HL7 Conformance Testing with

Message Maker
Robert Snelick
National Institute of Standards &
Technology (NIST)
rsnelick@nist.gov
http://www.nist.gov/messagemaker

Overview

HL7 Version 2 Overview

Conformance using Message Profiles

Methodology for producing a precise and

unambiguous specification

Building Message Profiles

Purpose, Definition, and Problems

MWB Tool to build XML representation of a

message profile

Testing HL7 Systems (NIST)

Message Maker tool to build message instances

to test HL7 systems for conformance

The Big Picture

ADT^A01

HL7
HL7
Standard
Standard

HL7 Message Structure

Message Profile

MSH
EVN
PID
NK1NK1 NK1NK1 NK1 ...
PV1

MSH
EVN
PID
NK1 NK1 NK1NK1NK1 ...
PV1

...
Universal design
Riddled with optionality
Implementation chaos
Interoperability difficult

HL7
System

PV2
OBX
AL1

...
PV2
OBX
AL1
...

...

Agreement
Define constraints

Messaging
Workbench

Test
System

Test
Harness

Conforms?

Tools to build profiles

e.g., MWB (VA)
XML representation

Message Profile

MSH|^~\&|
REGAEVN|A05|
199901PID|1||
191919^NK1|1|
MASSIE^ENK1|2|
MASSIE^I

Conformance testing needed

Profile based
Improves reliability and interoperability
Suite of test messages
Testing Framework
Suitable for conformance testing

<?xml version="1.0"?>
<HL7v2xConformanceProfile H
<MetaData Name="CALINX" Or
<Encodings>
<Encoding>ER7</Encoding>
</Encodings>
<DynamicDef AccAck="NE" Ap
<HL7MsgType=ADT"
EventType=A01
<MetaData Name="CALINX" >
<Segment Name="MSH" LongN
<Field Name="Field Separator" Us
</Field>
<Field Name="Encoding Characters"
<Reference>2.16.9.2</Reference
</Field>
<Field Name="Sending Application"

Message
Maker
Tools to build messages
Message Maker (NIST)
Automated and adaptable

What is HL7

Standards for the exchange, management,

and integration of data for clinical care
HL7 Version 2 is an application level
messaging standard
Deployed in 90% of US hospitals,
international use growing
Messages, for example

ADT
Lab order
Lab results

A framework for negotiation

HL7 and Healthcare Integration

R1 R2 R3

Cardiology
X12

Billing

HL7

DICOM

RIS

Hospital
Firewall

Scheduling
Rx

HIS

Diet

Nursing
LAB
HL7

L1

ASTM

L2

L3

NCPDP

L4

HL7

HL7 Message Structure

HL7 Message
Segments
Fields
Components
Sub-Components
Hierarchical data storage

Groups
Groups

Segments

Message Definition
ADT^A04^ADT_A01
MSH

Segment

PID
[ PD1 ]

Segments are defined once

[{ ROL }]

Each message selects from a

library of segments

[{ NK1 }]
PV1
[ PV2 ]

Group

[{ GT1 } ]
[{
IN1
[ IN2 ]
[{ IN3 }]
[{ ROL }]
}]
[ ACC ]

world event (admit a patient)

Hundreds of segments and
events

EVN

..
.

Message maps to a real

Think of them as data

structures (or classes)

{} Segment can repeat

[] Segment is optional

PID: Patient Identification Segment

SEQ

LEN

DT

OPT

SI

20

RP/#

TBL#

ITEM#

ELEMENT NAME

00104

Set ID - PID

CX

00105

Patient ID

250

CX

00106

Patient Identifier List

20

CX

00107

Alternate Patient ID - PID

250

XPN

00108

Patient Name

250

XPN

00109

Mothers Maiden Name

26

TS

00110

Date/Time of Birth

IS

00111

Administrative Sex

250

XPN

00112

Patient Alias

10

250

CE

00113

Race

11

250

XAD

00114

Patient Address

12

IS

00115

County Code

13

250

XTN

00116

Phone Number - Home

14

250

XTN

00117

Phone Number - Business

37

80

ST

01541

Strain

38

250

CE

01542

Production Class Code

0001

0005

0289

Segments contain fields

0429

Extended Person Name (XPN)

Components: <family name (FN)> ^ <given name (ST)> ^
<second and further given names or initials thereof (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
<prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (IS)> ^ <name type code (ID) > ^
<name representation code (ID)> ^ <name context (CE)> ^
<name validity range (DR)> ^ <name assembly order (ID)>
Subcomponents of family name: <surname (ST)> ^ <own surname prefix (ST)> ^
<own surname (ST)> ^ <surname prefix from partner/spouse (ST)> ^
<surname from partner/spouse (ST)>
Subcomponents of name context: <identifier (ST)> & <text (ST)> &
<name of coding system (IS)> &
<alternate identifier (ST)> & <alternate text (ST)> &
<name of alternate coding system (IS)>
Subcomponents of name validity range: <date range start date/time (TS)> &
<date range end date/time (TS)>

Elements have Attributes

Usage

Cardinality

Indicates how many time the element can appear

[0..0], [0..1], [1..1], [0..3], [3..5], [0..*]

Code Sets (Tables)

Indicates how the element can be used

Required, Optional, Not Supported, Conditional,
Required or Empty, etc.

Indicates a set of valid values for a given primitive

element
HL7 Table 001 Administrative Sex

Length

Indicates the maximum of an element or a

compound element

HL7 Message Framework

HL7 provides the framework to build

messages
Groups and Messages are defined each time
used
Building Blocks

Segments, Fields, Components, SubComponents, Data types, Tables (code sets)

are defined once

Universal Design: Needed for broad support

Flexible framework for building messages
for any given real world use case (e.g.,
request a blood test)

The Problem

Overwhelmingly large with many optional features

Little agreement on how to define an interface

Applications didnt know what to expect
No two interfaces were alike

Described as total chaos during implementation

Local Extensions (e.g., Z-segments) complicate
matters further
Interoperability Issues not plug-and-play

Two systems could be HL7 compliant but not

interoperable
e.g., sending system could support 10 repetitions of
a segment while the receiving systems may only
support 5.

The Solution

Conformance SIG
Trading Partner Agreement
Eliminate optionality (implementation
Specification)
Add specificity to existing messages and
identify specific scenarios/use cases
Identify, document, and bridge semantic
differences
Conformance through Message Profiles

Message Profile Defined

Refinement of the HL7 Standard

Provides an unambiguous specification of a standard
HL7 message
Measurable

Parts of a Message Profile

What data will be passed in the message

The format in which the data will be passed
The acknowledgement responsibilities of the sender and
the receiver
Message instances can be validated against a message
profile
Use case model
Static Definition
Dynamic Definition

Represented as an XML document (HL7 XML)

Static Definition
Building a Message Profile
ADT^A01

Message Profile

HL7 Message Structure

MSH

MSH

EVN

EVN

PID
NK1

PID
NK1

NK1

NK1

NK1

...

PV1

NK1

NK1

NK1

NK1

NK1

...

PV1

...

...

PV2

PV2

OBX

OBX

AL1

AL1

...

Segments/Segment Groups:
Usage (optionality)
Cardinality (min, max)

...

Fields/Components:
Field Usage (Optinality: R, RE, C, CE, X)
Cardinality (min, max)
Value Sets/Coding system
Descriptions
Length

Tools for Building Profiles

Commercial: Orions Symphonia, others

Free: VAs Messaging Workbench (MWB)

Message Profile Example (XML)

Snippet from PID segment

Value needs
to be in
table 0333

SSN not
supported

License is required
and must appear
exactly one time

<Field Name="SSN Number - Patient" Usage="X" Min="0" Max="*" Datatype="ST" Length="16" ItemNo="00122">
<Reference>3.4.2.19</Reference>
</Field>
<Field Name="Driver's License Number - Patient" Usage="R" Min="1" Max="1" Datatype="DLN" Length="250"
ItemNo="00123">
<Reference>3.4.2.20</Reference>
Value must
<Component Name="Driver's License Number" Usage="R" Datatype="ST" Length="100">
be a valid
</Component>
date
<Component Name="Issuing State, province, country" Usage="R" Datatype="IS" Length="10"
Table="0333">
</Component>
<Component Name="expiration date" Usage="R" Datatype="DT" Length="30">
</Component>
</Field>
<Field Name="Mother's Identifier" Usage=X" Min="0" Max="*" Datatype="CX" Length="250" ItemNo="00124">
<Reference>3.4.2.21</Reference>
<Component Name="ID" Usage="X" Datatype="ST" Length="3">
</Component>
<Component Name="Check digit" Usage="X" Datatype="ST">
</Component>
<Component Name="code identifying the check digit scheme employed" Usage="X" Datatype="ID"
Length="3" Table="0061">
</Component>

* Provides a roadmap for creating messages *

* Input into Message Maker *

Conformance Testing

A way to verify implementations of a specification to

determine whether or not deviations from the
specifications exist (through the use of test suites)
Standards are not enough to ensure interoperability
Specification
(Requirements)

Implementation

Conformance Tests

Benefits of Conformance Testing

Increase probability that products are implemented

correctly

Increased likelihood of portability and interoperability

Contains required functionality

Behaves as expected
Performs functions in a known manner

Portability the ability to move software or applications

among different systems
Interoperability the ability of two or more systems to
exchange and use information

Provides a feedback loop for developers

Increases buyers confidence in a product and
substantiate sellers claim
Not locked into purchasing from a single vendor

The Need for Dynamic Test Creation

Message
Types
ACK
ADR
ADT
BAR
CRM
CSU
DFT
DOC
DSR
EAC
EAN
EAR
EDR
EQQ
ERP
ESR
ESU
INR
INU
LSR
LSU
MCF
MDM
MFD
MFK
MFN
MFQ
MFR
NMD
NMQ
NMR
OMD
OMG
OML
OMN
OMP
OMS
ORD
ORF
ORG
ORL
ORM
ORN
ORP
ORR
ORS
ORU
OSQ
OSR
OUL
PEX
PGL
PIN
PMU
PPG
PPP

PPR
PPT
PPV
PRM
PRR
PTR
QBP
QCK
QCN
QRY
QSB
QSX
QVR
RAR
RAS
RCI
RCL
RDE
RDR
RDS
RDY
REF
RER
RGV
ROR
RPA
RPI
RPL
RPR
RQA
RQC
RQI
RQP
RQQ
RRA
RRD
RRE
RRG
RRI
RSP
SIU
SPQ
SQM
SRM
SSR
SSU
SUR
TBR
TCR
TCU
UDM
VQQ
VXQ
VXR
VXU
VXX

Message
Events
A01
A02
A03
A04
A05
A06
A07
A08
A09
A10
A11
A12
A13
A14
A15
A16
A17
A18
A19
A20
A21
A22
A23
A24
A25
A26
A27
A28
A29
A30
A31
A32
A33
A34
A35
A36
A37
A38
A38
A39
A40
A41
A42
A43
A44
A45
A46
A47
A48
A49
A50
A51

ADT^A01

Message Profile

HL7 Message Structure

Message Profile

MSH
EVN
PID
NK1NK1NK1NK1 NK1 ...
PV1

MSH
EVN
PID
NK1 NK1 NK1NK1NK1 ...
PV1

...
PV2
OBX
AL1

...

...
PV2
OBX
AL1
...

Profile
N
Message
Profile
Message Profile
Message defines
Profile
explicitly
Message
Profile
explicitly
defines
<?xml
version="1.0"?>
Message
Profile at
explicitly
defines
message
components

Message
Profile at H
explicitly
defines
message
components
<HL7v2xConformanceProfile

explicitly
defines at
message
components
each
level

<MetaData
Name="CALINX"
explicitly
defines at Or
message
components
eachmessage
level
components at
eachmessage
level
implementable
<Encodings>
each level components at
implementable
each<Encoding>ER7</Encoding>
level
implementable
specification
implementable
each
level
specification
</Encodings>
sites
implementable
specification
still
definedAccAck="NE"
their
sites
implementable
specification
still
<DynamicDef
defined their Ap
specification
still
sites
defined
their
own
profiles
(many)
<HL7MsgType=ADT"
still
specification
sites(many)
defined their
own
profiles
still
sites(many)
defined their
own
profiles
EventType=A01
nature
of
the
beast

defined their
own still
profiles
nature
of sites
the (many)
beast
>
own<MetaData
profiles
(many)
nature
of theName="CALINX"
beast
own
profiles
(many)
nature
<Segment
Name="MSH"
LongN
of
the
nature of thebeast
beast
<Field Name="Field
Separator" Us
nature
of the beast
</Field>

MSH|^~\&|
REGAEVN|A05|
199901PID|1||
191919^NK1|1|
MASSIE^ENK1|2|
MASSIE^I

MSH|^~\&|
REGAEVN|A05|
199901PID|1||
191919^NK1|1|
MASSIE^ENK1|2|
MASSIE^I

MSH|^~\&|
REGAEVN|A05|
199901PID|1||
191919^NK1|1|
MASSIE^ENK1|2|
MASSIE^I

Need test messages and a testing framework to ensure that

applications implement what was agreed upon in the message profiles

Automated and Adaptable Message Creation

Build your own
Profile
N
Message
Profile
Message Profile
Message defines
Profile
explicitly
Message
Profile
explicitly
defines
<?xml
version="1.0"?>
Message
Profile at
explicitly
defines
message
components
explicitly
Message
Profile at H
defines
message
components
<HL7v2xConformanceProfile

explicitly
defines at
message
components
eachmessage
level
level
<MetaData
Name="CALINX"
explicitly
defines at Or
components
eachmessage
components
at
eachmessage
level
implementable
each <Encodings>
level components at
implementable
each<Encoding>ER7</Encoding>
level
implementable
specification
implementable
each
level
specification
</Encodings>
sites
implementable
specification
still
definedAccAck="NE"
their
sites
implementable
specification
still
<DynamicDef
defined their Ap
specification
still
sites
defined their
own
profiles
(many)
<HL7MsgType=ADT"

specification
still
sites
defined
their
own profiles
(many)
sites
defined their
ownstill
profiles
(many)
EventType=A01
nature
of
the
beast
still
sites
defined
their
own
profiles
(many)
nature
of the Name="CALINX"
beast
>
own<MetaData
profiles
nature
of the (many)
beast
own
profiles
(many)
nature
<Segment
Name="MSH"
LongN
of
the
beast
nature of the beast
<Field Name="Field
Separator" Us
nature
of the beast

Manual Test Suite

tests needed for each profile
written individually
meticulous work
high cost $$$$$
often tests not performed

Message Maker Test Suite

tests needed for each profile
automatically generated
easy
lower cost $$
increases likelihood tests
will be performed

</Field>

Use Message Maker

Message Maker Overview

Purpose: to automatically and dynamically generate tests for any

given profile

Development:

Account for site-specific characteristics and options

Produce self-adapting test suites

tool to create test messages (Message Maker)

Reference database of HL7 data items
framework to send/receive messages, validate, and report

Capabilities:

Message Variation

structure
constraint attributes
data content
validity
message density
specific test location and type

Data Configuration
Methods to automatically determine test suite
Multiple encodings (XML, ER7)
Test Descriptions

Message Maker Design

Specification
Tool (e.g., MWB)
Data Sources

HL7
Standard
DB

NIST HL7
Reference
Database

Table
Values
Example
Values
from Profile
Default
Values

HL7 V2
Profile (XML)

Message
Maker
Message
Factory
(XSLT)

NIST Data
Repository
(XML)

Testing Options
Usage
Cardinality
Volume
Data Content
Length
etc.

HL7 Test
Messages
Profile based
Structurally correct
Validated
Varied
Descriptive
Suitable basis for
conformance testing

Testing
Framework

HL7 Test Framework Environment

Remote Tester
HL7 Test
Messages

HL7 Test
Driver
simulates application
controls testing
transmits HL7 messages
to the IUT

simulates application
controlled by Test Driver
receives and delivers
messages with IUT

HL7 Message

HL7 Implementation
Under Test (IUT)