INTRODUCTION
Each of the systems – Radiology Information System (RIS), Lab Information System (LIS), Hospital Information System (HIS), Electronic Health Record (EHR) and Electronic Medical Record (EMR) communicate with each other in different languages. Increased number of healthcare applications and the necessity of centralized electronic health record drive the requirement for the universal language among the applications. To solve this issue, HL7 was introduced as the single, ssh websocket flexible and universal standard of communication in 1987. This article summarizes the importance and steps involved in a successful HL7 integration.
Key Abbreviations
HL7 – Health Level Seven
HIPAA – Health Insurance Portability and Accountability Act
RIS – Radiology supermoz Information System
LIS – Lab Information System
HIS – Hospital Information System
EHR – Electronic Health Record
EMR – Electronic Medical Record
RIM – Reference Information Model
ISO – International Organization for Standardization
ANSI – American National Standards Institute
FIFO – First In First Out
CDA – Clinical Document Architecture
CCR – Continuity of Care
XML – Extensible Markup Language
DESCRIPTION:
What is HL7?
HL7 is the universal user-friendly standard which enables the communication between two or more healthcare applications. The health related information will be transferred in the form of one or more HL7 directory24x7 messages such as patient record and billing information.
The HL7 interoperability standard is often called the nonstandard standard, since it does not consider any specific part as special and, hence, there is no standard business or clinical model for clinical interaction.
HL7 development needs the involvement of clinical application analyst, buddylinks integration specialist, application programmers and system analyst.
What does HL7 stand for?
HL7 (Health Level Seven) symbolizes a 7-layer ISO communication model
Physical: seoboost Connects the entity to the transmission media
Data Link: Provides error control between adjacent nodes
Network: Routes the information in the network
Transport: Provides end-to-end communication control
Session: Handles problems that are not communication issues
Presentation: Converts the information
Application: Provides different services to the applications
1-4 deals with Communication; 5-7 deals with Function. All these layers are used by HL7 interface engine for transfer and retrieval of HL7 data.
HL7 Interoperability Standard versions
2.0 – 1988 – Prototype
2.1 – 1990 – First standard
2.2 – 1994 – Widely adopted
2.3 – 1997 – In operation
2.3.1 – 1999 – Approved ANSI standard
2.4 – 2000 – Approved ANSI standard
2.5 – 2003 – Current ANSI standard
3.0 – In development
OBJECTIVES: bizfront
The vision of HL7 development is a world where everyone can securely access and use the right health data when and where they need it. In order to achieve that goal, the workflow should be simplified between healthcare software applications and various vendors for the enhanced quality, accuracy, cost and efficiency of healthcare providers.
Strategies:
Develop clear standards of health care information to exchange between computer applications for an enhanced patient care.
Develop a methodology of HL7 interoperability standards from the HL7 bizprimary Reference Information Model (RIM).
Educate the healthcare industries, policy makers and public about the benefits of healthcare information standardization.
Promote the use of HL7 interoperability standards world-wide through the creation of HL7 International Affiliate organizations.
Encourage domain experts from healthcare industry stakeholder organizations to join in HL7 for developing healthcare information standards in their area of expertise.
Collaborate with other standards development organizations and national and international sanctioning bodies (e.g. ANSI and ISO), to promote the use of compatible standards.
Collaborate with healthcare information technology users to ensure that HL7 standards meet real-world requirements.
HEALTHCARE INTEGRATION SOLUTIONS
Healthcare integration overview
Export endpoint – sending application
Import endpoint – receiving application
Methodology – move data between two endpoints
Methodology – handling the queuing messages
Methodology – sorting the message flow
Each healthcare application must be accessible to send and accept patient data. There are certain fixed rules of what to accept and send for easy exchange. This access is strictly controlled by each application vendor to ensure data integrity within their application.
Healthcare Integration Requirements
First In, First out (FIFO): The exchange of clinical data must be in FIFO order. The first HL7 message received will also be the first HL7 message delivered.
Flexibility to Address Varying Requirements: Since HL7 is essentially a platform for negotiation, the interface solution must be flexible to deal with HL7 V2.3.1, V2.4, V2.5, ultradir etc. It should be able to send one message in varied versions to multiple applications.
External Application and Provider Integration: Real-world integration takes place between multiple applications in multiple locations. Healthcare interface traffic can be intense so a strong traffic director in the middle is extremely important. Else, the output will get delayed which might lead to costly implementations, application modifications, etc. Each application in the integration path should be able to send and/or receive data, ideally in an HL7 format.
Short Implementation Cycle: The workflow for interface configuration should be easy, logical and GUI driven. The developer does not have to be available to implement each application or site.
Scalable: The number of interfaces will grow over time. An interface solution must also be able to grow with the demands of the market.
Different Data Formats: In addition to HL7, the interface solution should be able to handle other clinical standards including the Clinical Document Architecture (CDA), Continuity of Care (CCR), and XML.
Ease of Interface Testing & Maintenance: Delivering quality interfaces is crucial. Hence, few testing functions such as conformance checking, message unit testing, and communication testing should be incorporated within the interface solution.
Ease of Monitoring & Management: To keep customer support costs low, interface implementations should be easy to monitor and resolution tools should be readily available to fix any upcoming error.
HIPAA & HL7 INTEGRATION PROTOCOLS
Data sharing between clinical and financial systems is always a challenging task, in terms of reliability, security and compliance. That is where exactly, the importance of HL7 and HIPAA arises.
HL7 exchanges clinical date between healthcare applications from different vendors. HIPAA (Health Insurance Portability and Accountability Act) was implemented in 1966 in order to update healthcare transactions and to uphold patients privacy rights.
HL7 will be triggered by the events like patient admission and billing within the enterprise like hospitals. Whereas between enterprises like hospitals and insurance companies, directori HIPAA enabled EDI-X12 transactions will be exchanged. HL7 is also used in certain HIPAA EDI-X12 transactions.
For instance, if a patient is admitted in hospital, the Patient Administration System (PAS) maintain the details about that patient. If other system like Pharmacy Systems need information about this patient, it sends an HL7 message about the patient to the proper hospital systems.
Later, when the hospital sends a claim for payment to another enterprise, like an insurance company, the hospital and the insurance company exchange HIPAA EDI-X12 messages. These HIPAA EDI-X12 messages may contain an embedded HL7 message about the patient also.
INTEGRATION OPTIONS AVAILABLE
An enterprise such as hospital has got many HL7 enabled applications. To reduce data entry duration and increase overall efficiency of the facility, these applications should communicate with each other.
