1. Pasi Leino
L-Force Oy, Finland
pasi.leino@lforce.fi

2.  HL7 crash course
 National efforts and applications (Finland)
 Choice of Techology

3.  20 year old (since 1987), non-profit
organisation
 National standard in the US (ANSI) since
1994
 Open, consensus based development
process
 In use?
◦ CHIME-study 2000 (153 Hospital CIOs in US)
 80% using HL7, 13.5% planning
 Hospitals over 400 beds: 95%
 For interoperability

4. Process level
Ability to adapt to work flow
Semantic level
Ability to exchange information
Operational level
Ability to exchange data

5.  Messaging standards
◦ HL7 v2.x (v2.5 ANSI-standard 2006)
◦ HL7 versio 3 RIM
 CDA (clinical document architecture) R1
and R2
 HL7 data types to become ISO standard
 CCOW (clinical context management)
 Arden syntax (represents medical
algorithms in clinical information) + GLIF +
Gello
 + small Working Groups
 Recommendations, implementation guides

6.  Data model (or information model)
◦ RIM (Reference Information Model) and D-MIM,
R-MIM, HMD
◦ Refine by constraining
 Vocabulary
 Data types
 Domain models
 ITS (Implementation Technology
Specification)
◦ XML ITS currently available

7. Information Model
Spec Define classes,
Develop Scope
attributes, and
Use Case Model relationships
Identify actors and
Use Cases RIM Spec
Spec
Class Diagram State Diagram Define vocabulary
domains and codes
Associate Actors
UCM Spec
and Use Cases Use Case Diagram Define states,
transitions and
triggers
Define
Application Roles
Message Design
Interaction Model Develop Refined
Message Information
Define Spec 2-nd Order h//mt:50”d” Model
Interactions 1 choice of …
0-n Drug … Specify CMET
Define
Inter Spec 0-1 Nursing …
Conformance Interaction Diagram
Specify HMD &
Criteria METs with
constraints
Source: HL7 Training, Scandinavia Tour, 2002

9. Relationship Act
Link Relationship
0..* 0..* 0..* 0..*
1 1 1 1
0..* 0..* 1
Entity 1
Role 1
Participation 0..*
Act
Patient Referral
Organization
Employee Transportation
Living Subject
Practitioner Supply
Material
Assigned Procedure
Place
Practitioner Condition Node
Health Chart
Specimen Consent
Observation
Medication
Act complex
(Source: G.W. Beeler) Financial act

10. Medication
(Act/ substance
Administation)
Is related to
(ActRelationship)
Dr Phil Doctor Performer
(Person) (Role) (Participation)
Visit
(Act/ Encounter)
Pasi Leino Patient Target
(Entity/ Person) (Role) (Participation)
Is related
(ActRelationship)
Study,
other action

11.  Entities in Green
◦ Organisations, persons, devices,
locations ...
 Roles in yellow
◦ professionals, patients, roleLinks
 Participation in Cyan
 Activities (act), in Red
◦ Observations, Events, medication,
Encounters, ...
Relations in activities

13. RIM DMIM RMIM
Dynaamic model:
Use cases, application roles, interactions
The static model an dynamic behavior is linked by interactions
XML HMD
Schema

14.  HL7 affilicate since 1995
 Has earned status of respect
 Receives funding from the Ministry of social
affair and health
 Finland is an early adopter of any technology
 CDA –centric approach

15. CDA is defined by the RIM
CDA RMIM is a constraint on the RIM
Classes “cloned” (replicated, renamed, constrained with
vocabulary, datatypes)
CDA is Persistence, stewardship, is Potential for authentication,
Whole, Human readable

16. CDA document
Header and context to describe the document
Body
Narrative, Structured
Human readable Machine readable
Structurd
data
text
text
text

17.  Forms used everywhere: patient core data,
health status, drivers license, leave of
absence...
 Very simple to define and implement
 However, a single concept (diagnosis etc.)
could be defied differently in different forms.
 Seemingly simplistic?
 In strict sence CDA document is not designed
for forms

18. kentän pituus
pakollisuus
tietotyyppi
toistuma
max
min
rivi tietokenttätunnus oid tunnus tietotyyppi koodisto huom. kentän nimi
1 1.2.246.537.6.12.2006.3 Label LB K lomake lomake HEN
2 1.2.246.537.6.12.2006.3. 1 Label LB K pääotsikko
Päivitystiedot
3 1.2.246.537.6.12.2006.3. 2 Coded Value CV K Henkilötietojen käy
4 1.2.246.537.6.12.2006.3. 3 Point in Time TS K Henkilötiedot on p
5 1.2.246.537.6.12.2006.3. 4 Character String ST K Henkilötietojen päi
6 1.2.246.537.6.12.2006.3. 5 Label LB K pääotsikko
Perustiedot
7 1.2.246.537.6.12.2006.3. 6 Instance Identifer II Henkilötunnus
8 1.2.246.537.6.12.2006.3. 7 Instance Identifer II Väliaikainen henki
9 1.2.246.537.6.12.2006.3. 8 Instance Identifer II Muut tunnisteet
10 1.2.246.537.6.12.2006.3. 9 Person Name PN Sukunimi, etunime
11 1.2.246.537.6.12.2006.3. 10 Person Name PN T Entinen sukunimim
12 1.2.246.537.6.12.2006.3. 11 Point in Time TS Syntymäaika

19.  Patient centric services, which promote
continuity of care
 Interoperability
 Electronic archiving or EPR, prescriptions,
centralised image repositories
 National services for codes, classifications,
archiving

20.  Scheduling-domain
◦ Regional shared scheduling
 ePrescription
◦ Medical Records messages
◦ CDA R2 based content- prescription, delivery, locking, etc.
 Death notice message
◦ V3 messaging spesifications for automatic reporting of
death to National citizen registy.
 eArchive messages
◦ V3 Messages, CDAR2 payload + W3C signature
 Diagnostic imaging patient records and reports
 CDA R2 implementation guidelines
◦ See: www.hl7.fi
◦ See: www.hl7.co.uk

21. YHDIS-
TELMÄ
LPSY
PSY
HENKILÖ- KIR
TIEDOT SIS Summary
YLE
documents
SOS LÄÄ KUUMEKU
LAB PSY LÄHETE
RAD ANS PSY HOSU
OPER RR HOSU
VEREN- DIA TAUDIN-
SIIRTO KULKU JA
HOITO
Service units Care programs Care episodes

22.  Structured and standardised core data
 Use of national codes and OID
 CDAR2 documents
 Open interface to exchange CDAR2
documents
 Ability to interface to national EPR archive,
ePrescription, code services
 Desktop integration, SSO
 User authentication, electronic signing,
concent management, referrals

24. Several Duodecim
providers Stakes
TEO
VRK Decision Public Health I. Stakes
Content Codes, Authentication support Consumer Healthcare
OID- Person service
providers classifications, codes of healthcare Consumer health
professionals identifier statistics
vocabularies health
Content
User
Code OID-code authentication Person Decision Enabling
service service & eSignature identifier support
service service services
service
National
EPR Medical EPR Service
Health ePre- Core
Service forms &
Portal scription (Active) (Long-term)
services
certificates Registry
Service Service Repository Archive
service
Secure Network &
Messaging Service
Enterprise
applications

25.  Information model to be updated according to
”structured core patient date definitions”
 Use of Codes and OID’s
 Use of CDA R2 for document generation
 Open interfaces for interchange of CDA R2
documents
 Access to decision support services
 Ability to use of the EPR, ePrescription etc. services
 Functionality to filter user tailored views from
retrieved patient documents
 Desktop integration & SSO
 User authentication, signature, consent
management

26.  XML is nothing alone
◦ SOAP
◦ Custom schemas
◦ XML RPC
 Decision points: the developer does not need
to know what goes in the wire
 Acid test of spesification: can this be done
using general purpose development tools?
 Caché, Enseble –objects
 eXtc, DOM model
 Example document

27. author
cdaBody
AD cdaHeader
component
BL custodian
CS dataComponent
documentationOf
CV encompassingEncounter
externalLink
ED externalObservation
toCDA(..
II localHeader Construct(...
paragraphComponent
INT textComponent
Generate(...
patient
IVL patientSubject
MO relatedPatient
performer
PN qualifier
rtgENVEntry
rtgRQOEntry
rtgOBSEntry
Section

30. Questions?