Download An HL7-Centric Immunization Registry

An HL7-Centric
Immunization Registry
Presented by Kevin Davidson
QS Technologies
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The Information Exchange Problem

How can unlike
systems understand
each other?
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Enter HL7

An international standard
for the exchange of health
information

Designed for unlike
systems to communicate
through a standard format
"HL7”, "Health Level Seven," and the
puzzle design are registered
trademarks, and the HL7 design is a
trademark of Health Level Seven, Inc.
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Implementation Guide for Immunization
Data Transactions using Version 2.3.1 of the
Health Level Seven (HL7) Protocol
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Actual HL7 Message

HL7 messages are not
designed for humans, but
machines like them
Segmen
t
MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03^V03|19970522M
A53|T|2.3.1|||NE|AL|<CR>
MSA|AA|19970522GA40|<CR> …
PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^
~430078856^^^^MA^||KENNEDY^JOHN^FITZGERALD^ JR^^^L|BOUVIER
^^^^^ ^M|19900607|M|KENNEDY^BABY BOY^^^^^^B|2106-3^WHITE^HL
70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSACODE^MA
034~345 ELM ST^^BOSTON^MA^00314^^BDL~^^^^^^BR^^MA002||(617)
555-1212^PRN^PH^^^617^5551212 …
Field
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HL7 Message Types for Immunizations

VXQ – Query for Vaccination Record

VXX – Response with Multiple Matches

VXR – Response with Vaccination Record

VXU – Unsolicited Vaccination Update

QCK/ACK – Acknowledgments

ORU – Unsolicited Transmission of an
Observation (used for VAERS)

ADT – Admit / Discharge / Transfer
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VXQ Message – Query for Vaccination
Record
Do you have
any shots for
Jimmy Smith?
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VXX – Response with multiple matches
Jimmy
Smith 4
Jimmy
Smith 1
Jimmy
Smith 5
Jimmy
Smith 2
Jimmy
Smith 3
Jimmy
Smith 6
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VXR – Response with Vaccination
Record

Patient demographics

Identifiers

Vaccination history

Adverse events

Contraindications

Recommendations for
shots due
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VXU – Unsolicited Vaccination Update
 Use
to add new individual immunizations
to the registry
 Use
for mass loading from other systems
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ORU – Unsolicited Transmission of an
Observation (used for VAERS)
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ADT – Admit / Discharge / Transfer

ADT Messages can
be used with legacy
hospital and billing
systems
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Coded Data in HL7
HL7
Codes
NIP
Codes
OMB Race
Over 50 Code Sets
MVX
CVX
LOINC
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An HL7-Centric Registry
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An HL7-Centric Registry
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Database
 Problems
with Legacy Databases

Do not provide ways to store all the possible
information in an HL7 message

Data fields have to be used in ways not
originally intended
Database
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An HL7-Centric Registry
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Problems with Legacy Code Sets

Legacy Code Sets may not
capture HL7 Coded Data
completely.

Translation tables are hard
to maintain.
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An HL7-Centric Registry
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Internal Messaging

Immunization messages – HL7

System Administration – HL7

Reporting – HL7
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The Need for Speed
HTTPS
Web Server &
Traffic Manager
One or Many HL7
Application Servers
Relational
Database Server
•Multi-tasking
•Scalable
•Lightweight Protocols
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An HL7-Centric Registry
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External Interfaces
Web
App
Server
HTTPS
Interface
HL7 Pipe
SSL
Batch
(FTP)
Email?
ebXML?
Internal
System
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Benefits of an HL7-Centric Approach
Best Practices
Interoperability
Fewer Design
Decisions
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Good designs are easier to implement

Standards encourage
completeness
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Good designs are easier to implement

Standards encourage
completeness

Standards encourage
modular design
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Good designs are easier to implement

Standards encourage
completeness

Standards encourage
modular design

Standards reduce false
starts
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High-Level Design Decisions
 Decide

what HL7 Messages to Support
VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
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High-Level Design Decisions
 Decide

VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
 Select

what HL7 Messages to Support
HL7 Mapping Tool (or write one)
iNTERFACEWARE Chameleon
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High-Level Design Decisions
 Decide

VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
 Select

what HL7 Messages to Support
HL7 Mapping Tool (or write one)
iNTERFACEWARE Chameleon
 Select
Development Tools
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High-Level Design Decisions
 Decide

VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
 Select

what HL7 Messages to Support
HL7 Mapping Tool (or write one)
iNTERFACEWARE Chameleon
 Select
Development Tools
 Select
Client Technology

100% HTML for widest acceptance
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Open Issues

Transport Mechanisms
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Open Issues

Transport Mechanisms

Digital Signatures (PKI)
33
Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface
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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface

Query Improvement
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Open Issues

Transport Mechanisms

Digital Signatures (PKI)

Deduplication Interface

Query Improvement

Coordinating Business Rules between
Registries – Minimal Data Quality
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Open Issues
 Inventory
Management
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Open Issues
 Inventory
Management
 Synchronization
and Mass Changes
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Open Issues
 Inventory
Management
 Synchronization
 Data
and Mass Changes
Representation Standards
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Conclusions
 You
can do everything you need to do
using HL7
 It
performs well
 It
is scalable
 Developers
are productive
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Start With HL7

The project goes much
better if you start with
HL7 rather than trying to
add it on at the end.
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Resources

National Immunization Program Registry Page


Health Level Seven


http://www.hl7.org
Committee on Immunization Standards and Electronic
Transactions (CIRSET)


http://www.cdc.gov/nip/registry
http://www.cirset.org
QS Technologies Immunization Registry information

http://www.immregistry.com
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End of
Presentation
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