Standards Perspectives

Healthcare regulations and policies are very complex and ever-evolving. It’s important for managers of health plans and state Medicaid agencies to understand what new legislation means and how it affects their programs. Standards Perspectives brings you the latest details on new policies and standards so you can quickly and clearly learn what’s important to make the right decisions.

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What is HL7 and Why is HL7 Important to Medicaid

HL7 (Health Level Seven International) is an American National Standards Institute (ANSI)-accredited standards development organization. They are dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice, as well as the management, delivery and evaluation of health services.

HL7 is supported by more than 1,600 members from over 50 countries, including 500+ corporate members representing healthcare providers, government stakeholders, payers, pharmaceutical companies, vendors/suppliers and consulting firms.

Furthermore, HL7 includes a number of collaborative work groups which use a formal, balloted and consensus-based process to make updates to a number of transactions, processes and products critical to the healthcare industry – particularly those which include clinical data to support patient care.


HL7 Products

EHR-S FM – Electronic Health Record System Functional Model: EHR-S defines a standardized model of the functions that may be present in EHR Systems.

HL7 V2 – HL7’s Version 2.x (V2) messaging standard is the workhorse of electronic data exchange in the clinical domain and arguably the most widely implemented standard for healthcare in the world. This messaging standard allows the exchange of clinical data between systems.

CDA – Clinical Document Architecture: The HL7 Version 3 Clinical Document Architecture (CDA®) is a document markup standard that specifies the structure and semantics of “clinical documents” for the purpose of exchange between healthcare providers and patients.

C-CDA – Consolidated Clinical Document Architecture: A complete architecture used to create documents and template methodologies for medical record exchange. Primary function of the CCDA is to standardize the content and structure for clinical care summaries.

CDA:CCD – Continuity of Care Document (CCD), an HL7 Version 3 artifact, one of two options for content exchange standards for the patient summary record.

FHIR – Fast Healthcare Interoperability Resources: FHIR builds on previous data format standards from HL7, including HL7 version 2.x and HL7 version 3.x. But it is easier to implement because it uses a modern web-based suite of API technology. Among its goals is interoperation between legacy healthcare systems, healthcare providers and individuals on a wide variety of devices from computers to cell phones. It also allows third-party medical applications to be easily integrated into existing systems.

RIM – Reference Information Model: The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process. The RIM is a large, pictorial representation of the HL7 clinical data (domains) and identifies the content that HL7 messages will carry. It is a shared model between all domains and, as such, is the model from which all domains create their messages.

SPL – Risk Evaluation Structured Product Labeling: SPL defines the content of human prescription drug labeling in an XML format.

The full suite of HL7 ANSI approved products can be viewed here.


HL7 Importance to Medicaid

CMS and MITA both expect that MMIS systems will, over time, begin to access clinical data in support of population health management and quality measures. HL7 messages and methods are the primary means by which a patient’s clinical data is maintained and exchanged. An MMIS can most readily access a member’s clinical data through an interface with the state or regional Health Information Exchange (HIE). HL7 adaptors would be needed to help interpret the clinical care summaries.

You can read more Conduent insights about healthcare regulations in previous editions of Standards Perspectives.