Revisiting HL7

The term HL7 may be used in a number of contexts and it may be worthwhile to know a little about it. I have tried to cull information from various places and put it down in a few brief passages.
HL7 is represents "global standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services." It also stands for the (HL7) group that is a Designated Standards Maintenance Organization comprised of healthcare providers, software vendors and consultants.

The initial Version 2 of HL7 was message based and built more or less in an ad hoc manner.HL7 V2.x focused mainly on the "syntax" (structure and layout) for communication between systems.

The Version 3 is model-based built upon the Reference Information Model (RIM)
Version 3 is object-oriented (meaning that it combines data structures with functions to create re-usable objects).RIM is a unique representation of the health care domain set of information and data. RIM represents the semantic and lexical connections between the information carried in the fields of HL7 messages. RIM provides the basis for creating HIS application architecture and persistence layers. There is a RIM implementation based on Java that is available.

HL7 version 3 specifications37 for RIM include:
- Nouns--things that are being communicated
- Adjectives--descriptors and relationships of the nouns
- Verbs--actions being requested or communicated
- semantics of the communication--the actual meaning of a message
- syntax for communication--the structure and layout of the communication
- A channel to carry the communication
On a technical level, RIM is a collection of:
- Subject areas
- Classes--a template which defines the variables and methods for a particular type of object, example: patient class. Core RIM classes are Entity, Role, Participation, Act, Act-Relationship and Role-Link.
- Attributes--qualities of a class, for instance patient class would have name, date of birth, sex, address, etc.39
- Use cases--a way in which a system can be used, described as a step-by-step sequence of actions, along with the system's response and certain other information
- Actors--patients, medical and health professionals, and anyone else involved in a health care event
- Trigger events, example: follow-up clinical visit by a patient
Interactions

For clinical content needs, the HL7 vocabulary tables refer to external terminology sources like SNOMED, ICD10.
Detailed RIM tutorials @ are here

EHR, itself being a repository if information, does not have a standard. But HL7 drafted a functional model for EHR systems. The model helps create functional profiles. The profiles are listed below
Direct Care Profile
- Care Management
- Clinical Decision Support
- Operations Management and Communication
Supportive Profile
- Clinical Support
- Measurement, Analysis, Reporting, Research
- Administrative and Financial
Information Infrastructure Profile
- EHR Security
- EHR Information and Records Management
- Unique Identity, Registry and Directory services
- Support for HIT standards
- Interoperability
- Manage Business Rules
- Workflows
In total there are about 125 functions each with a function name, function statement, description and rationale for inclusion.

The clinical domains include
– Laboratory, Radiology, Nursing, Surgery, Pharmacy, Dietary
Administrative domains include…
– Registration, Billing, Scheduling, Medical records, Staff demographics
– Authorization and permissions
In an effort to create a Healthcare Business Process Reference Model, we can use the HL7 Healthcare Development Framework's practices. One practice that interested me in particular is the Domain Analysis. The diagram below gives the structure of accomplishing a typical domain analysis.


In summary, there is much to be leveraged from HL7 artifacts but finding what is relevant in an ocean of artifacts is a challenge :-).

Information standards in healthcare Part 2 (final)

Writing anything on information standards without the mention of HL7 will be quite meaningless.
HL7 (Health Level Seven) is a Standards Developing Organization accredited by ANSI. It has complied a collection of message formats and related clinical standards that loosely represents clinical information.
Key observation:
HL7 was initiated to speeden up data interface and exchange between computer application and systems within or connected to one healthcare enterprise; irrespective of architecture, programming language or platform. It is less far reaching that HIPAA which is targetted at transforming business and patient are processes.
HL7 is similar to EDI but developed ground up. HIPAA is derived from X12 standards.
Under HIPAA the addtional information to support a patient claim or encoutner must be in HL7 format. THe likely transaction used in HIPAA are 275, 277, 278, 835.
Refer to Corepoint health for more information.

THe most commonly used message types are
ACK – General acknowledgement
ADT – Admit discharge transfer
BAR – Add/change billing account
DFT – Detailed financial transaction
MDM – Medical document management
MFN – Master files notification
ORM – Order (Pharmacy/treatment)
ORU – Observation result (Unsolicited)
QRY – Query, original mode
RAS – Pharmacy/treatment administration
RDE – Pharmacy/treatment encoded order
RGV – Pharmacy/treatment give
SIU – Scheduling information unsolicited
Some videos on HL7 worth listening to:
HL7 & Healthcare Interfacing Videos | Corepoint Health

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Information standards in healthcare Part 1

The healthcare world has a headspinning proportion of standards relevant to information management. Getting useful information on internet about such things is easier said than done. My thanks to all those who had some genuine information out there for the reentrants like me.

Title II, Administrative Simplification of the HIPAA of 1996 called for efficient and electronic transaction for administration and finance in healthcare. It impacted all "covered entities". American National Standards Institute (ANSI)standard was preferred by the federal regulators. Some of the key ANSI standards are Accredited Standards Committee(ASC) X12, National Council for Prescription Drug Program (NCPDP), Health Level Seven (HL7). An episode of health care may involve several HL7 messages and X12 transactions running sequentially or concurrently, all communicating about the the same health care “objects” or events. This may raise the issues of interoperability id data semantics to not match.

New version of current transactions and new transacation are being worked upon.The currently used formats being upgraded from X12 Version 4010A1 to 5010 and from NCPDP 5.1to D.0 (Refer to http://www.cms.hhs.gov/Versions5010andD0/downloads/5010_Provider_Natl_Conf_Call_06092009.pdf for more information). Jan 1, 2012 is the cutoff for all old transaction.
An over view of the interaction of X12 messages and HIPAA cross reference is given below:
HIPAA Transaction X12.
Claim 837
Eligibility 270/271
Auth. Request 278
Claim Status 276/277
Enrollment 834
Remittance 835
Premium Pmt. 820
Attachment 275
ACK TA1/997




Note: The UB04, CMS 1500 are standards to align the paper form to the electronic format.The CMS-1500 is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims.

In terms of the the contents of the electronic message, some other terms are relevant.
Diagnosis Related Group (DRG) is essentially categories under which reimbursements are sought for diseases classified under International Classification of Diseases (ICD-9). ICD-9 is used for inpatient and outpatient diagnosis and inpatient procedures (ICD-9-CM). Current Procedure Terminology (CPT) is used for outpatient services rendered.