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Sharing Healthcare Transactions

Sharing Healthcare Transactions. DCS 860D – Distributed Internet Computing Meg Broderick April 12, 2003. Agenda. Interoperability Importance in Healthcare HL 7 and XML Patient Record Architecture Integration Brokers Demo. Interoperability.

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Sharing Healthcare Transactions

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  1. Sharing Healthcare Transactions DCS 860D – Distributed Internet Computing Meg Broderick April 12, 2003

  2. Agenda • Interoperability • Importance in Healthcare • HL 7 and XML • Patient Record Architecture • Integration Brokers • Demo

  3. Interoperability • “…the ability of a system or a product to work with other systems or products without special effort on the part of the customer.. • “…Products achieve interoperability with other products using either or both of two approaches: • By adhering to published interface standards…, e.g., HTML, TCP/IP • By making use of a ‘broker’ of services that can convert one product's interface into another product's interface "on the fly“, …e.g. CORBA “ Source: www.whatis.com http://searchsystemsmanagement.techtarget.com/sDefinition/0,,sid20_gci212372,00.html

  4. Importance of Interoperability for Healthcare • Distributed Information Collection • Multiple Places • Different Function • Completeness Desirable • Large Volumes of Data • Distributed Use • Dispersed Locations • Different Functions: Information vs Transactions • Quality Essential • Different Levels of Computing Power

  5. W3C XML Linking Work Group • Mission: • To design advanced, scalable, and maintainable hyperlinking and addressing functionality for XML • Paul V. Biron & Sandra L. Boyer, “Introduction to XML,” HL7 Fall Plenary Meeting, Sept 27, 1999

  6. XML and HL7 • Start first with Patient Record Architecture • Expand Electronic Medical Record to include document-based clinical info • Exchange, reuse, longevity • System Independent • Local + Global • Hierarchical • Adds HL7 Messaging • Non-proprietary, standards-based (open)

  7. Patient Record Architecture (PRA) • Multilevel, XML • Level 1: Coded Header • Level 2: Coded Structure • Level 3: Coded Content • Syntax handles recursion • Nested structures • Unify segments, fields, components and subcomponents • Aka Clinical Document Architecture (CDA) • Header + Body

  8. Patient Record Architecture • Advantages of XML • Parsers are “free” (utilities) • Tools and technical staffing available • Supports type conversion • Order and placement of message elements specified • RIM Attribute Level Message Elements • Supports primitive and composite data types

  9. PRA: HL7 Conformance Profiles • Healthcare Orgs adapted HL7 message specs locally • Implementation specs stored in spreadsheet or word processing document • Message profile: HL7 spec + constraints + additions (z-segments) • Large amount of variance => maintenance nightmare • Store message profile in XML document: • Use XML to communicate metadata – data about data • Easily converted to PDF • Tools: Messaging Work Bench, Symphonia, Medi7 Parser Toolkit • Repository for message profiles on www.hl7.org • Concerns: • Vendor Competition • Correct with HCO pressure

  10. Concept Cluster Templates • Information Structures • HL7 messages • XML documents • Concepts • Generalization of notion of codes, including SNOMED • Archetypes or templates • Defines concept, units, values, mode e.g., BP Reading, concept ”systolic reading”, value, units, method (cuff), posture • Concensus Definition • HL7, British General Practitioner to General Practitioner, GEHR, etc. Source: W. Rishel, J. Klein, “Concept Cluster Templates: Next Step in Clincal Standards,” Tutorials, TU-14-7758, Research Note, November 9, 2001, Garter Group

  11. Other Technology • ebXML Electronic Business Extensible Markup Language • XML specs to streamline online business • Also X12 syntax • Components • Business Process Schema • Common Business Objects • Collaboration Protocol Profiles • Registry • Universal Description • Secure Messaging Service • CCOW • HL7, Context management standard • Technology Neutral • Patient Context/ User Mapping • HIPAA Impact • Possible efficiencies? Source: W. Rishel, “Healthcare and ebXML: Rx for HIPAA Security Compliance,” Events, EV-13-8185, Research Note, June 11, 2001, Garter Group Source: J. Klein, “CCOW: A Standard for Application Context Coordination,” Tutorials, TU-14-1690, Research Note, July 31, 2001, Garter Group

  12. Early XML Adopters • Industry • MetLife • To facilitate data exchange in financial services • To allow coordination across multiple new business units and acquistions • Build single customer view from back-end info silos • Resulted in: • Reduction of # of interfaces and reuse interfaces • Integration of services external and internal • Increased ease of data exchange Source: K. Harris, “Metlife: Insurance XML Early Adopter,” Case Studies, CS-15-2148, Research Note, February 11, 2002, Garter Group

  13. Early XML Adopters • Healthcare • End Stage Renal Disease Reporting • Needed to automate processing of 1.5 million forms/year from dialysis centers • Wide scope: 300,000 patients in 4,000 centers • VISION – Vital Information System to Improve Outcomes in Nephrology • Sponsored by Center for Medicare and Medicaid Services (CMS) – Distributed freely • Agency controlled both ends of information interface – more flexibility to evolve • Needed rapid implementation and deployment • Desired resemblance to HL7 standards • Used RIM, a complete Unified Modeling Language (UML) Source: W. Rishel, “Early XML Adoption for End Stage Renal Disease Reporting,” Case Studies, CD-15-6464, Research Note March 7, 2002, Gartner Group

  14. Integration Brokers • Types • Message-oriented middleware (MOM) • Transformation • Business Process Management • Context-based routing • Transformation • Specialized packages vs part of application platform • Synchronous vs Asynchronous

  15. Demo • Pause

  16. @echo off echo ************************************************* echo ****** ********** echo ****** LINKTools IDK Demonstration ********** echo ******---------------------------------********** echo ****** This Batch file takes you ********** echo ****** step-by-step through the ********** echo ****** interface processes. ********** echo ****** ********** echo *************************************************

  17. cd\ cd C:\LINKDemo\ pause cls echo ************************************************* echo *** The input files are copied from the ***** echo *** C:\LINKDemo\TestFiles\ folder to the ***** echo *** C:\LINKDemo\UDARecv folder. (HL7.*) ***** echo *** This simulates the receipt of HL7 ***** echo *** Admission, Discharge or Transfer (ADT) ***** echo *** Messages ***** echo ************************************************* echo *** Press SPACE BAR to copy input files ***** echo ************************************************* pause xcopy c:\linkdemo\testfiles\HL7.* c:\linkdemo\UDARecv\ cls

  18. echo ************************************************* echo *** The HL7.* files copied to the ***** echo *** C:\LINKDemo\UDARecv folder will be ***** echo *** processed and output to the ***** echo *** C:\LINKDemo\XMLOut folder ***** echo ************************************************* echo *** Press SPACE BAR to run update ***** echo ************************************************* pause c:\linkdemo\ltup.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPR cls

  19. echo ************************************************* echo *** To Simulate the reports passed back ***** echo *** from the target we will copy the ***** echo *** Report.001 file form the ***** echo *** C:\LINKDemo\TestFiles\ folder to the ***** echo *** C:\LINKDemo\ReportsIn folder. ***** echo ************************************************* echo *** Press SPACE BAR to copy input files ***** echo ************************************************* pause xcopy c:\linkdemo\testfiles\Report.001 c:\linkdemo\ReportsIn\ cls

  20. echo ************************************************* echo *** The Report.001 file copied to the ***** echo *** C:\LINKDemo\ReportsIn folder will be ***** echo *** merged in the database with the ***** echo *** previously received ADT data and ***** echo *** output to the ***** echo *** C:\LINKDemo\UDASend folder in HL7 ***** echo *** format ***** echo ************************************************* echo *** Press SPACE BAR to run update ***** echo ************************************************* pause

  21. c:\linkdemo\ltup.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPR cls echo ************************************************* echo *** Press SPACE BAR to view data **** echo *** in database with LINKSelect application **** echo ************************************************* pause c:\linkdemo\ltdb.exe c:\linkdemo\ADT2XML-Rep2HL7Demo.MPR exit

  22. The Future • Any to Any Connectivity and Transformation • Common Identification across all enterprises • Consistent and concurrent timing • Proprietary vs Independent Integration? • Improved availability and, perhaps quality, of healthcare information at point of care

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