HL7 Version 3 at NCICB Overview

1. HL7 Version 3 at NCICB Overview Session Details Introduction Reference Information Model (RIM) HL7 Modeling Conventions HL7 Process & Artifacts, Vocabulary & Data Types HL7 Version 3 at NCI Web Resources

2. Session Details • Target Audience: • Developers and Analysts • Adopters • Prerequisites: • Modeling concepts

3. Session Details:Presenters and Participants • <Presenter’s name here> • Who is in attendance? • Name • Title • Cancer Center • Reason for Attending Note: This training can also be used as a self-paced training. (See notes for each slide)

4. Session Details:Training Objectives • Objectives of this training are to: • Provide an overview of HL7 version 3 • Define terms and concepts used in HL7 • Describe the HL7 modeling methodology • Introduce reason for HL7 version 3 at NCICB

5. Introduction • In this section, we will: • Introduce the HL7 organization and the version 3 standard • Discuss the goal of HL7

6. Introduction:What is HL7? • Heath Level Seven (HL7)is an ANSI-accredited Standards Developing Organization (SDO) operating in healthcare arena • Provides standards for data exchange to allow interoperability between healthcare information systems • HL7 focuses on the clinical and administrative data domains • It is a not-for-profit organization made up of volunteers – providers, payers, vendors, government • Key goal is syntactic and semantic interoperability

7. Introduction:4 Pillars of Semantic Interoperability The 4 pillars of semantic interoperability are: • A common Reference Information Model (RIM) spanning the entire clinical, administrative and financial healthcare universe • A well-defined and tool-supported process for deriving data exchange specifications ("messages") from the RIM • A formal and robust Data Type Specification upon which to ground the RIM • A formal methodology for binding concept-based terminologies to RIM attributes.

8. Reference Information Model (RIM) • In this section, we will: • Discuss the modeling concepts used in HL7 Version 3 • Describe the Backbone Classes of the HL7 RIM

9. Reference Information Model (RIM): Overview Reference Information Model (RIM): • Follows object oriented developmental methodology based on a UML model • The fundamental model from which all v3 messages are derived is referred to as the Reference Information Model (RIM) • The RIM is a generic, abstract model that expresses the information content of all the areas of healthcare • Defines all the information from which the data content of HL7 messages are drawn • Forms a shared view of the healthcare domain and is used across all HL7 messages independent of message structure

10. Reference Information Model (RIM):Backbone Classes Entity Role Participation Act A physical thing, group of physical things or an organization capable of participating in Acts, while in a role. A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role. An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance. A record of something that is being done, has been done, can be done, or is intended or requested to be done. 1 0..n 0..1 0..n 0..n 1 0..1 0..n 1 1 1 1 Act Relationship Role Link 0..n 0..n 0..n 0..n A connection between two roles expressing a dependency between those roles. A directed association between a source act and a target act.

11. Reference Information Model (RIM)Backbone Class: Entity Entity: a person, animal, organization or thing A collection of classes related to the Entity class, its specializations and related qualifying classes. The classes represent health care stakeholders and other things of interest to health care. Entity has the following sub-classes: Container Device LanguageCommunication LivingSubject ManufacturedMaterial Material NonPersonLivingSubject Organization Person Place Entity classCode : CS determinerCode : CS id : SET<II> code : CE quantity : SET<PQ> name : BAG<EN> desc : ED statusCode : SET<CS> existenceTime : IVL<TS> telecom : BAG<TEL> riskCode : CE handlingCode : CE

12. Reference Information Model (RIM):Backbone Class:Role Roles: A responsibility or part played by an entity (e.g. Person in a role of patient, employee, etc.) – different faces of an Entity A collection of classes related to the Role class and its specializations. These classes focus on the roles participants may play in health care. Role has the following sub-classes: Access Employee LicensedEntity Patient Role classCode : CS id : SET<II> code : CE negationInd : BL addr : BAG<AD> telecom : BAG<TEL> statusCode : SET<CS> effectiveTime : IVL<TS> certificateText : ED quantity : RTO positionNumber : LIST<INT> ...

13. Reference Information Model (RIM):Backbone Class:RoleLink RoleLink: A connection between two roles expressing a dependency between those roles. RoleLink has no sub-classes. Role 0..n source 0..n outboundLink 0..n RoleLink 0..n inboundLink typeCode : CS effectiveTime : IVL<TS>

14. Reference Information Model (RIM):Backbone Class:Participation Participation: An association between an Act and a Role with an Entity playing that Role. Participation has the following sub-class: ManagedParticipation Participation typeCode : CS functionCode : CD ... contextControlCode : CS sequenceNumber : INT negationInd : BL noteText : ED time : IVL<TS> modeCode : CE awarenessCode : CE signatureCode : CE signatureText : ED performInd : BL substitutionConditionCode : CE

15. Reference Information Model (RIM):Backbone Class:Act Act: A collection of classes including the Act class and its specializations. These relate to the actions and events that constitute health care services. A record of something that is being done, has been done, can be done, or is intended or requested to be done. Act has the following sub-classes: Account ControlAct DeviceTask DiagnosticImage Diet FinancialContract FinancialTransaction InvoiceElement Act classCode : CS moodCode : CS id : SET<II> code : CD negationInd : BL derivationExpr : ST text : ED title : ST Observation Participation PatientEncounter Procedure PublicHealthCase SubstanceAdministration Supply WorkingList statusCode : SET<CS> effectiveTime : GTS activityTime : GTS availabilityTime : TS priorityCode : SET<CE> confidentialityCode : SET<CE> repeatNumber : IVL<INT> interruptibleInd : BL levelCode : CE independentInd : BL Note: Sub-classes also include Core Infrastructure, Message Communications Control and Structured Documents classes not shown here. uncertaintyCode : CE reasonCode : SET<CE> languageCode : CE

16. Reference Information Model (RIM):Backbone Class:ActRelationship ActRelationship: A directed association between a source Act and a target Act. A point from a later instance to a earlier instance OR point from collector instance to component instance. ActRelationship has no sub-classes. ActRelationship 0..n outboundRelationship typeCode : CS inversionInd : BL contextControlCode : CS source 0..n contextConductionInd : BL Act sequenceNumber : INT priorityNumber : INT pauseQuantity : PQ checkpointCode : CS splitCode : CS joinCode : CS negationInd : BL conjunctionCode : CS localVariableName : ST seperatableInd : BL 0..n inboundRelationship target 1

17. Reference Information Model (RIM):The Complete RIM Domain Related 1 1 1 1 Structured Documents Infrastructure Related

18. Reference Information Model (RIM):RIM-UML Instance Scenario Entity Role Participation Act John Doe Patient Subject (Procedure Act) Prostectomy Dr. Smith HealthCare Provider Surgeon* XYZ Hospital HealthCare Facility* Location Act Relationship Has Pertinent Information John Doe Patient Subject (Clinical Trial Act) Protocol ECOG 1112

19. HL7 Version 3 Process & Artifacts • In this section, we will discuss: • Domain Message Information Model (DMIM) • Refined Message Information Model (RMIM) • Hierarchal Message Definitions (HMDs) • Message Type (MT)

20. HL7 Version 3 Process & Artifacts:Overall Process R-MIM RIM D-MIM 1..* 1..* HMD 1..* MT 1..*

21. HL7 Version 3 Process & Artifacts:Examples Entry points Color-coding Directional Arrows Labeling

22. Reference Information Model (RIM):HL7 Modeling Conventions • Color-coding – colors of classes in the model denote the type of backbone class to which it belongs • Arrows – Participations, ActRelationships and RoleLinks are directional arrows that have rather than being lines that connect classes like in UML • Entry points – where to start reading the model; DMIMs have one or more entry points, RMIMs have one • RMIMs are directional – all associations flow out from the entry point to the remaining parts of the model • Labeling – associations in RMIMs are labeled on the distal end only

23. HL7 Process & Artifacts:Domain Message Information Model (DMIM) A DMIM is a refined subset of the RIM that includes a set of class clones, attributes and relationships that can be used to create messages for a particular domain (a particular area of interest in healthcare).

24. HL7 Process & Artifacts:Refined Message Information Model (RMIM) The RMIM is a subset of a DMIM that is used to express the information content for a message or set of messages with annotations and refinements that are message specific.

25. HL7 Process & Artifacts:Hierarchal Message Definitions (HMDs) A Hierarchal Message Definition (HMD) is a serialized version of the RMIM in a specific order.

26. HL7 Process & Artifacts:Message Type (MT) The Message Type elements and attributes in an XML message instance correspond to the sequence of data in the HMD

27. Vocabulary & Data Types • In this section, we will discuss: • HL7 Standard Vocabulary • Structural Attributes – prescribed HL7 vocabulary • Non-Structural Attributes – vocabulary chosen by organization • Robust Data Types

28. Vocabulary & Data Types:Structural Attributes An Act of the Class Observation (OBS) with a Mood of Event (EVN). classCode and moodCode are both Structural Attributes Structural attributes are used to specify type and state of each RIM class and what it means when used in a message. They use a standard vocabulary defined and controlled by HL7.

29. Vocabulary & Data Types :Non-Structural Attributes • Other attributes don’t have an assigned vocabulary • Organizations can choose any industry standard vocabulary • For example, commonly used ones for Observation Acts are LOINC, SNOMED, MedDRA, etc. • Must specify more than just the code value, other data is needed for semantic interoperability…this is where data types come in

30. Vocabulary & Data Types :Data Types What is a data type? lengthOfStayQuantity is attribute of the EncounterProcess class. lengthOfStayQuantity has a data type of Physical Quantity (PQ).

31. Vocabulary & Data Types :Data Types • Data types in HL7 version 3 are complex • Each data type has attributes • Each attribute has a data type of its own Physical Quantity (PQ) example <lengthOfStayQuantity value=“10”unit=“hours"/> The attributes ‘value’ and ‘unit’ are part of the complex data type Physical Quantity (PQ). Value is expressed as the data type of integer (int).

32. HL7 Version 3 at NCICB • In this section, we will discuss: • Why HL7 at NCICB? • NCICB Clinical Architecture Vision • caAdapter

33. HL7 Version 3 at NCICB:Why HL7? • Recommended by the Health and Human Service (HHS) as the messaging standard for electronic exchange of clinical data. • Over 90% of US hospitals have implemented some version of 2.x HL7 messages. • Support for translational research requires integration of research data with the clinical data. • V3 offers the syntactic and semantic interoperability to make this possible

34. Patient Identifiable Clinical Environment External Agencies Clinical/Clinical Trials Applications caBIG Analytical Applications caMATCH BIO-gopher Ad Hoc Query Tool Analytical and Reporting Tools (SAS, WebSDM, ToxViewer, I-Review, etc.) caPRI C3D C3PR SAE caGRID Study Specific Analysis Data caBIO/CTOM Secure Transport Between Sites BRIDG caBIO/CTOM HL7 v3 HL7 RIM JDBC 2 eCTD, Excel, Text, HL7 v2, etc. BRIDG HL7 RIM HL7 Transactional Database (HTB) Excel, Text, HL7 v1, v2, etc. Secure Transport Between Sites HL7 v3 CRIX Data Repository Master Index Translation Service (CAM/caAdapter) HL7 v3 FIREBIRD HL7 v3 Clinical Data Sources Message Exchange Services (ebXML) Extensions (CDUS/CTMS) Base Janus Model HL7 v3 Electronic Medical Record (EMR) HL7 v3 Labs FDA De-Identification/ Re-Identification Service HL7 v3 Tissues HL7 v3 etc. SPONSOR Translation Service (CAM/caAdapter) Excel, Text, HL7 v2, etc. CTEP DCP Common Security Module (CSM) Enterprise Vocabulary Service (EVS) Data Standards Repository (caDSR) Other HL7 Version 3 at NCICB:NCICB Clinical Architecture Vision HL7 version 3 supports messaging within the NCICB Clinical Architecture Vision.

35. HL7 Version 3 at NCICB:Highlights of the NCICB Clinical Architecture Vision • caAdapter – Open source toolkit which facilitates v3 message building, parsing and validation • Message Exchange – Service supporting message transmission and routing • HL7 Transactional Database - HL7 RIM-based transactional database and data access service • De-identification Service – Service for de-identifying patient information from HL7 messages • Analytical Applications - Applications for querying, reporting, mining clinical data • Cancer Data Standards Repository (caDSR) - Shared metadata repository • Enterprise Terminology Services (EVS) - Terminology service for hosting controlled vocabulary, including HL7 registered terminology

36. HL7 Version 3 at NCICB:caAdapter • Facilitates the building, parsing, and validation of HL7 v3 messages • Components include: • HL7 v3 Message Parser – parses HL7 version 3 messages to RIM object graph • HL7 v3 Message Builder – builds HL7 version 3 messages from the RIM object graph • HL7 v3 Artifacts – implements RIM objects, data types and metadata objects • Metadata Loader – represents HL7 version 3 metadata in-memory • Validation Services – integrates with NCICB caCORE components such as Enterprise Vocabulary Service (EVS) and W3C XML schema validation services • Mapping Tool – maps clinical data to the HL7 version 3 message specification currently, with extensible mapping and data transformation in the near future • caAdapter API – uses mappings to generate HL7 version 3 messages • Message Service – integrates with message exchange services (future plans)

37. HL7 Version 3 at NCICB:caAdapter • A platform to enable clinical applications to build and parse HL7 v3 messages based on specific schema definitions. • Capability to perform vocabulary validation of the RIM structural attributes. • An open source solution for implementing an international messaging standard allowing data to be exchanged between disparate systems. • Integration with NCI metadata repository (caDSR) and terminology services (EVS) • Facilitating the building and parsing of HL7 v3 messages from source clinical systems will promote data exchange in a standards based common format.

38. Recommended Resources Health Level Seven www.hl7.org HL7 Reference Information Model https://www.hl7.org/library/data-model/RIM/C30202/rim.htm HL7 Vocabulary Domains http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm HL7 Version 3 Standard http://www.hl7.org/v3ballot/html/welcome/environment/index.htm NCICB caAdapter Project Site trials.nci.nih.gov/projects/infrastructureProject/caAdapter HL7 Version 3: Driving Interoperability & Transforming Healthcare Information Management - Charles Mead, MD, MSc NIHSeminar_Charlie Mead.ppt