Achieving Healthcare Interoperability through HL7 Standards

In today’s time, various challenges and emergencies are faced by healthcare organizations. One of the major challenges faced is the inability to generate, record, and analyze data. For example, a particular patient tends to visit multiple doctors for consultation, and receives diverse advice, he goes through different tests at different hospitals, and all he has is a sheet of paper. All the crucial patient data is scattered. Managing such scattered data effectively has always been a tedious task in healthcare organizations. 

It is indeed true that everything that is being done in healthcare should be from the perspective of the patient. This approach was and always will be a patient-centric approach. The major solutions which have been proposed include the smooth and discrete transfer of data from one Electronic Health Record  to another, which is inclining towards interoperability of services. Such advanced and accurate interoperability can only be achieved by having some common standard. 

Certainly, many of the healthcare providers are creating their own Jason format or XML file, which is being understood by the next provider, but it just creates a dependent chain of all the formats wanting to integrate with the first one, which is definitely not a potential long-term solution, as creating a point-to-point interface is not a practical solution for linking millions of files. So, exposed to such operating issues, one common standard known as Hl7(Health Level 7) is being followed. 

Interoperability and its types: 

Understanding the core basics is crucial to get to the core aspects. So, one major question that arises is what is Interoperability? Interoperability in healthcare refers to timely and secure access, integration, and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations. And if you want to do anything with healthcare interoperability, two major aspects need to be considered. At first, Standard format, and secondly the ability to set up an accurate context or standard dictionary. Furthermore, there are two major types of Interoperability. Functional or technical interoperability and Semantic Interoperability. 

What is HL7? 

HL7 stands for Health Level 7, which is the name of an organization, which was founded in 1987 by HIS (Health Information System) and LIS (Laboratory Information System) in the United States of America., also the 7 in HL7 comes from the OSI Model Layer, and the seventh layer in the model is referred to as Application, which was also the Cruz of HL7. Also, to your surprise, HL7 is not a software application, there is no plug-and-play system in HL7. Health Level 7 is a protocol for data exchange. It gives standardized specs for the Electronic Medical Report. The very first Version2 came out in 1989. 

It is a very common perception to misjudge the name, and people often tend to make mistakes identifying it. Within HL7, there are multiple standards like Version2, Version3, CDA, FHIR, SPL, CCDA, and many more which are a family of standards. For example, Version2 has 17 chapters in the form of word or pdf, FHIR is a spec in the form of 100’s of HTML pages. Moreover, HL7 interfaces can be built using any programming language. Given such specifications, they are widely called platform-independent. 

Let us now consider one very generalized example to understand the entire process seamlessly: Suppose an XYZ patient visits the hospital and goes to the registration desk. The concerned authority records all the necessary information about the patient, Now, so all this information is stored in the Registration system. Further, after the diagnose, the patient has to be handed the bill, which will require the data submitted by the patient for registration, so this is where HL7 comes into play. It allows the smooth integration of the registration system and billing system so that the patient does not have to submit the details more than once.

Wide HL7 Coverage: 

Health Level 7 manages to cover all the major aspects involved in the healthcare sector. Also, apart from just the healthcare sector, many more industries are dependent on HL7. Drug and Pharmaceuticals, clinics, individual practitioners, and even insurance companies are regular users of HL7.  

Various Domains covered by HL7 include: 

• Accounting and Billing                                     Immunization 
• Care Provision                                                   Laboratory 
• Claims and Reimbursement                              Medical Records 
• Clinical Decision Support                                 Patient Administration 
• Clinical Document Architecture                       Personal Management 
• Clinical Genomics                                            Pharmacy 
• Clinical Statement                                            Registries 
• Regulated Products                                          Regulated Studies 
• Public Health Reporting                                  Scheduling 

HL7 Messaging Standards: 

There are four major standards given by HL7: 

• HL7 Version 2 – 

Version 2 is the oldest HL7 standard. There have been many upgrades to this version, and it is still very popularly used due to its convenience and easy useability. The major aim of this standard was to support hospital workflows. It uses a textual, non-XML encoding syntax based on delimiters. Apex, Serner, All Script, and Aetna Health are still actively using the version 2 standard.  

• HL7 Version 3 –

This version was released in 2005. This version was designed to provide an extended domain, far beyond the hospital. The difference in this version was that it used XML encoding syntax, and was based on the RIM model standard. Eventually, this version failed to impress the masses, as it was difficult to learn, understand, and implement, and now has become a kind of obsolete. 

• HL7 CDA (Clinical Document Architecture) –

CDA is more like a substandard of Version 3 and has gained much more popularity. It aims to provide an exchange model for clinical documents like discharge summaries or progress notes. But, CDA’s job is very limited, it can only exchange documents (which are actually in XML format), and not all types of data. 

• HL7 FHIR (Fast Healthcare Interoperability Resources) – 

This is the latest HL7 standard. This version has gained tremendous recognition, and the United States government has made it mandatory to exchange hospital data through the means of FHIR. To date, there have been publications, namely DSTU 1, DSTU 2, STU 3, and R4. It also supports a lot of web-based technologies including XML, Jason, and Turtle for data exchange. Furthermore, FHIR also comes up with its own API methods. 

Building HL7 Interfaces: 

There are multiple options for building customized HL7 interfaces. One can directly start building the interface from scratch. There are multiple libraries available online that can be utilized as a beginning. Java, .Net, C#, and many more such libraries can be used to start building. All such libraries are widely used while dealing with FHIR. Furthermore, there are various integration engines like Mirth Connect, Raphsody, Corepoint, Interfaceware, etc., which are more famous in Version 2 world. These are paid software that is capable of doing the entire communication, from end to end. 

Key aspects to consider while building HL7 solutions: 

The very first decision that should be taken is whether to use Version 2 or FHIR. This aspect needs to be carefully analyzed and based on the requirements, the standard should be selected accurately. 

Scope of work is the next crucial feature. The developer should understand the actual usability of the standard, and make the changes accordingly. Understanding the core basis, right from the initiation to the functioning of each element is a vital factor. 

The next key step is mapping the backed data, and building the technical code to pull the data from the backend and implement it in the selected standard. 

Concluding with all the important aspects of Exchange paradigms, exchange mechanisms, validation tools, and testing will help to generate the perfect and required HL7 standard. 

FHIR – The Future of Interoperability! 

There are various advantages of working with FHIR, and here are some of the crucial reasons for stating FHIR as the future of Interoperability: 

• FHIR is extremely easy to learn and implement. 
• There are numerous libraries available, which make development from scratch quick and efficient. 
• FHIR has laid a strong foundation in Web Standards like XML, JSON, HTTP, and OAuth. 
• It has concise specifications and a human-readable serialization format for ease of use by developers. 
• Various types of Open-source implementations like SMART on FHIR will help developers to easily launch applications in EMR. 

Full video on the topic can be checked here

Hope this article helped you to understand healthcare interoperability and how it can be built for healthcare systems. If you are building a healthcare software and need help, feel free to get in touch with us and check out our healthcare technology services.