Next month we will be in our house for 12 years. That is the longest I have ever lived somewhere in my adult life. As I think about the lessons I learned when we were building this house, which there are many, one stands out above all else: the notorious wall in the middle of the room.
When we were shopping for houses, we looked at a lot of display homes for builders. There was one house that we fell in love with the moment we walked through the door. It was an open floor plan where you could see all of the way to the back of the house when you open the front door. The openness of the house was a big selling point for us.
One day, about a month after we had started building, I went to the house to check on the progress. I open the door and …. What??!!!! There is a big wall in the middle of the room. This wall extends up from the basement to the second floor in the center of the staircase. I immediately call the project manager to find out what is going on with this wall in the middle of what is supposed to be an open view to the back of the house.
Through the building process, you choose all of the colors, flooring, cabinets, etc. One thing we picked was the type of stairs and if the stair spindle goes all of the way to the stair or to a side wall. We chose the side wall. We had told the sales representative several times what we loved about the display home … just down the street! No one ever said that our stair choice would require a wall in the middle of the room, but we learned later that was the standard way they built our choice. Well, that “standard” wasn’t our standard, and didn’t fit our needs. We thought all houses built with that floor plan would have the same openness. Needless to say, part of that wall came out and that builder stopped selling that type of stairs in that floor plan.
This story reminds me of what’s happening in the healthcare integration industry, especially when it comes to HL7. Everyone knows that HL7 standards are not standard. They are a starting point. You must take time to understand the process the interface must facilitate in order to understand if the HL7 standard will meet your needs. The requirements may dictate modifications to the standard.
One common non-standard use of HL7 is using ORU messages for transcription. Recently we built an ORU bidirectional interface where we sent out a standard diagnostic imaging order in an ORU, but depending on a descriptor we receive in a segment that we weren’t using, we use the ORU result as a result to the diagnostic imaging order or to populate a progress note. The progress note is an ultrasound operative report. The ORU has different OBX segments for the different parts of the operative report. We place the text from the specified OBX segment in the proper note section in the progress note.
Once the requirements are defined, it is up to the sender and receiver to come up with a common understanding of the message format. For this reason, we always request a specification from the system from which we are receiving data, or the system to which we are sending data. No specification was provided in the example provided earlier, so we provided our standard specification with the modifications we thought necessary to accomplish the requirements.
Once both sides come to an agreement on message format, you don’t find out until testing whether the interface facilitates all of the process requirements (both documented and UNdocumented). There are always modifications to be made. We made several modifications to the original scope in our example. It seems that even the owners of the process sometimes don’t know all of the variables to the process. This always leads to new discoveries about the process through the testing process.
The key is to try to understand as much about the process as possible. You will always find out more later, but try not to code yourself into a corner so that you can respond efficiently to changing requirements. Try to keep an open mind about HL7 and use its non-standardness to your advantage to create effective interfaces to facilitate complex processes.
We are Mi7. We make HL7 interfaces, HL7 standards and making the translation between two electronic health records systems exciting. Yes, in our world, questioning the standards, dictating modifications, and finding a way gets our adrenaline pumping. If your medical practice, hospital, or physicians network is in need, contact us and see just how jazzed we can get.