standards in medical informatics dr jeremy rogers md mrcgp senior clinical fellow in health...

Standards in Standards in Medical InformaticsMedical InformaticsDr Jeremy Rogers MD MRCGPSenior Clinical Fellow in Health InformaticsNorthwest Institute of Bio-Health Informatics

Why Standardise ?Why Standardise ?

How Standards are builtHow Standards are built

Standards BodiesStandards Bodies

HL7HL7


Standards Bodies Standards Bodies


HL7HL7

Why Standardise?Why Standardise?

Joseph Whitworth1803-1887

Stanley Grove Care Home (1892)

British Standard Whitworth (BSW)BS 84:1956 : 55º Pitch

Whitworth HospitalDarley Dale (1887)

Whitworth InstituteDarley Dale (1890)

About Standards…About Standards…

DefinitionsDefinitions

Minimum acceptable manufacturing specification, issued by a body that creates such specifications

Concrete example of an item or a specification against which all others may be measured

Common technical specification for competing entities in a market that brings benefits without hurting competition

Conspicuous object used as a rallying point in battle


TypesTypes

De jure – followed because you have to

De facto – followed because they’re worth it

Open – publicly availablethough not necessarily royalty free

E.g. 50Hz AC, HTML, POP3

ProprietaryE.g. Sony Memory Stick, VHS/Betamax


BenefitsIncreased interoperability of components (in theory)

Reduce duplication of effort

Enable competitive supplier market

PitfallsProprietary ~ supplier lock-in

Open ~ “Embrace, extend and extinguish”

Aka “Copy, corrupt, copyright, circulate, control”

Extinguish = turn and open standard into a proprietary one

'The main reason standards 'The main reason standards are so wonderful is that are so wonderful is that

there are there are so many to choose from'so many to choose from'Anon




HL7HL7


ISO

CEN

HL7See also IEEE, ANSI, DICOM, W3C, NCPDP, NCCLS, Corba etc

ISOISO International Organisation for StandardisationInternational Organisation for Standardisation

ISO is acronym for…?

Est 1947

TC 215 – medical informaticsWG1 Health Records and Modelling

WG2 Messaging and Communication

WG3 Health Concept Representation

WG4 Security

WG5 Health Cards

CENCEN

ComitComitéé Europ Europééen de Normalisationen de Normalisation MISSION: to promote voluntary technical harmonization in Europe in conjunction with worldwide bodies and its partners in Europe.

Harmonization:

Diminishes trade barriers

Promotes safety

Allows interoperability of products, systems and services

Promotes common technical understanding

2005 Budget: 11,202,000 Euro (~$13.5m)

CENCENWho is in it?Who is in it?

AustriaBelgiumCyprusCzech RepublicDenmarkEstoniaFinlandFrance

Germany GreeceHungary IcelandIrelandItalyLatviaLithuaniaLuxembourgMalta

The NetherlandsNorwayPolandPortugalSlovakiaSloveniaSpainSwedenSwitzerlandUnited Kingdom

ALL procurements by government or other public bodies from these CEN members MUST comply with all relevant CEN standards

CENCENTC 251 Health InformaticsTC 251 Health Informatics

Website: www.centc251.org

Working GroupsInformation models (WG I)

Terminology and knowledge representation (WG II)

Security, Safety and Quality (WG III)

Technology for Interoperability (WG IV)

HL7HL7Health Level SevenHealth Level Seven

Independent, but ANSI accredited activity, entirely devoted to health

HL7 = level 7 of ISO model for OSI

OSI = Open Systems Interconnection1. The physical layer deals with data at a bit level

2. The data link layer breaks input data into data frames and the receiver returns acknowledgement frames

3. The network layer controls the transmission of packets of data, including routing and control of traffic congestion

4. The transport layer manages data from the session layer, if necessary splitting it into smaller sections

5. The session layer allows machines to communicate, this includes synchronisation of activity

6. The presentation layer manages the syntax and semantics of information, this may also include data compression and encryption

7. The application layer defines file structure and transfer, and manages compatibility between different systems

HL7HL7Raison d’Raison d’êêtretre

‘When two healthcare providers in the USA merge (one buys the other) they often have different computer systems.

To make one business IT system, you need to get the two systems working as one system, if possible. Before HL7 version 2, the whole thing was such a mess that it could easily cost more than a million dollars and take forever. With HL7 version 2 it is estimated that it still costs several hundred thousand dollars and takes months. HL7 version 2 is, therefore, better than nothing but far from ideal. We need to do better (because there are a lot of US healthcare organisations merging right now).

The hope is that connecting two HL7 version 3 systems together might only cost a few tens of thousands of dollars and take a few weeks, because trying to work out how to make the data flow will require even fewer experts and less time. This is because a lot more things that were previously variable or optional in version 2 will now be fixed or compulsory in version 3.’

Dan Russler

HL7HL7Who is in it?Who is in it?

USA origin and primary market

National Groups in:

KoreaLithuaniaThe NetherlandsNew ZealandSouthern AfricaSwitzerlandTaiwanTurkeyUnited Kingdom

ArgentinaAustraliaCanadaChinaCzech RepublicFinlandGermanyIndiaItalyJapan

HL7HL7 OrganisationOrganisation

3 plenary meetings per year

Special Interest Groups

Technical Committeesemail discussions

Arden Syntax

Attachments

Cardiology

Clinical Guidelines

Clinical Genomics

Community Based Health Services

Conformance

Emergency Care

Generation of Anesthesia Standards

Government Project

Health Care Devices

Imaging Integration

Java

Laboratory

Patient Safety

Pediatric Data Standards

Pharmacy

Public Health and Emergency Response

Template

XML

Ballot Task Force

Clinical Statements

Common Message Element Types

Dynamic Model

Harmonization

HL7Terminfo

Services BOF

27 HL7 SIGsTechnical Steering Committee

Architectural Review Board

CCOW

Clinical Decision Support

Education

Electronic Health Record

Electronic Services

Financial Management

Implementation

Infrastructure and Messaging

International Affiliates

Marketing

Medical Records/Information Management

Modeling and Methodology

Orders/Observations

Organization Review Committee

Outreach Committee for Clinical Research

Patient Administration

Patient Care

Personnel Management

Process Improvement

Publishing

Regulated Clinical Research Information Mgmt.

Scheduling and Logistics

Security

Structured Documents

Tooling Committee

Vocabulary

28 HL7 Technical Committees

RIM Harmonisation Committee

Iterative process, final ballot


Standards Bodies Standards Bodies


HL7HL7

Building StandardsBuilding Standards Who builds them?Who builds them?

Manufacturers of products

Customers of products

Collectors of tax when one person buys something from another

Competitors with any of the above

Academic experts largely innocent of the above dynamics

CENCEN Development of CEN standardsDevelopment of CEN standards

Influence of members:National standards bodies in each member state

e.g. BSI

Mirror panels of national experts

e.g. NHS IST 35 mirrors CEN TC 251

Nominated expert goes to CEN meetings

CEN Working: Options:Adopt a pre-existing standard

often but not always from ISO

Ask ISO to develop it

the Vienna agreement

Convene a CEN Technical Committee to draft new standard

Building StandardsBuilding Standards How are they built?How are they built?

TC 251Member

Anyone

WorkingGroup

ProposalTC 251Board

Reject

ProjectTeam

InterimReports(INR)

InterimReports(INR)

ShortStrategic

Study

OpenTender

Document

Reject

FirstWorking

Draft(FWD)

FirstWorking

Draft(FWD)

FinalVersion(FFV)

FinalVersion(FFV)

CommentsVotingPre-Standard(ENV)

Pre-Standard(ENV)

Full Standard(EN)

Full Standard(EN)

AbandonAbandon 3 months

3 years

Building StandardsBuilding Standards

The Economic CostThe Economic Cost

$400 Individual Annual Subscription$11000 for company with >$50M turnover

$16000 ~ 3 Meetings per year3 x $700 Transatlantic flight

3 x $900 Hotel for a week

3 weeks physically in attendance

3 weeks consultancy time

StandardsStandards

An ObservationAn Observation

Labour intensive process

Costly to participants

Economic viability:Revenue from process

Revenue from result

DISCUSSION EXERCISEDISCUSSION EXERCISEStandards: friend or foe ?Standards: friend or foe ?

Standards and ProcurementProblems with monolithic MegaCorp

Problems with TinyCorp

Standards and SalesHow do standards create a market?

Can a standard create an acceptable customer lock-in?

Who funds development of competing ‘open’ standards? Why?

Why are emergent standards used in marketing e.g. 811g?




HL7HL7

HL7 Standard VersionsHL7 Standard Versions

2.0 (1988) Prototype

2.1 (1990) First standard

2.2 (1994) Widely Adopted

2.3 (1997) In operation

2.3.1 (1999) Approved ANSI standardApproved ANSI standard

2.42.4 (2000) Approved ANSI standard(2000) Approved ANSI standard

2.52.5 (2003)(2003) Current ANSI standardCurrent ANSI standard3.0 In development

Limitations of Version 2.xLimitations of Version 2.x

Implicit information model, not explicit

Events not tightly coupled to profiles

Uncontrolled vocabularies

Limited to a single encoding syntax

No explicit support for object technologies

No explicit support for security functions

Optionality is ubiquitous and troublesome

Version 2.x Version 2.x Implementation IssuesImplementation Issues

Complex integration: at least 2-4 months to implement interfaces

Problem

Honest misunderstanding of specifications

Misleading conformance claims

Cause

Different implicit information models

No vocabulary to describe conformance concepts

Other FactorsOther Factors

Increasing pace of business change

Migration toward an evidence-based model

Transition from managing visit to managing cost

Regulatory pressures

Increasing complexity of HIT

HL7 Version 3HL7 Version 3

Clinical Messaging

Clinical Documentation

(Vocabulary)LegLower LimbFemur

HL7 version 3HL7 version 3Main Messaging ComponentsMain Messaging Components

Message Development Framework (MDF)

Reference Information Model (RIM)Large, shared object model representing clinical domain

Message, and ACT life-cycle focus

“An ANSI standard … simple abstract framework which addresses the wildly heterogeneous and interlinked nature of clinical data with only six important classes”

RIM-derived information models DMIM, RMIM

XMLCMET, HMD

Approved Vocabularies

HL7HL7Overview of ComponentsOverview of Components

HierarchicalMessage

Description

CommonMessage ElementTypes

ReferenceInformation Model

MessageInformation

Model

Inpatient_encounter

actual_days_qtyestimated_days_qtyPatient_admission

admission_dttmadmission_reason_cdadmission_referral_cdadmission_source_cdadmission_type_cdpre_admit_test_indreadmission_ind

1

1is_preceded_by

1

preceded

1

Encounter_practitioner

participation_type_cdPerson_as_IHCP

phon : TIL

Person_name_for_IHCP

cd : CVpurpose_cd : CVtype_cd : CVnm : PN

1

1

has1

is_for

1

Patient_billing_account

id : TIIs tatus_cd : CVbilling_status_cd : CVpatient_financial_class_cd : CVprice_schedule_id : TII

Patient_encounter

id : TIIs tatus_cd : CVencounter_classification_cd : CVstart_dttmend_dttmexpected_insurance_plan_qty : NMfirst_similar_illness_dttm

1..*

1

is_associated_with

1..*

has_as_participant 1Individual_healthcare_practitioner

id : TII

0..*

1

is_participant_for 0..*

participates_as1

1

1

is_a_role_of

1

takes_on_role_of1

Patient

id : TIIs tatus_cd : CVnewborn_baby_indmultiple_birth_indorgan_donor_ind

0..1

1

belongs_to

0..1

has1

1

1

involves

1

is_involved_in

1

0..*

0..1

has_a_primary_provider0..*

is_the_primary_provider_for0..1Person_as_Patient

birth_dttm : TSbirthplace_addr : STdeceased_dttm : TSeducation_level_cd : CVgender_cd : CVmarital_s tatus_cd : CVrace_cd : CVreligious_affiliation_cd : CVphon : TIL

1..1

1..1

is_a_role_of

1..1

takes_on_role_of

1..1

Person_name_for_Patient

nm : PNeffective_dt : TScd : CVpurpose_cd : CVtermination_dt : TStype_cd : CV

1

1..*

has

1

is_for1..*

Exactly one occurrence

InteractionModel

Domain SpecificationDatabase

DomainInformation

Model

Use Case Model

HL7 RIMHL7 RIMUltra High Level ViewUltra High Level View

ENTITY

MESSAGE CONTROL

ROLE

STRUCTUREDDOCUMENTS

PARTICIPATIONACT

6 classes:

ACT actions that must be documented as healthcare unfolds

ACT-RELATIONSHIP mutual binding between acts e.g. order and observation

ENTITY physical things of interest or take part in healthcare

ROLE role that entities play in different ACTS

ROLE LINK relationship between roles

PARTICIPATION binds acts to Entities (e.g. who did it, where etc)

HL7HL7Reference Information Model (RIM)Reference Information Model (RIM)v0.99 (Sep 2000)v0.99 (Sep 2000)

Champus_coverage

handicapped_program_cd : CEnon_avail_cert_on_file_ind : BLretirement_dttm : TSstation_id : II

Referral

authorized_visits_qty : REALdesc : EDreason_txt : ED

Healthcare_finances

Message_control

Acts (Services)

Appointments & scheduling

Roles

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0099

released September, 2000 reflects RIM changes through Harmonization on 8/31/2000

Observation

value : ANYderivation_expr : ST

Medication

form_cd : CDroute_cd : CDdose_qty : PQstrength_qty : PQrate_qty : PQdose_check_qty : PQ

Procedure

entry_site_cd : SET<CD>

Supply

qty : PQ

Diet

energy_qty : PQcarbohydrate_qty : PQ

Condition_node

Consent

Enitites

Document_service

completion_cd : CVset_id : IIstorage_cd : CVversion_nbr : INTcopy_dttm : TSorigination_dttm : TS

Billboard produced by:Rochester Outdoor Advertising

Healthcare_provider

specialty_cd : CV

Container

capacty_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseperator_type_cd : CDcap_type_cd : CD

Access

gauge_qty : PQentry_site_cd : CDbody_site_cd : CD

Device_slot

Device_request

requested_qty : REALtype_cd : CE

Device_group

id : II

0..*

0..1

requests 0..*

is_requested_by 0..1

Device

slot_size_increment_qty : PQmanufacturer_model_nm : STlast_calibration_dttm : TS

0..*

1

is_scheduleable_unit_for

0..*

is_scheduled_by1

0..*

1

requests0..*

is_requested_by1

0..*

1..*

contains0..*

belongs_to1..*

Notary_public

notary_county_cd : CEnotary_state_cd : CE

Employee_Employer

addr : ADhazard_exposure_txt : EDjob_class_cd : CVjob_title_nm : STtelecom : TELprotective_equipment_txt : EDsalary_qty : MOsalary_type_cd : CVstatus_cd : SET<CS>occupation_cd : CEjob_status_cd : CV

Sample

body_site_cd : CEcategory_cd : CVcontent_category_cd : CVdescription_txt : ED

Living_subject

birth_dttm : TSdeceased_dttm : TSdeceased_ind : BLeye_color_cd : CEqty : REALdiet_category_cd : CS Material_relationship

type_cd : CSinversion_ind : BLeffective_tmr : IVL<TS>position_nbr : LIST<INT>qty : PQ

Material

form_cd : CVdanger_cd : CEdesc : EDqty : SET<PQ>status_cd : SET<CS>effective_tmr : IVL<TS>handling_cd : CEcategory_cd : CE

0..* 1

has_source

0..* is_source_for 1

0..* 1

has_target

0..*

is_target_for

1

Patient_service_location_group

id : II

Patient_service_location_request

type_cd : CV

0..1

0..*

is_requested_by

0..1

requests0..*

Patient_service_location_slot

Facility

mobility_ind : BLaddr : ADdesc : EDlicensed_bed_nbr : REALtelecom : TELstatus_cd : SET<CS>category_cd : CVslot_size_increment_qty : PQ

1..*

0..*

belongs_to

1..*

contains

0..*

1

0..*

is_requested_by

1

requests0..*

0..*

1

is_scheduleable_unit_for 0..*

is_scheduled_by1

Inpatient_encounter

length_of_stay_qty : PQ

Practitioner_provider

position_cd : CVprimary_care_ind : BLslot_size_increment_qty : PQ

Practitioner_Certifier

board_certification_type_cd : CVcertification_dttm : TSrecertification_dttm : TSresidency_field_cd : CE

Military_person

military_branch_of_service_cd : CVmilitary_rank_nm : STmilitary_status_cd : CV

Location

gps_txt : ST

Software_module

software_version_nm : ST

Logical_entity

logical_entity_type_cd : CSdefinition : ED

Bad_debt_billing_account

bad_debt_recovery_qty : MObad_debt_transfer_qty : MOtransfer_to_bad_debt_dttm : TStransfer_to_bad_debt_reason_cd : CV

Encounter_drg

approval_ind : BLassigned_dttm : TSconfidential_ind : BLcost_outlier_qty : MOdesc : EDgrouper_review_cd : CEgrouper_version_id : IIoutlier_days_nbr : REALoutlier_reimbursement_qty : MOoutlier_type_cd : CV

0..*

1

is_assigned_to0..*

is_assigned 1

Language_ability

mode_cd : CVproficiency_level_cd : CV

Manufactured_material

expiration_dttm : TSlot_nbr : ST

Health_chart

status_cd : SET<CS>

Health_chart_deficiency

assessment_dttm : TSdesc : EDlevel_cd : CVtype_cd : CV

1

0..*

has_an_assessment_of1

is_assessed_against

0..*

Bad_debt_collection_agency

0..*

1

is_assigned_to0..*

is_assigned

1

Diagnostic_related_group_definition

base_rate_qty : MOcapital_reimbursement_qty : MOcost_weight_qty : MOid : IImajor_diagnostic_category_cd : CEoperating_reimbursement_qty : MOreimbursement_qty : MOstandard_day_qty : PQstandard_total_charge_qty : MOtrim_high_day_qty : PQtrim_low_day_qty : PQ

1

0..*

defines 1

is_defined_by0..*

Guarantor

financial_class_cd : CEhousehold_annual_income_qty : MOhousehold_size_nbr : REAL

Insurance_certification_contact

participation_type_cd : CE

Healthcare_benefit_product_purchaser

Act_collection

name : STdesc : EDeffective_tmr : IVL<TS>

Organization

org_nm : SET<ON>standard_industry_class_cd : CEaddr : SET<AD>telecom : SET<TEL>

0..1

1

is_a_role_of0..1

takes_on_role_of 1

1..1

0..*

establ ishes

1..1

is_established_by

0..*

Billing_information_item

condition_cd : CEoccurrence_cd : CEoccurrence_dttm : TSoccurrence_span_cd : CEoccurrence_span_from_dttm : TSoccurrence_span_thru_dttm : TSquantity_nbr : REALquantity_type_cd : CVvalue_amtvalue_cd : CE

Guarantor_contract

billing_hold_ind : BLbilling_media_cd : CEcharge_adjustment_cd : CEcontract_duration_cd : CEcontract_type_cd : CEeffective_tmr : IVL<TS>interest_rate_nbr : REALperiodic_payment_qty : MOpriority_ranking_cd : CV

1

1..*

guarantees_payment_under

1

has_payment_guaranteed_by

1..*

Patient_Provider

Act_relationship

type_cd : CSinversion_ind : BLsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS

Act_act_collection_relationship

sequence_nbr : REALpriority_nbr : REALnote_txt : ED

1

0..*

has_parts

1

is_part_of

0..*

Patient_billing_account

account_id : IIadjustment_cd : CVauthorization_information_txt : EDbilling_status_cd : CVcertification_required_ind : BLcurrent_unpaid_balance_qty : MOdelete_dttm : TSdeleted_account_reason_cd : CVexpected_insurance_plan_qty : REALexpected_payment_source_cd : CVnotice_of_admission_dttm : TSnotice_of_admission_ind : BLpatient_financial_class_cd : CVprice_schedule_id : IIpurge_status_cd : CVpurge_status_dttm : TSreport_of_eligibility_dttm : TSretention_ind : BLsignature_on_file_dttm : TSspecial_program_cd : CVstoploss_limit_ind : BLsuspend_charges_ind : BLtotal_adjustment_qty : MOtotal_charge_qty : MOtotal_payment_qty : MOseparate_bill_ind : BL

0..*

1pertains_to

0..* has

1

0..1

0..1

is_the_prior_account_for

0..1

has_as_a_prior_account

0..1

0..*

0..*

has_payment_guaranteed_by0..*

provides_payment_guarantee_for

0..*

0..*

1belongs_to

0..*

has 1

Act

id : SET<II>mood_cd : CSservice_cd : CDtxt : EDstatus_cd : SET<CS>activity_time : GTScritical_time : GTSmethod_cd : SET<CV>body_site_cd : SET<CD>interpretation_cd : SET<CS>confidentiality_cd : SET<CV>max_repeat_nmr : IVL<INT>interruptible_ind : BLsubstitution_cd : CVpriority_cd : SET<CV>orderable_ind : BLavailability_dttm : TS

0..* 1

has_source

0..*

is_source_for

1

0..*1

has_target

0..*is_target_for 1

10..*

is_collected_by

1

col lects

0..*

0..*

0..1

is_charged_to

0..*

has_charges_for

0..1

Participation

type_cd : CStmr : IVL<TS>note_text : EDsignature_cd : CVfunction_cd : CDawareness_cd : CV

0..*

1

for0..*

has1

Role_role_relationship

type_cd : CSeffective_tmr : IVL<TS>id : SET<II>status_cd : SET<CS>responsibility_cd : CS

1..1

0..*

is_root_for

1..1

is_leaf_of

0..*

Transportation

Encounter_facility_association

accommodation_cd : CVeffective_tmr : IVL<TS>status_cd : SET<CS>transfer_reason_cd : CV

1

0..*

is_site_for

1

is_sited_at

0..*

Person_Language

0..*

1

specifies_abi lity_in 0..*

is_specified_by1

Person_name

effective_tmr : IVL<TS>nm : PNtype_cd : CV

Patient_appointment_request

Patient_slot

Financial_transaction

alternate_desc : EDdesc : EDextended_qty : MOfee_schedule_cd : CEinsurance_qty : MOposting_dttm : TSqty : MOtransaction_batch_id : IItransaction_cd : CEtransaction_dttm : TStransaction_id : IItransaction_type_cd : CEunit_qty : MOunit_cost_qty : MO

0..1

0..*

categorizes

0..1

is_categorized_by0..*0..*

1

is_associated_with 0..*

has 10..*

1

pertains_to

0..*

is_associated_with

1

Healthcare_benefit_coverage_item

service_category_cd : CVservice_cd : CEservice_modifier_cd : CEauthorization_ind : BLnetwork_ind : BLassertion_cd : CEcovered_parties_cd : CEqty : REALquantity_qualifier_cd : CEtime_period_qualifier_cd : CErange_low_qty : PQrange_high_qty : PQrange_units_cd : CVassertion_effective_tmr : IVL<TS>eligibility_cd : CEpolicy_source_cd : CEeligibility_source_cd : CEcopay_limit_ind : BL

0..1

0..*

has_as_components

0..1

is_a_component_of

0..*

1..*

0..*

is_covered_by

1..*

provides_coverage_for

0..*

Resource_slot

offset_qty : PQallocated_qty : REALresource_type_cd : CVstatus_cd : SET<CS>start_dttm : TS

Schedule

id : II10..*

manages

1is_managed_by0..*

Patient_encounter

discharge_disposition_cd : CVacuity_level_cd : CVadministrative_outcome_txt : EDbirth_encounter_ind : BLcancellation_reason_cd : CVclassification_cd : CVencounter_classification_cd : CVfirst_similar_illness_dttm : TSfollow_up_type_cd : CVpractice_setting_cd : CVvaluables_desc : EDpre_admit_test_ind : BLpublicity_constraint_cd : CVreadmission_ind : BLreason_cd : CVsource_cd : CVreferral_cd : CVspecial_courtesies_cd : CVstatus_cd : SET<CS>triage_classification_cd : CVurgency_cd : CVvaluables_location_desc : ED

0..*

1

is_util ized_during0..*

uti lizes

1

0..*

1

is_used_by 0..*

uses1

Person

disability_cd : CEethnic_group_cd : CErace_cd : CEadministrative_gender_cd : CEambulatory_status_cd : CVbirth_order_nbr : INTeducation_level_cd : CVliving_arrangement_cd : CVmarital_status_cd : CVmultiple_birth_ind : BLorgan_donor_ind : BLreligious_affiliation_cd : CVstudent_cd : CVstatus_cd : SET<CS>credit_rating_cd : CVaddr : SET<AD>telecom : SET<TEL>special_accommodation_cd : SET<CV>

1

0..*

communicates_in

1

is_communicated_by

0..*

1

0..*

has1

is_for

0..*

1

0..*

is_requested_by

1

requests 0..*

0..*

1

is_a_scheduleable_unit_for

0..*

is_scheduled_by

1

0..* 1is_entered_by0..* enters 1

1

0..*

has

1

pertains_to0..*

Resource_request

allowable_substitutions_cd : CVduration_qty : PQstart_dttm : TSstart_offset_qty : PQstatus_cd : SET<CS>

Service_scheduling_request

allowable_substitutions_cd : CVduration_qty : PQstart_dttm : TSstart_offset_qty : PQstatus_cd : SET<CS>

Appointment

appointment_duration_qty : PQnotification_reason_cd : CVexpected_service_desc : EDscheduled_time : GTSid : IIstatus_cd : SET<CS>urgency_cd : CE

0..* 0..*is_reserved_by0..* reserves0..*

1..* 0..*

books

1..* is_booked_in0..*

0..1

0..*

is_parent_of

0..1

is_child_of 0..*

0..1

0..1

is_scheduled_by

0..1

schedules

0..1

Entering_person

0..*

1

is_entered_by0..*

enters

1

1

0..1

takes_on_role_of

1

is_a_role_of

0..1

Scheduling_parameter

type_cd : CVnm : STvalue : ANY

Appointment_request

reason_cd : CEadministrative_type_cd : CEid : IIpriority_cd : CVchange_reason_cd : CEduration_qty : PQrequested_time : GTSappointment_rqst_category_cd : CEstatus_cd : SET<CS>dttm : TS

0..*1 is_requested_by 0..*requests1

1

0..*

requests1

is_requested_by 0..*

0..1

0..*

requests

0..1

is_requested_by0..*

0..1

0..*

enters0..1

is_entered_by0..*

0..*

1

parameterizes 0..*

has_as_parameter1

Query_response_message_type

Tabular_row_data

FileorBatch

control_id : IIname : STcreation_dttm : TSreference_control_id : IIsending_application_id : IIreceiving_application_id : IIsecurity : STfile_batch_count : INTfile_comment : SET<ST>

Application_response_message_type

Query_ack

query_tag : IIquery_status_cd : CVmessage_query_name : CVhit_count_total : INThit_count_current : INThit_count_remaining : INT

1

0..*

has_response

1

is_response_with0..*

1

0..*

has_response

1

is_response_with0..*

Response_control

quantity_limited : PQresponse_modality : CV

Response_field

field_id : STdata_type : CVlength : INT

TBL_response_control

0..*

1

returns_to 0..*

has 1

TBL_sort_control

name : STdirection : CV

1

0..*

has1

is_for0..*

Element_sort_control

element_name : STdirection : CV

Element_response_control

name : SET<CV>

0..*

1

is_for0..*

has1

Query_by_parameter

Query_spec_message_type

1

1

contains1

appl ies_to1

Non_Person_living_subject

taxonomic_classification_cd : CEbreed_txt : EDstrain_txt : EDcoat_or_feather_coloring_txt : EDeuthanasia_ind : BLproduction_class_cd : CEgender_status_cd : CE

MESSAGE CONTROL

Role

type_cd : CSeffective_tmr : IVL<TS>addr : SET<AD>telecom : SET<TEL>

0..*

0..1

has_as_participant0..*

participates_in

0..1

0..*

1

has_as_target0..*

is_target_for1

1

0..*

is_source_of

1

has_as_source0..*

Entity_relationship

relationship_cd : CS

Attention_line

key_word_txt : STvalue : ST

Batch

control_id : IIname : STcreation_dttm : TSreference_control_id : IIsending_application_id : IIreceiving_application_id : IIsecurity : STmessage_count : INTbatch_totals : SET<INT>batch_comment : SET<ST>

0..10..*

contains

0..1

is_contained_by

0..*

TC_defined_message_type

Acknowledgement

type_cd : CVnote_txt : EDerror_detail_cd : CVexpected_sequence_nbr : INT

1

0..1

occurs_with 1

has

0..11

0..1

has

1

occurs_with0..1

Query

message_query_name : CVquery_tag : IIpriority : CVmodify_indicator : CVexecution_and_delivery_time : TS

1

1

has

1

is_for 1

Message

sending_application_id : IIid : SET<II>creation_dttm : TSinteraction_id : IIevent_dttm : TSversion_id : STprofile_id : SET<OID>processing_cd : CVsequence_nbr : INTreply_to_com : TELreceiving_application_id : SET<II>

0..*1

can_accompany

0..*

can_include

1

0..1

0..* contains

0..1is_contained_by

0..*

0..1

1

occurs_with0..1

has1

1..*

1

acknowledges1..*

has 1

0..1

1

occurs_with0..1

has1

0..1

1 occurs_with

0..1has

1

Entity

id : SET<II>type_cd : CSprimary_nm : STdeterminer_cd : CSprimary_name_type_cd : CEimportance_status_txt : ED

10..*

plays_a_role

1

is_played_by

0..*

0..*

1has_as_target

0..* is_target_for

1

1

0..*

is_source_of

1has_as_source

0..*

0..*

1..*

has_recipient0..*

shall_receive

1..*

0..*

1..1

has_sender

0..*

sends

1..1

Query_by_selection

Selection_criteria

name : STrelational_operator_cd : CVvalue : STrelational_conjunction_cd : CV

1

1..*

contains 1

appl ies_to 1..* 0..1

0..*

is_father_to0..1

is_son_of

0..*

Preauthorization

authorized_encounters_qty : REALauthorized_period_begin_tmr : IVL<TS>id : IIissued_dttm : TSrequested_dttm : TSrestriction_desc : EDstatus_cd : SET<CS>status_change_dttm : TS

1

0..1

is_authorized_by1

authorizes

0..1

Insurance_certification

appeal_reason_cd : CEcertification_duration_qty : PQeffective_tmr : IVL<TS>id : IIinsurance_verification_dttm : TSmodification_dttm : TSnon_concur_cd : CEnon_concur_effective_dttm : TSpenalty_qty : MOreport_of_eligibility_dttm : TSreport_of_eligibility_ind : BL

1

1..*

has_contact

1

is_contact_for 1..*

10..*

has_coverage_affi rmed_by

1

affirms_insurance_coverage_for

0..*

0..*

1

provides_validation_for0..*

is_validated_by1

Insurer1

0..*

issues1

is_issued_by

0..*

1

0..*

issues

1

is_issued_by

0..*

Master_healthcare_benefit_product

assignment_of_benefits_ind : BLbenefit_product_desc : EDid : IIbenefit_product_nm : STbenefit_product_type_cd : CEbenefits_coordination_ind : BLcob_priority_nbr : REALcombine_baby_bill_ind : BLeffective_tmr : IVL<TS>group_benefit_ind : BLmail_claim_party_cd : CErelease_information_cd : CEstatus_cd : SET<CS>coverage_type_cd : CEagreement_type_cd : CEpolicy_category_cd : CEaccess_protocol_desc : ED 0..*

0..1

is_child_of

0..*

is_parent_of

0..1

1..1

0..*

is_the_purchaser_of 1..1

has_as_purchaser0..*

0..*

0..1

is_covered_by 0..*

covers0..1

0..*

1

is_a_instance_of

0..*

is_instantiated_as1

0..*

0..*

insures0..*

is_insured_by

0..*

1

0..*

offers

1

is_offered_by 0..*

Clinical_document_header

availability_status_cd : CVchange_reason_cd : CVcompletion_status_cd : CVconfidentiality_status_cd : CVcontent_presentation_cd : CVdocument_creation_dttm : TSfile_nm : STlast_edit_dttm : TSreporting_priority_cd : CEresults_report_dttm : TSstorage_status_cd : CVtranscription_dttm : TSdocument_change_cd : CVversion_nbr : INTversion_dttm : TS

Clinical_document

1

1

is_part_of1

has_parts1

Individual_healthcare_practitioner_slot

Individual_healthcare_practitioner_pool

id : II

Individual_healthcare_practitioner_request

practitioner_type_cd : CE

0..1

0..*

is_requested_by 0..1

requests 0..*

Certification_additional_opinion

effective_dttm : TSstatus_cd : SET<CS>

0..*

1

provides_opinion_on0..*

includes1

Individual_healthcare_practitioner

fellowship_field_cd : CEgraduate_school_nm : ONgraduation_dttm : TSboard_certified_ind : BLpractitioner_type_cd : CE

1

0..*

is_scheduled_by1

is_scheduleable_unit_for

0..*

1..*

0..*

belongs_to1..*

contains

0..*

1

0..*

is_requested_by1

requests 0..*

0..*

1

is_provided_by0..*

provides

1

Role-role relationships

HL7HL7Reference Information Model (RIM)Reference Information Model (RIM)v2.11 (Jul 2005)v2.11 (Jul 2005)

HL7 v3 RIM version 2.1114TH July 2005

ENTITY PARTICIPATION ACT

MESSAGE CONTROL

ROLE

STRUCTUREDDOCUMENTS

HL7 RIMHL7 RIM e.g. ACTSe.g. ACTS

HL7 RIMHL7 RIM e.g. Message Controle.g. Message Control

EXERCISEEXERCISECompare RIM v0.99 with v2.11Compare RIM v0.99 with v2.11

When was each version released?

List the subtypes of [Role] that an [Entity] may play

Can all subytpes of [Entity] sensibly play all subtypes of [Role]?

What attributes can [Person] take in each version?

Which attributes of [Person] have disappeared since v0.99?

RIM-derivativesRIM-derivatives

Domain Message Information Model (D-MIM)

Makes the abstract RIM specific

Defines the information elements for a specific domain or specialty area

e.g. Prescribing

Refined Message Information Model (R-MIM)

Refines a DMIM to define elements of a family of messages

e.g. Parent Prescribing

Common Message Element Types (CMET)

Reusable DMIM or RMIM components

Hierarchical Message Definition (HMD)

Tabular ordered representation of RMIM elements

? Similar to an XML DTD

Pharmacy DMIM 2003Pharmacy DMIM 2003

Institutional Supply Order(PORX_RM222000)

Supply promise in an institutional setting

0..* subjectCoveragetypeCode*: <= PERTpertainsTo

0..* alerttypeCode*: <= TRIGtriggerFor

0..* formulary

typeCode*: <= INSTdefinition

0..* justifyingObservationIndication

typeCode*: <= RSONreason2

0..* encountertypeCode*: <= COMPcomponentOf1

Note:E.g. radioactive substance mustbe administered in secured location,oral morphine in pharmacy

Note:This Act represents the core of the act ofordering a medication and administering to apatient. It directly holds the route and dosageinstructions.

ObservationIndicationclassCode*: <= OBSmoodCode*: <= EVNid: (used for future maintenance)statusCode: (Complete, Superceded)effectiveTime:confidentialityCode:value*: CE CWE [0..1] <= ObservationValue (e.g. ICD9)targetSiteCode:

FormularyclassCode*: <= SPLYmoodCode*: <= DEFid*: [1..*] (catalogue #)

ObservationCriteriaclassCode*: <= OBSmoodCode*: <= EVN.CRTcode: CE CWE <= ObservationTypetext*:effectiveTime:value:

MedicationAdministrationclassCode*: <= SBADMmoodCode*: <= ActMoodid*:text: (Summary of act)effectiveTime:activityTime:availabilityTime:priorityCode:confidentialityCode: "N"routeCode: <= RouteOfAdministrationapproachSiteCode: <= ActSite (Can't have this without a route)doseQuantity:rateQuantity:doseCheckQuantity: SET<RTO<QTY,QTY>>maxDoseQuantity: SET<RTO<QTY,QTY>>

MedicationSupplyclassCode*: <= SPLYmoodCode*: <= ActMoodid: (defaults to Sub_admin_order.id)code: <= ActPharmacySupplyType (partial, trial, etc. - this would be used to indicate authorizationfor trial/partial dispense)text: (pharm. instructions)effectiveTime: (Earliest/last allowed dispense, frequencyrestrictions, etc.)confidentialityCode:repeatNumber: INT "1" (ie this is issue 3 (of 5))quantity*: [1..1]expectedUseTime: (days supply ordered)

CMET: (COV) A_Coverage

[universal](COCT_MT180000)

CMET: (ALRT) A_Alert


CMET: (ENC) A_Encounter


CMET: (LOCE) R_LocationLocatedEntity


0..* playedRole

CMET: (ASSIGNED) R_AssignedPerson


CMET: (LOCE) R_LocationLocatedEntity


0..* playedRole





CMET: (ASSIGNED) R_AssignedDevice




CMET: (ASSIGNED) R_AssignedDevice


0..* locatedEntity

typeCode*: <= DSTdestination

0..* assignedEntity

overseertypeCode*: <= x_ParticipationVrfRespSprfWitmodeCode:signatureCode:signatureText:

0..* participant

author2typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

1..* participant *

author2typeCode*: <= AUTtime*: (time of creation)modeCode:signatureCode:signatureText:

0..* assignedEntity

dataEnterertypeCode*: <= ENT

0..* assignedEntity

author1typeCode*: <= AUT

0..* assignedEntity

overseertypeCode*: <= x_ParticipationVrfRespSprfWittime*: (verification or attestation)modeCode:signatureCode:signatureText:

0..* assignedEntity

dataEnterertypeCode*: <= ENT

0..* assignedEntity

author1typeCode*: <= AUT

0..* medication

typeCode*: <= CSMconsumable

1..* aRole *

typeCode*: <= PRDproduct

0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:

performer

0..* locatedEntity

typeCode*: <= LOClocation

0..* pertinentCoverage

typeCode*: <= PERTpertinentInformation

0..* locatedEntity

typeCode*: <= ORGorigin



0..* assignedEntity

typeCode*: <= RCVreceiver

0..* a_SubstanceAdminMaster

typeCode*: <= INSTdefinition

Note:Used to refererencepharmacy protocolsgoverning how a drugshould be prescribed/administered.

A_SubstanceAdminMasterclassCode*: <= SBADMmoodCode*: <= DEFid*: [1..*] (catalogue #)

Pharmacy Domain ModelPORX_DM000000 v11.1

20 March 2003

Updated to Rim 2.02

Note:Eg: Use dose of 50mgif pulse <40bpmorGive medication untilpain relieved

0..* pertinentObservationDx

typeCode*: <= PERTpertinentInformation

Note:Observations that supportthe decision on which medicationor what dose to use.Eg Body weight, Surface Area,Allergies, Medical conditions

CMET: (OBS) A_ObservationDx

[minimal](COCT_MT120104)

CMET: (PAT) R_Patient[universal]

(COCT_MT050000)

1..* patient *

subjecttypeCode*: <= SBJ

Note:The medication ordered or administeredto the patient.Eg Amoxicillin 250mg Tablets.

Will normally be specialised to Kind

Note:The patient who is goingto receive the medication

Note:The header for the visitto the primary care physicianor a particular hospital stay.Includes information on therelevant financial account

Note:The reason for the medfication order.Eg Treatment of bronchitis

Note:Who wrote the order,typically a doctor

Note:Who gave the medicationto the patient, typically unused incommunity and a nurse insecondary care

Note:Who confirmed the order or the admin

Note:Who entered the data sayingfor the order or the admin

Note:Who should be called for clarificationtypically the same as the Author.

Note:Identifies information about an eligibilitycheck or authorization that has beenreceived in relation to an action. It is initiatedfrom the Supply and provides confirmationback to the SubstanceAdministration

Note:Intended to identify problems orwarnings associated with an Actthat have previously been evaluatedand discounted.

This CMET is missing at presentand the mechanism will not work.

Note:Who confirmed the supplytypically a pharmacist

Note:Who entered the data sayingwhat the supply is

Note:Who should be called for clarificationtypically the same as the Author.

Note:Who wrote the supply requesttypically the doctor who wrotethe medication order,but could also be a nurseor ward pharmacist

Note:The formulary which governswhat can be supplied

Note:Who will receive the supply.It may be the patient, a carer.

Note:The medication that is being suppliedeg Amoxil 250mg tables, 56 tablets

Will normally be specialised to instance

Note:For a supply, where the supplycame from and where it was sent to.Eg Pharmacy, Ward

Note:This act represents the act of supplyingmedication to a patient or their representative.It does NOT deal with administering it to the patient.

component / componentOf2

0..* medicationAdministration1

0..* medicationAdministration2

typeCode*: <= COMPNote:Links together a series oforders or administrations that formpart of a series whether scheduledor not or where an order fulfills partof a previous order.

Also used for complex doses, ormultiple routes.

component / componentOf

0..* medicationSupply1

0..* medicationSupply2

typeCode*: <= COMPNote:Links together a series ofsupply acts that formpart of a series whether scheduledor not or where an order fulfills partof a previous order.

0..* participant

typeCode*: <= PRFsignatureCode: <= ParticipationSignaturesignatureText:

performer

Note:Changed fromCOCT_MT070103, but is the the correct CMET?

Note:Need to redo diagnosis code

0..* locatedEntity

typeCode*: <= DSTdestination

0..1 justifiedMedicationAdministration *

0..* justifyingMedicationSupply *

typeCode*: <= RSON

reason1 /reasonOf

inFulfillmentOf

0..* priorMedicationAdministration

typeCode*: <= FLFS

predecessor

0..* priorMedicationAdministration

typeCode*: <= SUCCNote:Allows for modeling revisionof an order

Note:Allows relation of differentmoods of the act.

inFulfillmentOf

0..* priorMedicationSupply

typeCode*: <= FLFS

predecessor

0..* priorMedicationSupply

typeCode*: <= SUCC

Note:Allows for modeling revisionof an order

Note:Allows relation of differentmoods of the act.

AssignedPractitionerOrDevice

AssignedPractitionerOrDevice

Note:See Q&A 31

MedicationAdministrationInstructionsclassCode*: <= SBADMmoodCode*: <= ActMoodtext: (Additional free text instructions)

0..* medicationAdministrationInstructions

typeCode*: <= COMPcomponent1

Community Supply Event(PORX_RM124000)

Supply Event in a community setting

Institutional Combined Order(PORX_RM232000)

Administration and Supply Orderin an institutional setting

Institutional SupplyPromise(PORX_RM223000)

Supply promise in an institutional setting

Institutional Supply Event(PORX_RM224000)

Supply event in an institutional setting

Community Combined Order(PORX_RM132000)

Administration and Supply Orderin a community setting

Institutional Administration Order(PORX_RM212000)

Administration promise in an institutional setting

Institutional Administration Promise(PORX_RM213000)

Administration promise in an institutional setting

Institutional Administration Event(PORX_RM214000)

Administration event in an institutional setting

0..* outcomeObservationCriteria

outcometypeCode*: <= OUTCcheckpointCode:negationInd:conjunctionCode:

0..* observationCriteria

preconditiontypeCode*: <= PRCNcheckpointCode:negationInd:conjunctionCode:

CMET: (MMAT) E_Medication


1..1 manufacturedMedication

MedicationclassCode*: <= MANU

1..1 manufacturedMedication

MedicationDispensedclassCode*: <= MANU

CMET: (MMAT) E_Medication


Pharmacy DMIM

v11.1 (20.3.2003)

Detail from Pharmacy DMIM

v11.1 (2003)

RouteCode

Ontology of routes?

RouteCode

Ontology of routes?

CMET for encounterCMET for encounter

1..1 patient *

recordTargettypeCode*: <= RCT

ParentPrescriptionclassCode*: <= INFOmoodCode*: <= EVNid*: II [1..1]code*: CD CNE [1..1] <= SnomedCTeffectiveTime*: TS [1..1]

1..1 pertinentCareRecordElementCategory

pertinentInformation2typeCode*: <= PERTtemplateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation1"

CareRecordElementCategoryclassCode*: <= CATEGORYmoodCode*: <= EVNcode*: CV CNE [1..1] <= CREType

1..* actRef

typeCode*: <= COMP

component

PrescriptionclassCode*: <= SBADMmoodCode*: <= RQOid*: LIST<II> [2..2] (1 Prescription ID, 2 Prescription ID + Check Digit)code*: CD CNE [1..1] <= SnomedCT-AdministrationrepeatNumber: IVL<INT> [0..1]

1..1 participant *

authortypeCode*: <= AUT

contextControlCode*: CS CNE [1..1] <= OPtime*: TS [1..1] (time of creation)

signatureText*: ED [1..1]

0..1 participant

typeCode*: <= LAcontextControlCode*: CS CNE [1..1] <= OP

time*: TS [1..1]signatureText*: ED [1..1]

legalAuthenticator

0..1 participant *

typeCode*: <= PRFcontextControlCode*: CS CNE [1..1] <= OP

performerCMET: (ROL) R_AgentNPFITOrganizationSDS

[universal](UKCT_MT120501UK02)

0..1 pertinentTemporaryExemptionInfo

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)

pertinentInformation3 TemporaryExemptionInfoclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "EX" (Fixed)effectiveTime*: IVL<TS> [1..1]value*: CV [1..1] <= PrescriptionChargeExemption

ReviewDateclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "RD" (Fixed)effectiveTime*: TS [1..1]

LineItemclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1] (item ID)code*: CD CNE [1..1] <= SnomedCT-Administration (Route of and approach site)effectiveTime: GTS (3 times a day etc.)repeatNumber: IVL<INT>doseQuantity: IVL<PQ>rateQuantity: IVL<PQ>

PrescriberEndorsementclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PE" (Fixed)text: STvalue*: CV [1..1] <= PrescriberEndorsement (Justification)

0..1 pertinentReviewDate


pertinentInformation11

1..* pertinentLineItem *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf2"


RequestedMaterialclassCode*: <= MMATdeterminerCode*: <= KINDcode*: CE CNE [1..1] <= ManufacturedMaterialSnCT

1..1 manufacturedRequestedMaterial

ManufacturedProductclassCode*: <= MANU

1..1 manufacturedProduct *

producttypeCode*: <= PRDcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

0..* pertinentPrescriberEndorsement



0..1 priorOriginalItemRef

typeCode*: <= FLFSinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"

inFulfillmentOfOriginalItemRefclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1]

0..1 priorOriginalPrescriptionRef

typeCode*: <= FLFSinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"

inFulfillmentOf OriginalPrescriptionRefclassCode*: <= SBADMmoodCode*: <= RQOid*: II [1..1]

ActRefclassCode*: <= ACTmoodCode*: <= ActMoodid*: II [1..1]

Note:Nominated Pharm

Note:Charlie to add effective time tostatement commentary (change name?)

Note:Dose Instructionswill be here in the originaltext part of the CD code

Parent Prescription(PORX_RM132004UK04)

Description

Repeatprescriptionsonly

Constraint:

Repeatprescriptionsonly

Constraint:

Absent for Acute PrescriptionsMandatory otherwise

Constraint: repeatNumber

Relevant only forRepeat Dispensing Prescriptionsabsent otherwise

Constraint:

For RepeatPrescriptions use low and high value,for Repeat dispensing use only high value,for acute do not use.

Constraint: repeatNumber

1..1 pertinentPrescriptionType *


pertinentInformation4 PrescriptionTypeclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PT" (Fixed)value*: CV [1..1] <= PrescriptionType

1..1 pertinentPrescriptionTreatmentType *


pertinentInformation5 PrescriptionTreatmentTypeclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "PTT" (Fixed)value*: CV [1..1] <= PrescriptionTreatmentType

1..1 pertinentPrescription *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation"


CMET: (ROL) R_AgentNPFITPerson

[universal](UKCT_MT120201UK02)

Note:Add PTT & PT to PrescriptionAnnotation Vocab

Note:As this CMET carries the Patient IDit is a valid according to the CSMP

1..1 participant *

typeCode*: <= RESPcontextControlCode*: CS CNE [1..1] <= OP

responsibleParty

LineItemQuantityclassCode*: <= SPLYmoodCode*: <= RQOcode*: CD CNE [1..1] <= SnomedCT-Supplyquantity*: PQ [1..1]

DaysSupplyclassCode*: <= SPLYmoodCode*: <= RQOeffectiveTime*: IVL<TS> [1..1] (Dispensing window)expectedUseTime*: IVL<TS> [1..1] (Prescription duration)

Mandatory forRepeat Dispensing Prescriptionsabsent otherwise

Constraint: effectiveTime

1..1 pertinentDosageInstructions *



1..1 pertinentLineItemQuantity *



0..1 pertinentDaysSupply



CareEventRefclassCode*: <= ACTmoodCode*: <= ActMoodid*: II [1..1]

1..1 pertinentCareEventRef

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)contextConductionInd*: BL [1..1] "false" (Fixed)negationInd*: BL [1..1] "false" (Fixed)seperatableInd*: BL [1..1] "true" (Fixed)templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"


Note:PoC Event that resulted in thisprescription being generated

Note:The quantity can beeither days to supplyor amount

optionional butonly for Repeat Dispensing

Constraint: expectedUseTime

CMET: (PAT) R_Patient

[identifiedETP](COCT_MT050012UK04)

0..1 roleName

DosageInstructionsclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "DI" (Fixed)value*: ST [1..1] (Dose Instructions)

AdditionalInstructionsclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "AI" (Fixed)value*: ST [1..1] (Additional Instructions)

0..1 pertinentAdditionalInstructions



1..1 pertinentDispensingSitePreference *

typeCode*: <= PERTinversionInd*: BL [1..1] "false" (Fixed)

contextConductionInd*: BL [1..1] "true" (Fixed)negationInd*: BL [1..1] "false" (Fixed)

seperatableInd*: BL [1..1] "true" (Fixed)

pertinentInformation1DispensingSitePreferenceclassCode*: <= OBSmoodCode*: <= EVNcode*: CV CNE [1..1] <= PrescriptionAnnotation "DSP" (Fixed)value*: CV [1..1] <= DispensingSitePreference

HL7 RMIMHL7 RMIMe.g. e.g. Parent PrescribingParent Prescribing

Parent Prescribing RMIM v3.1.06 (2004)

Detail fromParent Prescribing RMIM v3.1.06 (2004)

HL7 HL7 Clinical DocumentationClinical Documentation

Clinical Document Architecture (CDA)Exchange model for clinical documents

Leverages XML, HL7 RIM and coded vocabularies

XML Syntax & framework for expressing clinical document semantics

Discharge Summary, Imaging Report, Admission & Physical etc

Minimum version ~ Dublin Core

XML-RIM metadata Header, content not marked up

Level 3 CDA implies extensively marked up content also

ANSI Standard November 2000

HL7 HL7 Clinical DocumentationClinical Documentation

Clinical Context Management Specification (CCOW)Protocol for linking multiple applications

Means to identify common clinical ‘context’ across boundaries

= identity of patient and previous encounters

ANSI Standard September 2000

TemplatesRIM-compliant CDA data structures

Express specific clinical data e.g. BP

May be combined to define template for larger datasets

Embedded data validation rules

(thus,similar to OpenEHR archetypes)


SummarySummary

Tool for interoperability

Extensive and costly activity in health informatics

Complex outputChiefly, information models (UML etc)

Cautious industrial buy-in: what’s the migration pathway?

HL7 Predominant body at the moment

standards in medical informatics dr jeremy rogers md mrcgp senior clinical fellow in health...

Documents

standards bodies hl7

health informatics slide

vhsbetamax slide

battle slide

health hl7

standards bodies iso

relevant cen standards

hl7 health level