HL7 Development Who Does it and How Do They Do It?
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Transcript of HL7 Development Who Does it and How Do They Do It?
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HL7 DevelopmentWho Does it
and How Do They Do It?
Shari DworkinCIHI
June 7, 2001SHIN HL7 Workshop
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Presentation Overview
• Who - The Movers and Shakers
– Membership– Working Group– Collaboration
• How - The Evolution of the Standard
– Balloting– v2.x Development– v3 Development– Publications
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Who - The Movers and Shakers
MembershipWorking GroupCollaboration
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Who are Members of HL7 (.org)• 450 Organizational Members, 2131
Members of HL7 (US) •946 Vendors•641 Providers•256 Consultants•119 Non Profits•13 Payors•18 Pharmacy•60 Affiliates•24 Students•54 Unknown
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What Do HL7 Members Do?
• Members develop the standard
– Participation in Working Group Meetings
– Voting on HL7 Ballots– Providing input on listservers and
teleconferences– Informing HL7 Canada of issues or
recommendations regarding the HL7s standard
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What is an HL7 Working Group?• The Working Group is the name that
shall be given to those activities related to the production and use of the Standard.
• The Working Group consists of the set of individual Technical Committees and Special Interest Groups which are focused on particular HL7 protocol specification issues and areas.
Taken from HL7 Bylaws
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Key to HL7 - The Working Group
• Draws equally from providers, software vendors, and consultants (interested parties)
• Group sets aside their individual interests, rolls up their sleeves and collaborates to get the tough work done
• Most discussions stem from– violent agreement, but failure to see the agreement– passionate beliefs
• Strong facilitators in the working group that help to resolve issues
Hard Work = 12 hours x 5 days x 3 general meetings / year +
12 hours x 3 days x 3 harmonization meetings / year +Active electronic collaboration in between
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HL7 TCs and SIGs• Technical Committees (TCs)
– Responsible for the development and maintenance of a section of the standard (usually a chapter)
– Exceptions (Vocabulary, Education, Marketing, Publishing, and International Affiliates)
• Special Interest Groups (SIGs)– Represent a variety of major initiatives in
healthcare– Work in conjunction with TCs to advance the
efforts of HL7
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HL7 (.org) Technical Committees
• CCOW• Clinical Decision Support • Control / Query• Data Warehousing• Education• Implementation• International Affiliates• Marketing• Medical Records / Info. Management• Modeling and Methodology
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HL7 (.org) Technical Committees (cont’d)
• Orders / Observations• Pt. Admin. / Financial Management• Patient Care• Personnel Management• Publishing• Scheduling and Logistics• Structured Documents• Vocabulary
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HL7 (.org) Special Interest Groups (SIGs)
• Arden Syntax• Attachments• Blood Bank• Clinical Guidelines• Clinical Trials• Community-Based Health Services• Conformance• Government Projects• Image Management• Lab Automation
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HL7 (.org) Special Interest Groups (SIGs) - cont’d
• Medication• Patient/Provider Messaging• Security and Accountability• Templates• XML
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HL7 (.org) Works with Other Key Stakeholders
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Collaboration Among Standard Development Organizations
• X12 and HL7 - Claims Attachment and Data Modeling
• DICOM WG20 and HL7 Imaging SIG - Joint Image Management SIG, IHE Demo
• IEEE and HL7 - Merged Activities• HL7 and CEN - Message Development
Framework, RIM and XMl syntax• HL7 and ISO TC215 - Message
Development Framework
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So… How does all this lead to a new standard?
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How - The Evolution of the Standard
Ballotingv2.x Developmentv3 Development
Publications
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Balloting• HL7 (.org) is an ANSI approved
Standards Development Organization
• According to ANSI rules, this means that…
– All new versions of the HL7 standard must undergo a balloting process that is open to all members
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Balloting - The 5Ws• HOW does something go to ballot?
– TCs propose new and/or improved content for the standard to HL7 Head Quarters
• WHO votes?– HL7 (.org) have 1 vote– HL7 International Affiliates have up to
8 votes• WHEN do ballots take place?
– 120 day cycle, Three cycles per year
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Balloting - The 5Ws (continued)
• WHERE can you vote?– Online - Ballots are available on the
HL7 (.org) site and the HL7 Canada site
• WHY would want to vote?– To influence the standard
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Balloting Procedures
• Two Rounds of Balloting
– Technical Committee Ballot
– Membership Level Ballot
• All negative ballots must be addressed
• According to ANSI rules, 90% of ballots must be affirmative
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HL7 v2.x Development
• New and/or improved content came from
TCs and SIGs
• Members wrote specific chapters of the
standard without considerations from
other TCs or SIGs
• Content was added as needed, and
under the discretion of the TC or SIG
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Limitations of Version 2.x
• No explicit information model• Events not tightly coupled to use cases• Need for controlled vocabularies• No explicit support for security functions• Optionality is troublesome• Lack of harmonization between chapter
domains• Expansion of the standard led to
incoherence
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Versions 2.xStrengths
– broad functional coverage– highly adaptable
• IS environments differ•system capabilities
variations– vocabulary independent– least common denominator
technological base
Difficulties– broad functional coverage– highly adaptable
•“Seen one? Seen one.”•vendor capability
mismatch– vocabulary independent– least common denominator
technological base
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HL7 Version 3 -
• HL7 “grew up” on the Version 2 series, culminating in 2.4
• But now, HL7 is into Version 3– How is it different?– Why is it important?
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HL7 v3 Development - We do it with Models!
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Version 3 Goals
• Provide a Message Development Framework based on modeling
• Improve clarity and precision of specification
• Improve adaptability of standards to change
• Work with other standards initiatives, such as DICOM
• Begin to approach “plug and play”
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Benefits of V3 to HL7
• Reduces optionality: results in more specific messages
• Uncovers hidden assumptions about application boundaries (for everything there is a reason)
• Facilitates defining clear, fine-grained, conformance claims
• Allows for multiple implementation specifications (XML, CORBA, etc..)
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HL7 Version 3 Development Approach
1. Define a consensus reference information model (RIM) that defines the data of interest in the healthcare domain.
2. Assemble the terminology and data types necessary to express the attributes of the RIM
3. Apply the model, vocabulary and types to: messages, patient record DTDs, medical logic modules, component specifications, etc.
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4. For any particular application, draw from the RIM to construct an abstract message structure - the Hierarchical Message Description (HMD)
5. For any particular implementation technology, HL7 will define an implementation technology specification (ITS) for mapping the HMD to that technology.
6. When the message (or equivalent) is sent, the HMD is used to marshal the data, and the ITS is used to format the data for communication.
HL7 Version 3 Development Approach
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HL7 Modeling
Abstractions:ActivitiesActivities(Use Case (Use Case
Model)Model)
Dispense Medications
Manage Care
Perform Lab Tests
Review Utilization
Objects Objects (Information (Information
Model)Model)
Account Patient Provider Encounter Order
Communication Communication (Interaction and (Interaction and Message Models)Message Models)
ADT Pharmacy
HL7 message
Finance
HAHALL
HL7 message
Version 2.x focused its energies at the communication level and covered the other abstractions only loosely in the specifications.
By demanding analysis of the requirements and information content, Version 3 assures consistency in and enhances the value of the resulting products.
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Use Case Model
Information Model
Interaction Model
2-nd Order 1 choice of 0-n Drug 0-1 Nursing
Message Specification
• Captures healthcare requirements• Defines scope for TSC approval
• Specifies data and its semantics• Specifies major state transitions• Specifies vocabulary for domains
• Defines information flows• Defines communication roles• Forms basis for conformance claims
• Defines message contents• Apply constraints to the
information model and vocabulary
HL7 Version 3 Models and Specifications
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Reference Model RepositoryReference Model Repository
RequirementsRequirementsAnalysisAnalysis
Use CaseUse CaseModelModel(UCM)(UCM)
DomainDomainAnalysisAnalysis
Information Information Model &Model &
VocabularyVocabulary(RIM)(RIM)
AnalysisAnalysis DesignDesign
InteractionInteractionDesignDesign
InteractionInteractionModelModel(IM)(IM)
MessageMessageDesignDesign
HierarchicalHierarchicalMessageMessage
DescriptionsDescriptions(HMD)(HMD)
ApplicationApplication
2-nd Order2-nd Order 1 choice of1 choice of 0-n Drug0-n Drug
0-1 Nursing0-1 Nursing
Medical logicMedical logic
VariableVariabledefinition for definition for Arden syntaxArden syntax
(AVD)(AVD)
data:data:location_of_actionlocation_of_action := READ LAST := READ LAST MPSLOC ; MPSLOC ; ‘ ‘ {patient{patient location} location}
DocumentsDocuments
Document Document Types forTypes forHL7 PRAHL7 PRA
(DTD)(DTD)
<!ENTITY %DT_MPSLOC<!ENTITY %DT_MPSLOC“MPSLOC.id,“MPSLOC.id, MPSLOC.name?, MPSLOC.name?, MPSLOC.addr?, MPSLOC.addr?, MPSLOC.phon?, MPSLOC.phon?, MPSLOC.emlAdr?"> MPSLOC.emlAdr?">
MessagingMessaging
Message TypesMessage Typesfor use with for use with
XML, ER7, etcXML, ER7, etc(MET)(MET)
TYPE MPSLOC TYPE MPSLOC CONTAINS {CONTAINS {id[id].TYPE IIDid[id].TYPE IIDnm[name].TYPE STnm[name].TYPE STad[addr].TYPE XADad[addr].TYPE XADph[phon].TYPE XTN ph[phon].TYPE XTN email_addressemail_address [emlAdr].TYPE XTN [emlAdr].TYPE XTN}}
HL7 V3 Message Development Lifecycle
C Code c Codea artb bluec color
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How do we get to Version 3?
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v3 Strategy• Board appointed V3 steering committee
– Woody Beeler (Chair), Wes Rishel, Abdul-Malik Shakir, Mark Shafarman, W. Ed Hammond
• Focus more working group time on Version 3– One day on Version 2.X– 4 days on Version 3
• Emphasize Version 2.x XML encoding for early adopters• Move quickly on first V3 products:
– CDA (Clinical Document Architecture) (Unanimous Approval)
– Version 3 data types– V3 data type XML ITS (Implementable Technology
Specification)
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Old and new will coexist.• How will transition happen?
– Never touch a running system!– HL7 v2.x versions will be operational for an
extended transition period (5 to 10 years)– HL7 v2.x will continue to be maintained for
errors and clarification– new features will only go into new versions of
v2 and HL7 v3• New implementations may use HL7 v3 once it
has been balloted• V2 and v3 interfaces will coexist for the extended
transition period.
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HL7 v3 Balloting
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Legend:
Normative: Content is balloted by general membership and is considered structural component of HL7 standard. Negative ballots MUST be resolved.
Reference: Content is harmonized during HL7 meetings or approved by the HL7 Board. It is not subject to ballot acceptance
Informative: Content is balloted by general membership; however, it is not considered to be a structural part of the standard, only supporting information.
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HL7 3.0 Core Publication Structure
V3 Backbone
•Welcome•Introduction•V3 Principles•Quick Start•Getting Started•Glossary
Message Ballot
Framework
ImplementableTechnology
Specifications
XML
Data Types
Data TypesPart I
Part II
Sub-sectionsSection
InfrastructureManagement
Sub-sectionsSection
AdministrativeManagement
Sub-sectionsSection
Health & ClinicalManagement
Vocabulary
Normative
Reference
Informative
Legend:
Reference Information
Model State Machines
Literary Expression
RIM Diagram
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V3 BackboneEquivalent to the 2.x Chapter 1
– Introduction
– Principles
– Managing message development
– Quick Start
– Getting Started
– Glossary
– Links to all other documents & content.
V3 Backbone
•Welcome•Introduction•Quick Start•Getting Started•Glossary
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HL7 3.0 Section Publication Structure
Sub-sections Domain
CMET
Storyboard
Application Roles
Interaction Category
R-MIM HMD Message Type
Interaction
Trigger Event
R-MIM HMD
StoryboardExamples
Message Type
Normative
Reference
Informative
Legend:
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Committee Deliverables
Domain
Storyboard
Application Roles
Interaction Category
R-MIM
Interaction
Trigger Event
R-MIM HMD
StoryboardExamples
Message Type
Design RepositoryVisio files
Domain MDB
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Publication FormatPublication in two final formats:• PDF
– appropriate for printing, submission to ANSII and off-line viewing
– Each document available as ‘stand alone’ or will be inter-linked *
• HTML– Appropriate for viewing online– Each document can be downloaded separately *
* Backbone is required
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Publication Schedule• June 15th – Deadline for non-Section content• July 9th – Deadline for Section content• July 9th to 13th – Ann Arbour ‘tiger team’ meeting to
convert and test content• July 17th to 19th – Indianapolis meeting to review
content with TCs• August 8th – Committee Ballot opens• October - Reconciliation of negative Ballots• January - Membership Level Ballot• May - HL7 Version 3 Approved Standard
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Questions?