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An HL7-Centric Immunization Registry Presented by Kevin Davidson QS Technologies 1 The Information Exchange Problem How can unlike systems understand each other? 2 Enter HL7 An international standard for the exchange of health information Designed for unlike systems to communicate through a standard format "HL7”, "Health Level Seven," and the puzzle design are registered trademarks, and the HL7 design is a trademark of Health Level Seven, Inc. 3 Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Protocol 4 Actual HL7 Message HL7 messages are not designed for humans, but machines like them Segmen t MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03^V03|19970522M A53|T|2.3.1|||NE|AL|<CR> MSA|AA|19970522GA40|<CR> … PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^ ~430078856^^^^MA^||KENNEDY^JOHN^FITZGERALD^ JR^^^L|BOUVIER ^^^^^ ^M|19900607|M|KENNEDY^BABY BOY^^^^^^B|2106-3^WHITE^HL 70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSACODE^MA 034~345 ELM ST^^BOSTON^MA^00314^^BDL~^^^^^^BR^^MA002||(617) 555-1212^PRN^PH^^^617^5551212 … Field 5 HL7 Message Types for Immunizations VXQ – Query for Vaccination Record VXX – Response with Multiple Matches VXR – Response with Vaccination Record VXU – Unsolicited Vaccination Update QCK/ACK – Acknowledgments ORU – Unsolicited Transmission of an Observation (used for VAERS) ADT – Admit / Discharge / Transfer 6 VXQ Message – Query for Vaccination Record Do you have any shots for Jimmy Smith? 7 VXX – Response with multiple matches Jimmy Smith 4 Jimmy Smith 1 Jimmy Smith 5 Jimmy Smith 2 Jimmy Smith 3 Jimmy Smith 6 8 VXR – Response with Vaccination Record Patient demographics Identifiers Vaccination history Adverse events Contraindications Recommendations for shots due 9 VXU – Unsolicited Vaccination Update Use to add new individual immunizations to the registry Use for mass loading from other systems 10 ORU – Unsolicited Transmission of an Observation (used for VAERS) 11 ADT – Admit / Discharge / Transfer ADT Messages can be used with legacy hospital and billing systems 12 Coded Data in HL7 HL7 Codes NIP Codes OMB Race Over 50 Code Sets MVX CVX LOINC 13 An HL7-Centric Registry 14 An HL7-Centric Registry 15 Database Problems with Legacy Databases Do not provide ways to store all the possible information in an HL7 message Data fields have to be used in ways not originally intended Database 16 An HL7-Centric Registry 17 Problems with Legacy Code Sets Legacy Code Sets may not capture HL7 Coded Data completely. Translation tables are hard to maintain. 18 An HL7-Centric Registry 19 Internal Messaging Immunization messages – HL7 System Administration – HL7 Reporting – HL7 20 The Need for Speed HTTPS Web Server & Traffic Manager One or Many HL7 Application Servers Relational Database Server •Multi-tasking •Scalable •Lightweight Protocols 21 An HL7-Centric Registry 22 External Interfaces Web App Server HTTPS Interface HL7 Pipe SSL Batch (FTP) Email? ebXML? Internal System 23 Benefits of an HL7-Centric Approach Best Practices Interoperability Fewer Design Decisions 24 Good designs are easier to implement Standards encourage completeness 25 Good designs are easier to implement Standards encourage completeness Standards encourage modular design 26 Good designs are easier to implement Standards encourage completeness Standards encourage modular design Standards reduce false starts 27 High-Level Design Decisions Decide what HL7 Messages to Support VXQ, VXR, VXX, VXU, ACK, QCK plus ORU 28 High-Level Design Decisions Decide VXQ, VXR, VXX, VXU, ACK, QCK plus ORU Select what HL7 Messages to Support HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon 29 High-Level Design Decisions Decide VXQ, VXR, VXX, VXU, ACK, QCK plus ORU Select what HL7 Messages to Support HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon Select Development Tools 30 High-Level Design Decisions Decide VXQ, VXR, VXX, VXU, ACK, QCK plus ORU Select what HL7 Messages to Support HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon Select Development Tools Select Client Technology 100% HTML for widest acceptance 31 Open Issues Transport Mechanisms 32 Open Issues Transport Mechanisms Digital Signatures (PKI) 33 Open Issues Transport Mechanisms Digital Signatures (PKI) Deduplication Interface 34 Open Issues Transport Mechanisms Digital Signatures (PKI) Deduplication Interface Query Improvement 35 Open Issues Transport Mechanisms Digital Signatures (PKI) Deduplication Interface Query Improvement Coordinating Business Rules between Registries – Minimal Data Quality 36 Open Issues Inventory Management 37 Open Issues Inventory Management Synchronization and Mass Changes 38 Open Issues Inventory Management Synchronization Data and Mass Changes Representation Standards 39 Conclusions You can do everything you need to do using HL7 It performs well It is scalable Developers are productive 40 Start With HL7 The project goes much better if you start with HL7 rather than trying to add it on at the end. 41 Resources National Immunization Program Registry Page Health Level Seven http://www.hl7.org Committee on Immunization Standards and Electronic Transactions (CIRSET) http://www.cdc.gov/nip/registry http://www.cirset.org QS Technologies Immunization Registry information http://www.immregistry.com 42 End of Presentation 43