Jim Wetzel 1-27-11

Host Team: Katie Ek, Byron Kazek, Eric Levicky

Professional Bio

I graduated from John Carroll in 2001 and upon graduation started working at National City. At the onset of my tenure at National City, I was placed on the "Branch/Call Center Systems Replacement Feasibility Study" project as a member of the Enterprise Application Integration (EAI) team and was responsible for documenting COBOL programs used as the middle-tier data access layer for National City's existing Call Center mainframe application. When the Feasibility Study project was concluded and the actual project to replace the systems was initiated, I was placed on the team responsible for designing all of the middleware components for enabling the new Branch/Call Center Client/Server application to communicate with the legacy mainframe data stores. After a period of time I was moved on to the team responsible for all front end modifications to the new application (named "Connections"), and implemented projects enabling Computer Telephony Integration in the Call Center version of the application as well as a multitude of other projects. In 2007, I was promoted to serve as the Application Architect for all Branch/Call Center Applications at which point I was responsible for high level architectural designs and guidance for any major project effecting the National City Branches and/or Call Centers. After seven years at National City, in 2008 (shortly before they were acquired by PNC), I left National City to pursue opportunities at the Cleveland Clinic.

Jim Wetzel is a HL7 expert who is now working on the Knowledge Program at the Cleveland Clinic. This project uses HL7 to communicate with EPIC, which is the host of the Electronic Medical Records. Jim also develops, maintains, and supports .NET applications for the Imaging Institute. Two of these applications are the Radiology Peer Review and Academic RVU. Radiology Peer Review is an application used to satisfy regulatory requirements which mandate that a certain percentage of all radiological studies are peer reviewed by other radiologists. Academic RVU is an application which is used to track physicians’ academic activities and provide quick generation of CVs and NIH Bio-sketches.

Topic

HL7 programming within the Cleveland Clinic.

Presentation

HL7

-Messaging protocol geared specifically towards healthcare information.
-Used to communicate health information as a standard for medical information such as lab results, billing information, patient records, etc. However, according to Roseann Spitznagel, HL7 is "more of a suggestion than a standard."

2 Versions of HL7

  • V3- XML Based; not yet used in the United States
  • V2- Still updated today. Text based language developed in September 1988.
    • version 2.6 was created in 2007
    • version 2.7 is currently under development

-All of HL7 is backwards compatible, and is usually a pipe delimited language.
-HL7 consists of segments; within those segments are fields, and within those fields are components and subcomponents.
-First Line always consists of an MSH segment (message header) of whats to come in the following fields of the HL7 message.
-Usually the 4th character in the 1st line is the field separator.

HL7 Delimiter Characters

0x0D Marks the end of each segment
| Composite delimiter
^ Sub-composite delimter
& Sub-sub composite delimiter
~ Separates repeating fields
\ escape character

-There are close to 450 Message Types and Message Event types that are utilized in HL7. An HL7 Reference book is necessary for trying to adhere to the HL7 standard.

EPIC

Many systems don't know how to decipher HL7 messages, therefore a translator is necessary.
The EPIC system is the Electronic Medical Records system utilized by the Cleveland Clinic which gathers and holds information such as admission, reporting, orders, results, etc. The EPIC system must communicate to all departments at the Clinic who need access to these records. It has a Visual Basic 6 front end and MUMPS database backend. There have been efforts underway to migrate towards a .NET Platform, although it seems as if this change won't happen in the near future.

The Egate barrier is the bridge between EPIC and other departments (Pharmacy, Labs, Radiology) and sends pertinent information from medical records to each system that needs it. These messages are sent "instantaneously," which means they are put into the queue immediately when 'Save' is clicked.

Physicians usually enter information directly into the EPIC system. This information is widely available to those who have access to the EMR's (i.e. Clinic Satellite hospitals, family practies); however every action is logged. Inappropriate Medical Record retrieval violates HIPAA Privacy laws, and could result in termination of employment and/or hefty fines ($200,000).

Because HL7 is text based, images cannot be saved in the EPIC sytem. Despite the storage issues, EPIC does contain links to images using DICOM, which can transfer images and image headers to a specified system.

The Knowledge Program is project that Jim is working on. This project takes all messages sent from the Egate barrier and interprets them so that information can be stored discretely. Seen as how EPIC stores information in a text format it is inefficient to parse the text file for information. The Knowledge Program is the solution to this problem.

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Resources

For further information, view Interfaceware HL7 Video Tutorials
For HL7 v3 examples, see Section 2.8 of the HL7 V3 online guide.

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