpatient_encounter Patient_admission Patient Patient_billing_account Individual_HC_practioner [Prim care phys] C is_preceded_by 1..1 involves 1..1 is_a_role_of 1..1 has 0..* has a primary provider 0..1 is_participant_for 1..1 Individual_healthcare_practitioner [Participant HCP] is_a_role_of 1..1 Encounter_practitioner includes 1..* Stakeholder_identifier [Pt] is_assigned 1..1 Stakeholder[Pt] Person[Pt] Stakeholder_identifier [Prim care phys] is_assigned 1..1 Stakeholder [Prim care phys] Person [Prim care phys] Stakeholder_identifier [Participant HCP] is_assigned 1..1 Stakeholder [Participant HCP] Person [Participant HCP] Patient person Primary MD person Attending MD person is_a_role_of 1..1 Message Object Diagram (MOD) Sample with three Person Objects

uReusable Elements Patient Patient Provider Provider Order Order Observation Observation uDefined by one group and applied to all messages Common Message Elements

Models are used to build the HMD Use Case Model Interaction Model Message Object Diagram Domain Information Model Hierarchical Message Description Common Message Element Definition Message Information Model Reference Information Model

Hierarchical Message Definition

The HMD & ITS then give messages Message Instance HL7-Conformant Application Data HL7 Message Creation HL7-Conformant Application HL7 Message Parsing Data Implementation Technology Specifications ITS Hierarchical Message Definition "Discontinue pharmacy order" "Send as ASCII string in XML format"

HL7 3.x Schedule uFall 2000 Interaction design complete (triggers list) Interaction design complete (triggers list) Preliminary message design (CMET list) Preliminary message design (CMET list) uWinter 2001 Committee ballot on Messages ready Committee ballot on Messages ready Committee ballot on Data Types & XML ITS complete Committee ballot on Data Types & XML ITS complete uSpring 2001 Committee ballot on Messages complete Committee ballot on Messages complete Member ballot on Messages ready Member ballot on Messages ready Member ballot on Data Types & XML ITS complete Member ballot on Data Types & XML ITS complete uFall 2001 Member ballot on Messages complete Member ballot on Messages complete Support documentation Support documentation Education prepared Education prepared u2002 Publish HL7 3.0 Publish HL7 3.0

HL7 3.x Status Report u80% of workgroup meeting time dedicated to 3.x development uGeorge (Woody) Beeler hired as project leader NOT expected to meet schedule outlined! Lack of resources Lack of resources Lack of structure/organization/process to complete required ballots Lack of structure/organization/process to complete required ballots

Reality Check uSolicit committed resources from key organizations. uCut scope: Postpone full use case analysis Postpone full use case analysis Postpone full interaction analysis Postpone full interaction analysis Postpone application role definitions Postpone application role definitions Postpone compliance verification Postpone compliance verification Minimize trigger events supported in 3.0 Minimize trigger events supported in 3.0 uRisk: Duplicate ‘hack’ mentality from 2.x Duplicate ‘hack’ mentality from 2.x Introduce errors perpetuated through ‘backward compatibility’ requirements Introduce errors perpetuated through ‘backward compatibility’ requirements

What is in HL7 3.0? uBallot is for Hierarchical Message Definitions (HMD) only – not RIM or vocabularies. RIM/Vocabulary are only locked once class / attribute is used in a message. RIM/Vocabulary are only locked once class / attribute is used in a message. uData Types uVocabulary uXML Implementation Technology Specification (ITS) u2.x messages (80/20 rule) uLimited new interactions

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