Anytime we want to communicate with another person, the first step is to find a language we both understand. If we don’t speak the same language, we need a translator.
In the world of health data exchange, HL7 is a method of translating, or helping people speak the same language.
The Mirth appliance (appliance really means a server with special software installed on it) is the way we can deliver messages in HL7 to other places.
If a public health agency collects data about you and a hospital collects data about you, they both collect some common information.
They each also collect information that is unique to the services and care they provide you.
Even when the services and care are similar, they may each talk about them using different languages/terminologies.
The common shared language is HL7.
So people from native HL7 land, are “HL7-ites” right? Okay, if you didn’t giggle at that it’s okay.
Seriously though, HL7 is an agreed upon way to communicate between entities that provide healthcare and who don’t necessarily use the same healthcare nomenclature.
Health Level 7 (HL7) started in 1987. It is a non-profit organization that was accredited by the American National Standards Institute (ANSI).
HL7 specifies how information is exchanged, and the file formats for healthcare information.
For example, there are HL7 specs for Admission Records, Discharge Summary and Continuity of Care Document (CCD).
We all know the Omaha System right? The Omaha System is utilized by our clients to document the care they provide to patients.
Hospitals that see those same patients may not use the Omaha System to describe the care they give.
The hospitals need to know and understand what care the Public Health Department provided and vice versa.
HL7 gives instructions on how to share information about a client’s health, and the care provided, between the hospital and the public health agency.
HL7 says “put all a client’s medications here on a CCD.” It also says put problem information (Omaha System problems or other nomenclature) “here” on a CCD.
This allows public health clinicians and hospital clinicians to look at a CCD and find the information they want in a place they expect it.
A CCD can be electronic, meaning it’s a file of human readable information that is not very pretty.
Below is part of a CCD for a person that lives in Alabama, takes Aspirin and has reported chest pain.
In the raw HL7 context, it looks like this:
That same information though, can then be put into an even easier to read format like a PDF.
See the example below of a person from Minnesota who takes several medications and has been seen for several problems. This is much nicer.
That is what the Nightingale Notes EHR software will be able to do.
A CCD can be generated for a client in a PDF.
Then, in Minnesota, where the data exchange project is nearing its end, those agencies in the grant will be able to have information about a client sent to the HIE in MN at the end of December, in the first, less pretty, but better for computers to read format.
The second part of this feature will only be available to grant partners in Minnesota.
We have to work with each state’s HIE to establish communications and iron out a lot of technical details to make this happen.
We are working with North Dakota to do the same by March of next year. Of course, this is a simplistic overview.
Now, just a bit more about the Mirth appliance. It does more than just deliver messages for us.
It also helps our data get through to other places that have unique “doorways.”
Some places we want to send data might only accept it through a TCP/IP protocol, or a Web Service, for example.
Mirth helps us take our data and get through those doorways. Mirth also helps Nightingale Notes by managing the messages going back and forth.
Imagine 835 messages, Immunization records, CCDs, all being sent to us at the same time from lots of other places.
Mirth is like the night security guard, only it’s on duty all the time.
Mirth watches the messages, makes sure they are formatted right, checks for security credentials to see if they should get through our door, and sort of keeps them all in line.