HL7, XBRL, etc.
David vun Kannon
Rational Exuberance
Agenda
• What is XBRL
• What is HL7
• Healthcare Taxonomies
• Opportunities
What is XBRL?
• The language of facts
• The instance document
• What is the meaning of 7?
• The language of concepts
• The taxonomy documents
• The importance of extensibility
XBRL is…
• Not just for financial data
• Already widely adopted
• Death and taxes
• SBR (NL, AU) - XBRL is adaptable to single payer, multi payer regimes
What is HL7?
• Long running effort at data interoperability
• Kaiser Permanente leadership
• Introduction to the Reference Implementation Model
• (following slide)
XBRL and HL7 comparison
• HL7 ‘act’ = XBRL ‘fact’
• Measureable event taking place at a defined time
• Entities
• XBRL – one primary entity
• HL7 – multiples entities
• HL7 – capturing the entire bundle of related objects and their
important facets
• XBRL – capturing individual aspects that can be isolated and
considered separately
Can XBRL be used to represent HL7 data?
• Qualified yes…
• <treatmentEvent>7</treatmentEvent>
• <context>
• <period>…</period>
• <entity schema=“GUID” identifier=“guidOfPatient”/>
• <scenario>
• All other entities captured as dimensional data
• </scenario>
• </context>
Comparison continued…
• All HL7 code lists and enumerations become XBRL taxonomies
What HL7 is missing
• Underspecified financial data
• GL level of detail/connectivity
• Even if health record was not XBRL,
XBRL and XBRL GL should be used
here!
Healthcare Taxonomies
• The best thing about standards is that there are so many of them…
• World Health Organization
• ICD – International Classification of Diseases
• CMS
• Medicare specialty
• Healthcare Provider Taxonomy
ICD-10
• Marked up in ClaML – Classification Markup Language
•
<Class code="A00" kind="category">
•
<Meta name="MortBCode" value="001"/>
•
<Meta name="MortL4Code" value="4-002"/>
•
<Meta name="MortL3Code" value="3-003"/>
•
<Meta name="MortL2Code" value="2-001"/>
•
<Meta name="MortL1Code" value="1-002"/>
•
<SuperClass code="A00-A09"/>
•
<SubClass code="A00.0"/>
•
<SubClass code="A00.1"/>
•
<SubClass code="A00.9"/>
•
<Rubric id="D0000003" kind="preferred">
•
<Label xml:lang="en" xml:space="default">Cholera</Label>
•
•
</Rubric>
</Class>
<Rubric id="id-SRFSFto-be-added-later-1249392569719-1"
kind="inclusion">
<Label xml:lang="en" xml:space="default">Use additional code,
<Reference class="in brackets" usage="dagger">E51.2</Reference><Reference class="in
brackets" usage="aster">G32.8</Reference>, if desired, when associated with
Wernicke’s disease or syndrome.</Label>
</Rubric>
<Rubric id="id-to-be-added-later-1210506823253-1503" kind="exclusion">
<Label xml:lang="en" xml:space="default">nonalcoholic Korsakov
psychosis or syndrome<Reference class="in brackets">F04</Reference></Label>
</Rubric>
</ModifierClass>
<ModifierClass code=".7" modifier="S05F10_4">
<SuperClass code="S05F10_4"/>
<Rubric id="D0004412" kind="preferred">
<Label xml:lang="en" xml:space="default">Residual and lateonset psychotic disorder</Label>
</Rubric>
<Rubric id="id-to-be-added-later-1210506823253-1504"
kind="definition">
<Label xml:lang="en" xml:space="default">
<Para>A disorder in which alcohol- or psychoactive
substance-induced changes of cognition, affect,
ClaML features
• Much more about marking up text for presentation
• Single document for labels, references, cross-references, etc.
• DTD based
• Not many programs can read ClaML
• ICD
• Huge range of concepts in a single ICD taxonomy
CMS taxonomies
• Not available for free!
Status Active
Code 207RC0000X
Type Level III Area of Specialization
Cardiovascular Disease
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source]
Additional Resources: American Board of Internal Medicine, http://www.abim.org/.
American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification
Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine.
Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.
Opportunities
• No single data standard
• Taxonomy data not stored for easy edits
• Not extensible for new diseases, procedures, devices, etc.
• Not multi-lingual
• Hard to integrate multiple sources of data
• Not free
• XBRL can help!
Final Thoughts
• HL7 – instance data
• ClaML – taxonomy data
• XBRL – instance _and_ taxonomy data
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Two languages designed to work together
Can bridge operational and financial data
Can even represent the control environment
Can tie to CSR, broader governance
Global standard