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Simulated Hospital

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Re: Simulated Hospital

#91

Post by noelsusman »

ArtWomb wrote: post #62
duffpkg wrote: post #33

I am frequently asked about why systems in institutional healthcare are so hard to modernize, this has come up a lot related to pricing transparency. While HL7 is in theory a standard, in practice it is a semi-parseable "email" between two parties that know each other. Widely used systems like EPIC have bugs and quirks that have existed so long that the bugs themselves have become their own standard. Because HL7 rela…

Bizarro-world that doctors actually defend EPIC! They all complain about the ASP.NET 1.0 UI. It's just the convenience of viewing all patients from all hospitals in one virtual "chart" ;)

Epic is the worst EMR system, except for all the others.

Re: Simulated Hospital

#92

Post by owenmarshall »

cmiles74 wrote: post #88
ThaDood wrote: post #86

Earlier quoted context omitted.

Well there is the FOSS Mirth option and the NextGen Mirth Option which is the "premium" corporate-backed version. Mirth is like the glue for healthcare in the US. Most of the companies I've worked with use it. Whats another options? Redox? HAPI? Qvera? It might not be great but I think its better then most offerings.

Redox has already priced themselves so high, it's unclear what value they are providing. A big reason to go with Redox is that you don't have to setup a VPN with the target hospital, have staff monitoring the VPN to ensure it's up and you don't have to parse your own HL7v2 messages. IMHO Redox is now so expensive that you have to wonder if you might be better off doing all of this work yourself. As others have mentio…

I think it really depends on your scale. If I'm a small healthtech startup and I can interchange with people hooked up to the candidate QHINs like eHealth and CommonWell I just saved thousands of independent VPN setups and HL7 mappings.

But I already have thousands of independent VPN setups and API integrations, so the cost is harder to justify at scale.

Re: Simulated Hospital

#93

Post by nradov »

robertlagrant wrote: post #76
pskinner wrote: post #51

Earlier quoted context omitted.

HL7v2 is just the schema - the mechanism for sending these messages is normally something called MLLP which is just a simple framing protocol and has no built in security. It is possible to send/receive HL7v2 over other protocols, MLLP is the most common. Its normal to secure the endpoints via network level security - ipsec etc. HL7v3 transformed into FHIR which is done over HTTPS instead.

It's normal to not encrypt it, in my experience.

It's really not normal to not encrypt HL7 V2 messages. Every interface that I've seen uses a VPN.

Re: Simulated Hospital

#94

Post by nradov »

viraptor wrote: post #74
lostlogin wrote: post #44

Earlier quoted context omitted.

You haven't lived until you've tried to debug it. The array isn't zero based. The line breaks have different characters for breaking the lines, and you get to guess which ones are doing it. Certain characters are ok (ASKII) but when a Mac gets a nice ' into the field, all hell breaks loose. Things like "lesion at 9 o'clock" then break the system, as does Mr O'Leary. The hours spent chasing down how some failure happe…

Add to that the fun bits like "let's attach a whole base64 encoded PDF as a field of the hl7 message". Which honestly is not a terrible solution given you want to keep it all together, but still... It would be nice if you could attach binaries after the ASCII content.

It is possible to include multiple binary attachments and text content in certain HL7 V2 message structures. Just use multiple OBX segments.

Re: Simulated Hospital

#95

Post by nradov »

MichaelZuo wrote: post #66
ape4 wrote: post #22

When they say "Most EHRs use a message format called HL7v2, which is ugly and tedious to type." they aren't kidding, here's an example of it: MSH|^~\&|FROM_APP|FROM_FACILITY|TO_APP|TO_FACILITY|20180101000000||ADT^A01|20180101000000|P|2.5| EVN|A01|20110613083617| PID|1|843125^^^^MRN|21004053^^^^MRN~2269030303^^^^ORGNMBR||SULLY^BRIAN||19611209|M|||123 MAIN ST^^CITY^STATE^12345| PV1||I|H73 RM1^1^^HIGHWAY 01 CLINIC||||51…

What does HL7v3 look like?

The HL7 V3 standard is mostly dead. Only the Clinical Document Architecture (CDA) offshoot of V3 still survives in widespread use. You can find examples here.

https://hl7-c-cda-examples.herokuapp.com/

Most new HL7 work has moved on to FHIR which is essentially "HL7 V4".

Re: Simulated Hospital

#96

Post by nradov »

owenmarshall wrote: post #73
friendzis wrote: post #68

Earlier quoted context omitted.

https://en.wikipedia.org/wiki/Health_Level_7#Version_3_messa...

R4 is where things get a bit kinder and gentler. https://www.hl7.org/fhir/us/core/Condition-condition-duodena...

I think you're kind of mixing up version or release numbers there. HL7 has several major standards: V2 Messaging, V3 (including CDA), and FHIR. And each of those has gone through multiple releases. FHIR was on R4 for a couple years and R5 was recently published.

Re: Simulated Hospital

#97

Post by nradov »

duffpkg wrote: post #33

I am frequently asked about why systems in institutional healthcare are so hard to modernize, this has come up a lot related to pricing transparency. While HL7 is in theory a standard, in practice it is a semi-parseable "email" between two parties that know each other. Widely used systems like EPIC have bugs and quirks that have existed so long that the bugs themselves have become their own standard. Because HL7 rela…

The baseline HL7 V2 Messaging standard is really intended as more of a toolkit. It's very generalized to allow for a wide range of uses anywhere in the world.

In order to establish real interesting between two organizations you generally need to follow an Implementation Guide which constrains and profiles the baseline standard. HL7 publishes some IGs itself and others are available from organizations like the CDC and DirectTrust.

Re: Simulated Hospital

#98

Post by [deleted] »

pskinner wrote: post #51
djfobbz wrote: post #49

Earlier quoted context omitted.

This message object seems to be missing the HIPAA^ENCRYPTED field (pun intended)...I am assuming the encryption is implemented above this layer? Is there a standard for HL7v2 encryption?

HL7v2 is just the schema - the mechanism for sending these messages is normally something called MLLP which is just a simple framing protocol and has no built in security. It is possible to send/receive HL7v2 over other protocols, MLLP is the most common. Its normal to secure the endpoints via network level security - ipsec etc. HL7v3 transformed into FHIR which is done over HTTPS instead.

[deleted]

Re: Simulated Hospital

#99

Post by jbrogers63 »

djfobbz wrote: post #49
ape4 wrote: post #22

When they say "Most EHRs use a message format called HL7v2, which is ugly and tedious to type." they aren't kidding, here's an example of it: MSH|^~\&|FROM_APP|FROM_FACILITY|TO_APP|TO_FACILITY|20180101000000||ADT^A01|20180101000000|P|2.5| EVN|A01|20110613083617| PID|1|843125^^^^MRN|21004053^^^^MRN~2269030303^^^^ORGNMBR||SULLY^BRIAN||19611209|M|||123 MAIN ST^^CITY^STATE^12345| PV1||I|H73 RM1^1^^HIGHWAY 01 CLINIC||||51…

This message object seems to be missing the HIPAA^ENCRYPTED field (pun intended)...I am assuming the encryption is implemented above this layer? Is there a standard for HL7v2 encryption?

If there's encryption, it's generally further up the stack (eg. wrapping in a TLS connection or IPSec tunnel).

Re: Simulated Hospital

#100

Post by jbrogers63 »

warent wrote: post #24
ape4 wrote: post #22

When they say "Most EHRs use a message format called HL7v2, which is ugly and tedious to type." they aren't kidding, here's an example of it: MSH|^~\&|FROM_APP|FROM_FACILITY|TO_APP|TO_FACILITY|20180101000000||ADT^A01|20180101000000|P|2.5| EVN|A01|20110613083617| PID|1|843125^^^^MRN|21004053^^^^MRN~2269030303^^^^ORGNMBR||SULLY^BRIAN||19611209|M|||123 MAIN ST^^CITY^STATE^12345| PV1||I|H73 RM1^1^^HIGHWAY 01 CLINIC||||51…

no shot anyone actually types this out, right? surely this must be generated by machines for machine ingestion.

Generally, it's machine generated. I've only ever typed it out manually if I needed something specific for a unit test and that only for small messages. It's tedious to do by hand.
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