Archive for HL7

Standard is not so Standard

Next month we will be in our house for 12 years. That is the longest I have ever lived somewhere in my adult life. As I think about the lessons I learned when we were building this house, which there are many, one stands out above all else: the notorious wall in the middle of the room.

When we were shopping for houses, we looked at a lot of display homes for builders. There was one house that we fell in love with the moment we walked through the door. It was an open floor plan where you could see all of the way to the back of the house when you open the front door. The openness of the house was a big selling point for us.

One day, about a month after we had started building, I went to the house to check on the progress. I open the door and …. What??!!!! There is a big wall in the middle of the room. This wall extends up from the basement to the second floor in the center of the staircase. I immediately call the project manager to find out what is going on with this wall in the middle of what is supposed to be an open view to the back of the house.

Through the building process, you choose all of the colors, flooring, cabinets, etc. One thing we picked was the type of stairs and if the stair spindle goes all of the way to the stair or to a side wall. We chose the side wall. We had told the sales representative several times what we loved about the display home … just down the street! No one ever said that our stair choice would require a wall in the middle of the room, but we learned later that was the standard way they built our choice. Well, that “standard” wasn’t our standard, and didn’t fit our needs. We thought all houses built with that floor plan would have the same openness. Needless to say, part of that wall came out and that builder stopped selling that type of stairs in that floor plan.

This story reminds me of what’s happening in the healthcare integration industry, especially when it comes to HL7. Everyone knows that HL7 standards are not standard. They are a starting point. You must take time to understand the process the interface must facilitate in order to understand if the HL7 standard will meet your needs. The requirements may dictate modifications to the standard.

One common non-standard use of HL7 is using ORU messages for transcription. Recently we built an ORU bidirectional interface where we sent out a standard diagnostic imaging order in an ORU, but depending on a descriptor we receive in a segment that we weren’t using, we use the ORU result as a result to the diagnostic imaging order or to populate a progress note. The progress note is an ultrasound operative report. The ORU has different OBX segments for the different parts of the operative report. We place the text from the specified OBX segment in the proper note section in the progress note.

Once the requirements are defined, it is up to the sender and receiver to come up with a common understanding of the message format. For this reason, we always request a specification from the system from which we are receiving data, or the system to which we are sending data. No specification was provided in the example provided earlier, so we provided our standard specification with the modifications we thought necessary to accomplish the requirements.

Once both sides come to an agreement on message format, you don’t find out until testing whether the interface facilitates all of the process requirements (both documented and UNdocumented). There are always modifications to be made. We made several modifications to the original scope in our example. It seems that even the owners of the process sometimes don’t know all of the variables to the process. This always leads to new discoveries about the process through the testing process.

The key is to try to understand as much about the process as possible. You will always find out more later, but try not to code yourself into a corner so that you can respond efficiently to changing requirements. Try to keep an open mind about HL7 and use its non-standardness to your advantage to create effective interfaces to facilitate complex processes.

We are Mi7. We make HL7 interfaces, HL7 standards and making the translation between two electronic health records systems exciting. Yes, in our world, questioning the standards, dictating modifications, and finding a way gets our adrenaline pumping. If your medical practice, hospital, or physicians network is in need, contact us and see just how jazzed we can get.

The Wheels on the Bus Go ‘Round

We were driving from St. Louis to Chicago on a Sunday afternoon for an appointment Monday morning.  When we were about an hour and a half outside of Chicago, our tire blew.  We were close to an exit, so I pulled off the highway and into a truck stop to assess the situation.  We have these run flat tires that allow you to go 50 miles at 50 mph.  We had more than 50 miles to go to our destination and I didn’t feel comfortable driving 50 mph on an interstate where people were going 80+ mph, so I assessed the situation. 

We needed a new tire.  Can we get a new tire somewhere close? Nope.  Many of the tire stores in the area were closed since it was late Sunday afternoon.  The big tire stores (Walmart and Sears) didn’t carry the tire we needed and would have to order it.  We had to be towed to the dealer in Chicago, so I called roadside assist.

I had two passengers with me, so I knew that riding in a standard tow truck was not going to work.  I requested a tow with 3 passenger ride along. I was given a 2 hour ETA.  I got a call from the contracted towing company about 40 minutes later.  I confirmed that there was room for 3 passengers.  Unfortunately, this was not communicated to the towing contractor, so the truck that was in the area did not have the room for 3 passengers.  This prompted another call to roadside assist and a new towing company dispatched a truck for us.  

This is not the end of this story, but it is enough for this post.  I relay this story because sometimes things get lost in translation.  It’s like when you played telephone as a kid.  You tell someone something, they tell someone else and so on.  By the end, what is being said may not be the same as what you told the first person.  

How does this apply to healthcare technology?  Many practices have seen the value  of in-house lab and imaging equipment for their business.  They can offer these services internally instead of referring the patients out to other businesses.  The issue is that not all lab and imaging devices can speak the same language as the practice’s EMR.  Sometimes the devices only communicate via serial or network via ASTM,  ABX, or Argos.  Sometimes the EMR will only accept HL7.  Mi7 has developed the expertise to take the device languages and translate the data to HL7 or, in some EMR’s, write the data directly to the EMR.   With the government incentives and mandates to store discrete data (test results as individual values), practices have been printing out these results and manually entering them.  This can reduce employee productivity and introduce potential errors to the result transcription process.  

I have seen practices take the data from these machines and create proactive marketing (called “health maintenance” programs in the patient arena) campaigns to promote patient maintenance of A1C, Cholesterol, and other key chronic maintenance values.  This helps the practices pay for the device and improve overall patient health.

There are many types of devices that collect and report on data.  If you are paying for the device, why not use the data provided by the device to improve patient care and potentially grow your business? Use the devices you have.  Maximize the value of data collected by these devices. It’s your data. Use it.