HL7 NLM EHR Contract Phase I

alschuler.spinosa CommerceNet

Webify

Liora Alschuler liora@the-word-electric.com

RFQ: Develop Phase I EHR Query-Response Message Set

The system components will be assembled from existing open source implementations, the initial components of which are: Transport/encryption/data integrity - candidate

CDC PHIN-MS Phase I EHR Query-Response Message Set-

developed within NLM project by modifying existing messages

Contract: how quick & how dirty is quick & dirty?

5 weeks “120” hours Lightweight Find and retrieve baseline, human-readable

information

Objectives How easy can we make it to request and receive

human-readable information? What HL7 components are available?

Identify Implement

Major deliverables: Operational prototype, proof-of-concept software and

implementation guide Report on what works as-is, what requires modification,

constraint or extension, where gaps lie and recommendations on best direction moving forward

Input into the standards development and refinement process

Scenario:

Client: requestor, low-end, small office, low-cost, simple, web-enabled

Server: data source, high-end, large facility, more sophisticated technically

Client can request, receive documents; Server can respond to query, supply documents

Server backend database has mix of data sources including non-CDA reports, CDA, V2 and V3 lab results

Primary components CDC’s Version 2 PHINMS messaging system MS SQL Server database development license

used locally by CommerceNet, other participants, including HL7, to supply own license

Version 3 query/response messages: Shared Messages, Medical Records

Utility to transform unstructured documents into CDA R1 (non-XML body): Webify

Client application for query definition and viewing of retrieved documents: Webify

Style sheet for displaying CDA R1 documents: adapted from one developed for CDA Claims Attachments (ASIG stylesheet)

Final report

Infrastructure Messages Data

Final report: Infrastructure

PHIN-MS Required addition of asp message handler

CDC had not implemented message handler talking to asp page; this was in the functional spec, but undocumented, so it took a bit of time

Now developed and working, will be deliverable back to CDC

Input into standards process: Should review with security and accountability

SIG

Final report: Messaging Candidate areas of V3: V3 messages to be considered: (from RFQ) Transport Specifications: ebXML, Release 1 DSTU - Pending Board Approval Webservices SOAP/WSDL Profile, Release 1 DSTU - Pending Board Approval MLLP, Release 1 ( Membership #1 ) Common Domains: Shared Messages: Act Status Topic Act Reference Topic QUMT (document query and query response) Infrastructure Management: Transmission Infrastructure: Generic Message Transmission Polling Message Transmission Infrastructure Management: Query Infrastructure: Query Control Act Topic Infrastructure Management: Master File/Registry Infrastructure: Master File Registry Topic Health and Clinical Management: Clinical Document Architecture Laboratory: Result Topic Medical Records: Document Topic RCMR (document request & retrieve) Public Health Reporting: ICSR Topic other, as desired (eg, Pharmacy, Blood Bank and so on)

Final report: Messaging

Input into standards process: Query messages: QUMT (document query and response)

-- CQ/OO/MRM: Review query parameters Review document parameters in query response

Retrieve messages: RCMR (document request and retrieve) – MRM/SDTC Accelerate creation of MRM query-by-parameter message Future consideration: query-by-example (new MRM/SDTC

project), constrained for implementation Promote use of MRM retrieve messages, possibly open

issue with OO as well

Final report: Clinical content

4 types of native data format: CDA

Henry Levin 7th (Release 1 Membership ballot sample) MS Word

CCR sample by Dr. Tom Sullivan Transform to CDA

V2 lab result Result sample provided by Mike Henderson Transform to CDA

V3 lab result Result in development (HIMSS 2004 as basis)

Final report: Clinical content

Input into standards process: CDA R1 sample: no issues Word to CDA: no issues V2 lab to CDA: rich source of issues to bring

forward within SDTC, in conjunction with O&O

Lab2CDA Transformation Issues

1. document ID: for every transform or every source document?

2. timestamp: time of source report creation? transmission? time of transform?

3. document type code: no LOINC scale=doc

4. provider: CDA assumes role in encounter; relationship to lab unclear

5. referring physician: anticipates an encounter

6. lab tech: no such role

7. order status: no such status

8. authentication: who is the authenticator?

Final report: clinical content Input into standards process:

CDA R1 sample: no issues Word to CDA (show): no issues V2 lab to CDA: rich source of issues to bring

forward within SDTC & O&O, many resolved in R2

V3 lab to CDA: in progress… input to O&O: Sample generation non-trivial because in active

development Cross-enterprise interaction modeling an incremental

challenge beyond V2 Schema generation complex (multiple CMETs) Sample available from HIMSS demo 2004 courtesy

Epic systems

Functional description Client: Invoke Send Query GUI, enter query parameters

(patient ID; optional: document type, provider, date range) Completed query, packaged in PHINMS and sent to Server. Server unpacks query, searches for corresponding artifacts,

formats response per guidelines, and sends response to Client listing matching data.

Client (requesting system) receives response, unpacks message, and renders response as HTML list in browser.

User selects one or more records to retrieve, sends request to Server.

Server unpacks request, identifies records to be retrieved; if needed, transforms them to CDA R1, packages in message and sends back to Client.

One or more documents received, can be displayed by Client using CDA R1 style sheet on Client java-enabled web browser.

Client Server

Client Sends HL7 Query

Server gets data from db and creates a HL7 V3 response

Server sends HL7 Response with a list of document metadata

Client parses HL7 V3 response and displays it on screen

Client Sends HL7 Query with specific document ID Server transforms/gets CDA document

from db and creates a HL7 V3 response

Server sends HL7 Response with a CDA document

Client parses CDA document response and displays it on screen

Do you have a referral for

Zsazsa from June ’03?

patientID=x123docType=LOINCxxxdate=YYYYmmDD

Yes, several

I’ll take that one

Okay, here it is

Thanks!

Application overview

Requesting a document

Showing what’s available

… and delivery

CDA Creation and Database Insertion

For More Information

Contact for technical InfoGary Griffin

Technical Consultant

Rainbow Builders Intl

RainbowBuilder@comcast.net Downloads

Phase I Deliverable (2c) - Implementation Guide

http://hl7.org/nlmcontract/ehrfiles.cfm

Thank you!

Questions?