Dr. Eric Fishman and Dr. Charles Jaffe, CEO of HL7, discuss how HL7 International has garnered affiliates in over 40 countries, and how the organization has become the leading global standards development organization for the sharing health information. Dr. Fishman and Dr. Jaffe discuss how HL7 International standards help physicians not just ‘use’ data, but reuse data through permanent electronic documentation, which will be more and more important as the government makes strides towards creating a National Health Information Infrastructure.
Dr. Eric Fishman: This is Dr. Eric Fishman at HIMSS10. We're speaking today with Dr. Chuck Jaffe, the Chief Executive Officer of HL7 International and Chuck, thank you very much for your time. I appreciate you taking your time here at this busy show.
Dr. Chuck Jaffe: My pleasure.
Dr. Eric Fishman: I have a number of questions for you but if I may let me start why physicians have heard about HL7 for 20 years. I know I, as an orthopedic surgeon, was on staff at the hospital and when I went to the hospital, HL7 was an important event in my life and now, with the new stimulus funding, the Meaningful Use, talk to me about HL7.
Dr. Chuck Jaffe: HL7 has been the global standard for health information for most of the last 20 years. It's widely deployed in virtually every hospital in many health care systems and is largely the lingua franca of sharing information in the U.S.
Dr. Eric Fishman: Your website says that's it's your goal to be the international standards organization. I think you're already there. I don't think that there's any other entity that's even close.
Dr. Chuck Jaffe: HL7 is used very widely around the world. We have affiliates in over 40 countries and it is the standard by which health care is exchanged in 50 plus countries.
Dr. Eric Fishman: Tell us why, as a physician, they would be interested in learning more about HL7.
Dr. Chuck Jaffe: The requirements for use of HL7 specifications are deeply embedded in the Meaningful Use requirements, the interim final rule and probably the ultimate requirements that health and human services embraces. Much like the other standards that we have that enter our life, it's only important when you don't have it. We like to think that HL7 will seamlessly provide unambiguous information without the end-user recognizing that the technology behind the electronic health record (EHR) is really present.
Dr. Eric Fishman: You made an analogy "turning on a car" and I thought that was very interesting.
Dr. Chuck Jaffe: Yes, when I step into my car and turn on the ignition, thousands of electronic and mechanical standards are invoked; I know nothing. I simply rely on the auto manufacturer to apply the standards that have been required for engineering the automobile. Likewise, we want the end-user - clinician, pharmacist, radiologist - to be able to recognize the information, to use it without pause and accept that it's the same meaning that was derived from the application is recognized by the person who needs it. The element of this that we embrace is not simply the use of data but the re-use of data. If I send you an EKG, you can read the same squiggly lines that I can but if some years hence, we want to evaluate other components of the patient's cardiac condition then having a permanent electronic document in which the tracing is embraced really is key to the process. An entire industry sprang up several years ago about prolongation of Q-T interval and we had millions of printed EKG records in which we had to re-read them for prolonged Q-T interval. In fact, had they been encoded in the HL7 standard called the annotated EKG, none of that would have been required.
Dr. Eric Fishman: It would have been taken care of beforehand I take it?
Dr. Chuck Jaffe: Yes.
Dr. Eric Fishman: And so we hear a lot about semantic interoperability. Is that an issue you'd like to address?
Dr. Chuck Jaffe: You can have what we call syntactic interoperability. That is, the sentence has grammatical sense. The fish ate blue leaves. It has no semantic sense and the purpose of interoperability at a semantic level is to ensure that the meaning is the same not just the syntax is correct.
Dr. Eric Fishman: Chuck, thank you. If you could start at the beginning now and give us a brief history of HL7 International that would be wonderful.
Dr. Chuck Jaffe: HL7 was born at the University of Pennsylvania in a small conference room almost 25 years ago. There was a very simple business case. It was the ability to get administrative data from one portion of the hospital to another. Quickly, clinical content took precedent and the adoption of HL7 as a clinical standard grew widely.
We made two promises to the end-users of HL7. One is that we would remain backwardly compatible and the other is that it would provide an opportunity for customization. Both of those have been hurdles for achieving the most well-defined forms of interoperability. As a result, about a decade ago, they created a new version of HL7. We now refer to that as Version 3. This was based on an information model, a structure vastly more complicated, the requirements much more detailed. The version 3 of HL7, while not widely adopted in the United States, is really the standard for most of the English speaking world and the greater part of Europe. In the last several years, we have adopted in the U.S. a sub-set of Version 3. We call it Clinical Document Architecture.
Dr. Eric Fishman: That's the CDA?
Dr. Chuck Jaffe: The CDA. Clinical Document Architecture ensures that the information is unalterable, verifiable, is sourced and is not able to be repudiated. For many people this means it will retain the form of a document, a complete blood count as an example. But there are other documents that we use that we really think of in a document form but are very critical to patient care. Things as simple as an admission note, a progress note or a discharge summary. We have expectations that the admission note will include the chief complaint in the patient's own words. Most other opportunities don't allow for such flexibility. The CDA is based on our reference information model to ensure that semantic interoperability does allow for persistent document and it's really the best of both worlds.
Dr. Eric Fishman: One last question if I may. We physicians have been using ICD-9 and we all hear that ICD-10 is coming down the road one of these years. Is there an interrelation between HL7 and ICD-10?
Dr. Chuck Jaffe: Just for the record, the rest of the world uses ICD-10 and they will be moving to ICD-11 about the time we get to 10. It is the oldest international health care information standard. In the context to which you're referring, HL7 is able to utilize many structured vocabularies. The College of American Pathologists had developed a vocabulary standard referred to as Snowmed CT. That's now managed internationally by a larger body headquartered in Copenhagen but we also support current procedural terminology, resource space, relative value scales, laboratory codes which go by the acronym of LOINC and other codes for other vocabularies so HL7 doesn't limit itself to one language or another.
Dr. Eric Fishman: And so HL7 could be considered to be at the apex of the pyramid of all of these standards in the various organizations that are using them?
Dr. Chuck Jaffe: Yes. Remarkably, in Hong Kong for example, they have an EHR which is able to utilize HL7 data in both English and Cantonese concurrently.
Dr. Eric Fishman: Interesting.
Dr. Chuck Jaffe: So a remarkable opportunity and that's because the data is one code for both English and Cantonese. A computer doesn't care what language it's in.
Dr. Eric Fishman: Great. Tell us a little bit more about HL7 if you'd care to.
Dr. Chuck Jaffe: HL7 has grown exponentially within the last few years because of our outreach opportunities. Not only have we focused on collaboration with other standards development organizations, but we've really leveraged that collaboration. One of our long-time ambitions was the seamless integration of patient care and clinical research data. Now in collaboration with CDISC, the Clinical Data Information Standards Consortium, we're able to pass data from a research environment to a patient care environment and back. We have an important collaboration with IHE integrating the health care enterprise for developing implementation guides so the companies that make software have a ready reference to implementing the product. And lastly, we have collaboration with international standards organizations like ISA headquartered in Geneva as well as the European standards organizations and others for whom a single reference for a world standard is really key to a global health care environment.
Dr. Eric Fishman: Chuck, it's been a pleasure.
Dr. Chuck Jaffe: Thank you.
Dr. Eric Fishman: And I think we'll be having a more detailed conversation soon.
Dr. Chuck Jaffe: Thank you.
Dr. Eric Fishman: This is Dr. Eric Fishman. We've been speaking with Dr. Chuck Jaffe, CEO of HL7 International. Thank you.