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HL7-NLM EHR Project Description
EHR Overview Document

EHR Phase II

The EHR Phase II stream was focused on creating HL7 V3 based implementation guide(s) and associated tooling to enable the transmission of electronic health record (EHR) data and documents between two systems, independent of source and destination architectures. The introduction of implementation guide tooling as an aspect of this project arose from the early recognition of the significance of consistency and accuracy in guide development.

In order to validate not only the guides but the process of guide development, the project was intended to engage partners at the right stage of their own infrastructure development projects to allow the guides and their use to be actually demonstrated. Moreover, the goal was to focus on key transactions to support "breakthrough" use cases from the American Health Information Community (AHIC), such as:

Laboratory
  • Query for Lab Results
  • Laboratory Results Response
  • Clinical Document Architecture (CDA) variant
Medication
  • Query for Medication History
  • Medication History Response
  • Clinical Document Architecture (CDA) variant
Record Locator Service
  • Find Candidates Query;
  • Find Candidates Response;

The project involved the following broad activities:

Identification of a Collaboration Partner

A key objective of this project was the collaborative development of implementation guide content based on an active development project. Consequently the project team engaged the broader health IT community to qualify potential collaboration partners and ultimately undertook collaborative work with the following partners:
  • The Markle Foundation's Connecting for Health (CFH) initiative: CFH provided an initial group through which to dialog potential implementation guide development collaboration. Although ultimately it was not possible to develop a full relationship, this early dialog helped shape the project's go forward characteristics and highlighted some of the challenges of finding projects that are at the right stage of development. It also surfaced the need for NCPDP to HL7 V3 mapping.
  • National Council for Prescription Drug Program (NCPDP) and RxHub: The development of an NCPDP SCRIPT to HL7 V3 mapping was an early deliverable of the project and was developed in collaboration with NCPDP and RxHub.
  • Accenture & Northrop Grumman: The core development of implementation guides was undertaken in collaboration with two contractors developing Nationwide Health Information Network (NHIN) prototypes as part of a contract with the Office of the National Coordinator for Health IT.

Implementation Guide Tool development

An Implementation Guide Tool (IGT) prototype was developed to leverage the current HL7 development methodology and tooling portfolio - particularly those tools that support the development of message information models. By aligning the tool with the current development infrastructure, it becomes immediately useable to specification or profile developers as well as to implementers. However, given current efforts by HL7 to substantially revamp its tooling over the coming 18 - 36 months, it is clear that the IGT is an interim approach that will need to be updated over time and, ultimately, its capabilities will need to be integrated into the new tooling to continue to support the efficient development of precise and complete implementation guide artifacts.

Collaborative Development of Sample Guides

Sample implementation guides were developed for certain messages drawn from the Accenture and Northrop Grumman NHIN prototypes. Unfortunately, timelines did not allow these guides to be tested as originally intended, since the guides tended to reflect an 'as built' view rather than an input specification. However, by reflecting real transactions that were being implemented, working with our partners allowed key issues to surface, including, for example, challenges that can be anticipated in NHIN subnet to subnet communication. These observations are highlighted in the body of this report.

In addition to the successful expansion of the HL7 tooling infrastructure, through the establishment of the IGT template, this project surfaced a variety of opportunities for the HL7 community to improve its portfolio of specification products. Although these opportunities are being actively considered and, in many cases pursued among the many HL7 committees, this report provided an opportunity to consolidate some of these points and bring them to the attention of HL7's leadership.

Deliverables

The following deliverables were produced during this Phase More details and downloadable materials on these two projects are available at EHR project and also at Vocabulary project web pages.

Management team:
  • EHR Co-leaders: Bill Braithwaite, Ed Hammond and Mark Shafarman
  • EHR project management: Caroline Harrison and Mark Shafarman
  • Vocabulary Co-leaders: Stan Huff and Chris Chute
  • Vocabulary project management: Sarah Ryan
  • HL7's NLM Contract Officer: Mark McDougall

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Downloadable Information

Please consult Policies 06.01.01, 02.03.01 and Procedure 02.03.01 for information related to Contract Work in the HL7 Policies and Procedures document.