HL7 provides a framework for exchanging clinical and administrative data between software applications used by various healthcare providers. Proper implementation of HL7 can greatly improve healthcare workflows, reduce costs, and enhance patient care.
Below, we examine the current state of HL7 usage, the barriers to adopting HL7, and how medical providers can leverage HL7 to unlock its full potential.
An Introduction to Health Level 7 (HL7)
HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. HL7 standards focus on the implementation of interfaces and messaging formats that allow disparate healthcare information systems to communicate with each other seamlessly.
The HL7 standards are developed by the Health Level Seven International, a not-for-profit standards developing organization. HL7 standards ensure the interoperability that is required to support a digital healthcare infrastructure. They allow the electronic movement and exchange of health-related information between the various parties involved in patient care.
Some of the most widely adopted HL7 standards include:
- HL7 Version 2 (V2) – HL7 V2 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. It is currently the most commonly used standard.
- HL7 Version 3 (V3) – A more recent standard that provides an object-oriented framework for healthcare information exchange.
- HL7 Fast Healthcare Interoperability Resources (FHIR) – A draft standard that provides open-source APIs for exchanging healthcare data via web services and mobile devices.
- Clinical Document Architecture (CDA) – An HL7 V3 standard that specifies an XML-based markup for encoding a patient’s healthcare documents and exchanging them.
The Need for Increased HL7 Adoption
The concept of HL7 was introduced in the late 1980s to address the need for standardized messaging protocols that allow computer systems at different healthcare providers to communicate reliably and share patient health information.
However, even today, HL7 adoption levels across the healthcare industry are lower than they should be. According to industry estimates, about 30% of hospitals and 10% of independent physicians in the US leverage HL7 interfaces. Many are still using outdated methods like faxing or manual data entry for exchange of patient information.
This is despite the fact that the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have recognized HL7 as a crucial standard and are encouraging its adoption.
Lack of HL7 implementation leads to major inefficiencies such as:
- Inability to easily transfer patient data – When a patient moves between different healthcare providers, their medical history data cannot be seamlessly shared if HL7 interfaces are missing. This leads to inconvenience as tests have to be repeated and diagnoses re-established.
- Risk of medical errors – In the absence of updated patient data, there is a risk of adverse drug interactions, allergic reactions, incorrect procedures, etc.
- Duplication of work – Redundant paperwork, manual entry of patient data, and reconstruction of health records causes duplicated efforts and increased overhead costs.
- Poor coordination of care – HL7 enables different applications to participate in computerized workflows for fulfilling health services. Missing HL7 interfaces hamper timely and organized delivery of care.
- Limited access to telemedicine – Many telehealth platforms rely on HL7 for remote patient monitoring, making them difficult to implement without HL7.
- Delayed public health reporting – HL7 facilitates transmission of public health data on conditions like COVID-19 to government agencies. Lacking HL7 means delayed reporting.
- Reduced patient engagement – HL7 allows patient health records to be easily shared with patients via portals/mobile apps. This increases transparency and keeps patients better informed.
Barriers to Wider HL7 Implementation
If the advantages of increased HL7 adoption are so clear, why are its adoption levels still so low?
There are a few key barriers holding back medical providers:
Initial Implementation Costs
For medical practices using outdated legacy IT systems, the costs of ripping and replacing with HL7-enabled solutions can seem daunting. Even for technology savvy providers, the upfront costs of software, hardware, employee training, and process changes required to implement HL7 may give pause.
However, these initial technology investments pay dividends in the long run by reducing overhead costs and improving efficiency. Providers can start with a phased implementation approach by prioritizing high impact areas like labs, pharmacies, imaging centers, etc.
Government initiatives to incentivize legacy upgrades via subsidies and grants can also offset some of the initial financial burden of HL7 adoption.
Perceived Complexity
The HL7 standards comprise extensive technical specifications spanning thousands of pages. For non-technical personnel, the standards may appear arcane and intimidating at first glance.
The good news is most HL7 functionality today is encapsulated within plug-and-play applications that handle the complexity behind the scenes. Providers mainly need to focus on high-level workflow design and understand basic HL7 messaging patterns.
Training staff on core HL7 concepts and leveraging expert guidance can prevent the standards’ complexity from becoming a roadblock.
Interoperability Issues
Since HL7 is a broad standard, variations in how it gets implemented can lead to interoperability issues when connecting disparate systems. For example, differences in message formats, choice of optional segments, use of outdated protocol versions, etc. can cause connectivity problems.
Thorough interface testing, establishing consistency in implementation approach, and use of intermediary integration tools can mitigate these challenges.
Concerns Over Data Security
Transmitting protected health information (PHI) over HL7 interfaces naturally raises data security concerns. However, the confidentiality and integrity of data exchanged via HL7 can be safeguarded through encryption, VPN tunnels, firewalls, and other security controls.
Proper access controls, activity logging, and cybersecurity best practices also need to be employed to prevent breaches. Adhering to HIPAA technical safeguards provides a blueprint for robust HL7 security.
Lack of HL7 Expertise
HL7 is a specialized healthcare interoperability skillset that takes time to develop. With the talent crunch impacting healthcare IT, finding or cultivating such expertise internally can be difficult for some providers.
Seeking guidance from specialized HL7 integration consultants is prudent to overcome this barrier. Partnerships with healthcare app vendors who maintain proficiency in HL7 can also augment providers’ capabilities.
Realizing the Potential of HL7 in Healthcare
While barriers exist, the potential benefits of increased HL7 adoption are too transformative for providers to ignore.
Some ways medical practices can start tapping into the true potential of HL7 include:
Automating Clinical Documentation
HL7 messaging allows patient vitals, medications, diagnosis details, and other clinical data to flow automatically into EHRs from connected medical devices and apps. This prevents duplicative manual documentation, ensuring up-to-date records.
Streamlining Public Health Reporting
Public health agencies rely on accurate and timely reporting of infectious diseases and chronic conditions from providers. HL7 facilitates automated and rapid transmission of case reports and status updates.
Improving Medication Management
HL7 interfaces enable seamless e-prescribing by allowing prescription details to flow electronically from physician EHRs to pharmacies. HL7 also helps reconcile medication orders, transfer drug allergy data, and coordinate medication fulfillment.
Enhancing Patient Engagement
HL7 makes it easier to exchange patient health records with Personal Health Record (PHR) apps and patient portals. This expands patients’ access to their own medical data for better self-management.
Supporting Population Health Analytics
HL7 enables large-scale data aggregation required for population health programs focused on specific conditions, risk factors, geographic areas etc. This allows better analytics and more customized interventions .
Accelerating Research and Clinical Trials
HL7 standards play a key role in data liquidity for clinical research by facilitating efficient exchange of detailed patient data elements between providers, labs, clinical trial systems etc.
Avoiding Duplicate Testing
Online access to patients’ comprehensive health records via HL7 prevents unnecessary duplicate ordering of blood tests, x-rays, screenings etc. already performed elsewhere, saving costs.
Enabling Effective Care Coordination
HL7 allows patient data to seamlessly follow them as they transition between primary care physicians, specialists, hospitals, nursing homes, home health agencies etc. This is essential for coordinated care.
Meeting Regulatory Mandates
Government initiatives like the CMS Interoperability and Patient Access final rule make HL7 proficiency a must for providers to qualify for EHR Incentive Programs and avoid Medicare payment cuts.
Key Takeaways
In summary, HL7 interoperability is vital for cost reduction, quality of care, patient empowerment, and regulatory compliance in healthcare.
Medical providers aiming to thrive in the era of value-based care must therefore prioritize HL7 implementation by: With its far-reaching applications, HL7 serves as a force multiplier that makes healthcare ecosystems much more capable and responsive. Unlocking its full potential will require providers across the industry to come together and embrace HL7-centric interoperability.
