Assignment is accredited by the ANSI (American National

Assignment 1: Information StandardsBackgroundHealth Level Seven is anot-for-profit standard developing organization that is accredited by the ANSI(American National Standards Institute). Health Level Seven is responsible forcreating the standards that are known as HL7 standards.  These are a set of standards for the “exchange,integration, sharing, and retrieval of electronic health information”1.

The vision and mission of HL7 is focused on providing standards that encourageand enforce the secure access and exchange of health data. The standards aremeant to do this in a way that enhances and encourages global health datainteroperability. The level seven of HL7 refers to the seventh level of theInternational Organization for Standardization (ISO) seven-layer communicationsmodel for Open Systems Interconnection (OSI). This seventh level is known asthe application level, the OSI model refers to network architecture.

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There are seven sections of the HL7standards, these are the Primary Standards, Foundational Standards, Clinicaland Administrative Domains, EHR Profiles, Implementation Guides, Rules andReferences, and Education and Awareness. Primary Standards is the section thatrefers to the most popular standards that are integral for system integrations.The Foundational Standards section defines the tools used to create thestandards and the technology that is to be regulated by HL7.

The third sectionof Clinical and Administrative Domains is responsible for regulating themessaging and document standards for the clinical domain. The implementation ofsection three is implemented after the implementation of section one (primarystandards) has been established. Section 4, EHR Profiles, manages theinformation aspects of the Electronic Health Record systems. There are severalspecifications in this category that work to manage the construct and transferof electronic health records. The fifth section of HL7 is ImplementationGuides, was mainly created as a support section to be used with an existing standard.

The information within this section provides supplemental support foroverarching standards. Section 6, Rules and References, provides Technical Specifications,programming structures, and guidelines for software and standards development.The final section of Education & Awareness focuses on supplementing theunderstanding and adoption of the HL7 standards.1The domain of influence HL7 isattempting to regulate is diverse and large. For this reason, while it may soundlike HL7 is a set of standards, it is more like an accumulation of a variety ofstandards. There are types of HL7 standards like FHIR and HQMF, and more. Someexamples to be further elaborated on are FHIR and HL7 Version 2. The HL7 FHIRis focused on combining existing HL7 standards with web technologies to supportthe efficient creation and implementation of interoperable healthcareapplications.

The HL7 version 2 focuses on the messaging standard for theexchange of patient care and clinical information. Version 2 has been publishedas an ISO standard since 2009. The CDA is another HL7 standard that is approvedby the ISO as an exchange model for clinical documents. It focuses on being animplementation guide to meet the meaningful use regulations that have beencreated.7HL7 states that their vision is aworld where everyone can securely access and use accurate health data in anysetting. They state that their mission is to provide standards that empowerglobal health data interoperability. These standards were created as the toolsto accomplish these goals.

1 The exchange of data is vital to manyaspects of healthcare, from interoperability to patient safety. Systems workmore efficiently, and patients are cared for better when there is anoverarching standard that all systems subscribe to. Additionally, it is morecost efficient to employ this standard both within health care systems andbetween systems. The more unique and personalized a health care system’scommunication style and interface is, the more effort it requires to transferand exchange the information. The creation of HL7 started in 1987when a group of healthcare industry professionals realized that there was aneed for overarching information exchange standards when working in ahealthcare environment that involved a variety of vendors.

5 The needfor the standard arose from the fact that the healthcare industry was becomingmore complex with more applications that had a growing need to communicate witheach other. Imagine one hospital with two or three different departmentsuniquely coding their information. Then imagine multiple hospitals doing thesame thing. The exponential level of complications that would arise from everysystem creating and using their own version of information would have led tovirtually no information exchange. Whatever exchange would occur in thissetting would come at an excessive cost and effort, multiple stakeholders wouldhave to come together to interpret each other’s coding system.

This is how clinicalinterface specialists realized that there was a need for a standard ofinformation exchange that was overarching and at the same time not overlyintrusive.  HL7 works with multiple otherorganizations to maintain relevance and avoid redundancy in their standards.They are apart of the Joint Initiative Council, “an internationalorganization on global health informatics standardization that is committed todeveloping a single standard for a single purpose”3. They workwith ISO (international organization of standardization) by submitting their ANSIapproved standards or draft standards to ISO for approval. Finally, they are apart of a collaboration of standards developing organization called SCO which”aims to facilitate the creation of industry-wide, interoperable standardsthat will support meaningful improvements in health outcomes”.3Current ApplicationsHL7 is implemented in a variety ofways in today’s healthcare industry.

Most healthcare systems are working ontheir systems to meet HL7 standards and be able to exchange within and outsideof their system. For example, hospitals are seeing the value in their databeing interchangeable with labs and diagnostic imaging centers. This means thatthere are specialists working on both ends of the HL7 spectrum. There are analystsand programmers writing the interfaces to be interoperable, and there arespecialists and users utilizing the systems. Another example is EMR and EHRsystems actively building HL7 solutions into their systems to ensure the easyand effective exchange of clinical information between different healthcarestakeholders. This way when multiple systems use the same EHR they do not haveto invest additional resources into becoming interoperable within theirorganization and with others. Specifically, HL7 standards arebecoming an important aspect of population health management due to the roleinformation plays in population health goals. The context of health data andthe numerous factors that go into patient outcomes are important tounderstanding multiple population health issues.

For example, in order toproperly address the development of chronic disease, the excess healthcarecosts of a system, or the rise in poor patient outcomes, analysts need fullcomprehensive health data. This data is scattered across various locations andsources, and for it to become useful it needs to be streamlined into astandardized format. For this reason, HL7’s FHIR standard is becoming highlyrelevant to population health management today.6Fast Healthcare InteroperabilityResources also known as FHIR is an interoperability standard for the electronicexchange of information. It was developed by HL7 to enable HIT developers toquickly and easily build applications for EHRs to exchange and retrieve datafaster from applications. FHIR is designed specifically for the web and targetsinteroperability challenges.7 It has recently gained support fromlarge venders such as Epic Systems and Cerner Corp.

Currently Cerner and theONC are promoting FHIR and API’s as key elements to expanding access to commonclinical data sets for better big data analytics.6 FHIR isattempting to address the need to getting health data from traditional EHRsinto more flexible environments where there is a larger potential forinnovation without compromising security and workflow. This will be vital topopulation health because the more data population health analysts have accessto the better they are able to accomplish their goals such as chronic diseasemanagement or preventing poor patient outcomes across a population. Asmentioned before, context of data is vital to proper population healthmanagement. However, this is directly challenged by hospital environments ofmulti-vendor environments because each vendor can potentially store and managetheir data using a variety of interfaces and methods. This can lead toexpensive and time-consuming data cleanup that takes time away from analyticsand problem solving.

The users of HL7 can be divided intothree sections, clinical interface specialists, government entities, andmedical informatics. The clinical interface specialists can be responsible forclinical data in a multitude of ways. This can include creating applicationsthat involve exchanging clinical data to the users who are responsible formoving the data themselves.

Government entities are interested in the standardsbecause it affects the future of how they plan on sharing data across multipleorganizations. Population Health largely relies onaccurate data regarding large groups of individuals. We need accurate andcomprehensive exchange of health data to be able to draw accurate conclusionsregarding different demographics of individuals. For example, surveillance ofcommunicable and non-communicable diseases is vital for prevention and control.EHRs and electronic health data play a vital role in this communication andsurveillance. This data needs to be accurate and quickly made available foranalysis.

For this reason HL7 standards are highly effective in supporting theexchange. By enforcing HL7 or FHIR standards we can standardize the process ofreporting and make it easier and faster for government agencies to act whennecessary. On a global level these standards arevital for staying relevant and connected as a global health industry. When oneregion or country is able to successfully find a healthcare solution oradvantage due to a healthcare technology or a system, for that solution to beimplemented in a similar way there needs to be some coherence among systems. Additionally,if the global healthcare industry participates in a global healthcare dataexchange the potential for data solutions is vast. Access to that much data isonly beneficial if it is accurate, efficient, and secure. However, if thisglobal level of exchange is achieved there will be a large responsibility toensure this data is not mismanaged or misused. The adoption of standards like HL7benefit population health practices mostly when they encourage rather thanlimit the access to information.

Population health practices are mostsuccessful when they have access to comprehensive information on the targetdemographics. This can become difficult partially due to security and partiallydue to the varying nature of population health data. When standards like HL7are introduced the standardization greatly benefits population health practicesbecause of how it streamlines the data for analysis.



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