HL7 Version 3 in Europe A Standard in Practice

Transcription

1 HL7 Version 3 in Europe A Standard in Practice Strategies & Concepts to Real Implementations Dr. Kai U. Heitmann M.D. Managing Consultant, Heitmann Consulting and Services (The Netherlands) Institute for Medical Statistics, Informatics & Epidemiology, University of Cologne (Germany) Director International Affiliates - Board of Directors HL7 USA Chair HL7 Germany BALTIC IT&T 2006 FORUM: ebaltics Riga (LV) April 5-7, 2006

2 HL7 Version 3 in Europe A Standard in Practice ehealth Questions (and answers): What is HL7? And why do we need it? How to start? HL7 Europe and Worldwide: What happened so far? How to conclude?

3 ehealth Concepts - Questions Applications? Prioritize functionality for patients & providers Communication? Facilitate electronic data exchange Allow cross-sectoral communication Infrastructure? Highway for healthcare information Dealing with Transport & Security Plan and Vision? Analysis of Care Processes Strategy and steps towards an EHR 3

4 Health Level Seven - The Organization HL7, founded 1987 ANSI-accredited Standards Development Organization Approx members First non-us country joined early 90s ISO s Open Systems Interconnect (OSI) model: Application Level level 7 Official first affiliates in 1992 (Germany, Canada, the Netherlands) 4

5 Who is HL7? Over 500 organizational members, about 2200 total members Up to 500 attend Working Group Meetings - including about 20% international attendees at International: 33 countries US Affiliates in Canada, Europe, Asia-Pacific, Latin America, Africa 5

6 HL7 International (more than 30 countries) Canada United States Mexico Argentina Uruguay Chile Brazil The Netherlands United Germany Finland Kingdom Denmark Lithuania Poland Ireland Switzerland Czech R France Italy Croatia Bulgaria Spain Greece Turkey India Southern Africa China Taiwan Malaysia Korea Japan Australia New Zealand 6

7 HL7 in Europe Starting point (1995) of International Activities / Affiliates 16 European Affiliates Ireland 2003 Netherlands 1996 Germany 1995 UK 2000 France 2004 Portugal 2006? Spain 2003 Switzerland 2000 Italy 2003 Sweden 2006 Finland 1996 Denmark 2003 Lithuania 2002 Poland 2003 Czech Republic 2001 Austria 2006? Croatia 2001 Latvia 2006? Bulgaria

8 HL7 Version 3 Basically HL7 Version 3 is a family of object-oriented communication standards, based on the HL7 Reference Information Model (RIM) The RIM is a worldwide accepted model for health information Also basis for other SDOs (CEN, ISO) Used in many projects and real world environments for more than 3 1/2 years now (Early Implementers) Models as a base of all products within HL7 V3 Symbolic structured representation of parts of the reality UML (Universal Modeling Language) used 8

9 Version 3 is based on models Models are the common language to express content, structure and interactions for communication Content: Data types, Vocabulary Structures and Semantics of the information Interactions between communicating parties Messages are the result when putting together The static model The dynamic model Answers the question: When do I exchange/share what? 9

10 HL7 Version 3 Building bricks for communication models Reference Information Model RIM All objects, activities and their relationship in ONE generic healthcare model Entity Role Participation Act 10

11 What s exciting about HL7 Version 3? Supports cross-sectoral Care Process Chains Reflects international contributions/standards Reflects expert knowledge collected over decades Healthcare System Patient Aftercare Information flow General Pract Lab Specialist Hospital Rad Surg 11

12 How is Version 3 better? Conceptual foundation a single, common reference information model to be used across HL7 Semantic foundation in explicitly defined concept domains drawn from the best terminologies Abstract design methodology that is technology-neutral able to be used with whatever is the technology de jour (e.g. XML, UML, etc.) 12

13 How is Version 3 better? Maintain a repository (database) of the semantic content assure a single source enable development of support tooling Tools to auto-generate XML schemas for messages once the semantic content is final (via ballot and conformance constraints) Tools for documentation of constraints for both message definition and conformance specifications 13

14 HL7 Version 3 in Europe A Standard in Practice ehealth Questions (and answers): What is HL7? And why do we need it? How to start? HL7 in Europe : What happened so far? How to conclude?

15 Starting V3 Starting real life project means...dealing with all these challenges & layers Content Exchange Format (=XML..., what else!?) Transport & Security (Infrastructure / Framework, International solutions / standards, Legal requirements) payload content exchange format transport security proprietary HL7 v3 CDA HL7 ^~ XML MLLP ebxml WS-* FTP/S S/MIME HTTP/S 15

16 Layers of activities in Europe XML HL7 v3 CDA Infrastructure Security Training XML encoding and application building V3 messaging standard early implementor projects V3 based documents Infrastructure and Framework Education 16

17 Drivers for v3 adoption Need of support for large scale integration V3 has built-in support for Complex Datatypes universally unique instance identifiers for persons, places, organizations, practitioners, URL s, orders, observations, etc. internationally feasible name datatype (persons and organizations) time and date-related datatype forms codes (binding standard vocabularies to RIM attributes) 17

18 Drivers for v3 adoption V3 has built-in support for large scale integration (city, region, province, nationwide, international) a coherent set of (structures) models guaranteeing semantic interoperability and re-usability identifier strategy supporting wide integration models and tools based design and implementation Support of decision support and rules-based processing 18

19 HL7 Version 3 in Europe A Standard in Practice ehealth Questions (and answers): What is HL7? And why do we need it? How to start? HL7 in Europe : What happened so far? How to conclude?

20 Short Trip through Europe Visiting some EU Activities and Activists HL7 Version 3 in Practice UK Finland Germany Netherlands Lithuania Croatia 20

21 HL7 Activities in Croatia

22 Croatia HL7 v3 Infrastructure Security Training HL7 Croatia in September 2002 Croatian Society for Medical Informatics (CSMI) and Croatian Society for Medical and Biological Engineering (CROMBES) Supported by Ministry of Health of the Republic of Croatia Croatian State Office for Standardization and Metrology Croatian Public Health Institute Education National Infrastructure Project WebService Based Infrastructure for the Exchange of Information Large Mobile Phone vendor 22

23 HL7 Activities in Finland

24 Finland CDA Infrastructure Security Use of HL7 s Clinical Document Architecture Start of activities around 2000 Connection implementation within four health districts in Finland HL7 Finland defined application level protocol Based on ebxml Currently: exchange of other documents like referrals, prescriptions and health certificates 24

25 Finland CDA CDA Release 2 specifications started 2004 funded by MoHSW and HL7 FI (together 260 k ) standarization activites build in a broad sense around HL7 TC (formal mandate) areal funding for towards 2007 MoSHW will distribute M for the areas one technical requirement is to use HL7 CDA... Infrastructure Security 25

26 Specialized care epicrisis 26

27 HL7 Activities in United Kingdom

28 United Kingdom GP 2 GP Project Early Implementor Project based on Version 3 Infrastructure Framework Support by NHS HL7 v3 Infrastructure Security NHS in England: Funding for several years Many bn s of money aims to connect more than 30,000 GPs and 270 acute, community and mental NHS Trusts in a single national system. 28

29 HL7 Activities in Germany

30 Germany HL7 v3 CDA Infrastructure Security Content: SCIPHOX Project (CDA) Infrastructure Framework Project by Ministry of Health Consortium of 5 vendors/organisations Introduction of the Health card for patients Health professional card for providers HL7 Version 3 messaging (Dialysis, Lab) 30

31 Germany: Cards as the key For a Telematic Infrastructure 31

32 The SCIPHOX project and CDA uses CDA R1 model as a start framework for basic shared information (CDA Header) sender, recipient, patient, event etc. definition of structures (CDA Body) Structure of information units based on analysis Story boards (discharge/referral documents, long term diabetes documentation, emergency info) Formal voting procedures for specifications Also activities in version 3 messaging CDA 32

33 Care Record Summary (Arztbrief) Recent development discharge letter Based on CDA R2 Implementation Guideline 150 pages Four defined use cases Numerous examples Implementation rules (formalized) Industry Driven! 33

34 HL7 Activities in The Netherlands

35 Let us think about having stable shelves... or a stable EHR... 35

36 The Netherlands HL7 Project Office Projects, Training (focussed on Version 3) National IT Institute for Healthcare Projects (among others) Modelling the perinatology domain Domain analysis, Modelling Implementation guidelines HL7 v3 Infrastructure Security Training Proof of concept: Modelling Medication Registry as one of the first steps to a EHR in the Netherlands Implementations with several vendors at large exhibition 36

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38 HL7 Activities in Lithuania

39 Lithuanian ehealth National Infrastructure Project Funded by the World Bank HL7 Version 3 Facilitate electronic data exchange To allow cross-sectoral communication Implementation Guidelines Stepwise approach Communication Backbone high priority applications first Preparing steps towards an EHR HL7 v3/cda Infrastructure Security 39

40 Lithuanian ehealth Concept Registries Also designed as switch points for communication Patients Providers Generic Activities Specific Activities Key roles: A transportation infrastructure including security ( backbone ) (a network of) Integration Engines connecting Hospitals (h), General Practitioners (g), Specialist (s) in an interoperable way h Registry h g Registry g s 40

41 HL7 Version 3 in Europe A Standard in Practice ehealth Questions (and answers): What is HL7? And why do we need it? How to start? HL7 in Europe : What happened so far? How to conclude?

42 Architecture (UK, CA, DE, NL, HR, LT) Provider Portal Patient Portal Public Health Reporting Legacy Systems... Database Content Maintenance Central/National/Regional Service Point Identification Authorization Authentication Logging Other functions Patient Registry Provider Registry Act Reference Registry Act Repository (later: the EHR ) Organization Registry GP Facility Registration Office CID/Demographics Social Insurance Verification Subscription to HCF Provider Assignment Consent Provider (GP) (appointment) Medical history Subject./Object./Ass./Plan Referral Specialist Facility Provider (Specialist) Consultation Request Medical history Subject./Object./Ass./Plan Referral Lab Facility Order Result Pharmacy Prescription/Dispense Hospitals/

43 HL7 Activities Worldwide Conclusion HL7 Migration in the past several years...from an US based standard used mainly in hospitals...to a globally defined suite of international standards...implemented locally...with major international contribution as a feedback to the development process...ready (and proven) to support care process chains More than 80 implementation projects Version 3 Messaging and Documents Practical implementations Feedback for the standard 43

44 HL7 Activities Worldwide Conclusion Education required! Modeling Methodology Version 3 Messaging and CDA Documents Early implementor projects Version 3 Messaging and CDA Documents Practical implementations Feedback for the standard Infrastructure Framework needed Funding collaboration with national bodies (Ministry of Health) 44

45 HL7 Calendar 2006 International HL7 Interoperability Conference Cologne (Germany), August 24+25,

46 Paldies Tänan Achiu - Thank you - Questions? Later? mailto: hl7@kheitmann.nl 46

47 A word about myself Dr Kai U. Heitmann Studies of medicine , doctor of medicine Complementary education in Medical Informatics Works in standards developing areas since 1995, internationally since 1998 Board Member of HL7 International, Chair HL7 Germany Germany Contributions to HIS of University of Cologne , system introduction and integration Deputy head of Medical Informatics Unit of the University of Cologne (Germany) Independent Healthcare IT Consultant with head office in the Netherlands since January 2004 Involved in and finalized many communication and integration projects in the Netherlands, Germany, Lithuania, Australia... 47