An HL7-Centric Immunization Registry

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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

Segment
MSH\MA0000GA0000199705221610VXRV03V03
19970522MA53T2.3.1NEALltCRgt MSAAA19970522
GA40ltCRgt PID1234SR1234-12LR3872
MR221345671SS 430078856MAKENNEDY
JOHNFITZGERALD JRLBOUVIER
M19900607MKENNEDYBABY BOYB2106-3WHITE
HL 70005123 MAIN STAPT 3BLEXINGTONMA00210
MMSACODEMA 034345 ELM STBOSTONMA00314BDL
BRMA002(617) 555-1212PRNPH6175551
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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 6
Jimmy Smith 3
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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
NIP Codes
HL7 Codes
Over 50 Code Sets
OMB Race
MVX
LOINC
CVX
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An HL7-Centric Registry
Database
Code Sets
HL7
Internal Messaging
External Interfaces
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An HL7-Centric Registry
Database
Code Sets
HL7
Internal Messaging
External Interfaces
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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
Database
Code Sets
HL7
Internal Messaging
External Interfaces
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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
Database
Code Sets
HL7
Internal Messaging
External Interfaces
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Internal Messaging
Connect Everything with HL7

• Immunization messages HL7
• System Administration HL7
• Reporting HL7

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The Need for Speed
ADO
HL7 LLP
HTTPS
Relational Database Server
One or Many HL7 Application Servers
Web Server Traffic Manager

• Multi-tasking
• Scalable
• Lightweight Protocols

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An HL7-Centric Registry
Database
Code Sets
HL7
Internal Messaging
External Interfaces
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External Interfaces
Web App Server
HTTPS Interface
SSL
HL7 Pipe
Email? ebXML?
Batch (FTP)
InternalSystem
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Benefits of an HL7-Centric Approach
Best Practices
Fewer Design Decisions
Interoperability
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Good designs are easier to implement
100

• Standards encourage completeness

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Good designs are easier to implement
100

• Standards encourage completeness
• Standards encourage modular design

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Good designs are easier to implement
100

• 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 what HL7 Messages to Support
• VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
• Select HL7 Mapping Tool (or write one)
• iNTERFACEWARE Chameleon

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High-Level Design Decisions

• Decide what HL7 Messages to Support
• VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
• Select HL7 Mapping Tool (or write one)
• iNTERFACEWARE Chameleon
• Select Development Tools

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High-Level Design Decisions

• Decide what HL7 Messages to Support
• VXQ, VXR, VXX, VXU, ACK, QCK plus ORU
• Select 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)

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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 and Mass Changes
• Data 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
Key Point

• 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
• http//www.cdc.gov/nip/registry
• Health Level Seven
• http//www.hl7.org
• Committee on Immunization Standards and
  Electronic Transactions (CIRSET)
• http//www.cirset.org
• QS Technologies Immunization Registry information
• http//www.immregistry.com

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End of Presentation