Implementing Electronic Health Record System Based on HL7 RIM -Reusing the RIM Model Archetypes
It is difficult to exchange healthcare information between different HealthCare Systems. Health Level Seven is a universal standard to facilitate the communication between different HealthCare Systems. Electronic Health Record System is a software platform that store patient health data which maintained by hospital and medical practice. Health Level 7 Reference Information Model was studied to provide the interoperability between different HealthCare Systems. In this paper, we studied about the various version of Health Level Seven standard including HL7 v2.x, HL7 v3.0, HL7 RIM. This paper focused on how the existing structure of HL7 is improved by reusing the HL7 RIM classes such as Act, Role, and Entity etc each are associated with set of attributes. It explains to modify the existing structure of HL7, need to modify the HL7 RIM because HL7 RIM model provide the structure of HL7. This paper also explained the role based queries are performed by the interested stakeholders like patients, doctors and hospitals. In this new structural form, role based information is maintained in the centralize database. This research fills the gap between skilled and semi-skilled users and query is performed on role base.
Keywords: HL7, RIM, Role, Archetypes
With the continuous development of health records, maintain and exchange the information in different HealthCare systems has become unavoidable. So, the communication between different hospitals or between different HealthCare system need to improved. Electronic Health Record is a repository of health information in a digital format about an individual patient or population managed by hospitals or medical practice that shared across different HealthCare Systems. It reduces the chances of data replication. More organizations adopt EHR; physicians, nurses and clinicians have greater access to patient information which helps in accurate diagnosis and complete data helps to ensure the best possible care.
Electronic Health Record (EHR) system is needed to focus on two requirements:
- dynamic involvement of different hospitals, patients and HealthCare Systems
- And the way of maintaining the information.
Standard compliant EHR provide facility of communication and to exchange information of patients between different hospitals, doctors, HealthCare systems. Each patient has his own queries respective to their role in the system. The query interface is designed to provide the effective knowledge among different kind of patients, hospitals.
Health Level Seven:
Heath Level Seven is a standard developing organisation accredited by ANSI (American National Standard Institute) founded in 1987. HL7 name refers the top layer of the OSI (Open System Interconnection) layer protocol for the health environment. HL7 specifies a number of various standards health information and also provide communication between different HealthCare System.
Standard are the set of rules that allow information to be shared in standardized and reliable manner.
HL7 messaging standard:
There are two main HL7 messaging standard HL7 v2.x and HL7 v3.0.
HL7 v2.x is also called as pipe hat. This standard provides the interoperability specification for health and medical transaction. HL7 v2.x message format are in human readable ASCII and non XML encoding syntax. It supports administrative, logistical, financial as well as clinical messages.
HL7 v3.0 provides the interoperability specification for health and medical transaction based on RIM (Reference Information Model). HL7 v3.0 message format based on XML encoding syntax and also on HDF (formal methodology) and object oriented principle. It supports only clinical data. Movement from HL7 v2 to HL7 v3 is that v3 would be model driven methodology means v3 standard support healthcare workflows through modelling; the end result maximize reuse and increase consistency in HL7 specification.
Another HL7 v2.7 supports all HealthCare department data for exchange between different HealthCare systems. It reduces the custom interface programming. But it is not plug and play; and not support transaction processing feature.
Table1.Difference between HL7 v2.x and HL7 v3.0
Not based on RIM model
Based on RIM model
Limited to backward compatible
Human readable ASCII syntax
XML encoding syntax
Not plug and play
Plug and play
Support hospitals workflows
Support health workflows
Exchange clinical, administrative and financial data
Only exchange clinical data
HL7 RIM (Reference Information Model):
The HL7 Reference Information Model provides the structural information of HL7 in the form of information classes. HL7 RIM is an object oriented model to make compatible the HL7 specification interoperability to all domains. It is important part of the HL7 v3.0 development model. It increases precision and reducing implementation costs. HL7 RIM is based on UML (Unified Modelling Language).
Reference information model has five components: Subject Area (major part of am model), class (about which information is collected), Relationship (relation between classes), attribute (information about class), and data type (specification of the format of an attribute).
RIM has six main important classes:
Act- It represents actions that are executed by entity.
Entity: These are the physical things that take part in health care.
Role: Role that entity plays as they participate in health care
Participation: It represent context for an act such as who perform, for whom and where.
ActRelationship: It represents the relationship between actions.
RoleLink: It represents the relationship between roles.
2. Related Work:
Electronic health record system based on health level seven, and HL7 used to provide the communication between different HealthCare systems, most of the research studies show perplexing which is further discussed in this paper review.
Tung Tran, Hwa-Sun Kim[] studied the research on,”A Development of HL7 Middleware for Medical Device Communication” to developed HL7 compliant middleware. Researcher used HL7 as a middleware to facilitate data transfer to information system in hospitals. Middleware has capability of receiving data from monitoring device and converting into HL7 data type format. It receive raw data from medical devices and convert to HL7 data and passed to HIS based on HL7 interface engine.
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Li-Fan Ko, Jen-Chiun Lin, Chi-Huang Chen, Jie-Sheng Chang, Faipei Lai[] concluded the research on,”HL7 Middleware Framework for Healthcare Information System. Researchers introduce HL7 and web services standard into framework which is basically Service Oriented Architecture (SOA). HL7 directly transmitted data over transport layer protocol TCP/IP: for small application HL7 message over TCP are simple and easy to implement; for larger application, system become complex and attacker increases. This research solved that problem by introducing web services which provide interoperation between software systems.
Jennifer Munnelly[] in his research study on,” HL7 Healthcare Information Management Using Aspect-Oriented Programming” focused the modification in application department without the requirement modification into complete structure by using HL7.Researcher suggested introduce HL7 functionality into exiting application without any modification through AOP.
Wooshik Kim[] studied the research on,” Integration of IEEE 1451 and HL7 Exchanging Information for Patients’ Sensor Data” showed the IEEE 1451 concerned with smart transducer and having plug –play capabilities. Patients wear sensors that measure the patient’s status in real time and transmitted these data to remote sites such as hospital. HL7 accepted this kind of data and interpreted with various online sensor data.
Pasquale De Meo[] studied on,” Integration of the HL7 Standard in a Multiagent System to Support Personalized Access to e-Health Services”. In this paper, he presented a system which has multi agents to maintain patients in seek of health related services in e-health care by using various algorithms PPB, DS-PPB, AB. This proposed system increases the quality service and effectiveness.
Maqbool Hussain[] concluded his research on,” Healthcare Applications Interoperability through Implementation of HL7 Web Service Basic Profile” studied all phases of web service component that implement HL7 Web Service Basic Profile. It is branch of the transportation subsystem progressed at NUST School of Electrical Engineering and Computer Science, Pakistan.
Naeem Khalid Janjua[] in research study presented work on, “Digital Health Care Ecosystem: SOA Compliant HL7 based Health Care Information Interchange” and proposed Service Oriented Architecture (SOA) based HL7 system design for patient information and showed the translation from HL7 V2 to V3 and mapping between database and user query.
Sara Gaion[] researched on,” Design of a Domain Model for Clinical Engineering within the HL7 Reference Information Model”. This paper develop a DIM (Domain Information Model) by providing the HL7 RIM to clinical engineering in a particular domain. This paper represent clinical engineering information in the HL7 RIM (Reference Information Model) with the reason of developing a HL7 v3 RIM model based on DIM (Domain Information Model) dedicated to CE(Clinical Engineering) by reuse of standard healthcare information models and show the process of repairing and maintenance of device used in hospital.
N.A. Mamani Macedo[] studied the research on,” Electronic Health Record: Comparative Analysis of HL7 and Open EHR Approaches”. This paper showed the comparison between HL7 and openEHR to automatism a Patient’s Record in any hospital which adopted: HL7 and OpenEHR. The method includes analyzing each way, defining some criteria of evaluation, design a comparative chart.
3. Design model:
The work is defined with the specification of the hospital and the relative attributes and the functional specification. It defines the role and requirement to specify the functional dependencies and its requirements. The role is defined for all the interested patients and hospitals and all interested users are connected to it along with their specified roles. The hospital is responsible for the information updating as well as to generate the query that queried by patients to obtain the information access about the patient, disease or diagnose. Complete information is defined in the form of centralized repository. Model is in the form of a query interface in which the communication to the system and different hospitals maintain the information in different way so that the mapping is required between the query set and the hospitals. To establish this mapping, the structural constructs for the system are defined so that the functional based information transition will be take place.
Steps in implementation model
First step is role identification and analysis: Users in this system are patients and hospitals(health organization). Role is defined for all the interested users ,patients and hospitals and they are coonnected to it along with their hospitals.
Second step is role specific query generation: Hospitals is reasponsible for the information updating as wel as to generate the query that queried by patients to obtain the information access about the patient,disease and diagnose.
Third step is query filteration and mapping done by RIM model: Complete information is defined in the form of centralized dataset.Model in the form of query interface in which the communication to the system and diff hospitals maintain the information in diff way. So that mapping is required between query set and hospitals.
Last step query result are extraced.
In changing the structure of HL7 and increasing the reusability over existing HL7 RIM model by reuse the RIM model archetypes. HL7 standard facilitate to exchange and sharing the healthcare information among different hospitals or in between different healthcare systems. We concluded that we extract the existing HL7 RIM model and improve the reusability over existing model by reusing the classes of RIM model and implement the user interface to accept request from different users and process the role base Queries.
 Explorative study of healthcare data Interchange standards
[] Tung, Kim, Cho,” A Development of HL7 Middleware for Medical Device Communication”, Fifth International Conference on Software Engineering Research, Management and Applications
[] Li-Fan Ko, Jen-Chiun Lin, Chi-Huang Chen, Jie-Sheng Chang, Faipei Lai,” HL7 Middleware Framework for Healthcare Information System”. Basically framework is service oriented architecture (SOA)”.
[] Wooshik Kim,” Integration of IEEE 1451 and HL7 Exchanging Information for Patients’ Sensor Data”, J Med Syst, pp 1033–1041, 2010
[] Pasquale De Meo,” Integration of the HL7 Standard in a Multiagent System to Support Personalized Access to e-Health Services“, IEEE Transactions on Knowledge and Data Engineering, pp 1244 – 1260, 2011
[] Maqbool Hussain,” Healthcare Applications Interoperability through Implementation of HL7 Web Service Basic Profile“, Sixth International Conference on Information Technology: New Generations, pp 308 – 313¸2009
[] Naeem Khalid Janjua,” Digital Health Care Ecosystem: SOA Compliant HL7 based Health Care Information Interchange“, 3rd IEEE International Conference on Digital Ecosystems and Technologies, pp 329 – 334, 2009
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