Friday, November 25, 2005

Misleading Claims regarding HL7 and EHR

As an example under the heading "HL7 and EHR", consider the document entitled "HL7 EHR System Functional Model and Standard: Draft Standard for Trial Use" (see also the revised version here). This document does not, in spite of its title, contain a functional model for an EHR system. Rather, it is merely specification of requirements - a profile of what would be needed to create such a functional model.

To call something a "model" is to suggest that it belongs on the solution side of the fence, rather than on the side of problem description, which is where these functional specifications belong. There is nothing in these specifications which provides information about how an EHR system could be built, only information about what it might be required to do, in the specific US-case.

In fact, the main intention of this work was not as requirements for building systems for this more technical requirements are needed, like ISO 18308. Rather it is intended as a checklist for system procurers to determine whether a given product satisfied some particular functional profile. It was designed as a way of a) comparing systems and b) determining system compliance.

We suspect, however, that the very title of the mentioned document has led to misleading assumptions. Thus the US Department of Health and Human Services (HHS) published a report on national health IT developments in 2004 containing the statement that:

  • "With HHS participation, HL7 has also created a functional model and standards for electronic health records."
We would be pleased to see HL7's "standard for electronic health records".

The Australia HealthConnect Clinical Information Project (CIP) considered the RIM in a report which came to the following conclusions [3]:

adopting HL7 RIM as a foundation for representing all HealthConnect EHR concepts will:

  • Significantly increase the complexity of concept representation;

  • Entail considerable burden upon HealthConnect staff to map clinical concepts to the RIM;

and

  • Likely lead to confusion in communication with HealthConnect stakeholders who are not well versed in HL7 concepts and methodologies.

HealthConnect (Australia). Clinical Information Project Phase 1 Report, PART A Stream 1: Clinical Information Framework. 2004.

1 comment:

Sam Heard said...

Valid criticism - but this document is in a different space.
This is valid criticism of the name. This standardisation effort is the first that I know of catering for the 'demand-side' of the health industry and as such might appear a little contrived to system developers.

It has features of a model - the functional features and profile methodology, but I accept that this is not the traditional IT use of the word.

It would be fair to say that the whole effort has involved many people with little IT experience and this is one of its strengths - getting procurement descriptions standardised.
Sam Heard, Former Chair EHR TC, HL7