Version 25 Office of Surveillance Epidemiology and Laboratory Services Division of Informatics Practice Policy amp Coordination Introduction This presentation will describe the following HL7 Background Information ID: 142511
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Slide1
Introduction to Health Level Seven (HL7)
Version 2.5
Office of Surveillance, Epidemiology, and Laboratory Services
Division of Informatics Practice, Policy & CoordinationSlide2
IntroductionThis presentation will describe the following:
HL7 Background InformationWhat is HL7?
HL7 EHR Work GroupLimitations of HL7
DefinitionsRulesCommon Message and Data Types
Relationship to Electronic Health Record – Meaningful UseONC Final Rule – Stage 1
HL7 Adoption
Role of HL7 Messaging
Message Syntax and ContentMessage SyntaxSample MessageSlide3
HL7 Background InformationSlide4
What is HL7?
HL7.org
About HL7
Founded in 1987, Health Level Seven International (HL7) is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.
Mission
HL7 provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first.
http://www.hl7.org/Slide5
Limitations of HL7The list below is some of the functionality that is not provided or supported:
Security/Access Control – HL7 does not provide for the enforcement of a user’s security policies. In addition, HL7 does not specify a specific encryption method.
Privacy/Confidentiality – HL7 does not address this issue and makes no assumption about how the data will be used at the source or destination of a message.
Accountability/Audit trails – HL7 does not attempt to define possible transaction processing features needed in a user’s environment.
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide6
DefinitionsData Type – a restriction on the contents of a field
Field – a string of characters defined by one of the HL7 data typesField Separator – this character separates two adjacent data fields within an HL7 segment
HL7 – an application protocol for electronic data exchange in healthcare environments
Message – the atomic unit of data transferred between systems, consisting of segments in a defined sequence
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide7
DefinitionsMessage Type – the specific purpose
Order – a request for material or serviceObservation – performance of the service including result data
Segment – a logical grouping of data fields identified by three letter identification (MSH, PID, OBX, …)
Trigger Event – a real world event that initiates an exchange of messages. There is a one to many relationship between message type and trigger event.
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide8
RulesMessage Header Segment (MSH) is required and always first
There may be more than one type of segment and can be nested
[ ] – Optional segment{ } – Repeating segment
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
Optionality
R – Required
RE – Required but may be empty
O – Optional
C – Conditional depending on trigger event or some other field
X – not used with this trigger event
B –
Backwards compatible with previous HL7 versionsSlide9
RulesRecommended message delimiters (field 2 of MSH)
There is a one to many relationship between message type and trigger event.
ADT – (A01, A02, A03, A04, A05, …)
Trigger events are specific to message type
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
Delimiter
Value
Field Separator
|
Component Separator
^
Subcomponent Separator
&
Repetition
Separator
~
Escape Character
\Slide10
RulesAcknowledgement messages are sent to indicate if receiving application was able to:
Parse message
Decode messageAssume responsibility for the message
Process message contentsSuccessfully commit to storage
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide11
RulesNull versus empty
Null is used when data is present but without a value “ “
The field is left blank when there is no dataExample: PID | | |54321|9876-3|Doe^John|”“|…
Receiving systems:Will ignore the data within segments, fields, etc that are present but not expected
Will treat expected segments that are not present as a segment with all fields not presentWill treat expected fields and components that are not included as not present
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide12
Common Message Types
Message Types in red represent the respective EHR – MU Public Health Objectives, Surveillance, ELR, and Immunization according to applicable CDC’s PHIN Messaging Guides
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
Type
Abbreviation
Admission,
Discharge, Transfer
ADT
General Clinical Order Message
OMG
Imaging Order
OMI
Laboratory Order
Message
OML
Pharmacy/treatment
Order Message
OMP
General
Order Message
ORM
Unsolicited Observation/Result
ORU
Unsolicited Vaccination
Record Update
VXUSlide13
Common Data Types
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.
Type
Abbreviation
Definition
Coded Element
CE
Used to transmit codes and associated text
Composite Quality
with units
CQ
Specifies the numeric quantity or amount,
and the units in which the quantity
is expressed
Extended Address
XAD
Specifies the address of a person, place, or organization plus associated information
Extended
Person Name
XPN
Specifies the complete name of a person plus associated information
Numeric
NM
A number (integer)
String Data
ST
Any displayable/printable
ACSII characters intended for strings less than 200 characters
Text Data
TX
Longer string data intended for display purposes
Time Stamp
TS
Specifies a point in time including time zoneSlide14
Relationship to Electronic Health Record (EHR) - Meaningful use (MU)Slide15
ONC Final Rule – Stage 1Within the ONC Final Rule, there are three Public Health objectives related to transmitting electronic data to public health agencies:
Immunization Registries/Immunization Information Systems (IIS)
For the purposes of electronically submitting information to immunization registries Certified EHR Technology must be capable of using HL7 2.3.1 or HL7 2.5.1 as a content exchange standard.
Electronic Laboratory Reporting (ELR)
For the purposes of submitting lab results to public health agencies, Certified EHR Technology must be capable of using HL7 2.5.1
Syndromic Surveillance
For the purposes of electronically submitting information to public health agencies for surveillance and reporting, Certified EHR Technology must be capable of using HL7 2.3.1 or HL7 2.5.1 as a content exchange standard
Federal Register / Vol. 75, No. 8 / Wednesday, January 13, 2010 / Rules and RegulationsSlide16
Role of HL7 MessagingTo improve the electronic exchange of demographic, and immunization records to State IIS (registries) from eligible providers and hospitals
To improve the ability of eligible hospital laboratories to send reportable data to public health agencies
To improve the electronic exchange of relevant syndromic surveillance data between healthcare providers and public health agencies
Federal Register / Vol. 75, No. 8 / Wednesday, January 13, 2010 / Rules and RegulationsCDC’s PHIN Messaging GuidesSlide17
HL7 EHR Work GroupThe goal of the Electronic Health Record (EHR) Work Group is to support the HL7 mission of developing standards for EHR interoperability. The Work Group will contribute to this goal by creating and promoting appropriate and necessary standards which include:
Functional Requirements for Electronic Health Records (EHR) and systems (EHRS)
Functional Requirements for Personal Health Records (PHR) and systems (PHRS)
Definition of a high-level framework to support the interoperability requirements and life cyclesIdentification of existing and emerging information requirements and other HL7 artifacts
http://www.hl7.org/Slide18
HL7 Adoption
Purpose
Adopted Standard to Support MU Stage 1
Submission of Lab Results to Public Health Agencies
HL7 2.5.1
Submission to Public Health Agencies for Surveillance or Reporting
HL7 2.3.1 or HL7 2.5.1
Submission to Immunization Registries
HL7 2.3.1 or HL7 2.5.1
CVX *
Patient Summary Record
HL7 CDA R2 CCD Level 2 or ASTM CCR
Federal Register / Vol. 75, No. 8 / Wednesday, January 13, 2010 / Rules and Regulations
http://www.hl7.org/
With respect to meaningful use Stage 1, Certified EHR Technology will be required to be certified as being capable of using the Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 Continuity of Care Document (CCD) to electronically exchange a patient summary record
CDA provides an exchange model for clinical documents, by leveraging the use of XML. The CDA makes documents both machine-readable, so they are easily parsed and processed electronically; and human-readable, so they can be easily retrieved and used by the people who need them using Web browsers or cell phones.
CDA provides an exchange model for clinical documents, by leveraging the use of XML. The CDA makes documents both machine-readable, so they are easily parsed and processed electronically; and human-readable, so they can be easily retrieved and used by the people who need them using Web browsers or cell phones.Slide19
Message Syntax and contentSlide20
Example Immunization Message SyntaxVXU^V04
Unsolicited Vaccination Update
Optionality Comment
MSH Message Header Segment R Every message begins with MSH[ { SFT } ] Software O
PID Patient Identification Segment R Every VXU has a PID segment[ PD1 ] Additional Demographics RE PID may have a PD1 segment
[ { NK1 } ] Next of Kin/Associated Parties RE PID may have an NK1 segment
[
--- PATIENT begin PV1 Patient Visit RE PID may have a PV1 segment [ PV2 ] Patient Visit – Additional Info O
]
--- PATIENT end
[ { GT1 } ] Guarantor O
[ { --- INSURANCE begin
IN1 Insurance O
[ IN2 ] Insurance Additional Info O
[ IN3 ] Insurance Add'l Info - Cert. O
}]
--- INSURANCE end
[{
--- ORDER begin
ORC Common Order RE
[{
--- TIMING begin
TQ1 Timing/Quantity O
[ { TQ2 } ] Timing/Quantity Order Sequence O
}]
--- TIMING end
RXA Pharmacy Administration Segment R ORC must have a RXA segment
[ RXR ] Pharmacy Route RE RXA may have an RXR segment
[ {
--- OBSERVATION begin
OBX Observation/Result RE RXA may have an OBX segment
[ { NTE } ] Notes (Regarding Immunization) RE OBX may have an NTE segment
}]
--- OBSERVATION end
}]
--- ORDER end
CDC’s PHIN Implementation Guide for Immunization Messaging, Release 1.1, 08/15/2010
The HL7 Version 2.5 Standard Copyright©2003 by Health Level Seven, Inc.Slide21
Sample Surveillance MessageIn this example, a non-Hispanic white female, 43 years old, visits the emergency department complaining of a stomach ache which she has had since February 15
th. She was diagnosed with appendicitis and is admitted as an inpatient.
MSH|^~\&||OTHER REG MED CTR^1234567890^NPI|||201102171658||
ADT^A01^ADT_A01|201102171658076|P|2.3.1<cr>EVN||201102171658<cr>
PID|1||FL01059711^^^^PI||~^^^^^^U|||F
||2106-3^
White
^CDCREC|^^^FL^33821|||||||||||2186-5^Not Hispanic^CDCREC<cr>PV1||I||E||||||||||7|||||V20220217-00274^^^^VN|||||||||||||||||09||||||||201102171656<cr>
PV2|||78907^ABDOMINAL PAIN, GENERALIZED^I9CDX<cr>
OBX|
1
||8661-1^CHIEF COMPLAINT^LN||^^^^^^^^
STOMACH ACHE
<cr>
OBX|
2
|NM|21612-7^AGE PATIENT QN REPORTED^LN||
43
|a^YEAR^UCUM|||||F|||201102171531<cr>
OBX|
3
|NM|11289-6^BDY TEMP 1ST ENCTR
^LN||99.1|[degF]^FARENHEIT^UCUM||A|||F|||201102171658<cr>
OBX|
4
|NM|59408-5^SAO2% BLDA PULSEOX^LN||95|%^PERCENT^UCUM||A|||F|||201102171658<cr>
OBX|
5
|TS|11368-8^ILLNESS/INJURY ONSET DATE/TIME^LN||
20110215
||||||F|||201102171658<cr>
DG1|
1
||78900^ABDMNAL PAIN UNSPCF SITE^I9CDX|||A<cr>
DG1|
2
||5409^
ACUTE APPENDICITIS
NOS^I9CDX|||W<cr>
PHIN Messaging Guide for Syndromic Surveillance, version 2.0, January 6, 2011Slide22
Thank you for viewing this presentation.
More information on HL7 can be found on http://www.hl7.org/
The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Conclusion
Office of Surveillance, Epidemiology, and Laboratory Services
Division of Informatics Practice, Policy & Coordination