Link to HL7 Version 3.0 January 2009 Ballot Site

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Ann Arbor, MI
USA
January 2009

Dear Member,

Welcome to the V3 January 2009 Ballot Cycle web site. The HL7 Board of Directors is pleased to offer you the HL7 Version 3 Messaging membership, committee, Draft Standard for Trial Use and informative-level ballots for September 2008, and to solicit your feedback. In this ballot you will find many elements that are now normative HL7 standards, thanks in major measure to the constructive critique you provided in previous ballot cycles. For those areas still undergoing ballot, you will find that many areas have been changed, again, based on the feedback that you provided in the previous ballot. Please help us by providing another thorough, honest review.

New this cycle is an improved cross-browser compliant left-hand navigation widget. Publishing hopes that this new javascript navigation tree will resolve some of the cross-browser issues experienced by some of our members and improve speed of use when navigating between nodes. Thanks go out to those attendees of the V3 Publishing calls who evaluated and tested this new navigation tree.

The schemas published as part of Ballot2009JAN are, in general, correctly structured. However, they share a flaw in the way that vocabulary constraints are expressed for structural attributes. This problem arises because, until recently, HL7 has not defined the vocabulary representations needed to allow a committee to bind to a coded concept and any of its future children. In prior ballots, the schema representation for structural attributes constrained to a single coded concept established these codes as a "fixed" value, even though the committee intent may have been to constrain only to the code and all of its present and future child concepts.

During the Interim Meeting in November 2007, Vocabulary and M&M agreed upon a strategy for representing the additional value sets needed to specify a code and all of its future children. These changes were made to the vocabulary content in January 2008. Moreover, the Vocabulary content representation in this ballot has been fully revised to a more correct and robust representation. However, there was insufficient time during this cycle to propogate these changes into the tooling that generates the Model Interchange Format (MIF) reprepresentations of static models or into the generated schemas.

As in the previous cycles, balloters should note a revised organizational structure in our domain content. This revision reflects the inclusion of realm-specific content alongside our (traditional) universal-realm content. Our goal is to fully support realm-specific content that references its own, as well as universal, content. In addition, we have done away with the sub-headings that used to segregate domain content, grouping all the universal-realm content in a single category to aid in its navigation. In addition, we continue the use of a feature intended to help with the issue of ballot fatigue — revision markers. Domain documents within the ballot site have a button following the Table of Contents header to allow you to 'View' or 'Hide' the revision markers. These revision markers are available only in those domains where the content editors have elected to apply them in their Publishing databases. The code behind these markers has been modified to address a browser issue and should work correctly with all browsers that support Java script. Revision markers are color coded to indicate when document contents have been added (red underlined text), revised (blue text) or deleted (Red struck-through text). In addition to the color coding of text, a colored bar will display on the left-hand side of the text (inserted: line; changed: blue; deleted: red), enabling you to quickly scan through a document and locate those sections that have changed. Your selection will be saved as you view other documents in the ballot site; to change your view, simply click the button to toggle your selection. Please note that this functionality relies on session cookies (cookies which are maintained only while you have your browser open and are not written to your hard drive), so you must have session cookies enabled for this functionality to work predictably.

For those of you who may not have reviewed the previous ballots, a more detailed description of this ballot follows. Sincerely,

The HL7 Board

We started the Version 3 effort years ago based on the principles of modeling and technology-neutrality. We believe that this approach will make the work of HL7 "future proof", i.e., able to respond to changes in requirements and technology without loss of existing work. This project has taken longer than we imagined, but we have finally reached a release where the majority of the material is already a standard. This was the result of intense and protracted effort of hundreds of volunteers, many of whom have worked so far beyond the call of duty that we can't possibly thank them enough.

Now it is Your Turn to Help

Responding to this ballot will take some study to understand the new approach. In exchange for that effort we are sure that you will appreciate the strategic benefits. We are equally sure that you will draw from your own experience to suggest improvements and we eagerly solicit your comments. For this round we are concerned with your comments and with your vote. This is another opportunity for our members to participate in the process and we eagerly await the opportunity to fold your comments into any subsequent ballots.

Update Notification List

To keep you continually apprised of any updates or patches to this ballot site, we have instituted a special list service to which you may subscribe. You can only sign up through this web page by clicking here. On this page, you will need to sign-in (if you have a list service ID, or create one if you do not), and, then, from the list services sign-up page go to the Publishing header and select the v3ballotupdates list. Only HL7 staff are permitted to post messages to this list; this ensures that only information about what has been updated is distributed. This list is not intended to provide a forum for discussion. Discussion regarding the ballot publishing may be hosted on the Editors list.

Why Version 3?

Healthcare costs evermore dominate national economies, and Draconian measures to control cost have hampered provider effectiveness and impacted citizen satisfaction and safety. Information Technology (IT) has helped, and is on the verge of being able to help much more. Version 3 will be a key part of the contribution of IT to healthcare's reaching new levels of
  • effective and cost-efficient patient care decisions
  • safety and cost savings that come from "doing it right," in the sense of preventing avoidable errors
  • the aggregation of health information for evidence-based medicine and data-based policy
Many general IT advances create the foundation for this new capability. These include:
  • The exponential increase of processing and storage capacity described by Moore's law
  • Enhancements in user interfaces such as voice entry and smarter programs that apply knowledge to limiting required information input
  • An increasing variety of devices for personal access to, and collection of information at the point of care and at points far distant from the point of care
  • The build-out of the Internet and related standards to create a ubiquitous, inexpensive infrastructure for secure communication of information among independent entities
  • The maturing of XML and related standards to provide a means for easy-to-program, highly extensible, robust exchange of information among information systems

The New HL7 Standard

These IT advances are important enablers, but the most intractable barrier to their use in healthcare has been the lack of standards for exchanging fine-grained, highly heterogeneous, structured clinical data among information systems created by different entities using different technologies. Since its inception in 1987, HL7 Version 2 has enabled information exchange among systems created by different entities. Indeed, Version 2 is so widely used that it will not soon go away and the Board is committed to continuing to evolve it as long as there is a clear need. However, where users have used Version 2 for fine-grained, structured clinical data, they have accomplished it through substantial investments in bilateral negotiations adapting it to establish specifications for representing fine-grained, clinical knowledge. Efforts to aggregate on a larger scale, for research or public health have had the same issue.

The strength of Version 3 messaging is precisely enabling the exchange of fine-grained data without the original research and bilateral negotiations that leading-edge organizations have attempted. Furthermore, you will find that we are reaching this in a way that is as future proof as any standards effort can be.

In reading the ballots you will see that the three conceptual models that form the basis of version 3 messages: (1) The Reference Information Model (RIM), which is now an ANSI standard has evolved into a simple abstract framework which addresses the wildly heterogeneous and interlinked nature of clinical data with only six important classes. We have similarly simplified the representation of administrative data. (2) In the Domain Information Model (D-MIM) you will see how the abstract RIM is made specific to define the information elements for a domain or specialty area. (3) In the Refined Message Information Model (R-MIM) you will see how the D-MIM is refined to define the information elements of a family of messages. (4) The vocabulary model provides the tools to deal with previously intractable problems of multiple vocabularies across organizational or national boundaries.

The Hierarchical Message Description is a convenient way to organize a mass of details about the contents of specific messages, providing the most authoritative list of all the constraints and detailed semantic definitions not appropriate in the more abstract representations. Finally, in the Implementable Technology Specification you will see how this information is represented as XML Schemas.

These deliverables are the basis of our belief that the Version 3 Messaging standards will be easily extended over time to incorporate new standards, deal with unanticipated requirements and even address areas of standardization other than application-to-application messages.

XML

We have demonstrated the flexibility of this approach by incorporating an important new technology, XML, in mid project without revising our modeling methodology or content. We believe you will find XML a primary value in Version 3. Its transparent representation of complex data and its extensibility is creating widespread acceptance throughout the IT industry. It is the basis of an expansion in the market of middle-ware vendors providing support for application-to-application integration. While version 2.x has been adapted to XML, Version 3 fully supports the expressive capability of XML. It generates XML schemas with the logical information relationships and element names that directly relate to the HL7 models -- and hence to the concepts that analysts and programmers will have to grasp to relate Version 3 messages to their own information systems or to use them in new ways for Web browsing, XML repositories, etc.

As industries have taken up XML they have come to recognize that it is not a substitute for application level semantic standards. HL7 Version 3 provides that missing ingredient, so that healthcare stakeholders can optimally reach the technological benefits of XML.

Your Comments Please

In short, we believe that your review will show that HL7 Version 3 Messaging brings interoperability to a level of clinical knowledge not previously possible. This is one of the important ingredients of IT solutions to improving healthcare processes, by "smarter" bilateral user interfaces, care-giving and management decision support, evidence-based medicine and data-based policy.

Please contribute your part by giving us a thorough, honest review. Be blunt. The Board thanks you, your fellow members will thank you, and most important, the volunteers who have given so much of their recent lives to making this happen will be grateful for the recognition and meaningful feedback.