Killdara Corporation
Health Data Courier™
Release 1.2
Interoperability Specification
Our work in refining the electronic information healthcare standard in non-proprietary; therefore we invite your
feedback by posting comments on http://www/egroups.com/invite/cistern. For further information please contact Mary
Ann Juurlink at (613) 256-8685 x227, email juurlink@killdara.com
About Killdara
There are very few technologies that will have a greater impact on healthcare management than the
integration of electronic patient records. A system for secure and seamless sharing of records would
obviously provide compelling benefits to patients – through increased speed and accuracy – and would
enable tremendous economies for the healthcare facility.
Killdara Corporation has introduced a groundbreaking healthcare integration device, the Health Data
Courier, a secure and intelligent data-sharing product for clinical applications that can be quickly and
economically built out to all of a health-care facility’s operating units and business partners. Moreover,
we at Killdara are committed to implementing the most widely used standards including:



HL7 (Health Level Seven), an application protocol for electronic data exchange in healthcare
environments;
XML (eXtensible Markup Language), a common approach to data type definition (DTDs), which
will allow healthcare facilities to electronically exchange patient records without the need to
manually map each data field; and
PKI (Public Key Infrastructure), a widely supported security protocol that has been recognized by
HIPAA (Health Insurance Portability Accountability Act) and that has been broadly adopted by
national healthcare organizations.
But our goal goes beyond using existing standards and maintaining a non-proprietary position. Killdara is
also working hard to further these standards, to produce commercially functional and friendly DTD’s and
to promote conformance within the Healthcare Industry.
Standard Conformance
Historically HL7 has been backwards compatible in order to encourage the uptake of the standard. While
the current version (HL7 V2.x) addresses immediate point-to-point interoperability needs, V3.0 (which is
currently work in progress) will be based on an object oriented domain analysis of the clinical, mostly
hospital-based, environment where the applications must interoperate. In anticipation of V3.0, we have
incorporated concepts such as: unambiguous message specification, conformance testing, and a more
usable message encoding scheme (XML) in our transition V2.x Interoperability Specification.
HL7 conformance for Version 2.x is based on clearly documented message profile. A message profile
represents an implementable message definition in which optionality and standard components are
clarified. Vendors and clinical institutions use the their specific data requirements to derive these
message profiles. The HL7 Conformance Special Interest Group (SIG), based on earlier developments
from the Andover Working Group, has balloted a specification for the documentation format of these
profiles. The XML dtds can play a very important role for describing the message profile and for building
XML encoded instances of the message.
Objectives
This document will show how the HDCourier can solve the concrete data exchange needs of our clients.
In the following scenario messages originate with one healthcare partner using a typical data
management system. The HDCourier translates the message in to an XML format (using standard DTDs),
applies public key encryption and then passes it across the Internet to the partner's system. At the
receiving end the HDCourier decrypts the message and parses the XML so that it can be acted upon.
This creates a seamless workflow between healthcare facilities without requiring drastic changes to the
business logic of each partner.
A sample of the HL7 2.x and XML encoding of the messages is attached along with diagrams that outline
the data model.
Scenario
A patient is referred by his primary care physician (GP) to the community hospital because of unusual
chest pain. The patient is registered (ADT^A04) by the attending medical doctor (MD) who will then order
a diagnostic study (lab order) from the remote laboratory facility (ORM^O01). The laboratory is off site in
the community. When the order is received by the laboratory, a confirmation (ORR^O02) will
automatically be sent to the Community Hospital’s clinical information system. If there are problems with
the order, they will be resolved even before the sample gets into the hands of the lab technician. The
blood sample is sent to the laboratory facility and the order is electronically processed to ensure the
quality of the information. The Community Hospital provides both the demographics of the patient
(including allergy information) and the order information (including specific test identifiers) using XML
encoded HL7 messages. When the laboratory results are available, the laboratory system sends them to
the community Hospital and to the referring GP.
Description
A registration event (ADT^A04) signals that a patient has arrived or checked in but is not assigned a bed.
Upon receiving the registration information the clinical information systems places a new Diagnostic
Study Order for the patient (ORM^O01). The Laboratory System will confirm that it has received the
order and that it can complete the request (the ORR^O02). When the results are available an unsolicited
mode of transmitting the observation results is broadcast to appropriate departments.
Actors
1. Hospital Registration System -- is responsible for notifying all interested Information Systems a
patient has been registered.
2. Clinical Information System -- is responsible for all departmental operation and provides the services
required.
3. Laboratory System – is responsible for acknowledging the clinical order and to broadcast, according
to application rules, unsolicited results when available.
Preconditions
There are preconditions for each event:
 ADT^A04: the patient is ready for clinical attention supplying demographic information.
 ORM^O01: the clinical information system authorizes and places a Diagnostic Study Order.
 ORR^O02: the laboratory system receives the order.
 ORU^R01: the laboratory has fulfilled the request and transmits the results.
Flow of Events
1. A patient is registered into the Hospital Registration System
2. The patient has outpatient status or emergency admission.
3. The clinical information system sends an order notification according to business rules.
4. The laboratory system sends an order confirmation, which indicates, based on the information
provided in the order that the laboratory can complete the order.
5. Using the unsolicited mode, the laboratory system returns the value of an observation as soon as it is
available.
Post Conditions
There are post conditions for each event:
 ADT^A04: The patient is registered and the clinical information system is notified.
 ORM^O01: The laboratory system is notified of a new Diagnostic Study Order
 ORR^O02: The clinical information system is notified that the laboratory is either able to accept,
unable to accept, cancels, or unable to cancel the new Diagnostic Study
 ORU^R01: The laboratory system displayed the results to the users as indicated.
Hospital
Registration
System
Clinical
Information
System
Remote
Physician's
Office
Laboratory
System
Patient
Registration
(ADT^A04)
Patient
Registration
(ADT^A04)
New Diagnostic
Study Order
(ORM^O01)
Order Accepted
(ORR^O02)
Lab Results
(ORU^R01)
Lab Results
(ORU^R01)
Sample Patient Registration Message
Ascii (ER7) encoding:
MSH|^~\&|||HBOC||CERNER||ADT^A04|41834979147914197|P|2.2|
EVN|A01|20001001120212|
PID|||0281755||SMITH^JOHN^FITZGERALD|19451206|M||||||||459832183|23245-4548|
NK1|1|SMITH^LAURA^MARY|12 River Street^Ap. 2^New
York^NY^23214^USA|12434
^SPOUSE^ISO|212-555-7873|
PV1||O|||||523422241^KRISHNASWAMI^PAVAN|999722241^JONES^JENNY|67676090^
RAMIREZ^PAUL^F|||||OUTPATIENT||||444244329|
PV2|||^Chest Pain|
AL1|1|^Pennicillin||^Severe|
XML encoding:
<RegisterPatient>
<MessageHeader>
<SendingApplication>HBOC</SendingApplication>
<ReceivingApplication>CERNER</ReceivingApplication>
<MessageType>ADT^A04</MessageType>
<MessageControlID>41834979147914197</MessageControlID >
<ProcessingID>P</ProcessingID>
<VersionID>2.2</VersionID>
<AcceptAcknowledgementType>NE</AcceptAcknowledgementType>
<ApplicationAcknowledgementType>NE </ApplicationAcknowledgementType>
</MessageHeader>
<EventType>
<EventTypeCode>A04</EventTypeCode>
<DateTimeOfEvent>20001001120212</DateTimeOfEvent>
</EventType>
<PatientDemographics>
<PatientInternalID>004-23-5669</PatientInternalID>
<PatientName><FamilyName>SMITH</FamilyName>
<GivenName>JOHN</GivenName>
<MiddleName>FITZGERALD</MiddleName>
</PatientName>
<DateOfBirth>19451206</DateOfBirth>
<Sex>M</Sex>
<PatientAccountNumber>459832183</PatientAccountNumber>
<SSNNumberPatient>232-45-4548</SSNNumberPatient>
<NextOfKin>
<SetIDNextOfKinAssociatedParties>1</SetIDNextOfKinAssociatedParties>
<Name>
<FamilyName>SMITH</FamilyName>
<GivenName>LAURA</GivenName>
<MiddleName>MARY</MiddleName>
</Name>
<Relationship>
<Identifier>12434</Identifier><Text_Value>SPOUSE</Text_Value>
<NameOfCodingSystem>ISO</NameOfCodingSystem></Relationship>
<Address>
<StreetAddress>12 River Street</StreetAddress>
<OtherDesignation>Ap. 23</OtherDesignation>
<City>New York</City>
<StateOrProvince>NY</StateOrProvince>
<ZipOrPostalCode>23214</ZipOrPostalCode>
<Country>USA</Country>
</Address>
<HomePhoneNumber>212-555-7873</HomePhoneNumber>
</NextOfKin>
</PatientDemographics>
<AdmitVisitInfo>
<PatientClass>O</PatientClass>
<AttendingDoctor>
<IDNumber>523422241</IDNumber>
<FamilyName>Krishnaswami</FamilyName>
<GivenName>Pavan</GivenName>
<MiddleInitialOrName>Krishnan</MiddleInitialOrName>
<Suffix>MD</Suffix>
</AttendingDoctor>
<ReferringDoctor>
<IDNumber>999722241</IDNumber>
<FamilyName>Jones</FamilyName>
<GivenName>Jenny</GivenName>
<MiddleInitialOrName>M</MiddleInitialOrName>
<Suffix>MD</Suffix>
</ReferringDoctor>
<ConsultingDoctor>
<IDNumber>67676090</IDNumber>
<FamilyName>Ramirez</FamilyName>
<GivenName>Paul</GivenName>
<MiddleInitialOrName>F</MiddleInitialOrName>
</ConsultingDoctor>
<AmbulatoryStatus>OUTPATIENT</AmbulatoryStatus>
<VisitNumber>444244329</VisitNumber>
</AdmitVisitInfo>
<MoreAdmitVisitInfo>
<AdmitReason>
<Text_Value>Chest Pain</Text_Value></AdmitReason>
<AllergyInfo>
<SetIDAllergy>1</SetIDAllergy>
<AllergyCodeMnemonicDescription>
<Text_Value>Penicillin</Text_Value>
</AllergyCodeMnemonicDescription>
<AllergySeverity><Text_Value>Severe</Text_Value></AllergySeverity>
</AllergyInfo>
</MoreAdmitVisitInfo>
</RegisterPatient>