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Jay's HL7 Information Page
This Wiki contains subject material on HL7 collected by Jay Konter

Health Level Seven (HL7), is a non-profit organization involved in the development of international healthcare informatics interoperability standards. "HL7" also refers to some of the specific standards created by the organization (e.g., HL7 v2.x, v3.0, HL7 RIM).

HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. The 2.x versions of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world.

Organization
HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. The organizational structure of HL7 Inc. is as follows:
 * The organization is managed by a Board of Directors, which comprises 10 elected positions and three appointed positions.

Origin
HL7 was founded in 1987 to produce a standard for hospital information systems. HL7, Inc. is a standards organization that was accredited in 1994 by the American National Standards Institute (ANSI).

The name "Health Level-7"
The name "Health Level-7" is a reference to the seventh layer of the ISO OSI Reference model also known as the application layer. The name indicates that HL7 focuses on application layer protocols for the health care domain, independent of lower layers. HL7 effectively considers all lower layers merely as tools.

HL7 standards
Most HL7 standards are not Open Standards, depending on the definition, since the current HL7 International IP Policy requires that an implementer or user be an organizational member of HL7, which requires annual payment of a fee. The revenue model and business plan of HL7 is discussed in HL7 Strategic Initiatives and Implementation Proposal. However, since the earlier policy as described in the Bylaws of October 2002 placed the HL7 protocol specifications in the Public Domain, and under 17 USC § 102 there is no copyright protection for an "idea, procedure, process, system, method of operation, concept, principle, or discovery", this revised policy may not be enforceable. As of Sept 4, 2012, the HL7 Board of Directors has announced its intention to relax this policy and allow free access and implementation to promote adoption and interoperability, as described in their press release.

HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards (e.g., HL7 CCOW), and messaging standards (e.g., HL7 v2.x and v3.0). Messaging standards are particularly important because they define how information is packaged and communicated from one party to another. Such standards set the language, structure and data types required for seamless integration from one system to another.

The Reference Information Model (RIM) and the HL7 Development Framework (HDF) are the basis of the HL7 Version 3 standards development process. RIM is the representation of the HL7 clinical data (domains) and the life cycle of messages or groups of messages. HDF is a project to specify the processes and methodology used by all the HL7 committees for project initiation, requirements analysis, standard design, implementation, standard approval process, etc.

HL7 standards:
 * Version 2.x Messaging Standard – an interoperability specification for health and medical transactions
 * Version 3 Messaging Standard – an interoperability specification for health and medical transactions, based on RIM
 * Version 3 Rules/GELLO – a standard expression language used for clinical decision support
 * Arden Syntax – a grammar for representing medical conditions and recommendations as a Medical Logic Module (MLM)
 * Clinical Context Object Workgroup (CCOW) – an interoperability specification for the visual integration of user applications
 * Claims Attachments – a Standard Healthcare Attachment to augment another healthcare transaction
 * Clinical Document Architecture (CDA) – an exchange model for clinical documents, based on HL7 Version 3
 * Electronic Health Record (EHR) / Personal Health Record (PHR) – in support of these records, a standardized description of health and medical functions sought for or available
 * Structured Product Labeling (SPL) – the published information that accompanies a medicine, based on HL7 Version 3

HL7 version 2.x
The HL7 version 2 standard has the aim to support hospital workflows. It was originally created in 1989.

V2.x Messaging

The following is an example of an admission record. MSH is the header record, PID the Patient Identity, etc. The 6th field for the PID record is the patients name.

HL7 v2.x has allowed for the interoperability between electronic Patient Administration Systems (PAS), Electronic Practice Management (EPM) systems, Laboratory Information Systems (LIS), Dietary, Pharmacy and Billing systems as well as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems. Currently, HL7’s v2.x messaging standard is supported by every major medical information systems vendor in the United States.

HL7 version 3
The HL7 version 3 standard has the aim to support all healthcare workflows. Development of version 3 started around 1995, resulting in an initial standard publication in 2005. The v3 standard, as opposed to version 2, is based on a formal methodology (the HDF) and object-oriented principles.

RIM - ISO/HL7 21731

The American Recovery and Reinvestment Act of 2009 (ARRA) and Health Information Technology for Economic and Clinical Health Act (HITECH) legislation specified HL7 versions 2.3.1 and 2.5.1, and the HL7 Continuity of Care Document (CCD), as the healthcare standards to meet certain certification requirements.

Critical reviews

 * HL7 RIM: An Incoherent Standard and The HL7 RIM Under Scrutiny - rebuttal
 * HL7 Watch – Blog; critical review of HL7. See also the posted comments for attempted rebuttals to some of the earlier posts.

Open source tools
There are a number of FOSS based tools that can foster worldwide adoption of the HL7 standards
 * Mirth Connect, an Open Source HL7 Integration Engine for HL7 V2/V3, DICOM, NCPDP and X12. Freely available under MPL 1.1 license
 * The open health tools consortium
 * The HL7 Java Special Interest Group's implementation of HL7 v3
 * The Eclipse OHF project - v2 and v3 implementations (IDE type tools and run-time libraries)
 * HAPI, An open-source, object-oriented HL7 2.x parser for Java
 * The Perl HL7 Toolkit, an Open-Source HL7 Perl module
 * Pear (PHP) HL7 messaging API module
 * The eXcessively Simple HL7 v2 Processing Platform using XML and XSLT
 * The Ruby HL7 Library
 * HL7 Java binding
 * nule.org HL7 Utilities
 * nHAPI open-source library for .NET
 * HL7v3 Messaging Framework for .NET
 * HL7 Analyst for .NET
 * HL7Kit Free Sender, HL7 Message Editor and Sender

Category:Health standards Category:Standards organizations Category:International standards Category:Multi-agent systems Category:ANSI standards

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