HL7 Daniel C. Russler, M.D. HL7 Version 3-- the clinical model tutorial HL7 Version 3-- the clinical model tutorial VP Medical Director McKessonHBOC

HL7 Know the Market for Healthcare Standards uHIPAA Regulations Privacy & Security Privacy & Security Administrative--eligibility, claims submission Administrative--eligibility, claims submission Clinical--vocabulary, claims attachments Clinical--vocabulary, claims attachments uCost and Quality Improvement Needs Service line methodology Service line methodology - Condition management orientation - Risk Management Workflow management Workflow management - Increasing task volume - Preventing errors - Decreasing low-value procedures - Increasing high-value procedures

HL7 A Mega-use-case--- Modeling the Condition Enrollment Episode Begins Doctor's Office Specialist Diagnostic Testing Relative Health Health Certification Admission Surgery Discharge Rehab Follow-up Doctor's Visit Chest Pain r/o Angina Angina ASHDs/p CABG

HL7 Typical Service Line Task Force Organization Perinatal Task Force--Full-Term Delivery Cardiac Task Force--Congestive Heart Failure Orthopedics Task Force--Hip Replacement Pulmonary Task Force--Asthma Primary Care Task Force--Health Maintenance Other Task Forces Chief Medical Officer Chief Information Officer Chief Nursing Officer Medical Director Clinical Informatics Nursing Director Clinical Informatics IS Support Staff

HL7 HL7 Mission Statement uTo provide standards for the exchange, management and integration of data that support clinical patient care and the management, delivery and evaluation of healthcare services. Specifically, to create flexible, cost effective approaches, standards, guidelines, methodologies, and related services for interoperability between healthcare information systems.

HL7 Clinical Modeling Goals uStandards for data Integration Integration - Reference Information Model(RIM) Management Management - Vocabulary & rule version control Exchange Exchange - Message formats: Version 2.x; Version 3 uSupporting Clinical patient care Clinical patient care - Service management--workflow guidelines - Service delivery--context & relationship tracking - Service evaluation--cost & quality tracking

HL7 Version 3 Highlights u New message syntax--XML u Support for XML document transmission u Support for an explicit information model u Support for multiple published vocabularies u Support for composite datatypes u First model message drafts September, 1999

HL7 Alert Messages & Information Modeling Dog! HL7/CORBA/DCOM

HL7 Clinical Classes Modeling Assumptions u Healthcare is a series of service actions u Each action contributes to cost and quality u All actions have a context of: - Prior actions - Current actors, things, & contracts - Future goals u Each action consists of: - Action name - Action methodology - Action result values u Action descriptions will change over time and must be versioned

HL7 Explaining the RIM-- Context of an Action Service Event Action Name: When? Who? Whom? Why? Where? How?

HL7 Unified Modeling Language Action Hierarchy Service Event Relationship Action Name: Dates: Cost: Privacy Level: Action Values: Observation Unique Action Values: Procedure Unique Action Values: Condition node Unique Action Values: Goal Unique Action Values: Future classes Unique Action Values:

HL7 List-Link Collections Service Event List-Link Service Event Relationship Action Name: Dates: Cost: Privacy Level: Observation Action Value:

HL7 Conditional-Link Collections Service Event Conditional - Link Service Event Relationship Action Name: Dates: Cost: Privacy Level: Observation Action Value: Timeline CBC U/A X-Ray ?

HL7 Judgement Collections Service Event Judgement Service Event Relationship Action Name: Dates: Cost: Privacy Level: Observation Action Value: Timeline hasReason CBC U/A X-Ray Pay

HL7 Judgement Collections Service Event Judgement Service Event Relationship Action Name: Dates: Cost: Privacy Level: Observation Action Value: hasReason CBC U/A X-Ray Pay

HL7 Vocabulary Modeling Compromises Pre-coordination e.g. LOINC Composition(needs composition datatype) e.g. SNOMED Conceptual Graphs; Mayo Metaphrase Information Modeling Extreme-- Value = Present/ Not Present Vocabulary Modeling Extreme-- One Class/ One Attribute

HL7 Vocabulary Modeling Compromises Pre-coordination e.g. LOINC Composition(needs composition datatype) e.g. SNOMED Conceptual Graphs; Mayo Metaphrase DiabetesAsthmaCHF Value: Not Present Pneumonia Value: Any SNOMED Code Healthcare Thing

HL7 Vocabulary Modeling Compromises F-xxxxx = chest pain radiating to left arm (F-xxxx = pain(T-xxxx = chest) (F-xxxx = radiating to(T-xxxx = arm(M-xxxx = left)))) DiabetesAsthmaCHF Value: Not Present Pneumonia Value: Any SNOMED Code Healthcare Thing