Transcript HL7 - The Key to interoperability

HL7 and the Electronic Healthcare Record:
Looking Back to the Future
September 1, 2001
Reading, England
Stanley M. Huff, MD
[email protected]
http://www.hl7.org
Outline
• HL7 International
• Issues from the HL7 Board Retreat
• HL7 and the EHR
7/17/2015
© 2001, Health Level Seven, Inc.
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Continued Growth of International Affiliates
• Affiliates are not only using HL7, but extending the scope
and depth of the standard with a new perspective
• Members from Japan and Taiwan have been very active in
character sets and data types for Version 3
• Members from Australia have been leading activities in
Community Health
• Members from Germany have been leading the creation and
maintenance of the V2 database, strong support in
publishing the V3 standard
• Members from Canada and financial transactions
• Members from the UK very active in modeling and
terminology
• Many other examples…
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Eastern European Road Trip
• Organized by Joachim Dudeck
• Follow-up by Klaus Veil
• Lithuania - has been accepted as Affiliate
• Czech Republic and Croatia - well advanced in
formation of an Affiliate.
• Poland and Hungary are in the planning stages
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Increasing international flavor
• HL7 Board meeting in Dresden (Joachim Dudeck)
• 1st HL7 International Affiliates Meeting in Dresden
• 2nd HL7 International Affiliates Meeting in Reading
• An international working group meeting?
– Schedule is 18 months to 2 years ahead
– Many questions, but we won’t know the real impact until
we try one
– Let’s get one scheduled!
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HL7 V2.4 as an ISO Standard
• Ed Hammond is leading this effort
• Board has approved offering V2.4 as an ISO Standard
• Negotiations with ANSI and ISO
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Version 3 Progress
• First Committee Ballot (George Beeler, Helen
Stevens)
• V3 Data Types (Gunther Schadow, Paul Biron)
• V3 ITS (Implementable Technology Specification)
• Methodology and Tools: Messages were developed
in 90 days
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HL7 V3 versus V2.X
• No reason to change interfaces that are meeting the need
• There will be V2.X interfaces for at least 5 years
• V2.X is the dominant clinical information standard in the
world, we don’t want to lose that market
• V3 offers fine grained interoperability that V2.X can not
provide
• V3 is ideal for leading edge institutions that want to move to
the next generation
• We will learn a bunch doing the first implementations of V3
• More conservative folks will wait until others have refined
V3 through implementations
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HL7 V3 versus V2.X (continued)
• V3 is not competing with V2.X – it will be adopted
on its own merits
• It has taken 8 years to reach the level of acceptance
that we have with V2, and adoption of V3 could
have a similar course
• Some countries have legislation that stipulates the
use of V2.X, and we want to support these countries
• V2.4 is being proposed as an ISO standard, making
it even easier to use internationally
HL7 Board and membership will support
V2.X for as long as it is needed!
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Danger: XML Barbarians
is consensus
also our goal
to deliver
real-world
• No“It
open
process
for creating
and
implementations
for the exchange of specific
maintaining the standard
types of clinical information. This has already
• No
formal
been
donemodel
successfully for the bidirectional
exchange
of dataacross
between
Medical
Health
• Lack
of consistency
vertical
domains
Record Systems and ECG, Spirometer and
• Blood
No connection
to standard
terminologies
Pressure
Measurement
devices. Other
havepath
beenwhen
started
for thechanges
exchange
• projects
No migration
technology
(Lifeof
laboratory
after
XML) order-entry messages and for
medical correspondence (specialist reports,
hospital discharge letters, admission and
transfer notifications).”
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Education about Version 3
• Need to get more V3 information out to
– HL7 members
– General medical IT community
– Medical Informaticists - conferences
• Need example messages to make it easy to explain
• Easy ways to view and browse R-MIMs and HMDs
• Need to make it easy and simple to implement
• Create blank messages from HMDs
• Early adopters forum?
• Press releases from the HL7 marketing committee
• Formal model as the framework that enables clinical experts
to discuss clinical content and needs
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Reorganize HL7 Working Group Meetings?
• What is a TC versus a SIG?
• Relationship between TC’s and SIG’s
• Overlap in subject domain of TC’s
– Pharmacy – OO and Vocabulary
• Infrastructure versus content
– Vocabulary, Control Query, XML SIG
– Blood Bank, Lab Point of Care Testing, Patient Care,
Pharmacy
• How do we get everyone involved in productive
work?
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Reorganize? (continued)
• How do we govern an increasingly large and diverse
organization?
• How do we develop new leadership?
• How do we accommodate clinical specialists?
– Nurses
– Specialty societies – Pediatricians, Ophthalmologists,
Cardiologists, Family Practice, Gastroenterologists
• Division of time between V2 and V3
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Whence HL7 and the EHR?
Intermountain Health Care (IHC)
• Not for profit
corporation
• 22 Hospitals
– 500->25 beds
• 24 Clinics
• 14 Urgent Care Centers
• Health Plans
(Insurance)
• Physician’s Division
(~400 employed
physicians)
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Clinical Integration
Sunquest Lab
HELP
IDX
(Inpatient HIS)
(Outpatient)
3M
IDX Systems
AGFA Radiology
HDM &
Medrec
3M
Tamtron Anatomic Pathology
ADT,
Orders,
Results,
Billing
McKesson Pharmacy
ARUP Blood Bank
Registration,
Scheduling
ADT,
Billing
MIMIR Blood Gas Machines
Dictaphone
Varis Oncology
MRS Mammography
ADT, Orders,
Results, Billing
DataGate
Interface
Engine STC
Logicare ER
Computrition Dietary
Tuxedo
ADT,
Results,
Orders
Registration,
Scheduling
Tuxedo
Health Data
Dictionary
3M
ADT, Billing,
Case Mix
Billing &
Financial
IHC
DataStage
Clinical
Workstation
3M
Tuxedo
CIS
EMMI/LDR
Database
(HEMS) 3M
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Data
Warehouse
IHC
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Statistical Profile
Interfaces
– 60+ different interfaces (mostly HL7 and X12)
– 400+ interface instances
– 1,000,000+ transactions per day
• Work to do:
– 11 interfaces in current development
– 16 new interfaces on the “To Do” list
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Conclusion
• IHC (and many other health care providers and
vendors) are using HL7
• What is the impact? A personal perspective…Shared
with permission from my daughter….
• “A Three Hour Tour ….” (apologies to Gilligan)
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Conclusions
• HL7 standards have improved patient care at IHC
• One father feels better while he is on the road!
• We (HL7) can do much more in creation of an
integrated EHR.
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EHR
• Traditional HL7 EHR policy
• Messages, but not behaviors or capabilities in the
EHR itself
• Discussion at the HL7 Board Retreat
– There is a clear need for EHR related standards
– HL7 has the right people to address EHR issues
– Existing HL7 standards form the basis for EHR standards
• Conclusion: Board to draft a revision of HL7
mission statement that reflects this new direction
(don’t tell anyone yet!)
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Proposed mission/charter for the EHR SIG
• Provide a Forum for discussion of different Electronic Health
Record (EHR) solutions.
• Create use cases to meet the requirements of an EHR, such
as:
–
–
–
–
Transfer of EHR extracts or pointers to EHR components
Coordinated/shared care of patients
Search and requests for portions of an EHR
Support integration of legacy Computerized Patient Records
• Create a high level architecture that supports EHR
requirements and the development of:
– An EHR interaction model
– A set of Refined Message Information Models (R-MIMs) and
corresponding Hierarchical Message Definitions (HMDs)
– Approaches to address security and privacy issues relating to EHRs
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From Thomas Beale
August 2001
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Activities NOT a part of EHR Standards
• NOT – a limit on the functionality that an EHR
should provide
• NOT – a full standardization of computer-based
patient record systems that maintain a longitudinal
record (longitudinal record systems)
• NOT - standardization of the information model of
longitudinal record systems
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What is the key to future success?
• The PEOPLE (You!)
• Willingness to share ideas
• Accommodate and expect change
• Remember our past
– Vendors, Providers, Consultants working together
– Representing their own needs, but working together for
the best solution for everyone
– Meet the needs of the users
– Provide a good solution, not a perfect solution
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Thanks!