1. 1 An HL7-Centric Immunization Registry Presented by Kevin Davidson QS Technologies

2. 2 The Information Exchange Problem  How can unlike systems understand each other?

3. 3 Enter HL7  An international standard for the exchange of health information  Designed for unlike systems to communicate through a standard format "HL7”, "Health Level Seven," and the puzzle design are registered trademarks, and the HL7 design is a trademark of Health Level Seven, Inc.

4. 4 Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Protocol

5. 5 MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03^V03|19970522M A53|T|2.3.1|||NE|AL| MSA|AA|19970522GA40| … PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^ ~430078856^^^^MA^||KENNEDY^JOHN^FITZGERALD^ JR^^^L|BOUVIER ^^^^^ ^M|19900607|M|KENNEDY^BABY BOY^^^^^^B|2106-3^WHITE^HL 70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSACODE^MA 034~345 ELM ST^^BOSTON^MA^00314^^BDL~^^^^^^BR^^MA002||(617) 555-1212^PRN^PH^^^617^5551212 … Actual HL7 Message  HL7 messages are not designed for humans, but machines like them Segmen t Field

6. 6 HL7 Message Types for Immunizations  VXQ – Query for Vaccination Record  VXX – Response with Multiple Matches  VXR – Response with Vaccination Record  VXU – Unsolicited Vaccination Update  QCK/ACK – Acknowledgments  ORU – Unsolicited Transmission of an Observation (used for VAERS)  ADT – Admit / Discharge / Transfer

7. 7 VXQ Message – Query for Vaccination Record Do you have any shots for Jimmy Smith?

8. 8 VXX – Response with multiple matches Jimmy Smith 1 Jimmy Smith 2 Jimmy Smith 3 Jimmy Smith 4 Jimmy Smith 5 Jimmy Smith 6

9. 9 VXR – Response with Vaccination Record  Patient demographics  Identifiers  Vaccination history  Adverse events  Contraindications  Recommendations for shots due

10. 10 VXU – Unsolicited Vaccination Update  Use to add new individual immunizations to the registry  Use for mass loading from other systems

11. 11 ORU – Unsolicited Transmission of an Observation (used for VAERS)

12. 12 ADT – Admit / Discharge / Transfer  ADT Messages can be used with legacy hospital and billing systems

13. 13 Coded Data in HL7 CVX NIP Codes OMB RaceMVX LOINC HL7 Codes Over 50 Code Sets

14. 14 An HL7-Centric Registry

15. 15 An HL7-Centric Registry

16. 16 Database  Problems with Legacy Databases  Do not provide ways to store all the possible information in an HL7 message  Data fields have to be used in ways not originally intended Database

17. 17 An HL7-Centric Registry

18. 18 Problems with Legacy Code Sets  Legacy Code Sets may not capture HL7 Coded Data completely.  Translation tables are hard to maintain.

19. 19 An HL7-Centric Registry

20. 20 Internal Messaging  Immunization messages – HL7  System Administration – HL7  Reporting – HL7

21. 21 The Need for Speed Relational Database Server One or Many HL7 Application Servers Web Server & Traffic Manager HTTPS HL7 LLP ADO Multi-tasking Scalable Lightweight Protocols

22. 22 An HL7-Centric Registry

23. 23 External Interfaces HL7 Pipe Web App Server SSL HTTPS Interface Email? ebXML? Batch (FTP) Internal System

24. 24 Benefits of an HL7-Centric Approach Best Practices Fewer Design Decisions Interoperability

25. 25 Good designs are easier to implement  Standards encourage completeness

26. 26 Good designs are easier to implement  Standards encourage completeness  Standards encourage modular design

27. 27 Good designs are easier to implement  Standards encourage completeness  Standards encourage modular design  Standards reduce false starts

28. 28 High-Level Design Decisions  Decide what HL7 Messages to Support  VXQ, VXR, VXX, VXU, ACK, QCK plus ORU

29. 29 High-Level Design Decisions  Decide what HL7 Messages to Support  VXQ, VXR, VXX, VXU, ACK, QCK plus ORU  Select HL7 Mapping Tool (or write one)  iNTERFACEWARE Chameleon

30. 30 High-Level Design Decisions  Decide what HL7 Messages to Support  VXQ, VXR, VXX, VXU, ACK, QCK plus ORU  Select HL7 Mapping Tool (or write one)  iNTERFACEWARE Chameleon  Select Development Tools

31. 31 High-Level Design Decisions  Decide what HL7 Messages to Support  VXQ, VXR, VXX, VXU, ACK, QCK plus ORU  Select HL7 Mapping Tool (or write one)  iNTERFACEWARE Chameleon  Select Development Tools  Select Client Technology  100% HTML for widest acceptance

32. 32 Open Issues  Transport Mechanisms

33. 33 Open Issues  Transport Mechanisms  Digital Signatures (PKI)

34. 34 Open Issues  Transport Mechanisms  Digital Signatures (PKI)  Deduplication Interface

35. 35 Open Issues  Transport Mechanisms  Digital Signatures (PKI)  Deduplication Interface  Query Improvement

36. 36 Open Issues  Transport Mechanisms  Digital Signatures (PKI)  Deduplication Interface  Query Improvement  Coordinating Business Rules between Registries – Minimal Data Quality

37. 37 Open Issues  Inventory Management

38. 38 Open Issues  Inventory Management  Synchronization and Mass Changes

39. 39 Open Issues  Inventory Management  Synchronization and Mass Changes  Data Representation Standards

40. 40 Conclusions  You can do everything you need to do using HL7  It performs well  It is scalable  Developers are productive

41. 41 Start With HL7  The project goes much better if you start with HL7 rather than trying to add it on at the end.

42. 42 Resources  National Immunization Program Registry Page  http://www.cdc.gov/nip/registry http://www.cdc.gov/nip/registry  Health Level Seven  http://www.hl7.org http://www.hl7.org  Committee on Immunization Standards and Electronic Transactions (CIRSET)  http://www.cirset.org http://www.cirset.org  QS Technologies Immunization Registry information  http://www.immregistry.com http://www.immregistry.com

43. 43 End of Presentation