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HL7 is an ANSI-accredited Standards Development Organization (SDO) operating in the healthcare arena. It is a non-profit organization made up of volunteers providers, customers, vendors, government, etc. HL7 is an acronym for Health Level Seven
Seven represents the highest, or application, level of the International Standards Organization (ISO) communications model for Open Systems Interconnection (OSI) networks.
Introduction to HL7:
Provides standards for data exchange to allow interoperability between healthcare information systems What is interoperability?
It is the ability of two or more systems or components to exchange information, and to use the information that has been exchanged predictably (IEEE Standard Computer Dictionary)
Syntactic interoperability has to do with structure Semantic interoperability has to do with meaning
Introduction to HL7:
It defines data exchange standards for these domains called messages or messaging specifications (aka HL7 messages).
Messages are developed by technical committees and special interest groups in the HL7 organization.
HL7 messaging (v2.x and higher) has been recommended as a data exchange standard by the E-Government initiative.
Introduction to HL7:
Over 90% of US hospitals have implemented some version of 2.x HL7 messages
The workhorse of data exchange in healthcare The most widely implemented standard for healthcare information in the world
HL7 v2.5 was approved as an ANSI standard in 2003 HL7 v2.6 is currently under development.
Introduction to HL7:
HL7 v2 does not support semantic grouping of messages to create comprehensive packets of information.
HL7 v2 messages do not specify coded terminologies as value sets.
HL7 v2 does not have conformance rules this results in site specific implementation.
HL7 v2 is an interchange standard, not an interoperability standard. HL7 v2 works well intra-enterprise, but does not scale well to inter-enterprise applications.
Introduction to HL7:
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Introduction to HL7:
Follows an Object Oriented (OO) approach Uses Universal Modeling Language (UML) principles
Introduction to HL7:
A uniform set of models Representation of complex relationships Formalisms for vocabulary support Top-down message development Solving re-use and interoperability issues across multiple domain contexts Scope is expanding to include community medicine, epidemiology, veterinary medicine, clinical genomics, security, etc.
Introduction to HL7:
A common Reference Information Model (RIM) which spans the entire patient care, administrative and financial healthcare universe A well-defined and tool-supported process for deriving data exchange specifications ("messages") from the RIM A formal and robust Data Type Specification upon which to ground the RIM A formal methodology for binding concept-based terminologies to RIM attributes
Introduction to HL7:
Any Questions?
The RIM is the cornerstone of HL7 v3 messaging. The RIM is an UML Model class diagram. The RIM: Is the fundamental model from which all v3 messages are derived Is a generic, abstract model that expresses the information content of all the areas of healthcare Forms a shared view of the healthcare domain, and is used across all HL7 messages independent of message structure
RIM Domains
Common Domains
0..n
1..n
Entity classCode : CS determinerCode : CS id : SET<II> code : CE quantity : SET<PQ> name : BAG<EN> desc : ED statusCode : SET<CS> ...
player 0. . 1 scoper 0. . 1
playedR e ol 0. . n scopedRole 0. . n
Role classCode : CS id : SET<II> code : CE negationInd : BL addr : BAG<AD> telecom : BAG<TEL> statusCode : SET<CS> ...
t ar get 1
RoleLink ...
0. . n 1
Participation typeCode : CS functionCode : CD contextControlCode : CS sequenceNumber : INT negationInd : BL noteText : ED time : IVL<TS> modeCode : CE ...
Act
sour ce out boundRelat ionship
ActRelationship
1
0. . n t ar get 1 1 inboundRelat ionship
0. . n
0. . n
ManagedParticipation ...
Domain Related
InvoiceElement modifierCode :... SET<CE> ...
Organization ...
Patient ...
Supply ...
Procedure ...
Observation
SubstanceAdministration
Account
... routeCode : CE ... WorkingList ownershipLevelCode : CE ... DeviceTask Diet ... ... subjectOrientationCode : CE ... FinancialContract parameterValue : LIST<ANY> ... PublicHealthCase DiagnosticImage paymentTermsCode : CE ... ... FinancialTransaction ...
Person NonPersonLivingSubject ... addr : BAG<AD> ... maritalStatusCode : CE ... ... Device manufacturerModelName : SC softwareName : SC localRemoteControlStateCode ... : CE ... Container capacityQuantity : PQ heightQuantity : PQ diameterQuantity : PQ capTypeCode : CE ...
ControlAct
1
0..*
1..* 0..*
Transmission id : II ...
1 0..n
AttentionLine ...
...
1 0..1
0..n
0..1
Message versionId : ST interactionId : II profileId : SET<II> processingCode : CS processingModeCode : CS acceptAckCode : CS applicationAckCode : CS ...
conveyingM essage 1 1 acknow dges le
EntityHeir
0. . n payload
RoleHeir QuerySpec modifyCode : CS responseElementGroupId : SET<II> ... responseModalityCode : CS responsePriorityCode : CS ... QueryAck ActHeir
Document
Table
...
...
TableStructure
Enitites
Acts
0. . 1
0. . n
1
acknowle dgedBy
Roles
Other
Acknowledgement
Infrastructure (Communications)
Bi l l board produced by: Rochest er O ut door A dvert i si ng
...
1 0..n
Paramet er id : II
0..n 0..1
QueryByPa rameter
QueryBySelection
0..n
SelectionExpression
0..n
TableCell
user AsLeft
0..n
AcknowledgementDetail
0..1
ParameterList ...
ParameterItem ...
RelationalExpression ...
0..1
le ftSid e
r ightSid e
0..1
scope : CS ...
LocalMarkup ...
Infrastructure Related
Structured Documents
Classes are color coded: Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message controller.
Role
A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role.
Participation
An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance.
Act
A record of something that is being done, has been done, can be done, or is intended or requested to be done.
1 0..n
1 0..n
Role Link
0..n
0..n
0..n
Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message controller.
Entity
Role
Participation
Act
John Doe
Patient
Subject
(Procedure Act)
Dr. Smith
Surgeon
Prostectomy
XYZ Hospital
Location
Act Relationship Has Pertinent Information (Clinical Trial Act)
John Doe
Patient
Subject
Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message controller.
Entity:
classCode : CS determinerCode : CS id : SET<II> code : CE quantity : SET<PQ> name : BAG<EN> desc : ED statusCode : SET<CS>
a person, animal, organization or thing A collection of classes related to the Entity class, its specializations and related qualifying classes. The classes represent health care stakeholders and other things of interest to health care.
Container Device LanguageCommunication LivingSubject ManufacturedMaterial Material NonPersonLivingSubject Organization Person Place
classCode : CS id : SET<II> code : CE negationInd : BL addr : BAG<AD> telecom : BAG<TEL> statusCode : SET<CS> effectiveTime : IVL<TS> certificateText : ED quantity : RTO positionNumber : LIST<INT>
A responsibility or part played by an entity (e.g. Person in a role of patient, employee, etc.) different faces of an Entity A collection of classes related to the Role class and its specializations. These classes focus on the roles participants may play in health care.
Participation:
An association between an Act and a Role with an Entity playing that Role.
ManagedParticipation
Act: A collection of classes including the Act class and its specializations. These relate to the actions and events that constitute health care services. A record of something that is being done, has been done, can be done, or is intended or requested to be done. Act has the following sub-classes: Observation
FinancialTransaction
InvoiceElement
WorkingList
Note: Sub-classes also include Core Infrastructure, Message Communications Control and Structured Documents classes not shown here.
ActRelationship:
A directed association between a source Act and a target Act. A point from a later instance to a earlier instance OR point from collector instance to component instance.
DMIM
1..*
RMIM
MT
HMD
1..*
1..*
DMIM Domain Message Information Model; RMIM- Refined Message Information Model; HMD Hierarchical Message Description; MT Message Type
Example: PRPA_DM201101UV01
Example: PRPA_RM201101UV01
Example: PRPA_HD201101UV01
Example: PRPA_MT201101UV01
Data types define the meaning (semantics) of data values that can be assigned to a data element
Meaningful exchange of data requires that we know the definition of the values exchanged
Every attribute in the RIM is associated with one and only one data type, and each data type is associated with zero or many attributes
Data types in HL7 v3 are complex:
Each data type has attributes Each data type attribute has a data type of its own
<raceCode code=1002-5 codeSystem= 2.16.840.1.113883.5.104 codeSystemName=HL7 Race Vocabulary Domain" displayName=American Indian or Alaska Native" codeSystemVersion=3.0 />
Structural attributes/elements are used to specify the type and state of each RIM class and what it means when used in a message. Structural attributes/elements use a standard vocabulary defined and controlled by the HL7 organization.
For capturing Observations: LOINC, SNOMED, etc. For Adverse Events: MedDRA, CTC, etc. caDSR/EVS
Any Questions?
Explain why HL7 and HL7 v3 are used at NCI CBIIT Discuss how caAdapter supports NCI CBIIT and caBIGTM goals of interoperability Explain NCI CBIITs Clinical Architecture
Nine out of ten US hospitals have implemented some version of 2.x HL7 messages.
Therefore, Health and Human Service (HHS) has recommended HL7 as the messaging standard for the electronic exchange of clinical data.
A goal of NCI CBIIT is to accelerate discovery through the synthesis of different types of cancer research data, thus facilitating translational research (combination of different disciplines of research). Support for translational research requires integration of research data with clinical data at a semantic level.
HL7 v3 offers the syntactic and semantic interoperability to make this integration possible.
Open source Open access Standards based Open development Collaboration with other intiatives Provides a toolset to support a federation of data sources
caAdapter (formerly called the HL7 SDK) is an open source tool that facilitates HL7 v3 message building, parsing and validation based on specific message definitions. caAdapter has leveraged HL7 Java Special Interest Group (SIG) work and built new enhancements. caAdapter provides the capability to perform vocabulary validation of core structural attributes through integration with NCI CBIIT caCORE components, such as the Enterprise Vocabulary System (EVS).
HL7 v3 is a potential data exchange solution within the NCI CBIIT Clinical Architecture Vision.
CSM
caAdapter Toolset which facilitates v3 message building, parsing and validation. caAdapter provides Comma Separated Values (CSV) and Excel files to HL7 v3 conversion capability. Message Exchange Service supporting message transmission and routing HL7 Transactional Database HL7 RIM based transactional database and data access service De-identification Service De-identifies patient information from HL7 v3 messages Research Application CMAP (Cancer Molecular Analysis Program) use case for demonstration purposes Cancer Data Standards Repository (caDSR) Shared metadata repository Enterprise Vocabulary Services (EVS) Vocabulary service for hosting controlled vocabulary, including HL7 v3 structural terminology
Any Questions?
Introduction to caAdapter
Discuss the usage of caAdapter Describe the components of caAdapter Illustrate how caAdapter works
Introduction to caAdapter:
Usage of caAdapter
caAdapter is a tool set that facilitates HL7 v3 message building, parsing, as well as some validation. It has a component based architecture that supports HL7 v3 message generation. It provides a mechanism to convert clinical data from legacy data sources to HL7 v3 messages. caAdapter provides a user interface that can help cancer centers transform their clinical data into HL7 v3 messages and help them achieve the goal of interoperability.
Introduction to caAdapter:
Using caAdapter
Assuming your data is in a non-HL7 v3 file format, how can you take advantage of HL7 v3s capabilities right now?
By converting your comma separated value (.csv) files to the proper HL7 v3 format using caAdapter
Introduction to caAdapter:
caAdapter has a component based architecture that offers a tool set to support HL7 v3 message generation. It accomplishes this via two major components:
Introduction to caAdapter:
A Java based API to HL7 v3 RIM components (such as RIM classes) HL7 Data Type classes Other supporting classes A Utility Package to support HL7 v3 message building and parsing Additional services of vocabulary validation
Introduction to caAdapter:
Has a GUI based front-end application for mapping clinical data to HL7 v3 specifications Has a user-friendly drag-and-drop interface Provides some data transformation functions
caAdapter Introduction:
Mapping Tool
Clinical Data
Transformation (APIs)
HL7 v3 XML
caAdapter Introduction:
caAdapter Introduction:
Mapping Tool
2 2a
Source Specification
2b
caAdapter Introduction:
Introduction to caAdapter:
Any Questions?
Describe the architecture and features of the Core Engine component Describe the architecture and features of the Mapping Tool component List the four main functions and sub-functions of caAdapter
HL7 v3 Message Parser Parses HL7 v3 messages to RIM object graph HL7 v3 Message Builder Builds HL7 v3 messages from the RIM object graph HL7 v3 Artifacts Implements RIM objects, data types and metadata objects Metadata Loader Represents HL7 v3 metadata in-memory Validation Services Using HL7 v3 specifications caApapter API Uses mappings to generate HL7 v3 messages
Mapping Functions
XML Transformer
Generation of XML message instances from source data based on the mapping
Defining source specification Defining target specification Defining mapping specification Converting source data to target data format
Each of these four functions has four sub-functions for handling data:
Any Questions?
Session Review
Now that you have successfully completed this session, you should be able to: Provide an introduction to HL7, HL7 v2, and HL7 v3 Discuss what HL7 v3 is and how it works Explain why HL7 v3 is used at NCI CBIIT and in caBIG Describe what caAdapter is and how it works
Follow on Training
caAdapter Fundamentals
www.hl7.org
https://www.hl7.org/library/data-model/RIM/C30202/rim.htm
http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm
HL7 v3 Standard
http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
http://ncicb.nci.nih.gov/NCICB/infrastructure/cacore_overview/caa dapter
Driving Interoperability & Transforming Healthcare Information Management by Charles Mead, MD, MSc.
HL7 v3:
http://www.healthcare-informatics.com/webinars/05_20_04.htm
caAdapter Contacts
http://trials.nci.nih.gov/projects/infrastructureProject/caAdapter/HL T_Tutorial
Telephone support is available Monday to Friday, 8 am 8 pm Eastern Time, excluding government holidays. You may leave a message, send an email or submit a support request via the Web at any time.