Using HL7 for Clinical Information Exchange

1
Using HL7 for Clinical Information Exchange
Jon Reid, Informatics Portfolio Manager, Office
of Public Health Informatics Richard Kurzban,
DTS/Office of Epidemiology Keyi Nu, DTS/USIIS
Program, CFHS Steve Tuttle, DTS, the Public
Health Laboratories
2
Problems of the current reporting process

• Involves manual steps that contribute to
• Incomplete reporting
• Delayed reporting
• Inefficient data gathering
• Involves multiple data sources
• Hospitals, Laboratories, Clinics, Patients/
• Families, Schools etc.
• Involves different report formats
• Fax, Phone, Email, Mail etc.

3
How we currently exchange information
Clinical Report on reportable disease generated
by automated or manual processes
Report is sent to the local health department
Local Health Departments
Yes
UDOH calls local health department or lab to get
demographic information, then updates NETSS with
new information
No
UDOH
Local Health Departments
Local Health Departments
Report Faxed to UDOH or local health department
Is report complete with demographic info (Name,
Address, etc.)
NETSS
4
Clinical Reporting from IHC
IHC generates lab report for a notifiable disease
complete with demographic information
Notification is sent to the local health
department
Message Database
Web CMR
IHC submits HL7 message to UDOH which gets parsed
and inserted into database
UT-NEDSS
Users access laboratory reports directly from the
UT-NEDSS database through web or application
interface
5
Benefits of using HL7

• Accuracy
• Complete with supporting information
• Timely Communication
• Report get routed to who needs it instantly
  instead of waiting to be faxed
• Transactions Logged
• Report history is kept so no report gets lost or
  unreported

6
Real-Time Clinical Electronic Notifiable Diseases
(RT-CEND)
UDOH Port Rhapsody HL7 Message Server
Storage Data Table
IHC Sends Case Notification HL7
Messages from IMC/LDS ERM
Extract /parse HL7 Message
Transaction Test
Baseline Evaluation
Data analysis
User Interface Development
LHD Uses
Operational Evaluation
SUPPORTING PRODUCTS CAN
BE SHARED WITH OTHER STATES HL7
Messages Implementation Guide
Knowledgebase Case Definition Logic
7
Rhapsody Integration Engine
8
(No Transcript)
9
Modeling the HL7 message
10
What is an HL7 message?

• Health Level Seven (HL7) is a standard format for
  packaging healthcare data in the form of messages
  to be transmitted among computer systems

11
HL7 Segments used

• MSH - includes message source and syntax
  specifics
• PID contains patient identifying and
  demographic information
• Name, address, gender, date of birth
• PV1 contains visit-specific information
• Hospitalization status
• OBR used to transmit data on a set of
  observations
• name of reportable condition, source of specimen
• OBX contains information on observations
• Name of reporting clinician, Test results

12
HL7 Message Example

• MSH\RT-CEND""20080930133000ORUR01P2
  .5
• PID135337744XTESTIDREP19600228000000MW
  999 XTEST DR APT 310SALT LAKE
  CITYUT84124USA""[phone]
• OBR1NOTF
  POSITIVE HEPATITIS C ANTIBODY (REPORTABLE)
  09/20/2008
• OBR2221621736LABRPT20071127162020071
  1271630F

13
HL7 Message Example

• OBX100000-0Parasitic AG/ALOINCGiardia
  lamblia antigen detected)
• OBX100000-0ALERT DATELOINC200712051029
  
• OBX200000-0PROVIDER NAMELOINCJABEEN
• OBX300000-0PROVIDER PHONELOINC8015357029
  
• OBX422025-1PROVIDER IDLOINC29598
• OBX545403-3ROOM NUMBERLOINCDSCH
• OBX642347-5ADMIT DIAGNOSISLOINCHYPOXIA
  
• OBX700000-0PREVIOUS ADMIT DATELOINC19870322
  0000
• OBX800000-0PREVIOUS DISCHARGE
  DATELOINC198703310000
• OBX900000-0CONTACT NAMELOINCCarrie
  Taylor
• OBX1000000-0CONTACT PHONELOINC8015077782
  
• OBX1121612-7PATIENT AGELOINC66

14
(No Transcript)
15

• Other implementations of HL7
• Keyi Niu (USIIS)
• Steve Tuttle (State Lab)

16
HL7 in USIIS

• USIIS
• Utah State Immunization Information System

17
What does HL7 stand for?
Health Level 7 A domain-specific protocol for
the exchange of health care information at the
Application level of the OSI Communication
Architecture Model.
HL7
7 Application
6 Presentation
5 Session
4 Transport
3 Network
2 Data Link
1 Physical
OSI Communication Architecture Model
18
HL7 facilitates interoperability

• Standard for exchanging information between all
  types of health care applications
• Common communications protocol
• Common format and content of messages

Integrated Health Care
19
Other advantages of HL7

• Open System
• Managed by the accredited ANSI Standards
  Developing Organization
• Tools to speed up the development of interfaces
• Rhapsody (200,000 )
• Neotool (20,000 50,000)
• Iguana (10,000 )
• Symphonia
• Chameleon (2,000 / yr)

20
Disadvantages of HL7

• HL7 is not plug-and-play
• Missing fields or values
• Same data in different fields or formats
• Multiple versions
• Invalid segment grammar
• Investment to develop

21
HL7 message protocol

• Domain-specific Messages are created and sent by
  an information system in response to an event
• Sample message types
• ADT patient admissions, discharges and transfers
• ORU clinical observation results in response to
  an order
• VXU immunization updates
• 118 message types in V2.4
• Event-triggered
• 257 events defined in V2.4
• Sample events
• patient admission
• finalized pathology result
• query from another system
• Format
• Delimited plain text (Version 1.0 2.5)
• XML (Version 3.0)

22
HL7 message

• Composed of specific format and content
• Segments (MSH, PID, RXA etc)
• Fields
• Datatype
• Simple Datatype ( e.g. ST, NM, DT)
• Composite Datatype (e.g. ID, XPN, XAD)

23
USIIS HL7

• Unsolicited update of Patient Information
• Message ADT
• Events A04, A08, A31
• Unsolicited update of Vaccine Information
• Message VXU
• Events V04
• Query for Vaccination Record
• Message VXQ
• Event V01
• Possible responses
• Messages ACK, VXR (Event V03), VXX (Event V02)

24
HL7 segments implemented in USIIS

• MSH Message Header
• MSA Message Acknowledgment
• QRD Query Definition
• QRF Query Filter
• PID Patient Identification
• PD1 Patient Additional Demographic
• NK1 Next of Kin
• RXA Pharmacy/Treatment Admin
• RXR Pharmacy/Treatment Route
• ERR Error
• OBX Observation/Result
• NTE Notes (Regarding Immunization)
• QAK Query Acknowledgement

25
HL7 interfaces to USIIS

• IHC (V 2.3.1,ADT)
• Real-time ADT data
• Granger Medical (V 2.3.1, VXU)
• Batch immunization data
• Indian Health Service (V 2.4, VXU)
• Batch immunization data
• Two-way Return updated immunization data
• e-Clinical Works (V 2.4, VXU)
• Under development
• IHC (V 3.0, Immunization domain)
• Under development

26
Pathways of HL7 to USIIS
Secure file upload/download
Batch Input
FHS BHS MSH MSH ...
Batch File
Input Stream
Batch output
Provider
ADT, VXU, VXQ
MSH PID RXA
Real Time
ACK, VXR, VXX
USIIS HL7 Engine
Provider HL7 Client
VXQ
JDBC
VXR, VXX
Web Form
USIIS Web App
Provider End user
USIIS Central DB
27
Future HL7 Models of USIIS
Secure file upload/download
SOAP WSDL
Batch Input
Web Service Request
FHS BHS MSH MSH ...
Batch File
Batch output
Web Service Response
Input Stream
Provider
ADT, VXU, VXQ
MSH PID RXA
V3 XML Messages
Real Time
Real Time
ACK, VXR, VXX
Provider HL7 V2 Client
USIIS HL7 V2.x Engine
USIIS HL7 V3 Engine
Provider HL7 V3 Client
VXQ
Web Form
JDBC
VXR, VXX
Provider End user
USIIS Web App
USIIS Central DB