An Introduction to HL7

Philip Firth IM&T Strategy Implementation Manager Wrightington, Wigan & Leigh NHS Trust 01942 773702 Philip.Firth@wiganlhs-tr.nwest.nhs.uk

My background
NHS IT Manager  Leading on the implementation of EPR at Wrightington, Wigan & Leigh NHS Trust  Best-of-breed strategy a lot of systems integration  Good understanding of HL7  BUT not an expert, especially in HL7v3


History - Healthcare Standards

1988  1988  1995  1997  2000  2002  2002


ASTM E.1238 Lab messages HL7 Version 2.0 CEN ENV 1613 Lab messages CEN CR 12587 Methodology CEN ENV 13606 EHR comms HL7 Version 3 (3rd Ballot) HL7 version 3 adopted by NPfIT

HL7 version 2

Why HL7 Version 2

    

UK specific version of HL7v2 Wide international industry and user support Extensive implementation base Extensive skill base Non-proprietary

Key issue  Not comprehensive (breadth of scope does not cover all healthcare interoperability)

Example message: patient admission

A typical patient admit message will include the following fields:Source and destination MSH (Message header) segment  Patient ID, demographics PID (Patient ID) segment  Message type EVN (Event Type) segment  Admit date and time EVN (Event Type) segment  Ward PV1 (Patient Visit) segment  Consultant PV1 (Patient Visit) segment


Example message: patient admission

Patient William A. Jones, III was admitted on July 18, 1988 at 11:23 a.m. by doctor Sidney J. Lebauer (#004777) for surgery (SUR). He has been assigned to room 2012, bed 01 on nursing unit 2000. The message was sent from system ADT1 at the MCM site to system LABADT, also at the MCM site, on the same date as the admission took place, but three minutes after the admit.
MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181 126|SECURITY|ADT-^A01|MSG00001-|P|2.3. 1|<cr> EVN|A01|198808181123||<cr> PID|1||PATID1234^5^M11^ADT1^MR^MCM~123 456789^^^USSSA^SS||JONES^WILLIAM^A^III ||19610615|M-||C|1200 N ELM STREET^^GREENSBORO^NC^27401-1020|GL|(9 1-9)379-1212|(919)271-3434||S|| PATID12345001^2^M10^ADT1^AN^A|12 3456789|9-87654^NC|<cr> NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NE XT OF KIN<cr> PV1|1|I|2000^2012^01||||004777^LEBAUER ^SIDNEY^J.|||SUR||-||ADM|A0-|<cr>

Systems integration approach



In-house development
supplier community often does not appreciate the complexity of the NHS

Use messaging / data exchange standards wherever possible

Web services XML HL7

Integration architecture

CASE STUDY 1: Developing an interface to: (a) send pathology results from the MasterLab system
and

(b) present them to clinicians in the EPR system

HL7v2 pathology interface in Wigan

MasterLab pathology system screen

HL7v2 pathology interface in Wigan

MasterLab pathology HL7 message: ORU
MSH|^~\&|MLAB||||20030306083246||ORU^R01|X675|P|2.3 PID|1||999999^^^^PAS~LK301079^^^^NHS||NAME^FORENAME^^^||19231231|M|||99 ACACIA AVENUE^ABRAM^WIGAN^^||||| ZMP|^^NAT^^^L|^^L ZPV|IP|ICUR^^^MLAB&RAEI&L^^W|&ALB^BLOWER^A.L.^^^Mr.|ICUR^^^MLAB&RAEI &L^^W|&ALB^BLOWER^A.L.^^^ OBR|1||5802432^CCMLAB|CC_RICUP^Intensive Care Profile^L^^^L|||20030306|||||||200303060730||&ALB^BLOWER^A.L.^^^ OBX|1|ST|CC_TONA^Sodium^L||136|mmol/L|135-145|N|||F OBX|2|ST|CC_TOK^Potassium^L||4.4|mmol/L|3.5-5.3|N|||F OBX|3|ST|CC_TOCL^Chloride^L||106|mmol/L|95-106||||F OBX|4|ST|CC_TOBIC^Bicarbonate^L||18|mmol/L|22-34|L|||F OBX|5|ST|CC_TOBUN^Urea^L||29.9|mmol/L|1.7-9.0|H|||F OBX|6|ST|CC_TOCRT^Creatinine^L||282|umol/L|60-140|H|||F OBX|7|ST|CC_TAGAP^Anion Gap^L||16|mmol/L|8-20|N|||F OBX|8|ST|CC_TOCA^Calcium^L||1.96|mmol/L|2.15-2.60|L|||F OBX|9|ST|CC_TOCAF^Calcium corrected for Alb conc^L||2.41|mmol/L|2.05-2.60|N|||F OBX|10|ST|CC_TOINP^Phosphate^L||2.27|mmol/L|0.8-1.45|H|||F OBX|11|ST|CC_TOTP^Total Protein^L||46|g/L|60-82|L|||F OBX|12|ST|CC_TOALB^Albumin^L||22|g/L|34-48|L|||F

HL7v2 pathology interface in Wigan

Use XSLT to convert HL7 message to XML

HL7v2 pathology interface in Wigan

Use XML Schema to validate XML message

HL7v2 pathology interface in Wigan

View XML pathology result in EPR system via a Stylesheet

CASE STUDY 2: Developing/Refining XML stylesheets to present pathology results in EPR: (a) Correctly (b) In a user friendly format

Needed to emulate presentation in the MasterLab system ============

Sensitivities in a tabular format

Cultures

Microbiology HL7v2 message

Result sections ============ The stylesheet design evolved bit by bits and was amended on recommendations from Microbiologists: Here the stylesheet had made some progress but had still not accounted for the need to associate antibiotic sensitivities with organism (a) Cultures

(b) Sensitivities

Needed to emulate presentation in the MasterLab system ============

Sensitivities in a tabular format

Cultures

Result sections ============ A stylesheet had to developed that was able to distinguish between:

(b) Cultures

(b) Organism

(c) Sensitivities

HL7 version 3

Why HL7 Version 3

Comprehensive (breadth of scope all healthcare interoperability)  Wide international industry and user support  Extensible (future-proof)  Conformance-testable  Non-proprietary  Uses up-to-date industry standards (UML, XML)


Reference Information Model



Overarching RIM to ensure consistent and cohesive message specifications across healthcare requirements Unique representation of health care domain

 

35 classes with 181 attributes  Descended from six critical backbone classes (Act, Role Entity, Participation, Role, ActRelationship, RoleLink RoleLink)

RIM Backbone
RoleLink -typeCode 0..* 0..* ActRelationship -typeCode 0..* 0..*

source 1 Entity -classCode -determinerCode 0..1 0..1 scopes plays 0..* Role

target 1 1 0..* Participation -typeCode 0..*

source 1 1 Act -classCode -moodCode

target 1

0..* -classCode

Core concepts of RIM

   

Every happening is an Act

Observation, Prescribe, Registration, etc.

Participation defines the context for an Act

Prescriber, Dispenser, Subject,etc.

The participants are Roles

Patient, Practitioner, Pharmacist, etc.

Roles are played by Entities

Person, PCT, Pharmacy, Medical product, etc.

Steps from the RIM to implementable messages

 

Reference Information Model (RIM)

The source or pattern for all HL7 messages

Refined Message Information Model (RMIM)

A specific model for a set of messages Derived from the RIM

 

Hierarchical Message Description (HMD)

Basis of one or more Message Types

Message Types
A fully refined structure capable of being mapped into an implementable form

Implementable Technology Specification (ITS)

The final step creating an implementable message

Refinement from RIM to Message

Tools: Representation of R-MIMs



R-MIMs are represented

Diagrammatically in Visio In a Repository in two forms: Access & XML

Visio for diagrams

Use of colour to distinguish RIM base class Visio extensibility with VBA allows
Validation of R-MIMs against the RIM repository Direct saving of R-MIMs in the repository

Tools: Visio for HL7 RMIM Design

Drag and drop Entry Point,
Name and identify the R-MIM

Drag and drop classes onto page

Naming of clone class Specification of structural codes values (e.g. classCode,
moodCode etc.)

Drag and connect relationships

Property window allows cardinalities to be specified

Tools: View/edit HMD in Rosetree

     

Create/edit HMD Export specifications to XML Generate documentation Generate XMLSchemas, Generate XSLTstylesheets Generate sample messages

An HL7v3 XML-Schema
Representation of content

HL7 Version 3 fragment as raw XML

HL7 Version 3 fragment as in a structured form for technical review

HL7 Version 3 fragment as transformed to a plain text view

HL7 version 3 and NPfIT

NHS endorses HL7 Version 3



NHS ISB (March 2002) Approval for HL7v3 to be the enabling standard for ICRS Delivering 21st Century IT Support for the NHS (June 2002) HL7v3 key element of Part 3: OBS1 and OBS2 NHS is sponsoring tool development to further improve the HL7 v3 development process

 

ICRS Phase 1
HL7v3 will play a key role in establishing E-Booking  Personal Demographics Service (PDS)  Personal Spine Information Service (PSIS)  Transaction Messaging Spine (TMS)


Clinical Document Architecture

Document Markup Standard that specifies the structure and semantics of clinical documents for the purpose of exchange  Human readable, encoded in XML  CDA II (Cleveland Draft) documents derive their meaning from the RIM and use HL7v3 datatypes  June 2003 - decision by NPfIT to adopt Messaging rather than CDA II for ICRS development


Want to know more about HL7?

Join HL7UK see www.hl7.org.uk  HL7 repository see www.hl7.org.uk  HL7 courses see www.hl7.org.uk


Acronyms
          

HL7 CEN RIM R-MIM D-MIM C-MET HMD ITS CDA UML ASTM

Health Level 7 European Standardization of Health Informatics Reference Information Model Refined Message Information Model Domain Message Information Model Common Message Element Type Hierarchical Message Description Implementation Technology Specification Clinical Document Architecture Unified Modelling Language American Society for Testing and Materials