V3 Software Implementation
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René Spronk M.Sc. FHL7
Trainer / Senior Consultant
Ringholm bv
Haarlem, the Netherlands
Tel.
Fax:
+31 (0)318 589 789
+31 (0)318 548 090
eMail:
Web:
Rene.Spronk@Ringholm.com
http://www.Ringholm.com
HL7/IHE roles:
•Co-chair of the international HL7 RIMBAA Working Group
•Co-chair of various Committees, HL7 Germany, HL7 Netherlands
•Contributor to the IHE Laboratory Technical Framework
•HL7 Fellow, 2011
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2
Key Objectives



Understand some architectural approaches
and techniques for v3 Implementation
Discuss some technologies and tools
available to implement v3 specifications
Show some of the ‘best practices’ collected
by the HL7 RIMBAA Workgroup
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Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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4
01/01/2011
An Introduction
HL7 v3 Implementation –
an introduction
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Agenda – Introduction section

HL7 v3 modeling/HDF – bottom up



MIF and the origins of schema
Conformance/validation principles
RIMBAA Technology Matrix
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An introduction
HL7 v3 modeling / HDF
-bottom upSlide contents published under the Creative Commons / Attribute-Share Alike license
Source: www.ringholm.com/download/implementation_mechanics.ppt
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XML example
XML ITS
DT R1
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8
HL7 v3: Model Refinement
ITS
(serialization format
of instances)
R-MIM / SIM
Serializable Model
Refinement of
D-MIM / DIM
Domain Model
Clinical
Pharmacy
Documents
Refinement of
RIM
Stable model,
Domain agnostic
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RIM
9
RIM – Abstract Data Model
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10
Notes


Core of all information models: Data Type
specification
Behavioral (dynamic) model:


Interactions, initial/response exchanges between 2
applications
Service layer, contractual issues, -work in
progress in HL7 v3-
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11
An introduction
MIF – Model Interchange Format
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MIF

The Model Interchange Format (MIF)




a set of XML formats used to support the
storage and exchange of HL7 version 3
artefacts
the pre-publication format of HL7 v3 artefacts
used by tooling.
the formal definition of the HL7 metamodel.
MIF can be transformed into derived
forms such as UML/XMI, OWL, or XML
schema.
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13
MIF documents:




Requirements-analysis related structures.
Static model related structures.
Dynamic model related structures.
Infrastructure related structures:




including data types, and vocabulary
Structures related to testing
Conformance-related HL7 structures
Publication related structures
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14
Derived forms
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15
MIF: How Is It Defined? (1)
MIF 2.1 - June 13, 2008
A set of XML
schemas (+
Schematron):
mif-COMPLETE
mif-model-package
mif-model-static-derived
mif-model-interface
mif-model-static-flat
mif-model-conformance
mif-model-static-serialized
mif-model-staticBase
mif-model-vocabulary
mif-core-changes
mif-model-requirements
mif-model-datatype
mif-model-testing
mif-model-dynamic
mif-model-publication
mif-model-documentation
mif-model-annotationLibrary
mif-core-staticBase
mif-model-crossReference
mif-core-base
Stable
xhtml1-strict
mif-core-patterns
Beta
Draft
Core
Static
Dynamic
xhtml-lat1.ent
xml
mif-core-enumerations
Vocabulary
Data type
xhtml-special.ent
xhtml-symbol.ent
Interface
Mark-up
Other
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16
MIF: How Is It Defined? (2)

The XML schemas define the MIF language
constructs as types, with the meaning of the types
explained informally in annotations:
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17
Why MIF instead of UML?


MIF is a single unified metamodel that spans
all HL7 artifacts. The metamodel is
maintained and under the sole control of HL7.
The metamodel represents all HL7 artifacts in
a consistent fashion.
There will always be a "newer" and "better"
technology out there, but there is currently no
alternative metamodel representation that
covers all of HL7's metamodel.
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18
An introduction
ITSs and
the origins of HL7 Schema
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ITS –
Implementable Technology Specification

An ITS specifies how instances of HL7 SIMs
should be ‘transmitted’


Serialization, deserialization, encoding syntax
The most commonly used ITS is the “XML
ITS”

Alternatives: RIM serialization ITS (“RIM ITS”),
Green CDA
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20
MIF transform to
XML based ITS schemas
Repository
MIF
MIF
MIF
XSLT
R-MIM
Pubs
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XSLT
XML Schemas
MIF Example:
E_NonPersonLivingSubject
Other attributes
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MIF Header
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23
MIF classes/associations
(snippet)
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24
MIF v. XML-based ITS
 XML
provides a syntax only
 An XML based ITS defines the set of
valid XML instances for a given
message type
 no

schema can do this
Download informative schemas with the v3
Ballot Package

Normative Edition schemas as a reference
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Generated XML-Schema for
BirthPlace (snippet, XML ITS 1.1)
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XML ITS
26
An introduction
Conformance and Validation
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A “Valid” v3 instance..

Complies with the requirements as defined
by the HL7 v3 information model


Conformance indicator, cardinality, vocabulary
Complies with additional (“contractual”)
requirements

Template definitions, business rules
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28
Attribute/Association
Conformance Levels

Conformance indicator:



Optional: MAY be present,
MAY be processed, allows for nullFlavors
Required*: SHOULD be present, SHALL be supported by
sender/receiver, SHALL be sent if known, allows
nullFlavors
Mandatory yes/no:

Mandatory*: SHALL be present, SHALL be
processed/supported by sender/receiver, no nullFlavors
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29
Vocabulary: Value Sets



Attribute is linked to
Concept Domain
The concept domain is
(UV Realm)
represented by a value
set.
The value set is based
on a coding system.
Person
name: EN [0..*]
administrativeGenderCode: CE CWE <= AdministrativeGender
…
AdministrativeGender
(Concept Domain)
The gender of a person used for
administrative purposes (as opposed to
clinical gender)
IAGC Release 2
(Coding System)
(Value Set – Universal Realm)
OID 2.16.840.1.113883.19.11.1
OID 2.16.840.1.113883.19.1
M, F, UN
M, F, UN, X, B
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30
R-MIM (SIM)..
and a Template (LIM)
Notes:
•
Template model must be a valid constraint on the R-MIM
-- An instance would not be able to conform to both if the
above doesn’t hold true
•
Reminder: Clone names of classes carry no semantics (they
are irrelevant)
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31
Constraint Language

To express additional constraints



OCL, ADL, Gello
No solution has been formally adopted
Typical (OCL) example:


The Person object should have either an id or a
name
context Person

inv: id.hasContent or name.hasContent
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32
Example: „Valid“ CDA Document
1.
Validates against the published XML Schema

2.
Validates against the abstract CDA model
specification

3.
XML Schema based validation tool
Use a MIF (specification of the abstract model) based validation
tool, includes conformance and vocabulary validation
Validates against requirements / templates as
specified in implementation guides

Mostly: a XML Schematron based validation tool; could be
MIF/OCL based
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33
An introduction
RIMBAA Technology Matrix
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RIM - Abstract Data Model
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35
The RIM is “abstract”
The same “instance” of information can be shared via
different information interoperability paradigms
 E.g. lab results can be shared




via (electronic) documents (v3 Clinical Document
Architecture)
via V3 lab messages
via Web Services with v3 payloads
..or they can be imported

In a RIM Based Application (RIMBAA)
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Use of V3 artefacts
Persistence
Layer
Other
RIM
Application
Object Layer
Interoperability
Paradigms
User Interfaces
Messages
RIM-based
Documents
Other
Other
RIM-based
RIMBAA
Services
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RIMBAA Technology Matrix
RIM
Application Constrained
specific Information
Model
Model
RIM
(generic)
Model
Persistent
Object
Serialized
Representation Representation Representation
RP
RO
RS
CP
CO
CS
AP
AO
AS
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Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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39
01/01/2011
XML Serialization
About the HL7 v3 XML Schema
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Two XML-based ITSs
XML ITS 1.1
 Has been in use since the
beginnings of HL7 v3
 Based on serialization of
an R-MIM (SIM)
 XML elements names
based on clone/business
names for classes as
used in the R-MIM
 Separate schema for
each and every R-MIM
(SIM)
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RIM ITS
 New (2010)
 Based on serialization of
the RIM
 XML element names
based on the RIM core
class names.
 One single schema for all
RIM-based models; 50
classes.
XML ITS example
<component typeCode="COMP">
<commonObservationEvent classCode="OBS" moodCode="EVN”
<templateId root='2.16.840.1.113883.10.20.1.24'/>
<code code="8302-2" codeSystem="2.16.840.1.113883.6.1"
displayName="Lichaamslengte“>
<statusCode code="completed"/>
<effectiveTime value="200907011346" />
<value xsi:type="PQ" value="90" unit="cm" />
<subject typeCode="SBJ" contextControlCode="OP">
<patient classCode="PAT">
<patientPerson classCode="PSN“
determinerCode="INSTANCE">
<name>ROELOFSEN, TOM</name>
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RIM ITS example
<rim-graph xmlns="urn:hl7-org:v3-rim"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" version="0226"
xmlns:sbad=“urn:oid:2.16.840.1.113883.10.20.1.24” >
<outboundRelationship xsi:type="ActRelationship" assocName="subject"
cloneName="Subject2" contextControlCode="AN" typeCode="SUBJ"
contextConductionInd="false">
<target xsi:type="SubstanceAdministration"
classCode="SBADM" moodCode="RQO“
templates=“sbad:root” >
<id root=""/>
<code code="DRUG" codeSystem=""/>
<participation xsi:type="Participation"
contextControlCode="OP" typeCode="DIR">
<role xsi:type="Role" assocName="medication"
cloneName="Medication" classCode="ADMM">
<player xsi:type="ManufacturedMaterial“
assocName="administerableMedicine"
classCode="MMAT"
determinerCode="KIND">
<code code="" codeSystem="?"/>
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ITSs - RIMBAA Technology
Matrix
RIM
Application Constrained
specific Information
Model
Model
RIM
(generic)
Model
Persistent
Object
Serialized
Representation Representation Representation
RP
RO
RS
CP
CO
CS
AP
AO
AS
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Note:
RIM
ITS
Note:
XML
ITS
Using HL7 v3 Schemas


HL7 produces informative XML
Schema Definitions (XSD) for all v3
messages
There are no normative XML schema


(current workitem) normative schema are being
discussed
Things to understand

An XML document that satisfies
Schema validation is not necessarily a
valid HL7 v3 Message/Document
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XML ITS Schema - Abstract
Models

In v3, Element Names are derived from the
permitted structural codes




XML ITS
No meaning is lost if you strip all element names
from HL7v3 XML
<Foo classCode=“PSN”>..</Foo> is the semantic
equivalent of
<Person classCode=“PSN”>..</Person>
However, most XML tools are useless if you strip
all element names from a document.


First generation implementations will use XML element
names, later systems will be driven off the structural
vocabulary (classCode, moodCode, typeCode.. )
Model Driven Architectures / Code Generation
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XML Schema
what are schemas bad at

No ambiguous content models allowed


No conditional constraints


HL7 uses short ISO dates (without validation)
Code list validation


cannot have an element that may either have a
nullFlavour, or a set of attributes
Date+Time types are a mess


Problem for model-XML mapping (requires use of
clone class names in XML instances)
Only for small (enumerated) code lists
Friendly messages when validation fails
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XML Serialization
Serialization/Deserialization
(using XML techniques)
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Parsing and Validation
Using XML Techniques

Serialized Message to Application
Object

Streaming API



SAX, XmlReader for efficient parsing of
XML instances
Stripping out of those parts one needs only,
skipping all other content
DOM, XPath


Total control on XML processing
In memory object which represents all of
the XML contents
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Parsing and Validation
Using XML Techniques
Pros
• Many commercial
and open source
tools support XML
technologies
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Cons
• Performance
impact with heavy
processing/large
message sizes
• Every tool seems to
have a different
interpretation of the
XML specifications
Normalization
Implementation
Specific
HL7
Rules
Information
Model
HL7
HL7 v3
Message
Extended
Validation
Clinical
Repository
Message
Parsing
Application
Rules
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Schema
Validation
HL7 v3
Schema
Transformation
Using XML Techniques

Serialized Message to/from other serialized
model:

XSLT 1.1, XSLT 2.0, EXSLT

Every platform has multiple implementations of
XSLT for XML transformations
•


Saxon, .NET Framework, JAXP…
Cascade XSLT transformations to simplify and
flatten the instances
XQuery


XML Query Language for procedural XML
processing
Several XQuery implementations are avaliable,
refer to W3C XQuery home page (over 50 listed)
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Serialization
Using a template
set message ={
<patientPerson>
<id root="2.16.578.1.34.1000.1" extension=“$PAT_ID"/>
<name use="L">
<given> $PAT_FIRSTNAME</given>
<given> $PAT_MIDDLE</given>
<family> $PAT_FAMILY</family>
</name>
<administrativeGenderCode code=“$PAT_GENDER"
codeSystem="2.16.840.1.113883.5.1"/>
<birthTime value=“$PAT_BIRTHDATE"/>
</patientPerson>
}
 Simply fill in the blanks to create message


Use XPATH for inbound models
Ignorant of V3 data model and XML
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Serialization
Using a template


Use only when variability is low, when a
few messages/documents need to be
supported
Beware of exceptions:


nullFlavor instead of code
Variable has no value:


<name></name> is valid XML, but it isn’t valid
in a V3 XML instance (1)
<Act code=“” codeSystem=“1.2.3”/>
isn’t valid in a V3 XML instance
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XML Serialization
XML Based conformance/validation
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Parsing and Validation
Using XML Techniques

XML Schema Validation



HL7 provides informative schemas for first-pass
message validation
Not sufficient for full validation
Schematron, RELAX NG

Better than XSD as validating messages, but still
not widely used



no HL7-provided schematron (although could be
generated from MIF)
May be provided by the author of an
implementation guide
Validating Stylesheet

Produces “human readable” errors
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Schematron is a …




Rules-based validation language
A way to test XML documents
A way to specify and test assertions about
patterns in XML documents
A cool report generator
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Reasons to Use Schematron






Business/operating rules that other
constraint languages can’t enforce
Different requirements for different stages
of the document lifecycle
Local or temporary constraints (not in base
schema)
Unusual (but not illegal) variation
No schema
Ad hoc querying and discovery
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A Short Example Schematron

...in a CDA instance
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
Schematron
<rule context="hl7:typeId">
<assert role="error“
test="@extension='POCD_HD000040'">
ClinicalDocument.typeId (2.16.840.1.113883.2.4.6.10.35.3)
@extension SHALL have value POCD_HD000040 static
</assert>
<assert role="error" test="@root='2.16.840.1.113883.1.3'">
ClinicalDocument.typeId (2.16.840.1.113883.2.4.6.10.35.3)
@root SHALL have value 2.16.840.1.113883.1.3 static
</assert>
</rule>
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Schematron – Example
(v3 Messages)
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60
Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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61
01/01/2011
In-memory object
processing
Class Generators
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Model Driven Software
Development (MDD)
Model
Generate
Image credits: Johan den Haan, Mendix.nl
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MDD - Application Generation
Generic Software
Components
-Terminology
-Data types
Software
application
RIM
Persistence
Database
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Class-based Parsing


Class generators – XML Schema driven

Every major development platform provides tools
to generate classes from XML Schemas

E.g. JAXB, .NET Framework/Mono (XSD.EXE), XML
Beans…
Class Generators – Model driven

Model Driven Software development
environments allow classes to be generated from
(UML-) models

E.g. MARC Everest API Generator (XML ITS/RIM ITS)
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Class-Based Parsing
Using Coding Techniques
Pros
Cons
• Don’t have to learn
XML, XSD, XSLT,
XQuery…
• Use OO frameworks
• Faster processing
• Harder to build
loosely coupled
systems
• Somewhat harder to
maintain
• Bottom-up approach
might create some
level of duplication
in generated classes
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Model based code generation

Full (abstract) model specification is stored in
a model repository (RoseTree)



Abstract model is expressed as a MIF (Model
Interchange Format) file
MIF can be transformed to less expressive XML
Schema
Code generation


MIF (to alternate model representation, e.g. UML)
to code (e.g. MDHT)
XML Schema to code (e.g. JAXB xjc)
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Code Generation
MIF Based Code Generation
68
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MIF Based Code Generator

Full (abstract) model specification is stored in a
model repository (RoseTree)


Abstract model is expressed as a MIF file – including
GELLO/OCL expressions and (DCM derived)
Template definitions
Code (class) generation

MIF - the code generator has to be aware of the
structure of the MIF

UML/EMF (derived from the MIF) - the code generator
has to know UML/EMF, including the v3 specific
extensions
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MIF v. Derived model
MIF
 Normative (full) specification
of a v3 model, inclusive of
documentation
 Full validation support
 No cross-industry tools for
class generation
 MIF based class generators
are being created: MRC-HI
Everest, OHT
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Derived (e.g. UML, Schema)
 Derived (lossy)
specification of v3
model
 Cross-industry tools
for code generation
70
Target
Model
MIF
Terminology server
API + data
Vocab
MIF
Reusable
components
CMET
MIF
Datatypes
Custom code
Wrapper
MIFs
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code
Serialization
Target
Model
DSL
XML encoding/decoding
Programming Components
Code generation
Model transform
71
Data Types – custom code

Custom library with support for v3 data
types




Mostly: ISO data types, patched to support data
types R1 as well
Relationship with Terminology Server (C* data
types)
Needs custom coding: data types MIF is abstract.
Mohawk (.net) and OHT (Java) contain such
libraries

Or use datatypes.xsd as the basis for development
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72
Serialization –
XML En/DeCoding

Serialization engine


Serialize RIM structures according to HL7 rules
XML En/DeCoding


Encoding of a serialized graph
Rules as specified by the ITS (e.g. XML ITS, RIM
ITS)
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73
Code Generation
Schema Based Code Generation
74
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Schema based code
generation



Advantage: wide availability of tools
Serious disadvantage: XMl schema
language isn’t powerful enough to express
all model requirements
Disadvantage when validating templates (inmemory, not on serialized format):
Templates are expressed in MIF, there is no
Schema version.
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75
Schema's serve multiple
masters

Schema’s serve more than one purpose






design
validation
contract
code generation
those purposes often need different
Schema’s
For code generation:
+ simplicity, readability
- reuseability, composability
Slide courtesy of: Marc de Graauw
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
XML ITS
The HL7v3 Schema’s
XML ITS Example:
QUPA_IN101102UV01 Get Person Demographics Query

MCCI_MT000300UV01

COCT_MT040203UV01



COCT_MT150003UV03
COCT_MT030203UV02
MFMI_MT700711

COCT_MT090300UV01

COCT_MT150000UV02
•


COCT_MT150003UV03
COCT_MT070000UV01
•

COCT_MT150000UV02
•



COCT_MT710000UV01
COCT_MT090003


COCT_MT070000UV01

COCT_MT710000UV01
COCT_MT150003UV03
COCT_MT070000UV01
•

COCT_MT710000UV01
COCT_MT090100


COCT_MT070000UV01

COCT_MT710000UV01
COCT_MT150003UV03
..and: voc, datatypes, infrastructureRoot
MCAI_MT900001
QUPA_MT101102_V01
QUPA_MT101101_V01
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Slide courtesy of: Marc de Graauw
Remove ‘includes’ from v3
Schema’s

Schema’s should be readable





tools can solve this
but they make you dependent on the tool
Therefore: flatten the Schema’s


XML ITS
remove all includes
put included schema’s where they belong
For readability: make the Schema resemble
the instance
Readable Schema’s generate readable code!
Slide courtesy of: Marc de Graauw
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
XML ITS
SOAP
ANY
Transmission
Wrapper
ANY
Control
Wrapper
ANY
Payload
Data
Slide courtesy of: Marc de Graauw
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
XML ITS
The XML ITS HL7v3 Schema’s

Not very readable



Generated from database
Fix them with XSLT or other:






without Schema editor not practically feasible
Flatten the Schema’s
Remove unneeded datatype hierarchies
Layer the Schema’s
Replace all CMET flavors by a generic CMET flavor
Makes the Schema’s much more readable
Generates simpler code
Slide (modified) courtesy of: Marc de Graauw
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RIM ITS
RIM ITS Schema

Essentially 1 core schema with 50
classes



Generated classes will process any RIM ITS
instance
Content validation to be done within application,
not at the XML level
Additional MIF based code generation
probably required

Processing of RIM-based object trees almost
always requires knowledge of the structure of
templates (SIM, LIM)
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81
Example use-case: E-Novation
RP
Database
1.
2.
3.
RO
CO
CS
Message
Serialized messages mapped to in-memory
message objects (JAXB, code generation)
Application (business-) objects mapped to
relational database (Hibernate ORM)
Custom code: mapping of message objects to
application objects
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Example use-case: JAXB
Marshaller.marshal(payload)



There is no direct link
between
 Payload
 ControlAct
 Message
From Object(s) to DOM in 3
separate steps
From DOM to Object in 3
steps (in reverse order)
<<POJO>>
<<DOM>>
Payload
Payload
Marshaller.marshal(controlAct)
<<POJO>>
ControlAct Any
ControlAct
Marshaller.marshal(message)
<<POJO>>
Message Any
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<<DOM>>
<<DOM>>
Message
Example use-case: JAXB
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E-Novation example: message object
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Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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01/01/2011
Persistence
Overview
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Database models (Relational)
RIM
RIM or RIM-based model:
Conceptual Data Model
LDM
Logical Data Model
•Not DBMS specific, no tables, no keys
ORM – Object Relational Mapping
PDM
Physical Data Model
•DBMS specific, tables, keys
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88
Conceptual Data model - RIM

Enormous flexibility, at the cost of a very
abstract structure.


Low number of tables


makes enforcement of data integrity rules very difficult
making it necessary to rely on stored procedures and
application logic to enforce rules.
less programming work, easier to learn, easier to add new
functionality. More data in each table, need to tune queries.
Main use-case:

If you're creating a data store for ad-hoc queries,
mining and exploration of all sorts of data from all
sorts of different sources
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89
Persistence
Persisting Data Types
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Data Types

At a lower level, the data types are complex
to support.

Complex data types


Abstract data types


Helper classes, or UDTs
Specialize; or use helper classes
Collection data types

Helper classes
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91
Normalization – Helper Classes
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92
Data Type expansion – Helper
Classes
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93
Watch for “Table Explosion”..
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94
CV with R1/R2 relations
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95
Example: RIM persistence OntoReason / MD Anderson
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96
Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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97
01/01/2011
HL7 version 3
Mapping v2 to v3 (optional)
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Representation of „Reality“ in
a standard


Dynamic: a subset of all
„business cycle trigger
events“
Static: a subset of the objects
and attributes which play a
role
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99
Migration scenario



Extensively document the HL7 v2 messages
Identify the corresponding HL7 v3
interactions
Create a mapping



Syntax
Semantic: Granularity, Vocabulary
Dynamic model (trigger events)
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100
Key Step: Version 2 Message
Profiles
proprietary,
ad-hoc
documentatio
n
Version 2
Implementati
on
Site
Interfa
ce Info
Vendor
Interfa
ce Info
Messag
e
Profilin
g
(Analys
is)
Version 2 Message
Profile („Version 3
Ready“)
Registrati
on OID
v2.x
Message
Structure
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Version 3
Implementati
on
Applicatio
n Role
Use Case
Model
Vendor
Scenario
Dynamic
Definition
Interactio
n Model
Static
Definition
Message
101
„Granularity“ of v3

The dynamic model in v3 is different than in
v2: Trigger Events occur at different points
in the business process.


v3  v2.x: Multiple v3 trigger events map to a v2
event
The static v3 models are „more granular“
than v2.x


v3  v2.x: details get lost
v2.x  v3: missing information – if filled by
defaults: significant risk of faulty interpretation
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102
Concepts

Does v3 contain the same concepts as v2 ?


The RIM supports all administrative, financial and
clinical concepts as present in v2. Therefore v3 is
from a functional perspective fully backwards
compatible with v2.
There is however not a guaranteed 1-to-1 mapping
between fields or datatypes in v2 and
classes/attributes in v3.
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103
Migration scenario - revisited


Avoid using mapping as a migration scenario
If you have to rely on a translation:
 Best practice recommendation
1.
2.
3.

Extensively document the HL7 v2 messages
Identify the corresponding HL7 v3 interactions
Create a mapping (syntax, semantic)
Kludge: (as a vendor) extend HL7 v2
messages with Z-segments [missing data &
additional granularity] to allow for a translation
to v3.
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104
Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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105
01/01/2011
HL7 version 3
Implementation Tools
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Implementation Tools
(Nov.2011)

Tools that directly suport the software development process:







Tools that support software developers:



MIF based class/code generators (e.g. MDHT. Everest, JavaSIG)
MIF based database schema generator (e.g. MGRID))
MIF based UI generators
ISO Datatypes library
CTS products (e.g. Mayo Clinic's LexEVS , Apelon DTS)
Mapping tools (e.g. Open Mapping Software)
Testing tools (e.g. Instance Editor, MDHT)
Code Documentation Generators
Tools that are used by analysts/providers:


Model (static/dynamic/UIs/..) Driven application development tools (e.g.
PHI Technology)
Model Driven Documentation generators (e.g. PHI Technology)
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107
OHT (Open Health Tools)

To assemble and/or develop a
comprehensive harmonized tool suite to
enable the definition, development and
deployment of interoperable Electronic
Health Records.

http://www.openhealthtools.org/
108
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HL7 version 3
Tools: MDHT
www.cdatools.org
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MDHT (part of OHT)

Management/definition of templates
Generating Java code from CDA (CDA only)
model inclusive of templates
Generation of documentation

.net version – seeking cooperation


110
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MDHT Inputs & Outputs
Add Custom
Validations &
Constraints
Java API
(Source Code)
Domain
Model
MDHT
Validation Code
Generation
Implementation
Guide(s)
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Constraints – DSL for
Templating
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112
CDA Template Models

MDHT are currently working on
implementations of the following CDA-based
document types:







Continuity of Care Document (CCD)
IHE Content Profiles
HITSP C32 Patient Summary
Public Health Case Report (PHCR)
IHE Lab Report Document
HITSP C74 Personal Health Monitoring Report
Essential Hypertension
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
MDHT Architecture
CDA
Includes
• CDA Support
• CDA Templates
• HITSP & IHE models
HL7 Core
Includes V3 datatype
support, MIF-> UML
support, HDF
Terminology
Services
Includes support for
terminology sets
Custom Tools
Includes
• UML Table Editor
• New Project Wizards
• New CDA templates
• Property Editors
MDHT
DITA
Document
generation
EMF
Eclipse
Modeling
Framewo
rk
Includes
EMF Core,
EMF.Edit,
EMF.Codegen
&
Validation
Framework
HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
Mode
l to
Mode
l
Transfor
mation
Includes
Domain
Model to
implemen
tation
models.
Includes
generation of DITA
xml files
Document
Publishing
Includes
generating
documents using
DITA-OT
JAVA Classes
Includes generating Java source code for
models and the constraints
Validation Suite
Includes testing instances of CDA and nonCDA models.
HL7 version 3
Tools: Everest
http://everest.marc-hi.ca/
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MARC-Hi Everest Framework


Mohawk College (a Canadian university)
has created a .net API-generator based
on MIF (supports all of v3).
Java port planned for Q2 2012.
D
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116
From MIF to Code
Optimize
r
MIF
2.1.x
GPM
R
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RES
T/JS
ON
.js
C#
.DLL
HTML
.HTM
Jav
a
.JAR
XSL
/XS
D
.XSL /
.XSD
COR
Repo.
MARC-Hi Everest –
From MIF to Instance
Data Types
Generated DLL
Vocabulary
RMIM
Classes
Formatters
Application
Code
XML ITS 1.x
Data Type R1
Create
GPMR
MIF v2
No ITS?
<PRPA_IN101
2..
<id root=“”
XML ITS1.0 with DT R1
D
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UV Support

NE2008 (since GPMR 0.9.x)


NE2009 / NE2010




*_HD*.*mif files should be removed
HTML renderer works on Patched MIF files in quirks
mode
Missing Several CMET definitions in DEFN IFC file
Templating issue with several Interactions
CDAr2 (NE2010) (since GPMR 1.1.x)
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Milestones

Q4 2011 – jEverest CTP (Community Tech. Preview)




Formatters
RMIM Structures
GPMR Patches
Q1 2012 – Release Candidate 3

Everest .NET:



jEverest :


CDA Support
Datatypes R2 Support
Connectors
Q2 2012 – Release of Everest 1.0


jEverest + Everest + GPMR Bundles
Documentation for jEverest
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HL7 version 3
Tools: Instance Editor
http://hl7book.net/index.php?title=Eclipse_Instance_Editor
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Instance Editor

Instance Editor (mostly used for CDA)


This tool provides context aware editing and
interactive validation for CDA documents. The tool
includes the best available validation for the data
types.
XML editor look-and-feel
122
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Eclipse CDA Editor tool
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123
Undetected error.
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124
Overall Agenda







Introduction
XML Serialization
In memory object processing
Persistence
Mapping v2 to v3 (optional)
Implementation Tools
User Interfaces (optional)
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125
01/01/2011
HL7 version 3
User Interfaces
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User Interfaces

There are two (extreme) options:

Run time: Dynamically (at run time) generate
the UI based on a CIM/LIM-like definition


need to do some pre-formatting, otherwise the
generated layout may be quite nonsensical for
the human user
Development time: Define the UI first; bind
elements in the UI to RO/CO/AO
classes/attributes.
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127
User Interface - Development

UI integration with templates (LIM):
commonality is one of the key reasons for
using RIM

start with the generic controls, make them work,
bolt them together, less generic as you go up the
data stack.
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128
Each Observation pattern will have a UI
●
●
●
●
●
●
BL will have a label and a Yes, No answer
PQ will have a label and a number input field with a
unit behind it
CD with a valueset of <4 will have a label and list of
items as radio buttons
CD with a valueset of >=4 and <32 will have a list
CD with a valueset of >1000 will have a Google
Search
etc.
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MS CUI Clinical Noting in Forms
Guidance
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Model Driven User Interfaces
Person
name: EN [0..*]
administrativeGenderCode: CE
…
(Value Set – Universal Realm)
•HL7 version 3 has an
elaborate terminology model.
•Based on HL7 (and ISO)
data types
M, F, UN
Person Demographics
IAGC Release 2
(Coding System)
OID 2.16.840.1.113883.19.1
M, F, UN, X, B
CE data type: (code, codeSystem)
OR (nullFlavor)
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Sex:
Male
Female
Undifferentiated
Unknown
Example: UMCG
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132
Example: UMCG
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133
Example: UMCG
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134
HL7 version 3
Summary
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Source: www.ringholm.com/download/implementation_mechanics.ppt
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Recommendations
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Never rely solely on XML schema
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MIF based code generation should be used
for any non-trivial projects
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At the least, use Schematron
Tools like MDHT and Everest
Don’t rely on a generic v2->v3 mapping
Use RIM based persistence
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For use-cases which require its flexibility and
‘future-proofness’
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Recommended reading (1/3)
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http://www.ringholm.com/docs/03060_en_HL7_MIF.htm (Whitepaper/video about
MIF)
http://www.ringholm.com/docs/03100_en.htm (The RIMBAA technology matrix)
(v3 standard publication) // Foundation / Core Principles / Special topics on
Implementation and Representation
(v3 standard publication) // Foundation / Model Interchange Format
http://wiki.hl7.org/index.php?title=XML_ITS ,
http://wiki.hl7.org/index.php?title=RIM_ITS, http://wiki.hl7.org/index.php?title=ITS
http://en.wikipedia.org/wiki/Schematron (Wikipedia on Schematron)
http://www.schematron.com/overview.html (Schematron overview)
http://wiki.hl7.org/index.php?title=Migration_from_HL7_v2_to_HL7_v3
http://openmapsw.com/ (Open Mapping software toolkit)
http://wiki.hl7.org/index.php?title=Software_Implementation_of_CDA (best
Practices document: implementation of CDA)
http://wiki.hl7.org/index.php?title=MIF_based_code_generation (MIF based code
generation)
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Recommended reading (2/3)
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http://wiki.hl7.org/index.php?title=Schema_based_code_generation (Schema
based code generation)
http://www.healthintersections.com.au/?p=769 (Blog: everything you didn’t want to
know about GTS)
http://www.healthintersections.com.au/?p=707 (Blogpost: intervals [IVL_T] and
boundary imprecision)
http://www.healthintersections.com.au/?p=705 (Blogpost: what content can ED
contain?)
http://www.healthintersections.com.au/?p=592 (Blogpost: how do you put tablets
into PQ.units ?)
http://www.healthintersections.com.au/?p=257 (Blogpost: NullFlavor)
http://www.hl7.tv/Data_Types.html (Video/presentation: Datatypes R2 - what’s
changed?)
(v3 standard publication) // Foundation / Core Principles / Types / Data Type
Flavors
(v3 standard publication) // Foundation / Refinement Constraint and Localization /
Localization / Data Types Specialization Constraints
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Recommended Reading (3/3)
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http://wiki.hl7.org/index.php?title=RIM_Based_Persistence (work in progress,
contains links to other pages)
http://en.wikipedia.org/wiki/Object-relational_mapping (ORM resource)
http://sourceforge.net/search/?q=object+AND+relational+AND+mapping (ORM
resource)
http://sharptoolbox.com/Category74089b0a-1105-4389-b1db-eedf27e20cfb.aspx
(ORM resource)
http://wiki.hl7.org/index.php?title=ORM_best_practices
http://tl7.intelliware.ca/validateMessage.faces (TL7 message validator)
http://www.openhealthtools.org/
http://www.cdatools.org (MDHT)
http://everest.marc-hi.ca/ (MARC-HI Everest toolkit)
http://hl7book.net/index.php?title=Eclipse_Instance_Editor (Instance Editor)
http://support.phitechnology.it/wiki (PHI application development tools)
See http://wiki.hl7.org/index.php?title=User_Interface_for_RIMBAA_Applications
for discussion and references.
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Any Questions ?
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