This guide is for healthcare integration analysts and their managers. In this chapter, learn how to tackle data challenges. The real problem is not with the plumbing (the interface engine); it's with the data. Read about how to address issues with format, workflows, and semantics.

1. HL7 SURVIVAL
GUIDE
CHAPTER 3
A publication of
A supplement to the HL7 Survival Guide, available at
http://caristix.com/blog/category/hl7-survival-guide/

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CHAPTER 3: The Heart of the Matter: Data Formats, Workflows, and
Meaning

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Chapter 2 in the Caristix HL7 Survival Guide looked at different
approaches to interfacing. But:
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Your main challenges are not with the plumbing,
or with the methods used to transport
or route date.
Interface and integration engines handle
this quite well.

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• The Real Issues:
– Date formats
– Workflows
– Meaning or data semantics
• Examples:
– Departments using different definitions to indicate the same
information
– Interpretations: NA – not applicable or no allergies?
– Non-recognition of terms
– Procedure definitions – just what does an order include?
– Data-time entry – AM or PM, time zones
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INTERFACE ENGINES DON’T ADDRESS THE REAL ISSUE

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• Real Challenge: At the information level
– Who needs the information, when and in what format.
• Once identified, validate that the information being
transferred is using the same semantics
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DATA AND INFORMATION CHALLENGES

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Issue Example
Data Structure Data structure is
specified based on
trigger events,
segments, fields, and
data types. The
recommended structure
must account for
complex clinical
workflows and data
representations.
Gaps based on the
maximum length of data
elements. One hospital
system specifies a
maximum length of 50
characters. The same
field in the system
under implementation is
set at a maximum of 20.
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DATA AND INFORMATION CHALLENGES (cont.)

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Issue Example
Data Tables HL7 provides a
recommended set of
data values, which can
be modified.
HL7 2.6 “suggests” six
different values for
patient gender.
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DATA AND INFORMATION CHALLENGES (cont.)

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Issue Example
Data Semantics Good data semantics
implies that the
meaning or intent of the
data is exchanged
accurately – not simply
the data value itself.
HL7 interfaces must
convey their
interpretation of the HL7
standard in use.
Patient identification is
the classic example.
Determine which fields
are in use. Possibilities
include: PID-2 Patient
ID, PID-3 Patient
Identification List, PID-
18 Patient Account
Number, PV1-19 Visit
Number, or a
combination thereof
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DATA AND INFORMATION CHALLENGES (cont.)

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Issue Example
Z-segments Custom message
segments used for
information outside the
scope of the HL7
standard.
All z-segments result in
gaps. If not mapped
accurately, critical
information can be lost.
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DATA AND INFORMATION CHALLENGES (cont.)

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Bottom Line: Understand the data, the source systems involved and
how each system handles the data semantics.
1. Understand the message/interface specification provided by your
vendor. Ask the vendor to provide details about:
• Messages, segments, fields,
• The need for z-segments, etc.
• How they handle data semantics. What does the data mean and
what is it used for?
• Understand workflow-related information, event timing,
vocabulary definitions, and who will use the information and how
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6 QUESTIONS & TIPS TO BETTER UNDERSTAND HEALTHCARE DATA

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2. Understand the type of message that will be generated based on the
event (e.g., a patient admission, patient visit, cancelling a transfer, sending
a partial lab result). Understand what data is provided with the event,
including the various code sets.
Watch this video for a 4-minute overview of an HL7 message:
• http://www.youtube.com/watch?feature=player_embedded&v=Wyp_4Xg
zP7A
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6 QUESTIONS & TIPS TO BETTER UNDERSTAND HEALTHCARE DATA

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3. How do the code sets and content evolve over time, and who handles the
updates and how?
4. Where does the data go? Is there a need to protect sensitive data?
5. How does the new system manage errors? What happens to messages
that aren’t understood by the destination system? What happens to rejected
messages. How would users and the overall workflow be impacted in such
a situation? How can you mitigate the risk?
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6 QUESTIONS & TIPS TO BETTER UNDERSTAND HEALTHCARE DATA

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6. How do you handle workflow changes? If adapting the interface, how is
this handled, how much time does it take, what does it cost, and who pays?
• Avoid Frozen Interface Syndrome, which occurs when you are trying to
implement a new interface and need all participants to switch over at the
same time but can’t get their cooperation.
• Worse yet is Interface Black Box Syndrome, when you lack full visibility
into all the work that has gone into interface development handled by a
third party, making it nearly impossible to upgrade, tweak, and manage
the interface without spending lots of money and time.
With these details, you need to pinpoint the gaps with the receiving
system(s) so you can bridge them with an interface.
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6 QUESTIONS & TIPS TO BETTER UNDERSTAND HEALTHCARE DATA

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From the details collected from the previous 6 questions, you need to
pinpoint the gaps with the receiving system(s) so you can bridge them with
an interface.
1. Map out the message process or workflow
2. Map out the business impacts of the interface
3. What information does the destination system need? Where in the
message structure is the information found?
4. Is the vocabulary used in the destination system different from that
used in the source system?
5. Is all of this information documented? If not, how will the vendor keep
you updated on changes?
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5 QUESTIONS FOR HIT VENDORS AND INTERNAL INTERFACING TEAMS

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• Chapter 4 in the HL7 Survival Guide
• Your EHR Strategy and Working with Vendors
– With meaningful use in full swing, it’s likely you’re in the
middle of implementation, migration or upgrading and
working with a 3rd party vendor. Make sure you stay in
control. Learn more in Chapter 4.
– Blog link: http://caristix.com/blog/2012/11/hl7-survival-
guide-chapter-4/
– Slide deck on Slideshare: coming soon.
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UP NEXT: CHAPTER 4

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