HL7 Version 3 at NCICB Overview

HL7 Version 3 at NCICB Overview
Session Details Introduction Reference Information Model (RIM) HL7 Modeling Conventions HL7 Process & Artifacts, Vocabulary & Data Types HL7 Version 3 at NCI Web Resources

Session Details Target Audience: Developers and Analysts Adopters
Prerequisites: Modeling concepts

Session Details: Presenters and Participants
<Presenter’s name here> Who is in attendance? Name Title Cancer Center Reason for Attending Instructor: Introduce yourself The notes provide you with additional information on slide topic. Note: This training can also be used as a self-paced training. (See notes for each slide)

Session Details: Training Objectives
Objectives of this training are to: Provide an overview of HL7 version 3 Define terms and concepts used in HL7 Describe the HL7 modeling methodology Introduce reason for HL7 version 3 at NCICB At the end of this training you should: Understand what HL7 is Define terms and concepts used in HL7 Read HL7 RIM based models HL7 at the NCI

Introduction In this section, we will:
Introduce the HL7 organization and the version 3 standard Discuss the goal of HL7 In this section, we will: Goal of HL7 4 Pillars of semantic interoperability

Introduction: What is HL7?
Heath Level Seven (HL7) is an ANSI-accredited Standards Developing Organization (SDO) operating in healthcare arena Provides standards for data exchange to allow interoperability between healthcare information systems HL7 focuses on the clinical and administrative data domains It is a not-for-profit organization made up of volunteers – providers, payers, vendors, government Key goal is syntactic and semantic interoperability The goal of HL7 is HL7 V3 is a standard for exchanging messages among information systems that implement healthcare applications. To accomplish this, HL7 uses an object-oriented development methodology and is based on a Reference Information Model (RIM) to create messages. The goal of HL7 is semantic interoperability. What Does the Name HL7 Mean "Level Seven" refers to the highest level of the International Standards Organization's (ISO) communications model for Open Systems Interconnection (OSI) - the application level. The application level addresses definition of the data to be exchanged, the timing of the interchange, and the communication of certain errors to the application. The seventh level supports such functions as security checks, participant identification, availability checks, exchange mechanism negotiations and, most importantly, data exchange structuring. How is HL7 Organized HL7 is managed by a Board of Directors, which is comprised of eight elected positions and three appointed positions. The organization is comprised of Technical Committees and Special Interest Groups that are responsible for defining the HL7 standard protocol. Each Technical Committee and Special Interest group is chaired by two or more co-chairs. Collectively, the co-chairs comprise the Technical Steering Committee, which votes on issues related to the standard. Votes of the Technical Steering Committee as passed as recommendations to the Board of Directors, who make the final decision. HL7 members are encouraged to participate in all of these committees.

Introduction: 4 Pillars of Semantic Interoperability
The 4 pillars of semantic interoperability are: A common Reference Information Model (RIM) spanning the entire clinical, administrative and financial healthcare universe A well-defined and tool-supported process for deriving data exchange specifications ("messages") from the RIM A formal and robust Data Type Specification upon which to ground the RIM A formal methodology for binding concept-based terminologies to RIM attributes. The 4 Pillars: The following slides will discuss these pillars. The Reference Information Model (RIM) The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process. An object model created as part of the Version 3 methodology, the RIM is a large pictorial representation of the clinical data (domains) and identifies the life cycle of events that a message or groups of related messages will carry. It is a shared model between all the domains and as such is the model from which all domains create their messages. Explicitly representing the connections that exist between the information carried in the fields of HL7 messages, the RIM is essential to our ongoing mission of increasing precision and reducing implementation costs. Data Types Data types are the basic building blocks of attributes. They define the structural format of the data carried in the attribute and influence the set of allowable values an attribute may assume. Some data types have very little intrinsic semantic content and the semantic context for that data type is carried by its corresponding attribute. However HL7 also defines quite extensive data types such as PNMP, person Name Part, which provides all the structure and semantics to support a person name. Every attribute in the RIM is associated with one and only one data type, and each data type is associated with zero or many attributes. Data Exchange Specifications HL7 defines its messages at an abstract level. The "7" in HL7 stands for the Application level of the ISO communication model -- ISO level 7. The V3 abstract message model is based on the RIM. HL7 Version 3 messages can be thought of as the communication of graphs of RIM objects from sender to receiver. Vocabulary Within HL7, a vocabulary domain is the set of all concepts that can be taken as valid values in an instance of a coded field or attribute. For example, the Living_subject class has a coded attribute called administrative_gender_code. The administrative_gender_code attribute becomes part of an HMD, and a message instance is subsequently created as part of an implemented interface, one would expect the administrative_gender_code attribute to convey male or female. In this example, male and female are concepts and there may be several coding schemes that contain concepts for male and female.

Reference Information Model (RIM)
In this section, we will: Discuss the modeling concepts used in HL7 Version 3 Describe the Backbone Classes of the HL7 RIM

Reference Information Model (RIM): Overview
Follows object oriented developmental methodology based on a UML model The fundamental model from which all v3 messages are derived is referred to as the Reference Information Model (RIM) The RIM is a generic, abstract model that expresses the information content of all the areas of healthcare Defines all the information from which the data content of HL7 messages are drawn Forms a shared view of the healthcare domain and is used across all HL7 messages independent of message structure The Health Level Seven (HL7) Reference Information Model (RIM) is a static model of health and health care information as viewed within the scope of HL7 standards development activities. It is the combined consensus view of information from the perspective of the HL7 working group and the HL7 international affiliates. The RIM is the ultimate source from which all HL7 version 3.0 protocol specification standards draw their information-related content. What is a information model? An information model is a structured specification of the information within a specific domain of interest. It expresses the classes of information required and the properties of those classes, including attributes, relationships, constraints, and states. In HL7, the scope of a domain of interest ranges from the domain of the entire system of health services to the specific context of a set of information exchanges to meet a particular identified business purpose. HL7 defines different types of information models to represent the different contexts of interest Information Model Components The information model consists of the following components: classes, their attributes, and relationships between the classes; data types for all attributes and vocabulary domains for coded attributes; state transition models for some classes. HL7 information models are based upon the Unified Modeling Language (UML), and may be represented graphically using the UML style. UML is a modeling language that unifies the object-oriented modeling methods of Grady Booch, Jim Rumbaugh, Ivar Jacobson, and others. The UML is a rich, mainly graphical, means of expressing object-oriented concepts. To obtain more information about UML see or the book UML Distilled by Martin Fowler (ISBN ).

Reference Information Model (RIM): Backbone Classes
Entity Role Participation Act A physical thing, group of physical things or an organization capable of participating in Acts, while in a role. A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role. An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance. A record of something that is being done, has been done, can be done, or is intended or requested to be done. 0..1 1 0..n 0..n 0..n 1 0..1 0..n 1 1 1 1 Role Link Act Relationship 0..n 0..n 0..n 0..n A connection between two roles expressing a dependency between those roles. A directed association between a source act and a target act. Note: RIM model is color coded based on the backbone class. The HL7 RIM The HL7 RIM is a critical component of the V3 development process. It is the root of all information models and structures. The HL7 V3 development process is a model-driven methodology. Inter-related models are developed that depict underlying semantics and business rules that govern them. The RIM provides a static view of the information needs of HL7 V3 standards. It includes class and state-machine diagrams and is accompanied by use case models, interaction models, data type models, terminology models, and other types of models. The classes, attributes, state-machines, and relationships in the RIM are used to derive domain-specific information models. The HL7 V3 standard development process defines the rules governing the derivation of domain information models from the RIM and the refinement of those. The rules require that all information structures in derived models be traceable back to the RIM and that their semantic and related business. The RIM therefore is the ultimate source for all information content in HL7 V3 standards. Examples of Subclasses of Foundation Classes: Entity - Organization - Place - Person - Living Subject - Material Role - Patient - Member - Healthcare facility - Practitioner - Practitioner assignment - Specimen - Location Participation - Author - Reviewer - Verifier - Subject - Target - Tracker - Performer Act - Referral - Transportation - Supply - Procedure - Consent - Observation - Medication - Administrative act - Financial act

Reference Information Model (RIM) Backbone Class: Entity
Entity: a person, animal, organization or thing A collection of classes related to the Entity class, its specializations and related qualifying classes. The classes represent health care stakeholders and other things of interest to health care. Entity has the following sub-classes: Container Device LanguageCommunication LivingSubject ManufacturedMaterial Material NonPersonLivingSubject Organization Person Place Entity classCode : CS determinerCode : CS id : SET<II> code : CE quantity : SET<PQ> name : BAG<EN> desc : ED statusCode : SET<CS> existenceTime : IVL<TS> telecom : BAG<TEL> riskCode : CE handlingCode : CE Note: classes are not the only.. The only ones show are the ones that have unique attributes Definition of Entity: A physical thing, group of physical things or an organization capable of participating in Acts, while in a role.

Reference Information Model (RIM): Backbone Class: Role
Roles: A responsibility or part played by an entity (e.g. Person in a role of patient, employee, etc.) – different faces of an Entity A collection of classes related to the Role class and its specializations. These classes focus on the roles participants may play in health care. Role has the following sub-classes: Access Employee LicensedEntity Patient Role classCode : CS id : SET<II> code : CE negationInd : BL addr : BAG<AD> telecom : BAG<TEL> statusCode : SET<CS> effectiveTime : IVL<TS> certificateText : ED quantity : RTO positionNumber : LIST<INT> ... Note: classes are not the only.. The only ones show are the ones that have unique attributes Definition of Role: A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that scopes the Role.

Reference Information Model (RIM): Backbone Class: RoleLink
A connection between two roles expressing a dependency between those roles. RoleLink has no sub-classes. Role 0..n source 0..n 0..n outboundLink 0..n RoleLink inboundLink typeCode : CS Definition of RoleLink: A connection between two roles expressing a dependency between those roles. Examples: A role of assignment or agency depends on another role of employment, such that when the employment role is terminated, the assignments would be terminated as well. This is the dependency of the assignment role with the employment role, or in other words, the assignment is "part of" the employment. effectiveTime : IVL<TS>

Reference Information Model (RIM): Backbone Class: Participation
An association between an Act and a Role with an Entity playing that Role. Participation has the following sub-class: ManagedParticipation Participation typeCode : CS functionCode : CD contextControlCode : CS ... sequenceNumber : INT negationInd : BL noteText : ED time : IVL<TS> modeCode : CE awarenessCode : CE signatureCode : CE signatureText : ED performInd : BL substitutionConditionCode : CE Note: classes are not the only.. The only ones show are the ones that have unique attributes Definition of Participation: An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance. The kind of involvement in the Act is specified by the Participation.typeCode.

Reference Information Model (RIM): Backbone Class: Act
A collection of classes including the Act class and its specializations. These relate to the actions and events that constitute health care services. A record of something that is being done, has been done, can be done, or is intended or requested to be done. Act has the following sub-classes: Account ControlAct DeviceTask DiagnosticImage Diet FinancialContract FinancialTransaction InvoiceElement Act classCode : CS moodCode : CS id : SET<II> code : CD negationInd : BL derivationExpr : ST text : ED title : ST statusCode : SET<CS> Observation Participation PatientEncounter Procedure PublicHealthCase SubstanceAdministration Supply WorkingList effectiveTime : GTS activityTime : GTS availabilityTime : TS Note: classes are not the only.. The only ones show are the ones that have unique attributes Definition of Act: A record of something that is being done, has been done, can be done, or is intended or requested to be done. Examples: The kinds of acts that are common in health care are (1) a clinical observation, (2) an assessment of health condition (such as problems and diagnoses), (3) healthcare goals, (4) treatment services (such as medication, surgery, physical and psychological therapy), (5) assisting, monitoring or attending, (6) training and education services to patients and their next of kin, (7) and notary services (such as advanced directives or living will), (8) editing and maintaining documents, and many others. priorityCode : SET<CE> confidentialityCode : SET<CE> repeatNumber : IVL<INT> interruptibleInd : BL levelCode : CE independentInd : BL uncertaintyCode : CE Note: Sub-classes also include Core Infrastructure, Message Communications Control and Structured Documents classes not shown here. reasonCode : SET<CE> languageCode : CE

Reference Information Model (RIM): Backbone Class: ActRelationship
A directed association between a source Act and a target Act. A point from a later instance to a earlier instance OR point from collector instance to component instance. ActRelationship has no sub-classes. ActRelationship 0..n outboundRelationship typeCode : CS inversionInd : BL contextControlCode : CS source 0..n contextConductionInd : BL Act sequenceNumber : INT priorityNumber : INT pauseQuantity : PQ checkpointCode : CS splitCode : CS joinCode : CS negationInd : BL conjunctionCode : CS Definition of ActRelationship: A directed association between a source Act and a target Act. ActRelationship on the same source Act are called the "outbound" act relationships of that Act. ActRelationships on the same target Act are called the "inbound" relationships of that Act. The meaning and purpose of an ActRelationship is specified in the ActRelationship.typeCode attribute. localVariableName : ST seperatableInd : BL 0..n inboundRelationship target 1

Reference Information Model (RIM): The Complete RIM
Domain Related 1 1 Understanding the RIM The RIM uses a abstract modeling style. The back-bone classes of the RIM and their structural attributes are its core. An understanding of these classes and attributes are essential to understanding the RIM. Defines all the information from which the data content of HL7 messages are drawn Follows object-oriented modeling techniques, where the information is organized into classes that have attributes and that maintain associations with other classes Forms a shared view of the information domain used across all HL7 messages independent of message structure Provides a means for discovering and reconciling differences in data definition 1 1 Infrastructure Related Structured Documents

Reference Information Model (RIM): RIM-UML Instance Scenario
Entity Role Participation Act John Doe Patient Subject (Procedure Act) Prostectomy Dr. Smith HealthCare Provider Surgeon* XYZ Hospital HealthCare Facility* Location Act Relationship Has Pertinent Information John Doe Patient Subject (Clinical Trial Act) Protocol ECOG 1112

HL7 Version 3 Process & Artifacts
In this section, we will discuss: Domain Message Information Model (DMIM) Refined Message Information Model (RMIM) Hierarchal Message Definitions (HMDs) Message Type (MT)

HL7 Version 3 Process & Artifacts: Overall Process
RIM D-MIM R-MIM 1..* 1..* HMD 1..* MT Notes about HL7 processes … message are derived from the RIM. Focus on the model methodology of DMIM and RMIM. People will be looking at the RMIM. 1..*

Entry points Color-coding Directional Arrows Labeling
HL7 Version 3 Process & Artifacts: Examples Entry points Color-coding Directional color-coded colors denotes type of backbone class Red = Act Blue = Participation Yellow = Role Green = Entity Light red or pink = Act Relationship Light Yellow = Role Link Arrows Participations, Role_Links and Act_Relationships are arrows that are directional have attributes rather than being lines that connect classes like in UML Entry Point Each D-MIM diagram will have at least one Entry Point. Entry Points designate the class(es) from which the messages begin for the particular domain. Since the D-MIM encompasses an entire domain, there may be several Entry Points, one for each R-MIM contained in the domain. RMIMs are directional All associations flow out from the entry point toward the remaining parts of the message labeling HL7 diagrams are a little different in how they label associations (only on distal end, not bi-directional) Normally in UML diagrams you have a label on both ends of an association and the association can be read both ways, but in an HL7 RMIM the association can only be read one way and thus there is only one label and it's on the distal (far) end of the association Arrows Labeling

Reference Information Model (RIM): HL7 Modeling Conventions
Color-coding – colors of classes in the model denote the type of backbone class to which it belongs Arrows – Participations, ActRelationships and RoleLinks are directional arrows that have rather than being lines that connect classes like in UML Entry points – where to start reading the model; DMIMs have one or more entry points, RMIMs have one RMIMs are directional – all associations flow out from the entry point to the remaining parts of the model Labeling – associations in RMIMs are labeled on the distal end only HL7 Modeling Conventions color-coded - colors mean type of backbone class arrows - participations and actRelationships are arrows that are directional have attributes rather than being lines that connect classes like in UML entry points - HL7 DMIMs and RMIMs have entry points (boxes with arrow pointing to a class); DMIMs can have more than one, RMIMs can only have one RMIMs are directional - all associations flow out from the entry point toward the remaining parts of the message labeling - HL7 diagrams are a little different in how they label associations (only on distal end, not bi-directional)

HL7 Process & Artifacts: Domain Message Information Model (DMIM)
A DMIM is a refined subset of the RIM that includes a set of class clones, attributes and relationships that can be used to create messages for a particular domain (a particular area of interest in healthcare).

HL7 Process & Artifacts: Refined Message Information Model (RMIM)
The RMIM is a subset of a DMIM that is used to express the information content for a message or set of messages with annotations and refinements that are message specific.

HL7 Process & Artifacts: Hierarchal Message Definitions (HMDs)
A Hierarchal Message Definition (HMD) is a serialized version of the RMIM in a specific order. Hierarchal Message Definitions (HMDs) is a serialize version of the RIM in a specific order

HL7 Process & Artifacts: Message Type (MT)
The XML elements and attributes in a message instance correspond one-to-one with individual rows in the HMD. The names of the XML elements and attributes are taken from the "element name" column of the HMD. The Message Type elements and attributes in an XML message instance correspond to the sequence of data in the HMD

Vocabulary & Data Types
In this section, we will discuss: HL7 Standard Vocabulary Structural Attributes – prescribed HL7 vocabulary Non-Structural Attributes – vocabulary chosen by organization Robust Data Types

Vocabulary & Data Types: Structural Attributes
An Act of the Class Observation (OBS) with a Mood of Event (EVN). classCode and moodCode are both Structural Attributes Structural attributes Structural attributes are used to specify more precisely what each RIM class means when used in a message. For example, Act has a class code. The class code states what sort of Act this is, such as an observation, an encounter, or the administration of a drug. Mood is analogous to the tense of a verb. Structural attributes are used to specify type and state of each RIM class and what it means when used in a message. They use a standard vocabulary defined and controlled by HL7.

Vocabulary & Data Types : Non-Structural Attributes
Other attributes don’t have an assigned vocabulary Organizations can choose any industry standard vocabulary For example, commonly used ones for Observation Acts are LOINC, SNOMED, MedDRA, etc. Must specify more than just the code value, other data is needed for semantic interoperability…this is where data types come in

Vocabulary & Data Types : Data Types
What is a data type? lengthOfStayQuantity is attribute of the EncounterProcess class. lengthOfStayQuantity has a data type of Physical Quantity (PQ). Coded Values HL7 uses two main types of code. The first type covers the specialized codes used for structural attributes and are defined by HL7 itself. The second type covers externally defined terms and codes such as SNOMED CT (Clinical Terms). Vocabulary Vocabulary is the set of allowed values for a coded field. All attributes with a code data type will have a vocabulary assigned to them. The ‘code system’ must be identified for any coded value in a message. NameTypeDescription Code= The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache. codeSystem= Specifies the code system that defines the code. codeSystemName= A common name of the coding system. codeSystemVersion= A version descriptor defined specifically for the given code system. displayName= A name or title for the code, under which the sending system shows the code value to its users. .

Vocabulary & Data Types : Data Types
Data types in HL7 version 3 are complex Each data type has attributes Each attribute has a data type of its own Physical Quantity (PQ) example Coded Values HL7 uses two main types of code. The first type covers the specialized codes used for structural attributes and are defined by HL7 itself. The second type covers externally defined terms and codes such as SNOMED CT (Clinical Terms). Vocabulary Vocabulary is the set of allowed values for a coded field. All attributes with a code data type will have a vocabulary assigned to them. The ‘code system’ must be identified for any coded value in a message. NameTypeDescription Code= The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache. codeSystem= Specifies the code system that defines the code. codeSystemName= A common name of the coding system. codeSystemVersion= A version descriptor defined specifically for the given code system. displayName= A name or title for the code, under which the sending system shows the code value to its users. . <lengthOfStayQuantity value=“10” unit=“hours"/> The attributes ‘value’ and ‘unit’ are part of the complex data type Physical Quantity (PQ). Value is expressed as the data type of integer (int).

HL7 Version 3 at NCICB In this section, we will discuss:
Why HL7 at NCICB? NCICB Clinical Architecture Vision caAdapter

HL7 Version 3 at NCICB: Why HL7?
Recommended by the Health and Human Service (HHS) as the messaging standard for electronic exchange of clinical data. Over 90% of US hospitals have implemented some version of 2.x HL7 messages. Support for translational research requires integration of research data with the clinical data. V3 offers the syntactic and semantic interoperability to make this possible

HL7 Version 3 at NCICB: NCICB Clinical Architecture Vision
etc. Tissues Labs JDBC 2 Analytical Applications Analytical and Reporting Tools (SAS, WebSDM, ToxViewer, I-Review, etc.) Ad Hoc Query Tool BIO-gopher Master Index Message Exchange Services (ebXML) Translation Service (CAM/caAdapter) Electronic Medical Record (EMR) HL7 v3 Excel, Text, HL7 v2, HL7 Transactional Database (HTB) Extensions (CDUS/CTMS) Base Janus Model BRIDG Clinical/Clinical Trials Applications C3D caMATCH C3PR SAE Study Specific Analysis Data Clinical Data Sources Patient Identifiable Clinical Environment caGRID caBIG Secure Transport Between Sites caBIO/CTOM HL7 RIM FDA SPONSOR CTEP DCP Other External Agencies Common Security Module (CSM) Enterprise Vocabulary Service (EVS) Data Standards Repository (caDSR) HL7 v1, v2, etc. De-Identification/ Re-Identification Service eCTD, Excel, Text, caPRI FIREBIRD CRIX Data Repository HL7 version 3 supports messaging within the NCICB Clinical Architecture Vision. HL7 v3 Messaging Standard at NCICB NCI’s Clinical Trials Architecture vision supports open sharing of clinical and research data across the cancer research and clinical care communities. Clinical systems supply trial data to a message exchange, using the HL7 Software Development Kit (SDK) to build HL7 V3 messages to carry the data. [NCICB Clinical Architecture Vision]

Message Exchange – Service supporting message transmission and routing
HL7 Version 3 at NCICB: Highlights of the NCICB Clinical Architecture Vision caAdapter – Open source toolkit which facilitates v3 message building, parsing and validation Message Exchange – Service supporting message transmission and routing HL7 Transactional Database - HL7 RIM-based transactional database and data access service De-identification Service – Service for de-identifying patient information from HL7 messages Analytical Applications - Applications for querying, reporting, mining clinical data Cancer Data Standards Repository (caDSR) - Shared metadata repository Enterprise Terminology Services (EVS) - Terminology service for hosting controlled vocabulary, including HL7 registered terminology

HL7 Version 3 at NCICB: caAdapter
Facilitates the building, parsing, and validation of HL7 v3 messages Components include: HL7 v3 Message Parser – parses HL7 version 3 messages to RIM object graph HL7 v3 Message Builder – builds HL7 version 3 messages from the RIM object graph HL7 v3 Artifacts – implements RIM objects, data types and metadata objects Metadata Loader – represents HL7 version 3 metadata in-memory Validation Services – integrates with NCICB caCORE components such as Enterprise Vocabulary Service (EVS) and W3C XML schema validation services Mapping Tool – maps clinical data to the HL7 version 3 message specification currently, with extensible mapping and data transformation in the near future caAdapter API – uses mappings to generate HL7 version 3 messages Message Service – integrates with message exchange services (future plans)

HL7 Version 3 at NCICB: caAdapter
A platform to enable clinical applications to build and parse HL7 v3 messages based on specific schema definitions. Capability to perform vocabulary validation of the RIM structural attributes. An open source solution for implementing an international messaging standard allowing data to be exchanged between disparate systems. Integration with NCI metadata repository (caDSR) and terminology services (EVS) Facilitating the building and parsing of HL7 v3 messages from source clinical systems will promote data exchange in a standards based common format.

Recommended Resources
Health Level Seven HL7 Reference Information Model HL7 Vocabulary Domains HL7 Version 3 Standard NCICB caAdapter Project Site trials.nci.nih.gov/projects/infrastructureProject/caAdapter HL7 Version 3: Driving Interoperability & Transforming Healthcare Information Management - Charles Mead, MD, MSc NIHSeminar_Charlie Mead.ppt

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