Congratulations to the HL7 Leaders Named to Health Data Management's "20 People to Watch in Healthcare IT in 2017"
The health IT industry publication Health Data Management released its list of the health leaders they expect to make large contributions to the discussion on HIT and provide guidance on where the industry needs to go in "20 People to Watch in Healthcare IT in 2017."
Happy Holidays!
From our family to yours, Health Level Seven International wishes you a happy holiday season.
We would like to take this opportunity to thank our members, business partners and colleagues who have donated their time and expertise to help HL7 achieve its mission to empower global health data interoperability. We cannot continue this important work without the support of the health IT community.
Working Together: Our best option to improve C-CDA® Content
Most people have heard of HL7 Fast Healthcare Interoperability Resources (FHIR®) Connectathon events, as well as IHE North America and European Connectathon events, which focus on testing the interoperability of solutions. But did you know that one of the most important content efforts – improving C-CDA® (Consolidated Clinical Document Architecture) documents – is also underway? At each HL7 C-CDA® Implementation-A-Thon, health IT activists have met to improve C-CDA quality and resolve industry differences that result from varying interpretations of standards and implementation guides.
Efforts to Improve the Content of the C-CDA
Many efforts are underway across the industry to help all of us improve the content of C-CDA documents. For example, the Relevant and Pertinent project and the ONC Site C-CDA Scorecard. For anyone who wants to improve C-CDA content quality, you will make the best use of your time at an HL7 C-CDA Implementation-a-Thon.
These two-day events provide an opportunity for multiple participants (20 – 30) from a diverse cross-section of companies and government agencies (16 – 20) to tackle specific use cases for both content creation and content consumption.
What We’ve Accomplished So Far at the C-CDA Implementation-A-Thons
Through the past three C-CDA Implementation-A-Thons, we have accomplished the following:
At Allscripts, we have products that cross the continuum of care, with the ability to both produce and consume CDA-based documents. I am fortunate to work with the very talented Community Solutions group, which is responsible for the creation and consumption of all CDA-based documents for Allscripts products.
Yet, even with this single, focused approach at Allscripts, we are still faced with a number of interesting choices about data, and the construction and consumption of CDA documents. Participation in the C-CDA Implementation-a-Thon events resulted in us making some useful changes, and feeling confident that these were changes made with an industrial consensus for producing an improved quality of C-CDA.
It's All About the Community
Someone recently asked me why I participate at HL7 and it didn’t take me long to answer: “It’s because of the community”. I wasn’t surprised when many other people answered the same in a recent HL7 Pulse survey.
My first experience at an HL7 Working Group Meeting
I first started participating just prior to the May 2008 Working Group Meeting (WGM) in Phoenix, AZ and I had no idea of the number people that I would be able to call friends and colleagues more than eight years later. I also had no idea of how much I would learn and grow from my participation!
I felt so intimidated at that first meeting – it’s a very daunting experience for a first-time attendee. I think back to the conversations I had in Phoenix where I just hoped that I wouldn’t come across like a newbie. There was no way I was going to wear a pink ribbon. Looking back I realize how silly that was. I now tell first-time attendees that it’s perfectly okay to ask newbie questions and wear the pink ribbon!
Finding my HL7 legs
It can definitely take some time to find your way at an HL7 working group meeting – there are so may work groups and so many activities. Luckily I had colleagues around me to help point me in the right direction. It actually took me almost 3 years to find my way to the Pharmacy Work Group and start participating on a regular basis. It seems like the Pharmacy Work Group should have been a no brainer for a pharmacist, but for lots of reasons it wasn’t. I visited many work groups along the way, but once I started participating in Pharmacy, I think I found my HL7 legs.
Many have asked the question: When are we going to realize the promises of sequencing the human genome?
Some argue the benefits are here. Others say not much has changed for healthcare consumers and patients. Some have invested in pharmcogenomic programs in the clinic, while there remain pharmacists who say the evidence still isn’t there. Patients see advertisements for cancer services that utilize genetic testing for targeted therapy, while others still claim most cancer patients don’t see any benefit.
We are in a period of both confidence and uncertainty, enough evidence and not enough evidence; let’s move forward with expanded testing and let’s only adopt a few tests, promises and warnings, a cost benefit or just increased cost.
Investments in Genomics Advances
In spite of the controversy, billions of dollars in investments are developing more products and services directed at healthcare consumers. This already includes direct-to-consumer genetic and genomic testing.
The precision medicine initiative is emerging as a high profile effort in genomic research and encourages patient-directed data ownership and sharing. It will be a major driver in building awareness and demand for genetic-based clinical services.
Tools from vendors—that range from biomarker and drug discovery to the clinical knowledge of diagnosis, risk assessment, and clinical meaning—are working toward advancing genetic-based care and realizing greatly improved outcomes.
Amidst this debate, many are committed to moving ahead to find clarity and the right path forward. In increasing numbers, people with day jobs are participating in mostly volunteer organizations to define and complete demonstration projects that prove both clinical utility to healthcare providers and significant value to patients.
Progress in Genomics
Internationally-focused organizations—like the Global Alliance for Genomics and Health (GA4GH), the Global Genomic Medicine Collaborative (G2MC), and US-based activities like the Genetic Alliance, the National Academies DIGITizE action collaborative, NIH grants like IGNITE and eMerge, and HL7 clinical genomics and Fast Healthcare Interoperability Resources (FHIR®)—are all making substantial progress. And there are many more related and critical activities I haven’t listed. Not only do we need to coordinate these activities, but we also need to bring together the diverse stakeholders in academics, research, technology, and national and global policy to see the vision move forward as well as how we’ll get there together.
Why FHIR for LATAM?
Latin America (LATAM) arrived on the scene late in terms of the use of earlier HL7 standards. HL7 Version 2 was created in 1985 but we (LATAM) did not begin using it until after 2000). HL7's Clinical Document Architecture (CDA®) was published in 2000 but we began using it after 2005. HL7's Fast Healthcare Interoperability Resources (FHIR®) is being created now and we are starting to use it in LATAM. Two implementation guides have been developed in Argentina and Colombia; Chile is working on one. We can discuss the ‘we’ (as in ‘Who in LATAM’?), but the trend cannot be discussed. Some countries in our region have yet to use any standard—there is NO installed base— why get stuck with stuff that’s 10 or 20 years old?
However, work is still in progress. While CDA Release 2 is good for document repositories, when it comes to mobile, what you can/should exchange is more discrete and granular. The choices will come down to how to use FHIR for examples such as:
A little history
Studying HL7 history, our standards went from a plain text, replication/messaging-based paradigm in the 1980s to the current, Internet 2.0, resource-based paradigm. We also created document-based standards such as the Clinical Document Architecture (CDA®) Release 2 and SOA based standards like Common Terminology Services (CTS).
These 30 years of history gave us a good insight on what we need as standards users and developers.
What do we need as standards users?
People who implement and use standards want open access to standards and implementation guides. They need understandable and short specifications, off-the-shelf tools, reference implementations, friendly representation of information (instances), easy access to vocabularies, automated validation of instances, affordable education, a formal extension mechanism.
Finally, they need examples, examples, and more examples. They need lots of examples!
What do we need as standards developers?
Standards developers have different needs. They want easy profiling with graphical user interfaces (GUI) and the ability to reuse templates. They also want one-click, automated publishing, validation and QA profiles, validation of instances, global profile registry, and ease of vocabulary binding.
January 1997: my first HL7 working group meeting
It was a dark and cold New England January in 1997 when I came down to my first HL7 working group meeting in Tampa Bay, Florida.
SGML
I was invited to talk about Standard Generalized Markup Language – SGML – an object of veneration of a small cult that would give the world both HTML and XML, the engines of the World Wide Web and what came to be called ecommerce. To put this in context, the Web was just over 3 years old and XML was still a suckling infant.
It had been announced the previous month, in Boston, simultaneously with a talk on “SGML in Healthcare” by me and clinical co-conspirators, John Spinosa, Dan Essin, and Tom Lincoln. We finished before the XML folks and caught the final few minutes of what we knew meant a dramatic change in electronic information publishing and processing.
Prior to XML, the electronic text world was torn between the advocates of HTML (it’s simple, you can use it!) and SGML (it’s powerful, you can move mountains).
For the HL7 Tampa talk, billed as a tutorial, I recruited two SGHappyML luminaries – Tim Bray and John McFadden – both Canadian, both showed up with winter colds. Tim was one of the prime movers behind XML; John later a reluctant convert. John had written the OmniMark language for markup conversion and he could actually make SGML work. Tim wrote one of the first programs to index the Web.
A litte about me
My name is Tim Hricik and I am a consultant with Accenture. I have been with the firm since late 2011 and have been a member of the HL7 community since 2013.
In May, I had the opportunity to attend my first HL7 working group meeting (WGM) in Montreal. As I attempted to navigate the WGM, I was introduced to a fellow Accenture colleague and longtime HL7 leader, Ken McCaslin. Ken is the head of HL7’s Technical Steering Committee and kindly helped shepherd me through the agenda and activities of the WGM. He provided introductions, shared his past experiences, and gave general words of wisdom to help me get the most out of my own experience.
Subsequently, Ken asked if I would write an article that might serve as a guide for future first-time attendees. Wishing that I had had a little more information about the WGM before my first visit, I jumped at the opportunity to share my observations with others. So, for all those attending a WGM for the first time in the near future, here is a little bit about my experience and what you might expect.
What did I anticipate for the working group meeting?
I really had no idea what to expect for my first visit to an HL7 WGM, but I knew that this would likely be different from other types of conferences I had previously attended. My initial intention was to simply attend the Fast Healthcare Interoperability Resources (FHIR®) sessions and connect-a-thon in hopes of learning as much as I could about the emerging standard.
I knew the HL7 organization was actually more than just one standard, but I will admit I let myself get a bit pessimistic about what I would encounter:
The Power of Community in HL7
I first became involved with HL7 a decade ago as I transitioned from medical practice to clinical informatics. I attended my first HL7 meeting, as many do, to take advantage of the tutorial sessions offered around foundational standards like HL7 Version 2 and the Clinical Document Architecture (CDA®). The most valuable takeaway from that first meeting however was not the knowledge of the standards but the beginning of my relationship with the community of individuals who are HL7.
HL7 is a diverse community
It is a remarkable community of individuals that are as diverse as the countries they call home, the organizations that employ them, and their backgrounds of education and experience. The one thing that is common and shared across the community is the sense that we move the needle as a community; move the needle a little with each use case enabled with an HL7 standard and each project that ends with consensus on a new data standard.