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XML for HL7 v.2 Messages: A Bridge to Clinical Documents PHIN Conference Atlanta, August 2007 Nancy McQuillen, M.S., Data Architect California Department.

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Presentation on theme: "XML for HL7 v.2 Messages: A Bridge to Clinical Documents PHIN Conference Atlanta, August 2007 Nancy McQuillen, M.S., Data Architect California Department."— Presentation transcript:

1 XML for HL7 v.2 Messages: A Bridge to Clinical Documents PHIN Conference Atlanta, August 2007 Nancy McQuillen, M.S., Data Architect California Department of Public Health

2 PHIN 20072 Syntax (XML) as a Bridge to Enlightenment? -- Well, maybe not; but public health workers read documents more easily than HL7 messages. via XML ->

3 PHIN 20073 Whats wrong with these statements? Interface developers: Interface developers: We are planning to use either HL7 (version 2) or XML. Standards watchers: Standards watchers: HL7 is introducing XML-based messaging starting with their latest release - version 3.

4 PHIN 20074 Presentation Goals 1) Raise Awareness – of HL7s XML syntax option for version 2 messages, as a potential bridge to forms, documents, and XML-aware technologies (web-based data exchange). 2) Describe Use Cases – for XML in relation to forms and documents. 3) Show some steps (and tools) – for defining HL7 XML messages, and presenting them as forms or clinical documents.

5 PHIN 20075 Traditional ER7 Syntax vs. XML Syntax HL7 is primarily a semantic standard (defining data content of messages). The semantics can be cast into multiple syntaxes. HL7 is primarily a semantic standard (defining data content of messages). The semantics can be cast into multiple syntaxes. In addition to traditional encoding rules (ER7) for HL7 v.2.x, HL7 also publishes a syntax guide (an Implementable Technology Specification (ITS)) for the XML representation of HL7 v.2.3.1, v.2.4, v.2.5 messages (and beyond). HL7 Standard (Syntax specification #1) (Syntax specification #2) ER7XML Also called: Bar syntax Pipe-and-hat^ EDI-style Traditional

6 PHIN 20076 ER7 Syntax vs. XML Syntax ER7: XML: This translation example provided by: (COMPACT!) (REALLY LONG!) The HL7 XML schema structure follows the simple structure of the HL7 v.2 standard:

7 PHIN 20077 A Closer Look at One HL7 XML Segment (PID) (PID.5) (XPN) (Surname) (Given name) Complex HL7 datatypes such as Extended Person Name (XPN) have component parts (e.g. XPN.1 and XPN.2) expressed as subordinate XML elements. PID Segment Snippet:

8 PHIN 20078 Use Cases for HL7 v.2 XML Useful as an adjunct (not a replacement) for traditional ER7 syntax, if you need to: Useful as an adjunct (not a replacement) for traditional ER7 syntax, if you need to: 1)Convert messages - to other versions of HL7 (or to custom XML formats) using standard XML-aware tools, such as integration brokers and graphical mapping tools. 2)Present and/or persist message data – on forms and documents, using XML- aware standards (e.g. XForms) and technologies (e.g. Adobes XML architecture for.pdf fillable forms).

9 PHIN 20079 Confidential Morbidity Report (CMR) - XML-Based Adobe.pdf Fillable Form Example

10 PHIN 200710 Example Data Flow: Clinical Public Health Using Both Syntaxes (and Multiple HL7 Versions) Example Data Flow: Clinical Public Health Using Both Syntaxes (and Multiple HL7 Versions) Dream scenario, or someday soon? Dream scenario, or someday soon? Electronic Health Records Systems Public Health Jurisdictions Integration Broker Flat CMR 2.4 ER7 CMR 2.5 ER7 CMR EHR Case Extracts (CDA) Rendered, Faxed CMRs EHR Case Data Requests (CDA) CDA CMRs, Case Extracts CMR Form HL7 XML CMR (Adobe Prof. 8) 2007? 2008? 2009?

11 PHIN 200711 Steps to (Truly) Interoperable Messages PHIN Compliant Profiled: Sample Messages Constrain! XML (the general standard: an open slate) HL7 XML (specific schema applied) Profiled HL7 XML Message Vocabulary and OIDs Datatype (parts) Rules and constraints XML Tag Language (Semantics) XML Structure (Elements/Attributes) HL7 Segments, Fields, Repeats Constrain! Tools Used (examples): Text/XML editors XMLSpy HL7 MWB XSLT Schematron Validate! Message Validators SUCCESS!

12 PHIN 200712 Steps to Implement an HL7 v.2.5 XML Message Behind an Adobe.pdf Form Step/Task Tool Used 1.Discover (reverse engineer) PHIN 2.5 ORU_RO1 message structure HL7 Messaging Workbench (MWB) 2.A) Adapt (profile) the message as a CMR; and B) generate XML schema HL7 Messaging Workbench (MWB) 3.Bind the XML schema to data fields of a fillable CMR.pdf form Adobe LiveCycle Designer (Adobe Acrobat 8 Professional) 4.Create an XSLT transformation to add PHIN codes, OIDs, final details Altova MapForce 5.Attach the auto-generated XSLT transform to outbound.pdf CMR form Adobe LiveCycle Designer (Adobe Acrobat 8 Professional) 6.Validate the resulting PHIN-adapted CMR against profiled HL7 ORU_RO1 Altova XMLSpy

13 PHIN 200713 Step 1: Messaging Workbench - Parse structure of sample (CDC case notification) message

14 PHIN 200714 Step 2a: Messaging Workbench - Profile the CMR (Select segments, fields, etc.)

15 PHIN 200715 Step 2b: Messaging Workbench - (XML schema generated for the profiled CMR) Hint: Schema is multi-page and organized from bottom up – progressing from general (whole ORU_R01) to specifics (segments and datatypes).

16 PHIN 200716 Step 3: Adobe LiveCycle Designer – Bind the XML schema to data fields of fillable form e.g. Patient First Name (on form) is bound to PID.XPN.2 (in the attached XML schema).

17 PHIN 200717 Step 4: Altova Mapforce Add PHIN Codes, OIDs, Rules, via XSLT

18 PHIN 200718 Step 5: Adobe LiveCycle Designer: Attach the XSLT to Transform Outgoing Data Insert snapshot: Insert snapshot:

19 PHIN 200719 Step 6: XMLSpy (or Other Validators) View XML generated via Form Entry (+ XSLT)

20 PHIN 200720 Binding to an HL7 CDA Document An HL7 Clinical Document is an XML document! An HL7 Clinical Document is an XML document! Representing a human-readable documentRepresenting a human-readable document A CDA message is composed of two parts: A CDA message is composed of two parts: A header and a bodyA header and a body Designed for communication between two systems Designed for communication between two systems A valid variant of HL7 v3 - A valid variant of HL7 v3 - based on the HL7 Reference Information Model (RIM); CDA is an HL7 v3 standardbased on the HL7 Reference Information Model (RIM); CDA is an HL7 v3 standard

21 PHIN 200721 Structure of a CDA Document (an XML Instance) Confidential Morbidity Report Confidential Morbidity Report..........

Established diagnosis Established diagnosis …..................
Header Body Clinical Statement(s)

22 PHIN 200722 Example: Mapping HL7 2.5 Segments to an HL7 CDA Message Schema

23 PHIN 200723 Conclusions, Hypotheses 1) HL7 XML Syntax for v.2 Messages is Useful - to facilitate message conversions (e.g. v2 to HL7 v3 Clinical Document Architecture (CDA)), and to facilitate integration with other XML-aware forms and document architectures (e.g. XForms and Adobe.pdf forms). 2)Tools for manipulating XML and HL7 XML schemas are emerging - and can be used to help bridge messages with documents, enabling public health professionals to visualize message content, and to participate in PHIN-compliant form development and vocabulary review. = PHIN 2007PHIN 2008 and Beyond

24 PHIN 200724 Acknowledgements The author would like to thank the following persons and organizations who have contributed their time and thought leadership to the XML, Adobe, HL7, and PHIN technical content of this presentation. The author would like to thank the following persons and organizations who have contributed their time and thought leadership to the XML, Adobe, HL7, and PHIN technical content of this presentation. Dr. Mark Starr, NEDSS Principal Investigator, California Department of Public HealthDr. Mark Starr, NEDSS Principal Investigator, California Department of Public Health Linda Sandoval, NEDSS Surveillance Systems Coordinator, California Department of Public HealthLinda Sandoval, NEDSS Surveillance Systems Coordinator, California Department of Public Health Dr. Cecil Lynch, OntoReason LLC and UC Davis InformaticsDr. Cecil Lynch, OntoReason LLC and UC Davis Informatics Kai Heitmann, Paul Biron, and the entire (former) XML Special Interest Group (SIG) of HL7Kai Heitmann, Paul Biron, and the entire (former) XML Special Interest Group (SIG) of HL7 Bob Dolin, M.D. and Liora Alschuler, Co-chairs of HL7 Structured Documents Technical CommitteeBob Dolin, M.D. and Liora Alschuler, Co-chairs of HL7 Structured Documents Technical Committee CDC NCPHI PHIN technical support team and DISS XForms teamCDC NCPHI PHIN technical support team and DISS XForms team


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