1. Survey of Medical Informatics
CS 493 – Fall 2004
September 20, 2004

2. Health Care Data Standards
Chapter 4: Patient Safety - Achieving a New Standard of Care.
IOM Report

3. Overview of healthcare data standards
Table 4-1
Data standards
Interchange
Terminologies
Knowledge Representation

4. Data Interchange Standards
Message Format Standards

5. Message Format Standards
CHI mandates:
HL7 Version 2.x
DICOM
NCPDP
IEEE standards for medical devices
LOINC

6. Healthcare Standards
HL7 Standard

7. Healthcare Standards: HL7
HL7 Messaging
Established Standards Body (1987)
ANSI accredited (1994)
Over 1700 members
Key efforts
HL7 CDA (XML documents) Effort
HL7 CCOW
HL7 EHR Effort
Healthcare Standards: HL7

8. Healthcare Standards: HL7
HL7 Philosophy
Designed as a protocol for exchange of healthcare and related information
Based on an event-based transactional model that mirrors real-life use-case scenarios
Healthcare Standards: HL7

9. Healthcare Standards: HL7
HL7 Version Evolution
Produced Version 1.0 late in 1987
Produced Version 2.0 late in 1988
Version 3.0 effort underway for a while
Clinical Document Architecture (CDA) effort – release 1 Nov 2000 & CDA release 2 passed in committee ballot – Sept 2003
Clinical Context Effort (CCOW)
Electronic Health Record (EHR) Functional Model (NHII initiative)
Healthcare Standards: HL7

10. Healthcare Standards Messages in HL7 are defined by:
HL7 Message Structure
Messages in HL7 are defined by:
A message ID (a 3 letter code - e.g., ADT for Admit, Discharge, Transfer-related messages)
One or more segments (logical grouping - e.g., PID segment to represent patient identifying information)
Nesting and repetition of segments as appropriate
“Z” segments for custom use

11. HL7 Clinical Context Object Working Group (CCOW)
Healthcare Standards
HL7 Clinical Context Object Working Group (CCOW)

12. Healthcare Standards: HL7
CCOW:
Focus is the on the visual integration of diverse applications in the user’s desktop
Healthcare Standards: HL7

13. Already have interoperable specifications and implementations
CCOW:
Technology-neutral specifications that will allow healthcare applications to switch contexts seamlessly—oriented toward making multiple Graphical User Interface (GUI) clients work together
Already have interoperable specifications and implementations
Currently working on an interoperable single-sign-on specification

14. CCOW – Visual Integration
The Provider's Workstation
“Data”
Integration
The Clinical Applications
Server
Visual Integration
* Acknowledgement: Slide provided by Wes Rishel, Gartner Group
The Provider

15. University Physicians
Technology solutions
Healthcare Standards
Patient ID Mapper
Context Manager
Master Patient Index
O'Donnell
University Physicians
General Hospital
O’Donnell
Furlow
O’Donnell
Crane 58233
* Acknowledgement: Slide provided by Wes Rishel

16. CCOW Process View App A CM App B User P 1 2 3 4 5 6 7 8 9 10 11 12 13
Register with CM
Log on
Context – User P
Select Patient X
Context – Patient X
View Patient X Notes
View Patient X Labs
Log off
Context - Reset 1 2 3 4 5 6 7 8 9 10 11 12 13

17. Web-based applications
CCOW current work:
Single sign-on:
users do not have to memorize many user names and passwords
authentication via password, badge swipe, biometrics
Web-based applications
* Acknowledgement: Slide provided by Wes Rishel

18. HL7 Version 3.0 Healthcare Standards
Acknowledgement: This set of slides are adapted from:
Andrew Hinchley’s “Understanding Version 3 – A primer on the HL7 Version 3 Communication Standard

19. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
HL7 Reference Information Model (RIM) – basis for all HL7 messages
RIM defines about 70 basic classes
D-MIM
Storyboard
Interaction
R-MIM
HMD
Storyboard
Message

20. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
From RIM we can instantiate a Domain Message Information Model
D-MIM
Storyboard
Interaction
R-MIM
HMD
Storyboard
Message

21. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
Reference Message Information Model are developed for a restricted group of models
HMD
Storyboard
Message

22. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
R-MIM’s are used to develop message model definitions – called Hierarchical Message Definitions
HMD
Storyboard
Message

23. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
HMD’s are used to define the HL7 V3 messages which are used to communicate between systems
HMD
Storyboard
Message

24. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
This defines the roles of sending and receiving application.
For example: Laboratory Observation Event Informer – an application that notifies pertinent information about lab results
Storyboard
Interaction
R-MIM
HMD
Storyboard
Message

25. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
This defines what causes a message to be sent.
Specifies the set of conditions that initiate a message transfer.
Trigger events are specified by: a name, identifier, description, structured name and a type. Different types of trigger events: interaction based, state-transition based, user based, unspecified.
Storyboard
Interaction
R-MIM
HMD
Storyboard
Message

26. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
HMD
A realistic scenario which requires a communication message to be designed
Message

27. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
HMD
Storyboard
Scope for the message to be designed – the interaction that needs to be supported
Message

28. The Reference Information Model
Act – something happened or may happen. Any action of interest.
Entity – a person, animal or organization or thing
Role – a part played by an entity
Participation – the involvement of a role in a act
Act_Relationship – a relationship between two acts
Role_Link – a relationship between two Roles

29. Examples of R-MIM Act Example Prescription classCode*: <= SPLY
moodCode*: <= ORD
statusCode: <= ActStatus
activityTime:
availabilityTime:
SPLY: act is related to supply
ORD: an instance of order
<=: code value or a vocabulary term
Entity Example
Person
classCode*: <= PSN
determinerCode*: <= INSTANCE
Name*: PN[1..1]
Addr: AD[1..1]
PSN: refers to person
INSTANCE: can be an instance or
quantified value

30. Examples of R-MIM Role Example Person classCode*: <= PSN
determinerCode*: <= INSTANCE
Name*: PN[1..1]
Addr: AD[1..1]
1..1 patientPerson
Patient
classCode*: <= PAT
Id*: [0..1]
Person is playing the role of
a patient.

31. Examples of R-MIM Participation Example Prescription patientSubject
classCode*: <= SPLY
moodCode*: <= ORD
statusCode: <= ActStatus
activityTime:
availabilityTime:
patientSubject
typeCode*: <= PATSBJ
1..1 medicalPractitioner
author
typeCode*: <= AUT
1..1 pharmacist
performer
typeCode*: <= PRF

32. Examples of R-MIM Act_Relationship Example Prescription
classCode*: <= SPLY
moodCode*: <= ORD
statusCode: <= ActStatus
activityTime:
availabilityTime:
component
typeCode*: <= COMP
1..* prescriptionItem
PrescriptionItem
classCode*: <= SPLY
moodCode*: <= ORD
code*: CD CWE[1..1] <= DrugCode text*: [1..1]
activityTime:
availabilityTime:

33. Key Concepts of V3 methodology
Application
Role
Trigger
Event
RIM
D-MIM
Storyboard
Interaction
R-MIM
HMD
Storyboard
Message

34. Healthcare Standards
HL7 CDA

35. Technology solutions
Healthcare Standards
Sample CDA Document

36. Technology solutions
Healthcare Standards

37. Healthcare Standards
HL7 EHR

38. HL7 EHR Functional Model*
Care Management
II7.0 Workflow
Ops Mgt & Comm
II6.0 Business Rules - Administrative Functions
II5.0 Interoperability
II4.0 Support for Health Informatics & Terminology Standards
II3.0 Unique Identity, Registry, and Directory
DC3.0 Ops Mgt & Comm
DC1.0 Care Management
S3.0 Admin & Financial
S2.0 Measurement, Analysis,
Research, Reporting
S1.0 Clinical Support
Direct
Care
Supportive
Infrastructure
Information
DC2.0 Clinical Decision
Support
II2.0 Information and Records Management
II1.0 Security
* Slide courtesy of Dr. Don Mon, Vice President of AHIMA

39. Building Block for Info Exchange*
Physician
Office
EHR-S
Nursing
Home
Health
Regional
Health Info
Exchange
Referral Data
Hospital
The Longitudinal Record: Distributed Across EHR’s
PHR
Data stays where it is (distributed, federated)
Federated MPI’s
* Slide courtesy of Dr. Don Mon, Vice President of AHIMA

40. HL7 Summary Healthcare Standards: HL7
Version 3.0 Reference Information Model
Interoperability Demonstrations using XML and HL7 RIM models have happened since HIMSS 99.
HL7 CDA effort has taken root
HL7 CCOW has made significant inroads.
EHR effort is ground-breaking and is lead by the Dept. of Health and Human Services as part of the NHII.
Healthcare Standards: HL7

41. Healthcare Standards HL7: Health Level 7: http://www.hl7.org/
Technology solutions
Healthcare Standards
HL7 References
HL7: Health Level 7: