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May 18th, 2013, 22:09
What has mr p. been up to part 2:

Give me a "H".
Give me a "L".
Give me a "7".

Wazzat spell? Wazzat spell? WAZZAT SPELL?

Health Level 7!!!!

Yepp. Health Level 7 it is. A standard for, surprise, surprise … Health … or more precisely: a standard for interoperability, for exchanging information between healthcare software solutions. The level 7 is a tribute to the 7th layer of the osi networking model.

The standard covers about every aspect of information exchange related to healthcare: patient demographics, patient administration, clinical information (for instance between a hospital and the doctor referring the patient), requests for an results from supplementary examinations like radiology and pathology. Clinical chemistry as well. And a lot more, including support for authentication, for maintaining confidentiality, security, and for auditing who did what with whose information.

The standard has been around for years, in the shape of version 2.x. There are several things wrong with version 2. It's not very readable. It's not based on a thoroughly developed information model. And there are too many options, which means that different operators use it differently. Which is bad.

Enter version 3. The foundation for version 3 is the RIM, the Reference Information Model. It's described in UML and it's huge. There are few things (health related) not covered by it. The model is supplemented by a set of datatypes, and a vocabulary, a set of standard terms and codes used to identify things within it. You can find more on it, including a picture here: http://www.hl7standards.com/blog/201…-intimidating/

In itself the RIM is too large and complex for practical use. In stead restricted (specialized) models are developed based on the RIM, so called RMIMs (Refined Message Information Model). These are adaptations covering specific types of information. One of them is CDA (Clinical Document Architecture). It covers storage and exchange of clinical information and results, whereas demographics (like a patient moving to a new address) and administration (for instance patient admittance to hospitals) are outside the model. It's implemented in XML, and it contains parts specifically designed to be human readable.

CDA is further adapted to different specialities. Thus there are or will be separate CDA's for instance for clinical reports to referring doctors after hospitalization, for transfer information with the patient from one institution to another, and for communicating results of supplementary exminations like ECG or an xray. Informatipon presented in an ECG report will be different from an xray report, but they're all based on the general CDA model (which again derives from the RIM)

Version 3 is still under development. The RIM itself is fairly stable by now, but there is still a lot to do regarding the RMIMs. And this is where pibbur comes in. Along with many others.

HL7 is governed by "Health Level 7 International". Much of the work is delegated to workgroups specializing in different aspects of the standard. 3 times a year workgroup meetings (WGM) are held. Mostly in the US, but occasionally they go abroad. They've been in Canada and Brazil. They've even gone to Australia. The may meeting in 2015 will be held in Paris.

At each WGM there are several training courses, but most important are the meeting of the workgroups. Pibbur attends two groups during these sessions. One of them is Order and Observation (OO), which is about ordering mostly clinical chemistry analyses and retrieving the results. The other is Imaging Integration (II) which covers results from xray examinations and other types of diagnostic imaging (like PET scanning). This is his favourite due to his many ears working as an administrator of PACS systems. And his 2 1/2 years as a radiologist wannabe. Pibbur may not want to work as a physician anymore (he definitely doesn't want that), it's still nice for him to be able to use some of his medical knowledge.

So far he's been to 3 WGMs in Baltimore, Phoenix and Atlanta. And in september he's scheduled for Boston.

Pibbur who now has finished his 2 pieces of longish drivel. Which you didn't need to know, but which pibbur, in the spirit of this thread, insisted on telling you.

PS. You may have noticed: HL7 people loooove acronyms. And now i'm going to share a secret with you. One of the RMIMs is called "Fast Healthcare Interoperability Resources" or … yepp … FHIR. But here's the deal: we pronounce it "fire". Don't ever pronounce it like "fur", unless you want to prove to everyonethat you're a newbie. You don't want that, do you? DS.

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