Archive for the ‘HL7 Standards’ Category

In the constellation of separate systems within a healthcare facility, it is common to have a single application which produces (HL7 ORU) Result/Report messages.  These ORU messages may correspond to Orders that originated with several different ordering facilities or ordering physicians.

In many instances, there is a need to send a different message structure to each of the systems which need the ORU messages.  The task of appropriately formatting and distributing the ORU messages is manageable with the flexibility and message processing power provided by an integration engine.

With a single inbound stream of ORU messages flowing to your integration engine, a method to route messages to the appropriate destinations is required.

If the ORU message contains a field to indicate which facility initiated the order, that field may be the only thing we need to use in order to route messages properly.  Another option is to route messages based on the field that contains the identity of the ordering physician (or “Ordering Provider”).  In this case, we are likely to benefit from the use of a lookup table, since there may be many ordering physicians associated with a given ordering facility. The technology used to implement the lookup table may vary, but the methodology would be consistent.

OrderingProviderID	OrderingProviderName	DestinationFacility
123	Smith, John  MD	Riverside
234	Jones, Mary  MD	Riverside
345	Johnson, Bill  MD	NorthSideClinic
456	Williams, Mike  MD	MemorialHospital
…	…	…

Our message processing logic would simply use the lookup table to find the DestinationFacility which corresponds to the OrderingProviderID presented in the ORU message (commonly populated in the OBR-16.1 field).  Using the example table above, an ORU message with an ordering provider of John Smith should be sent to Riverside.

An ordering physician may be associated with more than one ordering facility. In this case, a more robust routing method may be desired. We may want to send the Result message to all destination facilities that the ordering physician is associated with. This would require a slightly more complex lookup table and associated logic.

OrderingProviderID	OrderingProviderName	DestinationFacility
123	Smith, John  MD	Riverside
123	Smith, John MD	NorthSideClinic
345	Johnson, Bill  MD	NorthSideClinic
456	Williams, Mike  MD	MemorialHospital
…	…	…

In this case, our message processing logic would use the lookup table to find all rows that contain the OrderingProviderID and route the appropriately formatted message to each DestinationFacility. Using the example table above, a Result message with an ordering provider of John Smith should be sent to both Riverside and NorthSideClinic.

Something to keep in mind when using lookup tables such as the examples above is that the tables need to be maintained. A procedure to keep the lookup tables up-to-date should be put in place in order to ensure that message routing is accurate.

For more information and to see the original PDF, click here.

Social media, and twitter in particular, provides the unique opportunity to tune into the voices of leaders across the world for commentary on global events, trends and issues.

Each of the following twitter feeds are the voices of key individuals and organizations involved in the healthcare policy transformation, significant current events and the exciting debates defining the future of the healthcare industry. As social media leaders, they make up the foundation for the health IT information network on the Web and are shaping the future of health IT for all of those involved. Follow what these leaders are saying and join in on their conversations:

1. @HIMSS – HIMSS (or Healthcare Information and Management Systems Society) is a non-profit membership organization dedicated on “providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare.” @HIMSS currently has over 5,000 followers.
2. @HL7 – HL7 International (or Health Level 7) is an international not-for-profit organization, “ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.”
3. @HITECHActHelp – The HITECH Act and Meaningful Use guidelines have stirred up a significant amount of news recently, and most likely will continue to do so as the policies are implemented and enforced. @HITECHActHelp provides regular updates on this Act and how it affects those involved within the health IT industry.
4. @Histalk and @IngaHIStalk – HISTALK is an anonymous social media user who provides insight and opinion on current events in the industry. HISTALK, and his assistant Inga, regularly interview leaders in the industry, sponsor guest bloggers and tweet about current events. Although a self-proclaimed “cynic,” HIStalk provides a valuable perspective for those interested in HIT.
5. @kevinmd – Kevin Pho, M.D. holds an acclaimed social media presence within the healthcare community and has been recognized for his “punchy, prolific” healthcare insights by multiple major media outlets including The Wall Street Journal and The New York Times. @kevinmd provides daily commentary chronicling America’s healthcare system from a providers’ perspective.
6. @ahier – Brian Ahier is an active HIS thought leader in the healthcare community and currently has approximately 4,500 followers on twitter. He provides insights on health IT, healthcare reform and HITECH in addition to other broad technological advancements.
7. @SIIM_Tweets – SIIM (or The Society for Imaging Informatics in Medicine) is an organization dedicated to advancing the health IT industry through education and research. They are widely recognized within the healthcare IT and radiology industry for their SIIM Annual Meeting held each summer.
8. @ehrandhit – This twitter feed stems from the blog EMR and HIPAA that is dedicated to providing aggregated EMR, HER and HIT related content. @ehrandhit is recognized for providing information on health IT integration, HITECH and Meaningful Use.
9. @motorcycle_guy – Keith W. Boone is a thought leader on healthcare standards. He is the author of the Healthcare Standards blog that frequently reflects on current events in healthcare IT. Common topic threads are ARRA, CCD, HITECH, HL7 and healthcare integration.
10. @MedicalQuack – Barbara Duck, a healthcare IT consultant from Orange County, is a leading voice in the healthcare IT social media community. She is the author of one of the most popular health IT blogs online, The Medical Quack, and currently has over 3,000 followers on twitter.

Feel free to follow us on twitter @healthstandards for updates on HL7 standards and other health IT information, and Corepoint Health @corepointhealth for more information on interface engines and healthcare integration.

Who do you follow on twitter for news on healthcare IT?

HL7 International announced that a new implementation guide for ELINCS is now available. The new guide uses HL7 2.5.1 as the foundation instead of HL7 v2.4.

ELINCS stands for EHR-Lab Interoperability and Connectivity Standards, and it is a specification to refine (or constrain) “standard” HL7 messages to move lab results from labs to physician offices.

Key changes in the ELINCS HL7-R1 specification include:

• Shifts from HL7 v2.4 to HL7 v2.5.1
• Supports sending copies of lab results to other providers
• Supports a broader set of lab tests for which LOINC coding is required
• Outlines special rules for reporting the identifiers of ordered tests (depending on whether systems support unique identifiers for each test ordered on requisition)
• Supports the structured microbiology culture/sensitivity results

Outlined below are several great resources to learn more about the new ELINCS implementation guide:

• Change Summary: ELINCS v1.1 to HL7R1 Change Summary (PDF) – Delivered by the California HealthCare Foundation (CHCF).
• HL7 Press Release: HL7 Standards Are the Foundation and Enablers of Meaningful Use:  Version 2.5.1 Implementation Guide for Electronic Laboratory Reporting to Public Health Now Available; Several HL7 Standards Support Meaningful Use (PDF)
• White Paper: Accelerating EMR Interoperability with ELINCS provides a foundation to understand the role of ELINCS.

Each of the above resources are very helpful, especially the change summary. The HL7 press release is interesting to read since it also reviews how HL7 supports the new Meaningful Use requirements. It outlines HL7′s specific support for Stage 1 requirements. In the latter part of the press release, HL7 discusses how it plans to address the healthcare interoperability requirements and challenges identified by the ONC. If you are interested in healthcare standards, it is worth the time to review these resources.

If you need more information, there are several blog posts on HL7Standards.com on sending lab results to EMRs or EHRs. Feel free to search our site to learn more as well.

Recently, a poll was posted here asking, “Which HL7 version do you encounter the most in your interfacing projects?” Not surprisingly, the results offer some insight into the challenges awaiting greater HL7 v3 implementation. Ninety percent of respondents indicated they most encounter HL7 v2.x.

Below are the complete results:

• Version 2.3 – 36%
• Version 2.3.1 – 17%
• Version 2.4 – 12%
• Version 2.5 – 12%
• Version 3.0 – 10%
• Version 2.1 – 5%
• Version 2.2 – 5%
• Version 2.6 – 5%

As always, if you have a poll topic suggestion, please email them to us.

We are excited to introduce polling to www.hl7standards.com. You can participate and vote either on the home page or below the sponsor ads.

New polls will be added bi-monthly, and the results can be viewed after participating in the poll or clicking the “View Results” link at the bottom of the poll.

The current poll question, posted November 17,2009 is:

Which HL7 version do you encounter the most in your interfacing projects?

Vote now!

Please email us your ideas and feedback. We welcome any suggested poll topics or questions you would like to see in future posts.

National Quality Forum (NQF) joined with HL7, AHIMA and consulting firm Alschuler Associates to develop a draft standard called Health Quality Measure Format (HQMF).  To read more about HQMF, the following press release was issued by the HL7 organization -
Automating Performance Measurement Using Electronic Health Records (PDF).

The HL7 ballot for HQMF offers the following definition and structure outline:

“…is a standard for representing a health quality measure as an electronic document. A quality measure is a quantitative tool that provides an indication of an individual or organization’s performance in relation to a specified process or outcome via the measurement of an action, process or outcome of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base. Quality measures are also often referred to as performance measures or quality indicators.

Through standardization of a measure’s structure, metadata, definitions, and logic, the HQMF provides for quality measure consistency and unambiguous interpretation. A health quality measure encoded in the HQMF format is referred to as an “eMeasure”.

Standardization of document structure (e.g. sections), metadata (e.g. author, verifier), and definitions (e.g. “numerator”, “initial patient population”) enables a wide range of measures, currently existing in a variety of formats, to achieve at least a minimal level of consistency and readability, even if not fully machine processable.”

As is the case these days, one of the reasons for HQMF is to support “meaningful use” of electronic health records as described by the American Recovery and Reinvestment Act (ARRA). In the HL7 press release, the following explanation is offered:

“‘This work will make it easier for physicians and other clinicians to monitor and evaluate the care they are providing patients based on data routinely captured during care processes,’ said Floyd Eisenberg, NQF senior vice president of health information technology. ‘This new format standard will enhance the use of nationally-recognized performance measures at the point of care to enable greater transparency for providers and consumers.’”

HL7 is receiving comments on this new format and will make a determination if it ready to become a draft standards by December. Another article which outlines HQMF was recently in Modern Healthcare entitled Quality measure format could change EHR analysis.

The 23rd Annual Plenary and Working Group Meeting is next week in Atlanta, GA, September 20-25, 2009.

The HL7 organization describes a working group meeting as:

“HL7 Working Group Meetings are held three times per year at varying locations. These Working Group Meetings serve two important purposes:

1. They give the HL7 work groups a chance to meet face-to-face to work on the standards;
2. They provide an invaluable educational resource for the healthcare IT community.”

In addition to the working group meetings, there are many HL7 training sessions that will be occurring during the meeting. It is a great opportunity to interact with many other HL7 professionals.

The Continuity of Care Document (CCD) defines a detailed set of constraints, or templates, for CDA elements. Each template may have further supporting templates as required. The data contained in each of the templates is set by CCR.

Below is an overview of the templates (excludes supporting templates) and how they are used.

Header
Defines the type of document being created, who the document is regarding (patient, physician, author) and how the document relates to other existing documents (if applicable).

Purpose
States the reason the document was generated, but only if a specific purpose is known (i.e., a referral, transfer, or by request of the patient).

Problems
Provides a list of relevant clinical problems, both current and historical, that are present for the patient at the time the document was created.

Procedures
Provides a list of all relevant and notable procedures or treatments, both current and historical, for the patient.

Family history
Gives relevant family health information that may have an impact on the patient’s healthcare risk profile.

Social history
Describes the patient’s lifestyle, occupation, and environmental health risks plus patient demographics such as marital status, ethnicity and religion.

Payers
Provides payment and insurance data pertinent to billing and collection, plus any authorization information that might be required.

Advance directives
Includes information about wills, healthcare proxies and resuscitation wishes, including both patient instructions and references to external documents.

Alerts
Provides a list of allergies and adverse reactions that are relevant for current medical treatment.

Medications
Provides a list of current medications and relevant historical medication usage.

Immunizations
Gives information the patient’s current immunization status plus pertinent historical information about past immunizations.

Medical equipment
Provides a list of medical equipment and any implanted or external devices relevant to patient treatment.

Vital signs
Details information about vital signs for the time period including at a minimum the most recent vital signs, trends over time, and a baseline.

Functional stats
Details information about what is normal for the patient, deviations from the norm (both positive and negative) and extensive examples.

Results
Lists lab and procedure results, and at a minimum lists abnormal results or trends for the time period.

Encounters
Details relevant past healthcare encounters including the activity and location.

Plan of care
Lists active, incomplete or pending activities for the patient that are relevant for ongoing care – including orders, appointments, procedures, referrals and services.

For additional information on getting started with CCD, please read the post on the quick start guide provided by EHRVA.

Any “feed”, whether an ADT feed, ORU feed or ORM feed, is basically a streamlined way of getting messages. In the HL7 standards world, ADT, ORU (order messages) and ORM (results messages) are the most common HL7 messages. Of those three, ADT messages are the most commonly used.

ADT stand for “admissions, discharges, and transfers”. It basically means demographics; anytime you think of ADTs, think demographics: the patient’s name, the patient’s location in the hospital, his or her address, phone number, gender, etc.

There are many different types of ADT message types, such as:

• Registering a patient
• Discharging a patient
• Merging patient files to avoid duplication

An ADT feed is one way an application or a provider can get all that information from a clinic or hospital information system (HIS). With the constant updating of a client, customer or patient’s data, ADTs comprise the most HL7 messaging traffic. Change of address, addition of a middle name, and addition of next of kin are all examples of the type of data updates that make up ADT messages. Upon updating, this clinical data will then flow out to different places such as outpatient clinics or laboratories, dependent on who needs that information in their database.

Typically, a hospital registration database will have the master of the patient data and information. Each time patient information is updated, the updates will be pushed out in the form of an ADT message to the appropriate applications in facilities such as labs or clinics.

ADT feeds are usually received through either an interface engine or direct (point-to-point) interface.

In the case of an interface engine, clinical data can be provided to a variety of places. An export can be set up so there can be a one-on-one connection where, for example, a hospital registration system can establish a connection to a lab outside of the hospital. “Data dumps” are also possible, where one end of the application has all the files and the other doesn’t and through the connection, the patient data can all be transferred.

In summary, ADT feeds are the most common and high volume feed used. The updating of patient information eclipses the volume of order and result feeds. Having up-to-date patient information, though, is a critical component in streamlining and improving the continuity of patient care.

By now, you may have had enough of primaries and election results. What if, however, we applied the primary election process to healthcare standards? What would happen?

Just as there are factions the political candidates are trying to pull together to win, they probably have not seen as many factions as there are in healthcare standards. There is a major faction called the HL7 Standards, but emerging factions are getting noticed which are XML related – from Continuity of Care Record (CCR) to a faction-within-a faction, that is, HL7 V2, HL7 V3, HL7 Clinical Document Architecture (CDA), and HL7 Continuity of Care Document (CCD).

We don’t need new healthcare standards. We just need to enforce the ones we have.

What about the X12, DICOM, NCPDP, ASTM, LOINC, and SNOMED factions? And, let us not forget the common person’s healthcare standard – plain ol’ CSV file formats.

If the United States was going to eventually elect a healthcare standard to lead us in the 21st century, which one would win? All we need is a little harmony.

Harmony may be over-rated. How could someone from SNOMED endorse the LOINC? What do you mean CCR is campaigning with CCD? If these events happened, some people may just sit out the healthcare standards election.

What about the special interests? Each healthcare vendor has their own standard. Let’s hope that someone doesn’t “swift boat” one of the healthcare standard candidates.

The campaign slogans:  Healthcare standards are broken. We just don’t need to move the same standards to different chairs. We need to stand for change. We need hope! We need a healthcare standard ready to solve all of our problems Day 1!

Or, maybe what we need is another healthcare standard – a “third party” candidate – that can just end all of the “politics” and work for the people in health care. A “uniter” of healthcare standards. Some standard that can “reach across the aisle” and reach consensus.

Can’t we all just get along in the healthcare integration world?

Yes, this is a parody of sorts on healthcare standards, but it is the practical world that we live in. There are many standards, and we do all need to get along in order to deliver the best possible care for patients. Each healthcare standard faction delivers an essential piece in the healthcare puzzle, but putting the puzzle together can be challenging at times.

Maybe the final rallying cry should be:  “Read my lips. No new healthcare standards!”