# Presentation: 208097

## Make Your Registry More Useful—How Registries Can Talk to Providers and to Each Other 

**(HL7 and CIRSET) **

**Susan Abernathy**
**2000 Immunization Registry Conference**
**Newport, R.I.****	****March 28, 2000**

## What is HL7?

**Founded in 1987**
**ANSI-accredited in 1996**
**>1500 members--vendors, consultants, providers, government, organizations**
**An application protocol for electronic data exchange in healthcare environments**

## International Organization for Standardization (ISO*) Network Model

***ISO, from Greek isos, meaning “equal.”**

## HL7 Use Among Health Care Providers

***Health Information and Management Systems Society**

## HL7’s International Affiliates

**HL7’s International Affiliates**

- Australia		Japan
- Canada		New Zealand
- Finland		South Africa
- Germany		The Netherlands
- India			United Kingdom

## 1998 Hospital Information Systems Desk Reference:  A CIO Survey(153 Chief Information Officers)

**Results:  HL7 is most widely-used **
**standard among health care providers.**
**>80% overall respondents indicated HL7 use by their IS departments**
**additional 13.5% plan future implementation of HL7**
**>95% of large-scale providers (bed size 400+) use HL7**

## HL7’s Mission

**Provide standards for the exchange, management, and integration of data that support clinical patient care and the management and delivery of health care services.**

**Create flexible, cost effective approaches, standards, guidelines, methodologies, and related services for interoperability between health care information systems.  **
**Enable and simplify interfaces between different health care computer applications.**

## CDC’s National Immunization Program-- Working With the Healthcare Industry

- Increasingly computerized world of      healthcare
- Development of new technologies
- Economic realities of supporting numerous “silo” systems
- Need to use data more efficiently

## Health Level Seven (HL7), Version 2.3

**ADT**
**Orders**
**Results**
**Financial Transactions**
**Ancillary Reports**
**Clinical Observations**
**Queries**
**Scheduling**

**Patient Care**
**Nursing Care Plans**
**Clinical Trials**
**Immunizations**
**Master File Updates**
**General Acknowledgments**

## Slide 10

## HL7 Building Blocks

**HL7 Building Blocks**

**Message Header Segment**

**Patient Identification Segment**

**Pharmacy Administration Segment**

**Observation/ result Segment**

## Sample Immunization Message

**MSH****|^~\&||MA0000||GA0000|199705221610||**
**VXU^V04|19970522MA53|T|2.3.1|||AL<CR>**
**PID****|||3872^^^^MR^~221345671^^^^SS||**
**KENNEDY^JOHN^FITZGERALD^JR^^^L^A|**
**BOUVIER^^^^^^M^A|19900607|M|||123 MAIN ST^^LEXINGTON^ MA^00210^ ^M^MSA **
**CODE^ MA034^^ A||617^5551212^ PRN|||||||||| CHILDREN ‘S HOSPITAL<CR>**
**RXA****|0|1|19900607|19900607|08^HEPB- **
**PEDIATRIC/ADOLESCENT^ CVX^90744 **
**^HEPB-PEDIATRIC/ ADOLESCENT^CPT|.5| **
**ML^^ ISO+||||||| MRK12345||MSD^MERCK^ MVX<CR>**

## Resources for Registries

- Videotapes:
- Immunization Data Transmission:  Using Health Level Seven (HL7)
- Immunization Data Transmission:  Connecting Through Standards
- Guidelines:
- Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the HL7 Standard Protocol, June 1999

## Registries United for Record Exchange

- Fall 1998 meeting--registries with HL7 guides
- California				Illinois
- San Bernardino County	Georgia
- Michigan				New York State
- Participation by Indian Health Service, Kaiser

## CIRSETCommittee on Immunization Registry Standards and Electronic Transactions

**CIRSET formed during NIC in June 1999**
**Membership benefits:**
**	****Approach vendors with one voice**
**	****Establish common implementation policies**
**	****Provide technical assistance to other registries**
**	****Introduction to HL7**

## CIRSET

**Members sign a Memorandum of Agreement**
**Allow CIRSET to review registry’s plan for record exchange**
**Ensure registry’s data elements consistent with recommendation--revise, if necessary**
**Allow CIRSET to coordinate any new additions to the standard. **
**Obtain technical assistance on implementation**
**Successfully test implementation of record exchange with CIRSET member**
**Periodically review CIRSET recommendations and upgrade when necessary for consistency**

## What Can Registries Do?  

**Some registries are now building HL7 interfaces.**
**--Insist on adherence to Implementation Guide.**
**--Coordinate with CIRSET.**
**--Obtain technical assistance with CIRSET.**
**--Hire only experienced HL7 developers--don’t pay for their learning curve.**
**--Don’t allow them to convince you that your registry is so unique that it must be done differently.**

## Contact Information

**HL7 Implementation Guide for Registries:**
_**http://www.cdc.gov/nip/registry/guidoc.html**_
**NIP registry website:  ****	****	****	****	****	****	**_**http://www.cdc.gov/nip/registry**_
**HL7:  ****	**_**http://www.hl7.org**_
**ANSI:****	****http://www.ansi.org**
**Healthcare Informatics Standards: **
_**http://www.mcis.duke.edu/standards/guide.htm**_
**Susan Abernathy:  ****	**_**saa6@cdc.gov**_
**	****	****	****	****404-639-8177**

## Now That We’ve Agreed on the Format, What Next?  

- What are the implementation issues?
- --What port will we use to listen for messages?
- --When processing a query, should a registry keep the port open while processing the query?
- --What other considerations?