Link to HL7 Version 3.0 September 2010 Ballot Site

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Ann Arbor, MI
USA
September 2010

Dear Member,

Welcome to the V3 September 2010 Ballot Cycle web site.

Important Note: Please note that when you first open the V3 Ballot Web site the Viewing page defaults to the Welcome section of the Package Note to Readers. A linked listing of the ballotable content in the Version 3 Ballot site can be found under the V3 Ballot Packages heading of this section. Simply click on the "V3 Ballot Packages" link and you will jump to the correct list in this document. All of the ballotable items in this ballot can be found here, and the links will jump you either directly to that item or to the domain containing that item. We strongly recommend that you use this table of links to find ballot material you are interested in, especially if you are not familiar with the V3 structure in the TOC.

The HL7 Board of Directors is pleased to offer you the HL7 Version 3 Messaging Normative, Draft Standard for Trial Use and informative-level ballots for September 2010, and to solicit your feedback. In this ballot you will find many elements that are now normative HL7 standards, thanks in major measure to the constructive critique you provided in previous ballot cycles. For those areas still undergoing ballot, you will find that many areas have been changed, again, based on the feedback that you provided in the previous ballot. Please help us by providing another thorough, honest review.

For the September 2010 cycle, we have continued our Quality Assurance efforts with the extension of an auto-generated Quality Analysis report for domain content. Reviewers will find a new entry in the Table of Contents for all domains titled "Quality Analysis Report." The report provides both a detailed description of error conditions that it looks for as as a tabular listing of each type of error detected during an analysis of the domain content.

This report was previously used with the Normative Edition, but this is the first time that the report is provided as a domain-specific analysis. Further, the report includes two new of analysis tests:

  • The report flags, with yellow highlighting, all 'fatal errors' in the static model and interaction designs. A 'fatal error' is one that will break the integrity of either the generated MIF files or the generated schemas and thus prevent them from validating.
  • There is now an additional analysis of CMET references that cross-checks the name and identifier of the CMET in the reference with the name/identifer combination listed in the formal CMET definition list. This test is useful because while the RMIM designer selects CMETs by identifier, the V3 Schema Generator binds by CMET name.

We hope that this additional analysis, taken with the QA measures already in place, will provide the developers and reviewers of domain content with an additional aid in creating effective and usable standards.

One of the major efforts undertaken last ballot cycle was a cleanup of the content to remove material not considered necessary for the ballot web site. This cleanup was announced at both the May 2009 WGM in Kyoto, Japan, and the September 2009 WGM in Atlanta, GA, USA. During the cleanup, both normative content that is available in a V3 Normative Edition and draft content that has not been actively balloted in the past year were removed from the ballot site, expect when such content was necessary to support the standard as a whole (such as with the Messaging Infrastructure and other "core" content) or when draft material was needed to understand material such as CMETs that are under ballot. When it was not clear whether material should be removed or not, we tried to err on the side of including it. This effort continued, albeit to a much lesser extent, this cycle.

The removed content includes material that has achieved Normative status and appears in at least one V3 Normative Edition. Where such material has been removed from the V3 Ballot Site, a notice has been inserted including instructions on how to obtain that material and a link to the appropriate download page. Removed material also included content that has not balloted in the past year. Again, where such material was removed a notice to that effect was inserted. In these instances, the notice includes directions on how to find the material in previous V3 Ballot Sites, with links directly to the last appearance of this material (in most cases, the September 2009 V3 Ballot Site) and to the V3 Ballot Site Archive, with links to all previous V3 Ballot Sites.

The results of the ballot site cleanup has been a dramatic decrease in the number of reference errors. This in turn, helped to expose potential errors in material actually balloting this cycle so that they could be addressed during the QA portion of the ballot preparation. In addition, the total download size of the ballot package has been substantially reduced.

This ballot includes a significant change in the content representation of the RIM

  1. The RIM (currently undergoing Release 2 Normative ballot) is Release 2.30R1. The attributes of this release are bound to Abstract Data Types R1, whereas the RIM release used in the September 2009 ballot (2.27) were bound to data types R2.
    M&M and Tooling developed a means to automatically update the data types bindings of static models in order that they will align to the correct data types version.

As was true in the last two ballot cycles, this ballot also includes a significant change in the Generator "output." Specifically:

  1. This ballot has been prepared with a new V3 Generator release that, produces MIF2 files that correspond to MIF 2.1.5. The only change to this MIF release is to move the special xhtml constraints under the HL7-controlled MIF namespace in order to allow open distribution of the MIF2 schemas without violating the intellectual property of W3C. (The MIF 2.1.5 schemas are part of the latest V3 Generator Releases on the HL7 Gforge site.)

For those of you who may not have reviewed the previous ballots, a more detailed description of this ballot follows. Sincerely,

The HL7 Board

We started the Version 3 effort years ago based on the principles of modeling and technology-neutrality. We believe that this approach will make the work of HL7 "future proof", i.e., able to respond to changes in requirements and technology without loss of existing work. This project has taken longer than we imagined, but we have finally reached a release where the majority of the material is already a standard. This was the result of intense and protracted effort of hundreds of volunteers, many of whom have worked so far beyond the call of duty that we can't possibly thank them enough.

Now it is Your Turn to Help

Responding to this ballot will take some study to understand the new approach. In exchange for that effort we are sure that you will appreciate the strategic benefits. We are equally sure that you will draw from your own experience to suggest improvements and we eagerly solicit your comments. For this round we are concerned with your comments and with your vote. This is another opportunity for our members to participate in the process and we eagerly await the opportunity to fold your comments into any subsequent ballots.

Update Notification List

To keep you continually apprised of any updates or patches to this ballot site, we have instituted a special list service to which you may subscribe. You can only sign up through this web page by clicking here. On this page, you will need to sign-in (if you have a list service ID, or create one if you do not), and, then, from the list services sign-up page go to the Publishing header and select the v3ballotupdates list. Only HL7 staff are permitted to post messages to this list; this ensures that only information about what has been updated is distributed. This list is not intended to provide a forum for discussion. Discussion regarding the ballot publishing may be hosted on the Editors list.

Why Version 3?

Healthcare costs evermore dominate national economies, and Draconian measures to control cost have hampered provider effectiveness and impacted citizen satisfaction and safety. Information Technology (IT) has helped, and is on the verge of being able to help much more. Version 3 will be a key part of the contribution of IT to healthcare's reaching new levels of
  • effective and cost-efficient patient care decisions
  • safety and cost savings that come from "doing it right," in the sense of preventing avoidable errors
  • the aggregation of health information for evidence-based medicine and data-based policy
Many general IT advances create the foundation for this new capability. These include:
  • The exponential increase of processing and storage capacity described by Moore's law
  • Enhancements in user interfaces such as voice entry and smarter programs that apply knowledge to limiting required information input
  • An increasing variety of devices for personal access to, and collection of information at the point of care and at points far distant from the point of care
  • The build-out of the Internet and related standards to create a ubiquitous, inexpensive infrastructure for secure communication of information among independent entities
  • The maturing of XML and related standards to provide a means for easy-to-program, highly extensible, robust exchange of information among information systems

The New HL7 Standard

These IT advances are important enablers, but the most intractable barrier to their use in healthcare has been the lack of standards for exchanging fine-grained, highly heterogeneous, structured clinical data among information systems created by different entities using different technologies. Since its inception in 1987, HL7 Version 2 has enabled information exchange among systems created by different entities. Indeed, Version 2 is so widely used that it will not soon go away and the Board is committed to continuing to evolve it as long as there is a clear need. However, where users have used Version 2 for fine-grained, structured clinical data, they have accomplished it through substantial investments in bilateral negotiations adapting it to establish specifications for representing fine-grained, clinical knowledge. Efforts to aggregate on a larger scale, for research or public health have had the same issue.

The strength of Version 3 messaging is precisely enabling the exchange of fine-grained data without the original research and bilateral negotiations that leading-edge organizations have attempted. Furthermore, you will find that we are reaching this in a way that is as future proof as any standards effort can be.

In reading the ballots you will see that the three conceptual models that form the basis of version 3 messages: (1) The Reference Information Model (RIM), which is now an ANSI standard has evolved into a simple abstract framework which addresses the wildly heterogeneous and interlinked nature of clinical data with only six important classes. We have similarly simplified the representation of administrative data. (2) In the Domain Information Model (D-MIM) you will see how the abstract RIM is made specific to define the information elements for a domain or specialty area. (3) In the Refined Message Information Model (R-MIM) you will see how the D-MIM is refined to define the information elements of a family of messages. (4) The vocabulary model provides the tools to deal with previously intractable problems of multiple vocabularies across organizational or national boundaries.

The Hierarchical Message Description is a convenient way to organize a mass of details about the contents of specific messages, providing the most authoritative list of all the constraints and detailed semantic definitions not appropriate in the more abstract representations. Finally, in the Implementable Technology Specification you will see how this information is represented as XML Schemas.

These deliverables are the basis of our belief that the Version 3 Messaging standards will be easily extended over time to incorporate new standards, deal with unanticipated requirements and even address areas of standardization other than application-to-application messages.

XML

We have demonstrated the flexibility of this approach by incorporating an important new technology, XML, in mid project without revising our modeling methodology or content. We believe you will find XML a primary value in Version 3. Its transparent representation of complex data and its extensibility is creating widespread acceptance throughout the IT industry. It is the basis of an expansion in the market of middle-ware vendors providing support for application-to-application integration. While version 2.x has been adapted to XML, Version 3 fully supports the expressive capability of XML. It generates XML schemas with the logical information relationships and element names that directly relate to the HL7 models -- and hence to the concepts that analysts and programmers will have to grasp to relate Version 3 messages to their own information systems or to use them in new ways for Web browsing, XML repositories, etc.

As industries have taken up XML they have come to recognize that it is not a substitute for application level semantic standards. HL7 Version 3 provides that missing ingredient, so that healthcare stakeholders can optimally reach the technological benefits of XML.

Your Comments Please

In short, we believe that your review will show that HL7 Version 3 Messaging brings interoperability to a level of clinical knowledge not previously possible. This is one of the important ingredients of IT solutions to improving healthcare processes, by "smarter" bilateral user interfaces, care-giving and management decision support, evidence-based medicine and data-based policy.

Please contribute your part by giving us a thorough, honest review. Be blunt. The Board thanks you, your fellow members will thank you, and most important, the volunteers who have given so much of their recent lives to making this happen will be grateful for the recognition and meaningful feedback.