Presented at the 7th Healthcare CIO Certificate Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on September 15, 2016
Vip Kolkata Call Girls Cossipore đ 8250192130 âŁď¸đŻ Available With Room 24Ă7
Â
Hl7 Standards (September 15, 2016)
1. 1
HL7 Standards
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Certified HL7 CDA Specialist
Some slides reproduced & adapted with permission from
Dr. Supachai Parchariyanon
September 15, 2016
2. 2
ÂťProfile:
Dr. Supachai Parchariyanon is a medical doctor
whoâs passionate about information technology and
turn himself to be informatician and serial
entrepreneurs.
Heâs also earned Business Management degree
from Ramkamhaeng university and Biomedical
Informatics degree from the US. He led the team to
certify both HL7 Reference Information Model (RIM)
and Clinical Document Architecture (CDA). His
interest is now on standards and interoperability,
clinical informatics and project management.
ÂťKeep in touch
Âťsupachaimd@gmail.com
Âťhttp://www.facebook.com/supachaiMD
Supachai Parchariyanon
@supachaiMD
Slide reproduced/adapted from Dr. Supachai Parchariyanon
3. 3
Nawanan Theera-Ampornpunt
2003 M.D. (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
Former Deputy Chief, Informatics Division
Deputy Executive Director for Informatics,
Chakri Naruebodindra Medical Institute
Faculty of Medicine Ramathibodi Hospital
nawanan.the@mahidol.ac.th
http://groups.google.com/group/ThaiHealthIT
Research interests:
⢠EHRs & health IT applications in clinical settings
⢠Health IT adoption
⢠Health informatics education & workforce development
4. 4
Outline
⢠Introduction to Standards & Interoperability
⢠What is Health Level Seven (HL7)?
⢠What HL7 does?
⢠HL7 Version 2
⢠HL7 Version 3 Messaging Standard
⢠Reference Information Model (RIM)
⢠Clinical Document Architecture (CDA)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
6. 6
Standards: Why?
⢠The Large N Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950
10. 10
Various Kinds of Standards
⢠Unique Identifiers
⢠Standard Data Sets
⢠Vocabularies & Terminologies
⢠Exchange Standards
â Message Exchange
â Document Exchange
⢠Functional Standards
⢠Technical Standards: Data Communications,
Encryption, Security
11. 11
Functional
Semantic
Syntactic
How Standards Support Interoperability
Technical Standards
(TCP/IP, encryption,
security)
Exchange Standards (HL7 V2,
HL7 V3 Messaging, HL7 CDA,
DICOM)
Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 V3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 V3, HL7 CCD
Unique ID
12. 12
What is HL7?
⢠HL7 is an ANSI-accredited Standards
Development Organization (SDO)
operating in the healthcare arena.
⢠It is a non-profit organization made up of
volunteers â providers, customers,
vendors, government, etc.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
13. 13
What is HL7? (Cont.)
⢠HL7 is an acronym for Health Level Seven
â Seven represents the highest, or âapplicationâ
level of the International Standards
Organization (ISO) communications model for
Open Systems Interconnection (OSI) networks.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
15. 15
What HL7 does?
⢠HL7 focuses on the clinical and administrative
data domains.
⢠It defines data exchange standards for these
domains called messages or messaging
specifications (aka HL7 messages)
â Messages are developed by technical committees and
special interest groups in the HL7 organization.
⢠HL7 organization defines 2 versions of the
messaging standard:
â HL7 v2.x (syntactic only)
â HL7 v3.0 (semantic capability added)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
17. 17
HL7 Standards
⢠HL7 V2.x
â Defines electronic messages supporting hospital
operations
⢠HL7 V3
⢠HL7 Clinical Document Architecture
(CDA) Releases 1 and 2
⢠HL7 Arden Syntax
â Representation of medical knowledge
⢠HL7 EHR & PHR Functional Specifications
⢠Etc.
18. 18
The Industry Standard
HL7 Version 2 (HL7 V2)
⢠Not âPlug and Playâ - it provides 80 percent of the
interface and a framework to negotiate the remaining 20
percent on an interface-by-interface basis
⢠Historically built in an ad hoc way because no other
standard existed at the time
⢠Generally provides compatibility between 2.X versions
⢠Messaging-based standard built upon pipe and hat
encoding
⢠In the U.S., V2 is what most people think of when people
say âHL7âł
Slide reproduced/adapted from Dr. Supachai Parchariyanon
19. 19
HL7 version2
⢠HL7 V2 is still the most commonly used HL7
standard
â Over 90% of US hospitals have implemented some
version of 2.x HL7 messages
⢠The HL7 V2 messaging standard is considered:
â The workhorse of data exchange in healthcare
â The most widely implemented standard for healthcare
information in the world
⢠HL7 V2.5 was approved as an ANSI standard in
2003
⢠HL7 is currently working on version 2.7
Slide reproduced/adapted from Dr. Supachai Parchariyanon
20. 20
HL7 V2 Message
⢠Composed of reusable segments, each
identified by a 3-letter mnemonic
⢠All messages must start with header segment
MSH which includes sender, receiver, date-
time, message identifier, message type, and
trigger event
⢠Segments used in a message are determined
by message type
Slide reproduced/adapted from Dr. Supachai Parchariyanon
21. 21
Part of Sample HL7 V2 Message
(Lab Result)
OBX|1|NM|10839-9^TROPONIN-I^LN||5|ng/ml|
0-1.3|H||H|F|19980309âŚ
22. 22
HL7 Basic Transaction Model
send
HL7 ADT
A01 msg
receive HL7
ACK msg
ADT system
Lab system
Receive A01,
send ACK
(external) admit
event
trigger event
network
Slide reproduced/adapted from Dr. Supachai Parchariyanon
23. 23
Patient Admission Scenario,
Inform Lab System
⢠Trigger event is admission : A01
⢠Message type is: ADT
⢠Messages composed of:
â MSH (message header)
â PID (patient identification)
â PV1 (visit data)
Slide reproduced/adapted from Dr. Supachai Parchariyanon
24. 24
HL7 V2 Message
⢠Messages composed of
â Segments composed of
⢠Fields composed of
â Components
⢠Delimiters
â Field separator: |
â Component separator: ^
â Repetition separator: ~
â Escape character:
â Subcomponent: &
â Segment terminator: <cr>
Slide reproduced/adapted from Dr. Supachai Parchariyanon
25. 25
Message Header Segment - MSH
MSH|^~|&|SMS|OR2|TMR|SICU|201010191535|password|ADT^A01|MSG1632|P|2.7<cr>
Sending
Unit
Receiving
Unit Date
Time
Message
type
Trigger
ID
Sending
Place Receiving
Place
Message
Number
version
Delimiters
production
Slide reproduced/adapted from Dr. Supachai Parchariyanon
26. 26
PID Segment â 1/3
PID|Z12345^5^M11||||PATIENT^JOSEPH^M^IV|
Patient ID
Check digit
Method
Last name
First name
Middle
Initial
Suffix
Patient name
Null fields
Data field
Field delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
27. 27
PID Segment â 2/3
MAIDEN|19610605|M||C|1492 OCEAN STREET^
Motherâs
maiden name
Gender
Date of birth Race
Street
address
Data component Component
delimiter
Slide reproduced/adapted from Dr. Supachai Parchariyanon
28. 28
PID Segment â 3/3
DURHAM^NC^27705|DUR|(919)684-6421<cr>
City
State
Zip Code
County
Telephone
Segment terminator
Slide reproduced/adapted from Dr. Supachai Parchariyanon
32. 32
Problems with HL7 v2
⢠HL7 v2 cannot support all this!
â Ad Hoc design methodology
â Ambiguous â lacking definition
â Complicated, esoteric encoding rules.
â Artifacts left to retain backward compatibility
â Too much optionality
â Canât specify conformance
â No standard vocabulary
Slide reproduced/adapted from Dr. Supachai Parchariyanon
33. 33
Whatâs Different About V3?
⢠Conceptual foundation
â A single, common reference information model to be used across
HL7
⢠Semantic foundation
â Explicitly defined concept domains drawn from the best
terminologies
⢠Abstract design methodology
â That is technology-neutral
â Able to be used with whatever is the technology de jour
⢠XML, UML, etc.
⢠Maintain a repository
â Database of the semantic content
â Ensures a single source and enable development of support
tooling
Slide reproduced/adapted from Dr. Supachai Parchariyanon
34. 34
How is V3 different than V2?
⢠V3 is approaching âPlug and Playâ
⢠V2 uses pipe and hat messaging, while V3
uses the Reference Information
Model(RIM) and XML for messaging
⢠V3 is a brand new start â it is NOT
backward compatible with V2
Slide reproduced/adapted from Dr. Supachai Parchariyanon
35. 35
HL7 V3 Standards
⢠A family of standards based on V3
information models and development
methodology
⢠Components
â HL7 V3 Reference Information Model (RIM)
â HL7 V3 Messaging
â HL7 Development Framework (HDF)
36. 36
How HL7 V3 Works
⢠Message sent from sending application to
receiving application
⢠Mostly triggered by an event
⢠Typical scenario portrayed in a storyboard
⢠Message in XML with machine-processable
elements conforming to messaging
standard
⢠Data elements in message conform to RIM
⢠Not designed for human readability
37. 37
V3 Messaging Standard
⢠Based on an object information model, called the
Reference Information Model, (RIM)
â This model is âabstract,â that is, it is defined without
regard to how it is represented in a message âon the
wireâ or in a âservice architectureâ method or in a
âclinical documentâ
â In fact, each of these representations can contain the
same âinstanceâ of information
⢠Consequently, can be extended incrementally
when new clinical information domains need to
be added, in a way that doesnât require changing
what has already been created
Slide reproduced/adapted from Dr. Supachai Parchariyanon
38. 38
HL7 V3 Messaging
⢠V3 provides messaging standards for
â Patient administration
â Medical records
â Orders
â Laboratory
â Claims & Reimbursement
â Care provision
â Clinical genomics
â Public Health
â Etc.
40. 40
HL7 V3 Reference
Information Model
⢠Referral
⢠Transportation
⢠Supply
⢠Procedure
⢠Consent
⢠Observation
⢠Medication
⢠Administrative act
⢠Financial act
⢠Organization
⢠Place
⢠Person
⢠Living Subject
⢠Material
⢠Patient
⢠Member
⢠Healthcare facility
⢠Practitioner
⢠Practitioner assignment
⢠Specimen
⢠Location
Entity
0..*
1
Role
1
0..*
1
0..*
Act
Relationship
1..*
10..*
1
Participation Act
⢠Author
⢠Reviewer
⢠Verifier
⢠Subject
⢠Target
⢠Tracker
⢠Has component
⢠Is supported by
Slide reproduced/adapted from Dr. Supachai Parchariyanon
41. 41
HL7 V3 Components and Process:
RIM UML Instance Scenario
ď° Classes are color coded:
ďŽ Green = Entity, Yellow = Role, Blue = Participation, Red/Pink = Act, Purple = Infrastructure, Lilac = message
controller.
John Doe Patient Subject
Entity Role Participation Act
Dr. Smith
HealthCare
Provider
Surgeon
John Doe Patient Subject
Has Pertinent
InformationAct Relationship
(Clinical Trial Act)
Protocol ECOG
1112
XYZ
Hospital
HealthCare
Facility
Location
(Procedure Act)
Prostectomy
Slide reproduced/adapted from Dr. Supachai Parchariyanon
43. 43
Source: âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
44. 44
The HL7 V3 Solution
⢠Approaching âPlug and Playâ - less of a
âframework for negotiationâ
⢠Utilizes RIM for data model
⢠Utilizes XML as transport method
⢠HL7 V3 is not the next release of HL7 V2 -
It is a paradigm shift
Slide reproduced/adapted from Dr. Supachai Parchariyanon
45. 45
The HL7 V3 Solution (Cont.)
⢠HL7 V3 addresses the problems of HL7 V2
by:
â Reducing HL7 V2 optionality
â Including testable conformance rules
⢠HL7 V3 is based on a formal development
methodology:
â Follows an Object Oriented (OO) approach
â Uses Universal Modeling Language (UML) principles
⢠Most importantly, HL7 V3 supports
semantic interoperability
Slide reproduced/adapted from Dr. Supachai Parchariyanon
46. 46
Interoperability in HL7 V3
⢠The Four Pillars of Semantic
Interoperability in HL7 V3
â A common Reference Information Model (RIM) which
spans the entire patient care, administrative and
financial healthcare universe
â A well-defined and tool-supported process for deriving
data exchange specifications ("messages") from the
RIM
â A formal and robust Data Type Specification upon
which to ground the RIM
â A formal methodology for binding concept-based
terminologies (vocabulary) to RIM attributes
Slide reproduced/adapted from Dr. Supachai Parchariyanon
47. 47
HL7 Model Repository
⢠Database holding the core of HL7
semantic specifications
â RIM
â Storyboards
â Vocabulary domains
â Interaction models
â Message designs
â Message constraints
Slide reproduced/adapted from Dr. Supachai Parchariyanon
49. 49
Navigating the V3 Ballot
Publication
Slide reproduced/adapted from Dr. Supachai Parchariyanon
50. 50
Navigating the V3 Ballot
Publication
⢠Domains: The Functional Content of the
Publication
â Universal Realm Domains
⢠Administration Domains
⢠Health and Clinical Practice Domains
⢠Common Use Domains
â US Realm domains
⢠Medicaid Information Technology Architecture
(MITA)
â Other realm specific domains..
Slide reproduced/adapted from Dr. Supachai Parchariyanon
51. 51
Domain Publication
Structure
Each Realm contains a collection of
Domains. Domains are further divided into
Topics
⢠Domain
⢠Topic
Slide reproduced/adapted from Dr. Supachai Parchariyanon
52. 52
V3 Messaging Concerns
⢠Difficult to implement
⢠No one understands V3
⢠Overhead too much
â 1% of message is payload compared to V2
(delimiters) is about 90-95%
⢠No one understands what implementation of V3
messaging means
⢠Need stability, clarity, definition of V3 messaging
Slide reproduced/adapted from Dr. Supachai Parchariyanon
53. 53
The Future of HL7
⢠FHIR: Fast Healthcare Interoperability
Resources
â Pronounced âFireâ
⢠FHIR defines a set of âResourcesâ that
represent granular clinical concepts, which
can be managed in isolation, or
aggregated into complex documents
⢠Resources are based on simple XML or
JSON structures, with an http-based
RESTful protocol
http://wiki.hl7.org/index.php?title=FHIR
54. 54
HL7 Clinical Document
Architecture (CDA)
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Certified HL7 CDA Specialist
Some slides reproduced & adapted with permission from
Dr. Supachai Parchariyanon
55. 55
Message Exchange
⢠Goal: Specify format
for exchange of data
⢠Internal vs. external
messages
⢠Examples
ď§ HL7 V2
ď§ HL7 V3 Messaging
ď§ DICOM
ď§ NCPDP
Document Exchange
⢠Goal: Specify format
for exchange of
âdocumentsâ
⢠Examples
ď§ HL7 V3 Clinical Document
Architecture (CDA)
ď§ ASTM Continuity of Care
Record (CCR)
ď§ HL7 Continuity of Care
Document (CCD)
Exchange Standards
56. 56
Messages
⢠Human Unreadable
⢠Machine Processable
Clinical Documents
⢠Human Readable
⢠(Ideally) Machine
Processable
Exchange Standards
57. 57
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message Exchange
Message
Message
Message
Message
Message
58. 58
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Clinical Document Exchange
Message containing
Referral Letter
Message containing
Claims Request
Message containing
Lab Report
Message containing
Patient Visit Summary
Message containing
Communicable
Disease Report
59. 59
What Is HL7 CDA?
⢠âA document markup standard that
specifies structure & semantics of âclinical
documentsâ for the purpose of exchangeâ
[Source: HL7 CDA Release 2]
⢠Focuses on document exchange, not
message exchange
⢠A document is packaged in a message
during exchange
⢠Note: CDA is not designed for document
storage. Only for exchange!!
60. 60
What is CDA?
⢠CDA is based on XML
⢠XML is eXtensible Markup Language
⢠In XML, structure & format are conveyed
by markup which is embedded into the
information
Slide reproduced/adapted from Dr. Supachai Parchariyanon
62. 62
A Clinical Document (1)
⢠A documentation of clinical observations
and services, with the following
characteristics:
ď§ Persistence - continues to exist in an
unaltered state, for a time period defined by
local and regulatory requirements
ď§ Stewardship - maintained by an organization
entrusted with its care
ď§ Potential for authentication - an assemblage
of information that is intended to be legally
authenticated Source: HL7 CDA R2
63. 63
A Clinical Document (2)
⢠A documentation of clinical observations
and services, with the following
characteristics:
ď§ Context - establishes the default context for its
contents; can exist in non-messaging contexts
ď§ Wholeness - Authentication of a clinical
document applies to the whole and does not
apply to portions of the document without full
context of the document
ď§ Human readability - human readable
Source: HL7 CDA R2
64. 64
A Clinical Document (3)
⢠A CDA document is a defined & complete
information object that can include
ď§ Text
ď§ Images
ď§ Sounds
ď§ Other multimedia content
Source: HL7 CDA R2
65. 65
CDA Releases
⢠CDA Release 1 (ANSI-approved in 2000)
â First specification derived from HL7 RIM
⢠CDA Release 2 (2005) - Current Release
â Basic model essentially unchanged from R1
⢠Document has a header & a body
⢠Body contains nested sections
⢠Sections can be coded using standard vocabularies and can
contain entries
â Derived from HL7 RIM Version 2.07
Source: HL7 CDA R2
66. 66
Key Aspects of CDA
⢠CDA documents are encoded in XML
ď§ When alternative implementations are feasible,
new conformance requirements will be issued
⢠CDA documents derive their machine
processable meaning from HL7 RIM and
use HL7 V3 Data Types
⢠CDA specification is richly expressive &
flexible
ď§ Templates can be used to constrain generic
CDA specifications
Source: HL7 CDA R2
67. 67
Scope of CDA
⢠Standardization of clinical documents for
exchange
⢠Data format of clinical documents outside
of exchange context (such as data format
used to store clinical documents) is
out-of-scope
Source: HL7 CDA R2
68. 68
Scope of CDA
⢠CDA doesnât specify creation or
management of documents and messages
related to document management
⢠Instead, HL7 V3 Structured Documents
WG provides specifications on standards
for document exchange within HL7 V3
messages (where CDA clinical documents
can become contents of the messages)
Source: HL7 CDA R2
69. 69
Scope of CDA
Lab Technician Physician
Lab Report
Create
document
Process &
Store
document
Transmit
document
CDA
70. 70
Scope of document content
⢠Clinical content of the documents is
defined by the RIM and not by CDA.
⢠CDA only standardizes the structure and
semantics required to exchange
documents.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
71. 71
Goals of CDA (1)
⢠Give priority to delivery of patient care
⢠Allow cost effective implementation across
as wide a spectrum of systems as possible
⢠Support exchange of human-readable
documents between users, including those
with different levels of technical
sophistication
⢠Promote longevity of all information
encoded according to this architecture
Source: HL7 CDA R2
72. 72
Goals of CDA (2)
⢠Enable a wide range of post-exchange
processing applications
⢠Be compatible with a wide range of document
creation applications
⢠Promote exchange that is independent of the
underlying transfer or storage mechanism
⢠Prepare the design reasonably quickly
⢠Enable policy-makers to control their own
information requirements without extension to this
specification
Source: HL7 CDA R2
73. 73
CDA & HL7 Messages
⢠Documents complement HL7 messaging
specifications
⢠Documents are defined and complete information
objects that can exist outside of a messaging
context
⢠A document can be a MIME-encoded payload
within an HL7 message
Source: âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
74. 74
CDA & Message Exchange
⢠CDA can be payload (or content) in any kind of
message
â HL7 V2.x message
â HL7 V3 message
â EDI ANSI X12 message
â IHE Cross-Enterprise Document Sharing (XDS)
message
⢠And it can be passed from one kind to
another
Source: âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
75. 75
CDA & Message Exchange
Clinical Document
(Payload)
HL7 V3 Message
(Message)
HL7 V2 Message
(Message)
Source: Adapted from âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
76. 76
CDA As Payload
Source: From âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
77. 77
MIME
⢠Multipurpose Internet Mail Extensions
⢠An Internet standard that extends the format of e-
mail to support
â Text in non-ASCII character sets
â Non-text attachments
â Message bodies with multiple parts
â Etc.
⢠Often used in e-mails & some HTTP data
⢠Encoding: e.g. base64 (converting bits into
64 ASCII characters
Source: http://en.wikipedia.org/wiki/MIME
80. 80
Major Components of a CDA
⢠A CDA document is wrapped by the
<ClinicalDocument> element, and contains a
header and a body.
⢠The header lies between the <ClinicalDocument>
and the <StructuredBody> elements and identifies
and classifies the document and provides
information on authentication, the encounter, the
patient, and the involved providers.
Slide reproduced/adapted from Dr. Supachai Parchariyanon
86. 86
Rendering CDA Documents (1)
Source: From âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
87. 87
Rendering CDA Documents (2)
Source: From âWhat is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
88. 88
Rendering CDA Documents (3)
⢠Different recipients may use different style sheets
to render the same CDA document, and thus may
display it differently (but the same content is
presented)
⢠This can help facilitate display of CDA documents
with specific preferences or local requirements
89. 89
CDA & Document Management
⢠CDA focuses on document exchange, not
storage or processing
⢠Clinical documents are used for various reasons
â Clinical care
â Medico-legal reasons (as evidence)
â Auditing
â Etc.
⢠Clinical documents may contain errors or need
data updates (e.g. preliminary lab results vs. final
results)
90. 90
Some Possible Use Cases of CDA
ď§ Intra-institutional
ď§ Exchange of parts of medical records (scanned or
structured electronic health records)
ď§ Lab/Imaging requests & reports
ď§ Prescriptions/order forms
ď§ Admission notes
ď§ Progress notes
ď§ Operative notes
ď§ Discharge summaries
ď§ Payment receipts
ď§ Other forms/documents (clinical or administrative)
91. 91
Some Possible Use Cases of CDA
ď§ Inter-institutional
ď§ Referral letters
ď§ Claims requests or reimbursement documents
ď§ External lab/imaging reports
ď§ Visit summary documents
ď§ Insurance eligibility & coverage documents
ď§ Identification documents
ď§ Disease reporting
ď§ Other administrative reports
92. 92
Achieving Interoperability
ď§ CDA is a general-purpose, broad standard
ď§ Use in each use case or context requires
implementation guides to constrain CDA
ď§ Examples
ď§ Operative Note (OP)
ď§ Consultation Notes (CON)
ď§ Care Record Summary (CRS)
ď§ Continuity of Care Document (CCD)
ď§ CDA for Public Health Case Reports (PHCRPT)
ď§ Quality Reporting Document Architecture (QRDA)
93. 93
CDA Summary
ď§ CDA is a markup standard for document
exchange
ď§ Not message exchange
ď§ Not document storage or processing
ď§ CDA is a general-purpose standard
ď§ Use in specific context requires
Implementation Guides (and possibly
Extensions)
94. 94
CDA Summary
ď§ CDA is XML-based and RIM-based
ď§ CDA documents can be exchanged as
encapsulated data (payload) in any message
(HL7 V2, HL7 V3, etc.)
ď§ CDA is not dependent on using HL7 V3
messages
ď§ Most likely early use cases for CDA
ď§ Referrals
ď§ Claims & Reimbursements
ď§ Lab/imaging Reports
ď§ Electronic Health Records Documents
95. 95
HL7: Take Home Message
⢠HL7 is not panacea and so does other standards
⢠People and processes matter most
⢠Do not aim to build HIS to comply with HL7
specification but do aim to let it be able to
communicate to another systems via HL7
⢠Most specifications in standards and
interoperability provide framework but not
implementation guide, at times you need experts
Slide reproduced/adapted from Dr. Supachai Parchariyanon
96. 96
Additional Information
⢠Health Level Seven http://www.hl7.org
⢠HL7 Reference Information Model
â https://www.hl7.org/library/data-model/RIM/C30202/rim.htm
⢠HL7 Vocabulary Domains
â http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm
⢠HL7 v3 Standard
â http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
⢠HL7 v3:
â âDriving Interoperability & Transforming Healthcare Information
Managementâ by Charles Mead, MD, MSc.
â http://www.healthcare-informatics.com/webinars/05_20_04.htm
⢠FHIR: http://www.hl7.org/implement/standards/fhir/
Slide reproduced/adapted from Dr. Supachai Parchariyanon