ประสบการณ์ Health Level Seven : HL7 นพ.บดินทร์ ทรัพย์สมบูรณ์ นพ.ทนงชัย สิริอภิสิทธิ์ คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล 20 ตุลาคม 2549
ระบบสารสนเทศโรงพยาบาล (HIS) ปัญหา (Problems) ความต้องการ (Requirements) ระบบหลายระบบ Best-of-Breed กระจายระบบ Decentralized ระบบใหญ่อันเดียว
Computerized patient record Integrated HIS External services Internet External laboratories Community pharmacies Knowledge bases HL7 Support services Radiology HTTP FTP SMTP XML NCPDP DICOM & HL7 HL7 Hospital pharmacy Pharmacy benefit manager HL7 Hospital labs CPR Computerized patient record HL7 Payers E1384/E1391 Instruments Laboratory instruments Physiological monitors ECG monitor IV pump Ventilator X12N E1467 HL7 Billing P1073 HL7 HL7 HL7 Bedside computer Order-entry Charting Admission Transfer Discharge P1073 Clinical recordkeeping Administrative recordkeeping (Source: OTA, 1995)
Workflow 1. ลงทะเบียนผู้ป่วย 2. พบแพทย์ 3. แพทย์ส่งตรวจ Lab 5. รายงานผล 6. แพทย์วินิจฉัยและสั่งการรักษา 7. ผู้ป่วยชำระค่ารักษา 8. นัดหมายครั้งหน้า EMR CPOE LIS Auto mate Billing Appt ment
การเชื่อมต่อระบบ Workflow Dependency (เหตุการณ์อะไรมาก่อนมาทีหลัง) ลงทะเบียนผู้ป่วย แพทย์ส่งตรวจ Lab ข้อมูลผู้ป่วย สั่งการรักษา รายงานผล ตรวจ Lab
Messaging Communication Engine Listen & Talk Message Engine Network HTML, HL7, X.500 PC Client Database Engine Oracle, MS-SQL, MySQL Server
จำนวนการเชื่อมต่อ : Proprietary
จำนวนการเชื่อมต่อ : Standard HL7 HL7 HL7
Interface : N-1 v.s. 1 LIS OPD MRS IPD LIS OPD MRS IPD HL7
รูปแบบและความหมาย 198 Mr. X Paracet 250 mg No Name Drug Dosage UOM Doctor A ordered “Give Paracet 250 mg to Mr. X” Flat File Paracet, 250, mg, Oral, Mr. X Medication | Mr. X | Paracet | 250 | mg No Name Drug Dosage UOM 198 Mr. X Paracet 250 mg Database <name> Mr. X </name> <drug> Paracet <drug> <dosage> 250 </dose> <uom> mg </uom> XML
Format v.s. Content Memo To From Date Subject Body Mary John 1 Jul 2001 Project X will begin on 20 Jul 2001. John Dee
XML-Based Memo <?xml version="1.0" standalone="no" encoding="UTF-8"?> <!DOCTYPE memo SYSTEM http://www.site.com/dtds/memo.dtd> <memo> <to>Mary</to> <from>John</from> <date>1 July 2001</date> <subject>Project X</subject> <body> Project X will begin on 20 July 2000 John Dee </body> </memo>
ข้อมูลและโครงสร้าง <name> Mr. X </name> Paracet, 250, mg, Oral, Mr. X <name> Mr. X </name> <drug> Paracet <drug> <dosage> 250 </dose> <uom> mg </uom> Flat File XML
LIS เดิม : Flat File LIS Order Medical Record HIS Result ERP Billing Lab Result LIS Lab Order Order On-Line Medical Record HIS Result ERP Billing
HL7 2.X Messaging : Trigger Events Admit notification (A01) Transfer (A02) Visit notification (A04) Update patient information (A08) Observation Order (O01) Observation Report (R01) Billing Information HIS to LIS LIS to HIS
LIS ใหม่ : HL7 Interface LIS Web Report HL7 Engine Medical Record HL7 Lab Order Web Report HL7 MSG LIS HL7 MSG HL7 Engine Lab Result Medical Record HL7 DB HL7 Interface HIS LIS Staging ERP Billing
HL7 Data Exchange : Examples 1. HIS -> LIS : A lab test is ordered for patient JOHN SMITH in HIS MSH|^~\&|HIS|SIRIRAJ|LIS|SIRIRAJ|200411200952||ORM^O01|HIS00011|P|2.3<cr> PID|||50002|888-9898|^JOHN SMITH ||19760715|M|||100,JALAN MERAK 3^BANDAR PUCHONG JAYA^SELANGOR^^47200||(03)80751150|(03)78049275||||||<cr> ORC|NW|||||||||||||||||<cr> OBR|1|224488||PLT^Platelet Count|R|200411200950||||||||||101^CHUA MING HUAT|| OPD^Outpatient Department||||||||||<cr> 2. HCLAB -> HIS: LIS acknowledge the receipt of the order MSH|^~\&|LIS|SIRIRAJ|HIS|SIRIRAJ|2004011200954||ACK|HCL10020|P|2.3<cr> MSA|AA|HIS00011||||<cr> 3. LIS -> HIS: Lab Result for patient JOHN SMITH is reported in LIS MSH|^~\&|LIS|SIRIRAJ|HIS|SIRIRAJ|200411201032||ORU^R01|HCL10021|P|2.3<cr> PID|||50002|888-9898|^JOHN SMITH||19760715|M||| 100,JALAN MERAK 3^BANDAR PUCHONG JAYA^SELANGOR^^47200 ||(03)80751150|(03)78049275||||||<cr> OBR|1|224488||PLT^Platelet Count|R|200411200950||||||||||101^CHUA MING HUAT|| OPD^Outpatient Department||||||||||<cr> OBX|1|ST|PLT^Platelet Count||301|10^9/L|150-400|N|||F|||200411201030| |TLT^TAN LEE TING<cr> 4. HIS -> LIS: HIS acknowledge the receipt of the test result MSH|^~\&|HIS|SIRIRAJ|LIS|SIRIRAJ|2004011201034||ACK|HCL10020|P|2.3<cr> MSA|AA|HCL10021||||<cr>
HL7 Message Structure Message Type Segment Name ADT Admission, Discharge and Transfer MSH Message Header PID Patient Identification PV1 Patient Visit ORM General Order Message MSH Message Header PID Patient Identification PV1 Patient Visit ORC Common Order Segment OBR Observation Order Segment NTE Notes and comments Segment ACK General Acknowledgment MSH Message Header MSA Message Acknowledgment Segment
Message Segment Header (MSH) The Message Segment Header (MSH) indicates the beginning of a HL7 message. The following described those information required in this segment. Sending Application ID (Optional) Sending Site ID (Optional) Receiving Application ID (Optional) Receiving Site ID (Optional) MSH|^~\&|HIS|GLENEAGLE|SILIS|SIRIRAJ|200501271126||ADT^A01|HIS00001|P|2.3<cr> Version ID (Required) Process ID (Required) Message Control ID (Required) Encoding parameter (Required) Message Type (Required) Date/Time of message (Optional) MSH field definitions
Admit Notification : Event A01 MSH|^~\&|HIS|GLENEAGLE|LIS|SIRIRAJ|200501271123||ADT^A01|HIS00001|P|2.3<cr> PID|||50002|888-9898|^JOHN SMITH||19760715|M|||100,JALAN MERAK 3^BANDAR PUCHONG JAYA^SELANGOR^^47200||(03)80751150|(03)78049275||||||<cr> PV1||I|WARD1^ROOM1^BED1||||101^CHUA MING HUAT||||||||||||20050100233|<cr> Above message can be described as follow. Patient JOHN SMITH was admitted on January 27,2005 at 11:23am by doctor CHUA MING HUAT (#101). He has been assigned to room1,bed1 on ward1. The message was sent from system HIS at the GLENEAGLE hospital to system LIS, also at the SIRIRAJ hospital. Patient Demographic PID = 50001 Name = JOHN SMITH IC No = 888-8888 Date of Birth = 1971/06/15 Sex = M Address = 100 JALAN MERAK 3, BANDAR PUCHONG JAYA, SELANGOR 47200 Post Code = 0600
HL 7 Version 3 : Standardize Information Exchange / Interface Business process Integration Reference Information Model (RIM) Information exchange + Business process integration Object-oriented paradigm + XML Clinical Document Architecture (CDA)