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Health Level 7
Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and
administrative data between software applications used by various healthcare providers. These
standards focus on the application layer, which is "layer 7" in the OSI model. The HL7 standards are
produced by Health Level Seven International, an international standards organization, and are
adopted by other standards issuing bodies such as American National Standards Institute and
International Organization for Standardization.

Hospitals and other healthcare provider organizations typically have many different computer
systems used for everything from billing records to patient tracking. All of these systems should
communicate with each other (or "interface") when they receive new information, or when they wish
to retrieve information, but not all do so.

HL7 International specifies a number of flexible standards, guidelines, and methodologies by which
various healthcare systems can communicate with each other. Such guidelines or data standards are a
set of rules that allow information to be shared and processed in a uniform and consistent manner.
These data standards are meant to allow healthcare organizations to easily share clinical information.
Theoretically, this ability to exchange information should help to minimize the tendency for medical
care to be geographically isolated and highly variable.[1]

HL7 International considers the following standards to be its primary standards – those standards
that are most commonly used and implemented:[2]

Version 2.x Messaging Standard – an interoperability specification for health and medical
transactions
Version 3 Messaging Standard – an interoperability specification for health and medical
transactions
Clinical Document Architecture (CDA) – an exchange model for clinical documents, based on HL7
Version 3
Continuity of Care Document (CCD) – a US specification for the exchange of medical summaries,
based on CDA.
Structured Product Labeling (SPL) – the published information that accompanies a medicine,
based on HL7 Version 3
Clinical Context Object Workgroup (CCOW) – an interoperability specification for the visual
integration of user applications

Other HL7 standards/methodologies include:[3]

Fast Healthcare Interoperability Resources (FHIR) – a standard for the exchange of resources
Arden Syntax – a grammar for representing medical conditions and recommendations as a
Medical Logic Module (MLM)
Claims Attachments – a Standard Healthcare Attachment to augment another healthcare
transaction
Functional Specification of Electronic Health Record (EHR) / Personal Health Record (PHR)
systems – a standardized description of health and medical functions sought for or available in
such software applications
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GELLO – a standard expression language used for clinical decision support

Contents
Primary standards
Version 2 messaging
Version 3 messaging
Clinical Document Architecture (CDA)
Continuity of Care Document (CCD)
Structured Product Labeling (SPL)
CCOW
Other standards and methods
Fast Healthcare Interoperability Resources (FHIR)
Services Aware Interoperability Framework
Arden syntax
MLLP
Functional EHR and PHR specifications
Message details
The OBR segment
See also
References
External links
Critical reviews

Primary standards
HL7's primary standards are those standards that Health Level Seven International considers to be
most commonly used and implemented.[2]

Version 2 messaging

The HL7 version 2 standard (also known as Pipehat) has the aim to support hospital workflows. It was
originally created in 1989.[4]

HL7 version 2 defines a series of electronic messages to support administrative, logistical, financial as
well as clinical processes. Since 1987 the standard has been updated regularly, resulting in versions
2.1, 2.2, 2.3, 2.3.1, 2.4, 2.5, 2.5.1, 2.6, 2.7, 2.7.1, 2.8, 2.8.1 and 2.8.2. The v2.x standards are backward
compatible (e.g., a message based on version 2.3 will be understood by an application that supports
version 2.6).

HL7 v2.x messages use a non-XML encoding syntax based on segments (lines) and one-character
delimiters.[5] Segments have composites (fields) separated by the composite delimiter. A composite
can have sub-composites (components) separated by the sub-composite delimiter, and sub-
composites can have sub-sub-composites (subcomponents) separated by the sub-sub-composite

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delimiter. The default delimiters are carriage return for the segment separator, vertical bar or pipe (|)
for the field separator, caret (^) for the component separator, ampersand (&) for the subcomponent
separator, and number sign (#) for the default truncation separator. The tilde (~) is the default
repetition separator. Each segment starts with a 3-character string that identifies the segment type.
Each segment of the message contains one specific category of information. Every message has MSH as
its first segment, which includes a field that identifies the message type. The message type determines
the expected segment types in the message.[6] The segment types used in a particular message type
are specified by the segment grammar notation used in the HL7 standards.

The following is an example of an admission message. MSH is the header segment, PID the Patient
Identity, PV1 is the Patient Visit information, etc. The 5th field in the PID segment is the patient's
name, in the order, family name, given name, second name (or their initials), suffix, etc. Depending
on the HL7 V2.x standard version, more fields are available in the segment for additional patient
information.

MSH|^~\&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|20060529090131-0500||ADT^A01^ADT_A01|01052901|P|2.5

EVN||200605290901||||

PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||2028-9^^HL70005^RA99113^^XYZ|260 GOODWIN CREST

DRIVE^^BIRMINGHAM^AL^35209^^M~NICKELL’S PICKLES^10000 W 100TH AVE^BIRMINGHAM^AL^35200^^O|||||||0105I30001^^^99DEF^AN

PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||67890^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13
579^POTTER^SHERMAN^T^^^MD^0010^UAMC^L|||||||||||||||||||||||||||200605290900

OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F

OBX|2|NM|^Body Weight||79|kg^Kilogram^ISO+|||||F

AL1|1||^ASPIRIN

DG1|1||786.50^CHEST PAIN, UNSPECIFIED^I9|||A

HL7 v2.x has allowed for the interoperability between electronic Patient Administration Systems
(PAS), Electronic Practice Management (EPM) systems, Laboratory Information Systems (LIS),
Dietary, Pharmacy and Billing systems as well as Electronic Medical Record (EMR) or Electronic
Health Record (EHR) systems. Currently, the HL7 v2.x messaging standard is supported by every
major medical information systems vendor in the United States.[7]

Version 3 messaging

The HL7 version 3 standard[8] has the aim to support all healthcare workflows. Development of
version 3 started around 1995, resulting in an initial standard publication in 2005. The v3 standard,
as opposed to version 2, is based on a formal methodology (the HDF) and object-oriented principles.

RIM - ISO/HL7 21731

The Reference Information Model[9] (RIM) is the cornerstone of the HL7 Version 3 development
process and an essential part of the HL7 V3 development methodology. RIM expresses the data
content needed in a specific clinical or administrative context and provides an explicit representation
of the semantic and lexical connections that exist between the information carried in the fields of HL7
messages.[10]

HL7 Development Framework - ISO/HL7 27931

The HL7 Version 3 Development Framework (HDF) is a continuously evolving process that seeks to
develop specifications that facilitate interoperability between healthcare systems. The HL7 RIM,
vocabulary specifications, and model-driven process of analysis and design combine to make HL7

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Version 3 one methodology for development of consensus-based standards for healthcare information
system interoperability. The HDF is the most current edition of the HL7 V3 development
methodology.

The HDF not only documents messaging, but also the processes, tools, actors, rules, and artifacts
relevant to development of all HL7 standard specifications. Eventually, the HDF will encompass all of
the HL7 standard specifications, including any new standards resulting from analysis of electronic
health record architectures and requirements.

HL7 specifications draw upon codes and vocabularies from a variety of sources. The V3 vocabulary
work ensures that the systems implementing HL7 specifications have an unambiguous understanding
of the code sources and code value domains they are using.

V3 Messaging

The HL7 version 3 messaging standard defines a series of Secure Text messages (called interactions)
to support all healthcare workflows.

HL7 v3 messages are based on an XML encoding syntax, as shown in this example:[11]: 2.2.1 

<POLB_IN224200 ITSVersion="XML_1.0" xmlns="urn:hl7-org:v3"

xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">

<id root="2.16.840.1.113883.19.1122.7" extension="CNTRL-3456"/>

<creationTime value="200202150930-0400"/>

<!-- The version of the datatypes/RIM/vocabulary used is that of May 2006 -->

<versionCode code="2006-05"/>

<!-- interaction id= Observation Event Complete, w/o Receiver Responsibilities -->

<interactionId root="2.16.840.1.113883.1.6" extension="POLB_IN224200"/>

<processingCode code="P"/>

<processingModeCode nullFlavor="OTH"/>

<acceptAckCode code="ER"/>

<receiver typeCode="RCV">

<device classCode="DEV" determinerCode="INSTANCE">

<id extension="GHH LAB" root="2.16.840.1.113883.19.1122.1"/>

<asLocatedEntity classCode="LOCE">

<location classCode="PLC" determinerCode="INSTANCE">

<id root="2.16.840.1.113883.19.1122.2" extension="ELAB-3"/>

</location>

</asLocatedEntity>

</device>

</receiver>

<sender typeCode="SND">

<device classCode="DEV" determinerCode="INSTANCE">

<id root="2.16.840.1.113883.19.1122.1" extension="GHH OE"/>

<asLocatedEntity classCode="LOCE">

<location classCode="PLC" determinerCode="INSTANCE">

<id root="2.16.840.1.113883.19.1122.2" extension="BLDG24"/>

</location>

</asLocatedEntity>

</device>

</sender>

<!-- Trigger Event Control Act & Domain Content -->

</POLB_IN224200>

Clinical Document Architecture (CDA)

The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to
specify the encoding, structure and semantics of clinical documents for exchange.[12] The standard
was jointly published with ISO as ISO/HL7 27932.

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Continuity of Care Document (CCD)

CCD is a US specification for the exchange of medical summaries, based on CDA.

Structured Product Labeling (SPL)

SPL describes the published information that accompanies a medicine, based on HL7 Version 3.

CCOW

CCOW, or "Clinical Context Object Workgroup," is a standard protocol designed to enable disparate
applications to share user context and patient context in real-time, and at the user-interface level.
CCOW implementations typically require a CCOW vault system to manage user security between
applications.

Other standards and methods

Fast Healthcare Interoperability Resources (FHIR)

Fast Healthcare Interoperability Resources is a draft standard from HL7 International designed to be
easier to implement, more open and more extensible than version 2.x or version 3. It leverages a
modern web-based suite of API technology, including a HTTP-based RESTful protocol, HTML and
Cascading Style Sheets for user interface integration, a choice of JSON or XML for data
representation, OAuth for authorization and ATOM for query results.[13]

Services Aware Interoperability Framework

The HL7 Services-Aware Enterprise Architecture Framework (SAIF) provides consistency between all
HL7 artifacts, and enables a standardized approach to Enterprise Architecture (EA) development and
implementation, and a way to measure the consistency.

SAIF is a way of thinking about producing specifications that explicitly describe the governance,
conformance, compliance, and behavioral semantics that are needed to achieve computable semantic
working interoperability. The intended information transmission technology might use a messaging,
document exchange, or services approach.

SAIF is the framework that is required to rationalize interoperability of other standards. SAIF is an
architecture for achieving interoperability, but it is not a whole-solution design for enterprise
architecture management.

Arden syntax

The Arden syntax is a language for encoding medical knowledge. HL7 International adopted and
oversees the standard beginning with Arden syntax 2.0. These Medical Logic Modules (MLMs) are
used in the clinical setting as they can contain sufficient knowledge to make single medical decisions.
They can produce alerts, diagnoses, and interpretations along with quality assurance function and
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administrative support. An MLM must run on a computer that meets the minimum system
requirements and has the correct program installed. Then, the MLM can give advice for when and
where it is needed.

MLLP

A large portion of HL7 messaging is transported by Minimal Lower Layer Protocol (MLLP), also
known as Lower Layer Protocol (LLP)[14] or Minimum Layer Protocol (MLP).[15] For transmitting via
TCP/IP, header and trailer characters are added to the message to identify the beginning and ending
of the message because TCP/IP is a continuous stream of bytes.[16] Hybrid Lower Layer Protocol
(HLLP) is a variation of MLLP that includes a checksum to help verify message integrity. Amongst
other software vendors, MLLP is supported by Microsoft,[17] Oracle,[18] Cleo.[19]

MLLP contains no inherent security or encryption but relies on lower layer protocols such as
Transport Layer Security (TLS) or IPsec for safeguarding Protected health information outside of a
secure network.

Functional EHR and PHR specifications

Functional specifications for an electronic health record.

Message details

The OBR segment

An OBR Segment carries information about an exam, diagnostic study/observation.[20] It is a

required segment in an ORM (order message)[21] or an ORU (Observation Result) message.[22]

See also
CDISC
DICOM
DVTk
Electronic medical record
eHealth
EHRcom
European Institute for Health Records (European Union)
Fast Healthcare Interoperability Resources
Health Informatics
Health Informatics Service Architecture (HISA)
Healthcare Services Specification Project (HSSP)
Integrating the Healthcare Enterprise(IHE)
ISO TC 215
LOINC
NextGen Connect
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openEHR Foundation
Public Health Information Network
SNOMED, SNOMED CT
Nomenclature for Properties and Units terminology

References
  This article incorporates text from a free content work. Licensed under Creative Commons
Attribution-ShareAlike 3.0 license. Text taken from Spronk 2007.

1. Joel Rodrigues (2010). Health Information Systems: Concepts, Methodologies, Tools, and
Applications, Volume 1 (https://books.google.com/books?id=WnBJsRtfVbYC&pg=PR39). IGI
Global. p. xxxix. ISBN 978-1-60566-988-5.
2. "HL7 Primary Standards" (http://www.hl7.org/implement/standards/product_section.cfm?section=
1). Health Level Seven International.
3. "HL7 Standards" (http://www.hl7.org/implement/standards/index.cfm?ref=nav). Health Level
Seven International.
4. "HL7 FAQs" (http://www.hl7.org/about/FAQs/index.cfm?ref=nav). HL7.
5. "Understanding HL7 Messages" (http://www.interfaceware.com/understanding_hl7_messages.htm
l). iNTERFACEWARE.
6. "HL7 Messages and Descriptions" (http://healthstandards.com/blog/2007/09/24/hl7-separator-char
acters/). Health Standards.
7. "Standards Organizations" (https://aspe.hhs.gov/sp/nhii/standards.html). Assistant Secretary for
Planning and Evaluation (ASPE), Health and Human Services (HHS).
8. "HL7 V3 Standard - A High Level Overview" (https://saravanansubramanian.com/hl7V3intro/). 26
May 2020.
9. "HL7 Reference Information Model" (http://www.hl7.org/implement/standards/rim.cfm). HL7.
10. "Tools & Resources – V3 Modeling & Methodology Tools" (http://www.hl7.org/participate/toolsandr
esources.cfm). HL7.
11. Spronk, René, ed. (16 November 2007). "HL7 Message examples: version 2 and version 3" (htt
p://www.ringholm.de/docs/04300_en.htm). Ringholm. Ringholm bv.
12. Boone, Keith W. (20 May 2011). The CDA Book (https://books.google.com/books?id=rwa6DDB4jY
8C). ISBN 9780857293367.
13. Dan Munro (2014-03-30). "Setting Healthcare Interop On Fire" (https://www.forbes.com/sites/dan
munro/2014/03/30/setting-healthcare-interop-on-fire/). Forbes. Retrieved 2014-11-22.
14. "LLP - Lower Layer Protocol" (http://www.interfaceware.com/llp.html). iNTERFACEWARE.
15. "Minimum Layer Protocol" (https://www.lyniate.com/knowledge-hub/mlp-minimum-layer-protocol).
LYNIATE. 13 January 2020.
16. Spronk, Rene. "Transport Specification: MLLP, Release 1" (https://www.hl7.org/documentcenter/p
ublic/wg/inm/mllp_transport_specification.PDF) (PDF). hl7.org. Health Level Seven Inc. Retrieved
5 September 2022.
17. "MLLP Receive and Send Components" (http://msdn.microsoft.com/en-us/library/ee409260%28B
TS.10%29.aspx). MSDN.
18. "Oracle Application Server Integration B2B User's Guide, Supported Protocols" (http://download.o
racle.com/docs/cd/B14099_19/integrate.1012/b19370/supp_protos.htm#BACIFDJG). Oracle.

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19. "Which Secure Managed File Transfer Protocol is Right for You?" (https://web.archive.org/web/20
150607155326/http://www.cleo.com/solutions/compare-protocols/). Cleo. Archived from the
original (https://www.cleo.com/solutions/compare-protocols/) on 2015-06-07. Retrieved
2015-01-23.
20. "The HL7 OBR segment" (https://corepointhealth.com/resource-center/hl7-resources/hl7-obr-seg
ment/). Corepoint Health. Retrieved 2018-11-13.
21. "HL7 Glossary of Terms" (https://www.hl7.org/documentcenter/public/calendarofevents/FirstTime/
Glossary%20of%20terms.pdf) (PDF). www.hl7.org. Retrieved 2018-11-13.
22. "What Is an ORU Message?" (http://healthstandards.com/blog/2006/10/05/what-is-an-oru-messag
e/). Health Standards. Retrieved 2018-11-13.

External links
HL7.org site (http://www.HL7.org/)
What does HL7 education mean? (http://www.ehealthtraining.com.au/)
HL7 International is a member of the Joint Initiative on SDO Global Health Informatics
Standardization (http://www.jointinitiativecouncil.org/)
HL7 Tools Page (http://www.eHealthTraining.com.au/HL7-Tools.htm)
Australian Healthcare Messaging Laboratory (AHML) - Online HL7 Message Testing and
Certification (http://www.AHML.com.au/)
Comprehensive Implementation of HL7 v3 Specifications in Java (https://web.archive.org/web/201
10722053000/http://aurora.regenstrief.org/javasig)
NIST HL7 Conformance Testing Framework (https://web.archive.org/web/20110605024051/http://
www.cs.duke.edu/~jgm/files/nist.2006.ppt)
ICH-HL7 Regulated Product Submissions (https://web.archive.org/web/20100413213254/http://w
ww.globalsubmit.com/home/LearningCenter/HL7RegulatedProductSubmissions/tabid/252/Default.
aspx)
HL7 Tutorial Directory (http://www.hl7soup.com/hl7tutorials.html)
HL7 Programming Tutorials (https://saravanansubramanian.com/hl7tutorials/), Short Tutorials on
many HL7 concepts for Programmers.

Critical reviews
HL7 RIM: An Incoherent Standard (https://web.archive.org/web/20100612005842/http://ontology.b
uffalo.edu/HL7/doublestandards.pdf)
HL7 RIM Under Scrutiny (http://amisha.pragmaticdata.com/~schadow/Schadow-MIE06-r3.pdf)
(attempted rebuttal)(publication date?)
HL7 WATCH (http://hl7-watch.blogspot.com/)
Update 2013: Human Action in the Healthcare Domain: A Critical Analysis of HL7’s Reference
Information Model (http://ontology.buffalo.edu/HL7/RIM-2013.pdf)

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