HL7 V3 Research Articles

Enabling semantic interoperability in multi-centric clinical trials on breast cancer

Background and objectivesPost-genomic clinical trials require the participation of multiple institutions, and collecting data from several hospitals, laboratories and research facilities. This paper presents a standard-based solution to provide a uniform access endpoint to patient data involved in current clinical research. MethodsThe proposed approach exploits well-established standards such as HL7 v3 or SPARQL and medical vocabularies such as SNOMED CT, LOINC and HGNC. A novel mechanism to exploit semantic normalization among HL7-based data models and biomedical ontologies has been created by using Semantic Web technologies. ResultsDifferent types of queries have been used for testing the semantic interoperability solution described in this paper. The execution times obtained in the tests enable the development of end user tools within a framework that requires efficient retrieval of integrated data. ConclusionsThe proposed approach has been successfully tested by applications within the INTEGRATE and EURECA EU projects. These applications have been deployed and tested for: (i) patient screening, (ii) trial recruitment, and (iii) retrospective analysis; exploiting semantically interoperable access to clinical patient data from heterogeneous data sources.

HL7apy: a Python library to parse, create and handle HL7 v2.x messages

HL7 version 2 is the most popular messaging standard for clinical systems interoperability. Most of the tools for messaging management are Java or .NET based, while Python programming language lacks of comparable solutions. This paper describes HL7apy, an open-source HL7 v2 compliant messaging library, written in Python. The library offers means to create, parse, navigate and validate messages. As an example application, we present a full implementation of the IHE Patient Demographics Query ITI-21 transaction. The resulting module has been integrated in GNU Health, a popular open-source Hospital Information System.

IHE/HL7 Implementation Guide for eSupply

The use of eCommerce solutions in the German health care market is hindered by fragmented solutions and lack of guidance to the use of standards. Especially the area of procurement is mainly dominated by proprietary solutions. Also, the splits in the area of information transfer - which are attributable to the non-coverage usage of standards – result in delays, transcription errors, wrong orders and patient confusion. The project ”Standards zur Unterstutzung von eCommerce im Gesundheitswesen” (eCG) w a s launched in August 2012 and i s funded by the German Federal Ministry for Economic Affairs and Energy – ”Bundesministerium fur Wirtschaft und Energie” (BMWi) – within the programme ”Mittelstand Digital”. The eCG project consortium consists of ”Hochschule Niederrhein” (HSNR), ”Zentrum fur Informations- und Medizintechnik der Universitatsklinik Heidelberg” (ZIM), The German Medical Technology Association ”Bundesverband der Medizintechnologie” (BVMed e.V.) and ”Integrating the Healthcare Enterprise” in Germany (IHE Deutschland e.V.). One of the main goals of this project is to design a sustainable supply system for healthcare and subsequently produce a significant increase of potentials for efficiency within the health sector by developing interoperability between different, already used standards in the healthcare and the logistics domain. After a literature research and analyses of business processes in hospital new IHE Integration Profiles were modeled in order to describe the interaction between different (software) actors in a hospital starting with ordering products in a point of care until buying it by an external vendor. These profiles are described in an implementation guide ”eSupply in Healthcare”. For transactions between the actors HL7 v2 messages and GS1 standard were used.

A standard-based model for the sharing of patient-generated health information with electronic health records

This paper proposes a standard-based model for the automated collection of patient data using personal health devices and the secure sharing of these data with authorized providers' electronic health records (EHRs). The model addresses a number of important requirements for the practical collection and exchange of such data between patients and providers. The technical elements of the model are based on the features of personal health devices, health data repositories, and interoperability standards that already exist. For the automated collection of data from patients' personal health devices (such as wireless glucometers or smartphone-based applications), the model suggests a set of content standards developed by the Continua Alliance and already implemented in a number of commercial products. For the sharing of collected data with providers' EHRs, the model specifies a secure transport layer based on the DIRECT Project's secure email standards and an application data layer based on HL7 v2.5.1 query-response messages combined with the clinical document architecture Release 2.0 personal healthcare monitoring report implementation guide. All of these standards have been implemented and are in current use, although they have not yet been combined to meet the specific use case of sharing patient-generated health information with providers EHRs. The proposed standard-based model constitutes a "straw man" intended to foster thought, discussions, and refinement through pilot implementations and improvements.

호환 가능한 HL7 파서의 개발

기존의 HL7 인터페이스는 서로 다른 버전의 HL7 메시지를 처리하기 위해 버전마다 별도의 패키지 또는 변환 모듈로 개발해야 한다. 본 연구는 HL7 V2.5에 정의된 버전 호환성 요구사항을 기반으로 버전 간 호환 가능한 HL7 파서를 설계하고 개발하였다. 파서의 구조는 객체지향 프로그래밍에서의 상속 개념을 이용하여 하위 버전의 HL7 메시지 요소의 클래스 객체를 상위 버전의 클래스 객체가 상속하였다. 따라서 HL7 메시지의 버전에 상관없이 상위 클래스 객체만을 사용하여 모든 버전의 HL7 메시지를 처리할 수 있었다. 개발한 파서의 호환성 평가는 700건의 류마티스 입원 환자 데이터를 이용하였으며 성공적으로 테스트를 수행하였다. 향후에는 버전 간 상호 호환 가능한 HL7 파서의 구조에 대한 연구를 지속적으로 할 것이다. The previous HL7 interface should be developed as a separate package or conversion module for each version to process HL7 messages from different versions. This study designed and developed an HL7 parser compatible among different versions based on the requirements of compatibility defined in HL7 V2.5. According to the structure of the parser, the inheritance concept in object-oriented programming was adopted so that the class object of the HL7 message from the lower version could be inherited to the class object of the upper version. Therefore, every version's HL7 messages could be processed using only the upper class' object regardless of the version. To evaluate the compatibility of the developed parser, 700 data sets about inpatients with rheumatoid arthritis were used. The 700 cases underwent the compatibility test successfully. In the near future, further research on the Inter-compatibility HL7 parser is planned.

A new tool for sharing and querying of clinical documents modeled using HL7 Version 3 standard

We present a new software tool called CDN (Collaborative Data Network) for sharing and querying of clinical documents modeled using HL7 v3 standard (e.g., Clinical Document Architecture (CDA), Continuity of Care Document (CCD)). Similar to the caBIG initiative, CDN aims to foster innovations in cancer treatment and diagnosis through large-scale, sharing of clinical data. We focus on cancer because it is the second leading cause of deaths in the US. CDN is based on the synergistic combination of peer-to-peer technology and the extensible markup language XML and XQuery. Using CDN, a user can pose both structured queries and keyword queries on the HL7 v3 documents hosted by data providers. CDN is unique in its design – it supports location oblivious queries in a large-scale, network wherein a user does not explicitly provide the location of the data for a query. A location service in CDN discovers data of interest in the network at query time. CDN uses standard cryptographic techniques to provide security to data providers and protect the privacy of patients. Using CDN, a user can pose clinical queries pertaining to cancer containing aggregations and joins across data hosted by multiple data providers. CDN is implemented with open-source software for web application development and XML query processing. We ran CDN in a distributed environment using Amazon EC2 as a testbed. We report its performance on real and synthetic datasets of discharge summaries. We show that CDN can achieve good performance in a setup with large number of data providers and documents.

Healthcare Web Services by E-Governance

As India is one of the fastest developing countries in the world, it is important to improve the quality of our health maintenance management and preventive medical care to extend healthy life expectancy. Today's scenario for health care in Indian e governance is in the limit of contacting 75 hospitals of the ISRO Telemedicine network only. Whilst this is currently working best of it, the limitation of this can be retarded by introducing the health care web services to each individual of the country. We believe advanced implementation of Information and Communications Technologies (ICT) may improve the medical services and health maintenance management. As medical science is fast developing and information resource is pouring in, there is urgent need for dissemination knowledge by interlinking primary, secondary and tertiary level health centers by ICT applications. This will help health personal to deliver high quality services. Moreover, IT systems have been built to support different work flows in the health sector, but the systems are rarely connected and have become islands of data. From 2006 onwards corporate IT giants are experimenting for ICT application in health sector both in Government and private hospitals. In this paper, we discuss the potentialities and expansibility of the XML Web Services based on the Adaptive Collaboration (AC) which can be aggregated by the Indian e governance system as a health care web services. We would like to present ways of improving health maintenance service and regional medical services. In order to realize better health maintenance and prevention of disease, we would like to prove that incorporating medicine, life, and work through the XML Web Services is highly effective. The developed system is using data agent concept in transferring the format of information from different medical database systems to be an international standard format of metadata known as HL7 v3.0 using XML based cloud services called the Medical Cloud system which can take advantage of the Indian cloud revolution.

Semantic mapping to simplify deployment of HL7 v3 Clinical Document Architecture

HL7 Version 3 was developed to provide semantically reliable healthcare interoperability but has been perceived as overly complex to implement. This paper describes how semantic mapping can simplify usage of HL7 Version 3 Clinical Document Architecture (CDA) and reports on the rationale for adopting this approach in three particular use cases and lessons learned from the practical application experience. We envision a broad application of the semantic mapping approach in clinical documents, messaging and application design modelling.

HL7 v3 message extraction using Semantic Web techniques

Healthcare system integration is an area of utmost importance in the overall eHealth strategy of countries. The overall goal of these efforts is to provide a large scale and unified view of clinical information to healthcare practitioners, thereby enabling them to deliver accurate and timely services to the general public in a cost-efficient manner. In this paper, we present a novel framework for identifying HL7 v3 messages to represent healthcare transactions that take place in an integration scenario. The proposed technique provides a new categorisation of HL7 v3 message functionality according to a set of message contexts extracted by extensive study of HL7 v3 information hierarchies and messaging infrastructure. These contexts allow us to map the key terms in a healthcare scenario to the corresponding HL7 v3 messages using Semantic Web technology. We have developed a prototype tool and will present two healthcare case studies to demonstrate our solution.

Information Overload in Telemedicine: Using Complex Event Processing and Context for Intelligent Information Filtering and Supply

Today's central issues in the healthcare supply make it imperative to develop new concepts to reduce the emerging costs and ensure high quality standards. Applying information and communication technology (ICT) and especially telemedicine – technologies that offer the chance to optimize medical data transfer – is regarded as the promising strategy, when developing cost saving concepts. As a result, physicians, as recipients of medical data, are confronted with a growing amount of information, called information overload. Therefore information has to be transported according to the principles of information logistics (ILOG). This paper presents preliminary results of a new approach to use complex event processing (CEP) as a vehicle for information logistics processing termed as Telemedical ILOG Listener (TIL) using context to specify the users’ information need. Every telemedical value, like for instance blood-pressure, has to be described as a telemedical event on the basis of HL7 V3, a widespread international standard for data exchange in the healthcare sector. We will define a message type which is able to include the medical data, data necessary for CEP, context and at least data to represent the dimension of ILOG, so it can be processed by a TIL.

Medical Data Transmission Using Cell Phone Networks

A big challenge in telemedicine systems is related to have the technical requirements needed for a successful implementation in remote locations where the available hardware and communication infrastructure is not adequate for a good medical data transmission. Despite of the wide standards availability, methodologies, applications and systems integration facilities in telemedicine, in many cases the implementation requirements are not achievable to allow the system execution in remote areas of our country. Therefore, this paper presents an alternative for the messages transmission related to medical studies using the cellular network and the standard HL7 V3 [1] for data modeling. The messages are transmitted to a web server and stored in a centralized database which allows data sharing with other specialists.

Interoperability of Medical Device Information and the Clinical Applications: An HL7 RMIM based on the ISO/IEEE 11073 DIM

Medical devices are essential to the practice of modern healthcare services. Their benefits will increase if clinical software applications can seamlessly acquire the medical device data. The need to represent medical device observations in a format that can be consumable by clinical applications has already been recognized by the industry. Yet, the solutions proposed involve bilateral mappings from the ISO/IEEE 11073 Domain Information Model (DIM) to specific message or document standards. Considering that there are many different types of clinical applications such as the electronic health record and the personal health record systems, the clinical workflows, and the clinical decision support systems each conforming to different standard interfaces, detailing a mapping mechanism for every one of them introduces significant work and, thus, limits the potential health benefits of medical devices. In this paper, to facilitate the interoperability of clinical applications and the medical device data, we use the ISO/IEEE 11073 DIM to derive an HL7 v3 Refined Message Information Model (RMIM) of the medical device domain from the HL7 v3 Reference Information Mode (RIM). This makes it possible to trace the medical device data back to a standard common denominator, that is, HL7 v3 RIM from which all the other medical domains under HL7 v3 are derived. Hence, once the medical device data are obtained in the RMIM format, it can easily be transformed into HL7-based standard interfaces through XML transformations because these interfaces all have their building blocks from the same RIM. To demonstrate this, we provide the mappings from the developed RMIM to some of the widely used HL7 v3-based standard interfaces.

SS-MIX: A Ministry Project to Promote Standardized Healthcare Information Exchange

To promote healthcare information exchange between providers and to allow hospital information systems (HIS) export information in standardized format (HL7 and DICOM) in an environment of wide-spread legacy systems, which only can export data in proprietary format. Through the Shizuoka prefecture EMR project in 2004-2005, followed by the ministry's SS-MIX project, many software products have been provided, which consist of 1) a standardized storage to receive HL7 v2.5 messages of patient demographics, prescription orders, laboratory results, and diagnostic disease in ICD-10, 2) a referral letter creation system, 3) a formatted document creation system, 4) a progress note/nursing record system, and 5) an archive/viewer to incorporate incoming healthcare data CD and allow users to view on HIS terminal. Meanwhile, other useful applications have been produced, such as adverse event reporting and clinical information retrieval. To achieve the above-mentioned objectives, these software products were created and propagated, because users can use these software products, provided that their HIS can export the above information to the standardized storage in HL7 v2.5 format. In 20 hospitals of Japan, the standardized storage has been installed and some applications have been used. As major HIS vendors are shipping HIS with HL7 export function since 2007, HIS of 594 hospitals in Japan became capable of exporting data in HL7 v2.5 format (as of March 2010). In high CPOE installation rate (85% in 400+ bed hospitals), though most of them only capable of exporting data in proprietary format, prefecture and ministry projects were effective to promote healthcare information exchange between providers. The standardized storage became an infrastructure for many useful applications, and many hospitals started using them. Ministry designation of proposed healthcare standards was effective so as to allow vendors to conform their products, and users to install them.

Comparison of EuroMISE Minimal Data Model for Cardiology and HL7 V3 DAM: Cardiology Rel. 2

Background: The EuroMISE Minimal Data Model for Cardiology (MDMC) has been prepared by clinicians for clinical study in 2002. This model has been successfully implemented in an application for clinical data gathering. HL7 v3 Domain Analysis Model: Cardiology, Release 2 (HL7 DAM) has been published in HL7 September 2011 Ballot. Objectives: The objective of this paper is to compare these two data models. The main motivations for the comparison are nearly identical ways of development, and the same format of both specifications. Methods: HL7 DAM is much broader than EuroMISE MDMC. Thus I focus only on data elements present in MDMC but absent in HL7 DAM. Also dierent scales of elements present in both models are compared. Results: I have found 25 elements out of 181 elements defined in MDMC which are not contained in HL7 DAM.

Architectural Approaches for HL7-based Health Information Systems Implementation

Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration. Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components. Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveillance system based on Enterprise Java Beans technology. Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model - offered by the HIS-DF and supported in HL7 v3 artifacts - is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

Semantic Interoperability in Czech Healthcare Environment Supported by HL7 Version 3

The data interchange in the Czech healthcare environment is mostly based on national standards. This paper describes a utilization of international standards and nomenclatures for building a pilot semantic interoperability platform (SIP) that would serve to exchange information among electronic health record systems (EHR-Ss) in Czech healthcare. The work was performed by the national research project of the "Information Society" program. At the beginning of the project a set of requirements the SIP should meet was formulated. Several communication standards (openEHR, HL7 v3, DICOM) were analyzed and HL7 v3 was selected to exchange health records in our solution. Two systems were included in our pilot environment: WinMedicalc 2000 and ADAMEKj EHR. HL7-based local information models were created to describe the information content of both systems. The concepts from our original information models were mapped to coding systems supported by HL7 (LOINC, SNOMED CT and ICD-10) and the data exchange via HL7 v3 messages was implemented and tested by querying patient administration data. As a gateway between local EHR systems and the HL7 message-based infrastructure, a configurable HL7 Broker was developed. A nationwide implementation of a full-scale SIP based on HL7 v3 would include adopting and translating appropriate international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our pilot study showed that our approach is feasible but it would demand a huge effort to fully integrate the Czech healthcare system into the European e-health context.

Development of an electronic public health case report using HL7 v2.5 to meet public health needs

Clinicians are required to report selected conditions to public health authorities within a stipulated amount of time. The current reporting process is mostly paper-based and inefficient and may lead to delays in case investigation. As electronic medical records become more prevalent, electronic case reporting is becoming increasingly feasible. However, there is no existing standard for the electronic transmission of case reports from healthcare to public health entities. We identified the major requirements of electronic case reports and verified that the requirements support the work processes of the local health departments. We propose an extendable standards-based model to electronically transmit case information and associated laboratory information from healthcare to public health entities. The HL7 v2.5 message model is currently being implemented to transmit electronic case reports from Intermountain Healthcare to the Utah Department of Health.

Health Informatics Meets eHealth

Health informatics develops methods and tools that should, when applied to health care, contribute to a high-quality, efficient care of individuals and populations [1]. The translation of health informatics research into practice can be seen as a “continuum” from IT development to healthcare problem solving [2], starting with developing and validating early solutions (tools, algorithms, technologies ...) that are then integrated and tested in clinical practice, first in small pilot projects, later in larger evaluation studies. Scientific publication of the outcome of these projects and studies is an important step to increase awareness on new solutions, to allow sharing of experiences, and to decide on continuation or stop of the developments as part of evidence-based health informatics [3]. Health informatics has been developing solutions for intra-organizational information systems for many decades now. Recently, with the emergence of inter-organi zational (or trans-institutional) information systems [1, 4], the term “eHealth” has been shaped to describe “an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies” [5]. Generally speaking, the term eHealth encompasses more traditional concepts such as telemedicine and tele monitoring [6] as well as newer concepts such as shared electronic health records [7] or pervasive health care systems [8]. eHealth applications offer the potential for large benefits for health care, such as improved quality of care, patient empowerment, health promotion, and cost savings [9 –11]. However, a lot of challenges need to be overcome to exploit these potential benefits, such as semantic and technical integration and human-computer interaction [12], but also social, cultural, eco nomical and organizational challenges [10, 13], as eHealth will have an impact on the way health care is delivered in the future. This special issue presents the best three contributions from the eHealth2009 conference in Vienna, highlighting recent challenges and achievements in the area of eHealth. The eHealth-conference series is an annual series of scientific events dealing with health informatics methods and their applications to eHealth [14]. The paper by Christoph Rinner and coauthors [15] tackles the problem of semantic interoperability. At the moment, XML-based document standards such as Clinical Document Architecture (CDA) or ISO/EN 13606 are being developed to support semantic interoperability within inter-organizational information systems. The authors present an approach to automatically validate EHR documents, to assess whether they are conformant to the described standards. Their approach allows EHR documents to be validated for conformance with the underlying reference models and archetypes of the mentioned standards by means of XML schema, without requiring an additional validation language. This will allow simplifying the overall validation process in the future. The paper by Tuncay Namli and Asuman Dogac [16] addresses the technical interoperability of EHR systems. There are many standards and initiatives (such as HL7 v3 or IHE) that support the exchange of data. To allow interoperability based on these standards, application systems need to prove that they are conformant to these standards. The authors present an automated, modular and scenario-based testing framework that allows testing conformMethods Inf Med 2010; 49: 269–270

Testing Conformance and Interoperability of eHealth Applications

To explain the common conformance and interoperability testing requirements of eHealth applications through two case studies; one using a prominent eHealth messaging standard, namely HL7 v3 [1], and the other using Integrating the Healthcare Enterprise (IHE) [2] Profiles and to describe how these testing requirements can be addressed through an automated, modular and scenario-based testing framework, namely TestBATN. Summarizing the conformance testing requirements of HL7 v3 messages. Illustrating the interoperability testing requirements of IHE Profiles through a scenario based on the IHE XDS, IHE XDS-MS and IHE PIX profiles. Explaining how these requirements can be handled through a dynamic and configurable test framework addressing all the layers in the interoperability stack within a single test scenario. Conformance and interoperability testing are necessary to maintain correct information exchange as the correctness of the exchanged data is essential in the healthcare domain. There are many standards used in eHealth that the applications need to conform. Additionally, there are profiling initiatives such as IHE and Continua Health Alliance which publish integration profiles addressing a specific clinical need or a use case and describe how to combine or use the existing standards to provide interoperability. However, as the results of our case studies demonstrate, there are many commonalities in the conformance and interoperability testing requirements of these standards and profiles and therefore an integrated testing environment is needed. Our main conclusion is that rather than having individual testing tools for each standard or initiative, a generic and modular test framework exploiting the commonalities in the testing processes and fostering reusability of modular, pluggable testing components will improve the efficiency of testing. Through the TestBATN framework, we describe how this modularity can be achieved by providing common interfaces facilitating the development of adaptors which allows different testing components to be plugged into the system.

SU‐FF‐T‐481: Computerized Implementation of Radiation Treatment Planning Directives

Purpose: This presentation describes the implementation of a system for capturing radiation treatment planning directives. These directives capture site and protocol specific requirements for the various processes required for planning namely imaging studies, registration, contouring, and specification of target goals, and planning objectives. Method and Materials: The computer software used for this work is based on an open‐source electronic healthcare record (EHR) system . The software is based on industry standards and runs on a windows server, is written in Java, a standard database, and provides a web‐based user interface. The system uses a data model based on the HL7 V3 and continuity of care records. Patient related information (documents) trigger a rules‐based decision support engine that is used to maintain lists and initiate messaging to external systems. Documents can also be fed to the system via messages from external system. Customizations of this system have been made to capture and manage template treatment planning directives that are then selected and modified to create patient specific directives. Rules have been created and are triggered by completing various components of the planning directives. Over 50 treatment planning directives have been developed using paper forms and these have served as a guide for the development of the data requirements and user input styles. Extensive processes mapping has been undertaken to determine the best ways to implement this system within our clinical environment. Results: The resulting system has been used to implement most of our current planning directives. Messages from the hospital's HL7 feed provide basic patient identification information and clinical results as needed. Various worklists are maintained along with e‐mail notifications, and communications with our planning system are used to initialize planning parameters. Conclusion: This system for computer‐supported management of treatment planning directives has proven to be flexible and extensible.