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10 HL7 HL7

What is HL7?

HL7 Board of Directors Business affairs Elected Technical Steering Committee Technical affairs Appointed officers plus chairs of the committees & SIGs The Working Group The "real" HL7, Any member can register for any committee or SIG Technical Committees Create normative specifications or chapters in the standard Special Interest Groups Collaborate in area of interest to contribute to the work of the TCs Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 5

Technical Steering Committee Architectural Review Board CCOW Clinical Decision Support Control/Query Education Financial Management International Affiliates Marketing Medical Records/Information Management Modeling and Methodology Orders/Observations Patient Administration Patient Care Personnel Management Publishing Regulated Clinical Research Information Mgmt. Scheduling and Logistics Structured Documents Vocabulary Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 7

Special Interest Groups Arden Syntax Attachments Clinical Guidelines Community Based Health Services Conformance Electronic Health Records Government Project Imaging Integration Java Laboratory, Automated, and Testing Medication Security and Accountability Template XML Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 8

HL7 international affiliates Co-Chairs: Mark Shafarman / George (Woody) Beeler, Jr., PhD Argentina, Australia, Brazil, Canada, China, Czech republic, Finland, Germany, India, Japan, Korea, Lithuania, New Zealand, Southern Africa, Switzerland, Taiwan, Turkey, The Netherlands, United Kingdom 92 62 7 Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 9

HL7 7 6 5 Application Encoding Rules ISO/OSI Application presentation session 4 3 2 1 Fully Functional TCP/RPC (proprietary) Reliable Transport: TCP/IP X.25 SNA LU 6.2 DECNET LLP Lower Layer Protocols Unreliable: RS-232 (Some LANs) transport network data link physical Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 11

HL7 V2.x Functional coverage

Order Entry 1 (TQ) ORM/ORR( O01/O02) OSQ/OSR( Q06) OMG/ORG( O19/O20) OML/ORL( O21/O22) ORC( ) BLG( ) OBR( ) OMD/ORD( O03/O04) ODS( ) ODT( ) OMS/ORS( O05/O06) OMN/ORN( O07/O08) RQD( ) RQ1( 1) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 20

Order Entry 2 / OMP/ORP( O09/O10) / RDE/RRE( O11/O12) RDS/RRD( O13/O14) RGV/RRG( O15/O16) give RAS/RRA( O17/O18) administration / RXO( ) RXR( ) RXC( ) RXE( ) RXD( ) RXG(give ) RXA(administration ) VXQ/VXX,VXR( V01/V02,V03) / VXU( V04) RXA( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 21

Query / QBP/RSP / QBP/RTB / QBP/RDY / QSB - ( Q16) QVR - ( Q17) QCN/ACK - ( J01) QSX /ACK - ( J02) / DSP( ) QAK( ) QID( ) QPD( ) QRI( ) RCP( ) RDF ( ) RDT( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 22

Financial Management TRIGGER EVENTS AND MESSAGE DEFINITIONS BAR/ACK( P01 P02 P05 P06 P10) DFT/ACK( P03) QRY/DSR( P04) MESSAGE SEGMENTS FT1( ) DG1( ) DRG(DRG) PR1( ) GT1( ) IN1( ) IN2( ) IN3( - ) ACC( ) UB1(UB82 ) UB2(UB92 ) ABS( ) BLC( ) RMI( ) GP1( - ) GP2( - ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 23

Observation Reporting TRIGGER EVENTS & MESSAGE DEFINITIONS ORU( R01) OUL( R21) QRY/ORF( R02, R04) Segments OBR( ) OBX( ) CRM( C01-C08) CSU( C09-C12) CSR( ) CSP( ) CSS( ) CTI( ) PEX( P07, P08) SUR( P09) PES( ) PEO( ) PCR( ) PSH( ) PDC( FAC( ) W01 - W02 - Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 24

Master Files MFN/MFK MFD/ACK MFQ/MFR MFI( ) MFE( ) MFA( ) / / OM1( ) OM2( ) OM3( ) OM4( ) OM5( ) OM6( ) OM7( ) LOC( ) LCH( ) LRL( ) LDP( ) LCC( ) CDM( ) PRC( ) CM0( ) CM1( ) CM2( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 25

Medical Records/Information Management (Document Management) TRIGGER EVENTS AND MESSAGE DEFINITIONS MDM/ACK( T01~T11) QRY/DOC( T12) MESSAGE SEGMENTS TXA( ) OBX( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 26

Scheduling MESSAGES AND TRIGGER EVENTS SRM( S01~S11) SRR( S12~S26) SQM/SQR ( S25) MESSAGE SEGMENTS ARQ( ) SCH( ) RGS( ) AIS( - ) AIG( - ) AIL( - ) AIP( - ) APR( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 27

Patient Referral RQI/RPI( I01~ I03) RQP/RPI( I04) RQC/RCI( I05~I06) PIN/ACK( I07) RQA/RPA( I08~I11) REF/RRI( I12~I15) SEGMENTS RF1( ) AUT( ) PRD( ) CTD( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 28

Patient Care MESSAGE DEFINITIONS PGL/ACK ( PC6, PC7, PC8) PPR/ACK ( PC1, PC2, PC3) PPP/ACK ( PCB, PCC, PCD) ( ) PPG/ACK ( PCG, PCH, PCJ) ( ) QRY/PRR ( PC4/PC5) QRY/PPV ( PC9/PCA) QRY/PTR ( PCE/PCF) ( ) QRY/PPT ( PCK/PCL) ( ) MESSAGE SEGMENTS GOL( ) PRB( ) ROL( ) PTH( ) VAR( ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 29

Laboratory Automation Trigger Events and Message Definitions ESU/ACK ( U01) ESR/ACK ( U02) SSU/ACK ( U03) SSR/ACK ( U04) INU/ACK ( U05) INR/ACK ( U06) EAC/ACK ( U07) EAR/ACK ( U08) EAN/ACK ( U09) TCU/ACK ( U10) TCR/ACK ( U11) LSU/ACK ( U12) / LSR/ACK ( U13) / Message Segments EQU( ) ISD( ) SAC( ) INV( ) ECD( ) ECR( ) NDS( ) CNS( ) TCC( ) TCD( ) SID( ) EQP( / ) Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 30

Personnel Management TRIGGER EVENTS AND MESSAGE DESCRIPTIONS PMU/ACK ( B01) PMU/ACK ( B02) PMU/ACK ( B03) PMU/ACK ( B04) PMU/ACK ( B05) PMU/ACK ( B06) QBP/RSP ( Q25/K25) MESSAGE SEGMENTS AFF EDU LAN ORG PRA STF Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 32

HL7 V2.x Messages

MSH ^~ & ADT1 MCM LABADT MCM 198808181126 SECURITY ADT ^A01 MSG00001 P 2.3 <cr> EVN A01 198808181123 <cr> PID PATID1234^5^M11 JONES^WILLIAM^A^III 19610615 M C 1200 N ELM STREET^^GREENSBORO^NC^27401-1020 GL (919)379-1212 (919)271-3434 S PATID12345001^2^M10 123456789 987654^NC <cr> NK1 JONES^BARBARA^K WIFE NK^NEXT OF KIN<cr> PV1 1 I 2000^2012^01 004777^LEBAUER^SIDNEY^J. SUR ADM A0 <cr> Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 36

ADT ID ID ADT ADT MSH Message Header 2 EVN Event Type 3 PID Patient Identification 3 [PD1] Additional Demographics 3 PV1 Patient Visit 3 [ PV2 ] Patient Visit Add. Info. 3 [ { DB1 } ] Disability Information 3 [ { OBX } ] Observation/Result 7 ACK MSH Message Header 2 MSA Message Acknowledgment 2 [ ERR ] Error Information 2 Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 39

HL7 HL7 Attribute Table PID Patient identification SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME 1 4 SI O 00104 Set ID - PID 2 20 CX B 00105 Patient ID 3 250 CX R Y 00106 Patient Identifier List 4 20 CX B Y 00107 Alternate Patient ID - PID 5 250 XPN R Y 00108 Patient Name 6 250 XPN O Y 00109 Mother s Maiden Name 7 26 TS O 00110 Date/Time of Birth 8 1 IS O 0001 00111 Administrative Sex 9 250 XPN B Y 00112 Patient Alias 10 250 CE O Y 0005 00113 Race R- C- O- B- X- Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 40

SEQ DT OPT RP/# ELEMENT NAME EXAMPLE 3 CX R Y Patient ID list ID PID001 5 XPN R Patient Name Yamada^Tarou^^^^^L^A~ ^ ^^^^^L^I~ ^ ^^^^^L^P 7 TS Date/Time of Birth 19501127 8 IS Sex M Encoding Example PID OPC-001 PID001 ^ ^^^^^D^I~ ^ ^^^^^D^P~NIHON^Tarou^^^^^D^A 19501127 M XPN < > ^ < > ^ < > ^ > ^ < > ^ < > ^ < > ^ < > Value Description Value Description A I ( ) L A ( ) D P (ASCII, ) M C Yamada^Tarou^^^^^L^A~ ^ ^^^^^L^I~ ^ ^^^^^L^P Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 41

Field PID-5 Patient name (XPN) 3.4.2.5 PID-5 Patient name (XPN) 00108 Components: <family name (FN)> ^ <given name (ST)> ^ <second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> ^ <name context (CE)> ^ <name validity range (DR)> ^ <name assembly order (ID)> Definition: This field contains the names of the patient, the primary or legal name of the patient is reported first. Therefore, the name type code in this field should be "L - Legal". Refer to HL7 Table 0200 - Name type for valid values. Repetition of this field is allowed for representing the same name in different character sets. Note that "last name prefix" is synonymous to "own family name prefix" of previous versions of HL7, as is "second and further given names or initials thereof" to "middle initial or name". Multiple given names and/or initials are separated by spaces. Value A B C D I L M Alias Name Name at Birth Adopted Name Display Name Licensing Name Legal Name Maiden Name HL7 Table 0200 - Name type Description Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 42

Data types Data Type Name ST String TX Text data FT Formatted text NM Numeric ID Coded values for HL7 tables IS Coded value for user-defined tables HD Hierarchic designator PL Patient location TS Time stamp CE Coded element CK Composite ID with check digit Notes/Format <application identifier (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)> Used only as part of EI and other data types. <point of care (IS )> ^ <room (IS )> ^ <bed (IS)> ^ <facility (HD)> ^ < location status (IS )> ^ <patient location type (IS)> ^ <building (IS )> ^ <floor (IS )> YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ] ^ <degree of precision> <identifier (ID)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ID)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)> <ID number (NM)> ^ <check digit (NM)> ^ <code identifying the check digit scheme employed (ID)> ^ < assigning authority (HD)> XPN Extended person name <family name (ST)> & <last name prefix (ST)> ^ <given name (ST ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^ <name representation code (ID)> TQ Timing/quantity <quantity (CQ)> ^ <interval (*)> ^ <duration (*)> ^ <start date/time (TS)> ^ <end date/time (TS)> ^ <priority (ID)> ^ <condition (ST)> ^ <text (TX)> ^ <conjunction (ID)> ^ <order sequencing> Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 43

OBX-2 OBX-5 NM +0123.5 123.5 +123.5 NM -0199.8-199.8 NM <100 NM +4.5E+3 4.5E+3 +4.5E+3 ST +0123.5 +0123.5 ST <100 <100 ST CE ^ SN <^100 <100 100 SN <^1E+2 <1E+2 <100 100 SN >^100 >100 100 SN >=^100 >=100 100 SN ^2^+ 2+ ++ SN ^2^-^3 2~3 SN ^1^:^128 1:128 SN ^1^/^3 1/3 Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 44

MSH ^~ & ICU LAB01 QRY^Q01 MSG00001 P 2.3<cr> QRD 198709111012 D I 4387 20^LI 12233 RES ALL<cr> MSH ^~ & LAB01 ICU DSR ZXT23461 P 2.3<cr> MSA AA MSG00001P<cr> QRD 198709111012 D I 4387 20^LI 12233 RES ALL<cr> DSP RESULTS FOR PATIENT#12233 SMITH,JOHN 09/11/87<cr> DSP SPECIMEN#H85 COLLECTED 09/11/87 /07/0/0<cr> DSP<cr> DSP ELECTROLYTES<cr> DSP SODIUM 140 [135-148] MEQ/L STAT<cr> DSP POTASSIUM 4.0 [3.5-5.0] MEQ/L STAT<cr> DSP CHLORIDE 89 [95-111] MEQ/L STAT<cr> DSP CO2 20 [20-30] MEQ/L STAT<cr> DSP LB<cr> Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 47

MSH PID ORC OBR OBX OBX ORC OBR ORC OBR OBX OBX OBX GOT OBX GPT OBR OBX 170cm 60 MSH PID OBR OBX OBX OBX OBX OBR GOT 10U GPT 5U file://.png 100 /.png Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 48

XML vs. Standard HL7 Encoding <?xml version="1.0"?> <!DOCTYPE ORU.R01 SYSTEM "hl7_v23.dtd"> <ORU.R01> MSH <cr> <MSH> </MSH> <PID PID.1="1"> <PID.3 CX.1="123456789"/> <PID.5 XPN.1="Levin" XPN.2="Henry" XPN.3="the 7th"/> <PID.7 TS.1="19230513"/> </PID> <OBR OBR.1="1"> OBR 1 ^Chest X-ray<cr> <OBR.4 CE.2"Chest X-ray"/> </OBR> OBX 1 TX 71020&GDT Clinical data: <OBX OBX.1="1" OBX.2="TX"> <OBX.3 CE.1="71020" SUB="GDT"/> History of... <cr> <OBX.5 TX.1="Clinical data: History of..."/> </OBX> OBX 2 TX 71020&GDT Findings: <OBX OBX.1="2" OBX.2="TX"> <OBX.3 CE.1="71020" SUB="GDT"/> Comparison is made <cr> <OBX.5 TX.1="Findings: Comparison is made "/> </OBX> OBX 3 CE 71020&IMP ^RLL nodule, <OBX OBX.1="3" OBX.2="CE"> <OBX.3 CE.1="71020" SUB="IMP"/> suggestive of... <cr> <OBX.5 CE.2="RLL nodule, suggestive of..."/> </OBX> <OBX OBX.1="4" OBX.2="CE"> <OBX.3 CE.1="71020" SUB="REC"/> <OBX.5 CE.2="I notified the ordering physician... "/> </OBX> </ORU.R01> Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 51 PID 1 123456789 Levin^Henry^^the 7th 19230513<cr> OBX 4 CE 71020&REC ^I notified the ordering physician... <cr>

What is HL7 Version 3?

V3 HL7 Message Development Framework Requirements Analysis Solution Design and Implementation Use Case Analysis Information Analysis Interaction Design Message Design Message Specification 1-n Order choice of of 0-n Drug 0-1 0-1 Nursing ER7, ER7, CORBA/OLE, SGML/XML, EDIFACT Hierarchical Message Implementable Use Case Model Reference Description Message Interaction Model Information Model Specification (UCM) (HMD) (IM) (RIM) (IMS) Reference Model Repository Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 54

V3 HL7 HL7 HL7 Reference Reference Information Information Model Model RIM RIM Information Information Model Model Harmonization Harmonization Process Process DIM Message Message Information Information Models Models MIM MIM HL7 Technical Committees Domain Domain Information Information Models Models DIM DIM HL7 Technical Committees HL7 Member Organizations Standard Development Organizations Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 55

HMD Elements Information Model Mapping Message Elements Message Structures Data Object View Object Views and Attributes Att Segment Segment or Data Field C00XMM011 C00XMM013 Field Nesting Multiplicity Data Type Row Number Nesting Structure Segment Slot Type / Tag Relationship Name Value Slot Name 1 root Patient_encounter 1 1 1 ENC ENC 1 M 1 M 1 Shared Type? Slot Data Field Domain Spec. Note Conditional Presence Required Value Inclusion Repetitions Note Conditional Presence Required Value Inclusion Repetitions Note status_cd 1 CE 2 status_cd 1 26 M 1 M 1 encounter_classification_ cd 0..1 CE 3 encounter_classification _cd 2 12 M 1 M 1 id 0..1 ST 4 id 3 M 1 M 1 end_dttm 0..1 VTS 5 end_dttm 4 3 R 1 3 R 1 expected_insurance_ plan_qty 0..1 NM 6 expected_insurance_ plan_qty 5 R 1 R 1 first_similar_illness_dt 0..1 VTS 7 first_similar_illness_dt 6 R 1 R 1 patient_classification_c patient_classification_cd 0..1 CE 8 7 13 R 1 R 1 d start_dttm 0..1 VTS 9 start_dttm 8 4 M 1 M 1 10 1 Choice IPChoice M 1 M 1 11 Tag N 2 2 specialization none 12 13 Tag I 2 Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 57

Version 3 Messaging Timetable 1996 Introduced concepts to Technical Leadership 1997 Presented first methodology and draft RIM to Working Group 1997 Created Vocabulary Technical Committee 1998 Introduced complete methodology 1999 Unified Service Action Model (USAM) became part of RIM (11/ 99) 2000 Initiated Acceleration Project (5/ 00) 2001 First non- draft RIM, version 1.0 (1/ 01) 2001 First committee submissions of storyboards, interactions and message designs (7/ 01) 2001 Published 1 st comprehensive ballot (8/ 09) 2002 2 nd, 3 rd ballot and earliest possible publication Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 58

Version 3 Clinical Context Object Workgroup (CCOW) desk- top Clinical Document Architecture (CDA) Arden Syntax for Medical Logic Version 3 Messaging EHR Copyright 2002, F.Kawamata Otsuka Pharmaceutical Co., Ltd. 59