Les autres organismes de standardisation en informatique...

Les Les autres organismes autres organismes de de standardisation standardisation en en informatique informatique de santé :de santé :

HL7, CEN et ISO HL7, CEN et ISO ..

Joël ChabriaisJoël Chabriais(1)(1), Bernard , Bernard GibaudGibaud(3)(3), Florent Aubry, Florent Aubry(2)(2), Yves , Yves GandonGandon(4)(4), Gilles , Gilles MévelMével(5)(5), , Jérome GuignotJérome Guignot(5)(5),,

Andrew Andrew ToddTodd--PokropekPokropek(2)(6)(2)(6), Marco , Marco EichelbergEichelberg(7)(7), , Jörg Riesmeier Jörg Riesmeier (7)(7)..

(1) Département d’Imagerie Médicale (1) Département d’Imagerie Médicale -- Centre Hospitalier Henri Mondor Centre Hospitalier Henri Mondor -- Aurillac Aurillac -- France. (2) U 494 INSERM France. (2) U 494 INSERM -- Paris Paris -- France.France.

(3) Laboratoire IDM (3) Laboratoire IDM -- Université de Rennes 1 Université de Rennes 1 -- Rennes Rennes -- France.France.

(4) Service d’Imagerie Médicale (4) Service d’Imagerie Médicale -- Hôpital Hôpital Pontchaillou Pontchaillou -- Rennes Rennes -- France. (5) ETIAM France. (5) ETIAM -- Rennes Rennes -- France.France.

(6) (6) Department Department of of Medical Physics and Bioengineering Medical Physics and Bioengineering -- University College University College London London -- London London -- United KingdomUnited Kingdom..

(7) OFFIS (7) OFFIS -- Oldenburg Oldenburg -- DeutschlandDeutschland

Cliquez pour démarrerCliquez pour démarrer

Les autres organismes de standardisation en

informatique de santé : HL7, CEN et ISO

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Health Informatics

• Standardization in the field of Health

Informatics evolves very quickly with a great

numbers of actors.

• Our purpose is to summarize the most recent

evolutions relevant for medical imaging.

Summary

•• HL7HL7

•• CEN/TC 251CEN/TC 251

•• ISO/TC 215ISO/TC 215

Click on the chapter you want to learnClick on the chapter you want to learn

HL7

Health Level Seven

SeveralSeveral slides slides of of this presentation this presentation are are extracted from extracted from official official presentation presentation of HL7 of HL7 at at HIMMS’2001. The HIMMS’2001. The entire entire

set of set of slides could be download slides could be download on on wwwwww.HL7..HL7.org web org web site by site by clicking clicking on the «on the « 01 HIMSS01 HIMSS » » linklink..



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HL7 Summary

•• An Overview of HL7An Overview of HL7

•• CDACDA

•• RIMRIM

•• MessagesMessages

•• CCOWCCOW

•• HL7 and XMLHL7 and XMLClick on the chapter you want to learnClick on the chapter you want to learn

By clicking on By clicking on HL7 SummaryHL7 Summary button you will come back to this slidebutton you will come back to this slide

An overview of HL7



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Who is HL7?

• Over 500 organizational members.

• About 1500 total members.

• Up to 500 attend the Working Group Meetings.

• International affiliates in:

–Australia - Argentina - Canada

–China - Finland - Germany

–India - Japan - Korea

–The Netherlands - New Zealand - Southern Africa

–Switzerland - Taiwan - The United Kingdom

HL7 HL7 SummarySummary



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How is HL7 organized? • Collaborative volunteer organization.

• Paid staff limited to the secretariat.

• Primary funding is membership dues.

Technical Steering CommitteeTechnical affairs

Appointed officers plus chairsof the committees & SIGs

Technical CommitteesCreate normative specifications

or chapters in the standard

Special Interest GroupsCollaborate in area of interest tocontribute to the work of the TCs

The Working GroupThe "real" HL7

Any member can registerfor any committee or SIG

Board of DirectorsBusiness affairs

Elected




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The Working Group

• Draws equally from providers, software vendors, and

consultants.

• Group sets aside their individual interests, rolls up their

sleeves and collaborate to get the tough work done.

• HARD WORK - five, 12-hour days, three times a year

plus active electronic collaboration in between.




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Computing trends – last 15 years

• Rather than consolidating in large data centers, computer architectures have become increasingly fractionated.

• Computers are smaller, faster, cheaper.

• Networks give instantaneous access to anyone, anywhere, any time.

• Medical technology has rapidly expanded the data demands placed on health care computing.

• As a result, distributed architectures have become the norm for most medical centers, with a concomitant requirement for system interoperability.




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Innovation - users

• Interoperability has permitted users to select “best of

breed” applications and still bind them to an enterprise

data architecture.

• Flexible clinical standards support the full gamut of

clinical “topics of communication”.

• Implementation guides have let users take advantage of

their legacy data and interfaces in newer technical

environments.




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Innovation - vendors

• Interoperability standards enable development and

implementation of “best of breed” niche products.

• Mergers and acquisitions are possible because standards

allow linking of once-distinct products.

• Rapid adoption of new technologies is supported by

implementation recommendations for existing standards.

• Once a back-office standard, HL7 is now carrying data to the

desktop and coordinating the applications that appear there.




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HL7 innovation - ideas

• Open acceptance of new ideas remains a key-stone of HL7’s success.

• Fostered by a working group unified around the standards.

• Welcoming of new or expanded topics:

–XML & web technologies - Vocabulary

–Medical Logic - Workstation components

–Structured documents - Lab automation

–Record architectures - Personnel management




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HL7 innovation - ideas

• Welcoming of new communities.

• International participation:

–From six to fifteen affiliates in last 2-1/2 years,

–Affiliates are not just ‘passengers’ but are helping drive the standards,

–Strong collaboration with CEN European standards activities,

–HL7 active in ISO Healthcare Informatics TC.

• New domains of interest:

–Vocabulary, medical logic, health record communication, financial management.




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HL7 innovation - methods

• Initial efforts based on a pragmatic ‘just do it’ approach to standards.

• Saw the need to revise and formalize the process:

– to assure consistency of the standards,

– to meet plug’n’play demands,

– to be able to adopt and leverage new technologies for both HL7 and its users.

• Adopted the new methodology in 1997:

– based on best development & design practices,

– supports ‘distributed’ development across committees,

– is technology neutral. HL7 HL7 SummarySummary



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HL7 innovation - methods

• Methodology based on shared models:

– Reference Information Model (RIM):

• of the health care information domain.

– Defined vocabulary domains:• Drawn from the best available terminologies,

• Directly linked to the RIM,

• Supported by robust communication techniques.

• Harmonization process that:

– Assures each member and committee a voice in the process, yet,

– Produces a single model as the foundation for HL7 standards.




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HL7 innovation - devices

• Reference Information Model:

– Unique representation of health care domain,

– 64 classes with 350 attributes in six critical class hierarchies,

– Designed to support “informatical” detail of clinical events, their results and context.

• Vocabulary Domain Specifications:

– Support the RIM Hierarchies and the coded attributes,

– Link to the “best” of the available clinical and operational terminologies.




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HL7 innovation - devices• HL7 Model Repository – data base holding the core of

HL7 semantic specifications:

– RIM, - Use case models,

– Vocabulary domains, - Interaction models,

– Message designs, - Message constraints.

• Tool sets designed against the repository to:

– Permit management of repository content,

– Review and browsing of semantic specifications,

– Design of abstract information structures based on the RIM for use in messages, templates, documents,. Etc.

– Publish HL7 specifications and standards,

– Support implementation of HL7 standards. HL7 HL7 SummarySummary



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What has HL7 produced?• Founded in 1987.

• Produced Version 1.0 and 2.0 in ‘87 and ‘88.

• Approved HL7 message standards:

–2.1, 2.2, 2.3, 2.3.1 and 2.4 in ‘90, ‘94, ‘97, ‘99 and ‘00.

• Approved CCOW standards:–1.0, 1.1, 1.2, 1.3 in ’99, ’00 and ‘01.

• Approved Arden Syntax standard in ‘99.

• Approved XML-based Clinical Document Architecture standard in ‘00.

• Accredited as an SDO by ANSI in 1994:–All HL7 approvals since ‘94 are “American National Standards”.

• Published implementation recommendations for:

–Object broker interfacing ‘98,

–Secure messaging via e-mail ‘99,

–HIPAA Claims attachments ‘99,

–XML encoding of Version 2 ’00.




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HL7 Current Versions

• The HL7 current version in use is HL7 v2.3.1.

• The latest published version is HL7 v2.4

(October 2000).

• The most important work in progress is HL7 v3

(expected for publication early 2002).

This slideshow will now present the works on HL7 v3.xThis slideshow will now present the works on HL7 v3.x




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HL7 Standards

• HL7 have several components:

– Clinical Document Architecture,

– Reference Information Model,

– Messages,

– Integration Visualisation (Clinical Context Object

Working Group),

– Vocabulary.




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HL7 Standards: CDA

– CDA Level 1:

• HL7 adopt an architecture based on

persistent objects.

• Solid header (Patient, Order, Act).

• Weak content - Vague presentation.

• Complement the DICOM SR (rich

content, robust, some header).

– CDA Level 2:

• Introduction of codes for report titles.

– CDA Level 3:

• Everything remains to be done.

• Merge of:

– DICOM SR,

– EHCRC du CEN,

– CDA Level 1,

• Complex effort - Need a long

time.

• The meantime: CDA L1 and

DICOM SR.

•The Clinical Document Architecture have three levels:




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HL7 Standards: RIM

• Reference Information Model (RIM):

– The work of the century...

– A first stable version expected for 2002.

– Discussion with CEN to include parts of the model

developed by the CEN/TC 251.




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HL7 Standards: Messages

• Version 3 messaging:

– Precise, inter-enterprise clinical communication.

– Use a clearly define methodology.

– Based on the RIM.

– Use of XML syntax.




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HL7 Standards: CCOW

• Clinical Context Object Working Group (CCOW):

– The CCOW have joined HL7as the Special Interest

Group on Visual Integration on September 1998.

– Recently designed as the HL7 C COW Technical

Committee.

– Its mission is to define standards that enable the visual

integration of healthcare applications.




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HL7 Standards and XML

• HL7 have decided to use XML syntax for v3 messages:

– Availability of off-the-shelf (OTS) processors:

• freeware and commercial parsers,

• transformation and viewing tools.

– Availability of trained personnel.– Bottom line – less expensive – faster to develop – easier to

maintain!


The Clinical Document Architecture



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Clinical Document Architecture (CDA)

• CDA does simple things simply.

• RIM metadata header + generic clinical body =

portable display, retrievalportable display, retrieval.

• Lays basis for extensibility:

– domain-specific document types,

– fine-grained definitions.




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Clinical Document Architecture

CDA Level One DTD shown in “XML

Authority” from Extensibility

CDA Level One DTD shown in “XML

Authority” from Extensibility

CDA Level One document shown in “Internet

Explorer” from Microsoft

CDA Level One document shown in “Internet

Explorer” from Microsoft


1

1

2

2

3

3

How to read

next slides

At the root level



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The tree under Clinical

Document Header node

2

2



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3

The tree under Body node

3

4



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4

4

The paragraph

sub-tree



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• Implementation: US

– HIMSS 2001: Affinitex, Care Data Systems, Epic

Systems, MDinTouch.

– Mayo Clinic (30,000 notes/week).

– IDX (document management).

– CareFlow Net (transcription).

• In evaluation:

– by major providers and suppliers, as well as start-

ups and government projects.HL7 HL7 SummarySummary



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• Implementation: Germany

– SCIPHOX:

• Standardization of Communication between Information

Systems in Physician Offices and Hospitals using XML.

– Phase I: Discharge letter from hospital to physician

office system.

– Phase II: Referral information.

– Status: supported by multiple national organizations;

first implementation documents Q101.HL7 HL7 SummarySummary



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• Implementation: Canada

– HealthNet/BC, part of Ministry of Health in British

Columbia.

– CDA to provide clinical documentation in national

claims attachment project.

• In evaluation:

– by major providers and suppliers, as well as start-ups

and government projects.


The Reference Information Model



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V3 Methodology Mission

• To bring modern software engineering practices, such as

Object Oriented Analysis and Design and formal modeling,

to the standards development process.

• To bring the highest level of quality, understandability, and

flexibility to a messaging standard.

• Incorporate concept abstractions and behavior modeling

using roles in a rigorous set of work products.

• Express the standard in widely accepted UML notation.




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Version 3 Goals

• Provide a framework for coupling events,

data elements and messages.

• Improve clarity and precision of specification.

• Improve adaptability of standards to change.

• Begin to approach “plug and play”.




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Version 3 is a change to the HL7 Architecture

•• The HL7 2.x specifications have:The HL7 2.x specifications have:

–– Segments that imply information entities,Segments that imply information entities,

–– Events that indicate implied behaviors,Events that indicate implied behaviors,

–– Descriptive content that suggests use cases,Descriptive content that suggests use cases,

–– but never formally documents these.but never formally documents these.

•• Version 3 seeks to formalize this by applying object analytic Version 3 seeks to formalize this by applying object analytic

methods and style:methods and style:

–– to improve the internal consistency of HL7,to improve the internal consistency of HL7,

–– to provide sound semantic definitions,to provide sound semantic definitions,

–– to enable future architectures,to enable future architectures,

–– to produce an evolution not a revolution,to produce an evolution not a revolution,

–– Done by applying MODELING to the HL7 process.Done by applying MODELING to the HL7 process.




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Description of the HL7 2.x Standard• The Application Protocol for Electronic Data Exchange in Healthcare

Environments is an HL7 messaging standard that enables disparatehealthcare applications to exchange data.

• The standard provides the layout of messages that are exchanged between two or more applications based upon a particular trigger event.

• A message is comprised of an ordered collection of segments.

• A segment is an ordered collection of data elements that typically share a common subject.

• The HL7 standard specifies which data elements are to be sent, the data type and suggested length of each, and indicates whether the data element is required or optional and whether it may repeat.

• The message specification includes a declaration of the delimiters used to separate message segments, elements, and element components. HL7 HL7 SummarySummary



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HL7 Version 3.0• HL7 version 3.0 will be the most definitive HL7 standard to date, incorporating more

trigger events and message formats with very little optionality.

• Version 3.0 uses an object-oriented development methodology and a Reference Information Model (RIM) to create message specifications.

• The RIM is an essential part of the HL7 Version 3.0 development methodology, as it provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages.

• As part of version 3.0, the HL7 Vocabulary Technical Committee is developing methods that will allow HL7 messages to draw upon codes and vocabularies from a variety of sources.

• The V3.0 vocabulary work will assure that the systems sending and receiving V3.0 HL7 messages have an unambiguous understanding of the code sources and code value domains they are using.

• HL7’s primary goal for version 3.0 is to offer a standard that is definite and testable, and to provide certification of vendor’s conformance.




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History of HL7 V3 Activities

• 1996

– Introduce modeling to TC Chairs

– First V3 Tutorial to general membership

– Vocabulary SIG established

• 1997

– Roll-out of first RIM, version 0.80

– First Message Development Framework

– First RIM Harmonization meetings

• 1998

– Adopted Rational Rose for modeling

– Work begins on V3 XML ITS

– First RoseTree tools appear

• 1999

– V3 Data type proposal reviewed

– Notion of R-MIM added to MDF

– Vocabulary enters the V3 MDF

• 2000

– V3 data types out to ballot

– First vocabulary harmonization

– V3 Acceleration Project started

• 2001 (projected)

– XML and Datatype ballots complete

– RIM and Vocabulary stabilized

– Message specifications balloted




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*Future

Consideration

Common

Specs

Chapter-

Specific

Specs

Use

Case

Model

Use Use

Case Case

ModelModel

Information

Model

Information Information

ModelModelMessage ModelMessage ModelMessage Model

2-nd Order

1 choice of

0-n Drug

0-1 Nursing

Implementable

Message

Specification

EDIFACT*

ImplementableImplementable

Message Message

SpecificationSpecification

EDIFACT*EDIFACT*

Implementable

Message

Specification

OLE/CORBA


Message Message


OLE/CORBAOLE/CORBA

Implementable

Message

Specification

XML/ER7/…


Message Message


XML/ER7/…XML/ER7/…

HL7

Reference

Model

HL7

Reference

Model

Interaction

Model

Interaction Interaction

ModelModel

An HL7 Version 3.X Spec




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Reference Model RepositoryReference Model Repository

Requirements

Analysis

Use Case

Model

(UCM)

RequirementsRequirements

AnalysisAnalysis

Use CaseUse Case

ModelModel

(UCM)(UCM)

Domain

Analysis

Information Model &

Vocabulary(RIM)

DomainDomain

AnalysisAnalysis

Information Information Model &Model &

VocabularyVocabulary(RIM)(RIM)

AnalysisAnalysisAnalysis DesignDesignDesign

Interaction

Design

Interaction

Model

(IM)

InteractionInteraction

DesignDesign

InteractionInteraction

ModelModel

(IM)(IM)

Message

Design

Hierarchical

Message

Descriptions

(HMD)

MessageMessage

DesignDesign

HierarchicalHierarchical

MessageMessage

DescriptionsDescriptions

(HMD)(HMD)

ApplicationApplicationApplication

2-nd Order

1 choice of

0-n Drug

0-1 Nursing

22--ndnd OrderOrder

1 choice of1 choice of

00--n Drugn Drug

00--1 Nursing1 Nursing

Medical logic

Variable

definition for

Arden syntax

(AVD)

Medical logicMedical logic

VariableVariable

definition for definition for

Arden syntaxArden syntax

(AVD(AVD))

data:location_of_action:= READ LAST

MPSLOC ;‘ {patient

location}

data:data:location_of_actionlocation_of_action:= READ LAST:= READ LAST

MPSLOC ;MPSLOC ;‘ ‘ {patient{patient

location}location}

Documents

Document

Types for

HL7 PRA

(DTD)

DocumentsDocuments

Document Document

Types forTypes for

HL7 PRAHL7 PRA

(DTD)(DTD)

<!ENTITY %DT_MPSLOC“MPSLOC.id,MPSLOC.name?,MPSLOC.addr?,MPSLOC.phon?,MPSLOC.emlAdr?">

<!ENTITY %DT_MPSLOC<!ENTITY %DT_MPSLOC“MPSLOC.id,“MPSLOC.id,MPSLOC.name?,MPSLOC.name?,MPSLOC.MPSLOC.addraddr?,?,MPSLOC.MPSLOC.phonphon?,?,MPSLOC.MPSLOC.emlAdremlAdr?">?">

Messaging

Message Types

for use with

XML, ER7, etc

(MET)

MessagingMessaging

Message TypesMessage Types

for use with for use with

XML, ER7, etcXML, ER7, etc

(MET)(MET)

TYPE MPSLOC CONTAINS {id[id].TYPE IIDnm[name].TYPE STad[addr].TYPE XADph[phon].TYPE XTN email_address[emlAdr].TYPE XTN}

TYPE MPSLOC TYPE MPSLOC CONTAINS {CONTAINS {id[id].TYPE IIDid[id].TYPE IIDnm[name].TYPE STnm[name].TYPE STad[ad[addraddr].TYPE XAD].TYPE XADph[ph[phonphon].TYPE XTN ].TYPE XTN email_addressemail_address[[emlAdremlAdr].TYPE XTN].TYPE XTN}}C Code c Code

a artb bluec color

HL7 V3 Message Development Lifecycle




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Abstractions:

ActivitiesActivities(Use Case Model)(Use Case Model)

Objects Objects (Information Model)(Information Model)

Communication Communication (Interaction and (Interaction and

Message Models)Message Models)

Dispense Medications

Manage Care

Perform Lab Tests

Review Utilization

AccountAccount PatientPatient ProviderProvider EncounterEncounter OrderOrder

ADT Pharmacy

HL7 message

Finance

HALHAL

Version 2.x focused its energies at

the communication level and

covered the other abstractions only

loosely in the specifications.

HL7 message

HL7 Modeling


By demanding analysis

of the requirements and

information content,

Version 3 assures

consistency in and

enhances the value of the

resulting messages.



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The Reference Information Model (RIM)

• Expresses the information content for the collective work of the

HL7 Working Group in UML notation.

• A coherent, shared information model that is the source for the

data content of all HL7 messages.

• Maintained by a collaborative, consensus building process

involving all Technical Committees and Special Interest Groups.

• RIM change proposals are debated, enhanced, and reconciled by

technical committee representatives and applied to the RIM

during the model harmonization process.




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Subject Area: Subject Area: a major partition of a a major partition of a information model.information model.

Class:Class: something about which something about which information is collected.information is collected.

Relationship:Relationship: an affiliation between twoan affiliation between twoclasses.classes.

Attribute:Attribute: information about a class.information about a class.

Data Type:Data Type: a specification of the formata specification of the formatof an attribute.of an attribute.

Subject AreaSubject Area

Class

Attribute :: Datatype




Class





Relationship

Information Model Components




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Champus_coveragehandicapped_program_cd : CEnon_avail_cert_on_file_ind : BLretirement_dttm : TSstation_id : II

Referralauthorized_visits_qty : REALdesc : EDreason_txt : ED

Healthcare_finances

Message_control

Acts (Services)

Appointments & scheduling

Roles

HEALTH LEVEL 7REFERENCE INFORMATION MODEL

RIM_0100

released January 2001 reflects RIM changes through Harmonization on 11/17/2000

Observationvalue : ANYderivation_expr : STmethod_cd : SET<CV>body_site_cd : SET<CD>interpretation_cd : SET<CS>

Medicationform_cd : CDroute_cd : CDdose_qty : PQstrength_qty : PQrate_qty : PQdose_check_qty : PQmethod_cd : SET<CV>body_site_cd : SET<CD>substitution_cd : CV

Procedureentry_site_cd : SET<CD>method_cd : SET<CV>body_site_cd : SET<CD>

Supplyqty : PQ

Dietenergy_qty : PQcarbohydrate_qty : PQ

Consent

Enitites

Document_servicecompletion_cd : CVset_id : IIstorage_cd : CVversion_nbr : INTcopy_dttm : TSorigination_dttm : TS

Billboard produced by:Rochester Outdoor Advertising

Healthcare_providerspecialty_cd : CV

Containercapacty_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseparator_type_cd : CDcap_type_cd : CD

Accessgauge_qty : PQentry_site_cd : CDbody_site_cd : CD

Devicemanufacturer_model_nm : STlast_calibration_dttm : TSsoftware_nm : STlocal_remote_control_state_cd : CEalert_level_cd : CE

Notary_publicnotary_county_cd : CEnotary_state_cd : CE

Employee_Employeraddr : SET<AD>hazard_exposure_txt : EDjob_class_cd : CVjob_title_nm : STtelecom : SET<TEL>protective_equipment_txt : EDsalary_qty : MOsalary_type_cd : CVstatus_cd : CSjob_cd : CE

Specimenbody_site_cd : CE

Living_subjectbirth_dttm : TSdeceased_dttm : TSdeceased_ind : BLadministrative_gender_cd : CEorgan_donor_ind : BLmultiple_birth_ind : BL

Materialform_cd : CVdanger_cd : CEeffective_tmr : IVL<TS>handling_cd : CE

Practitioner_providerposition_cd : CVprimary_care_ind : BL

Practitioner_Certifierboard_certification_type_cd : CVcertification_dttm : TSrecertification_dttm : TSresidency_field_cd : CE

Military_person

military_branch_of_service_cd : CVmilitary_rank_nm : STmilitary_status_cd : CV

Placegps_txt : STposition_txtaddr : ADdirections_txt

Manufactured_materialexpiration_dttm : TSlot_nbr : ST

Health_chart

Health_chart_deficiencyassessment_dttm : TSdesc : EDlevel_cd : CVtype_cd : CV

1

0..*

has_an_assessment_of

1

is_assessed_against

0..*

Inpatient_encounter

length_of_stay_qty : PQ

Non_Person_living_subjecttaxonomic_classification_cd : CEbreed_cd : CEstrain_txt : EDeuthanasia_ind : BLproduction_class_cd : CEgender_status_cd : CE

Diagnostic_related_group_definitionbase_rate_qty : MOcapital_reimbursement_qty : MOcost_weight_qty : MOmajor_diagnostic_category_cd : CEoperating_reimbursement_qty : MOreimbursement_qty : MOstandard_day_qty : PQstandard_total_charge_qty : MOtrim_high_day_qty : PQtrim_low_day_qty : PQ

Encounter_drgapproval_ind : BLconfidential_ind : BLcost_outlier_qty : MOdesc : EDgrouper_review_cd : CEgrouper_version_id : IIoutlier_days_nbr : REALoutlier_reimbursement_qty : MOoutlier_type_cd : CV

1

0..*

defines 1

is_defi ned_by0..*

Billing_information_itemcondition_cd : CEoccurrence_cd : CEoccurrence_dttm : TSoccurrence_span_cd : CEoccurrence_span_from_dttm : TSoccurrence_span_thru_dttm : TSquantity_nbr : REALquantity_type_cd : CVvalue_amtvalue_cd : CE

Patient_Provider

Organizationorg_nm : SET<ON>standard_industry_class_cd : CEaddr : SET<AD>

Financial_transactionextended_qty : MOfee_schedule_cd : CEinsurance_qty : MOposting_dttm : TSqty : MOtransaction_batch_id : IIunit_qty : MOunit_cost_qty : MO

Clinical_document_headeravailability_status_cd : CVchange_reason_cd : CVcompletion_status_cd : CVconfidentiality_status_cd : CVcontent_presentation_cd : CVdocument_creation_dttm : TSfile_nm : STlast_edit_dttm : TSreporting_priority_cd : CEresults_report_dttm : TSstorage_status_cd : CVtranscription_dttm : TSdocument_change_cd : CVversion_nbr : INTversion_dttm : TS

Clinical_document

Patient_billing_accountadjustment_cd : CVcertification_required_ind : BLcurrent_unpaid_balance_qty : MOexpected_insurance_plan_qty : REALexpected_payment_source_cd : CVnotice_of_admission_dttm : TSnotice_of_admission_ind : BLpatient_financial_class_cd : CVprice_schedule_id : IIreport_of_eligibility_dttm : TSretention_ind : BLsignature_on_file_dttm : TSspecial_program_cd : CVstoploss_limit_ind : BLsuspend_charges_ind : BLtotal_adjustment_qty : MOtotal_charge_qty : MOtotal_payment_qty : MOseparate_bill_ind : BLbad_debt_recovery_qty : MObad_debt_transfer_qty : MO

Guarantor_contractbilling_hold_ind : BLbilling_media_cd : CEcharge_adjustment_cd : CEcontract_duration_cd : CEcontract_type_cd : CEeffective_tmr : IVL<TS>interest_rate_nbr : REALperiodic_payment_qty : MOpriority_ranking_cd : CV

Insurance_certificationcertification_duration_qty : PQeffective_tmr : IVL<TS>id : IIinsurance_verification_dttm : TSmodification_dttm : TSnon_concur_cd : CEnon_concur_effective_dttm : TSpenalty_qty : MOreport_of_eligibility_dttm : TSreport_of_eligibility_ind : BL

10..*has_coverage_aff ir med_by 1

affir ms_insurance_coverage_for

0..*

Individual_healthcare_practitionerfellowship_field_cd : CEgraduate_school_nm : ONgraduation_dttm : TSboard_certified_ind : BL

Role-role relationships

Healthcare_benefit_coverage_itemservice_category_cd : CVservice_cd : CEservice_modifier_cd : CEauthorization_ind : BLnetwork_ind : BLassertion_cd : CEcovered_parties_cd : CEqty : REALquantity_qualifier_cd : CEtime_period_qualifier_cd : CErange_low_qty : PQrange_high_qty : PQrange_units_cd : CVeligibility_cd : CEpolicy_source_cd : CEeligibility_source_cd : CEcopay_limit_ind : BL

Healthcare_benefit_product_policyassignment_of_benefits_ind : BLbenefit_product_desc : EDbenefit_product_nm : STbenefit_product_type_cd : CEbenefits_coordination_ind : BLcob_priority_nbr : REALcombine_baby_bill_ind : BLgroup_benefit_ind : BLmail_claim_party_cd : CErelease_information_cd : CEstatus_cd : CScoverage_type_cd : CEagreement_type_cd : CEpolicy_category_cd : CEaccess_protocol_desc : ED

Financial_acteffective_tmr : IVL<TS>reason_cd : CEstatus_dttm

Unmapped_financial_classes(from RIM_Healthcare_finances)

Language_abilitymode_cd : CVproficiency_level_cd : CV

Persondisability_cd : CEethnic_group_cd : CErace_cd : CEambulatory_status_cd : CVbirth_order_nbr : INTeducation_level_cd : CVliving_arrangement_cd : CVmarital_status_cd : CVreligious_affiliation_cd : CVstudent_cd : CVcredit_rating_cd : CVaddr : SET<AD>special_accommodation_cd : SET<CV>

Person_Language

0..*

1

specifi es_ability_in 0..*

is_specified_by1

1

0..*

communicates_i n

1

is_communi cated_by

0..*

Working_listownership_level_cd

Public_health_casedetection_method_cdtransmission_mode_cddisease_imported_cd

Outbreaktmr

Act_relationshiptype_cd : CSinversion_ind : BLsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS

Act_context

level_cd

Actid : SET<II>mood_cd : CStype_cd : CCtxt : EDstatus_cd : CSactivity_time : GTScritical_time : GTSconfidentiality_cd : SET<CV>max_repeat_nmr : IVL<INT>interruptible_ind : BLpriority_cd : SET<CV>orderable_ind : BLavailability_dttm : TS

0..*1

has_target

0..*

is_target_for

1

0..*1

has_source

0..*

is_source_for

1

1..*

0..*

originates_in_context_of1..*

provides_context_for0..*

Role_relationshiptype_cd : CCeffective_tmr : IVL<TS>id : SET<II>status_cd : CSresponsibility_cd : SET<CE>position_nbr : LIST<INT>qty : PQcertificate_txt : ED 0..*

0..1

is_part_of

0..*

has_parts

0..1

Participationtype_cd : CStmr : IVL<TS>note_text : EDsignature_cd : CVfunction_cd : CDawareness_cd : CVsignature_txt : EDencounter_accommodation_cd : CVstatus_cd : CS

0..*

1for

0..*

has 1

Roletype_cd : cceffective_tmr : IVL<TS>addr : SET<AD>telecom : SET<TEL>

0..*

1

has_as_target

0..*

is_target_for 11

0..*

is_source_of

1

has_as_source

0..*

0..*0..1

has_as_participant

0..*

participates_in

0..1Entity_name

effective_tmr : IVL<TS>nm : ENpurpose_cd : CV

Entityid : SET<II>type_cd : CCdeterminer_cd : CSimportance_status_txt : EDqtytelecom : SET<TEL>descstatus_cd : CS

10..*

plays_a_role

1is_played_by

0..*

0..* 1

is_for

0..*

has

1

Message_interaction

1..*shall_receive 1..*1..1sends 1..1

0..1

is_communicated_as

0..1

Transportation

Preauthorizationauthorized_encounters_qty : REALauthorized_period_begin_tmr : IVL<TS>id : IIissued_dttm : TSrequested_dttm : TSrestriction_desc : EDstatus_cd : CSstatus_change_dttm : TS

Patient_encounterdischarge_disposition_cd : CVacuity_level_cd : CVbirth_encounter_ind : BLstatus_reason_cd : CVclassification_cd : CVencounter_classification_cd : CVpractice_setting_cd : CVvaluables_desc : EDpre_admit_test_ind : BLsource_cd : CVspecial_courtesies_cd : CVvaluables_location_desc : EDeffective_tmr

0..*

1is_utili zed_during

0..*utilizes

1

1

0..1

is_authorized_by

1

authorizes

0..1

Healthcare_facilitylicensed_bed_nbr : REALmobile_ind : BL

Encounter_facility_associationeffective_tmr : IVL<TS>status_cd : CStransfer_reason_cd : CV

0..*

1

is_used_by

0..*

uses

11

0..*

is_site_for1

is_sited_at

0..*

Schedulestatus_cd : CSslot_size_increment_qty

Resource_slotstatus_cd : CStime_slot : GTS

1

0..*

manages1

is_managed_by

0..*

RIM Class Diagram V1.00

• 6 Primary Subject Areas

• 64 Classes

• 348 Attributes

• 73 Relationships

• 45 Data types HL7 HL7 SummarySummary



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Champus_coveragehandicapped_program_cd : CEnon_avail_cert_on_file_ind : BLretirement_dttm : TSstation_id : II

Referralauthorized_visits_qty : REALdesc : EDreason_txt : ED

Healthcare_finances

Message_control

Acts (Services)

Appointments & scheduling

Roles

HEALTH LEVEL 7REFERENCE INFORMATION MODEL

RIM_0100

released January 2001 reflects RIM changes through Harmonization on 11/17/2000

Observationvalue : ANYderivation_expr : STmethod_cd : SET<CV>body_site_cd : SET<CD>interpretation_cd : SET<CS>

Medicationform_cd : CDroute_cd : CDdose_qty : PQstrength_qty : PQrate_qty : PQdose_check_qty : PQmethod_cd : SET<CV>body_site_cd : SET<CD>substitution_cd : CV

Procedureentry_site_cd : SET<CD>method_cd : SET<CV>body_site_cd : SET<CD>

Supplyqty : PQ

Dietenergy_qty : PQcarbohydrate_qty : PQ

Consent

Enitites

Document_servicecompletion_cd : CVset_id : IIstorage_cd : CVversion_nbr : INTcopy_dttm : TSorigination_dttm : TS

Billboard produced by:Rochester Outdoor Advertising

Healthcare_providerspecialty_cd : CV

Containercapacty_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseparator_type_cd : CDcap_type_cd : CD

Accessgauge_qty : PQentry_site_cd : CDbody_site_cd : CD

Devicemanufacturer_model_nm : STlast_calibration_dttm : TSsoftware_nm : STlocal_remote_control_state_cd : CEalert_level_cd : CE

Notary_publicnotary_county_cd : CEnotary_state_cd : CE

Employee_Employeraddr : SET<AD>hazard_exposure_txt : EDjob_class_cd : CVjob_title_nm : STtelecom : SET<TEL>protective_equipment_txt : EDsalary_qty : MOsalary_type_cd : CVstatus_cd : CSjob_cd : CE

Specimenbody_site_cd : CE

Living_subjectbirth_dttm : TSdeceased_dttm : TSdeceased_ind : BLadministrative_gender_cd : CEorgan_donor_ind : BLmultiple_birth_ind : BL

Materialform_cd : CVdanger_cd : CEeffective_tmr : IVL<TS>handling_cd : CE

Practitioner_providerposition_cd : CVprimary_care_ind : BL

Practitioner_Certifierboard_certification_type_cd : CVcertification_dttm : TSrecertification_dttm : TSresidency_field_cd : CE

Military_personmilitary_branch_of_service_cd : CVmilitary_rank_nm : STmilitary_status_cd : CV

Placegps_txt : STposition_txtaddr : ADdirections_txt

Manufactured_materialexpiration_dttm : TSlot_nbr : ST

Health_chart

Health_chart_deficiencyassessment_dttm : TSdesc : EDlevel_cd : CVtype_cd : CV

1

0..*

has_an_assessment_of

1

is_assessed_against

0..*

Inpatient_encounterlength_of_stay_qty : PQ

Non_Person_living_subjecttaxonomic_classification_cd : CEbreed_cd : CEstrain_txt : EDeuthanasia_ind : BLproduction_class_cd : CEgender_status_cd : CE

Diagnostic_related_group_definitionbase_rate_qty : MOcapital_reimbursement_qty : MOcost_weight_qty : MOmajor_diagnostic_category_cd : CEoperating_reimbursement_qty : MOreimbursement_qty : MOstandard_day_qty : PQstandard_total_charge_qty : MOtrim_high_day_qty : PQtrim_low_day_qty : PQ

Encounter_drgapproval_ind : BLconfidential_ind : BLcost_outlier_qty : MOdesc : EDgrouper_review_cd : CEgrouper_version_id : IIoutlier_days_nbr : REALoutlier_reimbursement_qty : MOoutlier_type_cd : CV

1

0..*

defines 1

is_defi ned_by0..*

Billing_information_itemcondition_cd : CEoccurrence_cd : CEoccurrence_dttm : TSoccurrence_span_cd : CEoccurrence_span_from_dttm : TSoccurrence_span_thru_dttm : TSquantity_nbr : REALquantity_type_cd : CVvalue_amtvalue_cd : CE

Patient_Provider

Organizationorg_nm : SET<ON>standard_industry_class_cd : CEaddr : SET<AD>

Financial_transactionextended_qty : MOfee_schedule_cd : CEinsurance_qty : MOposting_dttm : TSqty : MOtransaction_batch_id : IIunit_qty : MOunit_cost_qty : MO

Clinical_document_headeravailability_status_cd : CVchange_reason_cd : CVcompletion_status_cd : CVconfidentiality_status_cd : CVcontent_presentation_cd : CVdocument_creation_dttm : TSfile_nm : STlast_edit_dttm : TSreporting_priority_cd : CEresults_report_dttm : TSstorage_status_cd : CVtranscription_dttm : TSdocument_change_cd : CVversion_nbr : INTversion_dttm : TS

Clinical_document

Patient_billing_accountadjustment_cd : CVcertification_required_ind : BLcurrent_unpaid_balance_qty : MOexpected_insurance_plan_qty : REALexpected_payment_source_cd : CVnotice_of_admission_dttm : TSnotice_of_admission_ind : BLpatient_financial_class_cd : CVprice_schedule_id : IIreport_of_eligibility_dttm : TSretention_ind : BLsignature_on_file_dttm : TSspecial_program_cd : CVstoploss_limit_ind : BLsuspend_charges_ind : BLtotal_adjustment_qty : MOtotal_charge_qty : MOtotal_payment_qty : MOseparate_bill_ind : BLbad_debt_recovery_qty : MObad_debt_transfer_qty : MO

Guarantor_contractbilling_hold_ind : BLbilling_media_cd : CEcharge_adjustment_cd : CEcontract_duration_cd : CEcontract_type_cd : CEeffective_tmr : IVL<TS>interest_rate_nbr : REALperiodic_payment_qty : MOpriority_ranking_cd : CV

Insurance_certificationcertification_duration_qty : PQeffective_tmr : IVL<TS>id : IIinsurance_verification_dttm : TSmodification_dttm : TSnon_concur_cd : CEnon_concur_effective_dttm : TSpenalty_qty : MOreport_of_eligibility_dttm : TSreport_of_eligibility_ind : BL

10..*has_coverage_aff ir med_by 1

affir ms_insurance_coverage_for

0..*

Individual_healthcare_practitionerfellowship_field_cd : CEgraduate_school_nm : ONgraduation_dttm : TSboard_certified_ind : BL

Role-role relationships

Healthcare_benefit_coverage_itemservice_category_cd : CVservice_cd : CEservice_modifier_cd : CEauthorization_ind : BLnetwork_ind : BLassertion_cd : CEcovered_parties_cd : CEqty : REALquantity_qualifier_cd : CEtime_period_qualifier_cd : CErange_low_qty : PQrange_high_qty : PQrange_units_cd : CVeligibility_cd : CEpolicy_source_cd : CEeligibility_source_cd : CEcopay_limit_ind : BL

Healthcare_benefit_product_policyassignment_of_benefits_ind : BLbenefit_product_desc : EDbenefit_product_nm : STbenefit_product_type_cd : CEbenefits_coordination_ind : BLcob_priority_nbr : REALcombine_baby_bill_ind : BLgroup_benefit_ind : BLmail_claim_party_cd : CErelease_information_cd : CEstatus_cd : CScoverage_type_cd : CEagreement_type_cd : CEpolicy_category_cd : CEaccess_protocol_desc : ED

Financial_acteffective_tmr : IVL<TS>reason_cd : CEstatus_dttm

Unmapped_financial_classes(from RIM_Healthcare_finances)

Language_abilitymode_cd : CVproficiency_level_cd : CV

Persondisability_cd : CEethnic_group_cd : CErace_cd : CEambulatory_status_cd : CVbirth_order_nbr : INTeducation_level_cd : CVliving_arrangement_cd : CVmarital_status_cd : CVreligious_affiliation_cd : CVstudent_cd : CVcredit_rating_cd : CVaddr : SET<AD>special_accommodation_cd : SET<CV>

Person_Language

0..*

1

specifi es_ability_in 0..*

is_specified_by1

1

0..*

communicates_i n

1

is_communi cated_by

0..*

Working_listownership_level_cd

Public_health_casedetection_method_cdtransmission_mode_cddisease_imported_cd

Outbreaktmr

Act_relationshiptype_cd : CSinversion_ind : BLsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS

Act_contextlevel_cd

Actid : SET<II>mood_cd : CStype_cd : CCtxt : EDstatus_cd : CSactivity_time : GTScritical_time : GTSconfidentiality_cd : SET<CV>max_repeat_nmr : IVL<INT>interruptible_ind : BLpriority_cd : SET<CV>orderable_ind : BLavailability_dttm : TS

0..*1

has_target

0..*

is_target_for

1

0..*1

has_source

0..*

is_source_for

1

1..*

0..*

originates_in_context_of1..*

provides_context_for0..*

Role_relationshiptype_cd : CCeffective_tmr : IVL<TS>id : SET<II>status_cd : CSresponsibility_cd : SET<CE>position_nbr : LIST<INT>qty : PQcertificate_txt : ED 0..*

0..1

is_part_of

0..*

has_parts

0..1

Participationtype_cd : CStmr : IVL<TS>note_text : EDsignature_cd : CVfunction_cd : CDawareness_cd : CVsignature_txt : EDencounter_accommodation_cd : CVstatus_cd : CS

0..*

1for

0..*

has 1

Roletype_cd : cceffective_tmr : IVL<TS>addr : SET<AD>telecom : SET<TEL>

0..*

1

has_as_target

0..*

is_target_for 11

0..*

is_source_of

1

has_as_source

0..*

0..*0..1

has_as_participant

0..*

participates_in

0..1Entity_name

effective_tmr : IVL<TS>nm : ENpurpose_cd : CV

Entityid : SET<II>type_cd : CCdeterminer_cd : CSimportance_status_txt : EDqtytelecom : SET<TEL>descstatus_cd : CS

10..*

plays_a_role1

is_played_by

0..*

0..* 1

is_for

0..*

has

1

Message_interaction

1..*shall_receive 1..*1..1sends 1..1

0..1

is_communicated_as

0..1

Transportation

Preauthorizationauthorized_encounters_qty : REALauthorized_period_begin_tmr : IVL<TS>id : IIissued_dttm : TSrequested_dttm : TSrestriction_desc : EDstatus_cd : CSstatus_change_dttm : TS

Patient_encounter

discharge_disposition_cd : CVacuity_level_cd : CVbirth_encounter_ind : BLstatus_reason_cd : CVclassification_cd : CVencounter_classification_cd : CVpractice_setting_cd : CVvaluables_desc : EDpre_admit_test_ind : BLsource_cd : CVspecial_courtesies_cd : CVvaluables_location_desc : EDeffective_tmr

0..*

1is_utili zed_during

0..*utilizes

1

1

0..1

is_authorized_by

1

authorizes

0..1

Healthcare_facilitylicensed_bed_nbr : REALmobile_ind : BL

Encounter_facility_associationeffective_tmr : IVL<TS>status_cd : CStransfer_reason_cd : CV

0..*

1

is_used_by

0..*

uses

11

0..*

is_site_for1

is_sited_at

0..*

Schedulestatus_cd : CSslot_size_increment_qty

Resource_slotstatus_cd : CStime_slot : GTS

1

0..*

manages1

is_managed_by

0..*

RIM Primary Subject Areas

Entity

Role

ParticipationAct

Relationship

Role

Relationship

Act

Entity

Role

ParticipationAct

Relationship

Role

Relationship

Act




SommaireSommaire

Entity Role Participation Act

1

0..*

1

0..*

1

0..*

Role Relationship Act Relationship

0..* 0..*

0..1 0..1

0..* 0..*

0..1 0..1

RIM Core Classes




SommaireSommaire

Entity

Type_CD : CC

Determiner_CD : CS

Status_CD : CS

Role

Type_CD : CS

Effective_TMR : IVL<TS>

Participation

Type_CD : CS

TMR : IVL<TS>

Status_CD : CS

Act

Type_CD : CC

Mood_CD : CS

Status_CD : CS

Activity_Time : GTS

1

0..*

1

0..*

1

0..*

Role Relationship

Type_CD : CS


Status_CD : CS

Act Relationship

Type_CD : CS

0..* 0..*

0..1 0..1

0..* 0..*

0..1 0..1

RIM Core Attributes




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Entity

Type_CD : CC

Determiner_CD : CS

Status_CD : CS

Role

Type_CD : CS


Participation

Type_CD : CS

TMR : IVL<TS>

Status_CD : CS

Act

Type_CD : CC

Mood_CD : CS

Status_CD : CS

Activity_Time : GTS

1

0..*

1

0..*

1

0..*

RIM Core Attribute Value Sets

Entity

Type Code

•• Living SubjectLiving Subject

•• PersonPerson

•• OrganizationOrganization

•• MaterialMaterial

•• PlacePlace

•• ......

Role

Type Code

•• PatientPatient

•• ProviderProvider

•• GuarantorGuarantor

•• SpecimenSpecimen

•• HomeHome

•• ......

Participation

Type Code

•• PerformerPerformer

•• AuthorAuthor

•• WitnessWitness

•• BeneficiaryBeneficiary

•• DestinationDestination

•• ......

Act

Mood Code

•• DefinitionDefinition

•• IntentIntent

•• OrderOrder

•• EventEvent

•• CriterionCriterion

•• ......

Act

Type Code

•• ObservationObservation

•• ProcedureProcedure

•• SupplySupply

•• MedicationMedication

•• FinancialFinancial

•• ......

Entity

Determiner

Code

•• ClassClass

•• InstanceInstance

•• QualifiedQualified

GroupGroupHL7 HL7 SummarySummary



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Vocabulary Domains and Codes

• Coded attributes in the RIM must be associated with one and only one

Vocabulary Domain prior to being used in a message specification.

• A vocabulary domain is “The set of all concepts that can be taken as

valid values in an instance of a coded field or attribute.”

• Each concept in the vocabulary domain is represented using a code from

a specific vocabulary.

• A vocabulary is a defined set of coded concepts.

• A vocabulary may be specified as an enumerated list of coded concepts

(HL7 defined) or as a reference to an externally maintained list of coded

concepts (e.g., SNOMED, LOINC, CPT, . . .).HL7 HL7 SummarySummary



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Vocabulary Domain Specification




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Vocabulary Codes & Definitions




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RIMRIM

(1)(1)

Define aDefine a

MIMMIM

MIMMIM

(2)(2)

Define aDefine a

RR--MIMMIM

RR--MIMMIM

(3)(3)

Create Create

an HMDan HMD

HMDHMD

RIMReference Information Model

MIMMessage Information Model

R-MIMRefined Message Information Model

HMDHierarchical Message Definition

•• Select a subset of the RIM classesSelect a subset of the RIM classes

•• Select a subset of class relationshipsSelect a subset of class relationships

•• Select a subset of class attributes Select a subset of class attributes

•• Select a subset of attributeSelect a subset of attribute datatypesdatatypes

•• Select a subset of attribute domains and value setsSelect a subset of attribute domains and value sets

•• Created clones of classes and attributesCreated clones of classes and attributes

•• Assign alias class and attribute namesAssign alias class and attribute names

•• Eliminate unnecessary class hierarchiesEliminate unnecessary class hierarchies

•• Finalize class relationships and multiplicityFinalize class relationships and multiplicity

•• Finalize attribute domains and value setsFinalize attribute domains and value sets

•• Select a root class for the messageSelect a root class for the message

•• Arrange classes and attributes hierarchicallyArrange classes and attributes hierarchically

•• Declare inclusion and repetition constraintsDeclare inclusion and repetition constraints

•• Declare domain value constraintsDeclare domain value constraints

•• Assign message element namesAssign message element names

RIM Implementation


Messages



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Hierarchical Message Definition




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HMD Components• The Information Model Mapping. The columns that are in this section describe classes and

attributes of the R-MIM, organized in a sequence that describes a "walk" from class to class on the R-

MIM.

• The Message Elements. The columns in this section describe the message elements and define the

Message Element Types. The message elements compose a hierarchy. This hierarchy is illustrated by

indentation in the column Message Element Name.

• General constraints and defaults. Describe specific constraints and defaults for the message element

defined in the row. The columns are the same as the corresponding section of the R-MIM. The values

in the columns may be the same or may be a more restrictive constraint. HL7 HL7 SummarySummary



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Message Specification

Reference Information Model

RefinedMessageInformation Model

Message Information Model

Interaction ModelHierarchical

Message Description

Use Case Model

Inpatient_encounteractual_days_qtyes timated_days_qtyPatient_admission

admiss ion_dttmadmission_reason_cdadmission_referral_cdadmiss ion_source_cdadmiss ion_type_cdpre_adm it_tes t_indreadm ission_ind

1

1is_preceded_by

1

preceded

1

Encounter_practitionerparticipation_type_cdPerson_as_IHCP

phon : TIL

Person_name_for_IHCPcd : CVpurpose_cd : CVtype_cd : CVnm : PN

1

1

has1

is_for

1

Patient_billing_account

id : TIIs tatus_cd : CVbilling_status_cd : CVpatient_financial_class_cd : CVprice_schedule_id : TII

Patient_encounterid : TIIs tatus_cd : CVencounter_class ification_cd : CVstart_dttmend_dttmexpected_insurance_plan_qty : NMfirs t_s im ilar_illness_dttm

1..*

1

is_associated_with

1..*

has_as_participant 1Individual_healthcare_practitioner

id : TII

0..*

1

is_participant_for 0..*

participates_as1

1

1

is_a_role_of1

takes_on_role_of1

Patientid : TIIs tatus_cd : CVnewborn_baby_indmultiple_birth_indorgan_donor_ind

0..1

1

belongs_to

0..1

has1

1

1

involves

1

is_involved_in

1

0..*

0..1

has_a_primary_provider0..*

is_the_primary_provider_for0..1Person_as_Patientbirth_dttm : TSbirthplace_addr : STdeceased_dttm : TSeducation_level_cd : CVgender_cd : CVmarital_s tatus_cd : CVrace_cd : CVreligious_affiliation_cd : CVphon : TIL

1..1

1..1

is_a_role_of

1..1

takes_on_role_of1..1

Person_name_for_Patientnm : PNeffective_dt : TScd : CVpurpose_cd : CVtermination_dt : TStype_cd : CV

1

1..*

has

1

is_for1..*

Exactly one occurrence




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Health care computing trends – since ‘87

• Rather than consolidating in large data centers, computer architectures have become increasingly fractionated.

• Computers are dramatically smaller, faster, cheaper.

• Networks give instantaneous access to anyone, anywhere, any time.

• Medical technology has rapidly expanded the data demands placed on health care computing.

• As a result, distributed architectures have become the norm for most medical centers, with a concomitant requirement for system interoperability.




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HL7’s mission is clinical interoperability“To provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.”

Source: HL7 Mission statement (1997)

• Observation:– HL7 Version 2 “works” for exchanging clinical data within an enterprise

(with bilateral negotiation),

– Inter-enterprise efforts (E-health) won’t permit bilateral negotiation.

• Highly “informatical” approach:– Reference Information Model,

– Vocabulary Model. HL7 HL7 SummarySummary



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SemanticinteroperabilityFunctional

interoperability

Interoperability• Main Entry: in·ter·op·er·a·bil·i·ty

Function: nounDate: 1977: ability of a system (as a weapons system) to use the parts or equipment of another system

Source: Merriam-Webster web site

• interoperability

: ability of two or more systems or components to exchange information and to use the information that has been exchanged.

Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]




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Innovating to meet the challenge

• Initial efforts based on a pragmatic ‘just do it’ approach to standards.

• Saw the need to revise and formalize the process:

– to assure consistency of the standards,

– to meet plug’n’play demands,

– to be able to adopt and leverage new technologies for both HL7 and its users.

• Adopted the Version 3 Methodology in 1997:

– based on best development & design practices,

– supports ‘distributed’ development across committees,

– is technology neutral. HL7 HL7 SummarySummary



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Version 3 Basics

• Methodology based on shared models:

– Reference Information Model (RIM):

• of the health care information domain.

– Defined vocabulary domains:

• Drawn from the best available terminologies,

• Directly linked to the RIM,

• Supported by robust communication techniques.

• Harmonization process that:

– Assures each member and committee a voice in the process, yet,

– Produces a single model as the foundation for HL7 standards.




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History of HL7 V3 Activities

1996 - Introduction to Technical Steering Committee.

1997 - First methodology (MDF) & RIM published.

1998 - Initial work on XML implementation

– First V3 design tools.

1999 - First HIMSS demo of V3 and XML interoperability

– First data type and vocabulary proposals.

2000 - Second V3 & XML demo at HIMSS

– Clinical Data Architecture Standard approved.

2001 - Third HIMSS demo. HL7 HL7 SummarySummary



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The result• HL7 Version 3 Acceleration Project – mid-2000.

• Increased Version 3 effort from about 50% to 80%.

• Authorized “fast-track” projects and project coordination to address the bottlenecks.

Goal: Goal: "To publish standard(s) for a comprehensive set of "To publish standard(s) for a comprehensive set of messages that adhere to the Version 3 Statement of messages that adhere to the Version 3 Statement of Principles and that will provide a sound basis for Principles and that will provide a sound basis for implementations by health care information systems implementations by health care information systems throughout HL7's base of users. This task will be throughout HL7's base of users. This task will be substantially completed by the end of calendar year 2001."substantially completed by the end of calendar year 2001."




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Observations in mid-flight

• Clearly doubled the V3 productive effort.

• Due to acceleration efforts, published version 1.0 of the RIM –the first non-"draft" version – 1/5/01.

• Addressing near-term issues with extra meetings and support.

• Significant increase in the productive collaboration with the new HL7 international affiliates and CEN.

• The project has had profound impacts on HL7:

– Increasing the production,

– Attracting participants,

– Increasing the stress.HL7 HL7 SummarySummary



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The V3 acceleration “messages”

• Rapidly approaching the finish line.

• The V3 methodology continues to hold up and to provide the process acceleration projected.

• There’s plenty of work to do, and enthusiasm for undertaking it.




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The Challenge

• Multiple disparate applications:

labs, meds, cardiology, scheduling, billing, etc.

• Users in need of easy access to data and tools:

physicians, nurses, therapists, administrators, etc.

• Kiosk as well as personal workstations:

hospitals, clinics, offices, homes, etc.


Clinical Context Object Workgroup



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( )( )

WHAT: Couple, Coordinate, Synchronize Applications at Point-of-Use.

HOW: “Easy” Standards Using Component-Based Technology.

WHY: Providers: Flexibility to Choose Applications They Want.

Vendors: Faster to Market with Best-of-Class Solutions.

Everyone: “Out-of-the-Box” Integration.

WHEN: NOW!

HL7 CCOW Technical Committee




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What They’re Saying …

“With CCOW, healthcare CIOs have an unparalleled

opportunity to link their myriad applications together,

achieving the oft-stated goal of getting the right

information to the right person at the right time. It's

difficult to overstate the significance of this breakthrough

because it means physicians finally have intuitive access to

the entire breadth and depth of clinical information.”

Leslie Kelly Hall, CIO, St. Alphonsus Regional Medical Center, Boise




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What They’re Saying …

“Originally an ad hoc group created to solve the

problem of insuring common context between different

applications in simultaneous use on the desktop,

CCOW is capturing extremely important space in web

browser and user security areas.”

CHIM Standards Insight, Feb. 7, 2000




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Example: Patient Link

Nancy Furlow




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Standard Subjects

Ratified as of V1.3:

• User,

• Patient,

• Encounter,

• Observation,

• Certificate.

Work in progress:

• Disease state,

• Various DICOM subjects,

• A moment in time. HL7 HL7 SummarySummary



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Other Capabilities

•• Secure SubjectsSecure Subjects - Only applications with access privileges may set or get (e.g., User).

•• Dependent SubjectsDependent Subjects - The value of a subject must be consistent with the value for another subject (e.g., Encounter depends on Patient).

•• Custom SubjectCustom Subjects - May be defined by healthcare providers and/or vendors, distinct from HL7’s standard subjects.

•• Annotation SubjectsAnnotation Subjects - Data that is in addition to a subject’s

identity (e.g., a Certificate is an annotation for the User subject).




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ArchitectureDisparate Applications

Context ManagerContext ManagerContext Manager

/ CCOW Interfaces

Copyright © 2000 Sentillion, Inc.

CCOW

Mapping Mapping

AgentAgent

Annotation AgentAnnotation Agent

CCOW




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Technology Neutral StandardTechnology Neutral Context Management Architecture

Technology Specific User Interface

Windows/Browser

(Swing)

(other)

COM

Web(CORBA)

Technology Specific Component Mapping

Technology-Neutral Subject

Data Defn’s

200 pgs

15 pgs

40 pgs

30 pgs




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CCOW Standard Status1.0 (Ratified April 1999)1.0 (Ratified April 1999)√ Component Architecture√ Common Links: Patient Link√ Secure Links: User Link√ Component Interfaces for:

ApplicationsContext ManagerPatient Mapping AgentUser Mapping AgentAuthentication Repository

√ Technology Mapping to COM√ User Interface for Windows

1.1 (Ratified January 2000)1.1 (Ratified January 2000)√ Inter-dependent Subjects: Encounter Link√ Custom Subjects and Items√ Conformance Statements

1.2 (Ratified May 2000)1.2 (Ratified May 2000)√ Technology Mapping to Web

1.3 (Ratified January 2001)1.3 (Ratified January 2001)√ Additional Security Capabilities√ Annotation Agents√ Observation Link√ Digital Certificate Annotation

1.4 (Scheduled January 2002)1.4 (Scheduled January 2002)√ Disease Link√ DICOM Study Link√ Multiple User Contexts / One Device√ XML data representations

1.4 (Scheduled May 2002)1.4 (Scheduled May 2002)√ Technology Mapping to SOAP√ Nested contexts√ More TBD




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Early UptakeIn Use:In Use: Rex (N.C.), Duke (N.C.), Marshfield Clinic (Wisc.), St. Josephs

(Wisc.), others

Implementing:Implementing: St. Alphonsus (Boise), Cottage (CA),

30+ others early 2001

Shipping Applications:Shipping Applications: 3M, Agilent, Bionetrix, CoreChange,

Care Data Systems, Drager, DR Systems, Eclipsys, GE/Marquette,

Medcon, Medscape, McKessonHBOC, Presideo, SpaceLabs/Burdick,

Stockell, many others in 2001

Shipping Platform/Tools:Shipping Platform/Tools: Sentillion

Acceptance:Acceptance: Worldwide (incl. U.S., Canada, Germany, France,

Taiwan, Japan) HL7 HL7 SummarySummary



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Additional InformationWeb Sites:Web Sites:

Health Level Seven, www.hl7.org

Sentillion, www.sentillion.com

List server:List server:

[email protected] (see HL7 web site to join)

CoCo--Chairs:Chairs:

Robert Seliger, Sentillion, [email protected]

Barry Royer, Siemens/SMS, [email protected]

Michael Macaluso, McKessonHBOC, [email protected] HL7 SummarySummary

HL7 and XML



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Benefits of XML

• Availability of off-the-shelf (OTS) processors:

– freeware and commercial parsers:- OTS parsers can perform much of the validation of message/document instances,

so that applications don't have to.

– transformation and viewing tools:- XSL processor + a web browser = intelligent message/document viewer,

- XSLT could be used as an elementary interface engine rule specification language.

• Availability of trained personnel.• Bottom line – less expensive – faster to develop – easier

to maintain!HL7 HL7 SummarySummary

XML Will Enable E-Healthcare

ExternalIntegration

(B2C and B2B)

Patients, Members Doctors and Other Health

Professionals

HTML XML Applicationsof Business

Partners

Internet

XMLXML

Portal or Web Integration Server

ProprietaryProprietaryXML

Integration Broker (Interface Engine)

Legacy Host or Application Server

Legacy Host or Application Server

HTML

Legacy Environment

“E” Environment


Who Wants to Be Your XML SDO?

XML Namespaces

Web Interface DefinitionLanguage (WIDL)

Platform for Privacy Preferences (p3p)

Open SoftwareDistribution (OSD)

Channel Definition Format (CDF)

XML Data

SynchronizedMultimedia Integration

Language (SMIL)

Resource DescriptionFramework (RDF)

Document Object Model (DOM)

Extensible Markup Language (XML) Extensible Style

Language (XSL)

XML PointerLanguage (X Pointer)

Mathematical Markup Language (MathML)

Scalable Vector Graphics

(SVG) Precision Graphics Markup Language

(PGML)

Schema for OO XML (SOX)

Meta ContentFramework (MCF)

Universal Commerce Language and Protocol (UCLP)

Trading Partner Agreement Markup Language (tpaML)

Software Open Access Protocol (SOAP)

XML Forms (Xforms)

ElectronicCatalog

XML (eCX)

Name and AddressMarkup Language (NAML)

Customer Identity Markup Language (CIML

Product Data Markup Language (PDML)

Well LogMarkup Language

(WellLogML)

Telecommunications Interchange Markup (TIM)

Extensible3D(X3D)

Commerce XML (cXML)

Information and Content Exchange (ICE)

XML-Electronic Data Interchange (XML-EDI)

Financial Information eXchangeMarkup Language (FIXML)

Extensible FormsDescription Language (XFDL

Commerce Business Library (CBL)

Weather Observation Markup Format (OMF)

Bank Internet Payment System

Signed Document Markup Language (SDML)

Open Trading Protocol (OTP)

SmartX (smart card) Markup Language (SML)

XML QueryLanguage (XML-QL)

XSL Transformations (XSLT)

XML Metadata Interchange (XMI)

Vector Markup Language (VML)

Document Content Description (DCD)Document Type

Definition (DTD)

XML Forms Architecture (XFA)

Financial PlanningMarkup Language (FpML)

Predictive ModelMarkup Language

(PMML)

Telecommunications Interchange Markup (TIM)

Electronic Business XML (ebXML)

Business Rules for E-Commerce (BREC))

Health Level-Seven (HL7)

Source: Gartner Research




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How Will Industry End the Confusion?• From the point of view of standards, XML is a

“disruptive technology”:

– can break the mold of established standards.

• After a period of competition among would-be

standards developers, an industry will coalesce behind

standards organizations that:

– have comprehensive coverage across multiple ways of

using XML,

– have a consistent approach,

– have de jure status. HL7 HL7 SummarySummary



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How is HL7 Approaching XML?

• Comprehensive coverage across multiple ways

of using XML:

– Clinical Document Architecture,

– highly granular clinical messages (version 3),

– legacy messages (version 2/XML),

• Consistent standards through the Reference

Information Model.

• First de jure standard approved by ANSI

November, 2000. HL7 HL7 SummarySummary



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XML RepositoryXML Repository

DatabaseDatabase

Clinical NoteClinical NoteJones Jones

BP 183/147BP 183/147

Face SheetSmith 12345

Clinical ObservationsClinical Observations37362 BP 183/14737362 BP 183/14712345 BP 120/8012345 BP 120/80

Demographic DataJones 37362Smith 12345

Face SheetJones 37362Face SheetFace Sheet

Smith 12345Smith 12345

Collect Collect DemographicsDemographics

Clinical NoteClinical NoteSmith Smith

BP 120/80BP 120/80

Clinical NoteClinical NoteSmith 12345 Smith 12345

BP 120/80BP 120/80

Perform AdmissionPerform AdmissionPhysicalPhysical

“Document” (Content) vs. “Message” (Event)




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HL7 Version 3

• Goal: interoperability for clinical data.

• Observation:

– HL7 Version 2 “works” for exchanging clinical data

within an enterprise (with bilateral negotiation),

– E-health won’t permit bilateral negotiation.

• Highly “informatical” approach:

– Reference Information Model,

– Vocabulary Model,

– Templates. HL7 HL7 SummarySummary



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HL7 V.2 XML

• Legacy Messages, XML Syntax.

• Brings the power of cross-industry XML-based tools to environments that are already running hundreds of legacy HL7 messages.

• Enables the use of existing HL7 standards in “e” environments that require the XML syntax.


1Q01

1Q01

Non-XML, 2Q00Non-XML, 2Q00

Non-XML, 2Q03Non-XML, 2Q03

StudyingStudying

DesigningDesigning

Pilot Pilot ProjectsProjects

ANSI ANSI CertificationCertification

UsageUsage

DominanceDominance

HL7HL7 X12NX12N NCPDPNCPDP DICOMDICOM

0.60.7

0.6

0.70.80.9

0.9

0.8

XML, 2Q00XML, 2Q00

XML, 2Q03XML, 2Q03

Healthcare XML Standards

Source: Gartner Research




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Why should HL7 be your XML SDO?

• We know clinical health care and the challenges it presents for interoperability.

• We know XML – its opportunities, limitations and likely evolution.

• Thus, HL7 is uniquely positioned to leverage XML for your benefit.

• HL7 is committed to succeeding in this endeavor.




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More on HL7?

Connect to http://www.HL7.org

You can findYou can find more information, more information,

downloadable downloadable information files information files and and

membership membership information.information.

CEN/TC 251

Health Informatics



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Scope of the CEN/TC 251

• Organization, coordination and monitoring of the

development of standards, including testing standards in

Health Care Informatics, as well as promulgation of

these standards.

• Four Working Groups:

– WG 1: Information Model and Medical Records.

– WG 2: Terminology.

– WG 3: Security, Safety and Quality.

– WG 4: Technologies for Interoperability.



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CEN/TC 251

• ENV 13606 “Electronic Healthcare Record and

Communication”:

– Part 1: Extended Architecture.

– Part 2: Domain Termlist.

– Part 3: Distribution Rules.

– Part 4: Message for the exchange of information.

• ENV 13607 “Message for the exchange of information

on medicine prescriptions”.



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CEN/TC 251

• ENV 13608 “Security for Healthcare

Communication”:

– Part 1: Concepts and Terminology.

– Part 2: Secure Data Objects.

– Part 3: Secure Data Channels.



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CEN/TC 251

• All published ENVs are currently revisited.

• The review of the ENVs will take place in the

framework of the MoU with HL7, especially for

messaging.



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More on CEN/TC 251?

Connect to http://www.centc251.org

You can findYou can find more information more information and and

downloadabledownloadable information files.information files.

ISO/TC 215

Health Informatics



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ISO/TC 215

• In August 1998, ISO/TC 215 was started with a scope

similar to that of CEN/TC 251.

• HL7 had a positive action to launch TC 215

• These International efforts have been welcomed by

Europe and an active collaboration between European

and International level has been started.



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ISO/TC 215

• Five Working Groups:

– WG 1: Healthcare Folder and Modelling Coordination.

– WG 2: Message and Communication.

– WG 3: Health Concept Representation.

– WG 4: Security.

– WG 5: Health Cards.

• Task Force DICOM Liaison (Liaison Type A).

• Discussion on an possible liaison with OMG.



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ISO/TC 215

• Business plan is currently proposed for

comments by members of the TC.

• According to Vienna agreement, it is proposed

to harmonize works between CEN/TC 251 and

ISO/TC215, especially on Health cards.



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ISO/TC 215

• First standards are expected by 2002.

• Nowadays the most consistent publication is the

proposition of a methodology by WG 2.

• There is also a strong collaboration between WG

2, HL7 and DICOM.



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More on ISO/TC 215?

Connect to:

http://www.iso.ch/meme/TC215.html (english)

http://www.iso.ch/memf/TC215.html (french)

You can findYou can find somesome information information and and links.links.



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HL7HL7

CEN/TC 251CEN/TC 251

ISO/TC215ISO/TC215

Nous espérons que vous avez maintenant une Nous espérons que vous avez maintenant une meilleure connaissance du monde de la standardisation meilleure connaissance du monde de la standardisation

en Informatique de Santé.en Informatique de Santé.

Merci !Merci !

Jérome GuignotJérome Guignot

Joël ChabriaisJoël Chabriais

Florent AubryFlorent Aubry

Andrew ToddAndrew Todd--PokropekPokropek

Yves Yves GandonGandon

Bernard Bernard GibaudGibaud

Gilles Gilles MévelMével

Charles Charles ParisotParisot

Jörg RiesmeierJörg Riesmeier

Marco Marco EichelbergEichelberg

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