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Daniel C. Russler, M.D.

HL7 Version 3-- the clinical model tutorial. Daniel C. Russler, M.D. VP Medical Director McKessonHBOC. Know the Market for Healthcare Standards. HIPAA Regulations Privacy & Security Administrative--eligibility, claims submission Clinical--vocabulary, claims attachments

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Daniel C. Russler, M.D.

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  1. HL7 Version 3-- the clinical model tutorial Daniel C. Russler, M.D. VP Medical Director McKessonHBOC

  2. Know the Market for Healthcare Standards • HIPAA Regulations • Privacy & Security • Administrative--eligibility, claims submission • Clinical--vocabulary, claims attachments • Cost and Quality Improvement Needs • Service line methodology • Condition management orientation • Risk Management • Workflow management • Increasing task volume • Preventing errors • Decreasing low-value procedures • Increasing high-value procedures

  3. Chest Pain Episode Begins Enrollment Certification Angina Specialist Surgery Rehab Health Relative Health Doctor's Office Admission Discharge Follow-up Doctor's Visit Diagnostic Testing r/o Angina ASHD s/p CABG A Mega-use-case---Modeling the Condition

  4. Typical Service LineTask Force Organization Chief Medical Officer Chief Information Officer Chief Nursing Officer Perinatal Task Force--Full-Term Delivery Cardiac Task Force--Congestive Heart Failure Orthopedics Task Force--Hip Replacement Pulmonary Task Force--Asthma Primary Care Task Force--Health Maintenance Other Task Forces Medical Director Clinical Informatics Nursing Director Clinical Informatics IS Support Staff

  5. HL7 Mission Statement • To provide standards for the exchange, management and integration of data that support clinical patient care and the management, delivery and evaluation of healthcare services. Specifically, to create flexible, cost effective approaches, standards, guidelines, methodologies, and related services for interoperability between healthcare information systems.

  6. Clinical Modeling Goals • Standards for data • Integration • Reference Information Model(RIM) • Management • Vocabulary & rule version control • Exchange • Message formats: Version 2.x; Version 3 • Supporting • Clinical patient care • Service management--workflow guidelines • Service delivery--context & relationship tracking • Service evaluation--cost & quality tracking

  7. Version 3 Highlights • New message syntax--XML • Support for XML document transmission • Support for an explicit information model • Support for multiple published vocabularies • Support for composite datatypes • First model message drafts September, 1999

  8. Dog! Alert Messages & Information Modeling HL7/CORBA/DCOM

  9. Clinical Classes Modeling Assumptions • Healthcare is a series of service actions • Each action contributes to cost and quality • All actions have a context of: • Prior actions • Current actors, things, & contracts • Future goals • Each action consists of: • Action name • Action methodology • Action result values • Action descriptions will change over time and must be versioned

  10. Service Event Explaining the RIM--Context of an Action How? Who? Action Name: When? Why? Whom? Where?

  11. Service Event Relationship Service Event Observation Procedure Condition node Goal Future classes Unique Action Values: Unique Action Values: Unique Action Values: Unique Action Values: Unique Action Values: Unified Modeling Language Action Hierarchy Action Name: Dates: Cost: Privacy Level: Action Values:

  12. Service Event Relationship Service Event Observation List-Link Action Value: List-Link Collections Action Name: Dates: Cost: Privacy Level:

  13. Service Event Relationship Service Event Observation Conditional-Link CBC U/A X-Ray ? Action Value: Conditional-Link Collections Action Name: Dates: Cost: Privacy Level: Timeline

  14. Service Event Relationship Service Event Observation Judgement CBC U/A X-Ray Pay Action Value: hasReason Judgement Collections Action Name: Dates: Cost: Privacy Level: Timeline

  15. Service Event Relationship Service Event Observation Judgement CBC U/A X-Ray Pay Action Value: Judgement Collections Action Name: Dates: Cost: Privacy Level: hasReason

  16. Vocabulary ModelingCompromises Pre-coordination e.g. LOINC Information Modeling Extreme-- Value = Present/ Not Present Vocabulary Modeling Extreme-- One Class/ One Attribute Composition(needs composition datatype) e.g. SNOMED Conceptual Graphs; Mayo Metaphrase

  17. Diabetes Asthma CHF Vocabulary ModelingCompromises Pre-coordination e.g. LOINC Healthcare Thing Pneumonia Value: Any SNOMED Code Value: Not Present Composition(needs composition datatype) e.g. SNOMED Conceptual Graphs; Mayo Metaphrase

  18. Diabetes Asthma CHF Vocabulary ModelingCompromises F-xxxxx = chest pain radiating to left arm Healthcare Thing Pneumonia Value: Any SNOMED Code Value: Not Present (F-xxxx = pain(T-xxxx = chest) (F-xxxx = radiating to(T-xxxx = arm(M-xxxx = left))))

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