Introduction

In this section, we will:

Introduce the HL7 organization and the version 3 standard
Discuss the goal of HL7

Introduction:

What is HL7?
Heath Level Seven (HL7) is an ANSI-accredited Standards
Developing Organization (SDO) operating in healthcare arena
Provides standards for data exchange to allow interoperability
between healthcare information systems
HL7 focuses on the clinical and administrative data domains

It is a not-for-profit organization made up of volunteers

providers, payers, vendors, government
Key goal is syntactic and semantic interoperability

Introduction:

4 Pillars of Semantic Interoperability

The 4 pillars of semantic interoperability are:

1. A common Reference Information Model (RIM) spanning the
entire clinical, administrative and financial healthcare universe
2. A well-defined and tool-supported process for deriving data
exchange specifications ("messages") from the RIM
3. A formal and robust Data Type Specification upon which to
ground the RIM
4. A formal methodology for binding concept-based terminologies to
RIM attributes.

Reference Information Model (RIM)

In this section, we will:

Discuss the modeling concepts used in HL7 Version 3

Describe the Backbone Classes of the HL7 RIM

Reference Information Model (RIM):

Overview
Reference Information Model (RIM):
Follows object oriented developmental methodology based on a
UML model
The fundamental model from which all v3 messages are derived
is referred to as the Reference Information Model (RIM)

The RIM is a generic, abstract model that expresses the

information content of all the areas of healthcare
Defines all the information from which the data content of HL7
messages are drawn
Forms a shared view of the healthcare domain and is used
across all HL7 messages independent of message structure
5

Reference Information Model (RIM):

Backbone Classes
Entity

Role

Participation

Act

An association between an
A physical thing,
A competency of the Entity
A record of something
Act and a Role with an Entity
group of physical
playing the Role as
that is being done, has
playing
that
Role.
Each
things or an
identified, defined,
been done, can be
1
0..n
0..1
Entity (in a Role) involved in
guaranteed,
or
organization capable
0..n
0..n an Act in a certain way is
1 done, or is intended or
acknowledged by the Entity
requested to be done.
of participating in
linked to the act by one
0..1
that Scopes the Role.
Acts, while in a role.
Participation-instance.
0..n
1

Role Link 0..n

Act Relationship 0..n

0..n

A connection between two

roles expressing a
dependency between those
roles.

0..n

A directed association
between a source act and a
target act.

Reference Information Model (RIM)

Backbone Class: Entity

Entity
classCode : CS
determinerCode : CS
id : SET<II>
code : CE
quantity : SET<PQ>
name : BAG<EN>
desc : ED
statusCode : SET<CS>
existenceTime : IVL<TS>
telecom : BAG<TEL>
riskCode : CE
handlingCode : CE

Entity: a person, animal, organization or thing

A collection of classes related to the Entity class, its
specializations and related qualifying classes. The classes
represent health care stakeholders and other things of interest
to health care.
Entity has the following sub-classes:
Container
Device
LanguageCommunication
LivingSubject
ManufacturedMaterial
Material
NonPersonLivingSubject
Organization
Person
Place

Reference Information Model (RIM):

Backbone Class: Role

Role
classCode : CS
id : SET<II>
code : CE
negationInd : BL
addr : BAG<AD>
telecom : BAG<TEL>
statusCode : SET<CS>
effectiveTime : IVL<TS>
certificateText : ED
quantity : RTO
positionNumber : LIST<INT>
...

Roles:
A responsibility or part played by an entity (e.g. Person in a role
of patient, employee, etc.) different faces of an Entity
A collection of classes related to the Role class and its
specializations. These classes focus on the roles participants
may play in health care.
Role has the following sub-classes:
Access
Employee
LicensedEntity
Patient

Reference Information Model (RIM):

Backbone Class: RoleLink

RoleLink:
Role

A connection between two roles expressing a dependency

between those roles.
RoleLink has no sub-classes.

0..n

0..n
source
0..n

0..n
inboundLink

outboundLink

RoleLink
typeCode : CS
effectiveTime : IVL<TS>

Reference Information Model (RIM):

Backbone Class: Participation

Participation

typeCode : CS
functionCode : CD
... : CS
contextControlCode
sequenceNumber : INT
negationInd : BL
noteText : ED
time : IVL<TS>
modeCode : CE
awarenessCode : CE
signatureCode : CE
signatureText : ED
performInd : BL
substitutionConditionCode : CE

Participation:
An association between an Act and a Role with an Entity
playing that Role.
Participation has the following sub-class:
ManagedParticipation

10

Reference Information Model (RIM):

Backbone Class: Act

Act

classCode : CS
moodCode : CS
id : SET<II>
code : CD
negationInd : BL
derivationExpr : ST
text : ED
title : ST
statusCode : SET<CS>
effectiveTime : GTS
activityTime : GTS
availabilityTime : TS
priorityCode : SET<CE>
confidentialityCode : SET<CE>
repeatNumber : IVL<INT>
interruptibleInd : BL
levelCode : CE
independentInd : BL
uncertaintyCode : CE
reasonCode : SET<CE>
languageCode : CE

Act:
A collection of classes including the Act class and its
specializations. These relate to the actions and events that
constitute health care services. A record of something that is
being done, has been done, can be done, or is intended or
requested to be done.
Act has the following sub-classes:
Account
ControlAct
DeviceTask
DiagnosticImage
Diet
FinancialContract
FinancialTransaction
InvoiceElement

Observation
Participation
PatientEncounter
Procedure
PublicHealthCase
SubstanceAdministration
Supply
WorkingList

Note: Sub-classes also include Core Infrastructure, Message

Communications Control and Structured Documents classes not
shown here.
11

Reference Information Model (RIM):

Backbone Class: ActRelationship

ActRelationship
0..n
outboundRelationship typeCode : CS
inversionInd : BL
contextControlCode : CS
source 0..n
contextConductionInd : BL
Act
sequenceNumber : INT
priorityNumber : INT
pauseQuantity : PQ
checkpointCode : CS
splitCode : CS
joinCode : CS
negationInd : BL
conjunctionCode : CS
localVariableName : ST
seperatableInd : BL

ActRelationship:
A directed association between a source Act and a
target Act. A point from a later instance to a earlier
instance OR point from collector instance to
component instance.

ActRelationship has no sub-classes.

0..n
1

target

inboundRelationship

12

Reference Information Model (RIM):

The Complete RIM

0. . n

LanguageCom m unication
languageCode : CE
m odeCode : CE
...

0..n

1..n

Entity
classCode : CS
deter m iner Code : CS
id : SET<II>
code : CE
quantity : SET<PQ>
nam e : BAG<EN>
desc : ED
statusCode : SET<CS>
...

player

playedRole

0. . 1

0. . n

scoper

scopedRole

0. . 1

0. . n

Role
classCode : CS
id : SET<II>
code : CE
negationInd : BL
addr : BAG<AD>
telecom : BAG<TEL>
statusCode : SET<CS>
...

t ar get

RoleLink

inboundLink

...

0. . n

1
sour ce

out boundLink

0. . n
1

Par ticipation
typeCode : CS
functionCode : CD
contextContr olCode : CS
sequenceNum ber : INT
negationInd : BL
noteText : ED
tim e : IVL<TS>
m odeCode : CE
...

Or ganization
...

Place
m obileInd : BL
addr : AD
dir ectionsText : ED
...
...

Em ployee
jobCode : CE
jobTitleNam e : SC
jobClassCode : CE
salar yTypeCode : CE
...

Mater ial
for m Code : ...
CE

Access
appr oachSiteCode : CD
...
...

NonPer sonLivingSubject
...
addr : BAG<AD>
...
m ar italStatusCode
... : CE
...

inboundRelat ionship

1
1

typeCode : CS
inver sionInd : BL
...
contextContr olCode
...
: CS
contextConductionInd
...
: BL
...

0. . n

classCode : CS
m oodCode : CS
id : SET<II>
code : CD
negationInd : BL
der ivationExpr :...
ST
...

Domain Related

Patient

Pr ocedur e

Supply

PatientEncounter
pr eAdm itTestInd : BL
adm issionRefer r alSour ceCode : CE
lengthOfStayQuantity : PQ
dischar geDispositionCode : CE
specialCour tesiesCode : SET<CE>
...

...

Obser vation

SubstanceAdm inistr ation

Account

InvoiceElem ent

...
...
...

r outeCode : CE
...

m odifier Code :...

SET<CE>
...

Wor kingList

Per son
Device
m anufactur er ModelNam e : SC
softwar eNam e : SC
localRem oteContr olStateCode ...
: CE
...

0. . n

t ar get

0. . n

...

LicensedEntity
r ecer tificationTim...
e : TS

Manufactur edMater ial

lotNum ber Text : ST
...

out boundRelat ionship

sour ce

ManagedPar ticipation
...

LivingSubject
adm inistr ativeGender Code :...
CE
bir thTim e : TS
deceasedInd : BL
deceasedTim e : TS
...

ActRelationship

Act

owner shipLevelCode
...
: CE

Container
capacityQuantity : PQ
heightQuantity : PQ
diam eter Quantity : PQ
capTypeCode : CE
...

DeviceTask
par am eter Value
... : LIST<ANY>FinancialContr act

Diet

PublicHealthCase

FinancialTr ansaction

paym entTer m...sCode : CE

...

DiagnosticIm age

...

...
subjectOr ientationCode
...
: CE

Message Contr ol

0..*

Com m unicatio
nFunction
typeCode : CS
telecom : TEL

0. . 1

Contr olAct

Infr astr uctur e (Str uctur ed docum ents)

1..*

Tr ansm ission
id : II
...

0..*

1
0..n

...

AttentionLine
...

ContextStr uctur e

Infr astr uctur eRoot

localId : ST

0..1

0..n

Quer yEvent
...
...

0..1

HEALTH LEVEL 7
REFERENCE INFORMATION MODEL
VERSION 1.23 (RIM_0123)
Reflects changes to RIM in RIM Har m onization Meeting 03/20/2003.

Enitites

Acts

Batch
r efer enceContr olId : II
nam e : SC
...

Message
ver sionId : ST
inter actionId : II
pr ofileId : SET<II>
pr ocessingCode : CS
pr ocessingModeCode : CS
acceptAckCode : CS
applicationAckCode : CS
...
1

conveyingM essage

EntityHeir

0. . n

RoleHeir

payload

Sor tContr ol
0..n
sequenceNum ber...: INT
...

acknowledges

Table

Docum ent

Quer yAck

Quer ySpec
m odifyCode : CS
r esponseElem entGr oupId : SET<II>
...
r esponseModalityCode : CS
r esponsePr ior ityCode : CS
...

ActHeir

...

...

TableStr uctur e

sum m ar y...: ST
...

...
LinkHtm l

Quer yContinuation
conveyedAcknowledgem ent

Roles

Other

0. . 1

0. . n

ack nowle dgedBy

LocalAttr

Acknowledgem ent

...
...

Infr astr uctur e (Str uctur ed

docum ents)

Par am et
er

...

Infr astr uctur e

(Com m unications)

0..n

Bi l l board produced by:

Rochest er O ut door Advert i si ng

id : II

0..n

0..1

Quer yByPa
r am eter

SelectionExpr ession

Quer yBySelection

TableCell

0..n

user AsLeft

0..1

le ftSid e

0..n

Acknowledgem entDetail

0..1

Par am eter List

RelationalExpr ession

Par am eter Item

...
...

...

Infrastructure Related

13

...

0..n
user AsRight

0..n

r ightSid e

0..1

scope : CS
...

TableColum n
Str uctur e
spa
n:

LocalMar kup
...

LogicalExpr ession
r elationalConjunctionCode
...
: CS

Structured Documents

Reference Information Model (RIM):

RIM-UML Instance Scenario

Entity

Role

Participation

John Doe

Patient

Subject

Dr. Smith

HealthCare
Provider

Surgeon*

XYZ Hospital

HealthCare
Facility*

Location
Act Relationship

John Doe

Patient

Subject
14

Act

(Procedure Act)

Prostectomy

Has Pertinent Information

(Clinical Trial Act)

Protocol ECOG 1112

HL7 Version 3 Process & Artifacts

In this section, we will discuss:

Domain Message Information Model (DMIM)

Refined Message Information Model (RMIM)
Hierarchal Message Definitions (HMDs)
Message Type (MT)

15

HL7 Version 3 Process & Artifacts:

Overall Process
RIM

R-MIM

D-MIM
1..*

1..*

HMD

MT
1..*

16

1..*

HL7 Version 3 Process & Artifacts:

Examples
Entry points
Color-coding

Directional

Arrows
17

Labeling

Reference Information Model (RIM):

HL7 Modeling Conventions

Color-coding colors of classes in the model denote the type of
backbone class to which it belongs
Arrows Participations, ActRelationships and RoleLinks are
directional arrows that have rather than being lines that connect
classes like in UML
Entry points where to start reading the model; DMIMs have
one or more entry points, RMIMs have one
RMIMs are directional all associations flow out from the entry
point to the remaining parts of the model
Labeling associations in RMIMs are labeled on the distal end
only

18

HL7 Process & Artifacts:

Domain Message Information Model (DMIM)

A DMIM is a refined subset

of the RIM that includes a
set of class clones,
attributes and relationships
that can be used to create
messages for a particular
domain (a particular area of
interest in healthcare).

19

HL7 Process & Artifacts:

Refined Message Information Model (RMIM)

The RMIM is a subset of a

DMIM that is used to
express the information
content for a message or
set of messages with
annotations and
refinements that are
message specific.
20

HL7 Process & Artifacts:

Hierarchal Message Definitions (HMDs)

A Hierarchal
Message
Definition (HMD)
is a serialized
version of the
RMIM in a
specific order.
21

HL7 Process & Artifacts:

Message Type (MT)

The Message Type elements and attributes in an XML message instance

correspond to the sequence of data in the HMD
22

Vocabulary & Data Types

In this section, we will discuss:

HL7 Standard Vocabulary

Structural Attributes prescribed HL7 vocabulary

Non-Structural Attributes vocabulary chosen by organization

Robust Data Types

23

Vocabulary & Data Types:

Structural Attributes

An Act of the Class

Observation (OBS) with
a Mood of Event (EVN).

classCode and moodCode are

both Structural Attributes

Structural attributes are used to specify type and state of each RIM
class and what it means when used in a message. They use a
standard vocabulary defined and controlled by HL7.
24

Vocabulary & Data Types :

Non-Structural Attributes
Other attributes dont have an assigned vocabulary
Organizations can choose any industry standard vocabulary
For example, commonly used ones for Observation Acts are
LOINC, SNOMED, MedDRA, etc.
Must specify more than just the code value, other data is needed
for semantic interoperabilitythis is where data types come in

25

Vocabulary & Data Types :

Data Types
What is a data type?

lengthOfStayQuantity
is attribute of the
EncounterProcess
class.

lengthOfStayQuantity
has a data type of
Physical Quantity (PQ).

26

Vocabulary & Data Types :

Data Types
Data types in HL7 version 3 are complex
Each data type has attributes
Each attribute has a data type of its own
Physical Quantity (PQ) example

<lengthOfStayQuantity value=10 unit=hours"/>

The attributes value and unit are part of the
complex data type Physical Quantity (PQ).
Value is expressed as the data type of integer
(int).
27

HL7 Version 3 at NCICB

In this section, we will discuss:

Why HL7 at NCICB?

NCICB Clinical Architecture Vision
caAdapter

28

HL7 Version 3 at NCICB:

Why HL7?
Recommended by the Health and Human Service (HHS) as the
messaging standard for electronic exchange of clinical data.
Over 90% of US hospitals have implemented some version of 2.x
HL7 messages.
Support for translational research requires integration of research
data with the clinical data.

V3 offers the syntactic and semantic interoperability to make this

possible

29

Recommended Resources
Health Level Seven
www.hl7.org
HL7 Reference Information Model
https://www.hl7.org/library/data-model/RIM/C30202/rim.htm
HL7 Vocabulary Domains
http://www.hl7.org/library/data-model/RIM/C30123/vocabulary.htm
HL7 Version 3 Standard
http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
NCICB caAdapter Project Site
trials.nci.nih.gov/projects/infrastructureProject/caAdapter
HL7 Version 3: Driving Interoperability & Transforming Healthcare Information
Management - Charles Mead, MD, MSc
NIHSeminar_Charlie Mead.ppt
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