Assignment 1: Information Standards Background Health Level Seven is

Assignment 1: Information Standards


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Health Level Seven is a
not-for-profit standard developing organization that is accredited by the ANSI
(American National Standards Institute). Health Level Seven is responsible for
creating 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 encourage
and enforce the secure access and exchange of health data. The standards are
meant to do this in a way that enhances and encourages global health data
interoperability. The level seven of HL7 refers to the seventh level of the
International Organization for Standardization (ISO) seven-layer communications
model for Open Systems Interconnection (OSI). This seventh level is known as
the application level, the OSI model refers to network architecture.

There are seven sections of the HL7
standards, these are the Primary Standards, Foundational Standards, Clinical
and Administrative Domains, EHR Profiles, Implementation Guides, Rules and
References, and Education and Awareness. Primary Standards is the section that
refers to the most popular standards that are integral for system integrations.
The Foundational Standards section defines the tools used to create the
standards and the technology that is to be regulated by HL7. The third section
of Clinical and Administrative Domains is responsible for regulating the
messaging and document standards for the clinical domain. The implementation of
section three is implemented after the implementation of section one (primary
standards) has been established. Section 4, EHR Profiles, manages the
information aspects of the Electronic Health Record systems. There are several
specifications in this category that work to manage the construct and transfer
of electronic health records. The fifth section of HL7 is Implementation
Guides, was mainly created as a support section to be used with an existing standard.
The information within this section provides supplemental support for
overarching 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 the
understanding and adoption of the HL7 standards.1

The domain of influence HL7 is
attempting to regulate is diverse and large. For this reason, while it may sound
like HL7 is a set of standards, it is more like an accumulation of a variety of
standards. There are types of HL7 standards like FHIR and HQMF, and more. Some
examples to be further elaborated on are FHIR and HL7 Version 2. The HL7 FHIR
is focused on combining existing HL7 standards with web technologies to support
the efficient creation and implementation of interoperable healthcare
applications. The HL7 version 2 focuses on the messaging standard for the
exchange of patient care and clinical information. Version 2 has been published
as an ISO standard since 2009. The CDA is another HL7 standard that is approved
by the ISO as an exchange model for clinical documents. It focuses on being an
implementation guide to meet the meaningful use regulations that have been

HL7 states that their vision is a
world where everyone can securely access and use accurate health data in any
setting. They state that their mission is to provide standards that empower
global health data interoperability. These standards were created as the tools
to accomplish these goals.1 The exchange of data is vital to many
aspects of healthcare, from interoperability to patient safety. Systems work
more efficiently, and patients are cared for better when there is an
overarching standard that all systems subscribe to. Additionally, it is more
cost efficient to employ this standard both within health care systems and
between systems. The more unique and personalized a health care system’s
communication style and interface is, the more effort it requires to transfer
and exchange the information.

The creation of HL7 started in 1987
when a group of healthcare industry professionals realized that there was a
need for overarching information exchange standards when working in a
healthcare environment that involved a variety of vendors.5 The need
for the standard arose from the fact that the healthcare industry was becoming
more complex with more applications that had a growing need to communicate with
each other. Imagine one hospital with two or three different departments
uniquely coding their information. Then imagine multiple hospitals doing the
same thing. The exponential level of complications that would arise from every
system creating and using their own version of information would have led to
virtually no information exchange. Whatever exchange would occur in this
setting would come at an excessive cost and effort, multiple stakeholders would
have to come together to interpret each other’s coding system. This is how clinical
interface specialists realized that there was a need for a standard of
information exchange that was overarching and at the same time not overly

HL7 works with multiple other
organizations to maintain relevance and avoid redundancy in their standards.
They are apart of the Joint Initiative Council, “an international
organization on global health informatics standardization that is committed to
developing a single standard for a single purpose”3. They work
with ISO (international organization of standardization) by submitting their ANSI
approved standards or draft standards to ISO for approval. Finally, they are a
part of a collaboration of standards developing organization called SCO which
“aims to facilitate the creation of industry-wide, interoperable standards
that will support meaningful improvements in health outcomes”.3

Current Applications

HL7 is implemented in a variety of
ways in today’s healthcare industry. Most healthcare systems are working on
their systems to meet HL7 standards and be able to exchange within and outside
of their system. For example, hospitals are seeing the value in their data
being interchangeable with labs and diagnostic imaging centers. This means that
there are specialists working on both ends of the HL7 spectrum. There are analysts
and programmers writing the interfaces to be interoperable, and there are
specialists and users utilizing the systems. Another example is EMR and EHR
systems actively building HL7 solutions into their systems to ensure the easy
and effective exchange of clinical information between different healthcare
stakeholders. This way when multiple systems use the same EHR they do not have
to invest additional resources into becoming interoperable within their
organization and with others.

Specifically, HL7 standards are
becoming an important aspect of population health management due to the role
information plays in population health goals. The context of health data and
the numerous factors that go into patient outcomes are important to
understanding multiple population health issues. For example, in order to
properly address the development of chronic disease, the excess healthcare
costs of a system, or the rise in poor patient outcomes, analysts need full
comprehensive health data. This data is scattered across various locations and
sources, and for it to become useful it needs to be streamlined into a
standardized format. For this reason, HL7’s FHIR standard is becoming highly
relevant to population health management today.6

Fast Healthcare Interoperability
Resources also known as FHIR is an interoperability standard for the electronic
exchange of information. It was developed by HL7 to enable HIT developers to
quickly and easily build applications for EHRs to exchange and retrieve data
faster from applications. FHIR is designed specifically for the web and targets
interoperability challenges.7 It has recently gained support from
large venders such as Epic Systems and Cerner Corp. Currently Cerner and the
ONC are promoting FHIR and API’s as key elements to expanding access to common
clinical data sets for better big data analytics.6 FHIR is
attempting to address the need to getting health data from traditional EHRs
into more flexible environments where there is a larger potential for
innovation without compromising security and workflow. This will be vital to
population health because the more data population health analysts have access
to the better they are able to accomplish their goals such as chronic disease
management or preventing poor patient outcomes across a population. As
mentioned before, context of data is vital to proper population health
management. However, this is directly challenged by hospital environments of
multi-vendor environments because each vendor can potentially store and manage
their data using a variety of interfaces and methods. This can lead to
expensive and time-consuming data cleanup that takes time away from analytics
and problem solving.

The users of HL7 can be divided into
three sections, clinical interface specialists, government entities, and
medical informatics. The clinical interface specialists can be responsible for
clinical data in a multitude of ways. This can include creating applications
that involve exchanging clinical data to the users who are responsible for
moving the data themselves. Government entities are interested in the standards
because it affects the future of how they plan on sharing data across multiple

Population Health largely relies on
accurate data regarding large groups of individuals. We need accurate and
comprehensive exchange of health data to be able to draw accurate conclusions
regarding different demographics of individuals. For example, surveillance of
communicable and non-communicable diseases is vital for prevention and control.
EHRs and electronic health data play a vital role in this communication and
surveillance. This data needs to be accurate and quickly made available for
analysis. For this reason HL7 standards are highly effective in supporting the
exchange. By enforcing HL7 or FHIR standards we can standardize the process of
reporting and make it easier and faster for government agencies to act when

On a global level these standards are
vital for staying relevant and connected as a global health industry. When one
region or country is able to successfully find a healthcare solution or
advantage due to a healthcare technology or a system, for that solution to be
implemented in a similar way there needs to be some coherence among systems. Additionally,
if the global healthcare industry participates in a global healthcare data
exchange the potential for data solutions is vast. Access to that much data is
only beneficial if it is accurate, efficient, and secure. However, if this
global level of exchange is achieved there will be a large responsibility to
ensure this data is not mismanaged or misused.

The adoption of standards like HL7
benefit population health practices mostly when they encourage rather than
limit the access to information. Population health practices are most
successful when they have access to comprehensive information on the target
demographics. This can become difficult partially due to security and partially
due to the varying nature of population health data. When standards like HL7
are introduced the standardization greatly benefits population health practices
because of how it streamlines the data for analysis.