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TEP/HL7 Transform StatusLatest Update: 2/5/2015

BACKGROUND.................................................................................................................................................... 1

USE CASES..................................................................................................................................................................2

TRANSFORM SPREADSHEET................................................................................................................................ 5

3/2014 BALLOT VERSION OF THE SPREADSHEET................................................................................................................5CURRENT WORKING VERSION OF THE SPREADSHEET...........................................................................................................6

TRANSFORMATION SPECIFICATION..................................................................................................................... 7

3/2014 BALLOT VERSION OF THE SPECIFICATION...............................................................................................................7CURRENT WORKING VERSION OF THE SPECIFICATION..........................................................................................................7

ACTION ITEMS.................................................................................................................................................... 7

BackgroundHospitals use the HL7 standard internally and in information exchange with other hospitals. The EDXL-TEP/HL7 transform is being developed to bridge the electronic gap between the Emergency Management and EMS communities and the hospital community.

The OASIS Emergency Management Technical Committee (EM-TC) Tracking of Emergency Patients (TEP) subcommittee (SC) has been working with the HL7 Public Health and Emergency Response (PHER) Working Group (WG) on the EDXL-TEP/HL7 transform. The HL7 Project Scope Statement was approved 1/13/2013 with Patient Care (PC) as a co-sponsoring WG.

An initial, but incomplete, transform was balloted by HL7 PHER in March of 2014. This ballot should probably have been postponed until the transform was more complete, but we did get some good feedback from the HL7 WGs. This initial transform work was prepared by Tim Grapes, Werner Joerg, Lizzie DeYoung, and Brian Wilkins. All of these EM-TC members became unavailable right when the transform was balloted.

Patti Aymond attended the May 2014 HL7 WG meeting to work through the ballot comments with the HL7 WG members. She has been working, almost completely singularly, in folding in the feedback gathered at the May 2014 and subsequent September 2014 HL7 WG Meetings in revising and completing the transforms. She became almost completely unavailable to work further on the transformation as of 1/15/2015.

1 TEP/HL7 Transform Status

The transformation remains incomplete to this date. The current goal is to have the transformation complete and ready to ballot in March of 2015. This living document is intended to act as a status snapshot of the transform effort under development.

Use CasesIn working with HL7, we have identified 5 messaging use cases for patient tracking. In all use cases where an HL7 → TEP transform is required, the HL7 message type A03 is used. In all use cases where a TEP → HL7 transform is required, the HL7 A14 is used. Note: the pharmaceutical fields have not yet been mapped between the two standards. It is expected that additional HL7 message type(s) will be required to complete the transformation.

1. The first one is hospital to hospital communication. This is strictly within the HL7 domain and is considered out-of-scope for the TEP/HL7 transform.


2. A second use case is patients arriving to the hospital ED via EMS. The EMS system uses EDXL-TEP and the hospital uses HL7. The incoming TEP message is transformed into an HL7 A14 message type for ingest by the hospital system.

3. A third use case is patients transferring from one hospital to another via EMS. An HL7 A03 message type is transformed into a TEP message to provide information to EMS, and the TEP message is again transformed into an HL7 A14 message type for ingest by the receiving hospital system. This is the situation of day-to-day transfers, so the complete electronic health record can be exchanged directly between hospitals via HL7.


4. In an emergency, the evacuation, transfer and transport may be coordinated through Emergency Management or regional healthcare coalition coordination. In this situation, an HL7 A03 message type is transformed into a TEP message to provide information to the transport coordinator, and the TEP message is again transformed into an HL7 A14 message type for ingest by the receiving hospital system. Since the sending hospital may not know where the patient will be received, the complete electronic health record can be bundled with the TEP message in an EDXL-DE wrapper.


5. Similar to the regional transfer and evacuation, long distance evacuation coordination can be facilitated via HL7/TEP and TEP/HL7 transforms using JPATS support. Now, Tim is going to show us some examples of how TEP can and is being used.

Transform SpreadsheetDuring the initial mapping effort, an Excel spreadsheet was created to facilitate the capture of the transformations. The format of this spreadsheet has changed over time, and is expected to continue to change until the transformation is complete.

3/2014 Ballot Version of the SpreadsheetThe version of the spreadsheet that was used for the 3/2014 ballot contains 9 worksheets:

1. Introductiona. Provides the color legend and key for the spreadsheet.

2. TEP to HL7 V2.7.1a. Worksheet structure:

i. The left most columns provide the details of the TEP messaging structure ii. The right most columns provide the details of the HL7 messaging elements

that the TEP messaging elements are mapped toiii. Between these sets of columns are two columns that capture the TEP →

HL7 transformation and the HL7 → TEP transformation. Note: The anticipation is that most of the transformations will used the same fields in both directions, but this is not always the case. Once a HL7 V2.7.1 to TEP worksheet is added to the spreadsheet, the HL7 → TEP transformation column should probably be deleted to minimize data integrity issues.


b. There are several complex data structures that are not expanded in this worksheet. Instead, these complex structures are mapped in separate worksheets.

c. At the time of the 3/2014 balloting, this worksheet was 47% complete. 100/189 entries contained a designation of “TBD”.

3. ct-PersonDetails to HL7 V2.7.1a. This worksheet is expected to contain the mapping between the HL7 ADT and EDXL

PersonDetails common type.b. At the time of the 3/2014 balloting, this worksheet was 0% complete.

4. ct-EDXLLocation to HL7 V2.7.1a. This worksheet is expected to contain the mapping between the HL7 ADT and EDXL

Location common type.b. At the time of the 3/2014 balloting, this worksheet was 0% complete.

5. ct-EDXLAddress to HL7 V2.7.1a. This worksheet is expected to contain the mapping between the HL7 ADT and EDXL

Location common type.b. At the time of the 3/2014 balloting, this worksheet was 0% complete.

6. CWEa. This worksheet contains a few of the details of the HL7 Coded With Exception

(CWE) data type.7. EI

a. This worksheet contains the details of the HL7 Entity Identifier (EI) data type.8. OBX

a. This worksheet contains a note about the HL7 Observation/Result (OBX) segment.9. Notes

a. This worksheets contains notes from those working on the transformation.

Current Working Version of the SpreadsheetA new worksheet has been added to the spreadsheet:

1. EDXL-DE to HL7 V2.7.1a. This worksheet, yet to be completed, contains the mapping of the EDXL-DE, the EDXL-

TEP message wrapper to the HL7 A14 message.

Two temporary working worksheets have been added to the spreadsheet to expedite the mapping process:

1. tmpHL7MessageTypesa. This worksheet contains a side-by-side expansion of the datatypes contained in the A03

and A14 ADT message types. These two message types are almost identical, so the mapping from TEP to A14 is expected to be very similar to the mapping from A03 to TEP.

b. Grey fields are required. Bold fields are complex structures.2. tmpTEPMessageType


a. This worksheet contains the expanded TEP message structure along with the HL7 A14 message mapping.

b. Grey elements are required. Grey sub-elements are required if parent elements are present. Bold elements denote complex elements. Blue rows indicate complex elements that have not yet been mapped to a complex HL7 datatype.

3. tmpPersonDetailsa. Contains the TEP complex structure of the ct-PersonDetails data type.

4. tmpLocationTypea. Contains the TEP complex structure of the ct-EDXLLocation data type.

5. tmpAddressTypea. Contains the TEP complex structure of the xal-Address data type.

6. tmpAddressMappinga. Contains the mapping from xal-Address to the HL7 XAD data type.

Transformation Specification

3/2014 Ballot Version of the SpecificationWerner Joerg created a version of the transform specification for inclusion in the 3/2014 HL7 ballot. It isn’t clear where the breakdown occurred, but an early draft version with comments and revision markings was used in the balloting. Very few comments were received on the specification – primarily, that it needs to be finished.

Current Working Version of the SpecificationThe current working version of the specification is the one that Werner created for the HL7 ballot. A member of PHER (Rob Savage?) provided a copy of the January 2007 “HL7-NCPDP Electronic Prescribing Coordination Mapping Document, Release 1” HL7 Informative Ballot as an example and guide for revision and completion of the Transformation Specification

Action ItemsStatus Action Item Assignment Target

CompletionNotes

TEP → HL7 Mapping√ 1. Complete mapping of

“simple” TEP elements to A14

Patti Aymond

The following complex TEP elements have not been mapped with this action item:1. EDXL-DE2. PersonDetailsType3. AddressType4. EDXLLocationType5. MedicationType


Status Action Item Assignment TargetCompletion

Notes

In progress 2. Transfer mapping information from the tmpTEPMessageType worksheet to the “TEP to HL7 V2.7.1” worksheet

Patti Aymond

2/19/2015

Unassigned

3. Complete the EDXL-DE to A14 mapping

Unassigned

4. Complete the PersonDetailsType to A14 mapping

This transform is expected to require the definition of a profile.

Unassigned

6. Complete the AddressType to A14 mapping


Unassigned

7. Complete the EDXLLocationType to A14 mapping



Status Action Item Assignment TargetCompletion

Notes

Unassigned

8. Complete the MedicationType to A14 mapping

This transform is expect to require the use of a subsequent RXA message.

Email from Riki Merrick, OO:“What is the best way to connect an ADT message to a subsequent RXA message - example is ADT message sends patient info from ambulance to hospital, then ambulance sends RXA message to notify what medication has been given en route to the hospital?

During the session we suggested based on PID-3 (and possibly PID-5 and PID-7 in addition) but wanted to check with Hans - and here is his answer:

PID-3 makes sense and should be the primary linkage. PID-5 and PID-7 start to get challenging.

The other piece could be the PV1 data, but only if it is relevant to link at a visit level as well. Most important is the patient level.”

Unassigned

9. Crosswalk A14 required fields with those population by the transform to make sure all required fields are mapped

Hold 10. Apply for all necessary new LOINC codes

Pending completion of previous action items

HL7 → TEP MappingHold Pending completions of the

TEP → HL7 mappingTransform Specification

Hold Pending completions of the TEP → HL7 and HL7 → TEP mappings


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