1. The international experience in
interoperability of Health Information
Systems
George Kakoulidis
CEO, Apollo SA
8th WORLD HELLENIC BIOMEDICAL
CONGRESS

2. HL7 Hellas
in this Presentation
Interoperability definitions
HL7 Standards
Interpretability Tools
The Future

3. HL7 Hellas
Health Care Industry
Health Care is an industry where a diverse set of
players must collaborate to provide a wide array of
services
Primary Hospital
Pharmacy Doctor’s Office
Employee Employer
PATIENT DATA
Chem Lab
Insurance
Secondary Hospital
Home Health Care Nursing Home Care

4. HL7 Hellas
HealthCare Enterprise
 involve complex processes
 involve clinical and administrative
tasks
 large volumes of data
 large numbers of patients and
personnel
 performed either by humans or by
automated systems

5. HL7 Hellas
Definition
 What is computer interoperability?
 "The ability of two or more systems or components
to exchange information and to use the information
that has been exchanged.“
 [Institute of Electrical and Electronics Engineers
IEEE Standard Computer Dictionary: A Compilation
of IEEE Standard Computer Glossaries, IEEE,
1990]

6. HL7 Hellas
Definition
 What is application integration?
 "The way to create interoperability solutions
in HealthCare Information Systems "
 " The successful integration of disparate
systems, applications, data, vendors,
functions"

7. HL7 Hellas
Historical need for Integration
1960 1980 1990 2000
So
me
Al
No
EA
Min
LA
Ma
ot
Int
nee
WA
I
er f
N/
inf
d
i-L
ace
N
r
WA
am
s
an
es
N

8. HL7 Hellas
Problems in HealthCare IT
 Hospitals never had a lot of money
 Lots of Departments with unique IT solution
 Multiple proprietary systems, varying
platforms, different languages
 Local data /Lack of Standards
 Structured and Unstructured data (free text)
 All systems Must work together

9. HL7 Hellas
What need integration ?
 Hospital service-related functions, as ADT,
Order Entry, Result Reporting, Materials
Management, Patient Accounting, Medical
Chart
 Departmental systems, as Clinical
Laboratory, Pharmacy, Radiology,
Pathology
 Resource management, scheduling,
physician billing

10. HL7 Hellas
Interoperability
 “Interoperability” can only be
achieved through the use of
data standards and clinical
terminologies.

11. HL7 Hellas
Standards
 Why Standards ?
 HealthCare information is increasingly
transmitted electronically
 In order to exchange information using
common data format cost effective
 Examples (Mobile –GSM, ATMs,)

12. HL7 Hellas
What standards are needed?
 Communication standards
 Data interchange standards
 Information model standards
 Vocabulary standards
 Security standards

13. HL7 Hellas
Standards – HL7
 HL7 provides a set of communication
standards as a cost-effective approach
for connecting disparate information
systems in health.

14. HL7 Hellas
HL7
 Health Level Seven is an ANSI Standards
Developing Organization
 Mission :
"To provide a comprehensive framework and related standards
for the exchange, integration, sharing, and retrieval of
electronic health information that supports clinical practice
and the management, delivery and evaluation of health
services. Specifically, to create flexible, cost effective
standards, guidelines, and methodologies to enable
healthcare information system interoperability and sharing of
electronic health records.“
(Source: HL7 Mission statement, revised 2001)

15. HL7 Hellas
HL7 History
 1987 : Start work as a standard
 1990 : First standard (v2.1)
 1993/94: First International Affiliates join.
 1994: HL7 becomes ANSI-accredited.
 August 2001: 1st V3 Draft is released.
 June 2003: HL7 V2.5 released.

16. HL7 Hellas
HL7 Organization
 ANSI-approved Standards Developing
Organisation (SDO).
 Not-for-profit.
 >2200 members.
 >500 corporate members.
 Local organisations in more than 27 countries.
 www.HL7.org
 www.hl7hellas.org

17. HL7 Hellas
Why HL7 ?
 International Standard since 1991 International
Standard since 1991
 Used Worldwide (27 HL7 Affiliates)
 Used in EU (Germany, Holland, Finland, Italy
etc)
 HL7 HL7-TC251 Task Force
 ANSI Standard ANSI Standard
 Used in Real-life for more than 10 years
 Open Standard continuously updated
 Latest Version 2.5 (Conformance Statements)

18. HL7 Hellas
HL7 Facts
 HL7 is not a software application
 The HL7 standard is a ‘book of rules’
 prime objective of HL7 is to simplify the
implementation of interfaces between
healthcare software applications
 HL7 has grownup and become the de
facto model for the entire healthcare
industry’s data exchange challenges.

19. Interoperability & HL7 HL7 Hellas
Considerations
 HL7 is not a plug and play
 Not all the Health Information Systems
have HL7 interface
 Complex data exchanges needs special
software applications like “Interface
Engines”

20. HL7 Hellas
Interface Engines
 Mission Critical Component
 Formatting Messages and Routing them
 Complex data exchanges needs special
software applications like “Interface
Engines” or “Integration Engines”

21. HL7 Hellas
Interface Engines
 Hospital’s Clinical Data “Telephone
Exchange”

22. HL7 Hellas
Interface Engines
 Past
 complicated issue
 required extensive programming expertise from IT stuff
 hard to deal with different HL7 versions and formats
 different communication points
 complicated administrative tasks
 maintenance and support was very complex
 Today
 Graphical UI
 Easy of use
 Ready Protocol Libraries (HL7 Versions)
 Different ways to Communicate

23. HL7 Hellas
Large Scale Implementation
Health Regional System
Sub-Systems CDR Scheduling Portal
ERP
MIS Scheduling
Integration Engine
Hospital 1 Hospital 10
Reg.Centers
HIS IE IE
…… HIS - ERP
ERP - MR
ADT
LAB
LAB PACS

24. HL7 Hellas
Integration strategy
 Integration Engine on its own is not
enough!
 Need Master Patient Index for validation
 Need highly skilled IT resources
 Need money to invest in integration (not
a given today)

25. HealthCare Interoperability the Future HL7 Hellas
What we expect ?
 HL7 v3.0
 Promise of plug and play interoperability
 Robust approach to development
 Widespread support
 Open Systems
 Integration of Services and Technologies
 Use of new Technologies in Software
Integrations
 Web Services
 Service Oriented Architecture

26. HL7 Hellas, Apollo SA
8th WORLD HELLENIC BIOMEDICAL
CONGRESS