Transcript An HL7-Centric Immunization Registry

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