Health Level Seven(HL7)

8/12/2019 Health Level Seven(HL7)

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HL7

Health Level Seven(HL7), is an all-volunteer, non-profit organizationinvolved in development

of international healthcareinformatics interoperability standards. "HL7" is also used to refer tosome of the specific standards created by the organization (e.g., HL7 v.!, v.#, HL7 $%&).

HL7 and its members provide a frame'or (and related standards) for the e!change, integration,

sharing, and retrieval of electronic health information. v.! of the standards, 'hich supportclinical practice and the management, delivery, and evaluation of health services, are the most

commonly used in the 'orld.

Organization

HL7 is an international community of healthcare subect matter e!perts and information

scientists collaborating to create standards for the e!change, management and integration ofelectronic healthcare information.

HL7 promotes the use of such informatics standards 'ithin and among healthcare organizations

to increase the effectiveness and efficiency of healthcare information delivery for the benefit of

all.

*he HL7 community is organized in the form of a global organization (Health Level +even, %nc.)

and country-specific affiliate organizations

Health Level +even, %nc. (HL7, Inc.) is headuartered in nn rbor, &ichigan.

HL7 affiliate organizations, not-for-profit organizationsincorporated in local

urisdictions, e!ist in over /# countries. *he first affiliate organization 'as created in

0ermany in 122.3

*he organizational structure of HL7 %nc. is as follo's

*he organization is managed by a 4oard of 5irectors, 'hich comprises 1# elected

positions and three appointed positions.

*he 6hief !ecutive 8fficer (currently 6harles 9affe, &5, :h5) serves as an e! officio

member of and reports to the 4oard of 5irectors. *he 6hief *echnology 8fficer

(currently 9ohn ;uinn)< and the 6hief 8perations 8fficer (currently &ar &c5ougall)

report to the 68 and also serve as e! officio members on the 4oard of 5irectors.

&embers of HL7 are no'n collectively as "*he =oring 0roup". *he =oring 0roupis responsible for defining the HL7 standard protocol and is composed of +tanding

dministrative 6ommittees and =oring 0roups.

o Standing Administrative committeesfocus on organizational or promotional

activities, such as ducation, %mplementation, &areting, 8utreach 6ommitteefor 6linical $esearch, :ublishing and :rocess %mprovement and *ooling.
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o Working groupsare directly responsible for the content of the +tandards, framing

the actual language of the specifications.

Origin

HL7 'as founded in 12>7 to produce a standard for hospital information systems. HL7, %nc. is astandards organizationthat 'as accredited in 122/ by the merican ?ational +tandards %nstitute(?+%).

HL7 is one of several merican ?ational +tandards %nstitute accredited +tandards 5eveloping

8rganizations (+58s) operating in the healthcare arena. &ost +58s produce standards(sometimes called specifications or protocols) for a particular healthcare domain such as

pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level

+even@s domain is clinical and administrative data.

*oday, HL7 has been adopted by several national +58s outside the Anited +tates. *hose +58s

are conseuently not accredited by ?+%. Ho'ever, HL7 is no' adopted by %+8 as a centre ofgravity in international standardization and accredited as a partnering organization for mutual

issuing of standards. *he first mutually published standard is %+8BHL7 171##C Health

informaticsDHL7 version D$eference information modelD$elease 1.

The name "Health Level-7"

*he name "Health Level-7" is a reference to the seventh layer of the %+8 8+% $eference model

also no'n as the application layer. *he name indicates that HL7 focuses on application layer

protocols for the health care domain, independent of lo'er layers. HL7 effectively considers alllo'er layers merely as tools.

Collaboration

HL7 collaborates 'ith other standards development organizations and national and internationalsanctioning bodies (e.g. ?+% and %+8), in both the healthcare and information infrastructure

domains to promote the use of supportive and compatible standards. HL7 collaborates 'ith

healthcare information technology users to ensure that HL7 standards meet real-'orldreuirements, and that appropriate standards development efforts are initiated by HL7 to meet

emergent reuirements.

bout /EF of the global membership (of either HL7 %nc. or an HL7 affiliate) is located in

urope, EF in ?orth merica, 1EF in sia-8ceania and EF else'here.

HL7 standards

Hospitals and other healthcare provider organizations typically have many different computer

systems used for everything from billing records to patient tracing. ll of these systems should

communicate 'ith each other (or "interface") 'hen they receive ne' information but not all doso. HL7 specifies a number of fle!ible standards, guidelines, and methodologies by 'hich
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various healthcare systems can communicate 'ith each other. +uch guidelines or data standards

are a set of rules that allo' information to be shared and processed in a uniform and consistent

manner. *hese data standards are meant to allo' healthcare organizations to easily share clinicalinformation. *heoretically, this ability to e!change information should help to minimize the

tendency for medical care to be geographically isolated and highly variable.

HL7 develops conceptual standards (e.g., HL7 $%&), document standards (e.g., HL7 65),

application standards (e.g., HL7 668=), and messaging standards (e.g., HL7 v.! and v.#).&essaging standards are particularly important because they define ho' information is pacaged

and communicated from one party to another. +uch standards set the language, structure and data

types reuired for seamless integration from one system to another.

HL7 encompasses the complete life cycle of a standards specification including the development,

adoption, maret recognition, utilization, and adherence. 4usiness use of the HL7 standards

reuires a paid organizational membership in HL7 %nc. HL7 &embers can access standards for

free and non members can buy the standards from HL7 or ?+%.

HL7 version 2.

*he HL7 version standard has the aim to support hospital 'orflo's. %t 'as originally createdin 12>2.

!2. essaging

HL7 version defines a series of electronic messages to support administrative, logistical,

financial as 'ell as clinical processes. +ince 12>7 the standard has been updated regularly,resulting in versions .1, ., ., ..1, ./, .E, .E.1 and .C. *he v.! standards are bac'ard

compatible (i.e. a message based on version . 'ill be understood by an application thatsupports version .C).

HL7 v.! mostly uses a te!tual, non-G&L encoding synta! based on delimiters.

HL7 v.! has allo'ed for the interoperabilitybet'een electronic :atient dministration +ystems(:+), lectronic :ractice &anagement (:&) systems, Laboratory %nformation +ystems (L%+),

5ietary, :harmacy and 4illing systems as 'ell as lectronic &edical $ecord(&$) or

lectronic Health $ecord(H$) systems. 6urrently, HL7@s v.! messaging standard issupported by every maor medical information systems vendor in the Anited +tates.

HL7 version #

*he HL7 version standard has the aim to support all healthcare 'orflo's. 5evelopment ofversion started around 122E, resulting in an initial standard publication in ##E. *he v

standard, as opposed to version , is based on a formal methodology (the H5) and obect-

oriented principles.

$I - ISO%HL7 2&7#&
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*he $eference %nformation &odel($%&) is the cornerstone of the HL7 Iersion development

process and an essential part of the HL7 I development methodology. $%& e!presses the data

content needed in a specific clinical or administrative conte!t and provides an e!plicitrepresentation of the semanticand le!icalconnections that e!ist bet'een the information carried

in the fields of HL7 messages. *he $%& is essential to increase precision and reduce

implementation costs. &odelsare available.

HL7 'evelo(ment )rame*or+ - ISO%HL7 27#&

*he HL7 Iersion 5evelopment rame'or (H5) is a continuously evolving process that

sees to develop specifications that facilitate interoperability bet'een healthcare systems. *he

HL7 $%&, vocabulary specifications, and model-driven process of analysis and design combineto mae HL7 Iersion one methodology for development of consensus-based standards for

healthcare information system interoperability.*he H5 is the most current edition of the HL7

I development methodology.

*he H5 not only documents messaging, but also the processes, tools, actors, rules, and artifactsrelevant to development of all HL7 standard specifications. ventually, the H5 'ill encompass

all of the HL7 standard specifications, including any ne' standards resulting from analysis of

electronic health record architectures and reuirements.

HL7 specifications dra' upon codes and vocabularies from a variety of sources. *he Ivocabulary 'or ensures that the systems implementing HL7 specifications have an

unambiguous understanding of the code sources and code value domains they are using.

!# essaging

*he HL7 version messaging standard defines a series of electronic messages (calledinteractions) to support all healthcare 'orflo's. HL7 v messages are based on an G&Lencoding synta!.

!# Clinical 'ocment rchitectre - ISO&/70&

*he HL7 version 6linical 5ocument rchitecture(65) is an G&L-based marup standard

intended to specify the encoding, structure and semantics of clinical documents for e!change.

ethods a((lied b1 HL7

Services *are Intero(erabilit1 )rame*or+

*he HL7 +ervices-'are nterprise rchitecture rame'or (+%) provides consistency

bet'een all HL7 artifacts, and enables a standardized approach to nterprise rchitecture ()

development and implementation, and a 'ay to measure the consistency.

+% is a 'ay of thining about producing specifications that e!plicitly describe the governance,conformance, compliance, and behavioral semantics that are needed to achieve computable
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semantic 'oring interoperability. *he intended information transmission technology might use

a messaging, document e!change, or services approach.

+% is the frame'or that is reuired to rationalize interoperability of other standards. +% isan architecture for achieving interoperability, but it is not a 'hole-solution design for enterprise

architecture management.

rden s1nta

*he rden synta!is a language for encoding medical no'ledge. HL7 adopted and oversees the

standard beginning 'ith rden synta! .#. *hese &edical Logic &odules(&L&s) are used in

the clinical setting as they can contain sufficient no'ledge to mae single medical decisions.

*hey can produce alerts, diagnoses, and interpretations along 'ith uality assurance function and

administrative support. n &L&must run on a computer that meets the minimum system

reuirements and has the correct program installed. *hen, the &L& can give advice for 'henand 'here it is needed.

LL

large portion of HL7 messaging is transported by &inimal Lo'er Layer :rotocol (&LL:).mongst other soft'are vendors this protocol is supported by &icrosoft and 8racle.

CCO3

668=, or "6linical 6onte!t 8bect =orgroup," is a standard protocol designed to enable

disparate applications to share user conte!t and patient conte!t in real-time, and at the user-

interface level. 668= implementations typically reuire a 668= vault system to manage user

security bet'een applications.

)nctional 4H$ and H$ s(eci5ications

unctional specifications for anelectronic health record.

Contr1 s(eci5ic as(ects

stralia

HL7 ustralia 'as established in 122>.

ustralia 'as an early adopter of the HL7 I.! standards, 'hich are no' ubiuitously used in

ustralian public and private healthcare organisations.

*he localisation of the HL7 standards is undertaen in cooperation 'ith the national standardsbody, +tandards ustralia.
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HL7 ustralia closely cooperates 'ith the ?ational -Health *ransition uthority (?H*).

HL7 ustralia

+tandards ustralia (%*-#1/ "Health %nformatics"

?H*

)inland

6ational IT services 5or healthcare

*he +ocial %nsurance %nstitution of inland is building a national e:rescribing and patient record

archival service based on HL7 65 $ and I messages. :hased deployment is scheduled for

##>-#11. Iersion messaging is 'idely deployed in most hospitals and healthcare centers.65 $1 is used in sharing patient records on a regional level.

HL7 inland national affiliate

erman1

*he 0erman chapter of HL7 'as founded in 122. *his is an entity for benefit to the public andregistered as an association as HL7 e. I.

5ue to federal structure of operational administration in 0erman healthcare, the standardization

aspect is much behind the possibilities of the public economy and due to competitive interests inindustry of lo' normative impact to healthcare information systems development. 6urrently HL7

in 0ermany operates as an informal cluster and collaborates 'ith the national standardization

body.

*he voluntary membership in HL7 relies on personal interest and engagement of clinical usersand mainly on industrial interest 6linical memberships are in minority. *here is lo'

membership of governmental administration and thus lo' contribution to ongoing discussion e.g.

on patient data records (: J eletronische :atientenate) balancing data availability vs. data

security. %mpact on productivity for hospital information systems (called K%+ J Kranenhaus-%nformationssysteme in 0erman) is of no importance yet, as the variability of H%+ systems has

not been challenged by HL7.

0overnmental funding for a broader adoption of HL7 does yet not e!ist in 0ermany, neither on

federal level nor in most of the regional governments.

The 6etherlands

O$T - 6ational Healthcare ICT in5rastrctre

8$* is the 5utch national infrastructure for the e!change of data bet'een healthcare

providers. 8$* uses HL7 version messages and documents as its core mechanism for
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information e!change. *he initial specifications 'ere created in ##. *he 5utch &inistry of

Health is 'oring on a virtual national lectronic :atient $ecords (:$) 'hich 'ill enable

healthcare providers to share patient data. *his development taes place in close collaboration'ith ?ictiz, the ?ational %nformation and 6ommunication *echnology %nstitute for Healthcare.

?ictiz coordinates its efforts 'ith regard to the usage of HL7 version 'ith the volunteers of

HL7 the ?etherlands.

lmost all hospitals use HL7 version to support hospital-internal 'orflo's. 5%fact is beingused to support 'orflo's involving general practitioners (0:sB:6:s). 5%fact 'ill be slo'ly

replaced by HL7 version .

HL7 the ?etherlands

?ictiz

8$* 'hitepaper

a+istan

HLH - Health Life Horizon

HLH (a national proect) is carrying out at +chool of lectrical ngineering and 6omputer

+ciences of ?ational Aniversity of +cience and *echnology and is supported by 0ovt of :aistan'ith funds provided by ?ational %6* $5 und. HLH basic theme is to target health care

information e!change and interoperability using HL7 version . *hough the penetration and use

of HL7 in :aistan is lo'er than the countries lie A+ and that of urope. 4ut its getting

popularity among the staeholders in :aistan. HLH team put its tremendous efforts to developstate of the art HL7 version tools and technologies. lso they are continuously involved to

carry out research taing the development one step ahead. dditionally they organized and are

organizing a'areness seminars, meetings and 'orshops from time to time at various locationsin :aistan. HLH is collaborating 'ith several other reno'ned organizations from :aistan to be

part of this ourney. *hese efforts created a very good impression not only at national level but

also at international level. HLH *eam members regularly participated in HL7 international=oring 0roup &eetings and conferences for last t'o years. 8n 8ct 1, #1# HL7 %nternational

announced :aistan chapter formally at /th :lenary and =0& in 6ambridge A+. :aistan is

no' 7th affiliate of HL7 %nternational around the 'orld.HL7 :aistanis no' officially

authorized to give memberships to local organizations along 'ith other privileges liecertification, training etc.

8S

Lai+a

*he 6ertification 6ommission for Healthcare %nformation *echnology (66H%*)has developed

an open-source program called Laiato test H$ soft'are for compliance 'ith 66H%*interoperability standards.
http://www.hl7.nl/http://www.nictiz.nl/http://www.ringholm.de/docs/00980_en.htmhttp://www.hl7.org.pk/http://www.hl7.org.pk/http://www.hl7.org.pk/http://en.wikipedia.org/wiki/Certification_Commission_for_Healthcare_Information_Technologyhttp://en.wikipedia.org/wiki/Laika_(EHR_testing_framework)http://www.hl7.nl/http://www.nictiz.nl/http://www.ringholm.de/docs/00980_en.htmhttp://www.hl7.org.pk/http://en.wikipedia.org/wiki/Certification_Commission_for_Healthcare_Information_Technologyhttp://en.wikipedia.org/wiki/Laika_(EHR_testing_framework)


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HI

HL7@s initial involvement in the Health %nsurance :ortability and ccountability ct(H%:)

legislation began in 122C 'ith the formation of the ttachments special interest group tostandardize the supplemental information needed to support health care insurance, and othere-

commercetransactions. *he initial deliverable of this group 'as a set of si! recommended6laims ttachments for the ?otice of :roposed $ule &aing (?:$&) process. uture

attachment proects include, but are not limited to, Home Health, +illed ?ursing acility,durable medical euipment(5&), end stage renal disease(+$5), and :re-uthorization and

$eferrals. *he ttachment special interest group is responsible for implementing the

dministrative +implification provisions of H%: mandates, providing on-going support, andrepresenting HL7 in the 5esignated +tandards &aintenance 8rganization (5+&8) efforts. %ts

purpose is to encourage the use of HL7 for uniform implementation of this supplemental

information. *his +%0 coordinates industry input to produce and maintain guides for HL7messages that can stand alone or be embedded 'ithin?+% G1transactions.

Hrricane 9atrina

*he HL7 group oined forces 'ith the lectronic Health $ecord Iendors ssociation (H$I)

to assist patients in the aftermath ofHurricane Katrina. &embers of both organizations 'ere

actively 'oring on activities 'ith local, state 'ide and national agencies (including the5HH+and the 656) to provide solutions for those in the affected area.
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Health Level Seven(HL7)