Health Level 7

Health Level Seven (HL7), is an all-volunteer, not-for-profit organization involved in development of international healthcare standards. %u201CHL7%u201D is also used to refer to some of the specific standards created by the organization (i.e. HL7 v2.x, v3.0, HL7 RIM etc.).

HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing and retrieval of electronic health information. The standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.[citation needed]

Organization

HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information.[citation needed]. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all.

It collaborates with other standards development organizations and national and international sanctioning bodies (e.g. ANSI and ISO), in both the healthcare and information infrastructure domains to promote the use of supportive and compatible standards. HL7 collaborates with healthcare information technology users to ensure that HL7 standards meet real-world requirements, and that appropriate standards development efforts are initiated by HL7 to meet emergent requirements.

The HL7 community is organized in the form of a global organization (Health Level Seven, Inc.) and country-specific affiliate organizations.

About 45% of the global membership (of either HL7 Inc. or an HL7 affiliate) is located in Europe, 35% in North America, 15% in Asia-Oceania and 5% elsewhere. [1].

The organizational structure of HL7 Inc. is as follows:

  • The organization is managed by a Board of Directors, which comprises eight elected positions and three appointed positions.
  • Members of HL7 are known collectively as %u201CThe Working Group%u201D. The Working Group is responsible for defining the HL7 standard protocol and is composed of Standing Administrative Committees, Special Interest Groups, and Technical Committees.
    • Standing Administrative committees focus on organizational or promotional activities, such as Education, Implementation, Marketing, Outreach Committee for Clinical Research, Publishing and Performance Improvement and Tooling.
    • Special interest groups serve as a test bed for exploring new areas that may need coverage in HL7%u2019s published standards, such as Clinical Genomics, Clinical Guidelines, Community Based Health Services, etc.
    • Technical committees are directly responsible for the content of the Standards, framing the actual language of the specifications.

HL7 Standards

Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or "interface") when they receive new information but not all do so. HL7 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can do this. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information. Theoretically, this ability to exchange information should help to minimize the tendency for medical care to be geographically isolated and highly variable.

HL7 develops Conceptual Standards (i.e. HL7 RIM), Document Standards (i.e. HL7 CDA), Application Standards (i.e. HL7 CCOW) and Messaging Standards (i.e. HL7 v2.x and v3.0). Messaging standards are particularly important because they define how information is packaged and communicated from one party to another. Such standards set the language, structure and data types required for seamless integration from one system to another [1].

HL7 encompasses the complete life cycle of a standards specification including the development, adoption, market recognition, utilization, and adherence.[citation needed] Access to the HL7 standards requires paid membership of HL7 Inc. or one of its affiliates.

Version 2.x

V2.x Messaging

The HL7 version 2 standard has the aim to support hospital workflows. Originally created in 1987 it defines a series of electronic messages to support administrative, logistical, financial as well as clinical processes. Since 1987 the standard has been updated regularly, resulting in versions 2.1, 2.2, 2.3, 2.3.1, 2.4, 2.5, 2.5.1 and 2.6. Collectively these versions are known as version 2.x. The v2.x standards are backwards compatible, i.e. a message based on version 2.3 will be understood by an application that supports version 2.6.

HL7 v2.x mostly uses a proprietary (non-XML) encoding syntax based on delimiters.

HL7 v2.x has allowed for the interoperability between electronic Patient Administration Systems (PAS), Electronic Practice Management (EPM) systems, Laboratory Information Systems (LIS), Dietary, Pharmacy and Billing systems as well as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems. Currently, HL7%u2019s v2.x messaging standard is supported by every major medical information systems vendor in the United States [2].

Version 3

RIM

The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process and an essential part of the HL7 V3 development methodology. RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages. The RIM is essential to increasing precision and reducing implementation costs. Models are available.

HL7 Development Framework

The HL7 Version 3 Development Framework (HDF) is a continuously evolving process that seeks to develop specifications that facilitate interoperability between healthcare systems. The HL7 RIM, vocabulary specifications, and model-driven process of analysis and design combine to make HL7 Version 3 one methodology for development of consensus-based standards for healthcare information system interoperability. The HDF is the most current rendition of the HL7 V3 development methodology.

The HDF documents the processes, tools, actors, rules, and artifacts relevant to development of all HL7 standard specifications, not just messaging. Eventually, the HDF will encompass all of the HL7 standard specifications, including any new standards resulting from analysis of electronic health record architectures and requirements.

V3 Messaging

The HL7 version 3 standard has the aim to support any and all healthcare workflows. Development of version 3 started around 1995, resulting in an initial standard publication in 2005. The v3 standard, as opposed to version 2, is based on a formal methodology (the HDF) and object oriented principles.

As part of Version 3, the HL7 Vocabulary Technical Committee developed methods that allow HL7 specifications to draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work assures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using.

V3 Clinical Document Architecture

The HL7 version 3 Clinical Document Architecture allows for a common format for exchanging a patient's medical record between different hospital systems or even different hospitals. This HL7 standard has come to serve as a foundation for the universal electronic medical record.[citation needed]

Arden syntax

The Arden syntax is a language for encoding medical knowledge. HL7 adopted and oversees the standard beginning with Arden syntax 2.0. These Medical Logic Modules (MLMs) are used in the clinical setting as they can contain sufficient knowledge to make single medical decisions.[citation needed] They can produce alerts, diagnoses, interpretations, and contain a quality assurance function and administrative support. An MLM must be run on a computer that meets the minimum system requirements and has the correct program installed. Once this is provided, the MLM can give advice when and where it is needed.

MLLP

A large portion of HL7 messaging is transported by MLLP. [3][4]

CCOW

Specification of components for context management , See: CCOW

Functional EHR and PHR specifications

Functional specifications for an electronic health record

Country specific aspects

Finland

National IT services for healthcare

The Social Insurance Institution of Finland is building a national ePrescribing and patient record archival service based on HL7 CDA R2 and V3 messages. Phased deployment is scheduled for 2008-2011. Version 2 messaging is widely deployed in most hospitals and healthcare centers. CDA R1 is used in sharing patient records on a regional level.

UK

English NHS

The English National Health Service (NHS) uses HL7 version 3 messages as well as version 3 CDA documents for the exchange of clinical data between healthcare providers. Version 2 is also widely used within providers.

    USA

    HIPAA

    HL7%u2019s initial involvement in the Health Insurance Portability and Accountability Act (HIPAA) legislation began in 1996 with the formation of the Attachments special interest group to standardize the supplemental information needed to support health care insurance, and other e-commerce transactions. The initial deliverable of this group was six recommended Claims Attachments for the Notice of Proposed Rule Making (NPRM) process. Future attachment projects include, but are not limited to, Home Health, Skilled Nursing Facility, durable medical equipment (DME), end stage renal disease (ESRD), and Pre-Authorization and Referrals. The Attachment special interest group has the responsibility for the implementation of the Administrative Simplification provisions of HIPAA mandates, providing on-going support, and representing HL7 in the HIPAA Designated Standards Maintenance Organization (DSMO)efforts. Its purpose is to encourage the use of HL7 for uniform implementation of this supplemental information. This SIG coordinates industry input to produce and maintain guides for HL7 messages that can stand alone or be embedded within ASC X12N transactions.

    Hurricane Katrina

    The HL7 group joined forces with the Electronic Health Record Vendors Association (EHRVA) to assist patients in the aftermath of Hurricane Katrina. With the single largest pool of expertise in connecting healthcare information systems[citation needed], these groups were actively working on activities with local, state wide and national agencies (including the DHHS and the CDC) to provide solutions for those in the affected area.

      Open source tools

      There are a number of OSS based tools that can foster worldwide adoption of the HL7 standards

        Commercial Tools

        Additionally HL7 has been embraced and implemented by many commercial software vendors.

        		  


         
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