There Are Very Few Technologies That Will Have a Greater Impact on Healthcare Management

Killdara Corporation

Health Data Courier™

Release 1.2

Interoperability Specification

Our work in refining the electronic information healthcare standard in non-proprietary; therefore we invite your feedback by posting comments on For further information please contact Mary Ann Juurlink at (613) 256-8685 x227, email

About Killdara

There are very few technologies that will have a greater impact on healthcare management than the integration of electronic patient records. A system for secure and seamless sharing of records would obviously provide compelling benefits to patients – through increased speed and accuracy – and would enable tremendous economies for the healthcare facility.

Killdara Corporation has introduced a groundbreaking healthcare integration device, the Health Data Courier, a secure and intelligent data-sharing product for clinical applications that can be quickly and economically built out to all of a health-care facility’s operating units and business partners. Moreover, we at Killdara are committed to implementing the most widely used standards including:

HL7 (Health Level Seven), an application protocol for electronic data exchange in healthcare environments;
XML (eXtensible Markup Language), a common approach to data type definition (DTDs), which will allow healthcare facilities to electronically exchange patient records without the need to manually map each data field; and
PKI (Public Key Infrastructure), a widely supported security protocol that has been recognized by HIPAA (Health Insurance Portability Accountability Act) and that has been broadly adopted by national healthcare organizations.

But our goal goes beyond using existing standards and maintaining a non-proprietary position. Killdara is also working hard to further these standards, to produce commercially functional and friendly DTD’s and to promote conformance within the Healthcare Industry.

Standard Conformance

Historically HL7 has been backwards compatible in order to encourage the uptake of the standard. While the current version (HL7 V2.x) addresses immediate point-to-point interoperability needs, V3.0 (which is currently work in progress) will be based on an object oriented domain analysis of the clinical, mostly hospital-based, environment where the applications must interoperate. In anticipation of V3.0, we have incorporated concepts such as: unambiguous message specification, conformance testing, and a more usable message encoding scheme (XML) in our transition V2.x Interoperability Specification.

HL7 conformance for Version 2.x is based on clearly documented message profile. A message profile represents an implementable message definition in which optionality and standard components are clarified. Vendors and clinical institutions use the their specific data requirements to derive these message profiles. The HL7 Conformance Special Interest Group (SIG), based on earlier developments from the Andover Working Group, has balloted a specification for the documentation format of these profiles. The XML dtds can play a very important role for describing the message profile and for building XML encoded instances of the message.

Objectives

This document will show how the HDCourier can solve the concrete data exchange needs of our clients.

In the following scenario messages originate with one healthcare partner using a typical data management system. The HDCourier translates the message in to an XML format (using standard DTDs), applies public key encryption and then passes it across the Internet to the partner's system. At the receiving end the HDCourier decrypts the message and parses the XML so that it can be acted upon. This creates a seamless workflow between healthcare facilities without requiring drastic changes to the business logic of each partner.

A sample of the HL7 2.x and XML encoding of the messages is attached along with diagrams that outline the data model.Scenario

A patient is referred by his primary care physician (GP) to the community hospital because of unusual chest pain. The patient is registered (ADT^A04) by the attending medical doctor (MD) who will then order a diagnostic study (lab order) from the remote laboratory facility (ORM^O01). The laboratory is off site in the community. When the order is received by the laboratory, a confirmation (ORR^O02) will automatically be sent to the Community Hospital’s clinical information system. If there are problems with the order, they will be resolved even before the sample gets into the hands of the lab technician. The blood sample is sent to the laboratory facility and the order is electronically processed to ensure the quality of the information. The Community Hospital provides both the demographics of the patient (including allergy information) and the order information (including specific test identifiers) using XML encoded HL7 messages. When the laboratory results are available, the laboratory system sends them to the community Hospital and to the referring GP.

Description

A registration event (ADT^A04) signals that a patient has arrived or checked in but is not assigned a bed. Upon receiving the registration information the clinical information systems places a new Diagnostic Study Order for the patient (ORM^O01). The Laboratory System will confirm that it has received the order and that it can complete the request (the ORR^O02). When the results are available an unsolicited mode of transmitting the observation results is broadcast to appropriate departments.

Actors

Hospital Registration System -- is responsible for notifying all interested Information Systems a patient has been registered.
Clinical Information System -- is responsible for all departmental operation and provides the services required.
Laboratory System – is responsible for acknowledging the clinical order and to broadcast, according to application rules, unsolicited results when available.

Preconditions

There are preconditions for each event:

ADT^A04: the patient is ready for clinical attention supplying demographic information.
ORM^O01: the clinical information system authorizes and places a Diagnostic Study Order.
ORR^O02: the laboratory system receives the order.
ORU^R01: the laboratory has fulfilled the request and transmits the results.

Flow of Events

A patient is registered into the Hospital Registration System
The patient has outpatient status or emergency admission.
The clinical information system sends an order notification according to business rules.
The laboratory system sends an order confirmation, which indicates, based on the information provided in the order that the laboratory can complete the order.
Using the unsolicited mode, the laboratory system returns the value of an observation as soon as it is available.

Post Conditions

There are post conditions for each event:

ADT^A04: The patient is registered and the clinical information system is notified.
ORM^O01: The laboratory system is notified of a new Diagnostic Study Order
ORR^O02: The clinical information system is notified that the laboratory is either able to accept, unable to accept, cancels, or unable to cancel the new Diagnostic Study

ORU^R01: The laboratory system displayed the results to the users as indicated.

Sample Patient Registration Message

Ascii (ER7) encoding:

MSH|^~\&|||HBOC||CERNER||ADT^A04|41834979147914197|P|2.2|

EVN|A01|20001001120212|

PID|||0281755||SMITH^JOHN^FITZGERALD|19451206|M||||||||459832183|232-45-4548|

NK1|1|SMITH^LAURA^MARY|12 River Street^Ap. 2^New York^NY^23214^USA|12434

^SPOUSE^ISO|212-555-7873|

PV1||O|||||523422241^KRISHNASWAMI^PAVAN|999722241^JONES^JENNY|67676090^RAMIREZ^PAUL^F|||||OUTPATIENT||||444244329|

PV2|||^Chest Pain|

AL1|1|^Pennicillin||^Severe|

XML encoding:

<ReceivingApplication>CERNER</ReceivingApplication>

</MessageHeader>

</EventType>

<PatientName<FamilyName>SMITH</FamilyName>

<MiddleName>FITZGERALD</MiddleName>

</PatientName>

<Name>

<FamilyName>SMITH</FamilyName>

<GivenName>LAURA</GivenName>

</Name>

<Identifier>12434</Identifier<Text_Value>SPOUSE</Text_Value>

<StreetAddress>12 River Street</StreetAddress>

</Address>

</NextOfKin>

</PatientDemographics>

<FamilyName>Krishnaswami</FamilyName>

<GivenName>Pavan</GivenName>

<MiddleInitialOrName>Krishnan</MiddleInitialOrName>

</AttendingDoctor>

<FamilyName>Jones</FamilyName>

<GivenName>Jenny</GivenName>

</ReferringDoctor>

<FamilyName>Ramirez</FamilyName>

</ConsultingDoctor>

<AmbulatoryStatus>OUTPATIENT</AmbulatoryStatus>

</AdmitVisitInfo>

<Text_Value>Chest Pain</Text_Value</AdmitReason>

<Text_Value>Penicillin</Text_Value>

</AllergyCodeMnemonicDescription>

<AllergySeverity<Text_Value>Severe</Text_Value</AllergySeverity>

</AllergyInfo>

</MoreAdmitVisitInfo>

</RegisterPatient>