Survey of Medical

Informatics
CS 493 Fall 2004
September 20, 2004

Health Care Data

Standards
Chapter 4: Patient Safety - Achieving a
New Standard of Care.
IOM Report

Overview of healthcare data

standards

Table 4-1
Data standards

Interchange
Terminologies
Knowledge Representation

Data Interchange
Standards
Message Format Standards

Message Format Standards

CHI mandates:

HL7 Version 2.x

DICOM
NCPDP
IEEE standards for medical devices
LOINC

Healthcare Standards

HL7 Standard

HL7 Messaging
Established Standards Body (1987)
ANSI accredited (1994)
Over 1700 members
Key efforts

HL7 CDA (XML documents) Effort

HL7 CCOW
HL7 EHR Effort

Healthcare Standards: HL7

HL7 Philosophy

Designed as a protocol for exchange of

healthcare and related information
Based on an event-based transactional
model that mirrors real-life use-case
scenarios

Healthcare Standards: HL7

HL7 Version Evolution

Produced Version 1.0 late in 1987
Produced Version 2.0 late in 1988
Version 3.0 effort underway for a while
Clinical Document Architecture (CDA) effort
release 1 Nov 2000 & CDA release 2 passed
in committee ballot Sept 2003
Clinical Context Effort (CCOW)
Electronic Health Record (EHR) Functional
Model (NHII initiative)

Healthcare Standards: HL7

Healthcare Standards
HL7 Message Structure

Messages in HL7 are defined by:

A message ID (a 3 letter code - e.g., ADT for

Admit, Discharge, Transfer-related messages)
One or more segments (logical grouping - e.g.,
PID segment to represent patient identifying
information)
Nesting and repetition of segments as
appropriate
Z segments for custom use

Healthcare Standards

HL7 Clinical Context

Object Working Group
(CCOW)

CCOW:

Focus is the on the visual integration of

diverse applications in the users
desktop

Healthcare Standards: HL7

CCOW:

Technology-neutral specifications that will allow

healthcare applications to switch contexts
seamlesslyoriented toward making multiple
Graphical User Interface (GUI) clients work
together
Already have interoperable specifications and
implementations
Currently working on an interoperable single-signon specification

CCOW Visual Integration

Data
Integration

Server
Server

Visual
Integration

Server
The Clinical
Applications

The
Provider's
Workstation

The Provider
* Acknowledgement: Slide provided by Wes Rishel, Gartner Group

Technology solutions

Healthcare Standards
O'Donnell
2234444

University
Physicians

ODonnell 2234444
Furlow
6731123

Context
Manager
Patient ID
Mapper

O'Donnell

3222111

Master Patient Index

General
Hospital

O'Donnell
Furlow
Crane

University
Physicians

3222111 2344444
-- 6731123
582233
--

General Hospital
ODonnell 3222111
Crane
58233

* Acknowledgement: Slide provided by Wes Rishel

CCOW Process View

User P
3
6
9

App A
1
Log on
Select Patient X

CM

App B

Register with CM

Register with CM

Context User P

Context User P

Context Patient X

Context Patient X

10

View Patient X Labs

11

Log off

13

Context - Reset

View Patient X Notes

12

Context - Reset

CCOW current work:

Single sign-on:

users do not have to memorize many user

names and passwords
authentication via password, badge swipe,
biometrics

Web-based applications

* Acknowledgement: Slide provided by Wes Rishel

Healthcare Standards

HL7 Version
3.0
Acknowledgement: This set of slides are adapted from:
Andrew Hinchleys Understanding Version 3 A primer on the HL7 Version 3 Communication Standard

Key Concepts of V3
methodology
Application
Trigger
Role

Storyboard

Event

HL7 Reference
Information Model (RIM)
basis for all HL7
Interaction messages

RIM

D-MIM

R-MIM

RIM defines about 70

basic classes
Storyboard

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Storyboard

Storyboard

Event

From RIM we can

instantiate a Domain
Message Information
Interaction Model

RIM

D-MIM

R-MIM

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Storyboard

Interaction
Reference Message
Information Model are
developed for a
restricted group of
models

R-MIM

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Interaction
R-MIM

Storyboard

R-MIMs are used to

develop message model
definitions called
Hierarchical Message
Definitions

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Interaction
R-MIM

Storyboard

HMDs are used to

define the HL7 V3
messages which are
used to communicate
between systems

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Storyboard

This defines the roles of sending

and receiving application.
Interaction
For example: Laboratory
Observation Event Informer an
application that notifies pertinent
information about lab results

R-MIM

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Storyboard

This defines what causes a message

Interactionto be sent.
Specifies the set of conditions that
initiate a message transfer.
Trigger events are specified by: a
name, identifier, description,
structured name and a type. Different
types of trigger events: interaction
based, state-transition based, user
based, unspecified.

R-MIM

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Interaction
R-MIM

A realistic scenario which

requires a
communication message
to be designed

HMD

Message

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Interaction
R-MIM

Storyboard

Scope for the message

to be designed the
interaction that needs to
be supported

HMD

Message

The Reference Information

Model

Act something happened or may happen. Any action of interest.

Entity a person, animal or organization or thing
Role a part played by an entity
Participation the involvement of a role in a act
Act_Relationship a relationship between two acts
Role_Link a relationship between two Roles

Examples of R-MIM
Act Example
Prescription
classCode*: <= SPLY
moodCode*: <= ORD
statusCode: <= ActStatus
activityTime:
availabilityTime:

SPLY: act is related to supply

ORD: an instance of order
<=: code value or a vocabulary term

Entity Example
Person
classCode*: <= PSN
determinerCode*: <= INSTANCE
Name*: PN[1..1]
Addr: AD[1..1]

PSN: refers to person

INSTANCE: can be an instance or
quantified value

Examples of R-MIM
Role Example

1..1 patientPerson

Patient
classCode*: <= PAT
Id*: [0..1]

Person
classCode*: <= PSN
determinerCode*: <= INSTANCE
Name*: PN[1..1]
Addr: AD[1..1]

Person is playing the role of

a patient.

Examples of R-MIM
Participation Example
1..1 patient

Prescription
patientSubject
classCode*: <= SPLY
typeCode*: <= PATSBJ
moodCode*: <= ORD
statusCode: <= ActStatus
1..1 medicalPractitioner
activityTime:
author
availabilityTime:
typeCode*: <= AUT
1..1 pharmacist

performer
typeCode*: <= PRF

Examples of R-MIM
Act_Relationship Example
Prescription
classCode*: <= SPLY
moodCode*: <= ORD
statusCode: <= ActStatus
activityTime:
availabilityTime:
component
typeCode*: <= COMP

1..* prescriptionItem

PrescriptionItem
classCode*: <= SPLY
moodCode*: <= ORD
code*: CD CWE[1..1] <= DrugCode
text*: [1..1]
activityTime:
availabilityTime:

Key Concepts of V3
methodology
Application
Trigger
Role

Event

RIM

D-MIM
Storyboard

Interaction
R-MIM

Storyboard

HMD

Message

Healthcare Standards

HL7 CDA

Technology solutions

Healthcare Standards

Sample CDA
Document

Technology solutions

Healthcare Standards

Healthcare Standards

HL7 EHR

Direct
Direct
Care
Care

HL7 EHR Functional

Model*
Care Management
Management
DC1.0 Care
Ops Mgt & Comm
DC3.0 Ops Mgt & Comm

Supportive
Supportive
Information
Information
Infrastructure
Infrastructure

S1.0

Clinical Support

S2.0

Measurement, Analysis,
Research, Reporting

S3.0

Admin & Financial

II1.0

Care Management
Security
Ops Mgt & Comm
Information and Records Management
Care Management
Unique
Identity, Registry, and Directory
Ops Mgt & Comm
Support for Health Informatics & Terminology Standards

II2.0
II3.0
II4.0
II5.0
II6.0
II7.0

DC2.0

Clinical Decision
Support

Care Management
Interoperability
Ops Mgt & Comm
Business Rules - Administrative Functions
Care Management
Workflow

* Slide courtesy of Dr. Don Mon, Vice President of AHIMA

Building Block for Info

Exchange*
The Longitudinal Record: Distributed Across EHRs
Physician
Office
EHR-S

Referral
Data

PHR

Hospital
EHR-S

Referral
Data

Regional
Health Info
Exchange

* Slide courtesy of Dr. Don Mon, Vice President of AHIMA

Nursing
Home
EHR-S

Referral
Data

Home
Health
EHR-S

Data stays where it is

(distributed, federated)
Federated MPIs

HL7 Summary

Version 3.0 Reference Information Model

Interoperability Demonstrations using XML and
HL7 RIM models have happened since HIMSS
99.
HL7 CDA effort has taken root
HL7 CCOW has made significant inroads.
EHR effort is ground-breaking and is lead by
the Dept. of Health and Human Services as part
of the NHII.

Healthcare Standards: HL7

Technology solutions

Healthcare Standards

HL7 References

HL7: Health Level 7:

http://www.hl7.org/