2001 Annual HIMSS Conference and Exhibition

The HL7 Messaging Standard
Current and Future Directions
Mike Henderson
President, Eastern Informatics, Inc.

© 2001 Healthcare Information Management and Systems Society

The HL7 Messaging Standard

Learning objectives
Overview of clinical interfacing ! Data types and message formats used in the current HL7 standard ! The HL7 Version 3 Message Development Framework ! Usages in HL7 of various encoding rules including XML for message formatting
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Overview of clinical interfacing
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The HL7 Messaging Standard

History of clinical computing and interfacing ! The beginnings of messaging standards ! Introductory summary of HL7

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The HL7 Messaging Standard History of clinical interfaces ! Uses of computers as medical data repositories since 1950’s Administration ! Billing ! ADT ! Clinical information ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 4 .

The HL7 Messaging Standard History of clinical interfaces ! Issues with computers ! ! ! ! ! ! ! Expense (large) Size (ditto) Point-of-care practicality (im) Interfaces (batch) Data timeliness (non-real) Administrative priorities (elsewhere) Clinicians’ familiarity (not much) 5 2/4/2001 2001 Annual HIMSS Conference and Exhibition .

Octo Barnett devises MUMPS at Massachusetts General Hospital in mid 1960s ! Language now known as M ! Infrastructure aka M Technology ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 6 .The HL7 Messaging Standard History of clinical interfaces ! Real-time interactive computing Dr.

The HL7 Messaging Standard History of clinical interfaces ! Strengths of MUMPS ! ! ! ! ! ! Ran on smaller “minicomputers” (DEC PDP/11) User instruction set built around native data structure Compact. interpreted code – no waiting for compilation Evolved to be relatively platform-independent ANSI standard language Still in use today in medical and non-medical applications (InterSystems’ CACHÉ) 2001 Annual HIMSS Conference and Exhibition 7 2/4/2001 .

The HL7 Messaging Standard History of clinical interfaces ! What MUMPS didn’t do Support logical database design (at least not as well as hoped) ! Enforce database integrity ! Address clinical vocabulary issues ! Define high-level data interchange formats between systems ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 8 .

if any • Much clinical work (lab tests.The HL7 Messaging Standard History of clinical interfaces ! Data interchange? ! Many medical centers were minimally computerized or non-computerized • Single administrative system. procedures) performed and recorded manually ! Laboratory automation and biomedical computing were on separate tracks from administrative computing 2001 Annual HIMSS Conference and Exhibition 9 2/4/2001 .

The HL7 Messaging Standard History of clinical interfaces ! De facto standard: sneakernet ! ! Results recorded manually or by instruments Transcribed into data processing systems • Punch card • Paper tape • Terminal 2/4/2001 2001 Annual HIMSS Conference and Exhibition 10 .

The HL7 Messaging Standard History of clinical interfaces ! Manual transcription issues Timeliness ! Accuracy ! Consistency ! Usefulness ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 11 .

The HL7 Messaging Standard 2/4/2001 2001 Annual HIMSS Conference and Exhibition 12 .

The HL7 Messaging Standard History of clinical interfaces ! Identified need: automated results interfaces between systems ! ! Recognized source: data generating systems (e.g. laboratory instruments) Recognized destination: medical center mainframe computer • Minicomputer adoption would take 10+ years ! Automated order entry interface not yet in the picture • This would take even longer 2/4/2001 2001 Annual HIMSS Conference and Exhibition 13 ..

1970 ! Batch • Punch cards • Paper tape • Magnetic tape ! Real-time • Cable 2/4/2001 2001 Annual HIMSS Conference and Exhibition 14 .The HL7 Messaging Standard History of clinical interfaces ! Hardware interfaces ca.

1970 ! ! ! ! Proprietary cabling Coaxial cables.The HL7 Messaging Standard History of clinical interfaces ! Real-time hardware interfaces ca. asynchronous protocols (mini) Decisions largely driven by instrument vendors 2/4/2001 2001 Annual HIMSS Conference and Exhibition 15 . bisynchronous protocols (mainframe) RS-232.

1970 Proprietary data formats ! Generally vendor driven ! Generally incompatible between vendors ! Not much influence from programming languages such as MUMPS ! • Important exception: Delimited data 2/4/2001 2001 Annual HIMSS Conference and Exhibition 16 .The HL7 Messaging Standard History of clinical interfaces ! Software interfaces ca.

The HL7 Messaging Standard History of clinical interfaces ! Software interfaces ca. 1970 ! Bottom line • Virtually every interface required custom programming • Format and content had to be negotiated between vendor and institution • Fixed lengths and size restriction constraints • 2-digit years 2001 Annual HIMSS Conference and Exhibition 2/4/2001 17 .

Clement McDonald in 1970’s and onward ! Used to transmit laboratory order and results information from instruments to central systems ! Still in use today ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 18 .The beginnings of messaging standards ! The HL7 Messaging Standard A laboratory data solution: ASTM 1238 Developed by Dr.

units. codes ! Did not require fixedlength records ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 19 . numbers.The beginnings of messaging standards ! The HL7 Messaging Standard A laboratory data solution: ASTM 1238 Permitted agreement on formats for times.

The beginnings of messaging standards ! The HL7 Messaging Standard ASTM 1238-type message H^headerdata1^headerdata2… P^patientdata1^patientdata2… O^orderdata1^orderdata2… R^1^result1data1^result1data2… R^2^result2data1^result2data2… ! Each line represents a record 2/4/2001 2001 Annual HIMSS Conference and Exhibition 20 .

The beginnings of messaging standards
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The HL7 Messaging Standard

Mmm, tastes just like MUMPS!
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Like MUMPS, ASTM 1238 popularized the use of the variable-length record with ^ (caret) as a field delimiter

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The beginnings of messaging standards
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The HL7 Messaging Standard

Other interfacing standards development
DICOM (radiology) ! X12 (financial transactions) ! ACH (banking)
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The beginnings of messaging standards
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The HL7 Messaging Standard

Drawbacks to other standards
DICOM
• Limited to radiology • Originally required proprietary cabling

X12 and ACH weren’t suitable for clinical data ! ACH used fixed-length fields
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The beginnings of messaging standards ! The HL7 Messaging Standard 1980’s: HL7 is developed ! Original developers • Regenstrief Institute • Duke University • University of Virginia • Mayo Clinic • Many others 2/4/2001 2001 Annual HIMSS Conference and Exhibition 24 .

The beginnings of messaging standards ! The HL7 Messaging Standard 1980’s: HL7 is developed Formats resemble ASTM 1238 (not surprising) ! Accommodates more kinds of data than just laboratory results ! • Recognizing integration of administrative and order entry systems with the clinical data repository 2/4/2001 2001 Annual HIMSS Conference and Exhibition 25 .

Introductory summary of HL7 ! The HL7 Messaging Standard What is HL7? ! ! ! ! A balloted standard for electronic exchange of health care related information An American National Standards Institute accredited standard A volunteer organization to develop and refine the HL7 standard Level 7 of the Open Systems Interconnection model 2001 Annual HIMSS Conference and Exhibition 2/4/2001 26 .

Introductory summary of HL7 ! The HL7 Messaging Standard What HL7 isn’t A physical communication protocol ! A magic wand ! A fully defined specification ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 27 .

Ethernet) others 2001 Annual HIMSS Conference and Exhibition 28 2/4/2001 .g.Introductory summary of HL7 ! The HL7 Messaging Standard Seven what? ! ! ! The “7” in “HL7” refers to the top.g. Motif) Transmission (e. DCOM) Connection (e.. Windows. or application.. layer of the Open Systems Interconnection series of communications protocols There’s no HL1 through 6 Other standards are used for lower layers • • • • Presentation (e.g. TCP/IP..

Introductory summary of HL7 ! The HL7 Messaging Standard HL7 Standard status Current version (published November 2000) is 2.0 prototype to be available in 2001 ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 29 .4 ! Current version will continue to be refined and extended ! Object oriented version 3.

Introductory summary of HL7 ! The HL7 Messaging Standard HL7 structure Messages and trigger events ! Segments ! Data fields ! Data types and components ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 30 .

Introductory summary of HL7 ! The HL7 Messaging Standard Messages and trigger events Based on activities in the health care world ! Activities create the need for information flow ! Examples: ! • ADT^A01 .Post a lab test result 2/4/2001 2001 Annual HIMSS Conference and Exhibition 31 .Admit a patient • OML^O21 .Order a lab test • ORU^R01 .

Message header PID .Order information OBX .Patient identification ORC .Observation/result information 2001 Annual HIMSS Conference and Exhibition 32 2/4/2001 .Introductory summary of HL7 ! The HL7 Messaging Standard Segments ! ! ! ! ! Building blocks of messages Correspond to records in ASTM 1238 Contain related information Used in many different types of messages Examples: • • • • MSH .

Introductory summary of HL7 ! The HL7 Messaging Standard Fields ! ! ! ! Building blocks of segments Define the information carried in the message Must be one of the predefined data types Examples: • MSH-3 .Ordering provider 2/4/2001 2001 Annual HIMSS Conference and Exhibition 33 .Sending application • PID-5 .Patient name • ORC-12 .

Introductory summary of HL7 ! The HL7 Messaging Standard Data types and components Specify the exact format of data fields ! Can be complex ! Are a pre-defined set for all messages ! Examples: ! • ST .Data string • IS .Time stamp 2/4/2001 2001 Annual HIMSS Conference and Exhibition 34 .Coded value • TS .

] Disability Information ] Observation/Result ] Allergy Information ] Diagnosis Information Diagnosis Related Group Procedures Role The HL7 Messaging Standard ! Looking at a message Message delimiters ! Message syntax ! } } } } } ] 2/4/2001 2001 Annual HIMSS Conference and Exhibition 35 .Additional Info.Introductory summary of HL7 ADT^A01 MSH EVN PID [PD1] [ { NK1 PV1 [ PV2 ] [ { DB1 [ { OBX [ { AL1 [ { DG1 [ DRG [ { PR1 [{ROL}] }] ADT Message Message Header Event Type Patient Identification Additional Demographics ] Next of Kin /Associated Parties Patient Visit Patient Visit .

Lebauer (#004777) for surgery (SUR).m. bed 01 on nursing unit 2000. 1988 at 11:23 a. 004777^LEBAUER^SIDNEY^J. SUR |A0|<cr> 2/4/2001 2001 Annual HIMSS Conference and Exhibition 36 .Introductory summary of HL7 ! The HL7 Messaging Standard Looking at a message Patient William A. Jones.|||SUR SUR||||ADM 2000^2012^01 004777^LEBAUER^SIDNEY^J. He has been assigned to room 2012.3. by doctor Sidney J. III was admitted on July 18. MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A01|MS G00001|P|2.1|<cr> EVN|A01|198808181123 198808181123||<cr> 198808181123 PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONE JONE S^WILLIAM^A^III||19610615|M||C|1200 N ELM S^WILLIAM^A^III STREET^^GREENSBORO^NC^27401-1020|GL|(919)379-1212|(919)271 -3434||S||PATID12345001^2^M10^ADT1^AN^A|123456789|987654^N C|<cr> NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr> PV1|1|I|2000^2012^01 2000^2012^01||||004777^LEBAUER^SIDNEY^J.

Introductory summary of HL7 ! The HL7 Messaging Standard Messaging roles for the new millennium ! Communicating systems assume roles in pairs • Placer – filler • Generator .tracker ! Usually a client-server relationship • Peer-to-peer relationships are not generally assumed. although they may exist • May be multi-tiered and multi-participant 2001 Annual HIMSS Conference and Exhibition 2/4/2001 37 .

filler • Protocol • Source system makes request of destination • Destination acknowledges request to source • Acknowledgement always expected • Uses • Orders • Scheduling/ADT requests • Queries and subscriptions 2/4/2001 2001 Annual HIMSS Conference and Exhibition 38 .Introductory summary of HL7 ! The HL7 Messaging Standard Messaging roles ! Placer .

Introductory summary of HL7 ! The HL7 Messaging Standard Messaging roles ! Generator-tracker • Protocol • Source system provides information • Destination system may acknowledge receipt • Acknowledgement not expected in all instances • Uses • Results • Subscription fulfillment • Query responses 2/4/2001 2001 Annual HIMSS Conference and Exhibition 39 .

Introductory summary of HL7
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The HL7 Messaging Standard

Clinical and administrative domains
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Laboratory Radiology Appointment scheduling ADT Pharmacy Immunization Blood bank Anatomic pathology
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The HL7 Messaging Standard

Data types and message formats used in the current HL7 standard
Message structures ! Encoding of messages ! Data types ! Messages within domains
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The HL7 Messaging Standard

Message structures
Overall structure rules prescribed by HL7 Chapter Two, Control ! Application domain structure rules prescribed by “content chapters”
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Patient Administration (3) ! Orders (4) ! Query (5) ! others
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and protocol information.The HL7 Messaging Standard Message structures ! Each message is divided into segments Each segment corresponds to one line of the message ! All messages begin with a Message Header (MSH) segment ! • Gives general sender. possibly including encoding data 2/4/2001 2001 Annual HIMSS Conference and Exhibition 43 . receiver.

The HL7 Messaging Standard Message structures ! Example message definition 2 ORU^R01 Observational Results (Unsolicited) Chapter MSH Message Header { [ PID Patient Identification [PD1] Additional Demographics [{NK1}] Next of Kin/Associated Parties [{NTE}] Notes and Comments [PV1 Patient Visit [PV2]] Patient Visit .Additional Info ] { [ORC] Order common OBR Observations Report ID {[NTE]} Notes and comments { [OBX] Observation/Result {[NTE]} Notes and comments } {[CTI]} Clinical Trial Identification } } [DSC] Continuation Pointer 3 3 3 2 3 3 4 7 2 7 2 7 2 2/4/2001 2001 Annual HIMSS Conference and Exhibition 44 .

The HL7 Messaging Standard Message structures ! Example message MSH|^~\&|LIS.1|||AL|NE|| PID|||301836900017^^^1||Henderson^Mike^M||19510901|F|||555 OAK ST^WAIKIKI^HI^91188||(626) 555-9988| PV1||O||| ORC|RE|r833376666kj^CIS|r833376666kjM1234^1|||||||||301836 900013^Henderson^Mike^P^^^^^1||(510) 267-2000||| OBR||r833376666kj^CIS|r833376666kjM1234^1|AST^AST(SGOT)||| 20008171100|||||||20008171100||301836900013^Henderson^M ike^P^^^^^1||||M1234||20008171100||HM|F||^^^^^R| OBX|1|NM|AST^AST(SGOT)||35|5-45|F|| 2/4/2001 2001 Annual HIMSS Conference and Exhibition 45 .3.FLEXILAB52|HI|CIS|HI|200008171101||ORU^R01|44 75|P|2.

ER/7 is used for HL7 Version 2 messages ! XML generally will be used for HL7 Version 3 messages ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 46 .The HL7 Messaging Standard Message structures ! Encoding of messages The “cosmetic” syntax of the message ! Not prescribed by the HL7 standard ! In practice.

The HL7 Messaging Standard Data types Philosophy ! Examples ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 47 .

The HL7 Messaging Standard What is a data type? An attribute of a data field ! The data type is used to ! Characterize information ! Validate information ! Associate related information ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 48 .

The HL7 Messaging Standard What is a data type? ! A data type may consist of Values ! Attributes ! • A component or field containing attributes is generally associated with another (generally previous) component or field containing values 2/4/2001 2001 Annual HIMSS Conference and Exhibition 49 .

The HL7 Messaging Standard Types of types ! Simple Values with understood constraints (if any) ! Identifiers from understood tables ! ! Complex Coded values and code sets ! Alpha/numeric values and attributes ! Multiple associated values and attributes ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 50 .

1|||AL|NE|| PID|||301836900017^^^1||Henderson^Mike^M||19510901|F|||555 OAK ST^WAIKIKI^HI^91188||(626) 555-9988| PV1||O||| ORC|RE|r833376666kj^CIS|r833376666kjM1234^1|||||||||301836 900013^Henderson^Mike^P^^^^^1||(510) 267-2000||| OBR||r833376666kj^CIS|r833376666kjM1234^1|AST^AST(SGOT)||| 200008171100-1000|||||||2000081711001000||301836900013^Henderson^Mike^P^^^^^1||||M1234||200 008171100-1000||HM|F||^^^^^R| OBX|1|NM|AST^AST(SGOT)||35|5-45|F|| 2/4/2001 2001 Annual HIMSS Conference and Exhibition 51 .3.The HL7 Messaging Standard Our sample message MSH|^~\&|LIS.FLEXILAB52|HI|CIS|HI|2000081711011000||ORU^R01|4475|P|2.

MSH segment definition SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 NAME 1 4 180 180 180 180 26 40 7 20 3 60 15 180 2 LEN ST ST HD HD HD HD TS ST CM ST PT VID NM ST ID ID ID ID CE ID DT R R O O O O O O R R R R O O O O O O O O Y OPT RP/# TBL# 00001 00002 00003 00004 00005 00006 00007 00008 00009 00010 00011 00012 00013 00014 00015 00016 00017 00692 00693 01317 ITEM # 0361 0362 0361 0362 0076 0003 0104 0155 0155 0211 0356 The HL7 Messaging Standard ELEMENT Field Separator Encoding Characters Sending Application Sending Facility Receiving Application Receiving Facility Date/Time Of Message Security Message Type Message Control ID Processing ID Version ID Sequence Number Continuation Pointer Accept Acknowledgment Type Application Acknowledgment Type Country Code Character Set Principal Language Of Message Alternate Character Set Handling Scheme 16 2 17 2 18 16 19 60 20 20 2/4/2001 2001 Annual HIMSS Conference and Exhibition 52 .

e. use escape sequences ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 53 . i.The HL7 Messaging Standard Data type ST Simple string ! Any printable 7-bit ASCII data. between 0x20 and 0x7E ! To send delimiter characters as literals outside MSH-1 and MSH-2..

The HL7 Messaging Standard Data type IS Coded value for user-defined tables ! Table number appears in segment definition. not in message ! ! (Example table: 0361 Sending/receiving application) ! Example field: PID-8-sex 2/4/2001 2001 Annual HIMSS Conference and Exhibition 54 .

The HL7 Messaging Standard Data type ID Coded value for HL7-defined tables ! Table number appears in segment definition. not in message ! ! (Example table: 0301 .Universal ID type) ! Example field: MSH-15-accept acknowledgment type 2/4/2001 2001 Annual HIMSS Conference and Exhibition 55 .

The HL7 Messaging Standard Data type HD ! ! Hierarchic designator Complex: 3 components ! ! ! namespace ID (IS) universal ID (IS) universal ID type (ID) Local with universal equivalent Member of a universal ID set ! One of two types of fields ! ! ! Example field: MSH-3-sending application 2001 Annual HIMSS Conference and Exhibition 56 2/4/2001 .

timezone offset ! degree of precision (for backward compatibility only) ! • Example: ‘YYYYMMDD’ 2/4/2001 2001 Annual HIMSS Conference and Exhibition 57 .The HL7 Messaging Standard Data type TS Time stamp ! Complex: 2 components ! date. time.

custombuilt complex data types ! Example: MSH-9-message type ! Message type (ID) ! Trigger event (ID) ! Message structure (ID) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 58 .The HL7 Messaging Standard Data type CM Composite ! Used for many different.

The HL7 Messaging Standard Data type PT Processing type ! Complex: 2 components ! processing ID (ID) ! processing mode (ID) ! ! Example: MSH-11-processing type 2/4/2001 2001 Annual HIMSS Conference and Exhibition 59 .

The HL7 Messaging Standard Data type CE ! ! Coded element Complex: 6 components ! ! ! ! ! ! Identifier (ID) Text (ST) Name of coding system (ST) Alternate identifier (ID) Alternate text (ST) Name of alternate coding system (ST) ! Example: MSH-19-principal language of message 2001 Annual HIMSS Conference and Exhibition 60 2/4/2001 .

The HL7 Messaging Standard Data type VID Version identifier ! Complex: 3 components ! version ID (ID) ! internationalization code (CE) ! international version ID (CE) ! ! Example: MSH-12-version ID 2/4/2001 2001 Annual HIMSS Conference and Exhibition 61 .

20 = 1.The HL7 Messaging Standard Data type NM Numeric ! Optional leading sign and insignificant zeros ! +01.2 ! Example: MSH-13-sequence number 2/4/2001 2001 Annual HIMSS Conference and Exhibition 62 .

PID Patient Name Mother’s Maiden Name Date/Time of Birth Sex Patient Alias Race Patient Address County Code Phone Number .The HL7 Messaging Standard PID segment definition SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 4 20 20 20 48 48 26 1 48 80 106 4 40 40 LEN SI CX CX CX XPN XPN TS IS XPN CE XAD IS XTN XTN CE DT O B R B R O O O O O O B O O O OPT RP/# TBL# 00104 00105 00106 00107 00108 00109 00110 00111 00112 00113 00114 00115 00116 00117 00118 ITEM# ELEMENT NAME Y Y Y Y 0001 Y Y Y Y Y 0296 0005 0289 Set ID .Business Primary Language 15 60 2/4/2001 2001 Annual HIMSS Conference and Exhibition 63 .Home Phone Number .PID Patient ID Patient Identifier List Alternate Patient ID .

The HL7 Messaging Standard

PID segment definition
SEQ 16 80 17 80 18 20 LEN CE CE CX DT O O O B O O O O O O O O O O O Y Y OPT RP/# 0002 0006 TBL# 00119 00120 00121 00122 00123 00124 00125 00126 00127 00128 00129 00130 00739 00740 00741 ITEM# ELEMENT NAME Marital Status Religion Patient Account Number SSN Number - Patient Driver's License Number Mother's Identifier Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veterans Military Status Nationality Patient Death Date and Time Patient Death Indicator

19 16 ST 20 25 DLN Patient 21 20 CX 22 80 CE 23 60 ST 24 1 ID 25 2 NM 26 80 CE 27 60 CE 28 80 29 26 30 1 CE TS ID

0189 0136

Y

0171 0172 0212

0136

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The HL7 Messaging Standard

Data type CX
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Extended composite ID with check digit Complex: 6 components
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ID (ST) check digit (ST) code identifying the check digit scheme employed (ID) assigning authority (HD) identifier type code (IS) assigning facility (HD)

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Example: PID-3-patient identifier list

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The HL7 Messaging Standard

Data type XPN
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Extended person name Complex: 8 components
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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)

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Example: PID-5-patient name
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The HL7 Messaging Standard Data type XAD ! ! Extended address Complex: 11 components ! ! ! ! ! ! ! ! ! ! ! street address (ST) other designation (ST) city (ST) state or province (ST) zip or postal code (ST) country (ID) address type (ID) other geographic designation (ST) county/parish code (IS) census tract (IS) address representation code (ID) ! Example: PID-11-patient address 2001 Annual HIMSS Conference and Exhibition 67 2/4/2001 .

The HL7 Messaging Standard Data type XTN ! ! Extended telecommunication number Complex: 9 components ! ! ! ! ! ! ! ! ! [NNN] [(999)]999-9999 [X9999] [B9999] [C any text] telecommunication use code (ID) telecommunication equipment type (ID) email address (ST) country code (NM) area/city code (NM) phone number (NM) extension (NM) any text (ST) ! Example: PID-13-phone number-home 2001 Annual HIMSS Conference and Exhibition 68 2/4/2001 .

1962 2/4/2001 2001 Annual HIMSS Conference and Exhibition 69 .The HL7 Messaging Standard Data type DT Date ! Format: YYYY[MM[DD]] ! Examples: ! |200010| = October 2000 |19620910| = September 10.

The HL7 Messaging Standard Data type DLN Driver’s license number ! Complex: 3 components ! license number (ST) ! issuing state. province. country (IS) ! expiration date (DT) ! ! Example: PID-20-driver’s license number – patient 2/4/2001 2001 Annual HIMSS Conference and Exhibition 70 .

The HL7 Messaging Standard Question Break #1 2/4/2001 2001 Annual HIMSS Conference and Exhibition 71 .

The HL7 Messaging Standard Messages within domains ! ! ! ! ! ! ! Chapter 3 (Patient Administration) Chapter 4 (Orders) Chapter 5 (Query) Chapter 6 (Financial Management) Chapter 7 (Observation Reporting) Chapter 8 (Master Files) Chapter 9 (Document Management) ! ! ! ! ! ! Chapter 10 (Scheduling) Chapter 11 (Patient Referral) Chapter 12 (Patient Care) Chapter 13 (Clinical Laboratory Automation) Chapter 14 (Application Management) Chapter 15 (Personnel Management) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 72 .

Chapter 3 (Patient Administration) ! The HL7 Messaging Standard Purpose ! ! Transmit new or updated demographic and visit information about patients Information typically entered into an administrative system and transmitted to clinical/administrative ancillaries • Unsolicited updates (generator) • Record-oriented query responses (filler) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 73 .

Chapter 3 (Patient Administration) ! The HL7 Messaging Standard Messages ADT (62 varieties) ! QRY (old-style queries) ! QBP (conformance-based queries) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 74 .

Chapter 3 (Patient Administration) ! ! ! ! ! ! ! 2/4/2001 The HL7 Messaging Standard Some ADT messages Event A01: admit/visit notification Event A17: swap patients Event A28: add person or patient information Event A39: merge person – patient ID Event A54: change attending doctor Event A60: update adverse reaction information 75 2001 Annual HIMSS Conference and Exhibition .

The HL7 Messaging Standard Chapter 4 (Orders) ! Purpose ! Provide for transmission of orders or information about orders ! Participants Order entry applications (placers) ! Clinical ancillaries (fillers) ! Others as needed (interested third parties) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 76 .

The HL7 Messaging Standard Chapter 4 (Orders) ! What is an order? ! A request for • Material • • • • • Medication Food Films Linens Supplies 2/4/2001 2001 Annual HIMSS Conference and Exhibition 77 .

The HL7 Messaging Standard Chapter 4 (Orders) ! What is an order? (cont’d) ! A request for • Services • Clinical observations • Tests • Medication and other orders 2/4/2001 2001 Annual HIMSS Conference and Exhibition 78 .

floor stock) are also accommodated ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 79 ..g.The HL7 Messaging Standard Chapter 4 (Orders) ! What is an order? (cont’d) Usually for a specific patient ! Bulk orders (e.

The HL7 Messaging Standard Chapter 4 (Orders) ! General messages ORM (general order) ! ORR (general response) ! OSQ (order status query) ! OSR (order status response) ! OMG (general clinical order) ! ORG (general clinical order acknowledgment) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 80 .

The HL7 Messaging Standard Chapter 4 (Orders) ! Services having specific messages Laboratory ! Dietary ! Pharmacy ! Supply ! Vaccination ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 81 .

The HL7 Messaging Standard

Chapter 5 (Query)
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Purpose
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To allow data to be made available in one or more of several standard formats
• Message-based (segment pattern) • Tabular • Display

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To allow the fulfilling system to state what parameters may be specified by the Client system

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The HL7 Messaging Standard

Chapter 5 (Query)
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Purpose (cont’d)
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To maximize “plug-and-play” interoperability by implementing the concept of conformance
• Currently by means of a conformance statement • Control/Query Technical Committee is working with Conformance Special Interest Group to integrate this into the conformance profile

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The HL7 Messaging Standard

Chapter 5 (Query)
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Messages
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QBP (query by parameter)
• May include SQL or other query language if specified in Conformance Statement

! ! ! ! ! ! !

RSP (segment pattern response) RTB (tabular response) RDY (display response) QSB (create subscription) QVR (query for previous events) QCN (cancel query) QSX (cancel subscription)
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g. e.Chapter 6 (Financial Management) ! The HL7 Messaging Standard Purpose ! To facilitate patient accounting.: • Billing accounts • Charges • Payments • Adjustments • Insurance 2/4/2001 2001 Annual HIMSS Conference and Exhibition 85 .

Chapter 6 (Financial Management) ! The HL7 Messaging Standard Methodology Transactions may be generated in batch or in real time ! HL7 standard includes all data in National Uniform Billing Field Specifications ! Standard also accommodates the use of “Z” segments to meet state and other regulatory requirements ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 86 .

Chapter 6 (Financial Management) ! The HL7 Messaging Standard Messages ! BAR (billing account transaction) • • • • • Add (event P01) Purge (event P02) Update (event P05) End (event P06) Transmit APC groups (event P07) ! ! ! QRY (generate bills query) DSR (generate bills response) DFT (post detailed financial transactions) 2001 Annual HIMSS Conference and Exhibition 87 2/4/2001 .

e.g.Chapter 7 (Observation Reporting) ! The HL7 Messaging Standard Purpose ! ! ! To send structured patient-oriented clinical data between systems To associate these data in batteries of related results To facilitate the use of standard vocabularies.: • CPT4 • LOINC™ • SNOMED International 2/4/2001 2001 Annual HIMSS Conference and Exhibition 88 .

Chapter 7 (Observation Reporting) ! The HL7 Messaging Standard Examples of reports ! ! ! ! ! ! ! ! ! Laboratory 12-lead EKG Cardiac echo Obstetrical ultrasound Radiology History and physical findings Tumor registry Vital signs Intake and outputs 2001 Annual HIMSS Conference and Exhibition 89 2/4/2001 .

even if the order was not automatically generated 2001 Annual HIMSS Conference and Exhibition 90 2/4/2001 . units. and reference ranges Definitions of status and abnormal flags are common Every report has an associating OBR (observation request) segment.Chapter 7 (Observation Reporting) ! The HL7 Messaging Standard Methodology ! ! ! ! Each result is reported in its own OBX (observation/result) segment Each OBX segment may have its own data type.

Chapter 7 (Observation Reporting) ! The HL7 Messaging Standard Messages ! ! ! ! ! ! ! ORU (unsolicited observation) OUL (unsolicited laboratory observation) ORF (observational report) CRM (clinical study registration) CSU (unsolicited study data) PEX (product experience) SUR (summary product experience) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 91 .

The HL7 Messaging Standard Chapter 8 (Master Files) ! Purpose ! To facilitate synchronization of common reference files • Informational messages by the owning system • Update request messages by ancillary systems 2/4/2001 2001 Annual HIMSS Conference and Exhibition 92 .

) lab test definition exam code (radiology) definition charge master patient status master patient type master service item master 2001 Annual HIMSS Conference and Exhibition 93 2/4/2001 . etc.The HL7 Messaging Standard Chapter 8 (Master Files) ! Master file type examples ! ! ! ! ! ! ! ! ! ! staff and health practitioner master system user (and password) master location (census and clinic) master device type and location (e. terminals.g.. workstations. printers.

The HL7 Messaging Standard Chapter 8 (Master Files) ! Methodology Limited number of explicitly defined messages and segments ! Support for use of “Z” segments to transmit institution-specific information ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 94 .

The HL7 Messaging Standard Chapter 8 (Master Files) ! Messages MFN (master file notification) ! MFK (master file notification acknowledgment) ! MFD (master file delayed acknowledgment) ! MFQ (master file query) ! MFR (master file response) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 95 .

: ! • chart location and tracking • deficiency analysis • consents • release of information 2001 Annual HIMSS Conference and Exhibition 2/4/2001 96 .The HL7 Messaging Standard Chapter 9 (Medical Records/Information Management) ! Purpose Current: document management ! Future: other medical record functions.g. e.

and legible document that serves as a comprehensive account of healthcare services provided to a patient 2/4/2001 2001 Annual HIMSS Conference and Exhibition 97 .The HL7 Messaging Standard Chapter 9 (Medical Records/Information Management) ! Philosophy ! To facilitate the production of an accurate. legal.

The HL7 Messaging Standard Chapter 9 (Medical Records/Information Management) ! Assumptions ! ! ! The application system is responsible for meeting all legal requirements (on the local. and document numbers and file names are not reused Documents may be associated with one or more orders 2001 Annual HIMSS Conference and Exhibition 98 2/4/2001 . and federal levels) in the areas of document authentication. state. and retention All documents are unique. confidentiality.

The HL7 Messaging Standard Chapter 9 (Medical Records/Information Management) ! Trigger events for the MDM message ! ! ! ! Original document notification (T01) Original document notification and content (T02) Document status change notification (T03) Document status change notification and content (T04) 2001 Annual HIMSS Conference and Exhibition 2/4/2001 99 .

The HL7 Messaging Standard Chapter 9 (Medical Records/Information Management) ! Trigger events for the MDM message (cont’d) ! ! ! ! ! ! ! Document addendum notification (T05) Document addendum notification and content (T06) Document edit notification (T07) Document edit notification and content (T08) Document replacement notification (T09) Document replacement notification and content (T10) Document cancel notification (T11) 2001 Annual HIMSS Conference and Exhibition 100 2/4/2001 .

The HL7 Messaging Standard Chapter 10 (Scheduling) ! Purpose ! Communicating various events related to the scheduling of appointments • For services • For the use of resources 2/4/2001 2001 Annual HIMSS Conference and Exhibition 101 .

The HL7 Messaging Standard Chapter 10 (Scheduling) ! Messages ! ! ! ! ! SRM (schedule request) SRR (schedule request response) SIU (schedule information unsolicited) SQM (schedule query message) SQR (schedule query response) 102 2/4/2001 2001 Annual HIMSS Conference and Exhibition .

The HL7 Messaging Standard Chapter 10 (Scheduling) ! Examples of trigger events Request new appointment booking (S01) ! Request modification of service/resource on appointment (S08) ! Notification of appointment discontinuation (S16) ! Notification that patient did not show up for scheduled appointment (S26) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 103 .

Chapter 11 (Patient Referral) ! The HL7 Messaging Standard Purpose ! To facilitate patient referrals and inquiries between mutually exclusive healthcare entities 2/4/2001 2001 Annual HIMSS Conference and Exhibition 104 .

Chapter 11 (Patient Referral) ! The HL7 Messaging Standard Participant examples Primary care providers ! Specialists ! Payors ! Government agencies ! Hospitals ! Labs ! 2001 Annual HIMSS Conference and Exhibition 2/4/2001 105 .

Chapter 11 (Patient Referral) ! The HL7 Messaging Standard Philosophy Different entities possess (or have access to) differing amounts of patient data ! Referrals must contain sufficient identification information to satisfy all these entities’ needs ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 106 .

Chapter 11 (Patient Referral) ! The HL7 Messaging Standard Messages RQI (request patient information) ! RPI (return patient information) ! RPL (return patient display list) ! RPR (return patient list) ! RQP (request patient demographics) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 107 .

Chapter 11 (Patient Referral) ! The HL7 Messaging Standard Messages (cont’d) ! ! ! ! ! ! ! ! RQC (request clinical information) RCI (return clinical information) RCL (return clinical list) PIN (patient insurance information) RQA (request patient authorization) RPA (return patient authorization) REF (patient referral) RRI (return referral information) 2001 Annual HIMSS Conference and Exhibition 108 2/4/2001 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Purpose ! To support the communication of patient-specific data in problemoriented records • Clinical problems • Goals • Pathway information 2/4/2001 2001 Annual HIMSS Conference and Exhibition 109 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Possible care settings ! ! ! ! ! ! ! ! Acute care Clinic care Long-term care Residential care Home health care Office practices School-based care Community settings 2001 Annual HIMSS Conference and Exhibition 110 2/4/2001 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Clinical pathway ! A standardized plan of care against which progress towards health is measured 2/4/2001 2001 Annual HIMSS Conference and Exhibition 111 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Clinical pathway (cont’d) Applied based upon the results of a patient assessment ! Shows exact timing of all key patient care activities intended to achieve expected standard outcomes within designated time frames ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 112 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Clinical pathway (cont’d) ! Included elements • Documentation of problems • Expected outcomes/goals • Clinical interventions/orders 2/4/2001 2001 Annual HIMSS Conference and Exhibition 113 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Messages PGL (patient goal message) ! PPR (patient problem message) ! PPP (patient pathway problem-oriented message) ! PPG (patient pathway goaloriented message) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 114 .

The HL7 Messaging Standard Chapter 12 (Patient Care) ! Messages (cont’d) PRR (patient problem response) ! PPV (patient goal response) ! PTR (patient pathway problem-oriented response) ! PPT (patient pathway goal-oriented response) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 115 .

Chapter 13 (Clinical Laboratory Automation) ! The HL7 Messaging Standard Purpose ! Laboratory information system integration (“total automation”) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 116 .

Chapter 13 (Clinical Laboratory Automation) ! The HL7 Messaging Standard Participants ! ! ! Automated or robotic transport systems Analytical instruments Pre. e.or post-analytical process equipment.g.: • • • • • Automated centrifuges Aliquotters Decappers and recappers Sorters Specimen storage and retrieval systems 2001 Annual HIMSS Conference and Exhibition 117 2/4/2001 .

Chapter 13 (Clinical Laboratory Automation) ! The HL7 Messaging Standard Messages ESU (equipment status update) ! ESR (equipment status request) ! SSU (specimen status update) ! SSR (specimen status request) ! INU (equipment inventory update) ! INR (equipment inventory request) ! 2001 Annual HIMSS Conference and Exhibition 2/4/2001 118 .

Chapter 13 (Clinical Laboratory Automation) ! The HL7 Messaging Standard Messages (cont’d) EAC (equipment command) ! EAR (equipment response) ! EAN (equipment notification) ! TCU (test code settings update) ! TCR (test code settings request) ! LSU (log/service update) ! LSR (log/service request) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 119 .

Chapter 14 (Application Management) ! The HL7 Messaging Standard Purpose ! To provide a means to manage HL7supporting applications over a network • Clock synchronization • Statistical aggregation • Application migration/load balancing • Application “ping” 2001 Annual HIMSS Conference and Exhibition 2/4/2001 120 .

Chapter 14 (Application Management) ! The HL7 Messaging Standard Messages NMQ (application management query) ! NMD (application management data) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 121 .

Chapter 15 (Personnel Management) ! The HL7 Messaging Standard Purpose ! Transmission of new or updated healthcare administration information about: • individual healthcare practitioners • supporting staff members 2/4/2001 2001 Annual HIMSS Conference and Exhibition 122 .

Chapter 15 (Personnel Management) ! The HL7 Messaging Standard Some interesting events Hiring and firing ! Sabbaticals and leaves of absence ! Role assumption and termination ! Professional affiliation ! Education and certification ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 123 .

Chapter 15 (Personnel Management) ! The HL7 Messaging Standard Trigger events for the PMU message B01 ! B02 ! B03 ! B04 ! B05 ! B06 ! (add personnel record) (update personnel record) (delete personnel record) (activate practicing person) (deactivate practicing person) (terminate practicing person) 2001 Annual HIMSS Conference and Exhibition 2/4/2001 124 .

The HL7 Messaging Standard Question Break #2 2/4/2001 2001 Annual HIMSS Conference and Exhibition 125 .

The HL7 Messaging Standard The HL7 Version 3 Message Development Framework Introduction ! Principles ! Managing message development ! Use case model ! Information model ! 2001 Annual HIMSS Conference and Exhibition 2/4/2001 126 .

The HL7 Messaging Standard The HL7 Version 3 Message Development Framework Vocabulary domains ! Interaction model ! Conformance claims ! Creating message specifications ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 127 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Introduction Systematic process for defining messages ! Follows software development lifecycle ! Requirements ! Analysis ! Implementation ! 2001 Annual HIMSS Conference and Exhibition 2/4/2001 128 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Introduction ! Replaces ad hoc “methodology” of Version 2 messaging Unclear structural relationships ! Semantic inconsistencies ! Heavy optionality ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 129 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Introduction ! Methodology Requirements definition ! Structural analysis ! Behavioral analysis ! Message specification ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 130 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Introduction ! Methodology sources Ivar Jacobson ! Rumbaugh & Booch (Unified Method) ! Peter Coad ! Ed Yourdon ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 131 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Principles ! Support for legacy systems ! “Open systems” conformity not required ! Support for prior versions Translation will be required between V3 and V2 ! V3 will be revised via compatible enhancement ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 132 .

etc. e.The HL7 Messaging Standard HL7 V3 Message Development Framework Principles ! Conformance determination ! Application role definition. ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 133 .g.: • Lab order sender • Lab order filler • Enterprise patient identification store Implementers may make conformance claims to one or more roles ! HL7 may also create conformance profiles for encoding rules.

The HL7 Messaging Standard HL7 V3 Message Development Framework Principles ! Support for confidentiality and security Confidentiality and integrity ! Service authentication and authorization ! Non-repudiation ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 134 .

both in an unforgeable relationship. which can be verified by any third party at any time • an authentication that with high assurance can be asserted to be genuine. and that can not subsequently be refuted 2/4/2001 2001 Annual HIMSS Conference and Exhibition 135 .The HL7 Messaging Standard HL7 V3 Message Development Framework Principles ! Support for confidentiality and security (cont’d) ! Non-repudiation • a service that provides proof of the integrity and origin of data.

The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Constructs Use cases. state diagrams ! Reference Information Model ! Interaction model ! Hierarchical Message Definitions ! Implementation Technology Specifications ! 2001 Annual HIMSS Conference and Exhibition 2/4/2001 136 .

state diagrams ! Provide context to the definitions of trigger events 2/4/2001 2001 Annual HIMSS Conference and Exhibition 137 .The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Use cases.

The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Reference Information Model Specifies information content of messages ! Clarifies definitions ! Ensures that definitions are used consistently across messages ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 138 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Interaction model ! Specifies responsibilities • For senders • For receivers 2/4/2001 2001 Annual HIMSS Conference and Exhibition 139 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Hierarchical Message Definitions ! The exact fields of a message • Description • Grouping • Sequence • Optionality • Cardinality 2/4/2001 2001 Annual HIMSS Conference and Exhibition 140 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Managing message development ! Implementation Technology Specifications ! Syntax descriptions for encoding of messages • XML • Object-oriented • Encoding Rules/7 (“railroad tracks”) ! Different formats shall be functionally interchangable 2001 Annual HIMSS Conference and Exhibition 141 2/4/2001 .

to produce a product of value for the Actor 2/4/2001 2001 Annual HIMSS Conference and Exhibition 142 .The HL7 Messaging Standard HL7 V3 Message Development Framework Use case model ! Description (cf. Jacobson) ! An interaction between the system and an Actor that causes the system to fulfill a responsibility and. as a result.

The HL7 Messaging Standard HL7 V3 Message Development Framework Use case model Healthcare Information System Billing ADT Establish Pt Admit Admission Patient Care Send Pt BIlling Change Patient Clinical 2/4/2001 2001 Annual HIMSS Conference and Exhibition 143 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model Defines all information from which message content is drawn ! Object-oriented organization ! Classes ! Attributes ! Associations ! Shared view across messages ! Facilitates consistent definition ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 144 .

relationships ! State-transition models (where appropriate) ! Data types and constraints ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 145 .The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Content Classes. attributes.

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Types of information model ! Domain Information Model (DIM) • Supports work of a specific Technical Committee. Special Interest Group. or project ! Reference Information Model (RIM) • For the collective work of HL7 ! Message Information Model (MIM) • Data content of one or more messages 2001 Annual HIMSS Conference and Exhibition 2/4/2001 146 .

* 1 sees Physician 2/4/2001 2001 Annual HIMSS Conference and Exhibition 147 . 0..The HL7 Messaging Standard HL7 V3 Message Development Framework Information model Patient has 0.. has_phys.* has_pat..* sees Physician a Logical View Patient b has 1 0.. Pat-Phys-Assn.* 0.

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Class attributes Identifier ! Classifier ! State ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 148 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Data types Principal value sets for attributes ! Value set relations and structures ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 149 .

: • “not present” • No information • Not applicable • Not asked • Unknown ! Constraints 2001 Annual HIMSS Conference and Exhibition 150 2/4/2001 . e.The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Data types (cont’d) ! Formal representations for missing information.g.

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! States and transitions ! State • Condition that can be tested by examining attributes and associations ! Transition • Change in state by virtue of a change in attribute(s) and/or association(s) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 151 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model revise Not Done abort New create start In Progress finish redo Done purge skip 2/4/2001 2001 Annual HIMSS Conference and Exhibition 152 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Information model ! Modeling activities Construct/refine Domain Information Model ! Update/Harmonize Reference Information Model ! Construct Message Information Model ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 153 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! Definition ! A vocabulary domain is the set of allowed concepts for a coded field • Note: Concept ≠ value • M (sex/gender) = male • M (marital status) = married ! Compare with the definition of data type 2001 Annual HIMSS Conference and Exhibition 2/4/2001 154 .

e.The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! Why? ! ! ! To increase semantic understanding To enhance interoperability To facilitate processes.: • • • • Direct patient care Outcomes analysis and research Generation of alerts and reminders Other kinds of decision support processes 2/4/2001 2001 Annual HIMSS Conference and Exhibition 155 .g.

organizational environment May be qualified by Realm ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 156 . geographical.The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! ! May be extensible ! To allow use of local coding schemes Political.

The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! Requirements ! ! ! ! ! ! ! ! Unique. non-semantic identifier Unique textual name May have textual description Version tracking May be specific to Realm Value sets come from single vocabulary • Value set definition requires coding system context Value sets may be recursively defined Set notation shows derivation of value sets 2001 Annual HIMSS Conference and Exhibition 157 2/4/2001 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! Possible coding system examples CPT-4 ! LOINC™ ! SNOMED International ! MEDCIN ! ICD-9 ! Read Codes ! Many others! ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 158 .

g.240.20910.The HL7 Messaging Standard HL7 V3 Message Development Framework Vocabulary domains ! Vocabularies identified by OIDs (object identifiers) ! Internet-like addresses.: • 3.6254441 ! Applicable both to HL7-maintained and local vocabularies ! HL7-maintained vocabularies included in UMLS Metathesaurus 2/4/2001 2001 Annual HIMSS Conference and Exhibition 159 . e.4.

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model Describes parties that interchange HL7 messages ! Describes interactions between parties ! Supports requirements definition ! Facilitates conformance claims ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 160 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Steps Identify interactions ! Define interactions ! Validate interactions for conformance claims ! Group interactions into sets ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 161 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Elements Trigger events ! Application roles ! Interactions ! Interaction sequences ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 162 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Trigger event An occurrence causing information to be exchanged ! Derived from state models ! Exception: queries ! • Based upon “need to know” 2/4/2001 2001 Annual HIMSS Conference and Exhibition 163 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Application role Definition of sender or receiver without regard to functionality ! Tool to analyze relationships between messages and RIM classes ! A way to define interoperable messages ! Foundation for conformance claims ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 164 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Application role (cont’d) ! Provides context for messaging modes • Declarative (declarer-recipient) • Imperative (placer-filler) • Interrogative (questioner-answerer) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 165 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Interaction ! ! ! Transfer of information from sending role to receiving role Supported by a Hierarchical Message Definition (HMD) Creates a combination of • • • • Trigger event Sender application role Receiver application role Receiver responsibility 2001 Annual HIMSS Conference and Exhibition 166 2/4/2001 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Interaction model ! Interaction sequence Multiple. coupled interactions associated with a single trigger event ! Example ! • Order entry system places test order • Laboratory information system returns filler order number ! May also facilitate transmission (broadcast) to multiple receivers 2001 Annual HIMSS Conference and Exhibition 167 2/4/2001 .

perform the receiver responsibilities 2001 Annual HIMSS Conference and Exhibition 2/4/2001 168 .The HL7 Messaging Standard HL7 V3 Message Development Framework Conformance claims ! Assertions that a system will ! ! ! Send certain HL7 messages to other systems that conform to certain other application roles in response to certain trigger events Receive certain HL7 messages from other systems that conform to certain other application roles Upon receipt of certain messages.

The HL7 Messaging Standard HL7 V3 Message Development Framework Creating message specifications ! Work products Message Information Model (MIM) ! Refined Message Information Model (RMIM) ! Hierarchical Message Definition (HMD) ! Common Message Element Type (CMET) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 169 .

The HL7 Messaging Standard Defining a Message Structure Reference Information Model Use Case Model Interaction Model Domain Information Model Mess age Information Model Refined Mess age Information Model Hierarchical Mess age Description Common Mess age Element Definition ITS Sending a Message Instance Implementation Technology Specifications HL7 Mess age Creation Data Message Instance HL7 Mess age Parsing Data HL7-Conformant Application HL7-Conformant Application 2/4/2001 2001 Annual HIMSS Conference and Exhibition 170 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Creating message specifications ! Message Information Model (MIM) Contains RIM classes and relationships ! Describes a logically connected group of message types ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 171 .

1 marital_status_cd : CV race_cd : CV religious_aff iliation_cd : CV v ery _important_person_cd : CV has Individual_healthcare_practitioner id : II practitioner_ty pe_cd : CV residency _f ield_cd : CV participates_as is_participant_f or is_role_of 0..* is_the_primary _prov ider_f or 0.The HL7 Messaging Standard Stakeholder addr : AD id : SET<II> phon : TEL ty pe_cd : CV Healthcare_service_provider specialty _cd : CV Person administrativ e_gender_cd : CV birth_dttm : TS citizenship_country _cd : CV deceased_dttm : TS takes_on_role_of deceased_ind : BL ethnic_group_cd : CV 1....1 is_f or 0....1 is_associated_with has_as_participant 0.1 cd : CV eff ectiv e_dt : TS nm : PN purpose_cd : CV termination_dt : TS ty pe_cd : CV Patient_encounter encounter_classif ication_cd : CV end_dttm : TS expected_insurance_plan_qty : INT f irst_similar_illness_dttm : TS id : II start_dttm : TS status_cd : CV belongs_to Patient_billing_account Inpatient_encounter actual_day s_qty : INT estimated_days_qty : INT account_id : II billing_status_cd : CV patient_f inancial_class_cd : CV price_schedule_id : II 2/4/2001 2001 Annual HIMSS Conference and Exhibition 172 .* has_a_primary _prov ider Patient inv olv es 0.* 1...1 1.* 1.1 Encounter_practitioner participation_ty pe_cd : CV 1...1 0.1 1...1 takes_on_role_of 1.* id : II is_inv olv ed_in status_cd : CV has 1...1 0.* Person_name is_a_role_of 0..

The HL7 Messaging Standard HL7 V3 Message Development Framework Creating message specifications ! Refined Message Information Model (R-MIM) ! Constrains the MIM for use in specific instances • Cardinality • Optionality • Vocabulary ! Direct parent of the HMD 2001 Annual HIMSS Conference and Exhibition 173 2/4/2001 .

1 participates_as Patient_encounter encounter_classification_cd : CV end_dttm : TS expected_insurance_plan_qty : INT first_similar_illness_dttm : TS id : II start_dttm : TS status_cd : CV has_a_primary_provider 0.* involves 1 is_a_role_of 0.1 Patient is_for is_for Person_as_IHCP addr : AD id : SET<II> phon : TEL 1.1 is_participant_for is_associated_with 1..* Encounter_practitioner participation_type_cd : CV 0..* belongs_to has_as_participant 1...1 has 1......1 takes_on_role_of 1.* has 1..1 has 0.1 takes_on_role_of One per message instance 0..1 is_role_of Individual_healthcare_practitioner id : II practitioner_type_cd : CV residency_field_cd : CV specialty_cd : CV is_the_primary_provider_for 0.1 Person_as_Patient administrative_gender_cd : CV birth_dttm : TS citizenship_country_cd : CV deceased_dttm : TS deceased_ind : BL ethnic_group_cd : CV marital_status_cd : CV race_cd : CV religious_affiliation_cd : CV very_important_person_cd : CV addr : AD id : SET<II> phon : TEL type_cd : CV 1.* 0.The HL7 Messaging Standard Person_name_for_IHCP cd : CV nm : PN purpose_cd : CV type_cd : CV Person_name_for_Patient cd : CV effective_dt : TS nm : PN purpose_cd : CV termination_dt : TS type_cd : CV 0....* Patient_billing_account account_id : II billing_status_cd : CV patient_financial_class_cd : CV price_schedule_id : II Inpatient_encounter actual_days_qty : INT estimated_days_qty : INT 2/4/2001 2001 Annual HIMSS Conference and Exhibition 174 ...1 1 id : II is_involved_in status_cd : CV 1.

The HL7 Messaging Standard HL7 V3 Message Development Framework Creating message specifications ! Hierarchical Message Description (HMD) Information model mapping ! Message elements ! General constraints and defaults ! Message type definitions ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 175 .

The HL7 Messaging Standard source of msg element type of msg element type New type Clin ical_document_ header Data type CV New type Authentication Data type TS New type Healthcare_document _authenticator New type Organization Data type ST Data type ADDR Recursion Organization row type class attr assoc msg element name Clin ical_document_header availability_status_cd in msg element type Message on attr assoc assoc attr attr assoc Clin ical_document_ header is_related_to_Authenticati Clin ical_document_ header Authentication authentication_dttm is_source_of_Healthcare_ Authentication Document_authenticator Healthcare_Docu ment is_a_Organization _authenticator Organization organization_nm Organization addr is_a_subdivision_of Organization _Organization 2/4/2001 2001 Annual HIMSS Conference and Exhibition 176 .

The HL7 Messaging Standard HL7 V3 Message Development Framework Creating message specifications ! Common Message Element Type (CMET) Rows from an HMD corresponding to a single message element ! Abstracted from HMD for reuse in other messages ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 177 .

The HL7 Messaging Standard Question Break #3 2/4/2001 2001 Annual HIMSS Conference and Exhibition 178 .

The HL7 Messaging Standard Encoding rules Encoding Rules/7 (ER/7) ! Extensible Markup Language (XML) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 179 .

plain-text set of encoding rules ! Does not constrain field lengths or repetitions (these are defined by the segment and message definitions) ! Encoding/decoding information provided in MSH segment ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 180 .The HL7 Messaging Standard Message encoding in ER/7 A delimited.

FLEXILAB52|HI|CIS|HI|200008171101||ORU^R01|44 75|P|2.The HL7 Messaging Standard Message encoding in ER/7 MSH|^~\&|LIS.1|||AL|NE|| PID|||301836900017^^^1||Henderson^Mike^M||19510901|F|||555 OAK ST^WAIKIKI^HI^91188||(626) 555-9988| PV1||O||| ORC|RE|r833376666kj^CIS|r833376666kjM1234^1|||||||||301836 900013^Henderson^Mike^P^^^^^1||(510) 267-2000||| OBR||r833376666kj^CIS|r833376666kjM1234^1|AST^AST(SGOT)||| 200008171100|||||||200008171100||301836900013^Henderson^ Mike^P^^^^^1||||M1234||200008171100||HM|F||^^^^^R| OBX|1|NM|AST^AST(SGOT)||35|5-45|F|| 2/4/2001 2001 Annual HIMSS Conference and Exhibition 181 .3.

not between segments (although included on these slides for readability) ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 182 .The HL7 Messaging Standard Message encoding in ER/7 Segments delimited by ASCII 13 (carriage return) ! CAUTION: ASCII 10 (newline) occurs only between messages.

3.1|||AL|NE|| ! ! Bytes 1-3 (the segment header) must be valued ‘MSH’ for the first segment of the message Byte 4 of this segment is the field separator ! Used as primary delimiter for all fields in all segments of the message ! The following bytes up to the next field separator define the delimiters for sub-entities of the fields 2/4/2001 2001 Annual HIMSS Conference and Exhibition 183 .The HL7 Messaging Standard Message encoding in ER/7 MSH|^~\&|LIS.FLEXILAB52|HI|CIS|HI|200008171101||ORU^R01|44 75|P|2.

which can be addressed by the use of XML encoding 2001 Annual HIMSS Conference and Exhibition 184 2/4/2001 .The HL7 Messaging Standard Message encoding in ER/7 MSH|^~\&|LIS. This is a known limitation of ER/7. etc.3.FLEXILAB52|HI|CIS|HI|200008171101||ORU^R01|44 75|P|2.1|||AL|NE|| ! ! ! ! Encoding character Encoding character Encoding character Encoding character separator ! 1: 2: 3: 4: component separator repetition separator escape character subcomponent ! There’s no specified provision for ‘sub-subcomponents’.

3.1|||AL|NE|| ! ! ER/7 recommends the use of the encoding characters underlined above CAUTION: the receiving system must be able to accept and process any encoding characters transmitted by the sending system! ! This is the responsibility of the receiving system 2/4/2001 2001 Annual HIMSS Conference and Exhibition 185 .FLEXILAB52|HI|CIS|HI|200008171101|| ORU^R01|4475|P|2.The HL7 Messaging Standard Message encoding in ER/7 MSH|^~\&|LIS.

The HL7 Messaging Standard Message encoding in ER/7 An example of a complex field: …|99912121^LARSON&GREG&J^KFH\&HP~343434^LAR SON&GREGORY&JOSEPH^KPSCAL|… ! ! ! ! ! A hypothetical identifier field Contains two repetitions (~) Each repetition contains three components (^) The name component contains three subcomponents (&) The abbreviation KFH&HP must have the ampersand escaped (\) to avoid its being interpreted as a subcomponent separator 2/4/2001 2001 Annual HIMSS Conference and Exhibition 186 .

The HL7 Messaging Standard Message encoding in XML ! European Committee for Standardization (CEN) 1993 study compared several interchange formats for healthcare messaging.1 ASTM EDIFACT EUCLIDES ODA 2001 Annual HIMSS Conference and Exhibition 187 2/4/2001 . including: ! ! ! ! ! ASN.

The HL7 Messaging Standard Message encoding in XML A subsequent study extended the comparison to include Standard Generalized Markup Language (SGML) ! SGML was found to compare favorably ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 188 .

The HL7 Messaging Standard Message encoding in XML XML recommendation issued by World Wide Web Consortium (W3C) in 1998 ! XML encoding of HL7 messages has been successfully tested in 1999 and 2000 at HIMSS ! Visit the HL7 booth at this meeting to see the 2001 demo ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 189 .

The HL7 Messaging Standard Message encoding in XML ! Advantages of XML A well-recognized information interchange format ! Free parsers available on Web ! • James Clark’s NSGMLS 2/4/2001 2001 Annual HIMSS Conference and Exhibition 190 .

The HL7 Messaging Standard Message encoding in XML ! Advantages of XML (cont’d) ! Structures supported by programming languages and other technologies.g.: • Document Object Model (DOM) • Simple API for XML (SAX) • Various Perl modules 2/4/2001 2001 Annual HIMSS Conference and Exhibition 191 . e.

The HL7 Messaging Standard Message encoding in XML ! Advantages of XML (cont’d) ! Produces browseable documents • Browsers beginning to support Document Type Definitions (DTDs)/schemas directly • Documents may be converted into Extensible HyperText Markup Language (HTML) using Extensible Stylesheet Language Transformations (XSLT) 2/4/2001 2001 Annual HIMSS Conference and Exhibition 192 .

The next slide will show the XML representation (in 2 columns).1<CR> MSA|AA|ZZ9380<CR> 2/4/2001 2001 Annual HIMSS Conference and Exhibition 193 .3. MSH|^~\&|LAB^foo^bar|767543|ADT|767543|1990031413040 5||ACK^|XX3657|P|2.The HL7 Messaging Standard Message encoding in XML ! The following is a simple Version 2 acknowledgment message in ER/7.

1> <HD.1>P</PT.1>767543</HD.dtd"> <ACK> <MSH> <MSH.6> <HD.7>19900314130405</MSH.1>767543</HD.6> <MSH.12> <VID.10> <MSH.2>foo</HD.1> </MSH.9> <MSH.4> <HD.9> <CM_MSG_TYPE.5> <MSH.5> <HD.2> </MSA> </ACK> 2/4/2001 2001 Annual HIMSS Conference and Exhibition 194 .1>ADT</HD.1> </MSH.2>ZZ9380</MSA.1>ACK</CM_MSG_TYPE .12> </MSH> <MSA> <MSA.1>|</MSH.7> <MSH.3.2> <MSH.1> </MSH.1>AA</MSA.1>LAB</HD.</MSH.3>bar</HD.3> <HD.4> <MSH.11> <PT.3> <MSH.3> </MSH.2> <HD.10>XX3657</MSH.1> </MSH.1</VID.11> <MSH.1> </MSH.2>^~\&amp.1> </MSH.1>2.1> <MSA.The HL7 Messaging Standard Message encoding in XML <!DOCTYPE ACK SYSTEM "hl7_v231.1> <MSH.

The HL7 Messaging Standard Message encoding in XML ! HL7 Version 3 will use different formats for XML-encoded messages Reflective of Hierarchical Message Descriptions (HMDs) ! Formal structure still under development ! 2/4/2001 2001 Annual HIMSS Conference and Exhibition 195 .

w3.org 2001 Annual HIMSS Conference and Exhibition 196 ! ! ! Health Level Seven ! XML and other Web stuff ! American Medical Informatics Association ! 2/4/2001 .hl7.org http://www.The HL7 Messaging Standard More information ! Healthcare Information and Management Systems Society ! http://www.himss.amia.org http://www.org http://www.

com 2001 Annual HIMSS Conference and Exhibition 197 2/4/2001 .easterninformatics.The HL7 Messaging Standard Thanks for attending! ! Mike Henderson ! ! Mike@easterninformatics.com http://www.