HL7

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HL7 Development Framework - ISO/HL7 27931

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 the development of consensus-based standards for healthcare information systems interoperability. The HDF is the most current edition of the HL7 V3 development methodology.

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

HL7 specifications draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work ensures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using.

V3 Messaging

The HL7 version 3 messaging standard defines a series of Secure Text messages (called interactions) to support all healthcare workflows.

HL7 v3 messages are based on an XML encoding syntax, as shown in this example:[1]: 2.2.1  

<POLB_IN224200 ITSVersion="XML_1.0" xmlns="urn:hl7-org:v3"
 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">  
  <id root="2.16.840.1.113883.19.1122.7" extension="CNTRL-3456"/>
  <creationTime value="200202150930-0400"/>
  <!-- The version of the datatypes/RIM/vocabulary used is that of May 2006 -->
  <versionCode code="2006-05"/>
  <!-- interaction id= Observation Event Complete, w/o Receiver Responsibilities -->
  <interactionId root="2.16.840.1.113883.1.6" extension="POLB_IN224200"/>
  <processingCode code="P"/>
  <processingModeCode nullFlavor="OTH"/>
  <acceptAckCode code="ER"/>
  <receiver typeCode="RCV">
    <device classCode="DEV" determinerCode="INSTANCE">
      <id extension="GHH LAB" root="2.16.840.1.113883.19.1122.1"/>
      <asLocatedEntity classCode="LOCE">
        <location classCode="PLC" determinerCode="INSTANCE">
          <id root="2.16.840.1.113883.19.1122.2" extension="ELAB-3"/>
        </location>
      </asLocatedEntity>
    </device>
  </receiver>
  <sender typeCode="SND">
    <device classCode="DEV" determinerCode="INSTANCE">
      <id root="2.16.840.1.113883.19.1122.1" extension="GHH OE"/>
      <asLocatedEntity classCode="LOCE">
        <location classCode="PLC" determinerCode="INSTANCE">
          <id root="2.16.840.1.113883.19.1122.2" extension="BLDG24"/>
        </location>
      </asLocatedEntity>
    </device>
  </sender>
  <!-- Trigger Event Control Act & Domain Content -->
</POLB_IN224200>

Clinical Document Architecture

Main article: Medicine:Clinical Document Architecture

The HL7 Clinical Document Architecture (CDA) is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange.[2] The standard was jointly published with ISO as ISO/HL7 27932.

Continuity of Care Document

Main article: Continuity of Care Document

The Continuity of Care Document framework is a US-specific standard for the exchange of medical summaries, based on the Clinical Document Architecture standard.

Structured Product Labeling

Structured Product Labeling describes the published information that accompanies a medicine, based on HL7 Version 3.

Clinical Context Object Workgroup

CCOW, or "Clinical Context Object Workgroup," is a standard protocol designed to enable disparate applications to share user context and patient context in real-time, and at the user-interface level. CCOW implementations typically require a CCOW vault system to manage user security between applications.

Other standards and methods

Fast Healthcare Interoperability Resources (FHIR)

Main article: Medicine:Fast Healthcare Interoperability Resources

Fast Healthcare Interoperability Resources is a modern interoperability specification from HL7 International designed to be easier to implement, more open, and more extensible than HL7 versions 2.x or 3.x. It leverages a modern web-based suite of API technology, including a HTTP-based RESTful protocol, HTML and Cascading Style Sheets for user interface integration, a choice of JSON or XML for data representation, OAuth for authorization and Atom for query results.[3] The main purpose of the FHIR standard is to ensure interoperability between different computer systems. It defines the data format and protocol for exchanging medical information, regardless of how it is stored in these systems.[4]

Services Aware Interoperability Framework

Main article: HL7 Services Aware Interoperability Framework

The HL7 Services-Aware Enterprise Architecture Framework (SAIF) provides consistency between all HL7 artifacts, and enables a standardized approach to Enterprise Architecture (EA) development and implementation, and a way to measure the consistency.

SAIF is a way of thinking about producing specifications that explicitly describe the governance, conformance, compliance, and behavioral semantics that are needed to achieve computable semantic working interoperability. The intended information transmission technology might use a messaging, document exchange, or service approach.

SAIF is the framework that is required to rationalize interoperability of other standards. SAIF is an architecture for achieving interoperability, but it is not a whole-solution design for enterprise architecture management.

Arden syntax

Main article: Arden syntax

The Arden syntax is a language for encoding medical knowledge. HL7 International 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. They can produce alerts, diagnoses, and interpretations along with quality assurance function and administrative support. An MLM must run on a computer that meets the minimum system requirements and has the correct program installed. Then, the MLM can give advice for when and where it is needed.

Clinical Quality Language

Clinical Quality Language (CQL) is a ANSI certified[5] clinically focused high-level expression language standard curated by Health Level 7.[6] It is designated for clinical knowledge sharing in the domains of electronic clinical quality measurement and clinical decision support.[7]

Clinical quality language is being used for a variety of clinical applications including WHO SMART guidelines where it is used for encoding decision logic and performance indicators.[8] The Centers for Medicare & Medicaid Services adopted CQL for clinical quality measure specifications since 2019.[9][10]

CQL allows modular and flexible expression of logic and is both human-readable and machine processable.[9]

An implementation of CQL was open sourced and published by the National Committee for Quality Assurance in 2023 with the aim of encouraging adoption of the language.[11]

MLLP

A large portion of HL7 messaging is transported by Minimal Lower Layer Protocol (MLLP), also known as Lower Layer Protocol (LLP)[12] or Minimum Layer Protocol (MLP).[13] For transmitting via TCP/IP, header and trailer characters are added to the message to identify the beginning and ending of the message because TCP/IP is a continuous stream of bytes.[14] Hybrid Lower Layer Protocol (HLLP) is a variation of MLLP that includes a checksum to help verify message integrity. Amongst other software vendors, MLLP is supported by Microsoft,[15] Oracle,[16] Cleo.[17]

MLLP contains no inherent security or encryption but relies on lower layer protocols such as Transport Layer Security (TLS) or IPsec for safeguarding Protected health information outside of a secure network.

Functional EHR and PHR specifications

Functional specifications for an electronic health record.

Message details

The OBR segment

An OBR Segment carries information about an exam, diagnostic study/observation.[18] It is a required segment in an ORM (order message)[19] or an ORU (Observation Result) message.[20]

See also

References

Template:Open-source attribution

  1. ↑ Spronk, René, ed (16 November 2007). "HL7 Message examples: version 2 and version 3". Ringholm. Ringholm bv. http://www.ringholm.de/docs/04300_en.htm. 
  2. ↑ Boone, Keith W. (20 May 2011). The CDA Book. Springer. ISBN 9780857293367. https://books.google.com/books?id=rwa6DDB4jY8C. 
  3. ↑ Dan Munro (2014-03-30). "Setting Healthcare Interop On Fire". Forbes. https://www.forbes.com/sites/danmunro/2014/03/30/setting-healthcare-interop-on-fire/. 
  4. ↑ Kryszyn, Jacek; Smolik, Waldemar T.; Wanta, Damian; Midura, Mateusz; Wróblewski, Przemysław (2023). "Comparison of OpenEHR and HL7 FHIR Standards". International Journal of Electronics and Telecommunications 69 (1): 47–52. doi:10.24425/ijet.2023.144330. https://journals.pan.pl/dlibra/publication/144330/edition/126538/content. Retrieved 2024-01-08. 
  5. ↑ "Clinical Quality Language (CQL)". https://cql.hl7.org/. 
  6. ↑ "1. Introduction". https://cql.hl7.org/01-introduction.html. 
  7. ↑ "CQL - Clinical Quality Language | eCQI Resource Center". https://ecqi.healthit.gov/cql. 
  8. ↑ "L3 Implementation Guide". https://www.who.int/tools/CCC/l3-implementation-guide. 
  9. ↑ 9.0 9.1 Measures management system cms.gov Retrieved 3 April 2024
  10. ↑ Pioneers in Quality. Electronic Clinical Quality Measure (eCQM). Clinical Quality Language (CQL) Basics for Hospitals jointcommission.org
  11. ↑ Raths, David (May 11, 2023). "NCQA Makes Clinical Quality Language Software Open Source". https://www.hcinnovationgroup.com/policy-value-based-care/value-based-care-quality-measurement/news/53060218/ncqa-makes-clinical-quality-language-software-open-source. 
  12. ↑ "LLP - Lower Layer Protocol". iNTERFACEWARE. http://www.interfaceware.com/llp.html. 
  13. ↑ "Minimum Layer Protocol". LYNIATE. 13 January 2020. https://www.lyniate.com/knowledge-hub/mlp-minimum-layer-protocol. 
  14. ↑ Spronk, Rene. "Transport Specification: MLLP, Release 1". Health Level Seven Inc.. https://www.hl7.org/documentcenter/public/wg/inm/mllp_transport_specification.PDF. 
  15. ↑ "MLLP Receive and Send Components". MSDN. http://msdn.microsoft.com/en-us/library/ee409260%28BTS.10%29.aspx. 
  16. ↑ "Oracle Application Server Integration B2B User's Guide, Supported Protocols". Oracle. http://download.oracle.com/docs/cd/B14099_19/integrate.1012/b19370/supp_protos.htm#BACIFDJG. 
  17. ↑ "Which Secure Managed File Transfer Protocol is Right for You?". Cleo. https://www.cleo.com/solutions/compare-protocols/. 
  18. ↑ "The HL7 OBR segment". Corepoint Health. https://corepointhealth.com/resource-center/hl7-resources/hl7-obr-segment/. 
  19. ↑ "HL7 Glossary of Terms". https://www.hl7.org/documentcenter/public/calendarofevents/FirstTime/Glossary%20of%20terms.pdf. 
  20. ↑ "What Is an ORU Message?". Health Standards. http://healthstandards.com/blog/2006/10/05/what-is-an-oru-message/. 

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