Hl7 version 3 driving interoperability transforming healthcare information management
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“The great thing about standards is that there are so many to choose from.” --- anonymous. HL7 Version 3: Driving Interoperability & Transforming Healthcare Information Management. Charles Mead, MD, MSc Director, Healthcare Information Architecture Oracle Healthcare

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Hl7 version 3 driving interoperability transforming healthcare information management

“The great thing about standards is that there are so many to choose from.” --- anonymous

HL7 Version 3:Driving Interoperability & Transforming Healthcare Information Management

Charles Mead, MD, MSc

Director, Healthcare Information Architecture

Oracle Healthcare

[email protected]

BCIG Seminar

National Institutes of Health

October 14, 2004


A framework for change bits vs atoms being digital nicholas negroponte

A Framework for Change:Bits vs Atoms(“Being Digital,” Nicholas Negroponte)

  • Atoms

    • Occupy proportional physical space

    • Cost money to move or replicate

    • Take time to move or replicate

    • Atom processing today vs 2000BC is order-of-magnitude unchanged

  • Bits

    • Occupy disproportionately small physical space

    • Cost of replication not related to number of replications

    • Transport times virtually identical regardless of distance

  • Healthcare has traditionally used atoms (paper) to move bits (information)

BCIG Seminar October 14, 2004


A second framework process vs implementation

A Second Framework:Process vs Implementation

  • Process Description:“An implementation-independent description of an activity or sequence of activities focused on accomplishing a specific goal.”

    • e.g. ‘Communicate a message from Party A to Party B’

  • Implementation Solution:“An implementation-specific mechanism whereby a given process is realized and achieves its stated goal. Every implementation is a set of compromises on the original Problem statement”

    • e.g. Face-to-face conversation vs email vs voicemail vs US Mail

  • Healthcare personnel (clinical, administrative, and financial) often confuse the (historical) paper implementation as the essential care delivery / management process.

BCIG Seminar October 14, 2004


A third framework complex systems

A Third Framework:Complex Systems

  • Complex System: A system composed of multiple vertical organizational levels engaged in horizontal processes that cross vertical organizational boundaries

    • Problems occur at the interchange boundaries/interfaces

      • Duplication/redundancy of effort

      • Inefficiency/variability of process

BCIG Seminar October 14, 2004


The computer based patient record

The Computer-Based Patient Record

  • Described by 1991 IOM report: “The Computer-Based Patient Record: An Essential Technology for Health Care”

    • 180 features in 12 categories. “The CPR should support…”

      • direct data entry by all persons caring for a patient

      • measurement of health status and function (outcomes of care)

      • support for co-managing cost and quality of care

      • documentation of clinical reasoning and rationale

      • clinical problem solving/decision support

      • Problem/Condition Lists

      • relevant and timely linkage with all relevant patient information

      • layered confidentiality and audit trails

      • continuous (ad hoc) (authorized) user access

      • simultaneous user views

      • local and remote information access to relevant resources

      • existing and evolving specialty needs

BCIG Seminar October 14, 2004


What makes the cpr so difficult

What Makes the CPR so Difficult?

  • Complexity of purpose

  • Requirement for (computable semantic) interoperability

  • Historic lack of standards facilitating (computable semantic) interoperability

    • ‘Best of Breed’

  • E.g. Medication allergy

    • Initial text capture in an anesthetic setting

    • Need for machine processing and decision support in an ER setting

BCIG Seminar October 14, 2004


The national health information infrastructure nhii

The National Health Information Infrastructure (NHII)

  • 2004 Announcement: “An initiative set forth to improve the effectiveness, efficiency, and overall quality of healthcare in the US through the development of a comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information that will improve decision-making by making the information available when and where it is needed. The NHII includes the set of technologies, standards, applications, systems, values, and laws that currently or will be needed to support all facets of individual health, personal healthcare, and public health.”

BCIG Seminar October 14, 2004


The continuity of care record ccr

The Continuity of Care Record (CCR)

  • 2003 initiative: “developed in response to the need to organize and make transportable a sete of basic information about a patient’s healthcare accessible to all clinicians and patients. The CCR is intended to foster and improve the continuity of care, reduce medical errors, and ensure a minimum standard of secure health information transportabiliity. Adoption of the CCR by the medical community and IT vendors will be the first step in achieving interoperability of medical records.”

  • CCR is being developed by the AAFP, the Massachusetts Medical Society, the AMA, the AAP, HIMSS, American Health Care Association, and ASTM Committee E31.

BCIG Seminar October 14, 2004


The continuity of care record ccr1

The Continuity of Care Record (CCR)

  • Contexts of application include

    • Referral

    • Transfer

    • Discharge

  • Proposed components of the CCR include

    • Dx, Problems, and Conditions

    • Adverse Reactions/Alerts

    • Current Medications and Immunizations

    • VS

    • Lab results

    • Procedures and Assessments

    • “Extensions”

BCIG Seminar October 14, 2004


The cancer bioinformatics grid cabig

The Cancer Bioinformatics Grid (caBIG)

  • 2003-04 initiative: “…An informatics infrastructure that will connect teams of cancer and biomedical researchers together to enable them to better develop and share tools and data. Standards for common vocabularies and data elements will be an integral part of the caBIG infrastructure.”

BCIG Seminar October 14, 2004


A cabig example from covitz et al bioinformatics v19 n18 p2404

A caBIG Example(from Covitz et al, Bioinformatics, V19, N18, P2404)

  • Patient presents with headache, focal weakness, history of seizures

  • Workup reveals glioblastoma multiforma subtype astrocytoma

  • Is this tumor histology is associated with gene expression abnormalities?

    • Yes, in the p53 signaling pathway including BCL2, TIMP3, GADD45A, CCND1

  • Is there documented evidence of aberrant expression of (e.g.) CCND1?

    • Yes, SAGE tags for cyclin D1 appear with 3x greater frequency in cancerous vs normal brain tissue

  • Are any gene products of the p53 signaling pathway known targets for therapeutic agents?

    • Yes, TP53, RB1, BCL2, CDK4, MDM2, CCNE1

  • Are any of the agents known to target these genes being specifically tested in glioblastoma patients?

    • Yes, trials xxx and yyy are currently underway

  • Research data at the point of care, Clinical data at the point of research

BCIG Seminar October 14, 2004


Interoperability

“Interoperability”

  • Everyone in healthcare seems to want it (at least in some sense)

  • What does it mean?

  • Is it obtainable?

  • If so, at what cost ($$, effort, etc.)?

BCIG Seminar October 14, 2004


Clinical data interchange standards consortium cdisc

Clinical Data Interchange Standards Consortium (CDISC)

  • CDISC is an open, multidisciplinary, non-profit organization committed to the development of worldwide industry standards to support the electronic acquisition, exchange, submission and archiving of clinical trials data and metadata for medical and biopharmaceutical product development.

  • CDISC’s mission is to lead the development of global, vendor-neutral, platform-independent standards to improve data quality and accelerate product development in our industry.

BCIG Seminar October 14, 2004


The world of clinical trial standards circa 2004

The “World of Clinical Trial Standards” (circa 2004)

International Conference on

Harmonization (ICH)

U.S. Dept. of Health and Human Services

(HHS)

EFPIA

JPMA

PhRMA

EMEA

MHLW

KIKO

U.S. FDA

CDC

NIH/NCI

NLM

TC:

RCRIM

DICOM

Protocol Std

ISO/ANSI

CDISC

Health Level 7 (HL7)

ADaM

SDS

ODM

Reference

Information Model

RIM

LAB

MedDRA

LOINC

SNOMED

Clinical

Document

Architecture

eCTD

= Dictionary,

Codelist

= Document Standard,

or Architecture

= Organization

= Standard

= Model


Health level seven hl7

Health Level Seven (HL7)

  • “HL7 develops specifications that enable the semanticallyinteroperable exchange of healthcare data. ‘Data’ refers to any subject, patient, or population data required to facilitate the management or integration of any aspect healthcare including the management, delivery, evaluation of and reimbursement for healthcare services, as well as data necessary to conduct or support healthcare-related research. HL7 Specifications are created to enable the semanticallyinteroperable interchange of data between healthcare information systems across the entire healthcare continuum.”

    (C Mead paraphrase of HL7 Mission Statement)

BCIG Seminar October 14, 2004


Hl7 a brief history www hl7 org

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

HL7: A Brief History(www.hl7.org)

BCIG Seminar October 14, 2004


Syntax vs semantics

Syntax vs Semantics

  • The dog eats red meat.

  • The dog eats blue trees.

  • Give the patient pain medication.

  • Give the patient medication for pain.

  • Time flies like an arrow

  • Fruit flies like a banana.

  • Syntax  Structure

  • Semantics  Meaning

  • ….and then there’s Context

    • ‘he threw his hat into the ring….’

    • ‘he’s got a chip on his shoulder…’

BCIG Seminar October 14, 2004


The semiotic triangle how humans communicate

(Concept)

Symbol

“Shark”

Thing

Concept 1

“Delicious with cabernet.”

Concept 2

“A guy who hustled me.”

Concept

“A predator.”

Thing 1

Symbol

“Shark”

Symbol

“Shark”

Thing

Thing 2

The Semiotic Triangle:How Humans Communicate

BCIG Seminar October 14, 2004


Interchange vs interoperability

Semanticinteroperability

Syntacticinteroperability

(interchange)

Interchange vs Interoperability

  • Main Entry: in·ter·op·er·a·bil·i·ty: ability of a system ... to use the parts or equipment of another systemSource: Merriam-Webster web site

  • interoperability: ability of two or more systems or components toexchange information and to predictably use the information that has been exchanged.Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]

Syntax  Structure

Semantics  Meaning

BCIG Seminar October 14, 2004


The pillars of semantic interoperability necessary but not sufficient

The Pillars of(Semantic) InteroperabilityNecessary but not Sufficient

  • Common model across all domains-of-interest

    • Information model vs Data model

  • Model grounded on robust data type specification

  • Methodology for binding terms from concept-based terminologies

  • A formally defined process for defining specific structures to be exchanged between machines, i.e. a “messaging standard”

The Version 3 Tool Kit

BCIG Seminar October 14, 2004


Pillar 1 a common model

Pillar #1: A Common Model

  • The HL7 Reference Information Model (RIM) (ANSI)

  • RIM203.pdf

BCIG Seminar October 14, 2004


Pillar 2 a data type specification

Pillar #2: A Data Type Specification

  • The HL7 Version 3 Data Type Specification (ANSI)

BCIG Seminar October 14, 2004


Data types

Data Types

  • Design Goals for HL7 Data Type Specification

    • Coherence

    • Parsimony

    • Stability

    • Completeness

    • Simplicity

  • HL7 Data Type Specification as an interoperability standard

    • ANSI approved

    • Currently in ISO process

    • Endorsed by CEN

BCIG Seminar October 14, 2004


Pillar 3 a methodology for binding to concept based terminologies

Pillar #3: A Methodology for Binding to Concept-Based Terminologies

  • The HL7 Version 3 Vocabulary Technical Committee

  • Concept-based terminologies are essential for capturing the complexity of healthcare delivery in the context of the CPR and its derivative products

BCIG Seminar October 14, 2004


Taxonomy of terminologies from ingenerf medinfo proceedings 1995

Taxonomy of Terminologies(from Ingenerf, MEDINFO Proceedings, 1995)

Dictionaries and Thesauri

Collections of terms, definitions, associations, synonyms, etc.

Classification Systems

Exhaustive concept identification

Hierarchical structure

Disjunctive

Derived from / serve a particular perspective

ICD-9

CPT

NANDA


Taxonomy of terminologies from ingenerf medinfo proceedings 19951

Taxonomy of Terminologies(from Ingenerf, MEDINFO Proceedings, 1995)

Nomenclatures

Multi-axial

Combinations of atomic terms used to build complex terms

No formal grammar

C/C fx of L femur

C/C/fx of R eye

Formal Terminologies

Nomenclature + associated formal grammar

Requires tool support to enforce grammar rules during both construction and interpretation

SNOMED-CT

Grail (Galen Project, Rector et al)


Pillar 4 a messaging model

Pillar #4: A Messaging Model

  • The HL7 Version 3 Messaging Specifications (including Clinical Document Architecture, Release 2)

  • HL7 is an ANSI Standards Development Organization

  • HL7 v3 ‘Early Adopters’ Program

BCIG Seminar October 14, 2004


The hl7 v3 messaging standard

The HL7 V3 Messaging Standard

  • Focused on information exchange that enables semantic interoperability

  • All “message structures” are derived from the RIM

  • Message structures defined using HL7-defined process

  • Message content defined using HL7-supplied tools

  • Message implementation to multiple technologies

    • XML

    • Java

BCIG Seminar October 14, 2004


Pillar 1 a common model1

Pillar #1: A Common Model

  • The HL7 Reference Information Model (RIM) (ANSI)

  • RIM203.pdf

BCIG Seminar October 14, 2004


What s the rim about

What’s the RIM ‘About?’

  • The set of concepts, attributes, and relationships needed to describe any aspect of healthcare

    • Clinical

      • Patient Care

      • Aggregated Populations

      • Non-person domains-of-interest

        • Veterinary

        • Genomics

BCIG Seminar October 14, 2004


What s the rim about1

What’s the RIM ‘About?’

  • The set of concepts, attributes, and relationships needed to describe any aspect of healthcare

    • Administrative

      • Scheduling

      • Materials Management

      • Personnel Management

        • Credentialing and Privileging

BCIG Seminar October 14, 2004


What s the rim about2

What’s the RIM ‘About?’

  • The set of concepts, attributes, and relationships needed to describe any aspect of healthcare

    • Financial

      • Reimbursement model neutral

      • Supports ‘supply-chain’ approaches to patient care (‘inventory-to-bedside’)

BCIG Seminar October 14, 2004


How can the rim be all things to all parties

How Can the RIM be All Things to All Parties?

  • Constructs

    • High-level abstract structures

    • Well-defined set of data types

    • Well-defined interfaces to terminologies

  • Healthcare Domains (clinical, administrative, financial) are defined by the combination of common structures and unique terminologies

BCIG Seminar October 14, 2004


The hl7 reference information model

The HL7 Reference Information Model

  • Motivated by need for standard to facilitate semantic interoperability

    • HL7 2.x is an interchange standard

    • “Too technical and abstract for domain experts (‘I can’t find the things I need to describe my domain’)”

    • “Too abstract and not detailed enough for the technology cognoscenti (‘No methods, no foreign keys…worthless as a data model.’)”

BCIG Seminar October 14, 2004


The rim backbone essential structures of healthcare

The RIM BackboneEssential Structures of Healthcare

A Party (Person or Organization) is involved in zero-to-many Healthcare Actions

Party

Healthcare

Action

Is involved in

0.. *

1..*

involves

A Healthcare Action involves one-to-many Parties (Persons or Organizations)

How do we represent a Person as both a Patient and a Clinician?

BCIG Seminar October 14, 2004


The rim backbone essential structures of healthcare1

The RIM BackboneEssential Structures of Healthcare

A Party (Person or Organization) in Role is involved in zero-to-many Healthcare Actions

A Party (Person or Organization) plays zero-to-many Roles

Party

Role

Healthcare

Action

1

0..*

1..*

0..*

plays

involves

How do we represent a Clinician who is a Consultant in one Healthcare Action and a Supervisor in another?

BCIG Seminar October 14, 2004


The rim backbone essential structures of healthcare2

0..*

1

0..*

Role

1

The RIM BackboneEssential Structures of Healthcare

A Party (Person or Organization) in Role assuming a Participation is involved in zero-or-one Healthcare Action

A Party (Person or Organization) plays zero-to-many Roles

Party

Participation

Healthcare

Action

1

1..*

A Party (Person or Organization) in a Role may assume zero-to-many Participations

BCIG Seminar October 14, 2004


Collections using rim structures

‘Collections’ using RIM Structures

A Healthcare Action can be the source of zero-to-many Healthcare Relationships, each of which relate the source Healthcare Action to one-and-only one other Healthcare Action (the target action).

NOTE: Each Observation is ‘Attributed’

AR:

“is supported

by”

OBS:

Temp 101F

has target

is source for

OBS:

Dx Pneumonia

AR:

“is supported

by”

OBS:

Abnormal

CXR

has target

is source for

AR:

“is supported

by”

is source for

OBS:

Elevated

WBC

has target

BCIG Seminar October 14, 2004


The hl7 reference information model1

0..*

0..*

0..*

0..*

Role

Link

ActRelationship

1

1

1

1

0..*

1

0..*

Role

1

The HL7 Reference Information Model

Has component

Is supported by

Entity

Participation

Act

1

1..*

  • Organization

  • Place

  • Person

  • Living Subject

  • Material

Patient

Member

Healthcare facility

Practitioner

Practitioner assignment

Specimen

Location

Referral

Transportation

Supply

Procedure

Consent

Observation

Medication

Administrative act

Financial act

Author

Reviewer

Verifier

Subject

Target

Tracker

ReducedShakespeare.ppt

BCIG Seminar October 14, 2004


State

State

  • Definition: “A named stage in the lifecycle of an instance of a concept”

    • Washing Machine

      • Stopped, Running (Filling, Spinning, Emptying)

  • Lab order

    • New, Active, Suspended

  • The lifecycle of a concept (i.e. valid states and transitions) is shown in a State Diagram (a visual representation of a State Machine)

    • A single instance of a concept may take on one-to-many states over its ‘lifetime’

    • An instance does not have to pass through all possible states in its lifetime


The state diagram for the act class

The State Diagram for the Act Class


Hl7 version 3 driving interoperability transforming healthcare information management

Mood

  • Definition: “A named description – from the perspective of a single concept – of one stage of a business cycle”

    • e.g. Order/Request vs Event

    • In order to completely describe a business cycle (from the perspective of a single concept), multiple instances of that concept – each with their own mood designation – must be instantiated

  • The term ‘mood’ is used based on its meaning in formal grammar, where it is used to describe certain characteristics of verbs relative to time

  • A concept instance can have many state (aka status) values in its life; it can have one and only one mood


Mood in hl7 v3

Mood in HL7 V3

  • Specified by the value of the ‘moodCode’ attribute in the Act class

  • All instances of Act (or its subtypes) must have a value for moodCode attribute

    • Once assigned (at creation time), the value of moodCode never changes

  • moodCode value set is controlled by HL7

  • Examples include…

    • Define

    • Order/Request

    • Event

    • Goal


Mood example 1

Mood: Example 1

  • The Concept: Penicillin VK 500mg IV

  • In Master Service Catalogue (orderable)  DEFINE

  • Ordered or patients  ORDER/REQUEST

    • Mr. Brown TID x 10 days

    • Mrs. Smith QID x 7 days

    • Mr. Jones 2 doses STAT

  • Given to patients based on order  EVENT

    • Mr. Brown  3 x 10 = 30 events

    • Mrs. Smith  4 x 7 = 28 events

    • Mr. Jones  1 (or 2) events

  • State describes single instance; mood describes multiple instances in a business process


Mood example 2

Mood: Example 2

  • The Concept: Observation (Ambulatory Assessment)

  • 03.06.03: “Pt will walk 20 ft without assistance in 3 weeks.”

  • 03.27.03: “Pt walked 15 ft with assistance.”

  • 03.27.03: “Pt did not meet ambulatory goal.”

OBS:

Date1: 03.06.03

Date2: 03.27.03

Amb. Asmt.

moodCode: GOAL

Value: 20 w/o

AR:

“has outcome”

Is source for

Is target for

OBS:

Date: 03.27.03

Goal Assmt.

moodCode: EVT

Value: DNM

OBS:

Date: 03.27.03

Amb Asmt.

moodCode: EVT

Value: 15 w

AR:

“has explanation”

is source for

has target


Mood a final implication

Mood: A Final Implication

  • Because an instance in ORDER mood is different from an instance in EVENT mood, it follows that the ORDER mood instance will not have any ‘value’ associated with it, while the instance in the EVENT (or GOAL) mood will have a ‘value’ associated with it.

  • It follows (after a bit of thought) that Documents are collections of values which can be represented as instances of Acts in the EVENT mood

    • A document instance may have a complex structure which requires consider use of ActRelationship instances

    • Documents have additional semantics (discussed later)


Rmim specifications vs constraints

RMIM – Specifications vs Constraints


The communication pyramid

Standardized Models (UML)

Non-standard Graphics

ad hoc Drawings

Structured Documents

Free-text Documents

Discussions

The Communication Pyramid

`

ProblemSpace

SolutionSpace

Implementation-Independent

Implementation-Specific

Communication

Source: Charlie Mead, MD, HL7

BCIG Seminar October 14, 2004


Standards development

Specification Development

Requirements

Implementation

Domain Experts

Vendors

HL7 RCRIM

FDA

HL7

Documentation

XML message spec

SROs

CDISC

SEND

ICH

FDA

other

Other..

R. Levin, EuroInterchange, May 2004 (modified by Med, Oct 2004

Standards Development

BCIG Seminar October 14, 2004


Requirements documentation the problem space model

Requirements Documentation:The Problem Space Model

The “Problem Space” is defined using a combination of visual models and a rigorously-defined and linked Glossary

Mission Statement

And

Goals

Requirements

Documentation

Requirements Specification

  • Document Domain Process Flow: UML Activity Diagram

  • Capture Domain Structure: UML Class Diagram and Glossary

  • Capture Business Rules: Relationships, Triggers, and Constraints

  • Harmonize the resulting Problem Space Model with HL7 RIM etc.

BCIG Seminar October 14, 2004


Htb product vision

HTB Product Vision

Standards-based (including HL7 v3 and RIM) application development platform to enable:

Healthcare information management technology supporting:

  • Comprehensive view across entire community

  • Data reuse and portability

  • Analysis and control of patient care processes

  • Management of healthcaretransactions

    HTB is a platform/framework

    HTB is not an application

Healthcare information management technology that supports:

  • Comprehensive view across entire community

  • Data reuse and portability

  • Analysis and control of patient care processes

  • Management of healthcare transactions

Healthcare information management technology that supports:

  • Comprehensive view across entire community

  • Data reuse and portability

  • Analysis and control of patient care processes

  • Management of healthcare transactions

Healthcare information management technology that supports:

  • Comprehensive view across entire community

  • Datareuse and portability

  • Analysis and control of patient care processes

  • Management of healthcare transactions

Healthcare information management technology that supports:

  • Comprehensive view across entire community

  • Data reuse and portability

  • Analysis and controlof patient care processes

  • Management of healthcare transactions

BCIG Seminar October 14, 2004


Healthcare transactions

Check TechnicianAvailability

Check EquipmentAvailability

PerformProcedure

I need aChest X-rayfor Mr. Smith

OrderChest X-ray

Place

Image inRadiologist

Queue

InterpretStudy

ScheduleChest X-ray

ReportResult

Healthcare Transactions

RIM-based

Enterprise ObjectModel

BCIG Seminar October 14, 2004


Healthcare transaction base an interoperability framework

Healthcare Financial Apps

Healthcare Financial Apps

Sales

Contracts

Contracts

Marketing

Marketing

Service

Sales

Service

Healthcare Clinical Apps

Healthcare Administrative Apps

Healthcare Clinical Apps

Healthcare Administrative Apps

Human Resources

Supply Chain

Supply Chain

Internet Procurement

Financials

Projects

Human Resources

Order Management

Internet Procurement

Financials

Projects

Order Management

HTB

Oracle E-Business Platform

Oracle E-Business Platform

Oracle E-Business Platform

Healthcare Transaction BaseAn interoperability framework

BCIG Seminar October 14, 2004


Core services

Core Services

  • Terminology Mediation

  • Message Management

  • Security and Auditing

  • Person Services

  • Configuration

  • Workflow Integration

  • Terminology Mediation

  • Person Services

  • Auditing and Security

  • Configuration

  • Workflow Integration

  • Message Management

BCIG Seminar October 14, 2004


Terminology services

Terminology Services

  • All terminologies managed by HTB are Concept-based

    • Unique internal ID

    • ‘Standard’ and ‘homegrown’ terminologies managed identically

  • Intra-terminology version management

  • Inter-terminology cross mapping

    • Equivalence

    • Other semantic relationships (e.g. SNOMED-CT set)

BCIG Seminar October 14, 2004


Message services inbound

Legacy

System

HL7 IFEngine

HL7 IFEngine

InboundMessageProcessing

v2.x

v3.0

ApplicationProgrammingInterface

Responsibilities

HTB Applications

Oracle

App. Dev.

Customer

Message ServicesInbound

Repository

(RIM)

BCIG Seminar October 14, 2004


Messaging services details inbound message processor

Repository

Messaging Services DetailsInbound Message Processor

Ancillary

System

Interface

Engine

(iHub)

v2.X

pipe&bar

V3.0

XML

API Based HTB Services

DatabaseEntry Vehicle

Business APIs

Inbound Message Processor

  • Cross referencing external Ids

  • Mapping and domain validation via Enterprise Terminology Services

  • Extracting data from v3XML to Value Objects using mapping routines

  • Message Acknowledgement

Kickoff

Workflow

PostUpdate

OutboundMessageProcessor

Configuration

Acknowledge

Custom

BCIG Seminar October 14, 2004


Security and auditing hipaa requirements

Services

Emergency access

User/role/context-based access

Audit control

Consent/authorization control

Data authentication

Automatic logoff

Unique user identification

Security and AuditingHIPAA Requirements

Digital Signature

Message integrity

Non-repudiation

User authentication

E-Signature

Mechanisms

Services

Integrity control

Message authentication

Access control

Encryption

Alarm

Audit control

Entity authentication

Event reporting

BCIG Seminar October 14, 2004


Security and auditing authorization policy engine

Security MgmtApplication

  • Security Administrator defines policy

  • Application invokes security services

  • HTB compiles policy rules into DB constraints

  • DB constraints attached to application queries

Service API

Management API

HTB Applications

Enterprise Object Model

  • DB constraints associated with tables

  • DBMS executes extended queries

Data Model

Security and Auditing Authorization policy engine

BCIG Seminar October 14, 2004


Healthcare transaction base a healthcare interoperability platform

Researchers

Administrators

Providers

Patients

NewApplications

Point of CareAppliances

Internet

HL7 IFEngine

DataAccess

Registries

BusinessIntelligence

DataMining

Healthcare Transaction Base

Data Warehouse

ClinicalDataRepository

Messaging Services

Person Services

Terminology Management

Security and Auditing

ExternalWarehouse

Healthcare Transaction BaseA healthcare Interoperability platform

Clinical Trial

System (OC)

Clinical

Information

Systems

Laboratory

Information

Systems

BCIG Seminar October 14, 2004


Summary

Summary

  • Semantic interoperability is essential if we are to solve the myriad of problems facing the healthcare delivery system

  • Semantic interoperability is difficult

  • Semantic interoperability is possible if the ‘Four Pillars’ are addressed

  • HL7 Version 3 and the associated RIM provide a framework satisfying the ‘Four Pillars’

  • Oracle is building HTB, a standards-based interoperability platform based on HL7 v3, the RIM, and the ‘Four Pillars’

BCIG Seminar October 14, 2004


Hl7 version 3 driving interoperability transforming healthcare information management

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Q U E S T I O N S

A N S W E R S

A

BCIG Seminar October 14, 2004


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