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XML for HL7 v.2 Messages: A Bridge to Clinical Documents

XML for HL7 v.2 Messages: A Bridge to Clinical Documents. PHIN Conference Atlanta, August 2007 Nancy McQuillen, M.S., Data Architect California Department of Public Health. Syntax (XML) as a Bridge to Enlightenment?.

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XML for HL7 v.2 Messages: A Bridge to Clinical Documents

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  1. XML for HL7 v.2 Messages: A Bridge to Clinical Documents PHIN Conference Atlanta, August 2007 Nancy McQuillen, M.S., Data Architect California Department of Public Health

  2. Syntax (XML) as a Bridge to Enlightenment? -- Well, maybe not; but public health workers read documents more easily than HL7 messages. via XML ->

  3. What’s wrong with these statements? • Interface developers: ”We are planning to use either HL7 (version 2) or XML”. • Standards watchers: ”HL7 is introducing XML-based messaging starting with their latest release - version 3”.

  4. Presentation Goals • Raise Awareness – of HL7’s XML syntax option for version 2 messages, as a potential bridge to forms, documents, and XML-aware technologies (web-based data exchange). • Describe “Use Cases” – for XML in relation to forms and documents. • Show some steps (and tools) – for defining HL7 XML messages, and presenting them as forms or clinical documents.

  5. Traditional ER7 Syntax vs. XML Syntax HL7 is primarily a semantic standard (defining data content of messages). The semantics can be cast into multiple syntaxes. In addition to traditional encoding rules (ER7) for HL7 v.2.x, HL7 also publishes a syntax guide (an “Implementable Technology Specification (ITS)”) for the XML representation of HL7 v.2.3.1, v.2.4, v.2.5 messages (and beyond). HL7 Standard (Syntax specification #2) (Syntax specification #1) • Also called: • Bar syntax • Pipe-and-hat^ • EDI-style • Traditional ER7 XML

  6. ER7 Syntax vs. XML Syntax ER7: (COMPACT!) XML: (REALLY LONG!) • The HL7 XML schema structure follows the simple structure of the HL7 v.2 standard: • <Message> • <Segments> • <Fields> • <Components> This translation example provided by:

  7. A Closer Look at One HL7 XML Segment PID Segment Snippet: • <Segment> (PID) • <Field> (PID.5) • <Datatype> (XPN) • <Component> • (Surname) • <Component> • (Given name) Complex HL7 datatypes such as Extended Person Name (XPN) have component parts (e.g. XPN.1 and XPN.2) expressed as subordinate XML elements.

  8. “Use Cases” for HL7 v.2 XML Useful as an adjunct (not a replacement) for traditional ER7 syntax, if you need to: • Convert messages - to other versions of HL7 (or to custom XML formats) using standard XML-aware tools, such as integration brokers and graphical mapping tools. • Present and/or “persist” message data – on forms and documents, using XML-aware standards (e.g. XForms) and technologies (e.g. Adobe’s XML architecture for .pdf fillable forms).

  9. Confidential Morbidity Report (CMR) -XML-Based Adobe .pdf Fillable Form Example

  10. Example Data Flow: Clinical <-> Public HealthUsing Both Syntaxes (and Multiple HL7 Versions) Dream scenario, or someday soon? Rendered, Faxed CMRs 2007? CMR Form Flat CMR Integration Broker (Adobe Prof. 8) HL7 XML CMR 2.4 ER7 CMR 2008? 2.5 ER7 CMR CDA CMRs, Case Extracts EHR Case Extracts (CDA) EHR Case Data Requests (CDA) 2009? Electronic Health Records Systems Public Health Jurisdictions

  11. Steps to (Truly) Interoperable Messages Tools Used (examples): XML (the general standard: an open slate) • XML Tag Language (Semantics) Constrain! Text/XML editors HL7 XML (specific schema applied) • XML Structure (Elements/Attributes) XMLSpy Constrain! Profiled HL7 XML Message • HL7 Segments, Fields, Repeats HL7 MWB Constrain! PHIN Compliant Profiled: • Vocabulary and OIDs • Datatype (parts) • Rules and constraints XSLT Constrain! Schematron Sample Messages Message Validators Validate! SUCCESS!

  12. Steps to Implement an HL7 v.2.5 XML Message Behind an Adobe .pdf Form

  13. Step 1: Messaging Workbench -Parse structure of sample (CDC case notification) message

  14. Step 2a: Messaging Workbench -Profile the CMR (Select segments, fields, etc.)

  15. Step 2b: Messaging Workbench -(XML schema generated for the profiled CMR) Hint: Schema is multi-page and organized from “bottom up” – progressing from general (whole ORU_R01) to specifics (segments and datatypes).

  16. Step 3: Adobe LiveCycle Designer –Bind the XML schema to data fields of fillable form e.g. Patient First Name (on form) is bound to PID.XPN.2 (in the attached XML schema).

  17. Step 4: Altova MapforceAdd PHIN Codes, OIDs, Rules, via XSLT

  18. Step 5: Adobe LiveCycle Designer:Attach the XSLT to “Transform Outgoing Data” Insert snapshot:

  19. Step 6: XMLSpy (or Other Validators)View XML generated via Form Entry (+ XSLT)

  20. Binding to an HL7 CDA Document • An HL7 Clinical Document is an XML document! • Representing a human-readable document • A CDA message is composed of two parts: • A header and a body • Designed for communication between two systems • A valid variant of HL7 v3 - • based on the HL7 Reference Information Model (RIM); CDA is an HL7 v3 standard

  21. Structure of a CDA Document (an XML Instance) Header <ClinicalDocument > <title>Confidential Morbidity Report</title> <effectiveTime value="20050407"/> <author> ..... </author> <recordTarget> <patient>.....</patient> </recordTarget> <component> <structuredBody> <component> <section> <code code="14657009" ….. codeSystemName="SNOMED CT"/> <title>Established diagnosis</title> ….. <entry> <observation classCode="COND" moodCode="EVN"> ..... <value ... code="398565003" ... displayName="Botulism"> ... </value> </observation> </entry> </section> </component> </structuredBody> </component> </ClinicalDocument> Body Clinical Statement(s)

  22. Example: Mapping HL7 2.5 Segments to an HL7 CDA Message Schema

  23. Conclusions, Hypotheses • HL7 XML Syntax for v.2 Messages is Useful - to facilitate message conversions (e.g. v2 to HL7 v3 Clinical Document Architecture (CDA)), and to facilitate integration with other XML-aware forms and document architectures (e.g. XForms and Adobe .pdf forms). • Tools for manipulating XML and HL7 XML schemas are emerging - and can be used to help bridge messages with documents, enabling public health professionals to visualize message content, and to participate in PHIN-compliant form development and vocabulary review. = PHIN 2007 PHIN 2008 and Beyond

  24. Acknowledgements • The author would like to thank the following persons and organizations who have contributed their time and thought leadership to the XML, Adobe, HL7, and PHIN technical content of this presentation. • Dr. Mark Starr, NEDSS Principal Investigator, California Department of Public Health • Linda Sandoval, NEDSS Surveillance Systems Coordinator, California Department of Public Health • Dr. Cecil Lynch, OntoReason LLC and UC Davis Informatics • Kai Heitmann, Paul Biron, and the entire (former) XML Special Interest Group (SIG) of HL7 • Bob Dolin, M.D. and Liora Alschuler, Co-chairs of HL7 Structured Documents Technical Committee • CDC NCPHI PHIN technical support team and DISS XForms team

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