Published on September 28, 2007
Pasi Leino L-Force Oy, Finland firstname.lastname@example.org
HL7 crash course National efforts and applications (Finland) Choice of Techology
20 year old (since 1987), non-profit organisation National standard in the US (ANSI) since 1994 Open, consensus based development process In use? ◦ CHIME-study 2000 (153 Hospital CIOs in US) 80% using HL7, 13.5% planning Hospitals over 400 beds: 95% For interoperability
Process level Ability to adapt to work flow Semantic level Ability to exchange information Operational level Ability to exchange data
Messaging standards ◦ HL7 v2.x (v2.5 ANSI-standard 2006) ◦ HL7 versio 3 RIM CDA (clinical document architecture) R1 and R2 HL7 data types to become ISO standard CCOW (clinical context management) Arden syntax (represents medical algorithms in clinical information) + GLIF + Gello + small Working Groups Recommendations, implementation guides
Data model (or information model) ◦ RIM (Reference Information Model) and D-MIM, R-MIM, HMD ◦ Refine by constraining Vocabulary Data types Domain models ITS (Implementation Technology Specification) ◦ XML ITS currently available
Information Model Spec Define classes, Develop Scope attributes, and Use Case Model relationships Identify actors and Use Cases RIM Spec Spec Class Diagram State Diagram Define vocabulary domains and codes Associate Actors UCM Spec and Use Cases Use Case Diagram Define states, transitions and triggers Define Application Roles Message Design Interaction Model Develop Refined Message Information Define Spec 2-nd Order h//mt:50”d” Model Interactions 1 choice of … 0-n Drug … Specify CMET Define Inter Spec 0-1 Nursing … Conformance Interaction Diagram Specify HMD & Criteria METs with constraints Source: HL7 Training, Scandinavia Tour, 2002
Relationship Act Link Relationship 0..* 0..* 0..* 0..* 1 1 1 1 0..* 0..* 1 Entity 1 Role 1 Participation 0..* Act Patient Referral Organization Employee Transportation Living Subject Practitioner Supply Material Assigned Procedure Place Practitioner Condition Node Health Chart Specimen Consent Observation Medication Act complex (Source: G.W. Beeler) Financial act
Medication (Act/ substance Administation) Is related to (ActRelationship) Dr Phil Doctor Performer (Person) (Role) (Participation) Visit (Act/ Encounter) Pasi Leino Patient Target (Entity/ Person) (Role) (Participation) Is related (ActRelationship) Study, other action
Entities in Green ◦ Organisations, persons, devices, locations ... Roles in yellow ◦ professionals, patients, roleLinks Participation in Cyan Activities (act), in Red ◦ Observations, Events, medication, Encounters, ... Relations in activities
RIM DMIM RMIM Dynaamic model: Use cases, application roles, interactions The static model an dynamic behavior is linked by interactions XML HMD Schema
HL7 affilicate since 1995 Has earned status of respect Receives funding from the Ministry of social affair and health Finland is an early adopter of any technology CDA –centric approach
CDA is defined by the RIM CDA RMIM is a constraint on the RIM Classes “cloned” (replicated, renamed, constrained with vocabulary, datatypes) CDA is Persistence, stewardship, is Potential for authentication, Whole, Human readable
CDA document Header and context to describe the document Body Narrative, Structured Human readable Machine readable Structurd data text text text
Forms used everywhere: patient core data, health status, drivers license, leave of absence... Very simple to define and implement However, a single concept (diagnosis etc.) could be defied differently in different forms. Seemingly simplistic? In strict sence CDA document is not designed for forms
kentän pituus pakollisuus tietotyyppi toistuma max min rivi tietokenttätunnus oid tunnus tietotyyppi koodisto huom. kentän nimi 1 188.8.131.52184.108.40.2066.3 Label LB K lomake lomake HEN 2 220.127.116.1118.104.22.1686.3. 1 Label LB K pääotsikko Päivitystiedot 3 22.214.171.124126.96.36.1996.3. 2 Coded Value CV K Henkilötietojen käy 4 188.8.131.52184.108.40.2066.3. 3 Point in Time TS K Henkilötiedot on p 5 220.127.116.1118.104.22.1686.3. 4 Character String ST K Henkilötietojen päi 6 22.214.171.124126.96.36.1996.3. 5 Label LB K pääotsikko Perustiedot 7 188.8.131.52184.108.40.2066.3. 6 Instance Identifer II Henkilötunnus 8 220.127.116.1118.104.22.1686.3. 7 Instance Identifer II Väliaikainen henki 9 22.214.171.124126.96.36.1996.3. 8 Instance Identifer II Muut tunnisteet 10 188.8.131.52184.108.40.2066.3. 9 Person Name PN Sukunimi, etunime 11 220.127.116.1118.104.22.1686.3. 10 Person Name PN T Entinen sukunimim 12 22.214.171.124126.96.36.1996.3. 11 Point in Time TS Syntymäaika
Patient centric services, which promote continuity of care Interoperability Electronic archiving or EPR, prescriptions, centralised image repositories National services for codes, classifications, archiving
Scheduling-domain ◦ Regional shared scheduling ePrescription ◦ Medical Records messages ◦ CDA R2 based content- prescription, delivery, locking, etc. Death notice message ◦ V3 messaging spesifications for automatic reporting of death to National citizen registy. eArchive messages ◦ V3 Messages, CDAR2 payload + W3C signature Diagnostic imaging patient records and reports CDA R2 implementation guidelines ◦ See: www.hl7.fi ◦ See: www.hl7.co.uk
YHDIS- TELMÄ LPSY PSY HENKILÖ- KIR TIEDOT SIS Summary YLE documents SOS LÄÄ KUUMEKU LAB PSY LÄHETE RAD ANS PSY HOSU OPER RR HOSU VEREN- DIA TAUDIN- SIIRTO KULKU JA HOITO Service units Care programs Care episodes
Structured and standardised core data Use of national codes and OID CDAR2 documents Open interface to exchange CDAR2 documents Ability to interface to national EPR archive, ePrescription, code services Desktop integration, SSO User authentication, electronic signing, concent management, referrals
Several Duodecim providers Stakes TEO VRK Decision Public Health I. Stakes Content Codes, Authentication support Consumer Healthcare OID- Person service providers classifications, codes of healthcare Consumer health professionals identifier statistics vocabularies health Content User Code OID-code authentication Person Decision Enabling service service & eSignature identifier support service service services service National EPR Medical EPR Service Health ePre- Core Service forms & Portal scription (Active) (Long-term) services certificates Registry Service Service Repository Archive service Secure Network & Messaging Service Enterprise applications
Information model to be updated according to ”structured core patient date definitions” Use of Codes and OID’s Use of CDA R2 for document generation Open interfaces for interchange of CDA R2 documents Access to decision support services Ability to use of the EPR, ePrescription etc. services Functionality to filter user tailored views from retrieved patient documents Desktop integration & SSO User authentication, signature, consent management
XML is nothing alone ◦ SOAP ◦ Custom schemas ◦ XML RPC Decision points: the developer does not need to know what goes in the wire Acid test of spesification: can this be done using general purpose development tools? Caché, Enseble –objects eXtc, DOM model Example document
author cdaBody AD cdaHeader component BL custodian CS dataComponent documentationOf CV encompassingEncounter externalLink ED externalObservation toCDA(.. II localHeader Construct(... paragraphComponent INT textComponent Generate(... patient IVL patientSubject MO relatedPatient performer PN qualifier rtgENVEntry rtgRQOEntry rtgOBSEntry Section
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