Health Level Seven is anot-for-profit standard developing organization that is accredited by the ANSI(American National Standards Institute). Health Level Seven is responsible forcreating the standards that are known as HL7 standards. These are a set of standards for the “exchange,integration, sharing, and retrieval of electronic health information”1.The vision and mission of HL7 is focused on providing standards that encourageand enforce the secure access and exchange of health data. The standards aremeant to do this in a way that enhances and encourages global health datainteroperability. The level seven of HL7 refers to the seventh level of theInternational Organization for Standardization (ISO) seven-layer communicationsmodel for Open Systems Interconnection (OSI).
This seventh level is known asthe application level, the OSI model refers to network architecture.There are seven sections of the HL7standards, these are the Primary Standards, Foundational Standards, Clinicaland Administrative Domains, EHR Profiles, Implementation Guides, Rules andReferences, and Education and Awareness. Primary Standards is the section thatrefers to the most popular standards that are integral for system integrations.The Foundational Standards section defines the tools used to create thestandards and the technology that is to be regulated by HL7. The third sectionof Clinical and Administrative Domains is responsible for regulating themessaging and document standards for the clinical domain. The implementation ofsection three is implemented after the implementation of section one (primarystandards) has been established. Section 4, EHR Profiles, manages theinformation aspects of the Electronic Health Record systems. There are severalspecifications in this category that work to manage the construct and transferof electronic health records.
The fifth section of HL7 is ImplementationGuides, was mainly created as a support section to be used with an existing standard.The information within this section provides supplemental support foroverarching standards. Section 6, Rules and References, provides Technical Specifications,programming structures, and guidelines for software and standards development.The final section of Education & Awareness focuses on supplementing theunderstanding and adoption of the HL7 standards.
1The domain of influence HL7 isattempting to regulate is diverse and large. For this reason, while it may soundlike HL7 is a set of standards, it is more like an accumulation of a variety ofstandards. There are types of HL7 standards like FHIR and HQMF, and more. Someexamples to be further elaborated on are FHIR and HL7 Version 2. The HL7 FHIRis focused on combining existing HL7 standards with web technologies to supportthe efficient creation and implementation of interoperable healthcareapplications.
The HL7 version 2 focuses on the messaging standard for theexchange of patient care and clinical information. Version 2 has been publishedas an ISO standard since 2009. The CDA is another HL7 standard that is approvedby the ISO as an exchange model for clinical documents. It focuses on being animplementation guide to meet the meaningful use regulations that have beencreated.7HL7 states that their vision is aworld where everyone can securely access and use accurate health data in anysetting. They state that their mission is to provide standards that empowerglobal health data interoperability. These standards were created as the toolsto accomplish these goals.1 The exchange of data is vital to manyaspects of healthcare, from interoperability to patient safety.
Systems workmore efficiently, and patients are cared for better when there is anoverarching standard that all systems subscribe to. Additionally, it is morecost efficient to employ this standard both within health care systems andbetween systems. The more unique and personalized a health care system’scommunication style and interface is, the more effort it requires to transferand exchange the information. The creation of HL7 started in 1987when a group of healthcare industry professionals realized that there was aneed for overarching information exchange standards when working in ahealthcare environment that involved a variety of vendors.5 The needfor the standard arose from the fact that the healthcare industry was becomingmore complex with more applications that had a growing need to communicate witheach other. Imagine one hospital with two or three different departmentsuniquely coding their information. Then imagine multiple hospitals doing thesame thing.
The exponential level of complications that would arise from everysystem creating and using their own version of information would have led tovirtually no information exchange. Whatever exchange would occur in thissetting would come at an excessive cost and effort, multiple stakeholders wouldhave to come together to interpret each other’s coding system. This is how clinicalinterface specialists realized that there was a need for a standard ofinformation exchange that was overarching and at the same time not overlyintrusive. HL7 works with multiple otherorganizations to maintain relevance and avoid redundancy in their standards.They are apart of the Joint Initiative Council, “an internationalorganization on global health informatics standardization that is committed todeveloping a single standard for a single purpose”3. They workwith ISO (international organization of standardization) by submitting their ANSIapproved standards or draft standards to ISO for approval.
Finally, they are apart of a collaboration of standards developing organization called SCO which”aims to facilitate the creation of industry-wide, interoperable standardsthat will support meaningful improvements in health outcomes”.3