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Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, March 01, 2007

HL7, Seemingly Moving Ahead as Australia Languishes.

Over the last few months there has been a steady stream of announcements and releases from HL7 that, taken together, must be seen as encouraging for the steady improvement in the level of standardisation and interoperation that is possible in implementation of e-Health.

These major announcements have (selectively quoting from the press releases) included:

1. On January 22, 2007 Health Level Seven (HL7) today announced four major milestones toward harmonization of interoperability standards as a result of the HL7 Working Group meeting held January 8 – 13, 2007 in San Diego, CA. HL7’s four key accomplishments include the following:

• HL7 collaboration with the Object Management Group (OMG) has resulted in HL7's Services-Oriented Architecture Committee successfully balloting three Draft Standards for Trial Use (DSTUs), two of which are now adopted and part of the Object Management Group's technology adoption process.

• Collaboration between HL7 and ASTM has resulted in the co-development of the Continuity of Care Document (CCD) endorsed by the Healthcare Information Technology Standards Panel (HITSP) and passed HL7 balloting on January 4, 2007.

• HL7 finalized an agreement with the California Health Care Foundation to ballot the EHR-Lab Interoperability and Connectivity Specification (ELINCS) through HL7 as an implementation guide to enable reporting of lab results from laboratory information systems to electronic health records (EHRs) in the outpatient setting.

• HL7 reached out beyond its existing membership, bringing extensive clinical input into the development of the EHR-S Functional Model. The Functional Model is one step closer to becoming an industry standard, and has already proven to be a useful tool for the Certification Commission for Health Information Technology (CCHIT).

2. On February 12, 2007 Health Level Seven (HL7), announced that, with the collaboration of the ASTM International E31 Healthcare Informatics Committee, the Continuity of Care Document (CCD) has passed HL7 balloting and is endorsed by the Healthcare Information Technology Standards Panel (HITSP) as the harmonized format for the exchange of clinical information including patient demographics, medications and allergies.

The CCD is a joint effort of HL7 and ASTM to foster interoperability of clinical data to allow physicians to send electronic medical information to other providers without loss of meaning, which will ultimately improve patient care.

“The collaboration between HL7 and ASTM reflects the integration of two complementary specifications [ASTM’s E2369-05, Continuity of Care Record (CCR), and HL7’s Clinical Document Architecture (CDA)] developed by separate standards development organizations, and demonstrates what can be achieved when patient care is the driving priority,” said Robert Dolin, MD, co-editor of the CCD specification and board member of HL7.

3 On February 21, 2007 Health Level Seven (HL7), announced it has passed the healthcare industry’s first ANSI-approved standard that specifies the functional requirements for an electronic health record system (EHR-S).

The standard outlines important features and functions that should be contained in an EHR system. The standard’s Functional Model contains approximately 1,000 conformance criteria across 130 functions, including medication history, problem lists, orders, clinical decision support, and those supporting privacy and security.

The function list is described from a user perspective and enables consistent expression of EHR system functionality, while the conformance criteria serves as a reference for purchasers of EHR systems and vendors developing EHR software.”

These announcements are all pragmatic and considered incremental steps in the level of e-Health standardisation and all have been either been proven through actual implementation or are provided as Draft Standards for Trial Use – and will only be made full standards once proven. I hope those responsible in Australia are monitoring the progress carefully and planning to take full advantage of the positive outcomes.

All this good news is not to deny that there are still some remaining issues with the HL7 project – most especially with HL7 V3.0. These issues are reviewed and discussed by a fellow blogger at the following URL:


Having browsed his work I am sure Professor Smith would be as pleased as I am to see the continuing development of the HL7 V2.x standards while the complexity and wrinkles in Version 3.0 are worked through and a practical and fully usable standard emerges. Version 3.0 has now been over 10 years in the making so one can only hope it won’t be too much longer! There are some serious organisations (like the UK NHS) pinning their hopes on success soon. I also have a sense that NEHTA is developing specifications and standards which may require years in the implementation while from HL7 we are getting some real guidance that could move things along far more quickly.

On a related topic I happened to see a copy of the ISO/TC 215 Health Informatics
Opening Plenary Final Agenda and associated papers for the meeting of March 2007 in Montreal Canada. I have to say that I was surprised just how much of the material that was to be covered was termed to be in a ‘Preliminary” state. It would be good to see rapid progress at this meeting also!



Terry Hannan said...

This is a very informative 'blog'. As you know the HL7 as a Standard for health in Australia is enshrined in legislation (Our work in Standards Australia). Strangely, or not, we do not appear to have the directive that NO health IT application can be implemented unless it is HL7 standardised.
Terry hannan

Anonymous said...

NeHTA work is right, cautious embracing of HL7 by NeHTA is a very good thing.

You say;
" I also have a sense that NEHTA is developing specifications and standards which may require years in the implementation while form HL7 we are getting some real guidance that could move things along far more quickly."

'An analysis of modeling flaws in HL7 and JAHIS' says:

"HL7 has developed a Reference Information Model
(RIM), an object-oriented model of clinical data. JAHIS is a
Japanese organization that has developed extensions to this RIM.
Instead of using the Unified Modeling Language (UML), the
standard notation for object-oriented software development, these
two organizations have developed specialized object-oriented
models. This has resulted in languages which are incompatible
with the current use of UML. The consequences of this choice are
the loss of the possible use of a large variety of existing models
and patterns. What is worse, it will be difficult to add security
specifications in their models, a critical aspect in the electronic
interchange of medical records."

Dr David G More MB PhD said...


I think it is important to distinguish between HL7 V2.x and V3.0. I agree, as many others do, a wait and see attitude to V3.0 may be quite prudent. On the other hand much useful communication can be done with HL7 V2.x safely and reliably and while waiting for V3.0 (and NEHTA) we should be getting on with it I believe.


Charles Vaz said...

I feel the adoption of EMR and HL7 at a regional level is a must for every country in this age.
Information Technology is so far ahead in many spheres in Medical Technology but its strange that most departments in a hospital still use paper.
I have a nice article on EMR on my Blog discussing the need for EMR implementation and the ROI (Return on Investment).
I would appreciate your comments but I sincerely feel that waiting for HL7 version 3 is not recommended since a delay in getting healthcare improved and integrated will only lead to increased costs of implementation and a bigger learning curve for the stakeholders.
Also, with OMG and Service based Architectures the communicating departments in the hospital need not worry whether the communication under the hood is HL7 2.3 or HL7 3 or HL7 2.4 - since there will always be a myriad of products in a hospital - due to legacy reasons.
Lastly, thanks for your articles.