Comments on HIPAA and HL7

Apparently my correction about HIPAA and HL7 only began to scratch the surface. Several knowledgeable folks commented further or sent me e-mails.

First, the comments. John Quinn, HL7 CTO at Accenture, wrote:

HL7 Version 2.x (2.6 is the current version) is a standard for messages usually expressed in a proprietary byte-delimited syntax that looks a lot like X12.

Version 3.0 of HL7 can be expressed as messages, electronic documents or services. In all cases today the payload of the data exchange occurs in an XML syntax.

5010 is an X12 release and HL7’s involvement is minimal in the approved set of HIPAA transactions.

HL7 will be significantly involved in a HIPAA transaction if (when) DHHS’s Center for Medicare and Medicaid Services (CMS) publishes the final rules for the HIPAA 275 Attachments transaction. In this transaction the attachment (e.g., lab result) is expressed as an HL7 Version 2 format which is consistent with the X12 envelope that encapsulates it.

Dave Shaver, Co-Chair Infrastructure and Messaging (InM) Committee, added:

Below is the URL to a whitepaper that provides an overview of V2 and V3. As John noted, V3 is a very generic standard that can (and is) mapped to XML as one of its forms. There are other ways to use HL7 V3.

https://www.corepointhealth.com/sites/default/files/whitepapers/hl7-history-v2-v3.pdf

Via e-mail, Pete Austin, PMP, Vice President, eCommerce Services at AXIOM Systems, Inc., said:

I am the guy that noticed the inadvertent discrepancy in your article and followed up with DataDirect.

Is it confusing? Absolutely. Cumbersome, antiquated, burdensome and loaded with extraneous crap? You bet. However, it is like democracy: useless, worthless, expensive, intrusive, and not worth what we pay for it — the only thing it has going for it is that it is 10 times better than anything else out there.

Healthcare transactions *are* complex. Not because consultants built the standard with an eye to their own future earnings, though as a consultant, I certainly appreciate the ongoing revenue stream.

EDI is nothing more than the technical representation of what is, at its heart, a business transaction. All of these transactions, X12 (and its HIPAA subset), HL7, and NCPDP are built to represent their ‘real-life’ business counterpart. These electronic versions represent the real business conversation that occurs between two healthcare entities. Those conversations are very complex. The transactions are complex only because the conversations between organizations are complex.

HIPAA really did streamline the manner in which healthcare organizations moved data. You wouldn’t think so, looking at the transactions, but it really is so. I wont burden you with the details, but by way of example, there was a “standard” before HIPAA.

In theory each transaction had its own format. However, since there was no teeth behind the standard, organizations tweaked it endlessly for their own needs. An early pre-HIPAA analysis of a small subset of payers found that there were over 200 versions of the standard, just within those payers. This was in fact one of the early forces behind the move to HIPAA.

HIPAA, although complex, removes much of the variability. And once implemented, actually lives up to the hype of Healthcare Simplifications.