Attachments

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Mission

This work group supports the HL7 mission to create and promote its standards. The Attachments Work Group standardizes the supplemental information needed to support health care insurance and other e-commerce transactions. Our purpose is to encourage the use of HL7 for uniform implementation of this supplemental information.

Important efforts, as guided by the Board of HL7, are to:

  • Work jointly with X12N, the insurance subcommittee of ASC X12
  • Work jointly with HL7 Structured Documents Work Group in the creation of CDAs for attachments
  • Provide support in the development and maintenance of attachments 

Charter

Work Products and Contributions to HL7 Processes

Since its inception in 1997, the work group has created and balloted implementation guide and attachment specifications built upon HL7 version 2.x messaging and upon the HL7 Clinical Document Architecture (CDA) standards. The initial deliverable included an implementation guide and detailed specifications for six attachment types:  Ambulance Service, Rehabilitation Services, Clinical Reports, Laboratory Results, Medication and Emergency Department.  These were incorporated into a notice of proposed rulemaking (NPRM) under HIPAA in 2005. Other attachment offerings include but are not limited to, Patient Information Unspecified Content (PIUC), Children's Preventive Health Services, Periodontal, and Pre-Authorization/Referrals.

Formal Relationships With Other HL7 Groups

The Attachments Work Group coordinates its work products with the Structured Documents Work Group.

 

In addition, the HL7 version 3 Financial Claims and Reimbursement (FICR) Domain supports attachments globally for invoice, authorization, coverage extension, and pre-determination events. The Financial Management (FM) Work Group intends to directly reference claim attachments in FICR Release 2.

 

Formal Relationship With Groups Outside of HL7

The HL7 Attachments Work Group works jointly with the insurance subcommittee of Accredited Standards Committee X12 (ASC X12), American Dental Association Standards Committee on Dental Informatics (ADA SCDI), National Council for Prescription Drug Programs (NCPDP) and other standards development organizations as guided by the Board of HL7. The work group also collaborates with Workgroup for Electronic Data Interchange (WEDI) and the Regenstrief Institute in conjunction with the LOINC® (Logical Observation Identifiers Names and Codes) Committee.

Publications

These eight documents are the result of several rounds of balloting within HL7 from 1998-2004. The documents constitute a portion of a solution to the requirement for electronic transmission of claims attachments included in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS published a notice of proposed rulemaking (NPRM) in September 2005, followed by a 120-day public comment period. HL7 submitted comments during that period, and will be assisting HHS in resolving all HL7-related comments received by HHS during the public comment period.

The following documents, and the corresponding X12N 277 and X12N 275 implementation guides are also available from the Washington Publishing Company. In addition, much greater detail about LOINC® and RELMA" is available from the Regenstrief Institute.

HL7 Documents:

In 2003, a whitepaper was prepared by the Attachments Committee. Portions of the whitepaper are duplicated in the NPRM. While it is not a part of the formal recommendation, it describes many of the concepts at a high level, and may be useful as a learning tool.

In addition, the Attachments Committee has created a number of XML examples, XML schemas, and an XML stylesheet, and provides these as a non-normative "starter set" to facilitate early adoption. These were not subject to the NPRM comment process; however, your constructive ideas are welcome. See the list service link at the top of this page.

Mega download all of the above (all documents and examples)

Non-HIPAA HL7 Documents

In addition to the above documents, the Attachments Committee has been working towards new specifications, including the following.

Note: These are the latest ballot drafts.

Frequently Asked Questions

We have accumulated a few questions over the years in various venues, and have reached agreement on many of the answers. See the FAQ document below, and if you still have questions, please let us know - send an email to any or all of the Co-Chairs., and a team of volunteers will compose an answer to be included the next time we update the FAQ document.

HL7 and HIPAA

Decision Making Practices

Decision Making Practices

Date of Last Revision

October 1, 2009