While HL7 V3 is still in the “early adopter” phase, there are now over 100 registered projects in progress worldwide involving V3 – the overwhelming majority being outside the United States. Some important points to keep in mind with this HL7 standard still in an early adopter phase:
- Most deployments turn out to be rather custom based on realm-specific changes and that the current V3 standard is used as a starting point for a project – rather than the ending point.
- V3 appears to be morphing even more into a reference model and less of a messaging standard.
- Things are still in a relative state of flux as far as how V3 will be implemented by entities as evidenced with the National Health Service’s shift in the UK from using “V3 messaging” to “V3 CDA” for the Spine.
Keeping the above caveats in mind, it is still a good idea to prepare for V3 by acquainting yourself with some fundamentals.
With V3 being a model-driven standard, a logical starting point for preparation means starting with the information model upon which all V3 standards are based on – the Reference Information Model (RIM). This means that both V3 HL7 messaging standards (e.g., Inpatient Encounter, Ambulatory Encounter, etc.) and V3 Documents standards (e.g., CDA, CCD, etc.) are all based on the RIM.
As a side note, HL7 users in the United States generally think “HL7” means HL7 2.X messaging standard. Thus, when they think V3, they think about V3 messages replacing the V2 messages. While this is technically possible, market forces are not likely to make the leap to V3 for HL7 messaging anytime soon. If you work for a healthcare provider in the United States, outside of Clinical Document Architecture (CDA), there appears to be little movement towards V3. Some of these topics on the HL7 standards – V2 and V3 – are covered in more depth in a 14-page white paper entitled, The HL7 Evolution (PDF).
With this understanding, we can now get back to V3 and the RIM. With the RIM being an object-oriented methodology implemented via XML, a good starting point to understanding it is to familiarize yourself with the six core classes of the RIM:
- Act – represents the actions that are executed and must be documented as health care is managed and provided
- Participation – expresses the context for an act in terms such as who performed it, for whom it was done, where it was done, etc.
- Entity – represents the physical things and beings that are of interest to, and take part in health care
- Role – establishes the roles that entities play as they participate in health care acts
- ActRelationship – represents the binding of one act to another, such as the relationship between an order for an observation and the observation event as it occurs
- RoleLink – represents relationships between individual roles
With a firm understanding of the above six core classes and their associated attributes (see the latest HL7 Version 3 Normative Edition for details on associated attributes), you should be better prepared to more quickly analyze and implement your first HL7 Standard V3 interface, regardless of whether it is a V3 message or V3 document.
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