AAP: HL7: A framework for medical information

October 12, 2008

Wouldn’t it be great if your patient’s medical records preceded her to the emergency room? Or your patient’s surgical procedure arrived in his medical record prior to a follow-up visit with you? That’s the dream of electronic health records (EHRs).

Wouldn’t it be great if your patients’ medical records preceded themto the emergency room? Or if their surgical procedures arrived in theirmedical record prior to a follow-up visit with you? That’s the dream ofelectronic health records (EHRs).

According to Andy Spooner, MD, of Cincinnati Children’s Hospital MedicalCenter, the future for EHRs records is getting rosier. But there are still a numberof issues that need to be dealt with before the utopian fantasy becomes a reality.

Although some medical centers and private pediatricians may be able to communicatewith each other, and may even share the same vendor, serious interoperabilityissues are creating problems. The right data standards (which are a key part ofinteroperability) can improve the quality in child health.

However, medical data is more complex than most other types of information. Manydata standards work well outside of the venue of medicine, but have issues thatneed to be resolved before it can work well in a medical setting. Issues suchas the system you use to code with – MDDB or SNOMED CT are two -- and evensome medical diagnoses (such as allergies) have yet to be figured out.

Health Level 7 (HL7) is hard at work at doing that figuring out. It is a standardsdevelopment organization that is manned by volunteers, and has been working onmedical data standards since 1987. It identifies requirements, supports workgroups,validates standards, and supports safe care for children. It is accredited bythe American National Standards Institute, and consists of a number of work groups,including the Child Health Workgroup.

HL7’s Child Health Group is presently working on standardizing how qualityreporting can come out of the EHR. Since 1999, HL7 standards have been successfullyused for immunization registries. The AAP is supporting HL7’s initiative.

Spooner emphasized that it is important for pediatricians to get involved andhave their voices heard in what decisions will be made involving datastandards, EHRs, and ultimately their patients. Other entities such as insurancecompanies and the federal government are weighing in, so pediatricians should,too. He added that EHR vendors need that interoperability issues don’t juststop at the office. Physicians who want to participate in the community and regionalhealth information organizations will need an EHR that “talks” toeveryone else sitting at the table.