Original Article

Healthc Inform Res. 2011 December;17(4):214-223.

http://dx.doi.org/10.4258/hir.2011.17.4.214
pISSN 2093-3681 • eISSN 2093-369X

The Development of a Graphical User Interface

Engine for the Convenient Use of the HL7 Version
2.x Interface Engine
Hwa Sun Kim, PhD1, Hune Cho, PhD2, In Keun Lee, PhD2
1
Department of Medical Information Technology, Daegu Haany University; 2Department of Medical Informatics, Kyungpook National University School of
Medicine, Daegu, Korea

Objectives: The Health Level Seven Interface Engine (HL7 IE), developed by Kyungpook National University, has been em-
ployed in health information systems, however users without a background in programming have reported difficulties in
using it. Therefore, we developed a graphical user interface (GUI) engine to make the use of the HL7 IE more convenient.
Methods: The GUI engine was directly connected with the HL7 IE to handle the HL7 version 2.x messages. Furthermore,
the information exchange rules (called the mapping data), represented by a conceptual graph in the GUI engine, were trans-
formed into program objects that were made available to the HL7 IE; the mapping data were stored as binary files for reuse.
The usefulness of the GUI engine was examined through information exchange tests between an HL7 version 2.x message
and a health information database system. Results: Users could easily create HL7 version 2.x messages by creating a concep-
tual graph through the GUI engine without requiring assistance from programmers. In addition, time could be saved when
creating new information exchange rules by reusing the stored mapping data. Conclusions: The GUI engine was not able to
incorporate information types (e.g., extensible markup language, XML) other than the HL7 version 2.x messages and the da-
tabase, because it was designed exclusively for the HL7 IE protocol. However, in future work, by including additional parsers
to manage XML-based information such as Continuity of Care Documents (CCD) and Continuity of Care Records (CCR),
we plan to ensure that the GUI engine will be more widely accessible for the health field.

Keywords: Health Level Seven, Medical Informatics, Computer Graphics, Software Design

Submitted: August 31, 2011 I. Introduction

Revised: September 16, 2011
Accepted: October 11, 2011 Efforts to computerize health information have led to the
Corresponding Author development of various health information systems that are
In Keun Lee, PhD used in many facilities including hospitals [1-5]. However,
Department of Medical Informatics, Kyungpook National University, the information structures (e.g., database design and data
Samdeok-dong 2-ga, Jung-gu, Daegu 700-721, Korea. Tel: +82-53-
structure) used by multiple health information systems are
420-4896, Fax: +82-53-423-1242, E-mail: inkeunlee@gmail.com
not necessarily exchangeable. For guaranteeing interopera-
This is an Open Access article distributed under the terms of the Creative Com- bility between health information systems, various standards
mons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduc- for interoperability have been developed, such as Health
tion in any medium, provided the original work is properly cited.
Level Seven (HL7) [6], Digital Imaging and Communica-
ⓒ 2011 The Korean Society of Medical Informatics tions in Medicine (DICOM) [7], Clinical Document Archi-
 GUI-based HL7 Interface Engine

tecture (CDA) [8], Continuity of Care Document (CCD) [9], use for parsing and creation of HL7 messages. However,
and Continuity of Care Record (CCR) [10]. Despite that the commercial GUI engines connected with commercial HL7
structure of health information is different, health informa- interface engines prevent users from utilizing another parser,
tion systems can exchange information by transforming the because these engines use self-developed parsers for HL7
information according to common standards [5,11]. and extensible markup language (XML). This makes it very
HL7 is the leading international standard for exchang- difficult to connect a specific HL7 parser with a commercial
ing health information, and many facilities are using HL7 GUI engine without analyzing the commercial GUI engine
in their health information systems through HL7 interface or negotiating with companies supplying the software. Thus,
engines [12-16] developed by various research facilities and even though some non-commercial HL7 interface engines
companies. While HL7 interface engines are useful for pars- such as HAPI [12] have been released as open source tech-
ing and creation of HL7 messages, computer programmers nology with powerful parsers for HL7 messages, HL7 inter-
are required for practical operation of the HL7 interface en- face engines without GUIs are not suitable for users without
gine and for connecting it with health information systems. programming knowledge.
However, it is unreasonable to request assistance from a pro- Unlike commercial programs, the HL7 version 2.x Mes-
grammer whenever it is necessary to create or modify HL7 sage Interface Engine developed in Kyungpook National
messages. The connection module between an HL7 interface University [13] (we refer to it as “HL7 IE” to distinguish it
engine and a health information system may be modified by from general HL7 Interface Engines) did not provide a GUI.
a small alteration of a rule or system in the facility and a new Therefore, it is desirable to realize convenient use of HL7
connection module would accordingly have to be developed IE by connecting a GUI engine that is accessible to non-
according to the healthcare provider's needs. However, the programmer users. However, it should be noted that it is
speed of developing a connection module may be subject to difficult to develop a GUI engine that is compatible with all
the availability of a computer programmer. If there is a lack parsers developed by other parties.
of understanding between a healthcare provider and a com- The purpose of this study was to develop a GUI engine that
puter programmer, more time is needed. provides a convenient interface between users and HL7 IE
Some commercial solutions have been developed to ad- (we hereafter refer to the HL7 IE combined with the GUI
dress these problems, including Symphonia from Orion [14], engine as “GUI-based HL7 IE”). The usefulness of the GUI
Iguana from Interfaceware [15], and Mapforce from Altova engine was confirmed through an evaluation that demon-
[16]. These solutions minimize programmer intervention strated the simplicity of producing a health information ex-
when healthcare providers try to process HL7 messages by change model based on HL7 messages.
providing a graphical user interface (GUI) that is easy to

Figure 1. Graphical user interface (GUI)-based HL7 version 2.x interface engine architecture. HL7 IE: Health Level Seven Interface En-
gine, HIS: Health Information System, JDBC: Java database connectivity.

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Hwa Sun Kim et al

II. Methods 2) Design of the GUI

We designed a GUI to represent information items as graphs
1. Development of the GUI Engine and trees that allow the creation of mapping data linking
two fields using a mouse interface. Mapping data are created
1) Architecture of the GUI engine by designing graphs with lines and information items. They
The primary role of the GUI engine is to provide an easy should then be stored as program objects that computer
way to handle HL7 messages based on HL7 IE and health software can process. Thus, we designed the “Field Mapper”
information database systems. Therefore, as shown in Figure 1, by dividing objects into the following two classes, as shown
the GUI engine is connected with HL7 IE and the database in Figure 2: objects for graphic representation and objects
of a health information system to handle HL7 messages for mapping data. Figure 2 shows that “NodeBean” is used to
and database information, respectively. By using the GUI represent the field and “TreeBean” is the structure of a tree
engine, the user requires no understanding of the structure containing “NodeBean” objects. “InstanceBean” indicates an
or program code of HL7 IE. As such, the user only needs to object in the “TreeBean” and “ItemBean,” while the object
understand the structure of each information item (e.g., the “ItemBean” indicates the type of information item. “Linkage-
HL7 message structure or the table design of the relational Bean” is used to represent a link between two objects in “No-
database) when making rules for health information ex- deBean.” All objects are part of an object called “Mapping-
change between fields, which is accomplished using a graph DataBean” that facilitates easy handling of mapping results.
via the GUI of the “Field Mapper.” Here, we refer to columns The “MappingDataBean” object is used to manage the task
of the table in a relational database or the primitive data type of mapping data creation. To support the graphical creation
of the HL7 message structure as “fields,” and the rules of ex- of mapping data using the GUI, all information structures,
change between fields as “mapping data.” The mapping data linkage information, and the entire mapping task can be
are transformed into program objects using the “Field Map- represented graphically by using the “InstancePane,” “Link-
per” and the objects are processed by a “Data Translator,” agePane,” and “DesignPane,” respectively. The “InstancePane”
which translates the input data into the required output data. is used to draw the structure of information items including
“Parsers” and “Composers” are used to parse and compose fields and the “LinkagePane” is used to draw the lines linking
various types of data, such as Text, File, Network (Socket), fields. Individual designs are gathered in the “DesignPane.”
and Database, for each information item. In the case of a All classes are implemented using a “Serializable” Java inter-
HL7 message, in particular, HL7 IE performs parsing and face class allowing objects to be stored as a binary file.
creation of the HL7 message, and Java database connectivity
(JDBC) is used to connect with database. The mapping data 3) Representation of information items
can also be stored and reused at a different location/time The GUI engine deals with the following four types of infor-
from that where the GUI-based HL7 IE is installed. mation items: items related to input and output (I/O) that
are used to designate the type of I/O; items to represent the

Figure 2. Class diagram of graphical user interface (GUI) engine showing the field mapper and its graphical representation.

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 GUI-based HL7 Interface Engine

HL7 message types; items that represent database tables con- HL7 message creation using pre-defined data for “NodeBean”
nected to the GUI engine; and items related to functions for objects. The operations of item classes in the “ItemMaker_
transforming and creating data during field mapping. In Fig- Database” group execute the defined SQL queries, i.e., the
ure 3, the important role of “ItemBean” is to provide opera- “decode” operation of the item classes conducts the search of
tions (Java methods) such as “encode” and “decode” that are a specific database, while the “encode” operation performs
used to parse and compose health information. The details of tasks related to the database, such as inserting, updating,
operations are defined for each item class inherited from the and removing records. Groups and items can be represented
“ItemBean” class by overriding the operations. For example, graphically via the “ItemPanel” and new item groups or
the “decode” operation of item classes in the “ItemMaker_ items can be added to the GUI engine using the “ItemPanel.”
HL7_2_5” group performs parsing of an inputted HL7 mes-
sage, while the “encode” operation of item classes performs 4) Connection with the HL7 Version 2.x Interface Engine
Figure 4 shows the partial class structure of the HL7 IE for
the ADT_A01 message represented in Figure 5. Although
the properties of the MSH segment are “required” and “un-
repeatable” in the HL7 standard, HL7 IE designed the “ADT_
A01” object to have plural objects in “MSH,” providing a
consistent program structure. However, cardinality can be
limited by the properties of the MSH segment. “ADT_A01_
INSURANCE” class indicates a group containing segments
defined as “[{IN1 [IN2] [{IN3}] [{ROL}]}].” It is convenient
to manage these segments as a group, because the properties
of all segments in the group are “optional” and “repeatable.”
Here, the symbols “[]” and “{}” indicate the “optional” prop-
erty and the “repeatable” property, respectively.
The structure of classes related to HL7 messages in the GUI
engine also replicates that found in HL7 IE, as shown in
Figure 6. Classes in the GUI engine are directly connected
with those in HL7 IE, allowing effective parsing and creation
of HL7 messages. In the case of HL7 IE, “ADT_A01” class
was classified in the “Message” group, as shown in Figure 4.
However, in the case of the GUI engine, as shown in Figures
3 and 6, the “ADT_A01” class was classified in the “ItemBean”
group, because various information items such as “Database”,
“I/O”, “Functions”, and “HL7 2.x (messages)” are classified in
Figure 3. Class diagram of information items. the same manner in order to maintain the consistency and

Figure 4. Partial class diagram of the

Health Level Seven (HL7)
interface engine.

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Hwa Sun Kim et al

the extensibility of the program. after parsing the transmitted HL7 message, and it transmits
a response message to the transmitter side of the SeniCare
2. Examination of the GUI Engine system. Although the health information systems (SeniCare)
We simulated information exchange between health infor- used in the simulation were identical, we regarded them as
mation systems (SeniCare, as designed by Kim et al. [1]) different systems because they were operated independently
using the GUI engine, as shown in Figure 7. In the simula- of each other. We assumed the following scenario when pro-
tion, a GUI-based HL7 IE transmits a message through the ducing an HL7 message in the simulation: “There was a new
network after creating an HL7 message based on the Seni- addition to the SeniCare new allergy information relating
Care database on the transmitter side. Another GUI-based to ‘Penicillin’ for an outpatient named ‘Alice Smith’ born in
HL7 IE updates the SeniCare database on the receiver side 1953, and we need to send the information to the Kyung-

Figure 5. Example of Health Level

Seven (HL7) message struc-
ture.

Figure 6. Connection of the graphical user interface (GUI) engine with the Health Level Seven (HL7) interface engine.

218 www.e-hir.org http://dx.doi.org/10.4258/hir.2011.17.4.214

 GUI-based HL7 Interface Engine

Figure 7. Model of health information exchange using the graphical user interface (GUI) engines. HL7: Health Level Seven, IE: inter-
face engine.

perform basic functions such as saving and loading mapping

data, connecting to a database, and starting and finishing the
exchange process; 2) a design panel to create mapping data
via graphical inputs. Linkage information between fields is
represented using lines, while the structure of information
items is represented as a tree in this panel. Users can create
linkage information with a mouse interface by linking two
small squares (representing fields) on different large squares
(representing information items). Moreover, users can con-
firm in each field of the tree more detailed information such
as parsed data of HL7 messages and records of a table in the
Figure 8. Snapshot of the graphical user interface (GUI) engine. connected database. For example, a patient’s given name,
“WILLIAM,” is shown below the field “XPN-1” belonging to
the “ADT_A01” item tree in Figure 8; 3) an information item
pook National University Hospital (KNUH) facility.” To rep- panel. For example, if the input data of the HL7 message is
resent this sequence, the GUI engine on the transmitter side ADT_A01, the ADT_A01 item can be added to panel ② by
creates an ADT_A60 message representing “update adverse choosing it in panel ③; and ④ an information panel show-
reaction information” and it requests an update of the Seni- ing input and output messages, the progress of the exchange
Care database in KNUH by transmitting a message to the process, and the status of the GUI engine. The GUI-based
receiver side of SeniCare. HL7 IE was designed as a standalone system, as shown in
Furthermore, we conducted some tests creating four HL7 Figure 8, but it could also be used as a module in a system
messages (ADT_A60, ADT_A01, ADT_A49, RQI_I01) by developed in Java programming language.
creating mapping data using the GUI engine and by devel-
oping Java application programs based on the HL7 IE with 2. Examination of the GUI Engine
the help of two participants, a computer programmer and a
non-programmer. The non-programmer who created map- 1) Creation and treatment of HL7 messages using GUI engine
ping data had considerable experience in use of the GUI We used the GUI-based HL7 IE to handle HL7 messages and
engine, and the programmer who developed the application to update the SeniCare database according to the scenario.
programs was familiar with HL7 IE. And we confirmed the The details are as follows.
usefulness of the GUI engine by comparing records measuring Figure 9A shows that HL7 messages are created by the “HL7
the time spent creating the four HL7 messages in both ways. Encoder” based on data in the SeniCare database and user-
inserted data. When the format of the data from the database
III. Results is different from that of the HL7 message, the data are trans-
formed to the correct format for the HL7 message by “Func-
1. Development of the GUI Engine tion” items provided in the GUI engine. The created HL7
Figure 8 shows a snapshot of the developed GUI engine. The message is transmitted through the TCP/IP network. Figure
GUI engine consists of four parts based on their function, 9B shows an example of mapping data that implement the
as follows: 1) a control panel containing shortcut buttons to model in Figure 9A using the “Field Mapper” of the GUI

Vol. 17 • No. 4 • December 2011 www.e-hir.org 219

Hwa Sun Kim et al

Figure 9. (A) Conceptual model of

trans­mitter-side activities.
(B) Exchange model de-
signed using the graphical
user interface (GUI) engine
to create an ADT_A60 HL7
message. HL7: Health Level
Seven.

engine. Figure 9B shows the following: ⓐ input data type to MSH|^~\&|SeniCare|MIPTH|SeniCare|KNUH|20110818121005||

connect with the SeniCare database; ⓑ and ⓓ show groups ADT^A60^ADT_A60|316900860228771072|P|2.4
for extracting information on patients and physicians to be EVN||20110818121005
used to create ADT_A60 message; ⓒ shows the use of func- PID||17|||Smith^Alice||19530101|M
tions provided by the GUI engine for transforming the data PV1||O
format of the database to the HL7 message format. For ex- IAM|1|DA|^Penicillin|SV|rush on back|A|||AL||20110818||201108
ample, the representation of the gender of a patient is “1” for 18121005|||||1^Martinson^Frederic^T^^^MD
a male and “0” for a female in the database, whereas “M” and
“F” are used for male and female in HL7 messages. There- The HL7 message is transmitted through the network and
fore, the gender value should be transformed from “1” to parsed by the “HL7 Decoder,” as shown in Figure 10A. The
“M” and from “0” to “F” so that the user can define the role parsing data are used to update the SeniCare database on
of the function “Equals” to return the value “M” if the input the receiver side. A response message is created and trans-
data equals “1”; and otherwise “F.” Additional data absent mitted to the transmitter side after updating the database.
from the database can be inserted directly using the func- Figure 10B shows a detailed example of the conceptual de-
tion “User Text” indicated in ⓕ. Additional data can also be sign of Figure 10A. ⓗ shows that the GUI engine receives a
placed in ⓔ directly. However, it may be better to use ⓕ for message through the network. The role of ⓘ is to parse the
more convenient reuse of the mapping data, because han- transmitted HL7 message and to display the parsed data as
dling a complex HL7 message structure is difficult whenever a tree structure. The role of group ⓙ is to find the record
mapping data are reused. These data are used as sources for in the database that needs to be updated based on the input
creating ADT_A60 messages by linking with the ADT_A60 information related to a patient named “Alice Smith”, by se-
fields indicated in ⓔ. ⓖ shows the output data types, where quentially connecting the fields of the tables in the database.
the created HL7 message is transmitted through the network In ⓚ, the selected record is updated in ⓝ by integrating the
and printed as text. The created HL7 message for ADT_A60 transmitted information related to the allergy. Functions
shown as follows: such as “Union” and “Equals” are also used to transform the

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 GUI-based HL7 Interface Engine

input data to a specific symbol (e.g., “A” denotes “addition” MSH|^~\&|SeniCare|KNUH|SeniCare|MIPTH|20110818121006||

and “D” denotes “deletion”), according to the “Allergy Action ACK|316900860228771072|P|2.4
Code” in the structure of the IAM segment of the HL7 mes- MSA|AA|316900860228771072
sage. For example, if the “Allergy Action Code” is “A”, then
the record in the “chartcontent” table of the database should 2) Evaluation of the Usefulness of the GUI engine
be updated by integrating the transmitted allergy informa- We created four mapping data using the GUI engine and
tion with the previously stored allergy data in the database. developed four Java application programs to create the four
The role of ⓜ is to create a response message informing the HL7 messages. Table 1 represents the time recorded when
transmitter side of SeniCare that the receiver side of Seni- the mapping data were created by a non-programmer and
Care received the message. The response message created by when the programs were developed by a programmer. The
ⓜ is as follows: recorded time includes the verification time of the created

Figure 10. (A) Conceptual model of re-

ceiver-side activities. (B) An
exchange model designed
by the graphical user inter-
face (GUI) engine to update
the SeniCare database and
create a response message.

Table 1. Time recorded upon creation of mapping data using the GUI engine and development of Java application program using HL7 IE

[A] Creation of [B] Development of Difference Ratio

Order HL7 message
mapping data (min) Java application program (min) [B]-[A] (min) [A]/[B]
1 ADT_A60 24 86 62 3.58
2 ADT_A01 18 42 24 2.33
3 ADT_A41 15 28 13 1.86
4 RQI_I01 12 36 24 3
Average 17.25 48 30.75 2.78
HL7: Health Level Seven, GUI: graphical user interface.

Vol. 17 • No. 4 • December 2011 www.e-hir.org 221

Hwa Sun Kim et al

HL7 messages. might currently be better than that of the GUI engine, but
In terms of creation time of HL7 messages, as shown in we will update the functions of the GUI engine and confirm
Table 1, we found that the creation of HL7 messages by us- its usability based on continuous user feedback. The HL7
ing the GUI engine was faster than that by developing Java message parser in HL7 IE covers HL7 versions 2.1 to 2.5, and
application programs. Comparing the results of the first test hence the GUI engine can also deal with those versions of
and those of the other tests, the time was shortened as the items. We will update the items after developing newer ver-
tests continued, because the creation time could be saved by sions of the parsers, i.e., HL7 versions 2.6 and 2.7. In future
reusing the mapping data and the program that was made in research, we will include additional parsers to manage XML-
the first test. However, we found that creating HL7 messages based information such as CCR and CCD.
by developing java application programs involved almost 3
times longer time than that by using the GUI engine. From Conflict of Interest
the test results, we could conclude that the GUI engine pro-
vides a convenient and useful way to create HL7 messages No potential conflict of interest relevant to this article was
rather than direct use of HL7 IE. reported.

IV. Discussion Acknowledgements

We developed a GUI engine for convenient use of HL7 IE, This work was supported by the R&D Program of MKE/
developed in Kyungpook National University [13], as HL7 KEIT (KI10033576).
IE was released as a Java library that can only be used by Java
programmers. The GUI engine that was developed in this References
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