What s New in HL7 W. Ed Hammond, PhD Director, Duke Center for Health Informatics FACMI, FAIMBE, FHL7, FIMIA Secretary, HL7; Chair-Emeritus, HL7
In the beginning HL7 s initial venture into creating standards was to support the necessary interfaces for developing a Hospital Information System from best of breed components. Version 2.n was the result. Segments containing data fields whose contents were defined by position and separated by delimiters. 2 3/14/2013
What came next? Influenced perhaps by the IEEE Medix effort, HL7 developed the Reference Information Model and proceeded to develop a modeldriven messaging standard Version 3.0. As part of that development, HL7 developed a Model Development Framework and introduced the DMIM, DIM, RMIM, and ultimately the v3 message. 3
Adding XML Attracted a group that was developing a XMLbased Patient Record Architecture which evolved into the Clinical Document Architecture (CDA) In a collaborative effort with ASTM, HL7 included ASTM s Continuity of Care Record into a CDA framework known as the Continuity of Care Document (CCD) 4
Expanding into other areas Efforts from the HHS and others lead to an expanded effort to develop the EHR Functional Model These effort has evolved into the PHR Functional Model and a series of Implementation Guides focused on various documents, reports, and diseases. The same groups also are developing functional profiles 5
Functional Profiles EHR Behavioral Health Functional Profile Child Health Functional Profile Clinical Research Functional Profile Pharmacist/Pharmacy Provider Functional Profile Records Management and Evidentiary Support Functional Profile EHR System Long Term Care Functional Profile EHR System Vital Records Functional Profile Public Health Functional Profile 6
Clinical Decision Support A Clinical Decision Support Work Group was added to develop standards for decision support. Some of this work had been developed elsewhere and was brought into HL7. The Arden Syntax came from G. Hripsak and others via ASTM to HL7 The Infobutton came from Jim Cimino and others GLIFF and GELLO came from the work of Bob Greenes and others 7
Regulatory Standards Collaborative work with CDISC, the FDA, and Pharma led to the development of regulatory standards Individual Case Safety Report Structured Product Labeling Common Products Model Annotated ECG 8
Another Collaborative Effort Working with ASC X12, HL7 developed first a messaging standard that evolved into a CDA for Claims attachment. 9
Horizons continued to expand Genomics Work Group The HL7 Clinical Genomics Pedigree Model is a data standard for transmitting family health histories between systems. This standard includes describing a patient s full pedigree with diseases and conditions, and the option to link genetic data and risk analysis. The model has the ability to transmit complete family history information for clinical decision support. 10
Clinical Interoperability Council In an effort to bring in the clinical community, the CIC was formed to reduce the barriers between the clinical community and the technical community developing the standards Result was a series of Domain Analyses Models and a new category of membership in HL7 the Healthcare Provider Member Additional efforts are being made to bring nurses into HL7 11
Domain Analysis Models Cardiovascular DAM Tuberculosis DAM Diabetes DAM Schizophrenic DAM CG -omics Domain Analysis Model Anesthesiology Others (Security, Trauma, Emergency Care, Major Depressive Disorder, ) 12
Service Oriented Architecture The HL7 SOA-Aware Interoperability Framework provides an Interoperability Framework, i.e. a set of constructs, best practices, processes, etc. that enable HL7 specifications to achieve crossspecification consistency and coherency irrespective of the chosen interoperability paradigm (messages, documents, or services). SAIF consists of four core "frameworks": (1) Information (including RIM, data types, vocabulary bindings, etc.), (2) Behavior (subsuming the existing Dynamic Model), (3) Enterprise Conformance and Compliance (including HL7's existing Implementation and Conformance standards), and (4) Governance. 13
CCD to ASCII Blue Button Transform tool The Blue Button, developed by the U.S. Veterans Administration (VA) in collaboration with the U.S. Centers for Medicare and Medicaid Services (CMS), allows people to access and download their personal health information as an ASCII text file or PDF document simply by clicking on the Blue Button. The HL7 CCD to BlueButton Transformation Tool is a set of xslt transforms that enable the transformation of CCD, and Consolidated CDA CCD (DSTU release 1.0) files into a Blue Button text file that closely resembles the VA s own Blue Button text file extracts. 14
What s new Mobile Health Work Group Created September 2012 Mission create and promote health technology Standards and Frameworks for mobile health Much activity including a newsletter New people and new leadership 15
Mobile Health Work Group Created subgroups Definition, scope and context Education and communication External standards gap analysis Low to medium income countries Security of mobile devices Standards Gap analysis PHR/Mobile Use case development/scenarios 16
Clinical Quality Work Group The mission of the clinical quality workgroup is to create and maintain information technology standards in support of improving health care quality, including clinical care, and to foster collaboration between quality measurement, outcomes and improvement stakeholders 17
Fast Healthcare Interoperability Resources (FHIR) FIHR defines a set of "Resources" that represent granular clinical concepts. The resources can be managed in isolation, or aggregated into complex documents. The simple direct definitions of the resources are based on thorough requirements gathering, formal analysis and extensive crossmapping to other relevant standards. 18
RIM mapping to OWL The OWL 2 Web Ontology Language is an ontology language for the Semantic Web with formally defined meaning. OWL 2 ontologies provide classes, properties, individuals, and data values and are stored as Semantic Web documents. OWL 2 ontologies can be used along with information written in RDF, and OWL 2 ontologies themselves are primarily exchanged as RDF documents. 19
Current Drivers Omics Biomarkers Analytics Clinical Decision Support Learning Health System Phenotype Suites Big Data Mobile Health Consumer Engagement GIS + Environment Data Capture Usability Cloud Computing Social Networking Privacy and Security 20 Hammond - NCHICA
To the future Standards are a necessary but not sufficient requirement to support health-related HIT. Standards will continue to evolve into the future. HL7 will continue to create those standards. 21