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Using HL7 for Clinical Information Exchange

Using HL7 for Clinical Information Exchange. Jon Reid, Informatics Portfolio Manager, Office of Public Health Informatics Richard Kurzban, DTS/Office of Epidemiology Keyi Nu, DTS/USIIS Program, CFHS Steve Tuttle, DTS, the Public Health Laboratories . Problems of the current reporting process.

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Using HL7 for Clinical Information Exchange

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  1. Using HL7 for Clinical Information Exchange Jon Reid, Informatics Portfolio Manager, Office of Public Health Informatics Richard Kurzban, DTS/Office of Epidemiology Keyi Nu, DTS/USIIS Program, CFHS Steve Tuttle, DTS, the Public Health Laboratories

  2. Problems of the current reporting process • Involves manual steps that contribute to: • Incomplete reporting • Delayed reporting • Inefficient data gathering • Involves multiple data sources • Hospitals, Laboratories, Clinics, Patients/ • Families, Schools etc. • Involves different report formats • Fax, Phone, Email, Mail etc.

  3. Clinical Report Report manually entered in NETSS How we currently exchange information Clinical Report on reportable disease generated by automated or manual processes Local Health Departments Report is sent to the local health department Yes UDOH calls local health department or lab to get demographic information, then updates NETSS with new information No UDOH Local Health Departments Local Health Departments Report Faxed to UDOH or local health department Is report complete with demographic info (Name, Address, etc.) NETSS

  4. IHC Local Health Departments Rhapsody HL7 Lab Report Clinical Reporting from IHC IHC generates lab report for a notifiable disease complete with demographic information Notification is sent to the local health department Message Database Web CMR IHC submits HL7 message to UDOH which gets parsed and inserted into database UT-NEDSS Users access laboratory reports directly from the UT-NEDSS database through web or application interface

  5. Benefits of using HL7 • Accuracy • Complete with supporting information • Timely Communication • Report get routed to who needs it instantly instead of waiting to be faxed • Transactions Logged • Report history is kept so no report gets lost or unreported

  6. Real-Time Clinical Electronic Notifiable Diseases (RT-CEND) UDOH Port Rhapsody HL7 Message Server Storage Data Table IHC Sends Case Notification HL7 Messages from IMC/LDS ERM Extract /parse HL7 Message Transaction Test Baseline Evaluation User Interface Development Data analysis LHD Uses Operational Evaluation SUPPORTING PRODUCTS CAN BE SHARED WITH OTHER STATES HL7 Messages Implementation Guide Knowledgebase Case Definition & Logic

  7. Rhapsody Integration Engine

  8. Modeling the HL7 message

  9. What is an HL7 message? • Health Level Seven (HL7) is a standard format for packaging healthcare data in the form of messages to be transmitted among computer systems

  10. HL7 Segments used • MSH - includes message source and syntax specifics • PID – contains patient identifying and demographic information • Name, address, gender, date of birth • PV1 – contains visit-specific information • Hospitalization status • OBR – used to transmit data on a set of observations • name of reportable condition, source of specimen • OBX – contains information on observations • Name of reporting clinician, Test results

  11. HL7 Message Example • MSH|^~\&|RT-CEND|""|||20080930133000||ORU^R01||P|2.5 • PID|||135337744||XTEST^IDREP||19600228000000|M||W|999 XTEST DR APT 310^^SALT LAKE CITY^UT^84124^USA^^""||(801)888-8888 • OBR|1|||NOTF|||||||||||||||||||||||||||^***** POSITIVE HEPATITIS C ANTIBODY (REPORTABLE) ***** 09/20/2008 • OBR|2|221621736||LABRPT||200711271620||||||||200711271630|||||||||||F

  12. HL7 Message Example • OBX|1||00000-0^Parasitic AG/A^LOINC||Giardia lamblia antigen detected)|||||| • OBX|1||00000-0^ALERT DATE^LOINC||200712051029|||||| • OBX|2||00000-0^PROVIDER NAME^LOINC||JABEEN|||||| • OBX|3||00000-0^PROVIDER PHONE^LOINC||8015357029|||||| • OBX|4||22025-1^PROVIDER ID^LOINC||29598|||||| • OBX|5||45403-3^ROOM NUMBER^LOINC||DSCH |||||| • OBX|6||42347-5^ADMIT DIAGNOSIS^LOINC||HYPOXIA|||||| • OBX|7||00000-0^PREVIOUS ADMIT DATE^LOINC||198703220000|||||| • OBX|8||00000-0^PREVIOUS DISCHARGE DATE^LOINC||198703310000|||||| • OBX|9||00000-0^CONTACT NAME^LOINC||Carrie Taylor|||||| • OBX|10||00000-0^CONTACT PHONE^LOINC||8015077782|||||| • OBX|11||21612-7^PATIENT AGE^LOINC||66||||||

  13. Other implementations of HL7 • Keyi Niu (USIIS) • Steve Tuttle (State Lab)

  14. USIIS Utah State Immunization Information System HL7 in USIIS

  15. Function Communication What does “HL7” stand for? “Health Level 7” A domain-specific protocol for the exchange of health care information at the Application level of the OSI Communication Architecture Model. HL7 7 Application 6 Presentation 5 Session 4 Transport 3 Network 2 Data Link 1 Physical OSI Communication Architecture Model

  16. Laboratory Nurse PrimaryCarePhysican Pharmacy Departmentof Health Hospitals Patient InsuranceCompany SafetyatWork PublicHealth HL7 facilitates interoperability • Standard for exchanging information between all types of health care applications • Common communications protocol • Common format and content of messages Integrated Health Care

  17. Other advantages of HL7 • Open System • Managed by the accredited ANSI Standards Developing Organization • Tools to speed up the development of interfaces • Rhapsody ($200,000 +) • Neotool ($20,000 – $50,000) • Iguana ($10,000 +) • Symphonia • Chameleon ($2,000 / yr)

  18. Disadvantages of HL7 • HL7 is not plug-and-play • Missing fields or values • Same data in different fields or formats • Multiple versions • Invalid segment grammar • Investment to develop

  19. HL7 message protocol • Domain-specific: Messages are created and sent by an information system in response to an event • Sample message types: • ADT: patient admissions, discharges and transfers • ORU: clinical observation results in response to an order • VXU: immunization updates • 118 message types in V2.4 • Event-triggered • 257 events defined in V2.4 • Sample events: • patient admission • finalized pathology result • query from another system • Format • Delimited plain text (Version 1.0 – 2.5) • XML (Version 3.0)

  20. HL7 message • Composed of specific format and content • Segments (MSH, PID, RXA etc) • Fields • Datatype • Simple Datatype ( e.g. ST, NM, DT) • Composite Datatype (e.g. ID, XPN, XAD)

  21. USIIS HL7 • “Unsolicited” update of Patient Information • Message: ADT • Events: A04, A08, A31 • “Unsolicited” update of Vaccine Information • Message: VXU • Events: V04 • Query for Vaccination Record • Message: VXQ • Event: V01 • Possible responses: • Messages: ACK, VXR (Event: V03), VXX (Event: V02)

  22. HL7 segments implemented in USIIS • MSH Message Header • MSA Message Acknowledgment • QRD Query Definition • QRF Query Filter • PID Patient Identification • PD1 Patient Additional Demographic • NK1 Next of Kin • RXA Pharmacy/Treatment Admin • RXR Pharmacy/Treatment Route • ERR Error • OBX Observation/Result • NTE Notes (Regarding Immunization) • QAK Query Acknowledgement

  23. HL7 interfaces to USIIS • IHC (V 2.3.1,ADT) • Real-time ADT data • Granger Medical (V 2.3.1, VXU) • Batch immunization data • Indian Health Service (V 2.4, VXU) • Batch immunization data • Two-way: Return updated immunization data • e-Clinical Works (V 2.4, VXU) • Under development • IHC (V 3.0, Immunization domain) • Under development

  24. Pathways of HL7 to USIIS Secure file upload/download Batch Input FHS BHS MSH MSH ... Batch File Input Stream Batch output Provider ADT, VXU, VXQ MSH PID RXA Real Time ACK, VXR, VXX USIIS HL7 Engine Provider HL7 Client VXQ JDBC VXR, VXX Web Form USIIS Web App Provider End user USIIS Central DB

  25. Future HL7 Models of USIIS Secure file upload/download SOAP WSDL Batch Input Web Service Request FHS BHS MSH MSH ... Batch File Batch output Web Service Response Input Stream Provider ADT, VXU, VXQ MSH PID RXA V3 XML Messages Real Time Real Time ACK, VXR, VXX Provider HL7 V2 Client USIIS HL7 V2.x Engine USIIS HL7 V3 Engine Provider HL7 V3 Client VXQ Web Form JDBC VXR, VXX Provider End user USIIS Web App USIIS Central DB

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