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International and National Standards Development Organisations active in the area of Health Information Technologies

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HL7
HL7 is an ANSI-accredited Standards Developing Organization (SDO) focused on clinical and administrative data and interoperability between healthcare information systems. It is a not-for-profit, volunteer organisation and has affiliates in at least 27 countries. HL7 is probably the most significant healthcare standards development organization in the world.

HL7 was created in 1987 to develop standards for the electronic interchange, management and integration of clinical, financial and administrative information and data between computer systems in healthcare - hospital information systems, clinical laboratory systems, enterprise systems and pharmacy systems. The standards were designed to support clinical patient care and the management, delivery and evaluation of healthcare services.

HL7 is a messaging standard as well as a healthcare standards development organization, and since 1996 has been working on a new generation of standards under the Version 3 (V3) messaging standard. All standards developed under V3 are based around an underlying Reference Information Model (RIM). HL7 now defines standards for the representation of information objects as well as messaging: forms, decision-support mechanisms and electronic patient record structures.

' "Level Seven" refers to the application level, the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO)' [Karen Van Hentenryck], HL7 Associate Executive Director], designed to support interoperability between different computer programs.

Working groups
Clinical Decision Support Technical Commmittee

" The role of [the Clinical Decision Support Technical Commmittee] is to (a) identify the scope and range of data elements required for the functionality of decision support applications, (b) work with other SIGs, TCs, or outside organizations to identify appropriate controlled vocabulary for encoding those data elements, (c) identify or define messages (and objects) required to support the specific information exchange needs of decision support applications, both as feeders to decision support applications and as output from decision support applications."

"The TC [is also] responsible for support and development of Arden Syntax for Medical Logic Systems as well as a standard for representation of clinical guidelines."

Work on the development of a standard for developing computer-interpretable guidelines is focusing on the standardisation of shareable components rather than on a single standard representation formalism.

This committee is also responsible for the standardisation of technical components of a clinical information system infrastructure capable of providing guideline-based decision support. These include a clinical data model (efforts are focusing on a vMR, virtual Medical Reocrd, derived from the HL7 RIM, Reference Information Model), and an expression and query language (GELLO) to interface between the logic of a computerised guideline and patient data.

The committee is co-chaired by Robert Greenes, Robert Jenders, Ian Purves and R. Matthew Sailors.

Clinical Guidelines Special Interest Group

The Clinical Guidelines Special Interest Group (co-chaired by Robert Greenes and Samson Tu) of the HL7 Clinical Decision Support Technical Committee aims to create "the standard for the communication of clinical practice guidelines to facilitate their integration into health care systems, electronic medical records, and a variety of applications".

The infrastructure components of the evolving standards are based in part on GLIF work. In particular, GELLO, an object-oriented expression and query language is being proposed as an HL7 standard. The expression language can be used to write decision criteria and other logical and temporal expressions for clinical guidelines and Arden Syntax MLMs. The query language is used to specify in a platform-independent manner, the data items that are part of the expressions in guidelines and MLMs. The query language is thus an attempt to solve the Arden Syntax “curly braces” problem.

references

Jenders RA, Sailors RM. Convergence on a standard for representing clinical guidelines: work in health level seven. Medinfo. 2004;2004:130-4.

[PubMed]   []

" Concern regarding patient safety and practice variation has focused attention on clinical guidelines as a way of influencing the behavior of health care providers in order to improve patient outcomes. Despite the abundant number of guidelines produced, their use has been limited, in part because the nec-essary knowledge is relatively inaccessible at the point of care. In turn, this has led researchers to make guidelines comput-able so that they can be employed in information systems that provide tailored decision support. A number of different ef-forts have been mounted to create a standard formalism. Health Level Seven (HL7) is a key international standards development organization. Ongoing work in HL7 attempts to synthesize the best aspects of these efforts, producing along the way shareable components of a guideline representation, such as a common expression language and standard data model. These shareable components require in turn an infor-mation architecture that makes available a range of patient data encoded in an appropriate format. Convergence on a standard guideline formalism will facilitate use of guidelines and thus enhance patient care. "
links
 bullet  HL7 (USA)  bullet  HL7 CA  bullet  HL7 CH  bullet  HL7 CZ  bullet  HL7 DE  bullet  HL7 FI  bullet  HL7 NL  bullet  HL7 UK  bullet  HL7 ZA  bullet  HL7 JP  bullet  HL7 AUS/NZ  bullet  HL7 Clinical Decision Support Technical Commmittee  bullet  HL7 Clinical Guidelines Special Interest Group

 bullet  HL7 messaging standard [OC]  bullet  Arden Syntax [OC]  bullet  CDA - Clinical Document Architecture [OC]  bullet  GELLO [OC]  bullet  GEM - Guideline Elements Model [OC]  bullet  CCOW - Clinical Context Management Specification [OC]

acknowledgements
 
page history
Entry on OpenClinical: 2002
Last main updates: 18 December 2004, 31 August 2006
Restructure and redesign v0.2: 15 August 2006
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