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HL7 Version 3 at NCICB Overview
Session Details
Introduction
Reference Information Model (RIM)
HL7 Modeling Conventions
HL7 Process & Artifacts, Vocabulary & Data Types
HL7 Version 3 at NCI
Web Resources
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Session Details
Target Audience:– Developers and Analysts– Adopters
Prerequisites:– Modeling concepts
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Session Details:
Presenters and Participants
<Presenter’s name here>
Who is in attendance?– Name– Title– Cancer Center– Reason for Attending
Note:
This training can also be used as a self-paced training. (See notes for each slide)
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Session Details:Training Objectives
Objectives of this training are to:– Provide an overview of HL7 version 3– Define terms and concepts used in HL7– Describe the HL7 modeling methodology– Introduce reason for HL7 version 3 at NCICB
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Introduction
In this section, we will:– Introduce the HL7 organization and the version 3 standard– Discuss the goal of HL7
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Introduction:
What is HL7?
Heath Level Seven (HL7) is an ANSI-accredited Standards Developing Organization (SDO) operating in healthcare arena
Provides standards for data exchange to allow interoperability between healthcare information systems
HL7 focuses on the clinical and administrative data domains
It is a not-for-profit organization made up of volunteers – providers, payers, vendors, government
Key goal is syntactic and semantic interoperability
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Introduction:
4 Pillars of Semantic Interoperability
The 4 pillars of semantic interoperability are:
1. A common Reference Information Model (RIM) spanning the entire clinical, administrative and financial healthcare universe
2. A well-defined and tool-supported process for deriving data exchange specifications ("messages") from the RIM
3. A formal and robust Data Type Specification upon which to ground the RIM
4. A formal methodology for binding concept-based terminologies to RIM attributes.
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Reference Information Model (RIM)
In this section, we will:– Discuss the modeling concepts used in HL7 Version 3– Describe the Backbone Classes of the HL7 RIM
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Reference Information Model (RIM):
Overview
Reference Information Model (RIM):
Follows object oriented developmental methodology based on a UML model
The fundamental model from which all v3 messages are derived is referred to as the Reference Information Model (RIM)
The RIM is a generic, abstract model that expresses the information content of all the areas of healthcare
Defines all the information from which the data content of HL7 messages are drawn
Forms a shared view of the healthcare domain and is used across all HL7 messages independent of message structure
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Reference Information Model (RIM):
Backbone Classes
A physical thing, group of physical things or an organization capable of participating in Acts, while in a role.
A physical thing, group of physical things or an organization capable of participating in Acts, while in a role.
A record of something that is being done, has been done, can be done, or is intended or requested to be done.
A record of something that is being done, has been done, can be done, or is intended or requested to be done.
A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role.
A competency of the Entity playing the Role as identified, defined, guaranteed, or acknowledged by the Entity that Scopes the Role.
An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance.
An association between an Act and a Role with an Entity playing that Role. Each Entity (in a Role) involved in an Act in a certain way is linked to the act by one Participation-instance.
Entity Role Participation Act
A connection between two roles expressing a dependency between those roles.
A connection between two roles expressing a dependency between those roles.
A directed association between a source act and a target act.
A directed association between a source act and a target act.
Role Link Act Relationship
0..1
0..n
1
0..n
0..n
1
0..1
0..n
0..n 0..n
1 1
0..n 0..n
1 1
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Reference Information Model (RIM)
Backbone Class: Entity
Entity
classCode : CSdeterminerCode : CSid : SET<II>code : CEquantity : SET<PQ>name : BAG<EN>desc : EDstatusCode : SET<CS>existenceTime : IVL<TS>telecom : BAG<TEL>riskCode : CEhandlingCode : CE
Entity: a person, animal, organization or thing
A collection of classes related to the Entity class, its specializations and related qualifying classes. The classes represent health care stakeholders and other things of interest to health care.
Entity has the following sub-classes:ContainerDeviceLanguageCommunicationLivingSubjectManufacturedMaterialMaterialNonPersonLivingSubjectOrganizationPersonPlace
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Reference Information Model (RIM):
Backbone Class: Role
Role
classCode : CS
id : SET<II>code : CEnegationInd : BLaddr : BAG<AD>
telecom : BAG<TEL>statusCode : SET<CS>effectiveTime : IVL<TS>
certificateText : ED
quantity : RTOpositionNumber : LIST<INT>...
Roles:
A responsibility or part played by an entity (e.g. Person in a role of patient, employee, etc.) – different faces of an Entity
A collection of classes related to the Role class and its specializations. These classes focus on the roles participants may play in health care.
Role has the following sub-classes:AccessEmployeeLicensedEntityPatient
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Reference Information Model (RIM): Backbone Class: RoleLink
RoleLink
typeCode : CS
effectiveTime : IVL<TS>
Role
0..n outboundLink
0..nsource
0..n
inboundLink0..n
RoleLink:
A connection between two roles expressing a dependency between those roles.
RoleLink has no sub-classes.
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Reference Information Model (RIM):
Backbone Class: Participation
Participation
typeCode : CSfunctionCode : CDcontextControlCode : CS...
sequenceNumber : INTnegationInd : BLnoteText : EDtime : IVL<TS>modeCode : CEawarenessCode : CEsignatureCode : CE
signatureText : EDperformInd : BLsubstitutionConditionCode : CE
Participation:
An association between an Act and a Role with an Entity playing that Role.
Participation has the following sub-class:
ManagedParticipation
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Reference Information Model (RIM):
Backbone Class: Act
Act
classCode : CS
moodCode : CS
id : SET<II>code : CDnegationInd : BLderivationExpr : ST
text : EDtitle : STstatusCode : SET<CS>effectiveTime : GTS
activityTime : GTS
availabilityTime : TSpriorityCode : SET<CE>confidentialityCode : SET<CE>repeatNumber : IVL<INT>interruptibleInd : BLlevelCode : CEindependentInd : BL
uncertaintyCode : CEreasonCode : SET<CE>languageCode : CE
Act:
A collection of classes including the Act class and its specializations. These relate to the actions and events that constitute health care services. A record of something that is being done, has been done, can be done, or is intended or requested to be done.
Act has the following sub-classes:AccountControlActDeviceTaskDiagnosticImageDietFinancialContractFinancialTransactionInvoiceElement
ObservationParticipationPatientEncounterProcedurePublicHealthCaseSubstanceAdministrationSupplyWorkingList
Note: Sub-classes also include Core Infrastructure, Message Communications Control and Structured Documents classes not shown here.
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Reference Information Model (RIM): Backbone Class: ActRelationship
ActRelationship
typeCode : CSinversionInd : BL
contextControlCode : CS
contextConductionInd : BL
sequenceNumber : INTpriorityNumber : INTpauseQuantity : PQ
checkpointCode : CS
splitCode : CSjoinCode : CSnegationInd : BLconjunctionCode : CS
localVariableName : ST
seperatableInd : BL
Act
0..n
outboundRelationship0..n
source
inboundRelationship
0..n
target1
ActRelationship:
A directed association between a source Act and a target Act. A point from a later instance to a earlier instance OR point from collector instance to component instance.
ActRelationship has no sub-classes.
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Reference Information Model (RIM): The Complete RIM
11
11
Observation
...
SubstanceAdministration
routeCode : CE...
Procedure
...
Supply
...
Diet
...
Document
...
ContainercapacityQuantity : PQheightQuantity : PQdiameterQuantity : PQcapTypeCode : CE...
AccessapproachSiteCode : CD......
DevicemanufacturerModelName : SCsoftwareName : SClocalRemoteControlStateCode : CE......
EmployeejobCode : CEjobTitleName : SCjobClassCode : CEsalaryTypeCode : CE...
LivingSubjectadministrativeGenderCode : CE...birthTime : TSdeceasedInd : BLdeceasedTime : TS...
MaterialformCode : CE...
LicensedEntityrecertificationTime : TS...Place
mobileInd : BLaddr : ADdirectionsText : ED......
ManufacturedMateriallotNumberText : ST...
NonPersonLivingSubject...
Patient...
Organization...
Account
...
Person
addr : BAG<AD>...maritalStatusCode : CE......
WorkingList
ownershipLevelCode : CE...
PublicHealthCase
...
PatientEncounterpreAdmitTestInd : BLadmissionReferralSourceCode : CElengthOfStayQuantity : PQdischargeDispositionCode : CEspecialCourtesiesCode : SET<CE>...
Other
Acts
Infrastructure (Structured documents)
HEALTH LEVEL 7 REFERENCE INFORMATION MODEL VERSION 1.23 (RIM_0123)
Reflects changes to RIM in RIM Harmonization Meeting 03/20/2003.
Bi l l board produced by:Rochest er O ut door Advert i si ng
Roles
DiagnosticImage
subjectOrientationCode : CE...
QueryAck
...
QueryContinuation
...
Table
summary : ST......
TableStructure
...
TableColumnStructure
span :
TableCell
scope : CS...
LocalAttr
...
LocalMarkup
...
LinkHtml
...
ContextStructure
localId : ST
Infrastructure (Structured documents)
Infrastructure (Communications)
Enitites
Message Control
FinancialTransaction
...
InvoiceElement
modifierCode : SET<CE>......
FinancialContract
paymentTermsCode : CE...
RoleHeir
EntityHeir
SortControlsequenceNumber : INT......
QuerySpecmodifyCode : CSresponseElementGroupId : SET<II>...responseModalityCode : CSresponsePriorityCode : CS...
0..n
1
0..n
1
RelationalExpression
...
QueryBySelection SelectionExpression0..n
1
0..n
1
LogicalExpression
relationalConjunctionCode : CS...
0..n
0..1
user AsRight
0..n
r ightSide 0..1
0..n
0..1
user AsLeft0..n
leftSide0..1
QueryByParameter
ParameterList
Parameter
id : II0..n 0..10..n 0..1
0..1
0..n
0..1
0..n
Parameter Item
...
DeviceTask
parameterValue : LIST<ANY>...
ManagedParticipation...
ActHeir
ActRelationship
typeCode : CSinversionInd : BL...contextControlCode : CS...contextConductionInd : BL......
Act
classCode : CSmoodCode : CSid : SET<II>code : CDnegationInd : BLderivationExpr : ST......
0. . n1
inboundRelat ionship
0. . n
t ar get
1
0. . n1
out boundRelat ionship
0. . n
sour ce
1
ParticipationtypeCode : CSfunctionCode : CDcontextControlCode : CSsequenceNumber : INTnegationInd : BLnoteText : EDtime : IVL<TS>modeCode : CE...
0. . n1
0. . n1
RoleLink...
RoleclassCode : CSid : SET<II>code : CEnegationInd : BLaddr : BAG<AD>telecom : BAG<TEL>statusCode : SET<CS>...
0. . n1
0. . n1
0. . n1
out boundLink
0. . n
sour ce
1
0. . n1
inboundLink
0. . n
t ar get
1
LanguageCommunicationlanguageCode : CEmodeCode : CE...
AttentionLine...
BatchreferenceControlId : IIname : SC...
EntityclassCode : CSdeterminerCode : CSid : SET<II>code : CEquantity : SET<PQ>name : BAG<EN>desc : EDstatusCode : SET<CS>...
0. . n0. . 1
playedRole
0. . n
player
0. . 1
0. . n0. . 1
scopedRole
0. . n
scoper
0. . 1
10..n 10..n
Transmissionid : II...
0..n
1
0..n
1
0..1
0..n
0..1
0..n
CommunicationFunction
typeCode : CStelecom : TEL
1..n
0..*
1..n
0..*1..*
0..*
1..*
0..* InfrastructureRoot
...QueryEvent
...
ControlAct
...
0..1
1
0..1
1
MessageversionId : STinteractionId : IIprofileId : SET<II>processingCode : CSprocessingModeCode : CSacceptAckCode : CSapplicationAckCode : CS...
0. . 1
0. . n
0. . 1
payload
0. . n
Acknowledgement
...
0. . n
1
ack nowledgedBy0. . n
acknowledges1
0. . 1
1
conveyedAcknowledgem ent0. . 1
conveyingM essage1
AcknowledgementDetail
...
1
0..n
1
0..n
Domain Related
Infrastructure Related Structured Documents
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Reference Information Model (RIM):
RIM-UML Instance Scenario
John DoeJohn Doe PatientPatient SubjectSubject
Entity Role Participation Act
Dr. SmithDr. SmithHealthCare
ProviderHealthCare
ProviderSurgeon*Surgeon*
John DoeJohn Doe PatientPatient SubjectSubject
Has Pertinent InformationHas Pertinent InformationAct Relationship
(Clinical Trial Act)
Protocol ECOG 1112(Clinical Trial Act)
Protocol ECOG 1112
XYZ HospitalXYZ HospitalHealthCare
Facility*HealthCare
Facility*LocationLocation
(Procedure Act)
Prostectomy(Procedure Act)
Prostectomy
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HL7 Version 3 Process & Artifacts
In this section, we will discuss:– Domain Message Information Model (DMIM)– Refined Message Information Model (RMIM)– Hierarchal Message Definitions (HMDs) – Message Type (MT)
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HL7 Version 3 Process & Artifacts:
Overall Process
RIM D-MIM R-MIM
1..* 1..*
1..*HMD MT
1..*
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Entry points
HL7 Version 3 Process & Artifacts:Examples
Arrows
Color-coding
Labeling
Directional
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Reference Information Model (RIM): HL7 Modeling Conventions
Color-coding – colors of classes in the model denote the type of backbone class to which it belongs
Arrows – Participations, ActRelationships and RoleLinks are directional arrows that have rather than being lines that connect classes like in UML
Entry points – where to start reading the model; DMIMs have one or more entry points, RMIMs have one
RMIMs are directional – all associations flow out from the entry point to the remaining parts of the model
Labeling – associations in RMIMs are labeled on the distal end only
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HL7 Process & Artifacts:
Domain Message Information Model (DMIM)
A DMIM is a refined subset of the RIM that includes a set of class clones, attributes and relationships that can be used to create messages for a particular domain (a particular area of interest in healthcare).
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HL7 Process & Artifacts:
Refined Message Information Model (RMIM)
The RMIM is a subset of a DMIM that is used to express the information content for a message or set of messages with annotations and refinements that are message specific.
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HL7 Process & Artifacts:
Hierarchal Message Definitions (HMDs)
A Hierarchal Message Definition (HMD) is a serialized version of the RMIM in a specific order.
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HL7 Process & Artifacts:
Message Type (MT)
The Message Type elements and attributes in an XML message instance correspond to the sequence of data in the HMD
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Vocabulary & Data Types
In this section, we will discuss:– HL7 Standard Vocabulary
• Structural Attributes – prescribed HL7 vocabulary
• Non-Structural Attributes – vocabulary chosen by organization– Robust Data Types
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Vocabulary & Data Types:
Structural Attributes
Structural attributes are used to specify type and state of each RIM
class and what it means when used in a message. They use a standard vocabulary defined and controlled by HL7.
An Act of the Class Observation (OBS) with a Mood of Event (EVN).
classCode and moodCode are both Structural Attributes
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Vocabulary & Data Types :
Non-Structural Attributes
Other attributes don’t have an assigned vocabulary
Organizations can choose any industry standard vocabulary
For example, commonly used ones for Observation Acts are LOINC, SNOMED, MedDRA, etc.
Must specify more than just the code value, other data is needed for semantic interoperability…this is where data types come in
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Vocabulary & Data Types :
Data Types
What is a data type?
lengthOfStayQuantity is attribute of the EncounterProcess class.
lengthOfStayQuantity has a data type of Physical Quantity (PQ).
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Vocabulary & Data Types :
Data Types
Data types in HL7 version 3 are complex
Each data type has attributes
Each attribute has a data type of its own
<lengthOfStayQuantity value=“10” unit=“hours"/>
Physical Quantity (PQ) example
The attributes ‘value’ and ‘unit’ are part of the complex data type Physical Quantity (PQ). Value is expressed as the data type of integer (int).
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HL7 Version 3 at NCICB
In this section, we will discuss:– Why HL7 at NCICB?– NCICB Clinical Architecture Vision – caAdapter
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HL7 Version 3 at NCICB:
Why HL7?
Recommended by the Health and Human Service (HHS) as the messaging standard for electronic exchange of clinical data.
Over 90% of US hospitals have implemented some version of 2.x HL7 messages.
Support for translational research requires integration of research data with the clinical data. – V3 offers the syntactic and semantic interoperability to make this
possible
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HL7 Version 3 at NCICB:
NCICB Clinical Architecture Vision
HL7 version 3 supports messaging within the NCICB Clinical Architecture Vision.
etc.TissuesLabs
JDBC 2
Analytical ApplicationsAnalytical and
Reporting Tools (SAS, WebSDM, ToxViewer, I-
Review, etc.)
Ad HocQueryTool
BIO-gopher
Master Index
MessageExchangeServices(ebXML)
Translation Service(CAM/caAdapter)
ElectronicMedical
Record (EMR)
HL7 v3
Excel, Text,HL7 v2,
etc.
HL7 v3HL7 v3
HL7 Transactional
Database (HTB)
Extensions(CDUS/CTMS)
Base Janus Model
BRIDG
Clinical/Clinical Trials Applications
C3DcaMATC
H C3PR SAE
Study Specific Analysis Data
ClinicalData Sources
Patient Identifiable Clinical Environment
caGRID
caBIG
HL7 v3
SecureTransportBetween
Sites
caBIO/CTOM
HL7 RIM
BRIDG
caBIO/CTOM
HL7 RIM
FDA
SPONSOR
CTEP
DCP
Other
ExternalAgencie
s
HL7 v3
HL7 v3
Common Security Module (CSM) Enterprise Vocabulary Service (EVS) Data Standards Repository (caDSR)
SecureTransportBetween
Sites
Excel, Text,
HL7 v1, v2, etc.
De-Identification/Re-Identification
Service
HL7 v3
eCTD,Excel, Text,HL7 v2,etc.
Translation Service(CAM/caAdapter)
HL7 v3
caPRI
FIREBIRD
CRIX Data Repository
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HL7 Version 3 at NCICB:
Highlights of the NCICB Clinical Architecture Vision
caAdapter – Open source toolkit which facilitates v3 message building, parsing and validation
Message Exchange – Service supporting message transmission and routing
HL7 Transactional Database - HL7 RIM-based transactional database and data access service
De-identification Service – Service for de-identifying patient information from HL7 messages
Analytical Applications - Applications for querying, reporting, mining clinical data
Cancer Data Standards Repository (caDSR) - Shared metadata repository
Enterprise Terminology Services (EVS) - Terminology service for hosting controlled vocabulary, including HL7 registered terminology
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HL7 Version 3 at NCICB:
caAdapter
Facilitates the building, parsing, and validation of HL7 v3 messages
Components include:– HL7 v3 Message Parser – parses HL7 version 3 messages to RIM object
graph– HL7 v3 Message Builder – builds HL7 version 3 messages from the RIM
object graph– HL7 v3 Artifacts – implements RIM objects, data types and metadata
objects– Metadata Loader – represents HL7 version 3 metadata in-memory– Validation Services – integrates with NCICB caCORE components such as
Enterprise Vocabulary Service (EVS) and W3C XML schema validation services
– Mapping Tool – maps clinical data to the HL7 version 3 message specification currently, with extensible mapping and data transformation in the near future
– caAdapter API – uses mappings to generate HL7 version 3 messages– Message Service – integrates with message exchange services (future
plans)
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HL7 Version 3 at NCICB:
caAdapter
A platform to enable clinical applications to build and parse HL7 v3 messages based on specific schema definitions.
Capability to perform vocabulary validation of the RIM structural attributes.
An open source solution for implementing an international messaging standard allowing data to be exchanged between disparate systems.
Integration with NCI metadata repository (caDSR) and terminology services (EVS)
Facilitating the building and parsing of HL7 v3 messages from source clinical systems will promote data exchange in a standards based common format.
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Recommended Resources
Health Level Seven www.hl7.org
HL7 Reference Information Model https://www.hl7.org/library/data-model/RIM/C30202/rim.htm
HL7 Vocabulary Domains http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm
HL7 Version 3 Standard http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
NCICB caAdapter Project Site trials.nci.nih.gov/projects/infrastructureProject/caAdapter
HL7 Version 3: Driving Interoperability & Transforming Healthcare Information Management - Charles Mead, MD, MSc NIHSeminar_Charlie Mead.ppt
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