Each of the systems – Radiology Information System (RIS), Lab Information System (LIS), Hospital Information System (HIS), Electronic Health Record (EHR) and Electronic Medical Record (EMR) communicate with each other in different languages. Increased number of healthcare applications and the necessity of centralized electronic health record drive the requirement for the universal language among the applications. To solve this issue, HL7 was introduced as the single, flexible and universal standard of communication in 1987. This article summarizes the importance and steps involved in a successful HL7 integration.
HL7 – Health Level Seven
HIPAA – Health Insurance Portability and Accountability Act
RIS – Radiology Information System
LIS – Lab Information System
HIS – Hospital Information System
EHR – Electronic Health Record
EMR – Electronic Medical Record
RIM – Reference Information Model
ISO – International Organization for Standardization
ANSI – American National Standards Institute
FIFO – First In First Out
CDA – Clinical Document Architecture
CCR – Continuity of Care
XML – Extensible Markup Language
HL7 is the universal user-friendly standard which enables the communication between two or more healthcare applications. The health related information will be transferred in the form of one or more HL7 messages such as patient record and billing information.
The HL7 interoperability standard is often called the nonstandard standard, since it does not consider any specific part as special and, hence, there is no standard business or clinical model for clinical interaction.
HL7 development needs the involvement of clinical application analyst, integration specialist, application programmers and system analyst.
HL7 (Health Level Seven) symbolizes a 7-layer ISO communication model
1-4 deals with Communication; 5-7 deals with Function. All these layers are used by HL7 interface engine for transfer and retrieval of HL7 data.
2.0 – 1988 – Prototype
2.1 – 1990 – First standard
2.2 – 1994 – Widely adopted
2.3 – 1997 – In operation
2.3.1 – 1999 – Approved ANSI standard
2.4 – 2000 – Approved ANSI standard
2.5 – 2003 – Current ANSI standard
3.0 – In development
The vision of HL7 development is a world where everyone can securely access and use the right health data when and where they need it. In order to achieve that goal, the workflow should be simplified between healthcare software applications and various vendors for the enhanced quality, accuracy, cost and efficiency of healthcare providers.
Each healthcare application must be accessible to send and accept patient data. There are certain fixed rules of what to accept and send for easy exchange. This access is strictly controlled by each application vendor to ensure data integrity within their application.
Data sharing between clinical and financial systems is always a challenging task, in terms of reliability, security and compliance. That is where exactly, the importance of HL7 and HIPAA arises.
HL7 exchanges clinical date between healthcare applications from different vendors. HIPAA (Health Insurance Portability and Accountability Act) was implemented in 1966 in order to update healthcare transactions and to uphold patients privacy rights.
HL7 will be triggered by the events like patient admission and billing within the enterprise like hospitals. Whereas between enterprises like hospitals and insurance companies, HIPAA enabled EDI-X12 transactions will be exchanged. HL7 is also used in certain HIPAA EDI-X12 transactions.
For instance, if a patient is admitted in hospital, the Patient Administration System (PAS) maintain the details about that patient. If other system like Pharmacy Systems need information about this patient, it sends an HL7 message about the patient to the proper hospital systems.
Later, when the hospital sends a claim for payment to another enterprise, like an insurance company, the hospital and the insurance company exchange HIPAA EDI-X12 messages. These HIPAA EDI-X12 messages may contain an embedded HL7 message about the patient also.
An enterprise such as hospital has got many HL7 enabled applications. To reduce data entry duration and increase overall efficiency of the facility, these applications should communicate with each other.
An HL7 interface development includes:
There are two basic ways for effective communication:
Each provider should decide which option would be more productive and cost-effective for their organization. If the interfacing environment is limited and focused, then the point-to-point approach may work. If the interfacing requirements are growing internally to streamline workflow and externally to meet EMR requirements, then the interface engine approach would be better.
Rather than implementing the recent phase of your HL7 integration, analyse your health system’s needs and build a customized interface solution that will meet your budget along with current and future needs. A strong interface team with a coordinated testing by subject matter experts can provide successful outcome in HL7 implementation.
HL7 interfaces are required to support data integration. Properly integrated HL7 interfaces can reduce duplicate data entry and enhance user workflow due to application interoperability.
Common HL7 interfaces used within health care organizations.
The below mentioned flowchart shows the planning step of right interface.
In addition to this flow, the right staff members and consultants should be included for the project execution.
Identification of the right HL7 interface and their respective field content should be reviewed to avoid data irregularities. Especially, ADT workflows should be reviewed in terms of sending and receiving data.
The testing phase is another important phase of the HL7 integration. Proper review of the design, utilization and content of these interfaces is the most important step for the successful completion. Unit and integrated testing involve the expertise of application subject matter experts. They are typically great at working with the technical items relevant to an interface.
Healthcare communications such as HL7 need security measures added for both existing and new installations. At present, various security measures such as encryption and SSH tunnelling are used to secure HL7 data exchange. Healthcare needs to do more for data protection and that updation should take place soon.
Same way, each updated version of HL7 incorporates new features and options which complicates the standard one. With the emergence of new HIPAA guidelines, the best interface engine should allow multiple connections to both internal and external applications for an easy data exchange. Hence, HL7 will continue to be a major component in healthcare evolution.
HL7 Integration Options
Step 1: Plan the Interface
Step 2: Build the Interface
Step 3: Test & Validate
Riken Shah is the CEO of OSP. He is a tech enthusiast, healthcare innovation specialist, and avid reader. With over a decade of experience, Riken has helped healthcare companies to be more productive and successful.
An EHR-integrated remote health platform to seamlessly connect patients to the providers and approved by HIPAA and HL7 standards.