Health Level Seven® International (HL7®), the global authority for interoperability and standards in healthcare information technology, recently announced that it has published the Version 2.5.1 Implementation Guide for Electronic Laboratory Reporting to Public Health (as also specified in HITSP’s Interoperability Specification IS01).
The implementation guide is directly related to the initial set of standards and certification criteria interim final rule issued earlier this year by the Department of Health and Human Services U.S.A. The Version 2.5.1 Implementation Guide is intended to meet the needs and requirements of implementation guidance in public health entities. It contains the necessary specifications for laboratory results reporting to local, state, territorial and federal health agencies. In particular, the guide addresses messaging content and dynamics related to the transmission of Laboratory Reportable Result Messages/Electronic Laboratory Reporting. Each state and territory has requirements for laboratories to report certain findings to health officials. In the past, these reports were written by hand on forms provided by health departments and mailed to appropriate offices. With computerization of laboratories, it has become possible for laboratories to send reportable data to health departments electronically. The message described in this guide is not specific to any pathogen or reportable condition and is applicable for most biological and chemistry laboratory-reportable findings.
HL7 Version 2.5.1, the base standard on which this implementation guide is based, has been selected, along with other HL7 standards by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services to support Stage 1 of meaningful use in its interim final rule for the Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology. Under this rule, Certified EHR Technology should be capable of using the following HL7 standards:
• HL7 Version 2.5.1 for the submission of lab results to public health agencies. The Version 2.5.1 Implementation Guide for Electronic Laboratory Reporting to Public Health directly supports the implementation and use of Version 2.5.1 for this purpose.
• HL7 Version 2.3.1 or Version 2.5.1 for submitting information to public health agencies for surveillance or reporting (excluding adverse event reporting).
• HL7 Version 2.3.1 or Version 2.5.1 for submitting information to immunization registries as the content exchange standard and the CDC maintained HL7 standard code CVX—Vaccines Administered as the vocabulary standard.
• HL7 Clinical Document Architecture, Release 2 (CDA) Continuity of Care Document (CCD) as one of two options for content exchange standards for the receipt of a patient summary record.
In addition to being selected to support Stage 1 of meaningful use, several of HL7’s standards are key to overcoming four major challenges identified by The Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services to adoption and meaningful use of healthcare information technology data. HL7 has developed, or is currently developing, standards that address these challenges.
1.Security of Health Information Technology: This area addresses the challenges of developing security and risk mitigation policies and the technologies necessary to build and preserve the public trust as health IT systems become ubiquitous. The following HL7 standards address this challenge:
• Version 3 Standard: Privacy, Access and Security (PASS) Access Control
• Version 3 Standard: Role-based Access Control Healthcare Permission Catalog
2. Patient-Centered Cognitive Support: This area addresses the challenge of harnessing the power of health IT so that it integrates with, enhances and supports clinicians’ reasoning and decision making, rather than forcing them into a mode of thinking that is natural to machines but not to people. The following HL7 standards address this challenge:
• Continuity of Care Document (CCD)
• HL7 Clinical Context Management Specification (CCOW)
• HL7 Version 3 Standard: Clinical Genomics: Pedigree
• HL7 Arden Syntax for Medical Logic Systems
• Version 3 Standard: GELLO: A Common Expression Language
• HL7 Version 3 Standard: Context-aware Information Retrieval (HL7 Infobutton)
• HL7 Version 3: Decision Support Services (DSS)
• HL7 Virtual Medial Record (vMR) for Clinical Decision Support
• HL7 Version 3 Standard: Care Provision: Allergy and Intolerance
• HL7 Version 3 Standard: Structured Product Labeling
• HL7 Electronic Health Record System Functional Model
• HL7 Personal Health Record System Functional Model
3. Healthcare Application and Network Platform Architectures: This area focuses on the increased need for architecture supporting applications and resources that can capture, store, and analyze that data. Integration of application building blocks with the network building blocks provides an innovative platform in which the location or platform of the analysis is not important. The exchange of data is critical to a National Health Information Network (NHIN). The following HL7 standards address this challenge:
- HL7 Version 2.5
- HL7 Version 3
- HL7 Clinical Document Architecture (CDA)
- HL7 Services Aware Interoperability Framework (SAIF)
- HL7 Service Oriented Architecture (SOA) standards—RLUS (Resource Location and Updating Service), EIS (Entity Identification Service), SOA4HL7 Methodology Project,OMG Decision Support Service specification based on the HL7 Decision Support Service Functional Model, Context Aware Information Retrieval (Infobutton) SOA Implementation Guide:
- HL7 Electronic Health Record System Functional Model
- HL7 Personal Health Record System Functional Model
- HL7 Version 3 Standard: Common Terminology Services
- TermInfo—Using SNOMED CT in HL7 Version 3
- Domain Analysis Models (DAM) for security, emergency medical services, emergency care, medical records, public health reporting, cardiology acute coronary syndrome.
- (ACS), tuberculosis, Biomedical Research Integrated Domain (BRIDG), and vital records, among others
4. Secondary Use of EHR Data: This area focuses on strategies to enhance the use of health IT in improving the overall quality of healthcare. The following HL7 standards address this challenge:
- HL7 U.S. Vital Records Domain Analysis Model
- HL7 Version 2 for Immunization and Biosurveillance
- Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1
- HL7 Version 2.5.1 Immunization Administration
About Health Level Seven International (HL7)Founded in 1987, Health Level Seven International is the global authority for healthcare Information interoperability and standards with affiliates established in more than 30 countries. HL7 is a non-profit, ANSI accredited standards development organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services. HL7’s more than 2,300 members represent approximately 500 corporate members, which include more than 90 percent of the information systems vendors serving healthcare. HL7 collaborates with other standards developers and provider, payer, philanthropic and government agencies at the highest levels to ensure the development of comprehensive and reliable standards and successful interoperability efforts.