Health Level 7 (HL7)

Goal
Get a basic understanding of HL7
Messaging standard ,its structure and
use in the healthcare domain.
A Business Scenario

• Patient visits the hospital.

• He/she is registered.
• The doctor asks for a blood test.

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• The patient is registered in the Lab.
• Blood test is done and report is generated.
• The patient collects the lab report and shows it to his
or her doctor.
 Problem statement

• Patient admission system and lab

system are functioning
independently.

• They need to be integrated so that

they exchange data.
The Solution
• Patient admission system admits the patient.

• As soon as the physician advises the blood test the

patient admission system sends a message to the
lab system with the details of the patient.

•
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The lab system imports this message and processes
the details of the patient and creates a new patient
record in the system.

• This message is sent in a specific message format

 Information to be passed

Following information needs to be sent:

• Patient name
• Date of birth
• Address
• Problem and test to be carried out
• Insurance Information
Our own message format.
• Requirement:

System A System B

Admission System that

System Text messages records the
in a file Clinical test.
E.g.. Blood
test result
 Our own message format
• Important Elements of a message format:
• Starting and Ending.
• Sequence and Positioning.
• Delimiting. His
• Length of each data element.
 Our own message format
starting
$$&&PatientInfo&&patname=VijayChauhan***DOB=15
delimiters

*Jan*1980***Address=10JanpathNewDelhi***Zip=560
010***problem=generalCheckup&&InsuranceInfo***co
&
mpany=TAIG***plan=Nirvana***ID=123456&&$$
↓
Ending
delimiters
 Why disparate systems?

• *
Applications are often developed in need
based scenarios.
• &
Developed by different suppliers or in house
groups
• D
Applications address a specialized need and do
not solve the whole problem.
• &
Applications come bundled with equipments.
•
[ ⑨
Time frames and business considerations.
Ex software
. related
only to one device and unrelated to other devices
Why Standards ?

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 Why Standards ?
• Standards are controlled and universally
accepted.
• Standards are a result of research that aims at
providing a generic solution and areGrglobally
C
published.
• Promote tools, certifications and trainings and
products.
• Standards promote distributed development.
• Allow site variations.
 Goal of HL7
• “To provide standards for the exchange of data
among healthcare computer applications that
eliminate or substantially reduce the custom
interface programming and program
maintenance that may be otherwise required.”
• Such guidelines or data standards are a set of
rules that allow information to be shared and
processed in a uniform and consistent manner.
• These data standards are meant to allow healthcare
organizations to easily share clinical information.
• Theoretically, this ability to exchange information
should help to minimize the tendency for medical care
Common Information Systems in a
Hospital &Without HL7
some of them link
together and other are not

Pharmacy I3 Admission

Scheduling I5 Lab
I1 I4

Nutrition I2 Accounting
With HL7 · all systems connected together

Pharmacy Admission

Scheduling HL7 Lab

Nutrition Accounting
 HL7 Program used

translation
in

↑ HL7

System A Parser Parser System B

HL7

the format that we use it for communication

>

• HL7 standardizes only the communication

format between the applications(data
interchanges) and not the applications
-

themselves.
-
 The name HL7
8 - the 7 level of (150)

• HL7 stands for Health Level Seven.

• The term “Level 7” refers to the highest level of
the Open System Interconnection(OSI) model of
the International Organization for
Standardization (ISO)
• HL7 corresponds to the conceptual definition of
an application-to-application interface placed in
the seventh layer of the OSI model.
The Seven Layers Of OSI

③
Application
-
Function -
Presentation
- >

Session
Transport
④ -
Communication -
7
Network
-
Data Link
-
&

&

Physical
The seven layers of OSI
the highest layer

Application Layer : This is the level at which

-

applications access network services. This layer

represents the services that directly support
applications such as email, DB access and File
transfer application.
The name indicates that HL7 focuses on application
layer protocols for the health care domain,
independent of lower layers.
-

HL7 effectively considers all lower layers merely as tools

 The HL7 Organization
• A not-for-profit American standards
development organization
• Approx. 1700 members
• Working Meetings 3 + per year
• 13 international affiliates
• #Started in 1988
• Specs are adopted after involved balloting process.
 HL7 - An International Standard.
• Australia
• Canada
• China
• Finland
• Germany
• South Africa
• Japan
• South Korea
• The Netherlands
• New Zealand
• USA
• United Kingdom
• India
 HL7 Message basics
● Message is an atomic unit of data
transferred between systems.
● Each message is comprised of segments
in a defined sequence.
● Each segment is comprised of data
fields.
● The data fields are of a particular data
type.
 HL7 Message Composition
F1 F2 Segment .. Fn

Field F1 F2 Segment 2 Fn

Message F1 F2 Segment n…. Fn

Segment
HL7 Message basics
Message {
Segment { Fields….}
Segment {Fields….}
}
Which segments should comprise the message is
predefined in the HL7 specs.
The fields that should come together to form a particular
segment is also predefined in the HL7 specs.
The HL7 spec also defines the data types that form the
fields.
 5-segments

Segment Example
separate between the
field
·
go y
MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A0
1|MSG00001|P|2.4|<cr>
⑧
EVN|A01|198808181123||<cr>
G
PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JON
③S
ES^WILLIAM^A^III||196
10615|M||C|1200 N ELM STREET^^GREENSBORO^NC^27401-1020|GL|(91-
9)379-1212|
(919)2713434||S||PATID12345001^2^M10^ADT1^AN^A|123456789|987654^
NC|<cr>
8NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>
GPV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||||ADM|A0|
<cr>
 HL7 – Segments
• A segment is a logical grouping of data fields.
Segments of a message may be required or optional.
• They may occur only once or may be allowed to
repeat.
• Each segment is given a name and ID.
• The ID is a three character code as defined in the HL7
-

spec.
 HL7 – Segments
• E.g. of HL7 segments:

Message Header (MSH)

Event Type(EVN)
Patient ID (PID)
Patient Visit (PV1).
Diagnosis (DG1)
Insurance (IN1)
&10-9 -
Next of Kin (NK1)
 HL7 – Segments Example
Message header segment
sending sending Receiving
Receiving
application Facility (site) application facility (site) admission and discharge
I I ↓ ↓

MSH||STORE|MISSION|MIME|LAUREL|199801181007|security|ADT|MSGG0 -

0201|||<CR>
-
-
time
Date :
1998/1/18
10 : 07 am

Event type segment 10 : 05 Am >

-
the message sent after 2 minutes

EVN|01|199801181005||<CR> -

admission time

Patient ID segment
Patient ID
Gender
↑
name : John B .
Doe
Date
1947/7/1
of birth :

↑
:
caucasian
a

PID|||PATID1234567||Doe^John^B^II||19470701|m||c|371 MAIN AVE^SAN

c re a t e
- -

FRANCISCO^CA^94122-0619||415-681-2888||||||||<CR>
-
address

Next kin segment

NK1|Doe^Linda^E||wife|<CR>
-
name

Patient visit segment name

William
of the

K . Smith
doctor :

PV1|1|I|100^345^01||||00135^SMITH^WILLIAM^K||SUR|ADM|<CR>
F
- -

room
bed number

nursia
 Example Meaning
• The ADT message was sent from system STORE
at the MISSION site to system MIME at LAUREL
site on the same date two minutes after the admit
• Patient John B. Doe, II, male, Caucasian, born on
July 1, 1947, lives at 371 Main Avenue in San
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Francisco, was admitted on January 18, 1998, at
10:05 am.
• The next of kin is Linda E. Doe, wife.
• The patient has been assigned to Room 345 bed 01
on nursing unit 100 by Doctor William K. Smith
(#00135) for surgery.
 HL7 - Triggers
• Trigger is a real world event that creates the need for
data to flow amongst systems.

E.g. Patient is admitted in the patient administration

system.

Physician advises the patient to get a blood test

done.
 HL7 - Triggers
The trigger which initiated a particular message is
mentioned in the MSH segment. The MSH-9 field
indicates the trigger used.
MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY
|ADT^A01|MSG00001|P|2.4|<cr>

The MSH-9 is defined as

“type of Message(String)^trigger(String)” formula
=>

ADT is the type of message

L

admission
-

A01 is the trigger used to indicate the patient visit or admission.

-

Where do we get this information from ?

HL7 - Triggers
The various trigger events are documented in the HL7
spec in the HL70003 table.

Value Description
A01 Admit/Visit
from ward to another

A02 Transfer a patient

one

>
-

from department to other

A03 Discharge End Visit

……. ……..
O03 Diet Order
 HL7 – Message Types
• The HL7 spec contains the message types for most
possible message flows in a healthcare environment.
• The message type table enumerates the message type
code and the description for which a given message is to
be used.
HL7 – Message Control Segments.
The message control segments indicate the type of
message and the various meta data about the message
itself. not

tell
the information

something about
inside

the
the message

message

Following are the message control segments used

generally.
* MSH: Message header segment.

MSA: Message acknowledgment segment.

ERR: Error segment.
ADD: Addendum segment.
DSC: Discontinuation Pointer segment.
BHS: Batch header segment.
BTS: Batch Trailer segment.
 HL7 – MSH segment
• The MSH segment is the first segment in the
HL7 message. The MSH segment gives the
definition of the message and indicates data like
sending application and receiving application,
sending and receiving facility, date and time of
message, message Ids and control characters
used in the message.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT|AIIMSDelhi|19
8807181126|SECURE|ADT^A01|MSG00001|P|2.3|101|
|AL||IND||<cr>
HL7 – MSH segment
Message Control
MSH -1 Field Separator

The following segment indicates that the message

contains the “|” as the field separator.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
HL7 – MSH segment
Message Control
MSH –2 Encoding Characters

The following segment indicates that the

message contains the “^”,~,\ and & as
the encoding characters.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
HL7 – MSH segment
Message Control
MSH –3 Sending application software
>
MSH –5 Receiving application

The following segment indicates that the

message is sent from the ConnectX
application to the LABADT application.
Sending Receiving
application application

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
 HL7 – MSH segment
Message Control
MSH -4 Sending Facility
7 department ,
site

MSH –6 Receiving Facility

The following segment indicates that the message

is sent from the AIIMS Delhi facility to the
destination application in the AIIMS Delhi
facility.
sending
facility
MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
-

Receiving
facility

ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
HL7 – MSH segment
Message Control
MSH – 7 Date and Time of Message
The following segment indicates that the
message has been sent on 18 July 1988
at 11:26 A.M.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
Date time

|AIIMSDelhi|198807181126|SECURE|
-

ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
HL7 – MSH segment
Message Control
MSH – 8 Security.
The use of this segment is not yet specified. But can
be used to implement security features.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
 HL7 – MSH segment
Message Control
MSH – 9 Type of message.

This segment indicates that the

message is of type ADT and the
trigger is A01.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
-

ADT^A01|MSG00001|P|2.3|101||AL||
admit/ visit

IND||<cr>
HL7 – MSH segment
Message Control
3rd wil
MSH – 10 Message Control ID
&
-
5!
>
-
plon
-
.

n/
·sil's

The following segment indicates that the

message has a unique identifier
“MSG00001” in the sending application.
The receiving application must send
this ID back in the acknowledgement as
-

a correlation ID.
MSH|^~\&|ConnectX|AIIMSDelhi|LABADT|AIIMS
Delhi|198807181126|SECURE|ADT^A01|
MSG00001|P|2.3|101||AL||IND||<cr>
HL7 –Message Control
MSH - 11 Processing ID.

The following segment indicates that the

message is from a production system.
MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
The possible values are D,P and T
to indicate debug, production
and training resp.
HL7 – MSH segment
Message Control
MSH – 12 Version ID.

The following segment indicates that the

message follows the HL7 version 2.3.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
HL7 – MSH segment
Message Control
MSH – 13 Sequence Number >
- related to the application itself

The following segment indicates that the message

has a sequence number 101. The sequence
number is generated and sent by the sending -

application.
-

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT|AI
IMSDelhi|198807181126|SECURE|ADT^A0
1|MSG00001|P|2.3|101||AL||IND||<cr>
 HL7 – MSH segment
Message Control
MSH – 15 Acknowledgment Type
The following segment indicates that the
receiving application should send an
-
I
acknowledgment
acknowledgment message always.
that

nee
the is sende
message

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT
|AIIMSDelhi|198807181126|SECURE|
ADT^A01|MSG00001|P|2.3|101||AL||
IND||<cr>
Other possible values are: NE,SU,ER which
stand for never, success and error.
HL7 – MSH segment
Message Control
MSH – 17 Country Code.

The following segment indicates that the

message originated from India.

MSH|^~\&|ConnectX|AIIMSDelhi|LABADT|AI
IMSDelhi|198807181126|SECURE|ADT^A0
1|MSG00001|P|2.3|101||AL||IND||<cr>

<CR> Segment terminator

 Patient Administration - ADT
ADT stands for Admit Discharge and Transmit
message.

Types of ADT trigger events:

A01 - This trigger is used for admitting a
patient.
A03 -This trigger is used for discharging a
patient.
A08 - This trigger is used for updating a
patient information.
 Patient Admin ADT A01
• The ADT message of A01 type.
• An A01 event is sent as a result of a patient
undergoing the admission process which assigns the
patient to a bed. It signals the beginning of a patient’s
stay at the health care facility.
• The A01 event can be used to notify pharmacy,
nursing system, finance system, laboratory etc. all systems
in the hospital

• Each of these system can register the patient and start

providing services.
 Patient Admin ADT A01 Laboratory

Patient
Admission ADT Message

ADT Message

ADT Message

Billing

Nursing
ADT A01 required segments
Sr Segme Details
nt

1 MSH Contains the message details

2 EVN Contains the event details

real life details

3 PID Patient ID information

4 PV1 Patient Visit Information

The ADT information.
1)What is this message about ?
Ans: MSH

2) When and why was this message sent ?

Ans: EVN

3) This message is regarding whom?

Ans: PID

4) What are the details of the visit?

Ans: PV1
 Patient Admin ADT A01
th Example of ADT A01. Date : 1988/7/18

abouteage time : 11 : 26 Am nominiutes after the admission

Sending Receiving
sending Receiving
Y application application ↑
facility facility

~
MSH|^~\&|ADT1|MCM|LABADT|MCM|198807181126|SECURITY|ADT^A01|
- ~
version I

MSG00001|P|2.4|<cr>
-
T
admit/visit

unique identifier
about Production
-
event
EVN|A01|198807181123||<cr>
-
Date :
1988/7/18
admit/visit
time : 11 : 23 Am
Caucasian

Patient
male
↑
PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONE birth : 1961/6/15 -

S^WILLIAM^A^III||19610615|M||C|1200 N ELM
name :

William A Jonese

-
.
-

STREET^^GREENSBORO^NC^27401-1020|GL|(91-9)379-1212|
address (919)2713434||S||PATID12345001^2^M10^ADT1^AN^A|123456789|9876
-

54^NC|<cr>
Jones
name : BARBARA K .

NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>
- -

ebed
a
Room
PV1|1|I| 17NB^420^C^CommunityHospital^^N^6^Next to the ICU^
E
||||004777^LEBAUER^SIDNEY^J.|||SUR|<cr>
inpatient
-
-
name and #P of the doctor
Patient Admin ADT A01
Patient William A. Jones,III was admitted on July 18,
1988 at 11:23 a.m. by doctor Sidney J. Lebauer
(#004777) for surgery (SUR).
The patient is admitted as InPatient and has been
assigned the location 17 north block room no 420 bed
c at the community hospital, next to ICU.
The message was sent from system ADT1 at the
MCM site to system LABADT, also at the MCM site,
on the same date as the admission took place, but
three minutes after the admit.
Patient Discharge ADT A03 trigger

The ADT message of A03 type.

·
An A03 event signals the end of a patient’s stay at the
health care facility. It indicates that the patient’s
status has been changed to “discharged” and that a
discharge date has been recorded. Electronic medical record

·
The A03 event can be used to notify EMR system,
②
-

nursing system, finance system.

- -

1 2

Each of these system can change the patient status to

-

&

laboratory
discharged.
 Patient Discharge ADT A03
Patient
Discharge ADT A03 Message
EMR

ADT A03 Message

Billing