1. Vancouver British Columbia Canada
Tutorial: Introduction to Health Level Seven International (HL7) Organization & Process
John Quinn
HL7 International CTO
Vancouver British Columbia Canada
May 13, 2012

2. Organization
May, 2012

3. HL7 International Is a Consensus Driven Standards Organization
May, 2012

4. Consensus Driven Standards
Are:
Volunteer-driven
Not a full-time commitment by most
Marked by uneven levels of participation
Participant developers have unequal levels of understanding
Balloted with required resolution of negative ballots
Therefore they are also prone to compromise which often leads to ambiguity
May, 2012

5. And growing 34 HL7 International Affiliates / Countries Argentina
Mexico
Romania
Puerto Rico
New Zealand
Pakistan
Norway
Australia
Russia
And growing
Luxembourg
Uruguay
Singapore
Austria
United States
Japan
South Korea
Spain
Bosnia & Herzegovina
Italy
United Kingdom
Sweden
There are also now about 37 countries that participate in HL7 through local affiliates accredited by HL7 International.
The Netherlands
Turkey
Canada
Taiwan
India 5
Columbia
Greece
Croatia
China
Czech Republic
France
Finland
Germany

6. Influencers & Drivers vs. Members
While Similar, Influencers and Drivers shape and move the organizations shape and move the organization from mostly the outside of the organizations
Members influence and change the organization from through the HL7’s procedures.
Both are important but both act on the organization in different ways.

7. Examples of Influencers & Drivers
Governments (US ONC, Canada Health Infoway, Australia’s NEHTA, UK CfH, …)
Vendors
International Affiliates
Clinical users
Consultants
American National Standards Institute (ANSI)
International Standards Organization (ISO)
Other Standards Developing Organizations
May, 2012 5

8. The Users Our current four major stakeholder-users (imho):
ONC/US Federal Health Architecture
CDA Community
Canada Health Infoway
NHS Connecting for Health (CfH)
HL7 V3 (or V2) is not being applied to any two stakeholders in the same way. No two of the stakeholders have the same problem-set or the same approach and use of HL7.
A manageable problem when integration is within an organization (intra-organizational)
Less manageable when integration is in a large copmplex organization
Large IDN
Reference Lab Network (e.g., Quest, LabCorp)
Unacceptable when organization is large geographic areas that have little formal healthcare organizational governance (e.g., countries, states, counties, etc.)
May, 2012

9. HL7 International Products
HL7 International has a number of major products. Example groups include:
Version 2.x
Version 3 Reference Information Based Products
Version 3 Messaging
Version 3 Clinical Document Architecture (CDA)
CDA Implementation Specifications or IGs (e.g., CCD)
Version 3 Services (near-term future)
Gello
Attachments
Structured Product Labeling
EHR-S & PHR-S Set of Standards
CCOW
Arden Syntax
May, 2012

10. The Use of HL7 Products
V3 products (e.g., messaging, CDA, SPL, etc.) are now much more widely used around the world than even a few years ago.
Users include governments and government funded entities (e.g., NHS, CHI, Turkey, Argentina, Uruguay, Columbia, US, etc.)
The exact forms of use varies as well:
messaging, electronic documents or services
the approach and methodology
processes automated and terminologies applied
May, 2012

11. What the Market Always Wants
Better and Faster:
Implementations
Conformance & Conformability testing
Computable Semantic Interoperability
Quality, Methodology & Tools
Support of Confidentiality/Security
Harmonization with other standards
Support of the latest communication technologies
Charlie has a great slide on The Semiotic Triangle: ‘How we exchange meaning’ wine and sharks might be good addition to illustrate complexity of third bullet.
May, 2012 18

12. HL7 International What It Is & How It Is Organized and the Processes that support it?
May, 2012

13. HL7 – Health Level Seven International
HL7 International is an ANSI accredited standards organization (ASO) for clinical & operational EDI.
Members include: user (hospital, physicians practices, physician group practices, academic faculty practice plans, health maintenance organizations (HMO), preferred provider organizations (PPO), independent practice affiliations (IPA), utilization review (UR) companies, fiscal intermediaries, third-party administrators (TPA), peer review organizations (PRO), insurers and payers, manufacturers (pharmaceuticals, medical devices, etc.), professional associations and societies, industry consortia, regulators, and government agencies.
There are also now 34 countries that participate in HL7
ISO’s Open Systems Interconnect (OSI) model:
Application Level” – level 7
May, 2012 26

14. What is HL7 International?
HL7 International is one of several American National Standards Institute (ANSI) accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions.
May, 2012

15. What is HL7 International?
HL7 International’s domain is clinical and administrative data.
Many of our Standards are also ISO TC-215 Standards.
ISO TC-215 both adopts specific HL7 International Standards and also works with HL7 International to jointly develop standards.
May, 2012

16. Where & Who is HL7 International?
Headquartered in Ann Arbor, MI, HL7 International is like many other SDOs in that it is a not-for-profit volunteer organization. HL7 International also has an office in Brussels, Belgium.
Its members (providers, vendors, payers, consultants, government groups and others who have an interest in the development and advancement of clinical and administrative standards for healthcare) develop HL7’s standards.
May, 2012

17. What is HL7 International?
Like all ANSI-accredited SDOs, HL7 International adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest.
A frequent misconception about HL7 International (and presumably about the other SDOs) is that it develops software. While some small amount of software is developed (e.g., tools), what we actually develop are standards specifications. Our most widely used standards specifications enable disparate healthcare IT applications to exchange keys sets of clinical and administrative data.
May, 2012

18. What is HL7 International?
Members of Health Level Seven International are known collectively as the “Working Group”, which is organized into individual work groups.
The work groups are directly responsible for the content of the our products.
Work groups can also serve as a source for exploring new areas that need to be covered by HL7 International’s published standards.
May, 2012

19. HL7 International’s Vision
To create the best and most widely used standards in healthcare.
May, 2012

20. The Most Helpful Single Piece of Information?
May, 2012

21. HL7 International’s Mission
HL7 International provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients. In all of our processes we exhibit timeliness, scientific rigor and technical expertise without compromising transparency, accountability, practicality, or our willingness to put the needs of our stakeholders first.
May, 2012

22. What is the Origination of the name HL7?
"Level Seven" refers to the highest level of the International Standards Organization (ISO) communications model for Open Systems Interconnection (OSI) (i.e., the Application Layer).
May, 2012

23. The OSI Model Physical Data Network Transport Session Presentation
HL7
Physical
Data
Network
Transport
Session
Presentation
Application
Logical Connection
Physical
Data
Network
Transport
Session
Presentation
Application 7
Logical Connection 6
Logical Connection
Logical Connection 5
Logical Connection 4
Logical Connection 3
Logical Connection 2
Physical Connection 1
Application 1
Application 2
May, 2012

24. HL7 Subject Domains ADT Adverse event reporting Order entry
Result reporting
Clinical Guidelines
Clinical Observations
Scheduling
Patient care
Immunizations
Discharge summaries
Adverse event reporting
Automated waveforms
Medical transcriptions
Referrals
Consultations
Clinical trials
Nursing care plans
Data Warehousing
One of the comments from FTA was to illustrate relationship of domains and standards…maybe that’s a separate handout, or explain how top of domain documents steward workgroups
… And Growing …
May, 2012

25. HL7 Subject Domains … And Growing … SGML, (now XML) Vocabulary
Certification
Conformance
Security transactions
Claims attachment
Accountability, Quality, Assurance
Blood Bank
Personnel Management
Arden Syntax
Component Based Messaging (i.e., Java)
Visual/Context Integration
Government Projects
Master Patient Index
SOA
Image Management
… And Growing …
May, 2012

26. HL7 International’s Work Groups*
HL7 Work Groups:
Affiliate Due Diligence
Anatomic Pathology
Architecture Board
Arden Syntax
Attachments
Child Health
Clinical Context Object Workgroup (CCOW)
Clinical Decision Support
Clinical Genomics
Clinical Interoperability Council
Clinical Statement
Community Based Collaborative Care
Conformance and Guidance for Implementation and Testing
Education
Electronic Health Record
Electronic Services
Emergency Care
Financial Management
(18)
Generation of Anesthesia Standards
Governance and Operations
Government Projects
Health Care Devices
Imaging Integration
Implementable Technology Specifications
Implementation / Conformance
Infrastructure and Messaging
International Council
International Mentoring
Marketing
Mobile Health
Modeling and Methodology
Nomination Committee
Orders and Observations
Organizational Relations
Outreach Committee for Clinical Research
Patient Administration
Patient Care
(21)
Patient Safety
Pharmacy
Policy Advisory
Process Improvement
Project Services
Public Health and Emergency Response
Publishing
Recognition and Awards
Regulated Clinical Research Information Management (RCRIM)
RIM Based Application Architecture
Security
Services Oriented Architecture
Strategic Initiative Committee
Structured Documents
Templates
Tooling
Vocabulary
(17)
Updated: 05/12
*includes Board Appointed Committees / Work Groups
May, 2012

27. HL7 International’s Organization
May, 2012

28. TSC Structure Technical Steering Committee -
6 elected voting representatives, 4 appointed voting members
TSC-elects their Chair; CTO is ex-officio co-chair
Foundation & Technologies Steering Division
9 existing workgroups
2 Elected SD Co-Chairs plus Co-Chairs of workgroups in SD
Structure & Semantic Design Steering Division
11 existing workgroups
Domain Experts Steering Division
16 existing workgroups
Technical & Support Services Steering Division
6 existing workgroups
May, 2012

29. TSC – Mission
HL7 International’s Technical Steering Committee’s Mission
This group supports the HL7 International mission to create and promote its standards by:
Overseeing and coordinating the technical efforts contributed by the HL7 International participants, who make up the HL7 International Working Group, and assuring that the efforts of the Working Group are focused on the overall HL7 mission.
The Technical Steering Committee and the HL7 International Working Group operate in such a way so as to:
Respect the contributions and ideas of the talented individuals who make up the Working Group;
Maintain an effective focus on the goals of HL7 International;
Assure that the all major decisions are based on consensus of the stakeholders;
Maximize sharing and "re-use" of work products between elements of the Working Group;
Use project management to assure that project goals are articulated and met;
Reduce competition and conflict between the elements of the Working Group; and
Assure that HL7 International Standards are developed on a solid architectural foundation that assures consistency and interoperability.
May, 2012

30. Steering Divisions
Foundation & Technologies Provides fundamental tools and building blocks
Conformance
Infrastructure & Messaging
Implementable Technology Specifications (ITS)
Java
Modeling & Methodology
Security
Service Oriented Architecture (SOA)
Templates
Vocabulary
May, 2012

31. Steering Divisions (con’t)
Structure & Semantic Design Steering Division Focuses on creation of basic patterns and common messages that could exist on their own, but are mostly used by others:
Arden Syntax
Clinical Context Object Workgroup (CCOW)
Clinical Decision Support
Electronic Health Record (EHR)
Financial Management
Imaging Integration
Orders & Observations
Patient Administration
Personnel Management
Scheduling & Logistics
Structured Documents
May, 2012

32. Steering Divisions (con’t)
Domain Experts Steering Division Focuses on creation of messages, services, documents using many of the common structures in place
Anatomic Pathology
Anesthesiology
Attachments
Cardiology
Clinical Genomics
Clinical Guidelines
Community Based Health Services
Emergency Care
Government Projects
Health Care Devices
Laboratory
Patient Care
Patient Safety
Pediatrics Data Standards
Public Health Emergency Response (PHER)
Pharmacy
Regulated Clinical Research Information Management (RCRIM)
May, 2012

33. Steering Divisions (con’t)
Technical & Support Services Steering Division
The primary feature of these work groups is to support the Technical Steering Committee and work groups of the Working Group.
Education
Electronic Services
Implementation
Marketing Committee
Process Improvement Committee (PIC)
Project Services -- a new group that will take responsibility for the Project Life Cycle and will serve as the primary support for the PMO
Publishing
Tooling
May, 2012

34. U.S. Realm Health Messaging Standards Development Efforts
HL7 International (Health Level 7)
ACR/NEMA (DICOM) (American College of Radiologists / National Electrical Manufacturers Association) (Digital Image Communications)
ADA (American Dental Association)
ASTM (E31) ASTM International
(was American Society of Testing Materials)
CORE CAQH (Operating Rules for information exchange of healthcare administrative data) –i.e., real-time exchange of billing and administrative data
IEEE (Institute of Electrical and Electronic Engineers)
NCPDP (National Council of Prescription Drug Producers)
OASIS (International First Responder (e.g., ambulance)
X12N (Insurance workgroup of X12 including payment and administrative billing and reimbursement transactions)
US TAG to ISO TC 215
(ISO Medical Informatics Standards. The US TAG is held by ANSI)
ANSI (American National Standards Institute)
May, 2012 25

35. Other Countries / HL7 Affiliates
TC 215
Other Countries / HL7 Affiliates
Remove the arrow from HL7 straight to TC 215…doesn’t it have to go through ANSI (comment from Jan 06 mtg)
TC 251
May, 2012

36. History of HL7 (Through 2009)
Version 1.0 Published
Implementation Support Guide published
Version 2.2 Published
Version 2.2 ANSI
Version Published and ANSI
PRA (CDA 1.0)
Version 2.0 Published
Arden Syntax 2.0
Charter member of ANSI HISPP
2.4
2.5
First Meeting Hospital University of PA
Version 2.3 Published and ANSI
Version 3.0 1st published
Version 2.1 Published
CCOW
Reorganizes Hires CEO & CTO & starts work on SAIF
First work on SOA (Services) w/HSSP
V2.6 Published
V2.7 Published
May, 2012

37. HL7 International Process Meetings, Ballots & Life Cycle
May, 2012

38. HL7 International Meetings
Working Group Meetings occur three times a year.
September meeting is designated a “plenary” meeting.
Monday AM is a special program dedicated to business and reporting state of the organization.
Most (if not all) HL7 International work groups have face-to-face meetings during a working group meeting.
May, 2012

39. HL7 International Meetings
Workgroups set agendas for the “next” meeting at the end of the last meeting.
Agenda usually progresses work with time allocated to:
Version 2
Version 3
Joint meetings with related work groups
Current ballots normally take priority.
May, 2012

40. HL7 International Meetings
Work Groups have defined decision making processes that specify how they run meetings, debate and vote on issues discussed in a meetings.
HL7 International Process Improvement Committee (PIC) has default template procedures
May, 2012

41. HL7 International Meetings
Work Groups can customize their decision making processes. However:
PIC guidelines constrain the framework.
HL7 International’s By-Laws and Policy and Procedures take precedence
Default conduct is Robert’s Rules of Order.
May, 2012

42. Ballots
The end product of a ballot process is a document. The document could stand on its own. However, most balloted documents are a part of a published Standards Document (e.g., HL7 2.6, HL7 3.0, etc.)
May, 2012

43. Ballots Documents can be: Informative Draft Document for Comment Only
An Informative Document is the product of a Work Group that is not currently deemed normative, but nonetheless is intended for general publication. It explains or supports the structure of the HL7 Protocol Specifications, or provides detailed information regarding the interpretation or implementation of an HL7 Protocol Specification. The TSC shall approve the issuance of an informative document ballot.
Draft Document for Comment Only
A Work Group, with the concurrence of the TSC, may submit proposed content or requirements documents, such as a Domain Analysis Model (DAM), to comment-only review. The intent is to gather input from members outside of the Work Group on the viability and clarity of the proposed content or requirements document. The review of proposed content or requirements documents does not seek a vote, per se, but will capture all comments.
May, 2012

44. Ballots Draft Standards for Trial Use (DSTU) Normative Standard
Content is balloted by the general membership as the draft of a future standard which will, following a pre-specified period of evaluation and comment (usually 2 years), be expeditiously incorporated into normative standard. DSTU’s require at least two verified implementations that demonstrate the standard’s use.
Normative Standard
Content is balloted by the general membership and is considered a structural component of the HL7 Standard. Negative ballots must be resolved. Normative Standards are typically registered with ANSI.
May, 2012

45. Ballots
Ballots normally progress through two or more cycles of ballots.
Ballot pool is limited to declared interested members
Negative votes must be accompanied with a specific reason justifying the negative vote.
Affirmative w/edit change; Abstention with comment.
ALL HL7 Balloted Standards are introduced first as a DSTU and must show some successful implementations before being advanced as a Normative Standard.
May, 2012

46. Ballots Work Groups must resolve negative votes:
Accept the voters comment and recommended solution.
Negotiate with the voter and get them to agree to withdraw their negative.
Declare the vote non-persuasive.
Voters may appeal to the TSC and Board. They can also re-vote their same negative vote on the next round of balloting.
Substantive changes to a ballot (either to fix a negative or add new material) merit another round of balloting.
May, 2012

47. Ballots
When 90% (for normative documents) of the responses are registered as affirmatives…and hopefully all negatives withdrawn, a document is ready for publication as an HL7 International Standard.
May, 2012

48. HL7 Products and Projects
Project Lifecycle relies on the concept of HL7 International Products.
Examples:
Product Brand
Messaging, Arden Syntax, CCOW, CDA, XML,….
Version
V2, V3, R1, R2, R3, …
Multiple projects may be required to create viable ‘product’
May, 2012

49. HL7 Project Criteria Be consistent with HL7 strategic direction
Include appropriate project documentation - project charter, scope, resources, timelines, assumptions, constraints, planned deliverables, etc. per PMO methodology
Be aligned with market demand
Be sponsored by stakeholders intending to implement the product produced by the project
Define a reasonable balloting strategy to meet market demand and implementation timelines
Define how the project will engage with other impacted work groups
Follow project approval protocols to ensure appropriate project socialization and sign-off has taken place
May, 2012

50. HL7 Project Life Cycle for Product Development
Request to Sunset Product
HL7 Protocol Specifications (.1)
Request to enhance or create product
Request Approved (.2)
Cancel or Withdraw (.3) No
Yes
Sunset Product
(.4)
Project Initiation (.5)
QVSD
Move Forward (.6)
Requirements Analysis (.7)
Logical Design (.8)
Draft Specification (.9)
Ballot Type (.11)
Review
Normative
DSTU (.12)
Informative Document Ballot (.19)
Specification and Training (.14)
Industry Use (.15)
Go Normative (.20)
Seek Comments (.10)
Finalize Specification (.16)
Normative Ballot (.17)
Comment Only Ballot
Training Materials Implementation Guides Publish Standard (.21)
COMPLETE
END
DSTU Ballot (.13)
Pass (.18)
START
May, 2012

51. HL7 International Version 2.x
May, 2012

52. HL7 International Version 2.x
First widely used version 2.1 published in 1991
Used in 90%+ provider organizations in the US and widely supported by vendors.
Generally requires bi-lateral negotiations between communicating parties.
Backwards-fitted (imperfectly to HL7 International Reference Information Model (RIM))
Not well normalized.
Segments & Data Elements moved to a single location (Chapter 2) only in 2.5 in 2003.
Makes no formal attempt to define process
Most implementations are a mix of versions ranging from 2.1 to 2.3 (even though current version is 2.7)
May, 2012

53. May, 2012

54. Version 2.7 Chapters* Introduction Patient Care
Control / Data Types / Conformance & Code Tables
Patient Administration
Orders
Queries
Financial Management
Observations
Master Files
Medical Records / Information Mgmt
Scheduling
Patient Referral
Patient Care
Clinical Laboratory Automation
Application Management
Personnel Management
Non-US eClaims (new to 2.6)
Materials Mgmt. (new to 2.6)
Appendices:
Data Definition Tables
Lower Layer Protocol
BNF Definitions
Glossary
Index
2.7 is available on the HL7 “Standards” section of the HL7 web site. CDs are also available.
May, 2012

55. HL7 International Version 3
May, 2012

56. Some HL7 International Version 3 Terms
Use-case Models
Reference Information Model (RIM)
Domain Message Information Model (DMIM)
Refined Message Information Model (RMIM)
Message Implementation Manual (MIM-UK term for spec)
Message Object Diagram
Hierarchical Message Description (HMD)
Common Message Element Types (CMET)
May, 2012

57. HL7 International Version 3
First approved for publication and pro-motion to ANSI as an HL7 Standard in September, 2004.
Current Version: 2010 Published July 2010
Comment on this slide at May 2006 WGM colors may be readable for colorblind, e.g. may not conform to 508 disabilities act (US Realm); I have forwarded this to Publishing.
May, 2012

58. HL7 International Version 3
May, 2012

59. HL7 International Version 3
May, 2012

60. Appendices
Acronyms
Glossary
May, 2012

61. Some Acronyms* ADA American Dental Association
ACR American College of Radiology
AHA American Hospital Association
AHIC American Health Information Community (an advisory board within DHHS)
AHIMA American Healthcare Information Management Association
AHRQ Agency for Health Research and Quality
AMA American Medical Association
AMIA American Medical Informatics Association
ANA American Nursing Association
ANSI American National Standards Institute
ASC X12 Accredited Standards Committee X12 – for business transactions
ASC X12N Accredited Standards Committee X12N – for insurance and reimbursement data interchange
ASC Z80 Accredited Standards Committee Z80 – for Optometry
ASN.1 Abstract Syntax Notation One
ASTM American Society for Testing and Machinery—A US based SDO
CAP College of American Pathologists
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

62. Some Acronyms*
CCHIT Certification Commission for Health Information Technology
CCOW HL7 Clinical Context Object Workgroup (now Clinical Context Management)
CDC Centers for Disease Control and Prevention
CEN Comité Européen de Normalisation (EU Standards Body)
CENELEC European ` for Electrotechnical Standardization
CHIA Canadian Health Informatics Association
CIHI Canadian Institution for Health Information
CMA Context Management Architecture
CMET HL7 Common Message Element Type—reusable message components such as data types
CMS DHHS Centers for Medicare and Medicaid Services (was HCFA)
COM Component Object Model
CORBA Common Object Request Broker Architecture
CorbaMed OMG group working on health related projects
CPRI Computer-based Patient Record Institute
CPT Common Procedural Terminology. A systematic listing and coding of procedures and services performed by physicians. A five-digit code with modifiers, used for Billing Owned & maintained by AMA.
CTS HL7 Common Terminology Services
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

63. Some Acronyms* DAM HL7 Domain Analysis Model (see HL7 HDF)
DCOM Distributed Component Object Model
DES Data Encryption Standard
DHHS Department of Health and Human Services
DICOM Digital Imaging and Communications in Medicine. Standard for transferring images. Owned by ACR
DIM Domain Information Model
DIN German standards organization
DISA Data Interchange Standards Organization. The secretariat for ASC X12.
DMIM Domain Message Information Model
DOD Department of Defense
DRG Diagnostic Related Group
DSM-IV Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Assoc.
EPA Environmental Protection Agency. Has data registry.
EU European Union
EWG UN/EDIFACT Working Group
FDA Food and Drug Administration
FDIS ISO Final Draft International Standard
GEHR Good European Health Record
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

64. Some Acronyms* HCFA Health Care Financing Administration (now CMS)
HCPCS HCFA Procedure Coding System
HDF HL7 Healthcare Development Framework
HEDIS Health Employers Data and Information Set
HHCC Home Health Care Classification. Virginia Saba’s code set for home care.
HHS Health and Human Services (sometimes used instead of DHHS)
HIBCC Health Industry Business Communications Council
HIMA Health Industry Manufacturers Association
HIMSS Healthcare Information and Management Systems Society (a trade group)
HIPAA Health Insurance Portability and Accountability Act of 1996
HIT Health Information Technology
HITSP Healthcare Information Technology Standards Panel (owned and organized under ANSI
HL7 Health Level Seven International
HMD HL7 Hierarchical Message Definition
HMO Health Maintenance Organization
HOST Healthcare Open Systems and Trials
HPCC High Performance Communications and Computing
HTML Hyper-Text Markup Language
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

65. Some Acronyms* ICD International Classification of Disease
ICD9 Diagnostic and procedure codes, current version in the US is ICD9-CM
ICD9-CM ICD9 with Clinical Modification
ICD10 Latest version of ICD implemented in most countries
IDL Interface Definition Language
ICNP International Classification for Nursing Practice
IEC International Electrotechnical Commission
IEEE Institute of Electronic and Electrical Engineers
IETF Internet Engineering Task Force
IHS Indian Health Service
IMIA International Medical Informatics Association
IOM Institute of Medicine
ISSB Information Systems Standards Board
ISO International Standards Organization (part of the UN in Geneva Switzerland)
ITSEC Information Technology Security Evaluation Criteria
ITU International Telecommunication Union
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

66. Some Acronyms* JAHIS Japanese Association for Medical Informatics
JCAHO Joint Commission on Accreditation of Healthcare Organizations
JIRA Japan Industries Association of Radiation Apparatus
LOINC Logical Observations, Identifiers, Names and Codes
MDF Message Development Framework
MEDCIN Nomenclature for healthcare. Produced by Medicomp.
MEDINFO World Medical Informatics Conference; every 3 years; sponsored by IMIA.
MEDIX Medical Data Interchange Standard (IEEE)[P1157]
MEDRA Medical Dictionary for Drug Regulatory Affairs
MeSH Medical Subject Heading
MGMA Medical Group Management Association
MIB Medical Informatics Bus (IEEE)
MOU Memorandum Of Understanding
MPI Master Patient Index or Master Person Index
MPL Master Patient (Person) Locator
MSHUG Microsoft Healthcare User Group
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

67. Some Acronyms* NANDA North American Nursing Diagnoses Association
NCHS National Center for Health Statistics
NCCLS National Committee for Clinical Laboratory Standards
NCPDP National Council for Prescription Drug Programs
NCVHS National Committee for Vital and Health Statistics
NDC National Drug Codes. Produced by the FDA.
NEMA National Electrical Manufacturers Association
NHS National Health Service – UK
NHS CT National Health Service Clinical Terms (formerly Read Codes)
NIC Nursing Intervention Classification
NILT Nursing Intervention Lexicon and Taxonomy
NIST National Institute of Standards and Technology
NLM National Library of Medicine
NOC Nursing Outcomes Classification
NPRM Notice of Proposed Rule Making
NUBC National Uniform Billing Committee
NUCC National Uniform Claims Committee
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

68. Some Acronyms* OMAHA System Nursing Codes OMG Object Management Group
ORB Object Request Broker
PACS Picture Archiving and Communication System
PCDS Patient Care Data Set. Judy Ozbolt, Vanderbilt.
PHS Public Health Service
PRA Patient Record Architecture
PSRO Professional Standards Review Organization
READ Classification System: Clinical codes with a bias for primary care. Now part of NHS SNOMED CT.
RIM Reference Information Model
RMIM Refined Message Information Model
RSA Algorithm for encrypting / decrypting data. Developed by Ronald Rivest, Adi Shamir, and Leonard Adleman
RSNA Radiological Society of North America
SCAR Society for Computer Applications in Radiology
SDO Standards Development Organization
SGML Standard Generalized Markup Language
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

69. Some Acronyms* SCAR Society for Computer Applications in Radiology
SDO Standards Development Organization
SGML Structured Graphical Markup Language
SNOMED RT Systematized Nomenclature of Medicine Reference Terminology
SNOP Systematized Nomenclature of Pathology
SQL Structured Query Language
TC 215 ISO Technical Committee 215 – Healthcare Information
TC 215 WG1 Working Group 1: Modeling Coordination and Health Records
TC 215 WG2 Working Group 2: Messaging and Communications
TC 215 WG3 Working Group 3: Health Concept Representation
TC 215 WG4 Working Group 4: Security
TC 215 WG5 Working Group 5: Health Cards
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

70. Some Acronyms* TC 251 CEN Technical Committee for Medical Informatics
TC 251 WG1 Healthcare Information Modeling and Medical Records
TC 251 WG2 Healthcare Terminology, Semantics and Knowledge Bases
TC 251 WG3 Healthcare Communications and Messages
TC 251 WG4 Medical Imaging and Multimedia
TC 251 WG5 Communication with Medical Devices
TC 251 WG6 Healthcare Security, Privacy, Quality and Safety
TC 251 WG8 Intermittently Connected Devices (including Cards)
TCP/IP Transmission Control Protocol/Internet Protocol
Terminfo An HL7 International General Approach to resolving issues related to the interface between HL7 International Information Model and terminologies or code systems
TR ISO Technical Report
TS ISO Technical Specification
UCC Uniform Code Council
UCDS Uniform Clinical Data System
UMDNS Universal Medical Device Nomenclature System
UML Unified Modeling Language
UMLS Unified Medical Language System
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

71. Some Acronyms*
UN/EDIFACT United Nations Electronic Data Interchange For Administration, Commerce and Transport
UNIX Open Systems Operating system
UPC Universal Product Code. From UCC.
URL Universal Resource Locator (e.g.,
USHIK US Health Information Knowledgebase; Data Registry
US/TAG United States Technical Advisory Committee
VA Veterans Administration
WEDI Workgroup on Electronic Data Interchange
WHO World Health Organization
WS-I Web Services Interoperability Organization
www World Wide Web
W3C World Wide Web Consortium. Definers of HTML & XML among other things
XML Extensible Markup Language
* Courtesy of Ed Hammond, PhD 1999, with some updates from John Quinn, 2007
May, 2012

72. HL7 V 2.7 Glossary
May, 2012

73. HL7 V3 Glossary
May, 2012

74. HL7 Healthcare Development Framework (HDF)
May, 2012

75. Note, this web site requires registration but no fee.
ISO TC 215 Joint Initiative for Global Standards Harmonization Health Informatics Document Registry and Glossary
Note, this web site requires registration but no fee.
If you have interest, you can use this link to obtain a username & password and then access to the above ISO Document Registry and Glossary.
May, 2012

76. Glossary
Here are some definitions of organizations that have been mentioned in this presentation.
American National Standards Institute (ANSI) :
The Institute oversees the creation, promulgation and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: ANSI is also actively engaged in accrediting programs that assess conformance to standards – including globally-recognized cross-sector programs such as the ISO 9000 (quality) and ISO (environmental) management systems.
Standards Development Organizations (SDOs)—not healthcare specific :
Any organization whose primary activities are developing, coordinating, promulgating, revising, amending, reissuing, interpreting, or otherwise maintaining technical standards that address the interests of a wide base of users outside the standard-developing organization*.
*wikipedia

77. Glossary
ONC
The Office of the National Coordinator for Health Information Technology is an organization in the US Department of Health and Human Services reporting to the DHHS Secretary. ONC is designated in several laws by the US Congress to distribute funds and manage initiatives to meet requirements for the development, deployment and use of health information technology by providers, and public health agencies through inducement of financial incentives and, eventually, financial penalties.
International Standards Organization (ISO) Technical Committee (TC) 215 (Health Informatics):
ISO is an organization of the United Nations headquartered in Switzerland. Its governance structure is similar to the UN’s where each country has one vote. The secretariat for ISO TC 215 is held by the American National Standards Institute (ANSI).
ITC 215’s domain of work is standardization in the field of information for health, and Health Information and Communications Technology (ICT) to promote interoperability between independent systems, to enable compatibility and consistency for health information and data, as well as to reduce duplication of effort and redundancies.
The domain of ICT for health includes but is not limited to:
Healthcare delivery;
Disease prevention and wellness promotion;
Public health and surveillance;
Clinical research related to health service.

78. EU’s CEN (Comité Européen de Normalisation) TC251
Glossary
EU’s CEN (Comité Européen de Normalisation) TC251
(CEN Technical Committee 251) is a workgroup within the European Union working on standardization in the field of Health Information and Communications Technology (ICT) in the European Union. The goal is to achieve compatibility and interoperability between independent systems and to enable modularity in Electronic Health Records systems.
Workgroups establish requirements for health information structure in order to support clinical and administrative procedures, technical methods to support interoperable systems. In addition they establish requirements regarding safety, security and quality.*
*wikipedia