Tuesday, 6 February 2007

Candian Infoway and Myths

Ref: http://www.itbusiness.ca/it/client/en/Home/News.asp?id=40138&bSearch=True)

Canadian Infoway which aims to have a nationwide EHR by 2009 has recommended vendors to use version 3.0 in its blueprint. In 2006 The Association of health technologies industry (AITS) and the Canadian Health Information Technology Trade Association (CHITTA) have issued a position paper to Canada Health Infoway urging the agency to reconsider its support of Health Level 7 (HL7) Version 3. The paper calls instead for Infoway to endorse HL7v2.5, which the associations say provides greater interoperability.

This is old news but the reason why i felt compelled to blog on this issue is the following presentation which is a more recent one on the infoway site

Slide- 44
Myth #1• Interoperability on a large scale is possible with HL7 V2


• There is no common, pan-Canadian V2 standard

• No organization in North America is using V2.5

• The optionality in V2 inhibits (and in many cases, practically prevents)interoperability• V2 messages are designed for point-to-point systems integration, and donot easily support reuse and replication

• We need computable semantic interoperability in order to be successful withour agenda. HL7 V3 has the information model, robust data types,terminology bindings and a robust modeling methodology which support ourneeds …. and V2 does not

My Comment :Well i dont understand the concept of pan-canadian understandard. One of the biggest advantage of HL7V2.x is getting different versions of HL7V2.x interoperate with one another. The rules for compatibility between different versions (e.g. V2.3.1, V2.4 and V2.5) have been documented in the specifications. These rules describe the transmission and receipt of messages and converting their contents to data values with full backward compatibility between all 2.x versions of HL7.

So is it not better to use V2.x and force and constrain systems vendors and organisations on issues of optionality and using standard codesets rather than using V3.0

The next point is a bit contentious where it is said there is no "No organization in North America is using V2.5" by that standards then there are no organisations in N.America which use V3.0. Apart from this Biosurveillance Technical Committee in US which submitted its selected standards Healthcare Information Technology Standards Panel did endorse HL7V2.5 as one of the for use in construction of the Interoperability.

V2 messages are designed for point-to-point systems integration,this is a statement which is highly debatable considering the fact that several organisations which adopted middleware based integartion-EAI or SOA use V2.x.

The statement that "HL7 V3 has the information model, robust data types,terminology bindings and a robust modeling methodology which support ourneeds" is right to some extent but given the problems associated with the stability of RIM and the number of revisions it went through and the known problems of V3 messages with SNOMED-CT dimmens the context and relevance of the statement.


Myth #2
• Vendors will not commit to pan-Canadian standards and HL7 V3


• Not all vendors will or can

• Vendors are responding to the growing market demand being advanced byInfoway ... We need to grow that market demand!– Vendors also complying with standards when these are specified in RFPs, egCeRx for PEI and NL– There are V3 implementations in progress: IBM, Eclipse open source, Emergis,DeltaWare, etc

• Vendor community representatives are committed to pan-Canadianstandards so they only have to implement once and conformance test once• It’s largely not a V2 versus V3 issue. Often the challenge is XML enablementof the application, new functionality, new data requirements, newterminologies, not the V3 message syntax

My Comment:The realities quoted in it does indicate that V3 implementaions are in progress and the end result is not known. The slide also says "XML enablementof the application" is the issue not a v2 versus v3 issue ; well we do have V2.x XML encoding for which ready made adpaters are available from several vendors.


Myth #5

• All existing local standards must be replaced with pan-Canadian standards

• Example 1 – All existing HL7 messages do not need to be replaced with HL7v3 messages– V2 and V3 can co-exist, V3 can be mapped to V2, and V3 compliance can beachieved (with V2 components) with the use of brokers

• Example 2 - PoS systems are not required to update internal HL7 v2.xmessages to use the pan-Canadian standards– Pan-Canadian standards are not focused at the Departmental level but are forinteroperability with the pan-Canadian EHR or jurisdictional repositories

• We are requiring that new HL7 messages to communicate with the HIAL beimplemented in V3, not v2.x.

• Implementation of a pan-Canadian standard is most feasible when a net-newsystem is being installed, or an existing system is being enhanced.

My Comment:Well V2 and V3 co-existing is a reality and its happening as can be seen in the English NHS project where intra organisation integartion is done using V2.x and messages to national EHR is done using V3.0. But the statement that V3 compliance can be acheived with v2 components and use if brokers is really far fetched statement. The mapping or translation of v2-v3 is not defined properly nor any detailed documentation on the mapping is available. It is also a know fact that HL7 v3 is much more detailed than HL7 v2 and the trigger events in V2 and V3 are sufficiently different apart from the bussiness process which triggers those messages.

Iam not saying that HL7V3.0 is better compared to V2,0 but when making a statement to vendors to instill confidence in them atleast make a realistic and fact filled statement not a statement which hangs on a set of incorrect "Realities" .

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