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Interoperability and Innovation

An Overview of HL7

HIMSS 2001

www.HL7.org

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Semanticinteroperability

Functionalinteroperability

Interoperability & Innovation

• Main Entry: in·ter·op·er·a·bil·i·tyFunction: nounDate: 1977: ability of a system (as a weapons system) to use the parts or equipment of another system

Source: Merriam-Webster web site

• interoperability : ability of two or more systems or components to exchange information and to use the information that has been exchanged.

Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]

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Interoperability & Innovation

• Main Entry: in·no·va·tionFunction: nounDate: 15th century1 : the introduction of something new2 : a new idea, method, or device : novelty

Source: Merriam-Webster web site

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Interoperability & Innovation

HL7’s mission is clinical interoperability

“To provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.”

Source: HL7 Mission statement (1997)

HL7’s strategy is innovation – both by ourselves and by our users

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Who is HL7?

• Over 500 organizational members• About 1500 total members• Up to 500 attend the Working Group Meetings• International affiliates in:

–Australia - Argentina - Canada–China - Finland - Germany–India - Japan - Korea–The Netherlands - New Zealand - Southern Africa–Switzerland - Taiwan - The United Kingdom

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How is HL7 organized?

• Collaborative volunteer organization• Paid staff limited to the secretariat • Primary funding is membership dues

Technical Steering CommitteeTechnical affairs

Appointed officers plus chairsof the committees & SIGs

Technical CommitteesCreate normative specifications

or chapters in the standard

Special Interest GroupsCollaborate in area of interest tocontribute to the work of the TCs

The Working GroupThe "real" HL7

Any member can registerfor any committee or SIG

Board of DirectorsBusiness affairs

Elected

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The Working Group

• Draws equally from providers, software vendors, and consultants

• Group sets aside their individual interests, rolls up their sleeves and collaborate to get the tough work done

• HARD WORK - five, 12-hour days, three times a year plus active electronic collaboration in between

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What has HL7 produced?

• Founded in 1987• Produced Version 1.0 and

2.0 in ‘87 and ‘88• Approved HL7 message

standards - –2.1, 2.2, 2.3, 2.3.1 and 2.4 in ‘90, ‘94, ‘97, ‘99 and ‘00

• Approved CCOW standards–1.0, 1.1, 1.2, 1.3 in ’99, ’00 and ‘01

• Approved Arden Syntax standard in ‘99

• Approved XML-based Clinical Document Architecture standard in ‘00

• Accredited as an SDO by ANSI in 1994–All HL7 approvals since ‘94 are “American National Standards”

• Published implementation recommendations for:–Object broker interfacing ‘98–Secure messaging via e-mail ‘99–HIPAA Claims attachments ‘99–XML encoding of Version 2 ’00

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Computing trends – last 15 years

• Rather than consolidating in large data centers, computer architectures have become increasingly fractionated

• Computers are smaller, faster, cheaper• Networks give instantaneous access to anyone,

anywhere, any time• Medical technology has rapidly expanded the data

demands placed on health care computing • As a result, distributed architectures have become

the norm for most medical centers, with a concomitant requirement for system interoperability.

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Interoperability - where is HL7 used?

• 1998 CHIME survey of CIO’s found– 80 % of respondents use HL7 in their IT activity– a further 13 % plan to implement it in future– use is over 90% in hospitals over 400 beds

• HL7 is no longer an extra feature in computer applications, it is now a known requirement

• CCOW standard installed and in use in growing number of installations

• Clinical Document Architecture seeing rapid deployment in major medical centers

• Claims attachments will be part of HIPAA NPRM

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Innovation - users

• Interoperability has permitted users to select “best of breed” applications and still bind them to an enterprise data architecture

• Flexible clinical standards support the full gamut of clinical “topics of communication”

• Implementation guides have let users take advantage of their legacy data and interfaces in newer technical environments

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Innovation - vendors

• Interoperability standards enable development and implementation of “best of breed” niche products.

• Mergers and acquisitions are possible because standards allow linking of once-distinct products

• Rapid adoption of new technologies is supported by implementation recommendations for existing standards

• Once a back-office standard, HL7 is now carrying data to the desktop and coordinating the applications that appear there

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HL7 innovation - ideas

• Open acceptance of new ideas remains a key-stone of HL7’s success

• Fostered by a working group unified around the standards

• Welcoming of new or expanded topics–XML & web technologies - Vocabulary–Medical Logic - Workstation components

–Structured documents - Lab automation–Record architectures - Personnel management

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HL7 innovation - ideas

• Welcoming of new new communities• International participation

–From six to fifteen affiliates in last 2-1/2 years–Affiliates are not just ‘passengers’ but are helping drive the standards

–Strong collaboration with CEN European standards activities

–HL7 active in ISO Healthcare Informatics TC

• New domains of interest–Vocabulary, medical logic, health record communication, financial management

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HL7 innovation - methods

• Initial efforts based on a pragmatic ‘just do it’ approach to standards

• Saw the need to revise and formalize the process – to assure consistency of the standards – to meet plug’n’play demands– to be able to adopt and leverage new technologies for both

HL7 and its users

• Adopted the new methodology in 1997– based on best development & design practices– supports ‘distributed’ development across committees– is technology neutral

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HL7 innovation - methods

• Methodology based on shared models – Reference Information Model (RIM)

• of the health care information domain

– Defined vocabulary domains• Drawn from the best available terminologies• Directly linked to the RIM• Supported by robust communication techniques

• Harmonization process that– Assures each member and committee a voice in the process,

yet– Produces a single model as the foundation for HL7 standards

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HL7 innovation - devices

• Reference Information Model– Unique representation of health care domain– 64 classes with 350 attributes in six critical class

hierarchies– Designed to support “informatical” detail of clinical

events, their results and context

• Vocabulary Domain Specifications– Support the RIM Hierarchies and the coded attributes– Link to the “best” of the available clinical and

operational terminologies

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HL7 innovation - devices

• HL7 Model Repository – data base holding the core of HL7 semantic specifications– RIM - Use case models– Vocabulary domains - Interaction models– Message designs - Message constraints

• Tool sets designed against the repository to– Permit management of repository content– Review and browsing of semantic specifications– Design of abstract information structures based on the RIM for

use in messages, templates, documents,. Etc.– Publish HL7 specifications and standards– Support implementation of HL7 standards

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New capability

for HL7 users for HL7 itself

Impact – Who we are & What we do

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thru 1994 1996 1998 2000

Standards Recommendations New groups Affiliates

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Interoperability and innovation

• An overview of HL7?• No – core competencies of HL7

– have resulted in strong growth of HL7 and its capabilities

• A symbiotic cycle– We innovate to provide interoperability to our users– The users use interoperability to innovate in their

domains– User innovations lead to new ideas and new participants

for HL7– HL7 “interoperates” with these new ideas and people to

innovate in its own domain

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Health Level Seven

is its members, their ideas and contributions

is a group that innovates in standards to meet health care interoperability needs

is desirous that you benefit by joining us in our endeavor