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

2. Introductions Sondra R Renly John (Jack) Krueger
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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

3. Health Level 7
CDA R

4. HL7 Messages http://www.ringholm.de/docs/04200_en.htm
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HL7 Messages
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

5. Laboratory Use Case Messages Orders Results * child orders
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Laboratory Use Case
Messages
Orders
Results
* child orders
* status updates
* reflex tests
* preliminary results
MSH|^~\&|LABWARE.DE.STAG^ ^ISO|DE.Smyrna.SPHL^ ^ISO|US WHO Collab Labsys^ ^ISO|CDC-EPI Surv Branch^ ^ISO| ||ORU^R01| |P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^ ^ISO
PID|1|| ^^^LABWARE.DE.STAG& &ISO^PI||^^^^^^S|| |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^ ^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^
OBR|1||31804^LABWARE.DE.STAG^ ^ISO| ^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L||| ||||||| |LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^ ||||| |||F
OBX|1|CE| ^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L|| ^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||
OBR|2||14085^LABWARE.DE.STAG^ ^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND||| ||||||| |LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F
OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG& &ISO||||||F|||
TB Sample from the HIMSS Interoperability Showcase UC3 5

6. HL7 Documents http://www.ringholm.de/docs/04200_en.htm
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HL7 Documents
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

7. Laboratory Use Case Messages Documents Orders Results Final Report
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Laboratory Use Case
Messages
Orders
Results
Documents
Final Report
Summaries
MSH|^~\&|LABWARE.DE.STAG^ ^ISO|DE.Smyrna.SPHL^ ^ISO|US WHO Collab Labsys^ ^ISO|CDC-EPI Surv Branch^ ^ISO| ||ORU^R01| |P|2.3.1|||||||||PHLIP_ORU_v1.0.2^PHIN_Profile_ID^ ^ISO
PID|1|| ^^^LABWARE.DE.STAG& &ISO^PI||^^^^^^S|| |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^ ^ISO||CM||||||||||||||||AI Du Pont Hospital and Christiana Care Med Ctr|1600 Rockland Road^^Wilmington^DE^19899^^O|^WPN^PH^^^302^
OBR|1||31804^LABWARE.DE.STAG^ ^ISO| ^ Acid-Fast bacillus ^LN^PCR_Tuberculosis^Tuberculosis PCR^L||| ||||||| |LAVG&Lavage, Bronhial&HL70070&BAL&Bronchial Alveolar Lavage&L|MAREK^Marek^Liz^^^^^^^U|^WPN^PH^^^302^ ||||| |||F
OBX|1|CE| ^M TB Cmplx DNA XXX Ql PCR^LN^Tuberculosis^Tuberculosis^L|| ^Detected^SCT^POS^Positive; Nucleic Acid detected^L|||N|||F|||
OBR|2||14085^LABWARE.DE.STAG^ ^ISO|PLT40^Epidemiologically Important Information - Tuberculosis^NND||| ||||||| |LAVG&Lavage, Bronchial&HL70070&BAL&Bronchial Alveolar Lavage&L||||||||||F
OBX|1|CX|LAB202^Unique Specimen ID^PHINQUESTION||14085^^^LABWARE.DE.STAG& &ISO||||||F|||
TB Sample from the HIMSS Interoperability Showcase UC3 7

8. ONC EHR Certification http://onc-chpl.force.com/ehrcert
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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 8

9. ONC EHR Certification http://onc-chpl.force.com/ehrcert
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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 = Inpatient certified systems = 282 9

10. Continuity of Care Problems* Family History Social History Alerts*
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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

11. Continuity of Care Record Lab Result…
<Test>
<CCRDataObjectID>8b3fa370-67a5-11db-bd c9a66</CCRDataObjectID>
<DateTime>
<Type><Text>Assessment Time</Text></Type>
<ExactDateTime> T14:30Z</ExactDateTime>
</DateTime>
<Description>
<Text>WBC</Text>
<Code><Value> </Value><CodingSystem>LOINC</CodingSystem></Code>
</Description>
<Status><Text>Final Results</Text></Status>
<Source><Actor><ActorID>8a54f c-abd2-f29aad15481c</ActorID></Actor></Source>
<TestResult>
<Value>6.7</Value><Units><Unit>10+3/ul</Unit></Units>
</TestResult>
</Test>

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

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

14. Continuity of Care >> Case Report
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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

15. CDA Public Health Case Report
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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 HIMSS Interoperability Showcase UC3 15

16. CDA Case Report Pilot Team
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CDA Case Report Pilot Team
Participants
Observers
MAY 2012 16

17. BODY L3 MACHINE PROCESSABLE
CDA Primer
<ClinicalDocument ...>
<templateId root=" "/>
<recordTarget><patientRole/></recordTarget>
<author/>
<custodian/>
<legalAuthenticator/>
HEADER
<structuredBody>
<section>
<templateId root=" "/>
<templateId root=" "/>
<code code=" " codeSystem=" " 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=" "/>
<code code=" " codeSystem=" " displayName="History of Occupation"/>
<statusCode code="completed"/>
<effectiveTime value=" "/>
<value xsi:type="CD" code=" " codeSystem=" " codeSystemName="Occupation (SOC 2000)" displayName="Healthcare Support Occupations"/>
BODY L3 MACHINE PROCESSABLE

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

19. What’s Next? Messages & Documents
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What’s Next? Messages & Documents
Questions? 19