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An HL7-Centric Immunization Registry

Presented by Kevin Davidson

QS Technologies

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The Information Exchange Problem

How can unlike systems understand each other?

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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.

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Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the

Health Level Seven (HL7) Protocol

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MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03^V03|19970522MA53|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 …

Actual HL7 Message

HL7 messages are not designed for humans, but machines like them Segmen

t

Field

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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

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VXQ Message – Query for Vaccination Record

Do you have any shots for

Jimmy Smith?

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VXX – Response with multiple matches

JimmySmith 1

JimmySmith 2

JimmySmith 3

JimmySmith 4

JimmySmith 5

JimmySmith 6

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VXR – Response with Vaccination Record

Patient demographics

Identifiers

Vaccination history

Adverse events

Contraindications

Recommendations for shots due

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VXU – Unsolicited Vaccination Update

Use to add new individual immunizations to the registry

Use for mass loading from other systems

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ORU – Unsolicited Transmission of an Observation (used for VAERS)

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ADT – Admit / Discharge / Transfer

ADT Messages can be used with legacy hospital and billing systems

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Coded Data in HL7

CVX

NIPCodes

OMB Race MVX

LOINC

HL7Codes

Over 50 Code Sets

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An HL7-Centric Registry

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An HL7-Centric Registry

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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

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An HL7-Centric Registry

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Problems with Legacy Code Sets

Legacy Code Sets may not capture HL7 Coded Data completely.

Translation tables are hard to maintain.

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An HL7-Centric Registry

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Internal Messaging

Immunization messages – HL7 System Administration – HL7 Reporting – HL7

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The Need for Speed

Relational Database Server

One or Many HL7 Application Servers

Web Server &Traffic Manager

HTTPSHL7 LLP

ADO

•Multi-tasking

•Scalable

•Lightweight Protocols

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An HL7-Centric Registry

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External Interfaces

HL7 Pipe

WebApp

Server

SSL

HTTPSInterface

Email?ebXML?

Batch(FTP)

InternalSystem

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Benefits of an HL7-Centric Approach

Best Practices

Fewer Design DecisionsInteroperability

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Good designs are easier to implement

Standards encourage completeness

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Good designs are easier to implement

Standards encourage completeness

Standards encourage modular design

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Good designs are easier to implement

Standards encourage completeness

Standards encourage modular design

Standards reduce false starts

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High-Level Design Decisions

Decide what HL7 Messages to Support VXQ, VXR, VXX, VXU, ACK, QCK plus ORU

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High-Level Design Decisions

Decide what HL7 Messages to Support VXQ, VXR, VXX, VXU, ACK, QCK plus ORU

Select HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon

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High-Level Design Decisions

Decide what HL7 Messages to Support VXQ, VXR, VXX, VXU, ACK, QCK plus ORU

Select HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon

Select Development Tools

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High-Level Design Decisions

Decide what HL7 Messages to Support VXQ, VXR, VXX, VXU, ACK, QCK plus ORU

Select HL7 Mapping Tool (or write one) iNTERFACEWARE Chameleon

Select Development Tools

Select Client Technology 100% HTML for widest acceptance

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Open Issues

Transport Mechanisms

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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface

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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface

Query Improvement

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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface

Query Improvement

Coordinating Business Rules between Registries – Minimal Data Quality

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Open Issues

Inventory Management

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Open Issues

Inventory Management

Synchronization and Mass Changes

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Open Issues

Inventory Management

Synchronization and Mass Changes

Data Representation Standards

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Conclusions

You can do everything you need to do using HL7

It performs well

It is scalable

Developers are productive

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Start With HL7

The project goes much better if you start with HL7 rather than trying to add it on at the end.

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Resources National Immunization Program Registry Page

http://www.cdc.gov/nip/registry

Health Level Seven http://www.hl7.org

Committee on Immunization Standards and Electronic Transactions (CIRSET) http://www.cirset.org

QS Technologies Immunization Registry information http://www.immregistry.com

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End of Presentation