HIPAA and HL7 coverage

HL7 version 2 is the pipe-delimited message format that hospital systems, laboratories and imaging systems use to send admissions, orders and results to one another. It usually travels over a plain TCP/IP connection wrapped in the Minimal Lower Layer Protocol (MLLP). FHIR is HL7's newer standard: data is exchanged as resources, in JSON or XML, through web APIs.

HIPAA adds a third family. The transactions it adopts for claims, eligibility, claim status, prior authorization, enrollment and payment are X12 transaction sets, so they are exchanged like any other X12 EDI, with extra validation against the HIPAA implementation guides.

ECOM's B2B gateway validates HL7 2.9 messages, transforms HL7 v2 and converts it to and from FHIR, validates FHIR and handles FHIR prior authorization, connects over MLLP, and validates X12 HIPAA transactions. Emails, PDFs, Word and Excel files are converted to structured data by PRISM-SmartConvert, and the gateway then carries the result.

• Providers and health systems

  Connect clinical systems that speak HL7 v2 to partners and to FHIR-based applications.

• Payers and clearinghouses

  Exchange X12 HIPAA claims, eligibility and remittance transactions, and FHIR prior authorization.

• Healthcare software vendors

  Add HL7, FHIR and HIPAA connectivity to a product without building every connection yourself.

An HL7 v2 message is a set of segments (MSH for the header, PID for the patient, OBR and OBX for orders and results) separated by line breaks and divided into fields by a pipe character. An MLLP frame wraps each message with start and end bytes so the receiver knows where it ends.

A FHIR resource, such as a Patient, a Coverage or a ServiceRequest, is a JSON or XML document exchanged with REST calls. Prior authorization with FHIR uses resources in place of the X12 278, and the gateway can sit between the two worlds.

The gateway keeps one internal view of the data, so an HL7 v2 admission, a FHIR Patient and an X12 834 enrollment can all feed the same ERP or clinical application.

1. 1

   Connect

   Receive over MLLP on TCP/IP, HTTPS, AS2 or SFTP, depending on the partner.

2. 2

   Validate

   Check HL7 2.9 schemas, FHIR resources or X12 HIPAA rules.

3. 3

   Transform

   Convert HL7 v2, FHIR and X12 to and from your formats.

4. 4

   Deliver

   Route to your application or partner and return acknowledgments.