HL7

Health Level Seven (HL7), is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards. "HL7" is also used to refer to some of the specific standards created by the organization (e.g., HL7 v .!, v".#, HL7 $%&). HL7 and its members provide a frame'or( (and related standards) for the e!change, integration, sharing, and retrieval of electronic health information. v .! of the standards, 'hich support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the 'orld. Organization HL7 is an international community of healthcare sub)ect matter e!perts and information scientists collaborating to create standards for the e!change, management and integration of electronic healthcare information. HL7 promotes the use of such informatics standards 'ithin and among healthcare organizations to increase the effectiveness and efficiency of healthcare information delivery for the benefit of all. *he HL7 community is organized in the form of a global organization (Health Level +even, %nc.) and country-specific affiliate organizations,

Health Level +even, %nc. (HL7, Inc. ) is head-uartered in .nn .rbor, &ichigan. HL7 affiliate organizations, not-for-profit organizations incorporated in local )urisdictions, e!ist in over /# countries. *he first affiliate organization 'as created in 0ermany in 122".3

*he organizational structure of HL7 %nc. is as follo's,

*he organization is managed by a 4oard of 5irectors, 'hich comprises 1# elected positions and three appointed positions. *he 6hief 7!ecutive 8fficer (currently 6harles 9affe, &5, :h5) serves as an e! officio member of and reports to the 4oard of 5irectors. *he 6hief *echnology 8fficer (currently 9ohn ;uinn)< and the 6hief 8perations 8fficer (currently &ar( &c5ougall) report to the 678 and also serve as e! officio members on the 4oard of 5irectors. &embers of HL7 are (no'n collectively as "*he =or(ing 0roup". *he =or(ing 0roup is responsible for defining the HL7 standard protocol and is composed of +tanding .dministrative 6ommittees and =or(ing 0roups.
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Standing Administrative committees focus on organizational or promotional activities, such as 7ducation, %mplementation, &ar(eting, 8utreach 6ommittee for 6linical $esearch, :ublishing and :rocess %mprovement and *ooling.

Working groups are directly responsible for the content of the +tandards, framing the actual language of the specifications.

Origin
HL7 'as founded in 12>7 to produce a standard for hospital information systems. HL7, %nc. is a standards organization that 'as accredited in 122/ by the .merican ?ational +tandards %nstitute (.?+%). HL7 is one of several .merican ?ational +tandards %nstitute accredited +tandards 5eveloping 8rganizations (+58s) operating in the healthcare arena. &ost +58s produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level +even@s domain is clinical and administrative data. *oday, HL7 has been adopted by several national +58s outside the Anited +tates. *hose +58s are conse-uently not accredited by .?+%. Ho'ever, HL7 is no' adopted by %+8 as a centre of gravity in international standardization and accredited as a partnering organization for mutual issuing of standards. *he first mutually published standard is %+8BHL7 17"1, ##C Health informaticsDHL7 version "D$eference information modelD$elease 1. The name "Health Level-7" *he name "Health Level-7" is a reference to the seventh layer of the %+8 8+% $eference model also (no'n as the application layer. *he name indicates that HL7 focuses on application layer protocols for the health care domain, independent of lo'er layers. HL7 effectively considers all lo'er layers merely as tools.

Collaboration
HL7 collaborates 'ith other standards development organizations and national and international sanctioning bodies (e.g. .?+% and %+8), in both the healthcare and information infrastructure domains to promote the use of supportive and compatible standards. HL7 collaborates 'ith healthcare information technology users to ensure that HL7 standards meet real-'orld re-uirements, and that appropriate standards development efforts are initiated by HL7 to meet emergent re-uirements. .bout /EF of the global membership (of either HL7 %nc. or an HL7 affiliate) is located in 7urope, "EF in ?orth .merica, 1EF in .sia-8ceania and EF else'here.

HL7 standards
Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient trac(ing. .ll of these systems should communicate 'ith each other (or "interface") 'hen they receive ne' information but not all do so. HL7 specifies a number of fle!ible standards, guidelines, and methodologies by 'hich

various healthcare systems can communicate 'ith each other. +uch guidelines or data standards are a set of rules that allo' information to be shared and processed in a uniform and consistent manner. *hese data standards are meant to allo' healthcare organizations to easily share clinical information. *heoretically, this ability to e!change information should help to minimize the tendency for medical care to be geographically isolated and highly variable. HL7 develops conceptual standards (e.g., HL7 $%&), document standards (e.g., HL7 65.), application standards (e.g., HL7 668=), and messaging standards (e.g., HL7 v .! and v".#). &essaging standards are particularly important because they define ho' information is pac(aged and communicated from one party to another. +uch standards set the language, structure and data types re-uired for seamless integration from one system to another. HL7 encompasses the complete life cycle of a standards specification including the development, adoption, mar(et recognition, utilization, and adherence. 4usiness use of the HL7 standards re-uires a paid organizational membership in HL7 %nc. HL7 &embers can access standards for free and non members can buy the standards from HL7 or .?+%.

HL7 version 2.
*he HL7 version in 12>2. !2. "essaging HL7 version defines a series of electronic messages to support administrative, logistical, financial as 'ell as clinical processes. +ince 12>7 the standard has been updated regularly, resulting in versions .1, . , .", .".1, ./, .E, .E.1 and .C. *he v .! standards are bac('ard compatible (i.e. a message based on version ." 'ill be understood by an application that supports version .C). HL7 v .! mostly uses a te!tual, non-G&L encoding synta! based on delimiters. HL7 v .! has allo'ed for the interoperability bet'een electronic :atient .dministration +ystems (:.+), 7lectronic :ractice &anagement (7:&) systems, Laboratory %nformation +ystems (L%+), 5ietary, :harmacy and 4illing systems as 'ell as 7lectronic &edical $ecord (7&$) or 7lectronic Health $ecord (7H$) systems. 6urrently, HL7@s v .! messaging standard is supported by every ma)or medical information systems vendor in the Anited +tates. standard has the aim to support hospital 'or(flo's. %t 'as originally created

HL7 version #
*he HL7 version " standard has the aim to support all healthcare 'or(flo's. 5evelopment of version " started around 122E, resulting in an initial standard publication in ##E. *he v" standard, as opposed to version , is based on a formal methodology (the H5H) and ob)ectoriented principles. $I" - ISO%HL7 2&7#&

*he $eference %nformation &odel ($%&) is the cornerstone of the HL7 Iersion " development process and an essential part of the HL7 I" development methodology. $%& e!presses the data content needed in a specific clinical or administrative conte!t and provides an e!plicit representation of the semantic and le!ical connections that e!ist bet'een the information carried in the fields of HL7 messages. *he $%& is essential to increase precision and reduce implementation costs. &odels are available. HL7 'evelo(ment )rame*or+ - ISO%HL7 27,#& *he HL7 Iersion " 5evelopment Hrame'or( (H5H) is a continuously evolving process that see(s to develop specifications that facilitate interoperability bet'een healthcare systems. *he HL7 $%&, vocabulary specifications, and model-driven process of analysis and design combine to ma(e HL7 Iersion " one methodology for development of consensus-based standards for healthcare information system interoperability. *he H5H is the most current edition of the HL7 I" development methodology. *he H5H not only documents messaging, but also the processes, tools, actors, rules, and artifacts relevant to development of all HL7 standard specifications. 7ventually, the H5H 'ill encompass all of the HL7 standard specifications, including any ne' standards resulting from analysis of electronic health record architectures and re-uirements. HL7 specifications dra' upon codes and vocabularies from a variety of sources. *he I" vocabulary 'or( ensures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using. !# "essaging *he HL7 version " messaging standard defines a series of electronic messages (called interactions) to support all healthcare 'or(flo's. HL7 v" messages are based on an G&L encoding synta!. !# Clinical 'oc-ment .rchitect-re - ISO &/70& *he HL7 version " 6linical 5ocument .rchitecture (65.) is an G&L-based mar(up standard intended to specify the encoding, structure and semantics of clinical documents for e!change.

"ethods a((lied b1 HL7

Services .*are Intero(erabilit1 )rame*or+
*he HL7 +ervices-.'are 7nterprise .rchitecture Hrame'or( (+.%H) provides consistency bet'een all HL7 artifacts, and enables a standardized approach to 7nterprise .rchitecture (7.) development and implementation, and a 'ay to measure the consistency. +.%H is a 'ay of thin(ing about producing specifications that e!plicitly describe the governance, conformance, compliance, and behavioral semantics that are needed to achieve computable

semantic 'or(ing interoperability. *he intended information transmission technology might use a messaging, document e!change, or services approach. +.%H is the frame'or( that is re-uired to rationalize interoperability of other standards. +.%H is an architecture for achieving interoperability, but it is not a 'hole-solution design for enterprise architecture management.

.rden s1nta
*he .rden synta! is a language for encoding medical (no'ledge. HL7 adopted and oversees the standard beginning 'ith .rden synta! .#. *hese &edical Logic &odules (&L&s) are used in the clinical setting as they can contain sufficient (no'ledge to ma(e single medical decisions. *hey can produce alerts, diagnoses, and interpretations along 'ith -uality assurance function and administrative support. .n &L& must run on a computer that meets the minimum system re-uirements and has the correct program installed. *hen, the &L& can give advice for 'hen and 'here it is needed.

"LL2
. large portion of HL7 messaging is transported by &inimal Lo'er Layer :rotocol (&LL:). .mongst other soft'are vendors this protocol is supported by &icrosoft and 8racle.

CCO3
668=, or "6linical 6onte!t 8b)ect =or(group," is a standard protocol designed to enable disparate applications to share user conte!t and patient conte!t in real-time, and at the userinterface level. 668= implementations typically re-uire a 668= vault system to manage user security bet'een applications.

)-nctional 4H$ and 2H$ s(eci5ications

Hunctional specifications for an electronic health record.

Co-ntr1 s(eci5ic as(ects

.-stralia
HL7 .ustralia 'as established in 122>. .ustralia 'as an early adopter of the HL7 I .! standards, 'hich are no' ubi-uitously used in .ustralian public and private healthcare organisations. *he localisation of the HL7 standards is underta(en in cooperation 'ith the national standards body, +tandards .ustralia.

HL7 .ustralia closely cooperates 'ith the ?ational 7-Health *ransition .uthority (?7H*.).

HL7 .ustralia +tandards .ustralia (%*-#1/ "Health %nformatics" ?7H*.

)inland
6ational IT services 5or healthcare *he +ocial %nsurance %nstitution of Hinland is building a national e:rescribing and patient record archival service based on HL7 65. $ and I" messages. :hased deployment is scheduled for ##>- #11. Iersion messaging is 'idely deployed in most hospitals and healthcare centers. 65. $1 is used in sharing patient records on a regional level.

HL7 Hinland national affiliate

7erman1
*he 0erman chapter of HL7 'as founded in 122". *his is an entity for benefit to the public and registered as an association as HL7 e. I. 5ue to federal structure of operational administration in 0erman healthcare, the standardization aspect is much behind the possibilities of the public economy and due to competitive interests in industry of lo' normative impact to healthcare information systems development. 6urrently HL7 in 0ermany operates as an informal cluster and collaborates 'ith the national standardization body. *he voluntary membership in HL7 relies on personal interest and engagement of clinical users and mainly on industrial interest, 6linical memberships are in minority. *here is lo' membership of governmental administration and thus lo' contribution to ongoing discussion e.g. on patient data records (7:. J ele(tronische :atientena(te) balancing data availability vs. data security. %mpact on productivity for hospital information systems (called K%+ J Kran(enhaus%nformationssysteme in 0erman) is of no importance yet, as the variability of H%+ systems has not been challenged by HL7. 0overnmental funding for a broader adoption of HL7 does yet not e!ist in 0ermany, neither on federal level nor in most of the regional governments.

The 6etherlands
.O$T. - 6ational Healthcare ICT in5rastr-ct-re .8$*. is the 5utch national infrastructure for the e!change of data bet'een healthcare providers. .8$*. uses HL7 version " messages and documents as its core mechanism for

information e!change. *he initial specifications 'ere created in ##". *he 5utch &inistry of Health is 'or(ing on a virtual national 7lectronic :atient $ecords (7:$) 'hich 'ill enable healthcare providers to share patient data. *his development ta(es place in close collaboration 'ith ?ictiz, the ?ational %nformation and 6ommunication *echnology %nstitute for Healthcare. ?ictiz coordinates its efforts 'ith regard to the usage of HL7 version " 'ith the volunteers of HL7 the ?etherlands. .lmost all hospitals use HL7 version to support hospital-internal 'or(flo's. 75%fact is being used to support 'or(flo's involving general practitioners (0:sB:6:s). 75%fact 'ill be slo'ly replaced by HL7 version ".

HL7 the ?etherlands ?ictiz .8$*. 'hitepaper

2a+istan
HLH - Health Life Horizon HLH (a national pro)ect) is carrying out at +chool of 7lectrical 7ngineering and 6omputer +ciences of ?ational Aniversity of +cience and *echnology and is supported by 0ovt of :a(istan 'ith funds provided by ?ational %6* $L5 Hund. HLH basic theme is to target health care information e!change and interoperability using HL7 version ". *hough the penetration and use of HL7 in :a(istan is lo'er than the countries li(e A+ and that of 7urope. 4ut its getting popularity among the sta(eholders in :a(istan. HLH team put its tremendous efforts to develop state of the art HL7 version " tools and technologies. .lso they are continuously involved to carry out research ta(ing the development one step ahead. .dditionally they organized and are organizing a'areness seminars, meetings and 'or(shops from time to time at various locations in :a(istan. HLH is collaborating 'ith several other reno'ned organizations from :a(istan to be part of this )ourney. *hese efforts created a very good impression not only at national level but also at international level. HLH *eam members regularly participated in HL7 international =or(ing 0roup &eetings and conferences for last t'o years. 8n 8ct 1, #1# HL7 %nternational announced :a(istan chapter formally at /th :lenary and =0& in 6ambridge A+.. :a(istan is no' "7th affiliate of HL7 %nternational around the 'orld. HL7 :a(istan is no' officially authorized to give memberships to local organizations along 'ith other privileges li(e certification, training etc.

8S.
Lai+a *he 6ertification 6ommission for Healthcare %nformation *echnology (66H%*) has developed an open-source program called Lai(a to test 7H$ soft'are for compliance 'ith 66H%* interoperability standards.

HI2.. HL7@s initial involvement in the Health %nsurance :ortability and .ccountability .ct (H%:..) legislation began in 122C 'ith the formation of the .ttachments special interest group to standardize the supplemental information needed to support health care insurance, and other ecommerce transactions. *he initial deliverable of this group 'as a set of si! recommended 6laims .ttachments for the ?otice of :roposed $ule &a(ing (?:$&) process. Huture attachment pro)ects include, but are not limited to, Home Health, +(illed ?ursing Hacility, durable medical e-uipment (5&7), end stage renal disease (7+$5), and :re-.uthorization and $eferrals. *he .ttachment special interest group is responsible for implementing the .dministrative +implification provisions of H%:.. mandates, providing on-going support, and representing HL7 in the 5esignated +tandards &aintenance 8rganization (5+&8) efforts. %ts purpose is to encourage the use of HL7 for uniform implementation of this supplemental information. *his +%0 coordinates industry input to produce and maintain guides for HL7 messages that can stand alone or be embedded 'ithin .?+% G1 transactions. H-rricane 9atrina *he HL7 group )oined forces 'ith the 7lectronic Health $ecord Iendors .ssociation (7H$I.) to assist patients in the aftermath of Hurricane Katrina. &embers of both organizations 'ere actively 'or(ing on activities 'ith local, state 'ide and national agencies (including the 5HH+ and the 656) to provide solutions for those in the affected area.