Quiz 3

1. Mention the principles of the Belmont report and

explain (read ppt for explanation)
2. Give an example for unethical research (ppt)
3. Mention the verification process of IRB. (related to the
participants in the study)
UBM2524-MEDICAL INFORMATICS

HEALTH LEVEL 7
WHAT IS HL7?
• HL7 stands for Health Level 7 and it is a set of clinical standards &
messaging formats that provide a framework for the management,
integration, exchange and retrieval of electronic information across different
healthcare systems.
• The HL7 standards are developed and maintained by Health Level 7
international which is a healthcare standard organization, adopted by other
standard issuing bodies such as American National Standards Institute and
International organisation for standardization.
• The HL7 standards support clinical practice and the management, delivery
& evaluation of health services
• These standards are used to fetch, process, exchange and transfer medical
information between different entities of the same healthcare or between
different healthcare providers .
• The above is achieved by using electronic health record systems.
• HL7 provides sustainable ecosystem needed to support the intensifying
medical data.
 CONCEPTION OF HL7 WITH FURTHER
DEVELOPMENTS
• HL7 was originally developed in 1987. This is usually done through
electronic health records (EHRs) systems. HL7 is called so because it focuses
on the application layer, also referred to as layer 7.
• Health because it is used in Healthcare. Level Seven because its format is
layered upon the seventh level of the Open Systems Interconnection (OSI)
protocol of the International Standards Organization
The original version is HL7 2.0
• The most widely used version of HL7 is version 2.3
• In 2005 HL7 version 3.0 was released. In HL7 3.0 the format and structure of
the message syntax completely changed. HL7 3.0 is based on XML language
but it has not been adopted by most healthcare organizations.
• The most recent version is FHIR (Fast Healthcare Interoperability Resources)
 What Does HL7 MEAN FOR HEALTHCARE
• Before HL V2, every interface connecting system had to be custom
designed. It means sending and receiving application vendors invested
much time and effort in programming.
• As there were no standards for processing patient data, interface
implementation was expensive. Most importantly, data exchange between
healthcare apps was not always possible.

• HL7 V2 changed that. By following this standard, healthcare providers can

connect versatile applications, systems, and devices more easily. It
improves the quality of healthcare through integrated data and more
advanced health analytics.
 NEED FOR HL7
INTEGRATION • The Healthcare industry is incredibly complex and is
sitting on an ever-increasing mountain of information.
Recent research has found that each patient
contributes about 80 megabytes of EMR and imaging
data annually.
• Most of this data is stored and processed in isolated
pools that belong to different medical institutions.
• What’s even more disturbing is that data can be
dissociated and poorly structured even within the IT
systems of a single institution.
• Large healthcare providers usually rely on a variety of
IT systems to keep their administrative, diagnostic,
and treatment services running.
• A typical hospital, for instance, may use an HIS
(Hospital Information System), an EMR (Electronic
Medical Record), an LIS (Laboratory Information
System), an RIS (Radiology Information System), and
a PACS (Picture Archiving and Communication
System).
• These systems all gather and generate information,
but the different data formats they use prevent
effective communication between them.
 BACKGROUND OF HL7
STANDARDS
 DIFFERENT VERSIONS OF
HL7

Version 2 (V2)

Version 3 (V3)

The majority of HL7 messaging employs messages that use the 2.3 or 2.3.1
versions of the standard. Newer versions of the standard, including V3,
represent only a small portion of real-world usage in interfacing. HL7 is also
working on an emerging standard called HL7 FHIR.
 HEALTH LEVEL 7 V2
• The HL7 V2 standard was created mostly by clinical interface specialists
and was designed to provide a framework in which data could be
exchanged between disparate clinical systems.

• The V2 standard provides 80 percent of the interface framework, plus the

ability to negotiate the remaining 20 percent of needs on an interface-by-
interface basis.

The following ways in which is the goal is achieved is :

• Providing support for local variations in data interchanges by allowing
optional fields, additional messages, or additional portions of messages.

• Defining HL7 encoding rules, groupings, cardinality, and the default

character set (i.e. ASCII).
• Evolving and adapting to changes required in local implementations, or to
issues discovered via real-world usage of the standard.
Supporting batch processing of message file transfers.

Considering the relationship between the HL7 standard protocol with other
protocols, such as lower layer protocols (i.e. avoiding replication of
features), applications protocols (notably DICOM and X12, and protocols
published by ASTM and IEEE), and other proprietary healthcare protocols.
• The HL7v2 standard is not a complete plug-and-play solution for
interoperability and it is often referred to as the “non-standard standard”
as it provides around 80% of the interface foundation with 20% still
requiring some customization on an interface-by-interface basis.

• This is due to the nature of healthcare and its different interactions with
patients, healthcare personnel, clinical and operational data. Each hospital,
urgent care center, ambulatory care facility, imaging center, laboratory,
and other care facilities have unique clinical systems and operations,
making each implementation of HL7 require a slightly unique
representation of the data.
 HEALTH LEVEL 7 V3
• The HL7 V3 standard was first released in late 2005, and was strongly influenced
by the government and medical information users rather than clinical interface
specialists.
• The V3 version is not backwards compatible with V2 versions of the standard, so
existing V2 interfaces will not (without considerable modification) be able to
communicate with interfaces using V3.
• The goals of HL7 V3 were to increase worldwide adoption of the standard, define a
consistent data model, create a more precise and less vague standard, and create
an entirely new standard that would not be hindered by legacy issues.
• The decision to make HL7 V3 a new standard (and incompatible with older and
more widely implemented V2 versions) means that it is has not been widely
adopted thus far.
• To adopt HL7 V3, users would need to create and maintain HL7 V2-based
interfaces with HL7 V2-based applications, while deploying new V3-based
applications and implementing interfaces between them.
• For this reason, HL7 V3 has been adopted primarily for use in applications without
legacy communication requirements, without historical use of HL7 V2 in
communications, or in regions/locations that have high government enforcement
HL7 V3 was created to address the following challenges of HL V2 :
• An implied, rather than consistent, data model.
• An absence of formal methodologies with data modeling, creating
inconsistencies and difficulties in understanding.
• A lack of well-defined roles for applications and messages used in different
clinical functions.
• Too much flexibility and not enough of a full solution.
FHIR – FAST HEALTH INTEROPERABLE
RESOURCES
• Fast Health Interoperable Resources (FHIR) is a next generation standards
framework that combines the best features of HL7 V2, HL7 V3, and HL7
Clinical Document Architecture (CDA), while leveraging the latest web
service technologies.
• The design of FHIR is based on RESTful web services and is based on
modular components called ‘resources’. FHIR supports both XML and JSON.
• The implementation of FHIR creates an advanced way for integration and
better interoperability by opening up new opportunities in mobile health
applications and cloud communications.
• By providing EHRs the right ability to interact with each other, FHIR has
emerged as the basic building block for improved patient care.
IMPORTANCE OF FHIR OVER OTHER
VERSIONS OF HL7
• In 2014, HL7 introduced an important alternative to HL7 V2 and V3
standards: the Fast Healthcare Interoperability Resources (FHIR) standard.
And, within a few years, FHIR had quickly gained acceptance from high-
profile healthcare institutions
• FHIR, which was first drafted in 2011, is an open standard that enables new
apps and legacy systems to more easily exchange data than in the past.
FHIR was developed to not only improve interoperability and enhance the
efficiency of communication but also streamline implementation compared
with previous standards, providing easily understood specifications and
enabling developers to capitalize on common Web technologies.
• FHIR builds on previous standards, including HL7 V2, HL7 V3, and CDA
(Clinical Document Architecture—part of HL7 V3). FHIR employs RESTful web
services and open web technologies, including not only XML (used by
previous standards) but also JSON and RDF data formats.
• FHIR also offers multiple options for exchanging data among systems. It
supports messaging (similar to HL7 V2), documents (like CDA), as well as a
RESTful API approach. This RESTful approach offers the potential for greater
interoperability among a wide array of systems and devices—including not
only electronic health record (EHR) systems but also mobile apps, mobile
devices, medical devices, and wearables.
 ADVANTAGES OF HL7
INTEGRATION
 BENEFITS OF HL7 INTERFACE
INTEGRATION
• Ensuring data uniformity : By ensuring data uniformity between different
applications within and between medical facilities, allows patient information and
other health information exchange to be seamlessly transferred from admission, to
diagnostics, to treatment and billing.

• Automation of workflows: Manual data entry is time-consuming and automation

of repetitive tasks is both an energy and cost saver. A standardized HL7 data
workflow can help synchronize data updates simultaneously. For instance records,
lab tests, and prescriptions exchanged between departments can completely
eliminate manual data entry.

• Facilitate information exchange with regulators: When medical systems

achieve HL7 compliance, it can simplify this process and reduce the burden on
admin by sharing data electronically. This is particularly important when it comes
to medical devices sharing their specifications. Same for biopharmaceuticals that
• Facilitates collaboration globally : With over 27 countries and 1600
healthcare providers having adopted the HL7 standards, for the first time in
history, it has become easier to share medical data across borders. This
international collaboration has been of crucial importance in the global
Covid-19 pandemic.

• Patients can conveniently access their records : When EHR records

are coupled with interoperability, patients will be able to access their
records and new updates easily online. This becomes a boon when it comes
to consulting multiple specialists. The time-consuming process of lugging
around a pile of documents or providing a full picture of their medical
history is instantly solved.

• Reduce investments in new technology upgrades: While investing in

adding a new HL7 framework will require an initial investment, the costs
reduce in the long run. This is because the system life of legacy systems can
be extended since it uses the messaging services of the HL7 framework to
interface with newer systems.
Standards Are Everywhere
• In order to reduce disconnects between all health care systems,
there must some standard to achieve interoperability.
• Standards are vital for interoperability. - It is the ability of two or more
systems or components to exchange information, and to use the
information that has been exchanged predictably
• Provide quality improvement and greater value.
• Improve information access.
• Helps to identify the mechanisms for protecting the privacy
& confidentiality of individual’s health data.
• Allows industry to move forward without having each individual having to
the ground implementation.
 What is HL7? What HL7
(Cont.) does?
• HL7 is an acronym for Health
Level Seven
– Seven represents the highest, or
“application” level of the
International Standards
Organization (ISO) communications
model for Open Systems
Interconnection (OSI) networks.
7 Application Layer HL7 – Health Level 7

6 Presentation Layer

5 Session Layer

4 Transport Layer
OSI Model
3 Network Layer

2 Data Link Layer

1 Physical Layer
Version 2.8.2
• An Application Protocol for Electronic Data Exchange in
Healthcare Environments
• Health Level-7 or HL7 refers to a set of international standards for transfer
of clinical and administrative data
• Language that describes you, and your medical information, to all
the Hospital information systems
• Produced by the Health Level Seven International
• A not-for-profit, international standards developing organization
• ANSI-accredited
• Founded in 1987
 What HL7
does?
• HL7 focuses on the clinical and administrative data domains.
• It defines data exchange standards for these domains called
messages or messaging specifications (aka HL7 messages)
– Messages are developed by technical committees and special interest groups
in the HL7 organization.
• HL7 organization defines 2 versions of the messaging
standard:

– HL7 v2.x (syntactic only)

– HL7 v3.0 (semantic capability added)
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 HL7 Standards

• HL7 V2.x
– Defines electronic messages supporting hospital operations
• HL7 V3
• HL7 Clinical Document Architecture (CDA)
Releases 1 and 2
• HL7 Arden Syntax
– Representation of medical knowledge
• HL7 EHR & PHR Functional Specifications
• Etc.

20
Levels of Interoperability

Function
al

Semantic

Syntactic
 Levels of Interoperability

Functional Standards (HL7 EHR

Function Functional Specifications)

al Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)

Semantic Information Models (HL7 v.3 RIM,

ASTM CCR, HL7 CCD)
Standard Data Sets
Unique ID
Exchange Standards (HL7 v.2,
Syntactic HL7 v.3 Messaging, HL7 CDA,
DICOM)
Technical Standards
(TCP/IP, encryption,
security)

Some may be hybrid: e.g. HL7 v.3, HL7 CCD

 Goal of
interoperability
• HL7’s key goal of interoperability has
two aspects:
– Syntactic interoperability has to do with
structure
– Semantic interoperability has to do with
meaning
Things that can go wrong in message
exchange
Patient Registration Scenario

Patient Admit

Sends information to Finance

department (ADT_A01)
Patient Lab Test Scenario

Goes for lab test

Query Patient Admin (QBP_Q21)

Retrieves Info (RSP_K21)

Sends info to finance (ORU_R01)

Health Information Exchange (HIE)

Government

Hospital A Hospital B

Clinic C
Lab Patient at Home
 Why Health Information Standards?

Objectives Ultimate Goals

• Interoperability • Continuity of Care
• Inter-operable • Quality
systems  Safety
 Timeliness
 Effectiveness
 Equity
 Patient-Centeredness
 Efficiency
What we give?

34
 How has it stored?

PID <cr>
Name DOB Address

35
References

• http://www.hl7.org/
• HL7 Messaging Standard Version 2.8.2 -
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=
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