Subject: HL7 Standards Process (was RE: EDIINT and HIPAA)

From: "Rishel,Wes" <[email-masked]>
Date: Fri, 17 Nov 2000 21:31:43 -0500

As the chair-elect of HL7 I would like to respond to DB's question about HL7
process.

HL7 has two kinds of specifications that are published using slighly
different processes: a Standard is submitted to ANSI for certification once
it has passed ballot; a Recommendation is published by HL7 but is not
submitted to ANSI and does not become an ANSI standard. Some Recommendations
have had substantial acceptance among the HL7 community, including it's
"lower level protocols" which define ways to reliably pass discrete messages
over RS-232 and TCP, and were published sometime in the early 1990s.

A Standard originates under the sponsorship of a Technical Committee. If HL7
were to create a Standard for EDIINT it would be the Control/Query
committee. It is balloted at the committee level. (Actually anyone can
participate in the committee ballot, but in practice those who choose to do
so are usually those who participate in, or follow the work of, the
Technical Committee.) When it passes a committee level ballot it is
submitted for ballot by the full HL7 Working Group (which is the entire
organization). If it passes at this level it is automatically submitted to
ANSI for certification. The ANSI review allows time for public comment, but
it is primarily a certification that the process was fair and consistent
with our bylaws. To date, have never had an issue arise that prevented or
delayed the certification process.

In addition to Technical Committees HL7 has Special Interest Groups. Gunther
is co-chair of our SIG on security. Strictly speaking, a SIG cannot initiate
the balloting of a standard; but SIGs can prepare such a document, and
obtain the consent of a Technical Committee which sponsors the ballot.

The other kind of document, the Recommendation, is easier to get out the
door. It can be originated by a SIG, and it has only one level of balloting.
The majority that is required to pass a Recommendation is less severe than
the majority required to pass a Standard (67% vs. 90%).

Ballots are conducted using the Web. Assuming that both ballots pass an
energetic committee can easily complete the entire process in two of our
three-per-year Working Group meetings (roughly 8 months elapsed time). (Of
course most committees have substantial time invested in debating the
document before it begins the process.)

Most of the meetings required at certain points in the process can be
handled using conference calls; in theory a REALLY motivated committee could
accomplish the two-level ballot in five months and then wait about three
months for ANSI certication. (That is a theoretical figure that has never
been realized in practise.)

Recommendations can be passed in roughly four months.

Best regards,

Wes Rishel
Research Director
Healthcare Industry Research & Advisory Services
GartnerGroup
Alameda, CA
Client inquiries: call +1-203-316-1288 or email to [email-masked]
[email-masked]
510 522 8135
510 521 2423 (fax)

> -----Original Message-----
> From: Dick Brooks [mailto:[email-masked]]
> Sent: Thursday, November 02, 2000 10:27 AM
> To: Gunther Schadow
> Cc: Rik Drummond; Kepa Zubeldia; CLEM; Gary Crough; Beth Morrow;
> David@Drummondgroup. Com; [email-masked]; [email-masked]; Dick
> Brooks
> Subject: RE: EDIINT and HIPAA
> 
> 
> 
> <DB> I'm not familiar with the HL7 standards process, all of 
> my experience
> has been with IETF, DISA, GISB and recently ebXML. Each of these
> organizations has a different process for developing standards. If we
> brought AS2 to HL7 today, how long would it take to become an 
> ANSI standard?
> I would like to read HL7's operational process document, can 
> you provide a
> pointer?
> </DB>
>

---

From: "Dick Brooks" <[email-masked]>
Date: Sat, 18 Nov 2000 15:52:32 -0600

Thanks Wes.

Based on your description I would anticipate the EDIINT AS2 spec taking the
"Recommendation" route, IF the group decides to go forward. Do you see it
the same way?

FYI - other groups that have adopted AS2 have found it necessary to define
"interoperability profiles". These profiles identify the exact set of
"options" from AS2 that everyone in the "trading community" agrees to
follow, in order to ensure interoperability. For example, GISB has already
defined an AS2 interoperability profile and the New York Collaborative, in
accordance with the Public Service Commission regulations, is in the process
of defining their interoperability profile. I'm familiar with both these
groups and the process used to develop their profiles. I could help HL7
develop an AS2 interoperability profile, if the group decides to pursue this
approach.

Regards,

Dick Brooks
Group 8760
110 12th Street North
Birmingham, AL 35203
[email-masked]
205-250-8053
Fax: 205-250-8057
http://www.8760.com/

InsideAgent - Empowering e-commerce solutions

> From: Rishel,Wes [mailto:[email-masked]]
> Sent: Friday, November 17, 2000 8:32 PM
> To: [email-masked]'; Gunther Schadow
> David@Drummondgroup. Com; [email-masked]; [email-masked]
> Subject: HL7 Standards Process (was RE: EDIINT and HIPAA)
>
>

---

From: Gunther Schadow <[email-masked]>
Date: Sat, 18 Nov 2000 23:05:54 -0500

> "Recommendation" route, IF the group decides to go forward. Do you see it

Dick, I actually do see it the other way. The EDIINT work in HL7 as we 
discussed it in relation to HIPAA is only useful if we end up with an ANSI 
approved standard. That must be a standard, not a recommendation.

I'll fill in Wes on the HIPAA issue under separate cover. Glad you can
make it for 1/8/2001. Thank you for your help.

regards,
-Gunther

---

From: "Rik Drummond" <[email-masked]>
Date: Mon, 20 Nov 2000 07:38:36 -0600

the interoperability profiles we normally have to implement to make as2 and
as1 interoperable revolve around the pki and certs. these still are not very
interoperable across products we keep finding in our testing. i would like
to see the as2 spec move forward in hl7. we are going to edit the current
version taking into account the finding in the ucc/drummondgroup
interoperability tests now under way.... that should be don before
christmas/the holidays... rik

-----Original Message-----
From: Dick Brooks [mailto:[email-masked]]
Sent: Saturday, November 18, 2000 3:53 PM
To: Rishel,Wes; Gunther Schadow
Cc: Rik Drummond; Kepa Zubeldia; CLEM; Gary Crough; Beth Morrow;
David@Drummondgroup. Com; [email-masked]; [email-masked]
Subject: RE: HL7 Standards Process (was RE: EDIINT and HIPAA)

Thanks Wes.

Regards,

Dick Brooks
Group 8760
110 12th Street North
Birmingham, AL 35203
[email-masked]
205-250-8053
Fax: 205-250-8057
http://www.8760.com/

---

From: Kepa Zubeldia <[email-masked]>
Date: Mon, 20 Nov 2000 17:13:06 -0700

Dick,

Are you volunteering to create an interoperability profile for digital
signatures of the HIPAA standard transactions ?  X12, NCPDP, and X12+HL7
(in which the signature could be on the HL7 or on the X12 components)
are the immediate needs.  However, keep in mind that NCPDP could also be
in EDIFACT syntax (e.g. prescriptions) and HL7 could be in different
syntaxes.  But, for HIPAA purposes, at this time we need something for
the 275 attachment only.  Other HL7 messages could come later through
other interoperability profiles.

If we have a very narrow scope (HIPAA transactions as they were released
in the Final Rule, plus attachments as we know them) then it is possible
to get an agreement, even if there is not yet an agreement on other
issues or on PKI issues.

Other volunteers ?

Kepa

---

From: "Dick Brooks" <[email-masked]>
Date: Tue, 21 Nov 2000 17:20:15 -0600

Kepa,

> signatures of the HIPAA standard transactions ?

My offer to assist in the development of an interoperability profile was in
response to a need identified within HL7. However, I would be willing to
help the HIPAA folks create an interoperability profile, provided it's based
on a technology that I'm familiar with (e.g. EDIINT AS2, GISB EDM, ebXML).

I would hope the investment in developing an interoperability profile for
HL7 could be leveraged in other areas (e.g. HIPAA, ASTM), without any
additional work. Do you see HIPAA's requirements being significantly
different enough from HL7 to require a separate interoperability profile?

Thanks,

Dick Brooks
Group 8760
110 12th Street North
Birmingham, AL 35203
[email-masked]
205-250-8053
Fax: 205-250-8057
http://www.8760.com/

> From: Kepa Zubeldia [mailto:[email-masked]]
> Sent: Monday, November 20, 2000 6:13 PM
> To: Dick Brooks
> Cc: Rishel,Wes; Gunther Schadow; Rik Drummond; CLEM; Gary Crough; Beth
> Morrow; David@Drummondgroup. Com; [email-masked]; [email-masked]
> Subject: Re: HL7 Standards Process (was RE: EDIINT and HIPAA)
>
>
> Dick,
>

---

From: Gunther Schadow <[email-masked]>
Date: Tue, 21 Nov 2000 18:40:23 -0500

Dick,

yes, I think that the HL7 and HIPAA profiles would be similar if not the 
same. My goal is to get all the healthcare standards together (in fact
it is only two of them, HL7 and NCPDP, since X12 is covered already) and
develop one profile with options to account for the specific EDI payload
used. We have an AS#1 profile already for HL7 and I'd like to take this
to go over a couple of issues that we found. As much as I can see why
AS#2 is very useful, I would not want to throw out the AS#1/email option
if not absolutely necessary. You mention ebXML -- we have some interest
in ebXML but we're not sure if any of this is ready for prime time, but
would like to get your thoughts on this.

regards
-Gunther

---

From: Kepa Zubeldia <[email-masked]>
Date: Tue, 21 Nov 2000 15:52:09 -0700

Dick,

Probably the requirements are identical, except that the content will be
in X12 or NCPDP syntax instead of HL7 or XML.

Kepa

---

From: Kepa Zubeldia <[email-masked]>
Date: Tue, 21 Nov 2000 16:03:55 -0700

Gunther,

Here is some food for thought concerning AS1...

When a provider files a batch of claims, the transmission can easily be
sent with AS1 or AS2.  The claims will adjudicate over a period of a few
days.  When the claims adjudicate, there is an X12 835 transaction that
the payer needs to send back to the provider with the remittance advice.

A typical provider will deal with about 400 payers on a routine basis. 
A typical payers will deal with about 100,000 providers on a routine
basis.

So, if the provider must be using AS2 only, the provider will have to
periodically (probably daily) poll all the payers in case they have some
remittance advice or other transaction from that payer.  The payer, on
the other hand, will have to hold "mailboxes" for 100,000+ providers and
be polled by them periodically, so the remittance advices can be
distributed back to the providers.  Not strikingly efficient.

But if the provider can send the claims with either AS1 or AS2, and the
payer can send the remittance advices back with AS1, all the polling and
mailboxing is eliminated, as the flow goes through the standard email
pathways.  The provider does not have to maintain an internet server to
received EDI, only the capability to receive internet mail.  Sounds like
a much simpler approach.  Of course, this assumes that the AS1 is not
only signed but also encrypted.

So, if you ask me, I would say that AS1 should not go away, even if the
fancier and better way to do it is with AS2.  There is certain beauty in
simple solutions.

Kepa

---

From: "Dick Brooks" <[email-masked]>
Date: Tue, 21 Nov 2000 19:18:43 -0600

Gunther,

> would like to get your thoughts on this.

ebXML is still in a very formative stage so it's still a bit early...

Dick Brooks
Group 8760
110 12th Street North
Birmingham, AL 35203
[email-masked]
205-250-8053
Fax: 205-250-8057
http://www.8760.com/

> From: Gunther Schadow [mailto:[email-masked]]
> Sent: Tuesday, November 21, 2000 5:40 PM
> To: Dick Brooks
> Cc: Kepa Zubeldia; Rishel,Wes; Rik Drummond; CLEM; Gary Crough; Beth

---

From: "Dick Brooks" <[email-masked]>
Date: Tue, 21 Nov 2000 19:27:46 -0600

Kepa,

> in X12 or NCPDP syntax instead of HL7 or XML.

That's encouraging because both EDIINT AS2 and GISB EDM are capable of
signing and encrypting any type of content (a.k.a. payload), as will ebXML
when we're finished.

Thanks.

Dick Brooks
Group 8760
110 12th Street North
Birmingham, AL 35203
[email-masked]
205-250-8053
Fax: 205-250-8057
http://www.8760.com/

> Sent: Tuesday, November 21, 2000 4:52 PM
> To: Dick Brooks

---

From: Terry Harding <[email-masked]>
Date: Wed, 22 Nov 2000 16:23:15 -0700

> signing and encrypting any type of content (a.k.a. payload), as will ebXML

AS1 and AS2 can both send any type of payload. It is the individual vendors
implementation which determines if the other payload types are properly
processed.

Terry Harding
Cyclone Commerce Inc.