1. Dr Farzad Jahedi October – 2015 Malaysia
Introduction to HL7
Dr Farzad Jahedi
October – 2015
Malaysia

2. Outline Implementation HL7 Message HL7 Organization Interoperability
Message Types
Message Syntax
Data types
HL7 Organization
Interoperability

3. Main Components of Comprehensive Electronic Health Record
Clinical Documentation
Decision Support
Order Entry
Test and Imaging results

4. Interoperability Technical Semantic Process
moves data from system A to system B, neutralizing the effects of distance
Semantic
ensures that system A and system B understand the data in the same way
Process
coordinates work processes, enabling the business processes at the organizations that house system A and system B to work together

5. Hospital A Hospital B Inter-hospital
Transfer
Patient_Name
Patient_Family
DOB
Adm_D
Surname
Family_Name
Birth_Date
Date_of_Adm

6. STANDARD

7. International Standard Development Organizations (SDO)
ISO  International Standard Organization
ISO TC215
ANSI  American National Standards Institute
BSI  British Standards Institute
BSI IST/35
CEN  European Standards Organization
CEN TC251

8. International Organizations (non-ISO)
IHTSDO  [SNOMED CT]
International Health Terminology Standards Development Organization
CDISC  [coordinating data capture for clinical trials]
Clinical Data Interchange Standards Consortium
IHE 
Integrating the Healthcare Enterprise
Continua home tele-health devices
OpenEHR  elements of EHR architecture

10. HL7 HL7 creates standards for the of electronic healthcare information
exchange
management
integration
of electronic healthcare information
for clinical and administrative purposes.
Other ANSI-accredited SDOs have responsibility for
pharmacy (NCPDC)
medical devices (IEEE)
imaging (ACR/NEMA)
insurance (claims processing) transactions (X12)
dentistry (ADA)

11. Why?
Health H L 7 ! ?
Level

12. ISO’s Open Systems Interconnect (OSI) model
Layer 7 – Application
 The only domain-specific aspect
 Semantics or meaning of what is exchanged
Layer 6 – Presentation
Layer 5 – Session
Layer 4 – Transport
Layer 3 – Network
various aspects of technical interoperability
Layer 2 – Data-link
Layer 1 – Physical

13. HL7 versions
HL7 V2
HL7 V3
ASCII Messages
XML Messages
UML Model

14. HL7 V2 Message Syntax Data Type
describes the overall structure of messages and how the different parts are recognized
Data Type
Each message is composed of segments in specified sequence
each of which contains fields also in a specified sequence
these fields have specified data types

15. Message Syntax ADT^A04 Messages are sent in response to trigger events
Message name is derived from the message type and a trigger event
The trigger event indicates what happened to cause a message to be generated.
Trigger events are specific to a message type.
Examples of Message Types
Some Trigger Events of ADT
ACK  General acknowledgment message
ADT  ADT message
ORM  Order message
ORU  Observation result – unsolicited
A01  Admit/visit notification
A02  Transfer a patient
A03  Discharge/end visit
A04  Register a patient
ADT^A04
Message name

16. HL7 Message Types Admission, Discharge, Transfer (ADT)
Order Message (ORM, ORR, RDE, etc.)
Financial Management (DFT, BAR)
Ancillary Data Reporting (ORU, CRM, etc.)
Master File Notification (MEN, MEQ, etc.)
Medical Records Information Management (MDM)
Scheduling (SRM, SIU, SQM)
Patient Referral (RQI, REF, RQA, etc.)
Patient Care (PGL, PPR, PPG, etc.)

17. Allowable content a simple message message syntax table
The overall structure and allowable content of each message
Is defined in an abstract message syntax table,
lists segments in the order in which they occur.
shows which segments are optional and which can be repeated
a simple message
MSH  Message Header
EVN  Event Type
PID  Patient Identification
PV1  Patient Visit
message syntax table
ADT^A01 ADT Message
MSH Message Header
EVN Event Type
PID Patient Identification
[PD1] Additional Demographics
[ { NK1 } ] Next of Kin/Associated Parties
PV1 Patient Visit
Optional Segment
Optional + Repeatable
Mandatory

18. Segments Segments contain fields Fields contain components
Each segment has a three-character identifier
the segment ID (e.g., MSH).
In a message this segment ID is always the first three characters of the line.
Segments contain fields
Fields contain components
Components may contain subcomponents

19. Delimiters field separators component separators
Subcomponent separators
Symbol Usage
| Field separator
^ Component separator
~ Repetition separator
\ Escape character
& Subcomponent separator
<CR> Segment terminator

20. Some of commonly used segments
MSH  Message Header
PID  Patient Identification Details
PV1  Patient Visit
OBR  Request and Specimen Details
OBX  Result Details
Z-segment

21. MSH  Message Header

22. PID  Patient Identification Details

23. PV1  Patient Visit

24. OBX  Result Details

25. OBR  Request and Specimen Details

26. Z-Segment
develop your own segments, message types, and trigger events
using names beginning with Z.
are widely used and are one of the main reasons why there are so many different variants of HL7 V2 messages.
can be placed anywhere in a message.

27. Data Types Simple Data Types Complex Data Types
DT (date)  YYYY[MM[DD]].
DTM (date/time)  YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/–ZZZZ]
FT (formatted text) embedded formatting commands
ID a value from a HL7-defined table.
IS a value from a user-defined table.
NM (numeric) numeric values
SI (set ID) gives the order of a segment instance within a message
ST (string) short strings up to 200 characters.
TX (text) longer texts up to 64 K characters.
Complex Data Types
Coded values
Identifiers
Names
Addresses

29. abstract syntax of the HL7 V2 message
MSH Message header
PID Patient Identification Details
PV1 Patient Visit
OBR Results header
{OBX} Results detail (repeats)
MSH|delimiters||sender|||dateTime||messageType|messageID
|processingStatus|syntaxVersion
PID|||patientID^^^source^IDtype||familyName^givenName||d
ateOfBirth|sex|||streetAddress^addressLine2^^^postCode
PV1|||patientLocation|||||patientsGP
OBR|||accessionNumber|testCode^testName^codeType|||speci
menDate||||||||specimenSource^^^bodySite^siteModifier
|requester
OBX||valueType|observableCode^observableName|observatio
nSubID|valueCode^valueText^valueCodeType|||abnormalFl
ag|||result status
OBX ...

30. MSH|^~\&||^123457^Labs|||200808141530||ORU^R01|123456789|P|2.4
PID|||123456^^^SMH^PI||MOUSE^MICKEY|| |M|||14 Disney Rd^Disneyland^^^MM1 9DL
PV1|||5N|||||G123456^DR SMITH
OBR|||54321|666777^CULTURE^LN||| ||||||||SW^^^FOOT^RT|C987654
OBX||CE|0^ORG|01|STAU||||||F
OBX||CE|500152^AMP|01||||R|||F
OBX||CE|500155^SXT|01||||S|||F
OBX||CE|500162^CIP|01||||S|||F
ORU
HL7 message
ASCII
Report from Lab123457, 15:30 14-Aug-2008, Ref
Patient: MICKEY MOUSE, DoB: 14-Jan-1962, M
Address: 14 Disney Rd, Disneyland, MM1 9DL
Specimen: Swab, FOOT, Right, Requested By: C987654,
Location: 5N
Patients GP: Dr Smith (G123456)
Organism: STAU
Susceptibility: AMP R
SXT S
CIP S

31. <. -- v2. xml Message Definitions Version v2
<!-- v2.xml Message Definitions Version v2.2 - ADT_A04 Copyright (C) Sun Microsystems. All rights reserved. -->
<xsd:schema xmlns:xsd=" xmlns="urn:hl7-org:v2xml" xmlns:hl7="urn:com.sun:encoder-hl7-1.0" targetNamespace="urn:hl7-org:v2xml" xmlns:jaxb=" jaxb:version="2.0"> <!-- include segment definitions for version v2.2 -->
<xsd:include schemaLocation="segments.xsd"/>
<xsd:annotation>
<xsd:appinfo source="urn:com.sun:encoder">
<encoding xmlns="urn:com.sun:encoder" name="HL7 v2 Encoding" namespace="urn:com.sun:encoder-hl7-1.0" style="hl7encoder-1.0"/>
</xsd:appinfo>
</xsd:annotation>
<!-- MESSAGE ADT_A04 --> <!-- .. groups used in message ADT_A04 -->
<xsd:complexType name="ADT_A04.INSURANCE.CONTENT">
<xsd:sequence>
<xsd:element ref="IN1" minOccurs="1" maxOccurs="1"/>
<xsd:element ref="IN2" minOccurs="0" maxOccurs="1"/>
<xsd:element ref="IN3" minOccurs="0" maxOccurs="1"/>
</xsd:sequence>
</xsd:complexType>
<xsd:element name="ADT_A04.INSURANCE" type="ADT_A04.INSURANCE.CONTENT"/>
<!-- .. message definition ADT_A04 -->
<xsd:complexType name="ADT_A04.CONTENT">
<xsd:element ref="MSH" minOccurs="1" maxOccurs="1"/>
<xsd:element ref="EVN" minOccurs="1" maxOccurs="1"/>
<xsd:element ref="PID" minOccurs="1" maxOccurs="1"/>
<xsd:element ref="NK1" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="PV1" minOccurs="1" maxOccurs="1"/>
<xsd:element ref="PV2" minOccurs="0" maxOccurs="1"/>
<xsd:element ref="OBX" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="AL1" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="DG1" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="PR1" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="GT1" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="ADT_A04.INSURANCE" minOccurs="0" maxOccurs="unbounded"/>
<xsd:element ref="ACC" minOccurs="0" maxOccurs="1"/>
<xsd:element ref="UB1" minOccurs="0" maxOccurs="1"/>
<xsd:element ref="UB2" minOccurs="0" maxOccurs="1"/>
<xsd:element name="ADT_A04" type="ADT_A04.CONTENT">
<xsd:appinfo source="urn:com.sun:encoder"> <top xmlns="urn:com.sun:encoder">true</top> </xsd:appinfo>
</xsd:element>
</xsd:schema>
ADT
HL7 message
XSD

32. ACK HL7 message ASCII vs XML Version 2.3.1 (87 characters of data)
MSH|^~\&|LAB^foo^bar|767543|ADT|767543| ||ACK^|XX3657|P|2.3.1 MSA|AA|ZZ9380
Version 3 (477 characters of data)
<ACK>
<MSH>
<MSH.1>|</MSH.1>
<MSH.2>^~\&</MSH.2>
<MSH.3>
<HD.1>LAB</HD.1>
<HD.2>foo</HD.2>
<HD.3>bar</HD.3>
</MSH.3>
<MSH.4>
<HD.1>767543</HD.1>
</MSH.4>
<MSH.5>
<HD.1>ADT</HD.1>
</MSH.5>
<MSH.6>
</MSH.6>
<MSH.7> </MSH.7>
<MSH.9>
<CM_MSG_TYPE.1>ACK</CM_MSG_TYPE.1>
</MSH.9>
<MSH.10>XX3657</MSH.10>
<MSH.11><PT.1>P</PT.1></MSH.11>
<MSH.12>
<VID.1>2.3.1</VID.1>
</MSH.12>
</MSH>
<MSA>
<MSA.1>AA</MSA.1>
<MSA.2>ZZ9380</MSA.2>
</MSA>
</ACK>
ACK
HL7 message
ASCII vs XML

33. HL7  and  ICD DG1 - diagnosis segment
to transmit one patient diagnosis
Additional DG1 segments are sent for separate diagnoses.
If there is a new diagnosis, or a change in any of the diagnoses, they should all be resent.
Diagnosis coding method
ICD9 is the only valid coding system supported by the interface.
This field should contain "I9" if the diagnosis is an ICD9 Otherwise, the field should be omitted.
Diagnosis code
If the ICD9 code is available, it should be placed here.
Diagnosis description
This field should contain the diagnosis description (i.e., either the one related to the ICD9 code, or free text).
Diagnosis/DRG type
Valid types include "ADMITTING", "INTERIM" and "FINAL"
HL7  and  ICD
Seq
Len
Fmt
Opt
Element Name 3    R
Segment ID = "DG1" 1 4 SI O
Set ID – Diagnosis 2 ID
Diagnosis coding method 8
Diagnosis code 40 ST
Diagnosis description 5 14 TS
Diagnosis date/time 6
Diagnosis/DRG type 7
Major diagnostic category
Diagnosis related group (DRG) 9
DRG approval indicator 10
DRG grouper review code 11
Outlier type 12 NM
Outlier days 13
Outlier cost
Grouper version and type

34. ICD-10 in HL7
HL7 Vocabulary
Value sets using code system

35. A HIPAA-compliant ORU message
One or more observation request (OBR) segments defining observation type and request specifics.
One or more observation result (OBX) segments defining, quantifying, and qualifying the results.
One or more LOINC (Logical Observation Identifier Names and Codes) modifier codes used in the OBR and/or OBX segments as universal identifiers for laboratory and other clinical observations.
Health Insurance Portability and Accountability Act

36. HIS PACS Implementation HL7 Broker HL7 txt HL7 DICOM txt xml html
C3DEVER
xml
html
DICOM
PACS
INFOPSY

37. What you may learn Why Interoperability Standards? Why HL7?
Message Types?
HL7 V2 Structure?
Trigger Events?
Message Syntax?
Data Types?
Segments?
Delimiter?
Fields?
HL7 Broker?
Components / Subcomponents?