hl7及其在公共卫生信息系统

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2023/7/1@2003HealthLevel7China2◆HL7概况

◆HL7V2.X

◆HL7V3.0

◆HL7在PHIN的应用主要内容2023/7/1@2003HealthLevel7China3◆HealthLevelSeven(HL7)1987年成立

◆美国国家标准局〔ANSI〕授权的从事医疗效劳信息传输协议及标准研究和开发的机构

HL7概况2023/7/1@2003HealthLevel7China4HL7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本钱

▲提高卫生信息系统之间数据信息共享的程度HL7概况2023/7/1@2003HealthLevel7China5*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开展趋势。HL7的影响力

2023/7/1@2003HealthLevel7China621InternationalHL7Affiliates:

•Argentina •Australia•Brazil •Canada •China •Croatia

•CzechRepublic•Denmark

•Finland •Germany •

India •Japan •Korea •Lithuania •NewZealand •SouthernAfrica •Switzerland •Taiwan •Turkey •TheNetherlands •UnitedKingdomHL7isInternational!26•USA2023/7/1@2003HealthLevel7China7◆PAYERS

◆GENERALINTEREST

◆PROVIDERS

◆CONSULTANTS

◆VENDORSHL7会员2023/7/1@2003HealthLevel7China8PAYERS

BlueCross&BlueShied,UnitedHealthGroup,VytraHealthPlans,etc.

GENERALINTEREST

AMA,AHA,JCAHO,CDC,NCHS,PanAm.HealthOrganization/WHO,U.S.Dept.ofDefense—HealthAffairs,U.S.Dept.ofHealth&HumanService.

HL7会员2023/7/1@2003HealthLevel7China9PROVIDERS

JohnHopkinsHospital,BaptistHealthSystem,U.S.Dept.ofVeteransAffairs,etc.

CONSULTANTS

Ernst&YoungLLP,GartnerGroup,etc.

VENDORS

IBM,SUN,IDX,HP,NEC,Microsoft,3M,SMS,etc.

HL7会员2023/7/1@2003HealthLevel7China10HL7的应用GetyourhealthinformationAny-time,Any-where,Any-device.2023/7/1@2003HealthLevel7China111.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2023/7/1@2003HealthLevel7China121.HL7’sMessagingStandard

2.ArdenSyntaxforMedicalLogic

Systems

3.ClinicalContextObject

Workgroup(CCOW)

4.ClinicalDocumentArchitecture

(CDA)HL7研究的标准2023/7/1@2003HealthLevel7China13HL7’sMessagingStandard：

2.21994年2月公布(ANSI)

2.31997年5月公布(ANSI)

2.3.11999年4月公布(ANSI)

2.42000年10月公布(ANSI)

2.52003年8月公布(ANSI)

2.6研制中

3.02004年3月局部(ANSI)HL7研究的标准及其进展2023/7/1@2003HealthLevel7China14与相关标准的合作

DICOM、XML、IEEE(X12N)、ASTM(E31)

SNOMED、ICD、LOINC、CPT、NDC

CENTC251、ISO2152023/7/1@2003HealthLevel7China15ISO-OSI网络体系结构模型1 物理

Physical2 链路DataLink3 网络Network4 传输TransportCommunication5 会话Session6 表示Presentation7 应用ApplicationFunctionHL7

HL7

与网络体系结构及协议的关系2023/7/1@2003HealthLevel7China16HL7与OSI的关系链路

DataLink物理

Physical传输

Transport网络

Network表示

Presentation会话

Session应用

ApplicationFTPHTTPPOP3….TCPUDPIPLLC;MACSMTP实体线路HealthLevelSeven(HL7)2023/7/1@2003HealthLevel7China17◆HL7概况

◆HL7V2.X

◆HL7V3.0

◆HL7在PHIN的应用主要内容2023/7/1@2003HealthLevel7China18AnHL7Version2.XSpecCommonSpecsChapter-SpecificSpecsChapter-SpecificSpecsChapter-SpecificSpecsChapters2and8Chapters

3,4,6,...TriggerEventandMessagesSegmentsandFields2023/7/1@2003HealthLevel7China19HL7标准涵盖的内容GeneralIntroduction(Chapter1)MessageInfrastructure(Ch.2)GeneralconventionsDataTypesMessageConstructionRulesPatientAdministration(Ch.3)62PatientAdministrationtransactions238patient-relateddataitems2023/7/1@2003HealthLevel7China20Orders&Observations(Ch.4&7)DiagnosticServices(Lab,Radiology,etc.)MedicationsandDrugsTreatmentsClinicaltrialsDietarySupplyQueries(Ch.5)Queries&ResponsesHL7标准涵盖的内容2023/7/1@2003HealthLevel7China21FinancialManagement(Ch.6)basicservicebillingmessagese-claimsManagementofMasterFiles/Tables(Ch.8)PatientsProvidersLocationsClinicalDocumentManagement(Ch.9)HL7标准涵盖的内容2023/7/1@2003HealthLevel7China22SchedulingofMedicalServices(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2023/7/1@2003HealthLevel7China23HL7消息模型ConvertsandsendsinHL7ReceivesinHL72023/7/1@2003HealthLevel7China24HL7消息传输格式MessageSegmentField2023/7/1@2003HealthLevel7China25消息〔Message〕：

▲消息是数据在系统之间交换的根本单元，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

▲消息由假设干个消息段组成。HL7消息传输格式2023/7/1@2003HealthLevel7China26V2.4Message-ADTMSH MessageHeaderEVN EventTypePID PatientIdentification[PD1] AdditionalDemographics[{NK1}] NextofKin/AssociatedPartiesPV1 PatientVisit[PV2] PatientVisit-AdditionalInfo. …[{GT1}] Guarantor[{IN1 Insurance[IN2] InsuranceAdditionalInfo.[IN3] InsuranceAdd'lInfo-Cert.}] …[]optional{}mayrepeat2023/7/1@2003HealthLevel7China27AHL7V2.4AdmitMessageMSH|^~\&|PATH||GP123||200108261705+1100||A04|101|P|2.4|34567||AL|NE|AU||en<cr>EVN|A01|200108261645+1100|<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>NK1|1|Knees^Barbara^K|Wife||||CP^Contactperson|<cr>PV1|1|I|2000^2021^01|E||||004777^Getwell^Sara^J||TRMA||||ADM|A0|<cr>2023/7/1@2003HealthLevel7China28消息段〔Segment〕：

▲由一组数据字段〔Datafield〕按一定顺序和规那么组成，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2023/7/1@2003HealthLevel7China29AHL7V2.4SegmentMSH|^~\&|PATH||GP123||200108261705+1100||A04|101|P|2.4|34567||AL|NE|AU||en<cr>EVN|A01|200108261645+1100|<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>NK1|1|Knees^Barbara^K|Wife||||CP^Contactperson|<cr>PV1|1|I|2000^2021^01|E||||004777^Getwell^Sara^J||TRMA||||ADM|A0|<cr>2023/7/1@2003HealthLevel7China30HL7V2.4MSHSegment定义SEQ-positionwithinsegmentLEN-lengthoffieldDT-datatypeforfieldOPT-optionalityforfieldRP/#-repeatabilityTBL#-tablenumberforcodesITEM#-HL7fieldnumberELEMENTNAME-name2023/7/1@2003HealthLevel7China31Segments...MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>2023/7/1@2003HealthLevel7China32Segments...MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>2023/7/1@2003HealthLevel7China33Segments...MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>2023/7/1@2003HealthLevel7China34Segments...MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>2023/7/1@2003HealthLevel7China35Segments...MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>2023/7/1@2003HealthLevel7China36MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>RepeatedSegments...2023/7/1@2003HealthLevel7China37MSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>OBR|1|PMS66666|956635.9|LFT^LIVERFUNCTIONTEST^N2270<cr>OBX|1|NM|1751-7^SAlbumin^LN||38|g/L|35-45||||F<cr>OBX|2|NM|1779-8^SAlkalinePhosphatase^LN||52|U/L|30-120||||F<cr>RepeatedSegments...2023/7/1@2003HealthLevel7China38

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2023/7/1@2003HealthLevel7China39NK1|1|Knees^Barbara^K|Wife||||CP^Contactperson|<cr>PV1|1|I|2000^2021^01|E||||004777^Getwell^Sara^J||TRMA||||ADM|A0|<cr>Let’slookat“Fields〞...IDNameSexStreetAddressTown/SuburbDOBMSH|^~\&|PATH||GP123||20000826||ORU|101|P|2.4|34567||AL|NE|AU||en<cr>PID|||KNEE123||Knees^Nobby^J^^Mr||19331215|M|||23ShadyLane^

LIGHTNINGRIDGE^NSW^2392||||||||219171803<cr>2023/7/1@2003HealthLevel7China40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2023/7/1@2003HealthLevel7China410100DOndischarge0100OOnreceiptoforder0100RAttimeserviceiscompleted0100SAttimeserviceisstarted0100TAtadesignateddate/time表0100HL7WhentoCharge2023/7/1@2003HealthLevel7China42表0116UserBedStatus0116CClosed0116HHousekeeping0116IIsolated0116KContaminated0116OOccupied0116UUnoccupied2023/7/1@2003HealthLevel7China43HL7-enabledsystemReceiverDataHowdoesHL7Messagingwork?NetworkHL7-enabledsystemSenderDataHL7MessageCreationEncodingHL7MessageParsingEncodingHL7V2.xStandardHL7V2.xStandard2023/7/1@2003HealthLevel7China44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2023/7/1@2003HealthLevel7China45HL7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、平安存储确实认发送系统接收系统2023/7/1@2003HealthLevel7China46◆HL7概况

◆HL7V2.X

◆HL7V3.0

◆HL7在PHIN的应用主要内容2023/7/1@2003HealthLevel7China47HL7Version3HL7Version3isa"family"ReferenceInformationModel(RIM)VocabularySpecificationsDefinedMethodology2023/7/1@2003HealthLevel7China48AnHL7Version3.XSpecCommonSpecsChapter-SpecificSpecsUseCaseModelInformationModelMessageModel2-ndOrder1choiceof0-nDrug0-1NursingImplementableMessageSpecificationEDIFACT**FutureConsiderationImplementableMessageSpecificationOLE/CORBAImplementableMessageSpecificationASN.1/ER7HL7ReferenceModelInteractionModel2023/7/1@2003HealthLevel7China49SubjectArea:amajorpartitionofa

informationmodel.Class: somethingaboutwhich

informationiscollected.Relationship: anaffiliationbetween instancesoftwoclasses.Attribute: informationaboutaclass.DataType: aspecificationoftheformat

ofanattribute.SubjectAreaClassAttribute::DatatypeAttribute::DatatypeAttribute::DatatypeAttribute::DatatypeClassAttribute::DatatypeAttribute::DatatypeAttribute::DatatypeAttribute::DatatypeRelationshipInformationModelComponents2023/7/1@2003HealthLevel7China50RoleEntityParticipationActsNormativeRIMClassDiagram

4 PrimarySubjectAreas35 Classes181 Attributes9 Associations28 Generalizations2023/7/1@2003HealthLevel7China51

CoreconceptsoftheRIMEveryhappeningisanActProcedures,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.2023/7/1@2003HealthLevel7China5210..*plays10..*scopes0..*10..*1RIMCoreClassesEntityParticipationActRole

Link0..*0..*11ActRelationship110..*0..*ProcedureObservationPatientEnc’nt’rSubstanceAdmSupplyReferralFinancialact

Workinglist

ContractOrganizationLivingSubjectPersonMaterialPlace PatientEmployeeAssignedEntity

CertifiedEntity

Guarantor

AccessRole2023/7/1@2003HealthLevel7China53EntityClass_CD:CSCD:CVDeterminer_CD:CSStatus_CD:CSRoleClass_CD:CSCD:CVEffective_TMR:IVL<TS>ParticipationType_CD:CSTMR:IVL<TS>Status_CD:CSActClass_CD:CSCD:CDMood_CD:CSStatus_CD:CSActivity_Time:GTS10..*10..*10..*RIMCoreAttributeValueSetsEntityClassCodeLivingSubjectPersonOrganizationMaterialPlace...RoleClassCodePatientEmployeeAssignedEntityCertifiedEntityGuarantor...ParticipationTypeCodePerformerAuthorWitnessSubjectDestination...ActMoodCodeDefinitionIntentOrderEventCriterion...ActClassCodeObservationProcedureSupplySubstanceAdmFinancial...EntityDeterminerCodeKindInstance(Qualified

Group)10..*playsvalidates2023/7/1@2003HealthLevel7China54VocabularyDomainsandCodesEverycodedattributesintheRIMmustbeassociatedwithoneandonlyoneVocabularyDomainpriortobeingusedinamessage.Avocabularyisadefinedsetofcodedconcepts,whichmaybe:specifiedasanenumeratedlistofcodedconcepts(HL7defined)areferencetoexternalconcepts(e.g.,SNOMED,LOINC,CPT,..).2023/7/1@2003HealthLevel7China55RefinementfromRIMtoMessage2023/7/1@2003HealthLevel7China56DemoExampleOrderPhysicianPerformerLaboratorySubjectSpecimenRecordtargetPatientDefinitionOrderedTestAuthor2023/7/1@2003HealthLevel7China57DemoExampleOrderDefinitionPerformerAuthorRecordtargetPatientLaboratoryPhysicianOrderedtestSubjectSpecimen2023/7/1@2003HealthLevel7China58MessagestructurefromRMIM123489105672023/7/1@2003HealthLevel7China59HierarchicalMessageDescriptionInformationModelMappingMessage

StructureMessageElementsTieseveryelementofamessagedirectlytoaclass,attributeorassociationintheReferenceInformationModelProvidesthemessageprofilespecificationsforthedataelementsinthemessageEquivalenttopopulatingaV2.xAbstractMessageDefinitionwitheachoftherelevantSegmenttables

ANDthen

addingthemessageprofilespecificationforwhichsegmentstouseand/orrepeat,andwhichcodedomainstouse.2023/7/1@2003HealthLevel7China60Howdomodelstomessages?2023/7/1@2003HealthLevel7China61Ourexampleschema2023/7/1@2003HealthLevel7China62ImplementationTechnologySpecificationV3goalistosupportdifferentITSlayersCharacterbasedinterfaces:ER7XMLObjectBrokerTechnology

CORBAActive-X/DCOMOthersEDIFACTisapossibility2023/7/1@2003HealthLevel7China63◆HL7概况

◆HL7V2.X

◆HL7V3.0

◆HL7在PHIN的应用主要内容2023/7/1@2003HealthLevel7China64Cases,contactsandexposuregroupsLaboratoryordersandresultsSyndromicandhealthindicatordataInterventionsEnvironmentaldataSpatialdataHealthalertsRecommendationsPHIN的功能2023/7/1@2003HealthLevel7China65ClinicalCaseDetectionandResponseStateandLocalPublicHealthDepartmentsCentersForDiseaseControlandPrevention(CDC)PersonPublicHealthLabClinicalSiteHospitalClinicPositiveresultreturnedtoclinicalsiteandforwardedtostateandCDCSpecimensenttoLaboratoryResponseNetworklabforconfirmationCasedatasenttoStateHealthDept.andforwardedtoCDCwithrequestforassistanceLawenforcementLawenforcementnotifiedPatientpresentswithAnthraxsymptomsatclinicalsiteFederalresponseentitiesFederalresponseentitiesnotifiedResponseteamsidentifysourceofexposureFieldInvestigationTeamEnvironmentalspecimenssenttolabwithreportbacktofieldteamandstateFieldteamreportsfindingsbacktostateorlocalhealthdept.andCDCExposedindividualsidentified2023/7/1@2003HealthLevel7China66PHINFoodSafetyUSDA,FDAClinicalSectorLabs,CaredeliveryLawEnforcementFBI,LocalLaboratoryResponseUSDA,FDA,DOD,PublicHealthLabsSurveillanceCDC,StateHD,LocalHDResponseCDC,StateHD,LocalHD,FederalAgenciesPHIN与其他系统的关系2023/7/1@2003HealthLevel7China67DetectionandMonitoringSyndromicsurveillanceHealthIndicatorsExistingsurveillanceforspecificagentsLaboratoryResponseNetwork(LRN)PHIN的功能2023/7/1@2003HealthLevel7China68ResponseOutbreakmanagementsystemsDynamicinformationrequirementsConfigurableIntegratewithexistingactivitiesLaboratoryResponseNetworkClinicalcaredataPHIN的功能2023/7/1@2003HealthLevel7China69HL7在PHIN的应用Class:PublicHealthCase(CASE)ApublichealthcaseisanObservationrepresentingaconditionoreventthathasaspecificsignificanceforpublichealth.Itinvolvesaninstanceorinstancesofareportableinfectiousdiseaseorothercondition.2023/7/1@2003HealthLevel7China70Class:PublicHealthCase(CASE)Thepublichealthcasecanincludeahealth-relatedeventconcerningasingleindividualoritmayrefertomultiplehealth-relatedeventsthatareoccurrencesofthesamediseaseorconditionofinteresttopublichealth.HL7在PHIN的应用2023/7/1@2003HealthLevel7China71Class:PublicHealthCase(CASE)Apublicheal