HL7 compliance – and what the standards don’t cover
Health Level 7 (HL7) standards are among the most prevalent in healthcare worldwide, streamlining healthcare interoperability, maximising patient safety, and clinical practice efficiency.
HL7 standards enable healthcare providers to access and input synchronised data within various information systems. They facilitate interoperability and ensure smooth coordination among disparate applications. HL7 standards maintain consistency across all patient records, so data is the same across all the systems, no matter the source.
By ensuring seamless data coordination, HL7 standards greatly benefit the healthcare industry foremost by optimising patient safety. They also increase clinical efficiency, prevent administrative errors, and open up opportunities for innovative technologies.
Current Health Level Seven (HL7) International Primary Standards outline the six most prevalent and requested criteria for system interoperability and integration: CCDA, CDA, CCOW, FHIR, Version 2 Product Suite, and Version 3 Product Suite.
Healthcare IT Architects are already well-familiarised with the challenges in managing healthcare interoperability while ensuring compliance.
The goal is to ensure patient safety and security while maximising efficiency. A versatility of application technologies and interface abilities must exist to support most existing and future applications and underline the value of investing time in creating a comprehensive context management solution.
Finding a solution to be compliant starts with understanding the international standards.
Current Health Level Seven (HL7) International Primary Standards outline the six most prevalent and requested criteria for system interoperability and integration: CCDA, CDA, CCOW, FHIR, Version 2 Product Suite, and Version 3 Product Suite.
When looking for a context management solution, two of these (CCOW and FHIR) and one non-HL7 de facto standard (SMART on FHIR) are highly relevant to know. Here’s a quick run-through of these three standards.
HL7 Context Management Specification (CCOW)
The Clinical Object Content Workgroup (CCOW) is an organisation that provides guidelines for communication across visual (GUI-based) applications for healthcare providers. CCOW supports secure, unfailing retrieval of patient data, as the context manager coordinates patients with their respective medical records from disparate applications. Healthcare centres typically have multiple applications to store and handle patient data, and with CCOW, the context management system synchronises all the various sources to act as a single interface.
HL7 FHIR
HL7’s standard of Fast Healthcare Interoperability Resources, Release 4, aids in collaborating medical data between healthcare practitioners, patients, and other involved members. Its two primary sections include a content prototype and stipulations on sharing these resources within real-time RESTful applications and other communication flows. In connection with the FHIR standard is the FHIRcast specification for context synchronisation. FHIRcast enables subscribers to receive notifications either through a webhook or over a WebSocket connection. FHIRcast recommends the HL7 SMART on FHIR launch protocol for both session discovery and API authentication.
SMART on FHIR
The SMART App Launch Framework allows users to launch browser-based apps from an Electronic Health Record system. The framework implements a protocol in which certain data and contextual information can be handed over from the starting application to the new application, thus enabling the newly started application to start in the correct context. SMART Health IT proposes SMART as an API (application programming interface) to transform EHRs into platforms. By combining elements from SMART and FHIR, the SMART on FHIR solution presents a possible solution for browser-based apps on standard FHIR interfaces.
Since HL7 started promoting the FHIR standard, its use has become increasingly widespread. FHIRcast and SMART on FHIR’s real-time healthcare interoperability enable access to the same clinical data without a separate context management system. FHIRcast and SMART on FHIR solutions are likely to develop for browser-based applications. SMART on FHIR based applications are already running in a range of settings.
Although FHIRcast, SMART on FHIR, and CCOW address many of the same concerns, FHIRcast and SMART on FHIR can’t substitute CCOW as its design is more rudimentary and technologically constrained. FHIRcast and SMART on FHIR are not substitutions for CCOW but are emerging solutions for a subset of the use cases a CCOW Context Manager handles.
Challenges of HL7 compliance
Adaptability and flexibility are assets of HL7 standards – but they also present significant hurdles in compliance. An intention behind the HL7 workgroup was to make the standards easy to implement so that adopting them would instantly improve interoperability at minimal cost -- within any healthcare IT system.
While HL7 standards provide a go-to guideline for accessing and communicating patient data, the flexibility inherent in its implementation has resulted in a wide variety of ways healthcare organisations adhere to the standards.
The comprehensive and evolving nature of HL7 standards provides extensive coverage and innovations that keep up with the ever-changing technologies of healthcare interoperability. Though HL7 versions 2 and 3 deliver a host of advantages with their improvements and additional features, it decreases the uniformity of the standard since healthcare organisations all use different versions.
HL7 standards provide a consistent framework for data exchange, but the flexibility in implementation leads to non-standardisation in usage. This non-standardisation comes from a lack of uniform protocol in associated areas of interoperability, including how healthcare workers handle relevant data or communicate sensitive information with other healthcare workers and patients.
Beyond the standards - what HL7 doesn’t cover
The HL7 International Standards provide necessary regulations within healthcare interoperability. The HL7 organisation develops newer versions and additional standards on an ongoing basis to meet international healthcare systems’ needs as technology advances.
However, in the vast arena of context management within healthcare interoperability, there are still many gaps that can result in serious risks for patient safety and confidentiality and dramatically decrease productivity. Perhaps the greatest danger would be the mix-up of a patient’s data, whether within one patient’s records or with another patient’s data, that could have fatal consequences.
An associated issue is a potential breach of confidentiality and subsequent violation of HIPAA or GDPR. In the face of these daunting problems, the need for a comprehensive and compliant context management system is clear.
The next step is becoming aware of a solution that complies with HL7 and HL7 CCOW standards, is already up and running, and has proven successful over time. In addition to this, a SMART on FHIR and FHIRcast compatible system will ensure it is a permanent context management solution that can withstand the rapid changes of modern technology.
A solution to HL7 compliance hurdles
The flexibility and adaptability of HL7 standards certainly grant freedom and ease of use, but a downside is that they also create gaps. It becomes more difficult to prevent glitches and oversights within these gaps, which can result in drastic consequences. With broad variation across healthcare applications, that is where a compliant context manager really comes in handy since it ensures seamless and efficient communication between disparate applications within a system – no matter what version of HL7 standards it may use.
Although HL7 adopted CCOW standards in 1998, most applications do not fully support CCOW, and some are entirely non-compliant. As a result, it is essential to include these partial and non-CCOW-compliant applications for comprehensive integration of a desktop healthcare IT suite. A context manager must enable CCOW compliance across all three applications for seamless communication in the context sharing session.
For example, perhaps a hospital is using an older CCOW standard. A capable context manager will be able to handle this type of application, as well as newer CCOW and even non-CCOW applications. In addition, CCOW-compliant applications can participate in a context sharing session with a SMART on FHIR or FHIRcast-based application. It also keeps pace with technological advancements with several newer CCOW mappings, such as JSON/RPC and gRPC.
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