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Sharing Healthcare Transactions

This document discusses the importance of interoperability in healthcare systems, emphasizing the use of HL7 standards and XML for facilitating seamless data exchange. It covers various aspects, including the patient record architecture, integration brokers, and the role of distributed computing in managing large volumes of healthcare data across multiple locations. Additionally, it highlights the tools available for implementing these standards, such as messaging workbenches and XML parsers, and addresses industry challenges and early adopters in the healthcare sector.

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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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