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HL7 expands ebXML adoption in health care
Health Level 7 (HL7), an electronic health care industry standards consortium, released its new transport standards that include support for ebXML messaging, but other initiatives indicate greater use of ebXML in health care beyond message transport.
In late April 2004, Health Level 7 (HL7), an electronic health care industry standards consortium, released its new transport standards that include support for ebXML messaging. The HL7 announcement approved ebXML messaging, and corresponding Web services messaging profiles, as draft standards for trial use (DSTU) for 24 months.
HL7 is one of the early and most active standards organizations bringing electronic processes to the health care industry. The practice of health care has long used electronic methods for administrative tasks, but the industry has more slowly adopted technology as a way to improve delivery of its services. And for good reason. Health care practice has life-and-death implications, and thus the adoption of new processes involving technology must meet the highest standards of accuracy and effectiveness.
Electronic health records will bring new electronic processes
While it may have taken health care longer than many other industries to adopt electronic processes, it now appears ready to adopt those processes in a big way. The U.S. Department of Health and Human Services on 6 May appointed Dr. David Brailer its first health technology czar -- officially National Health Information Technology Coordinator. That same day HHS threw its public support behind HL7's proposed electronic health record (EHR) standards. HL7 completed voting on the draft EHR standards in early May 2004, and while majorities favored the standards, HL7 still needs to resolve over 350 comments submitted by reviewers.
HL7 specifically endorsed ebXML's Message Service specification "to provide secure, flexible transport for exchanging HL7 messages between message handling interfaces or ebXML Message Service Handlers (ebXML MSH)." The announcement noted ...
The transport will move HL7 content, messages and documents, as well as legacy standards over a variety of lower level transports, such as TCP/IP, HTML, and SMTP. This protocol optionally supports important features such as Duplicate Message handling, Reliable Messaging, Message Routing, Sequencing, and Digital Signatures. When using this protocol in combination with a certificate based TLS (Transport Layer Security) or SSL (Secure Sockets Layer) TCP/IP lower level transport it provides a robust, secure and authenticated communications infrastructure for exchanging HL7 V2 and V3 messages and content between organizations. It may also be used within organizations to exchange HL7 content, as well as legacy content, over internal networks.
In a posting on the XML/edi Group list, Wes Rishel of Gartner Research and immediate past chair of HL7 explained that the "ebXML DSTU is very concrete and prescribes how to use it with HL7 messages. Depending on the options you choose, there are multiple messaging paradigms (some examples: one-way transmission of messages with acknowledgment at the message service or application level, with or without digital signature for authentication, with or without encryption for authenticity; request-reply for 'real-time' or extended reply-time usage)."
HL7 has a long association with ebXML, dating back to ebXML's 1999-2001 development period. HL7 took part in the ebXML's proof of concept tests in May 2001, at the close of the development cycle, where ebXML transport protocols carried HL7 clinical and administrative messages.
At an OASIS e-health symposium in late April 2004, Tim Morris of the U.S. Centers for Disease Control (CDC) described how CDC's Public Health Information Network connects public health agencies, law enforcement authorities, medical labs, and clinical practitioners using ebXML messaging. The CDC network carries a number of HL7 message types reflecting industry standard vocabularies.
Message transport: only the beginning
In recent months demonstrations and presentations at industry meetings indicate that the health care industry is considering adoption of ebXML beyond messaging. At the same OASIS e-health meeting, Farrukh Najmi of Sun Microsystems outlined how ebXML, especially the registry specifications, can meet multiple requirements of public health, including epidemic control.
At the Healthcare Information and Management Systems Society meeting in February 2004, Raining Data Corporation took part in a demonstration of HL7 message exchanges that included use of ebXML registries. In the demo, the company's server extracted metadata from HL7 messages and posted the metadata to an eXML registry operated by the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland. The Raining Data demo covered two scenarios, one for bio-terrorism reporting, and the other for simulated clinical support for a patient before and after cancer surgery.
In the April OASIS meeting Dan Pattyn of Forum 9000 reported on pilot projects in Norway that introduce electronic processes to home health care. Pattyn described how the complex problems of meeting patients' individual health care go well beyond messaging and registry. He outlined a pyramid stack/architecture for electronic health care support that brings in ebXML's Business Process Specification Schema, Collaboration Protocol Profiles, and Core Components, culminating at the top with Collaboration Protocol Agreements, all reflecting ebXML specifications.
Pattyn also pointed out how related OASIS specifications on Business Centric Methodology and and Content Assembly Mechanism help fill in some of the business process and semantics management gaps. ebXML Forum plans to examine these related specifications in coming issues.
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