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Nov 30 2010   10:20AM GMT

Part 2: Exploring the impact of HL7 standards integration

Posted by: Jenny Laurello
Clinical integration, Compliance, Data standards, HL7

Part 2: Q&A with Eliot Muir, president, iNTERFACEWARE

Q. What’s different about HL7 version 3? How can healthcare providers prepare for the updated standards?

HL7 Version 2 was developed with the goal of standardizing and reducing the costs of building interfaces in healthcare. To expedite the adoption of these standards and to increase the number of users, clinical interface specialists and vendors tried to incorporate data fields and interface frameworks already in use. As a result, Version 2 was a set of loosely defined standards built in an ad hoc fashion but easy to conform to. Version 3 (V3) on the other hand was developed with a more ambitious goal of attempting to make a complete data model framework to try and achieve consistency across the whole message set. Additionally, V3 is XML based and therefore each message is significantly larger by one or two orders of magnitude compared with V2.

We’re still very much at the early adopter phase for V3 standards. Other than at the government level there really has not been much penetration of V3 standards into clinical environments.

Q. What are the benefits of HL7 integration versus web-based solutions?

Web-based solutions and HL7integration solutions are complementary. There are many innovative, smart health care solutions available in the market today that use the web platform for delivery and HL7 for integration.

The central systems of most hospitals run on their internal networks. They often use technology based on older Unix and mainframe platforms that already supports HL7 interfaces. To be competitive, vendors of web based solutions need to be savvy enough to integrate via HL7.

HL7 V2 is the most cost-effective way to integrate systems for these reasons:

  • HL7 provides more standardization and schema information than ad hoc interfaces based on web interfaces. A vendor with experience in HL7 integration and a good interface engine can typically build a fairly standard template that can map 90percent of the relevant data.
  • Interfaces that are not standard in comparison or are based in XML or JSON, do not have a common schema. As a result, every interface needs to be built from scratch making healthcare interfaces in ad hoc web based technology more expensive than HL7 based interfaces.
  • Combined with the fact that almost all major healthcare IT systems support HL7 standards, HL7 is the most cost effective way to integrate healthcare systems. In fact, for many important systems running on older mainframes and Unix platforms, integration using HL7 is the only way to get information out of these systems.

HL7 messages are typically sent unencrypted over TCP/IP using the LLP (Lower layer Protocol). This can be a minor speed bump. However, with cost effective VPN solutions from vendors like CISCO widely available, this is no longer a big challenge. In fact, this makes HL7 more interoperable than other protocols that require direct encryption as part of the protocol itself.

Q. Please discuss the impact of meaningful use and the push toward adoption of electronic medical records on HL7 integration?

Meaningful use will have a significant impact on HL7 integration.  As the discussions for Stage 2 and 3 requirements are well underway, it is clear that these next two stages will focus on infrastructure and interoperability.

With organizations scrambling to meet the requirements of meaningful use, HL7 integration is understandably on the minds of many EMR vendors and physician practices.  That’s good for the integration engine business since these vendors are going to be looking for interfacing solutions. However, the biggest concern centers around how these new participants will implement interface technology. As mentioned earlier, HL7 leaves a lot of room for personal interpretation. With so many EMR vendors flooding the market and promising to help customers meet the meaningful use requirements, there is always a risk that each vendor will handle HL7 differently. Thereby, more complexities will be introduced into the ecosystem of integrated healthcare systems.

From an integration standpoint, it is essential to ensure that these systems are equipped to deal with real-world integration challenges and improve future patient-care.

iNTERFACEWARE is a software provider committed to simplifying HL7 integration. More information about iNTERFACEWARE, can be found at:

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