HC3i-HL7CDCPre周子君教授讲座

HL7及其在公共卫生信息系统的应用周子君MD MPH北京大学公共卫生学院 2020 4 6 2003HealthLevel7China 2 HL7概况 HL7V2 X HL7V3 0 HL7在PHIN的应用 主要内容 2020 4 6 2003HealthLevel7China 3 HealthLevelSeven HL7 1987年成立 美国国家标准局 ANSI 授权的从事医疗服务信息传输协议及标准研究和开发的机构 HL7概况 2020 4 6 2003HealthLevel7China 4 HL7的目的 开发和研制医疗数据信息传输协议及标准 优化临床及其管理数据信息的程序 降低卫生信息系统互连的成本 提高卫生信息系统之间数据信息共享的程度 HL7概况 2020 4 6 2003HealthLevel7China 5 全美国约有95 的医院 95 的医疗相关设备及信息系统应用HL7作为其标准 HL7现有会员2200多名 代表着世界上主要国家和主流技术的发展趋势 HL7的影响力 2020 4 6 2003HealthLevel7China 6 21InternationalHL7Affiliates Argentina Australia Brazil Canada China Croatia CzechRepublic Denmark Finland Germany India Japan Korea Lithuania NewZealand SouthernAfrica Switzerland Taiwan Turkey TheNetherlands UnitedKingdom HL7isInternational 26 USA 2020 4 6 2003HealthLevel7China 7 PAYERS GENERALINTEREST PROVIDERS CONSULTANTS VENDORS HL7会员 2020 4 6 2003HealthLevel7China 8 PAYERSBlueCross BlueShied UnitedHealthGroup VytraHealthPlans etc GENERALINTERESTAMA AHA JCAHO CDC NCHS PanAm HealthOrganization WHO U S Dept ofDefense HealthAffairs U S Dept ofHealth HumanService HL7会员 2020 4 6 2003HealthLevel7China 9 PROVIDERSJohnHopkinsHospital BaptistHealthSystem U S Dept ofVeteransAffairs etc CONSULTANTSErnst YoungLLP GartnerGroup etc VENDORSIBM SUN IDX HP NEC Microsoft 3M SMS etc HL7会员 2020 4 6 2003HealthLevel7China 10 HL7的应用 GetyourhealthinformationAny time Any where Any device 2020 4 6 2003HealthLevel7China 11 1 HL7 sSIG成员提议2 SIG磋商 讨论 投票 90 3 SIG成员如有反对意见须注明理由 组长负责解决4 SIG通过的标准提案须提交HL7技术委员会通过5 HL7技术委员会通过的标准报ANSI审批 HL7制定标准的程序 2020 4 6 2003HealthLevel7China 12 1 HL7 sMessagingStandard2 ArdenSyntaxforMedicalLogicSystems3 ClinicalContextObjectWorkgroup CCOW 4 ClinicalDocumentArchitecture CDA HL7研究的标准 2020 4 6 2003HealthLevel7China 13 HL7 sMessagingStandard 2 21994年2月颁布 ANSI 2 31997年5月颁布 ANSI 2 3 11999年4月颁布 ANSI 2 42000年10月颁布 ANSI 2 52003年8月颁布 ANSI 2 6研制中3 02004年3月部分 ANSI HL7研究的标准及其进展 2020 4 6 2003HealthLevel7China 14 与相关标准的合作DICOM XML IEEE X12N ASTM E31 SNOMED ICD LOINC CPT NDCCENTC251 ISO215 2020 4 6 2003HealthLevel7China 15 ISO OSI网络体系结构模型 1物理Physical 2链路DataLink 3网络Network 4传输Transport 5会话Session 6表示Presentation 7应用Application HL7 HL7与网络体系结构及协议的关系 2020 4 6 2003HealthLevel7China 16 HL7与OSI的关系 FTP HTTP POP3 TCP UDP IP LLC MAC SMTP 实体线路 HealthLevelSeven HL7 2020 4 6 2003HealthLevel7China 17 HL7概况 HL7V2 X HL7V3 0 HL7在PHIN的应用 主要内容 2020 4 6 2003HealthLevel7China 18 AnHL7Version2 XSpec CommonSpecs 2020 4 6 2003HealthLevel7China 19 HL7标准涵盖的内容 GeneralIntroduction Chapter1 MessageInfrastructure Ch 2 GeneralconventionsDataTypesMessageConstructionRulesPatientAdministration Ch 3 62PatientAdministrationtransactions238patient relateddataitems 2020 4 6 2003HealthLevel7China 20 Orders Observations Ch 4 7 DiagnosticServices Lab Radiology etc MedicationsandDrugsTreatmentsClinicaltrialsDietarySupplyQueries Ch 5 Queries Responses HL7标准涵盖的内容 2020 4 6 2003HealthLevel7China 21 FinancialManagement Ch 6 basicservicebillingmessagese claimsManagementofMasterFiles Tables Ch 8 PatientsProvidersLocationsClinicalDocumentManagement Ch 9 HL7标准涵盖的内容 2020 4 6 2003HealthLevel7China 22 SchedulingofMedicalServices Ch 10 PatientReferral Discharge Ch 11 PatientCare Ch 12 LaboratoryAutomation Ch 13 ApplicationManagement Ch 14 PersonnelManagement Ch 16 Appendices HL7标准涵盖的内容 2020 4 6 2003HealthLevel7China 23 HL7消息模型 ConvertsandsendsinHL7 ReceivesinHL7 2020 4 6 2003HealthLevel7China 24 HL7消息传输格式 Message Segment Field 2020 4 6 2003HealthLevel7China 25 消息 Message 消息是数据在系统之间交换的基本单元 每条消息都有各自的消息类型 MessagetypeV2 4共有112种 用于定义消息目的 消息类型中有触发事件 TriggerEvent 如ADT 消息由若干个消息段组成 HL7消息传输格式 2020 4 6 2003HealthLevel7China 26 V2 4Message ADT MSHMessageHeaderEVNEventTypePIDPatientIdentification PD1 AdditionalDemographics NK1 NextofKin AssociatedPartiesPV1PatientVisit PV2 PatientVisit AdditionalInfo GT1 Guarantor IN1Insurance IN2 InsuranceAdditionalInfo IN3 InsuranceAdd lInfo Cert 2020 4 6 2003HealthLevel7China 27 AHL7V2 4AdmitMessage MSH PATH GP123 200108261705 1100 A04 101 P 2 4 34567 AL NE AU enEVN A01 200108261645 1100 PID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803NK1 1 Knees Barbara K Wife CP Contactperson PV1 1 I 2000 2012 01 E 004777 Getwell Sara J TRMA ADM A0 2020 4 6 2003HealthLevel7China 28 消息段 Segment 由一组数据字段 Datafield 按一定顺序和规则组成 每一消息段都有相应的名称 用于界定其内容或功能 V2 4共有138种消息段 MessageHeader MSH EventType EVN PatientID PID andPatientVisit PV1 消息段分为 必须 可选 可重复三种类型 HL7消息传输格式 2020 4 6 2003HealthLevel7China 29 AHL7V2 4Segment MSH PATH GP123 200108261705 1100 A04 101 P 2 4 34567 AL NE AU enEVN A01 200108261645 1100 PID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803NK1 1 Knees Barbara K Wife CP Contactperson PV1 1 I 2000 2012 01 E 004777 Getwell Sara J TRMA ADM A0 2020 4 6 2003HealthLevel7China 30 HL7V2 4MSHSegment定义 SEQ positionwithinsegmentLEN lengthoffieldDT datatypeforfieldOPT optionalityforfieldRP repeatabilityTBL tablenumberforcodesITEM HL7fieldnumberELEMENTNAME name 2020 4 6 2003HealthLevel7China 31 Segments MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F 2020 4 6 2003HealthLevel7China 32 Segments MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F 2020 4 6 2003HealthLevel7China 33 Segments MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F 2020 4 6 2003HealthLevel7China 34 Segments MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F 2020 4 6 2003HealthLevel7China 35 Segments MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F 2020 4 6 2003HealthLevel7China 36 MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F RepeatedSegments 2020 4 6 2003HealthLevel7China 37 MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803OBR 1 PMS66666 956635 9 LFT LIVERFUNCTIONTEST N2270OBX 1 NM 1751 7 SAlbumin LN 38 g L 35 45 FOBX 2 NM 1779 8 SAlkalinePhosphatase LN 52 U L 30 120 F RepeatedSegments 2020 4 6 2003HealthLevel7China 38 字段 Fields 是一个字符串 字段必须定义其在消息段中的位置 长度 数据类型 55种 选择类型 重复性 HL7消息传输格式 2020 4 6 2003HealthLevel7China 39 NK1 1 Knees Barbara K Wife CP Contactperson PV1 1 I 2000 2012 01 E 004777 Getwell Sara J TRMA ADM A0 Let slookat Fields MSH PATH GP123 20000826 ORU 101 P 2 4 34567 AL NE AU enPID KNEE123 Knees Nobby J Mr 19331215 M 23ShadyLane LIGHTNINGRIDGE NSW 2392 219171803 2020 4 6 2003HealthLevel7China 40 表 Table V2 4共有470余个表 分为HL7标准表和用户自定义表以及外部表三类 HL7消息传输格式 2020 4 6 2003HealthLevel7China 41 表0100HL7WhentoCharge 2020 4 6 2003HealthLevel7China 42 表0116UserBedStatus 2020 4 6 2003HealthLevel7China 43 HowdoesHL7Messagingwork 2020 4 6 2003HealthLevel7China 44 接收系统 发送系统 HL7消息传输 初始模式 生成HL7Message 发给应答系统 校验 如错误 返回拒绝消息应用程序生成确认 出错 拒绝消息 2020 4 6 2003HealthLevel7China 45 HL7消息传输 增强模式 生成HL7Message 发给应答系统 接收 检查MSH 确认发送端是否需要成功接收 安全存储的确认 发送系统 接收系统 2020 4 6 2003HealthLevel7China 46 HL7概况 HL7V2 X HL7V3 0 HL7在PHIN的应用 主要内容 2020 4 6 2003HealthLevel7China 47 HL7Version3 HL7Version3isa family ReferenceInformationModel RIM VocabularySpecificationsDefinedMethodology 2020 4 6 2003HealthLevel7China 48 AnHL7Version3 XSpec CommonSpecs ImplementableMessageSpecificationEDIFACT FutureConsideration ImplementableMessageSpecificationOLE CORBA ImplementableMessageSpecificationASN 1 ER7 HL7ReferenceModel 2020 4 6 2003HealthLevel7China 49 InformationModelComponents 2020 4 6 2003HealthLevel7China 50 Role Entity Participation NormativeRIMClassDiagram 4PrimarySubjectAreas35Classes181Attributes9Associations28Generalizations 2020 4 6 2003HealthLevel7China 51 CoreconceptsoftheRIM EveryhappeningisanActProcedures observations medications supply registration etc ActsarerelatedthroughanAct relationshipcomposition preconditions revisions support etc ParticipationdefinesthecontextforanActauthor performer subject location etc TheparticipantsareRolespatient provider practitioner specimen employeeetc RolesareplayedbyEntitiespersons organizations material places devices etc 2020 4 6 2003HealthLevel7China 52 RIMCoreClasses Entity Participation Act ProcedureObservationPatientEnc nt rSubstanceAdmSupplyReferralFinancialactWorkinglistContract OrganizationLivingSubjectPersonMaterialPlace PatientEmployeeAssignedEntityCertifiedEntityGuarantorAccess Role 2020 4 6 2003HealthLevel7China 53 Entity Class CD CSCD CVDeterminer CD CSStatus CD CS Role Class CD CSCD CVEffective TMR IVL Participation Type CD CSTMR IVLStatus CD CS Act Class CD CSCD CDMood CD CSStatus CD CSActivity Time GTS 1 0 RIMCoreAttributeValueSets 1 0 plays validates 2020 4 6 2003HealthLevel7China 54 VocabularyDomainsandCodes EverycodedattributesintheRIMmustbeassociatedwithoneandonlyoneVocabularyDomainpriortobeingusedinamessage Avocabularyisadefinedsetofcodedconcepts whichmaybe specifiedasanenumeratedlistofcodedconcepts HL7defined areferencetoexternalconcepts e g SNOMED LOINC CPT 2020 4 6 2003HealthLevel7China 55 RefinementfromRIMtoMessage 2020 4 6 2003HealthLevel7China 56 DemoExample 2020 4 6 2003HealthLevel7China 57 DemoExample 2020 4 6 2003HealthLevel7China 58 MessagestructurefromRMIM 1 2020 4 6 2003HealthLevel7China 59 HierarchicalMessageDescription InformationModelMapping MessageStructure MessageElements Tieseveryelementofamessagedirectlytoaclass attributeorassociationintheReferenceInformationModel Providesthemessageprofilespecificationsforthedataelementsinthemessage EquivalenttopopulatingaV2 xAbstractMessageDefinitionwitheachoftherelevantSegmenttablesANDthenaddingthemessageprofilespecificationforwhichsegmentstouseand orrepeat andwhichcodedomainstouse 2020 4 6 2003HealthLevel7China 60 Howdomodelstomessages 2020 4 6 2003HealthLevel7China 61 Ourexampleschema 2020 4 6 2003HealthLevel7China 62 ImplementationTechnologySpecification V3goalistosupportdifferentITSlayersCharacterbasedinterfaces ER7XMLObjectBrokerTechnologyCORBAActive X DCOMOthersEDIFACTisapossibility 2020 4 6 2003HealthLevel7China 63 HL7概况 HL7V2 X HL7V3 0 HL7在PHIN的应用 主要内容 2020 4 6 2003HealthLevel7China 64 Cases contactsandexposuregroupsLaboratoryordersandresultsSyndromicandhealthindicatordataInterventionsEnvironmentaldataSpatialdataHealthalertsRecommendations PHIN的功能 2020 4 6 2003HealthLevel7China 65 ClinicalCaseDetectionandResponse StateandLocal PublicHealth Departments CentersFor DiseaseControl andPrevention CDC ClinicalSite Hospital Clinic PositiveresultreturnedtoclinicalsiteandforwardedtostateandCDC SpecimensenttoLaboratoryResponseNetworklabforconfirmation CasedatasenttoStateHealthDept andforwardedtoCDCwithrequestforassistance Lawenforcementnotified PatientpresentswithAnthraxsymptomsatclinicalsite Federalresponseentities Federalresponseentitiesnotified Responseteamsidentifysourceofexposure FieldInvestigationTeam Environmentalspecimenssenttolabwithreportbacktofieldteamandstate Fieldteamreportsfindingsbacktostateorlocalhealthdept andCDC Exposedindividualsidentified 2020 4 6 2003HealthLevel7China 66 PHIN FoodSafetyUSDA FDA ClinicalSectorLabs Caredelivery LawEnforcementFBI Local LaboratoryResponseUSDA FDA DOD PublicHealthLabs SurveillanceCDC StateHD LocalHD ResponseCDC StateHD LocalHD FederalAgencies PHIN与其他系统的关系 2020 4 6 2003HealthLevel7China 67 DetectionandMonitoringSyndromicsurveillanceHealthIndicatorsExistingsurveillanceforspecificagentsLaboratoryResponseNetwork LRN PHIN的功能 2020 4 6 2003HealthLevel7China 68 ResponseOutbreakmanagementsystemsDynamicinformationrequirementsConfigurableIntegratewithexistingactivitiesLaboratoryResponseNetworkClinicalcaredata PHIN的功能 2020 4 6 2003HealthLevel7China 69 HL7在PHIN的应用 Class PublicHealthCase CASE ApublichealthcaseisanObservationrepresentingaconditionoreventthathasaspecificsignificanceforpublichealth Itinvolvesaninstanceorinstancesofareportableinfectiousdiseaseorothercondition 2020 4 6 2003HealthLevel7China 70 Class PublicHealthCase CASE Thepublichealthcasecanincludeahealth relatedeventconcerningasingleindividualoritmayrefertomultiplehealth relatedeventsthatareoccurrencesofthesamediseaseorconditionofinteresttopublichealth HL7在PHIN的应用 2020 4 6 2003HealthLevel7China 71 Class PublicHealthCase CASE Apublichealthcasedefinitionincludesthedescriptionoftheclinical laboratory andepidemiologicindicatorsassociatedwithadiseaseorconditionofinteresttopublichealth HL7在PHIN的应用 2020 4 6 2003HealthLevel7China 72 HL7在PHIN的应用 Class PublicHealthCase CASE Apublichealthcasei