Health Level 7

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The Reference Information Model (RIM) is an important component of the HL7 v3.0 standard and is based on XML.

Health Level Seven (HL7) is an international non-profit volunteer-based organization involved with the development of international health care informatics interoperability standards.[1] The HL7 community consists of health care experts and information scientists collaborating to create standards for the exchange, management, and integration of electronic health care information.

The term "HL7" is also used to refer to some of the specific standards created by the organization (e.g., HL7 v2.x, v3.0, HL7 RIM).[2] HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.[3]

History

The International Organization for Standardization (ISO) got involved with standardizing network exchanges of data between computers around 1979, creating the Open Systems Interconnect (OSI) standards model. These formal OSI standards ranged across seven levels, from OSI Level 1 (physical layer, e.g. communication over coaxial cable) to OSI Level 7 (application layer, e.g. communication between clinical software). By 1981, researchers at University of California - San Francisco had created a proprietary protocol that unbeknownst to them at the time fit under the OSI Level 7 model. The protocol was developed for clinical purposes such that "computers exchanged several core messages, including the synchronization of patient admission-discharge-transfer information, orders from clinical areas, and the display of textual results to the clinical areas."[4]

By 1985, Simborg Systems (which developed hospital information systems) sought to have a non-proprietary protocol created because "standardization efforts at the time was either fragmented, in a different direction or with a different scope."[4] This led to a push to create a new standards organization, with initial meetings occurring at the end of March 1987. The meetings produced the term "HL7" and prompted a non-profit organization to be created, eventually known as Health Level Seven International. Version 1.0 of the HL7 specification was released in October 1987. The direction of HL7 was largely led by Simborg Systems; however, with greater practical use seen in furthering the protocol and non-profit, the first non-Simborg Systems chairperson, Ed Hammond, took the reigns in 1989.[4] By June 1990, Version 2.1 was published and included mechanisms for results reporting and billing. By the early- to mid-1990s news of HL7 was beginning to spread to international clinical sectors, particularly parts of Europe, including Netherlands, Germany, Canada, Japan, Australia, and the United Kingdom.[4][5]

In June 1994 the American National Standards Institute (ANSI) awarded Health Level 7 International status as an accredited standards developer. Version 2.2 became an official ANSI standard in February 1996. HL7 had roughly 1,700 members from various health care industries around the globe by the late 1990s.[5]

Version 3.0 of the HL7 standard was released in late 2005, which internationalized it and made it more consistent and precise.[6]

Standards

In total HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards (e.g., HL7 CCOW), and messaging standards (e.g., 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.[7] Business use of the HL7 standards requires a paid organizational membership in HL7, Inc. HL7 members can access standards for free, and non-members can buy the standards from HL7 or ANSI.

HL7 v2.x and 3.x are the primary standards from the organization. However, a few other standards associated with HL7 include the following examples.

Reference Information Model (RIM)

The Reference Information Model (RIM) is an important component of the HL7 Version 3 standard. 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.[8] The standard is accepted as official by the ISO as ISO/HL7 21731; the original was approved in 2006, with a revised version appearing in 2014.[9]

Clinical Document Architecture (CDA)

The Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure, and semantics of clinical documents for exchange.[10] The standard is accepted as official by the ISO as ISO/HL7 27932; the most current version comes from 2009.[11]

Clinical Context Object Workgroup (CCOW)

The Clinical Context Object Workgroup (CCOW) family of standards are designed to enable disparate applications to share user context and patient context in real-time, particularly at the user-interface level. CCOW implementations typically require a CCOW vault system to manage user security between applications. The primary standard under CCOW is the Context Management Specifications (CCOW), which "serves as the basis for ensuring secure and consistent access to patient information from heterogeneous sources."[12] This standard is accepted as official by ANSI as ANSI/HL7 CMS V1.6.

Further reading


References

  1. "About Health Level Seven International". Health Level Seven International. http://www.hl7.org/about/index.cfm. Retrieved 02 March 2012. 
  2. "Healthcare Interoperability Glossary". Corepoint Health. http://www.corepointhealth.com/resource-center/healthcare-interoperability-glossary#H. Retrieved 02 March 2012. 
  3. Shaver, Dave. "The HL7 Evolution - Comparing HL7 Versions 2 and 3" (PDF). Corepoint Health. http://www.corepointhealth.com/sites/default/files/whitepapers/hl7-v2-v3-evolution.pdf. Retrieved 02 March 2012. 
  4. 4.0 4.1 4.2 4.3 Spronk, René (5 September 2014). "The Early History of Health Level 7". Ringholm BV. http://www.ringholm.com/docs/the_early_history_of_health_level_7_HL7.htm. Retrieved 17 February 2015. 
  5. 5.0 5.1 Di Lima, Sara N.; Johns, Lisa T.; Liebler, Joan Gratto (1998). A Practical Introduction to Health Information Management. Jones & Bartlett Learning. ISBN 9780834212312. https://books.google.com/books?id=vX_zVaMlR8sC&pg=PA90. Retrieved 17 February 2015. 
  6. Shaver,Dave (17 February 2015). "What Is HL7 Version 3 or V3?". HL7 Standards. http://www.hl7standards.com/blog/2006/10/05/what-is-hl7-version-3-or-v3/. 
  7. Kim, Katherine (July 2005). "Creating Clinical Data Standards in Health Care: Five Case Studies" (PDF). California HealthCare Foundation. http://www.kathykim.com/sitebuildercontent/sitebuilderfiles/ClinicalDataStandardsInHealthCare.pdf. Retrieved 02 March 2012. 
  8. "HL7 Reference Information Model". Health Level 7 International. http://www.hl7.org/implement/standards/rim.cfm. Retrieved 17 February 2015. 
  9. "ISO/HL7 21731:2006". ISO. http://www.iso.org/iso/home/store/catalogue_ics/catalogue_detail_ics.htm?csnumber=40399. Retrieved 17 February 2015. 
  10. Boone, Keith W. (2011). The CDA Book. Springer Science & Business Media. pp. 17–21. http://books.google.com/books?id=rwa6DDB4jY8C&pg=PA17. Retrieved 17 February 2015. 
  11. "ISO/HL7 27932:2009". ISO. http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=44429. Retrieved 17 February 2015. 
  12. "Product CCOW". HL7 Wiki. Health Level 7 International. 27 October 2010. http://wiki.hl7.org/index.php?title=Product_CCOW. Retrieved 17 February 2015.