HL7: New initiatives from Health Level Seven International

Globally, Healthcare IT is undergoing remarkable changes. Much of this has been spurred by a wave of investment by government agencies and by the vendor community. At the same time, innovative approaches to technical development have emerged from every strata of stakeholder involvement.

Clinical Document Architecture (CDA)              

CDA has become a global phenomenon. It did not happen overnight. After all, CDA has been an ISO standard for more than a decade. It has come to serve as an easy on-ramp for interoperable data exchange that preserves the character of a document while allowing the computable exchange of the most atomic of data elements. Application of CDA has become increasingly cost-effective and incremental. Much of the success has been predicated on the creation of templates, which can be created, exchanged, modified, and reused for a broad range of applications. 

In the US, consolidated CDA arose from a harmonization project, under the direction of the Standards and Interoperability office at ONC. It required the collaboration of divergent organizations in a very brief timeframe and under demanding circumstances. It is poised to become the cornerstone of Meaningful Use 2 (MU2). Although it remains a US-centric project, MU2 has garnered significant interest from many countries around the world. In fact, CDA is the interoperability core for the epSOS Project (Smart Open Services for European Patients), which is designed to enable the cross-border exchange of clinical summaries and electronic prescriptions. CDA has also been embraced by countries beginning the process of health information exchange.

More advanced users have embraced the notion of greenCDA.  In fact, greenCDA enables the interoperability of conformant CDA, but with a smaller footprint, less overhead, and reduced transmission bandwidth. Transforms have been developed to facilitate the conversion of greenCDA back into its conformant schema.  For some users, greenCDA is efficient and practical because it includes only the data and metadata needed to define a clinical summary. The various uses of this technology on a broad scale continue to be evaluated within the user community. 

In order to enable efficient use of CDA, developers and implementers have requested access to the extensive library of existing CDA templates. One such solution is provided by the Trifolia Workbench. This tool effectively captures, stores and manages CDA templates. Although still in beta release, Trifolia also serves as a repository for existing templates and provides tools for the modification and storage of new template solutions. HL7 is currently developing a template authoring language that is agnostic of any existing template development solutions.

Clinical Information Modeling Initiative (CIMI)

CIMI is a rapidly emerging international, multi-stakeholder development alliance that emerged from a new approach to standards development at HL7. This initiative, called Fresh Look, has embraced some of the best strategies and some of the most innovative thought-leaders in the global community. Once believed to be a strategic impossibility, highly diverse groups, many of which had not met in the same venue for more than a decade, came to the table in the name of true change for our industry. They have begun the difficult task of clinical information modeling using a broad, open and transparent consensus based process. Only time will tell if CIMI is able to achieve its lofty goals, but it will remain a formidable collaboration for the foreseeable future.

mHealth (Mobile Health Workgroup)

Everyone in healthcare will agree that even the concept and scope of mobile health are difficult to define. For many, it has emerged from the shadows of telemedicine. It transcends the technology of electronic health records on tablets, and may serve to supplant traditional computing platforms in the emerging economies. These technologies enable connectivity of personal health devices and support the interoperability of critical support instruments in acute care setting. Mobile health may serve as a conduit for gathering public health data and replace traditional decision support, disease management, and care coordination technologies. The mHealth workgroup at HL7 emerged from the efforts of leaders in many areas of development within HL7. At the same time, HL7 is collaborating with international organizations, with government agencies, and with academic centers, in order to identify gaps and harmonize existing standards. The initial announcement of this workgroup was met with a response from over 600 HL7 members and will be showcased during the workgroup meeting in September in Baltimore.

Caregiver Alliance

Today, many caregivers, including physicians, nurses, pharmacists and other professionals in the care continuum, struggle with the existing solutions for electronic health records. The Caregiver membership in HL7 allows individuals to participate in and contribute to the development of the standards and specifications that influence their patient care and wellness management. HL7 hopes to become their voice for this process. By providing insight into their specific requirements for usability, workflow, interface design and business enablement, HL7 hopes to impact the development of these technologies before they become deeply embedded in end-user products. This group is the descendant of the highly successful AHRQ-funded project, the Clinical Information Interoperability Council, which began almost three years ago.

Genomics

The Genomics Workgroup has spearheaded several new approaches to providing interoperable solutions for linking genetic and genomic data to electronic health records and personal health records. As the body of genomic data increases exponentially, and the number of nomenclatures increases in parallel, it is critical that the consequent data streams can provide support for personalized healthcare and evidence-based medicine. The day is not far off that we can map the entire individual genome for less than the cost of a routine chemistry profile and we can base clinical decisions upon the knowledge of one or only a few single nucleotide pairs. HL7 artifacts are becoming ready for that day. 

Fast Healthcare Interoperability Resource (FHIR)

Another innovative approach to standards development that has emerged from the HL7 Fresh Look initiative is FHIR. FHIR is not V4, but it represents a significant departure from some aspects of the HL7 development process. FHIR is a framework for the development of data exchange technology that offers the interoperability of the RIM, but hides the complexity of V3. In September, HL7 will host its first connectathon, which will allow developers and vendors to showcase the capacity and interoperability of products developed using the FHIR methodologies.

FHIR will not replace existing standards, however, and HL7 remains committed to the development and support of V2 and V3 artifacts. In fact, there has been a highly successful release of a new implementation of V2.7, which has received ANSI approval. This version should prove to achieve an even greater level of interoperability for the thousands of institutions worldwide that are committed to V2 messaging. In the V3 arena, balloting of Release 3 of CDA is near and plans are underway. This version will provide both a template exchange language and the associated tooling to support it.