Integration of IEEE 1451 and HL7 Exchanging Information for Patients’ Sensor Data

HL7 (Health Level 7) is a standard developed for exchanging incompatible healthcare information generated from programs or devices among heterogenous medical information systems. At present, HL7 is growing as a global standard. However, the HL7 standard does not support effective methods for treating data from various medical sensors, especially from mobile sensors. As ubiquitous systems are growing, HL7 must communicate with various medical transducers. In the area of sensor fields, IEEE 1451 is a group of standards for controlling transducers and for communicating data from/to various transducers. In this paper, we present the possibility of interoperability between the two standards, i.e., HL7 and IEEE 1451. After we present a method to integrate them and show the preliminary results of this approach.     

The Development of a Highly Constrained Health Level 7 Implementation Guide to Facilitate Electronic Laboratory Reporting to Ambulatory Electronic Health Record Systems

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.     

Using OPC and HL7 Standards to Incorporate an Industrial Big Data Historian in a Health IT Environment

Health Level Seven (HL7) is one of the standards most used to centralize data from different vital sign monitoring systems. This solution significantly limits the data available for historical analysis, because it typically uses databases that are not effective in storing large volumes of data. In industry, a specific Big Data Historian, known as a Process Information Management System (PIMS), solves this problem. This work proposes the same solution to overcome the restriction on storing vital sign data. The PIMS needs a compatible communication standard to allow storing, and the one most commonly used is the OLE for Process Control (OPC). This paper presents a HL7-OPC Server that permits communication between vital sign monitoring systems with PIMS, thus allowing the storage of long historical series of vital signs. In addition, it carries out a review about local and cloud-based Big Medical Data researches, followed by an analysis of the PIMS in a Health IT Environment. Then it shows the architecture of HL7 and OPC Standards. Finally, it shows the HL7-OPC Server and a sequence of tests that proved its full operation and performance.     

L7的现状、应用与进展

HL7是实现电子病历互连互通、互操作性最重要的信息交换内容和格式的标准。经过20年的发展,目前已成为一个广泛覆盖、普遍应用的世界性标准集,并部分地被美国官方选择为医疗卫生信息交换的强制性标准。对HL7的发展与进展进行一综述,概要但准确地给h~HL7在各领域的新进展,包括HL7与MeaningfulUse的关系、HL7与医疗质量、Infobutten、FHIR、CCDA,也简要介绍THL7的发展历程、知识产权的新政策以及开发应用HL7标准的常用工具。对HL7有一个全面、正确的轮廓性了解,对于当今我国电子病历与区域卫生信息化的健康发展,十分必要和有益。     

患者转诊信息及其结构化与标准化

根据我国医疗文书管理相关规定，遵循有关国际组织的健康文档标准化技术和方法，探讨了患者转诊时需要携带的个人健康信息的内容、文档结构以及数据标准化问题。转诊信息包括基本信息、转诊事件信息和临床信息三个方面，按照文档段／子文档段、数据组／子数据组、数据元等三个层次划分，形成包括10个文档段（子文档段）、18个数据组（子数据组）、123个数据元的转诊文档基本框架结构。文档段限定了所包含数据产生的背景和语境，数据组由一系列数据元组成。通过数据元属性描述进行标准化。研究表明，结构化和标准化的转诊文档可促进医疗信息传递中数据的准确、一致性理解。但有赖于共享范围内标准制定和应用的协调一致，目前我国还有大量的临床概念、术语和数据元有待标准化。     

Arden/J: An Architecture for MLM Execution on the Java Platform

The Arden Syntax was introduced more than 10 years ago, but it is still not in widespread use. One reason might be that for each particular architecture and information system, a different Arden Syntax compiler must be written as well as a program for the runtime execution of the medical logic modules (MLMs). The authors have designed and implemented an architecture that increases the portability of Arden Syntax rules, using the Java platform. The portability to a target information system is achieved by the addition of appropriate adapter components, which they call mappers. These mappers are dynamically selected using explicit and implicit elements of MLMs. Furthermore, they can help translate data from the clinical information system representation into the representation needed by an MLM. This was validated by an experiment in two clinical units. Also, the authors propose a convention to name signals that trigger other MLMs (called intermediate states) so that they remain unique to each institution. The authors implemented this architecture in their clinical system and in an XML-based medical record application that has been used experimentally in their urology and nephrology departments. The Tetrasys company that provided the medical record was able to incorporate their runtime without modifications, and typical MLM execution time was less than 1 sec.Arden Syntax–based decision support systems are not widely used in current medical information systems, despite the importance placed on them in the literature and their endorsement by standards organizations such as the American Society of Testing and Machinery (ASTM), Health Level 7 (HL7), and the American National Standards Institutes (ANSI, which approved Arden Syntax without giving a number to the standard). The major likely reasons include the difficult tasks of writing Arden Syntax compilers and integrating a decision support system with both the Arden compiler and the underlying information system.This paper presents a design and implementation approach of an Arden Syntax medical logic module (MLM)–based decision support system that uses an object-oriented model and the dynamic linking features of the Java platform. The approach enables the dynamic use of data mapping objects (which we call mappers) to accommodate the differences in data availability and representation among different institutions. This should lead to a faster and more reliable sharing of the medical knowledge encoded in MLMs. To demonstrate the portability advantage of this approach, this Arden/J framework has been used to implement Arden MLMs both in our clinical system and in an electronic medical record based on documents coded using XML.     

HL7 V3在区域医疗交换平台中的应用研究

区域医疗交换平台是所有医疗信息系统中覆盖数据量最大、涉及信息系统种类最多的系统之一。HL7（HealthLevelSeven）标准的出现为异构医疗信息系统之间的信息数据交换与共享提供了基础条件和重要的应用价值。针对区域交换平台在国内外的研究现状以及HL7发展,概述了HL7 V2．x版本与HL7 V3版本,结合HL7 V2在区域交换平台的应用,借助HL7 V3的RIM模型及V3消息,设计了基于HL7 V3标准的区域医疗交换平台,实现了医院之间、医院与卫生机构之间的信息交换与共享。     

BRIDG模型：医疗信息与临床研究信息交换的桥梁

BRIDG（Biomedical Research Integrated Domain Group）模型是一种介于医疗信息与临床研究信息之间的交换标准,它是连接HL7（Health Level Seven）和DCDISC（Clinical Data Interchange Standards Consortium）标准的桥梁。在通过医院信息系统（HIS）转出数据到临床数据管理（clinical data management,CDM）系统或电子数据采集（electronic data capture,EDC）系统时应用BRIDG模型,将为提高临床研究的效率、保证数据质量、促进数据共享等方面起到积极的作用。     

LIS中HL7接口设计与实现

将检验仪器或仪器系统与LIS系统以TCP通讯方式连接,交换的数据采用HL7标准,实现仪器系统与LIS间检验医嘱信息和检验结果信息的交互,提高实验室工作效率.利用.Net的C#开发平台,借助开源NHapi模块生成标准HL7消息,在处理接收消息处理中采用实时处理与缓存文件相结合方式,保证了传输的效率.实际使用中,接口程序LISHL7Srv最终以windows服务形式部署运行,使其在计算机开机后无需登录,服务即可启动.接口服务程序的功能和性能,满足医院实验室工作要求,信息交互顺畅、实时.采用HL7标准降低了信息交互整合的难度,提出的接口设计方案有效地解决了LIS与仪器、仪器系统连接问题,同时,该方案还可扩展到其他医疗信息系统间数据交换的应用场景中.     

基于军卫一号的离线式代理检验数据导入导出软件设计与实现

医疗卫生服务的供给与需求不平衡是导致看病难、看病贵的根本原因,构建区域协同医疗平台,实现医疗信息、医疗服务、医疗资源的共享是解决问题的关键。代理检验作为区域协同医疗平台的服务之一,可以提高社区医疗单位的医疗服务水平,缓解大医院接诊压力。针对我院军卫一号不能接入互联网的情况,设计并实现了以离线文件传输形式交换数据的数据导入导出软件,导入检验申请,导出检验结果。该软件保证了数据安全,可经过简单修改移植到其他医院,具有普适性。     

Building Clinical Data Groups for Electronic Medical Record in China

This article aims at building clinical data groups for Electronic Medical Records (EMR) in China. These data groups can be reused as basic information units in building the medical sheets of Electronic Medical Record Systems (EMRS) and serve as part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which were collected from hospitals. To categorize the information in these sheets into data groups, we adopted the Health Level 7 Clinical Document Architecture Release 2 Model (HL7 CDA R2 Model). The regulations and legal documents concerning health informatics and related standards in China were implemented. A set of 75 data groups with 452 data elements was created. These data elements were atomic items that comprised the data groups. Medical sheet items contained clinical records information and could be described by standard data elements that exist in current health document protocols. These data groups match different units of the CDA model. Twelve data groups with 87 standardized data elements described EMR headers, and 63 data groups with 405 standardized data elements constituted the body. The later 63 data groups in fact formed the sections of the model. The data groups had two levels. Those at the first level contained both the second level data groups and the standardized data elements. The data groups were basically reusable information units that served as guidelines for building EMRS and that were used to rebuild a medical sheet and serve as templates for the clinical records. As a pilot study of health information standards in China, the development of EMR data groups combined international standards with Chinese national regulations and standards, and this was the most critical part of the research. The original medical sheets from hospitals contain first hand medical information, and some of their items reveal the data types characteristic of the Chinese socialist national health system. It is possible and critical to localize and stabilize the adopted international health standards through abstracting and categorizing those items for future sharing and for the implementation of EMRS in China.     

A landscape survey of planned SMART/HL7 bulk FHIR data access API implementations and tools

The Office of National Coordinator for Health Information Technology final rule implementing the interoperability and information blocking provisions of the 21st Century Cures Act requires support for two SMART (Substitutable Medical Applications, Reusable Technologies) application programming interfaces (APIs) and instantiates Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) as a lingua franca for health data. We sought to assess the current state and near-term plans for the SMART/HL7 Bulk FHIR Access API implementation across organizations including electronic health record vendors, cloud vendors, public health contractors, research institutions, payors, FHIR tooling developers, and other purveyors of health information technology platforms. We learned that many organizations not required through regulation to use standardized bulk data are rapidly implementing the API for a wide array of use cases. This may portend an unprecedented level of standardized population-level health data exchange that will support an apps and analytics ecosystem. Feedback from early adopters on the API’s limitations and unsolved problems in the space of population health are highlighted.     

Integrating Hospital Information Systems in Healthcare Institutions: A Mediation Architecture

Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.     

基于HL7 V3标准的集成平台的初步研究

随着数字化医院的迅速发展和不断进步,医院信息化建设发挥着越来越重要的作用,医院信息系统数量日益增多,复杂程度不断提高,医院信息系统集成也逐渐成为一个专门的研究领域。首先介绍HL7 V3（HL7标准第三版）的信息模型和HL7 V3数据交换实现原理,并阐述了医院信息系统集成规范IHE在国内外的发展,总结现有几种常见的系统集成技术方案,提出了一种基于HL7 V3的医院信息系统集成平台。该平台可以在应用级、流程级及数据级进行系统整合与优化,从而解决了医院异构信息系统的集成问题,实现医院异构信息系统之间的无缝连接及信息共享,从整体上提高医院各项工作的效率和质量。     

家庭健康档案概念数据模型及其应用研究

目的构建家庭健康档案概念数据模型和数据模板,为家庭健康档案的数据采集、信息共享和信息系统建设提供标准支持。方法概念框架以居民健康档案相关业务规范为依据,数据模型参照HL7参考信息模型(RIM)和HL7数据类型,数据模板参照IHE PCC已发布的标准模板,将现行的武威市居民新型电子健康档案系统中家庭电子健康档案模块的数据项与模型和模板进行对照。建模方法采用统一建模语言(UML)。结果家庭健康档案概念数据模型包含家庭标识信息和家庭健康及其影响因素2个维度,家族性疾病等14个子维度。数据模板包含标识类、一般记录项目、家族性疾病,共产生72个数据元,现有系统中尚缺30个数据元。结论家庭健康档案概念数据模型和数据模板有助于实现健康档案内容的完整性,保证信息表达的规范化和标准化。     

基于HL7标准构建医院集成平台

目的:医疗信息化产品标准化进程加快,对医院集成平台的开放性、互联性、标准化等方面提出了更高的要求。方法:基于HL7标准进行医院集成平台的建设,对院内系统的交互服务进行HL7标准化改造,实现基于HL7标准的数据存储和区域协同。结果:推动HL7标准的落地实施,统一异构系统间的数据传输及共享,实现院内以及院间的无障碍信息交互。结论:HL7标准作为国际通用的标准,具有通用性强及一定的先进性,为后期医院整体可持续性信息建设道路铺垫了基石。     

Evaluation of family history information within clinical documents and adequacy of HL7 clinical statement and clinical genomics family history models for its representation: a case report

Family history information has emerged as an increasingly important tool for clinical care and research. While recent standards provide for structured entry of family history, many clinicians record family history data in text. The authors sought to characterize family history information within clinical documents to assess the adequacy of existing models and create a more comprehensive model for its representation. Models were evaluated on 100 documents containing 238 sentences and 410 statements relevant to family history. Most statements were of family member plus disease or of disease only. Statement coverage was 91%, 77%, and 95% for HL7 Clinical Genomics Family History Model, HL7 Clinical Statement Model, and the newly created Merged Family History Model, respectively. Negation (18%) and inexact family member specification (9.5%) occurred commonly. Overall, both HL7 models could represent most family history statements in clinical reports; however, refinements are needed to represent the full breadth of family history data.     

基于HL7的实验室仪器双工通信网关设计

HL7是医疗领域应用最广泛的电子信息交换标准,通过编程使符合HL7标准的检验数据经通信网关进行数据交换,实现各种实验室仪器与实验室信息系统（LIS）的双工通信,并保证数据交换的准确性,从而提高实际工作效率。