US Standards for Health Record Systems

James J. Cimino, M.D.

Columbia University, New York

For the Health Information Management Systems Society (HIMSS)

The Need for Standards

• Patient Safety• Quality of Care• Cost Effectiveness• Patient Involvement• Performance Evaluation• Research• Health Surveillance• Disaster Response

Current State of Standards

• Reporting – mandatory, intrusive

• Terminology – incomplete, not mandatory

• Messaging – incomplete, not mandatory

• Integration – not at all

A Look at Some US Efforts

• Bottom-Up: Health Level 7 (HL7)

• Top-Down: Integrating the Healthcare Enterprise (IHE)

Bottom-Up: Health Level 7 (HL7)

• Need for information exchange standard

• Message is the unit of information

• One actor tells another actor about an event

• Began in 1986 with 14 members, now with 2000 members and worldwide chapters

HL7 Version 2 Message

MSH|^~\&|MENDONC|UPLAB|CICSU9|20000209025800||ORU|0000000001|P|2.1|||

PID|||3131313||SANDIEGO^CARMEN|||F|||||||||||||

OBR|||M09000HABC0000^1|59058^TROPONINI^L^32506|||20000209025800|||||||20000209025800|^|NOR||||||||HE|F||^^^^^R|^^|||||||||

OBX|1|NM|59058^TROPONIN I^MED|0|0.1|ng/ml|0-0.4|||||||||||||||

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language_cd

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organ_donor_indpreferred_pharmacy_id

1

newborn_baby_ind

living_arrangement_cdliving_dependency_cd

Reference Information Model for HL7 Version 3 (RIM)

education_level_cd

language_cd

Person

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11

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1

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living_arrangement_cdliving_dependency_cd

Reference Information Model for HL7 Version 3 (RIM)

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Consent Care_event Assessment

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Master_treatment_servicedea_level_cddrug_category_cdformulary_status_cdmedication_form_cdpharmaceutical_class_cdroute_cdtherapeutic_class_cd

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Master_continuous_observationcorresponding_SI_unit_of_measure_cdcustomary_unit_of_measuredelta_check_numeric_change_computation_method_txtdelta_check_numeric_change_threshold_amtdelta_check_numeric_high_value_amtdelta_check_numeric_low_value_amtdelta_check_numeric_retention_days_qtylength_and_decimal_precision_amtminimum_meaningful_increment_amtsi_conversion_factor_txt

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Healthcare_financesHealthcare_finances

Healthcare_financesHealthcare_stakeholders

Healthcare_financesMaster_tables

Healthcare_financesPatient_encounters

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0088

released January, 1999reflects agreements made through harmonization in November, 1998

Advance_directivecompetence_inddirective_cddisclosure_level_cdlife_quality_descmortuary_preference_nmnotarization_dtassessment_dttmemployment_related_ind

Durable_medical_equipment_slot

Durable_medical_equipment_requestquantity_amttype_cd

Durable_medical_equipmentidslot_size_increment_qtytype_cd

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1

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Patient_departureactual_discharge_disposition_cddischarge_dttmdischarge_location_idexpected_discharge_disp_cd

Patient_admissionadmission_dttmadmission_reason_cdadmission_referral_cdadmission_source_cdadmission_type_cdpatient_valuables_descpre_admit_test_indreadmission_indvaluables_location_desc

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Inpatient_encounteractual_days_qtyestimated_days_qty

1

0..1

is_terminated_by

1

terminates

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1

1

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Resource_requestallowable_substitutions_cdduration_qtystart_dttmstart_offset_qtystatus_cd

Bad_debt_collection_agency

0..*

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is_assigned_to

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Encounter_drgapproval_indassigned_dttmconfidential_indcost_outlier_amtdescgrouper_review_cdgrouper_version_idoutlier_days_qtyoutlier_reimbursement_amtoutlier_type_cd

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Identifier_issuing_authorityeffective_dttermination_dt

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Stakeholder_affiliatefamily_relationship_cd

Stakeholder_affiliationaffiliation_type_cddesceffective_dttermination_dt

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Stakeholder_identifiereffective_dtididentifier_type_cdissued_dtqualifying_information_txttermination_dt

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Insurance_certification_contactparticipation_type_cd

Healthcare_document_authenticator

Person_employmentaddreffective_dthazard_exposure_txtjob_class_cdjob_title_nmphonprotective_equipment_txtsalary_amtsalary_type_cdstatus_cdtermination_dtoccupation_cdjob_status_cd

Authenticationauthentication_dttype_cd

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Document_recipient

Originator

Service_intent_or_order_relationshiprelationship_type_cdreflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Organizationorganization_name_type_cdorganization_nmstandard_industry_class_cd

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Master_service_relationshiprelationship_type_cdreflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Healthcare_benefit_serviceaccess_protocol_desccapitation_indcoinsurance_indcoinsurance_pctcopayment_amtdeductible_amtlower_coverage_limit_amtpay_cap_limit_amtpcp_referral_indprimary_care_provider_indreview_indupper_coverage_limit_amt

Producer_of_master_serviceservice_producing_department_type_cd

Service_scheduling_requestallowable_substitutions_cdduration_qtystart_dttmstart_offset_qtystatus_cd

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Patient_information_recipient

Healthcare_service_providerboard_certification_type_cdboard_certified_indcertification_dteffective_dtlicense_idrecertification_dtspecialty_cdtermination_dt

1

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participates_as1

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Health_chart_deficiencyassessment_dtdesclevel_cdtype_cd

Insurance_certificationappeal_reason_cdcertification_day_qtyeffective_dtidinsurance_verification_dttmmodification_dttmnon_concur_cdnon_concur_effective_dttmpenalty_amttermination_dtreport_of_eligibility_dtreport_of_eligibility_ind

1

1..*

has_as_a_contact1

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Healthcare_benefit_coverageannual_limit_amtbenefit_descbenefit_product_nmdependent_coverage_inddependent_coverage_limit_amteffective_dttmlifetime_limit_amttermination_dttmagreement_type_cdbaby_coverage_indblood_deductible_amtcopay_limit_inddaily_deductible_amtnon_covered_insurance_cdpolicy_amount_class_cdpolicy_amtpolicy_category_cdpolicy_deductible_amtpolicy_limit_day_qtypolicy_scope_cdroom_coverage_type_amount_cd

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Individual_healthcare_practitioner_slot

Individual_healthcare_practitioner_requestpractitioner_type_cd

Individual_healthcare_practitioner_groupid

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Certification_second_opinioneffective_dtstatus_cd

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Employee

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Notary_publiceffective_dtnotary_county_cdnotary_state_cdtermination_dt

Transcriptionist

Person_alternate_nameeffective_dtcdnmreason_cdtermination_dttype_cd

Billing_information_itemcondition_cdoccurrence_cdoccurrence_dtoccurrence_span_cdoccurrence_span_from_dtoccurrence_span_thru_dtquantity_amtquantity_type_cdvalue_amtvalue_cd

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0..*

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Healthcare_provider_organization0..1

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Patient_service_location_slot

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Patient_service_location_requesttype_cd

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Procedureanesthesia_cdanesthesia_minutes_qtydelay_reason_txtincision_closed_dttmincision_open_dttmpriority_amtprocedure_cdprocedure_dttmprocedure_functional_type_cdprocedure_minute_qtymodifier_cd

Stakeholderaddrcredit_rating_cdemail_address_txtphontype_cd

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1

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0..* 1has_as_primary_participant0..* participates_as_primary_in1

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1

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1 0..1takes_on_role_of1 is_a_role_of0..11

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Guarantorfinancial_class_cdhousehold_annual_income_amthousehold_size_qty

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1..*

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1

has_payment_guaranteed_by

1..*

0..1

1

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Employereffective_dttermination_dt

1

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has_as_employer

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1

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Health_benefit_plan_purchaser

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1

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Condition_nodeactual_resolution_dttmestimated_resolution_dttmlife_cycle_status_dttmlifecycle_status_cdmanagement_discipline_cdonset_time_txtonset_dttmranking_amtemployment_related_ind

Insurereffective_dttermination_dt

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Accident_information_source

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Service_reasondetermination_dttmdocumentation_dttmreason_txt

Service_event_relationshiprelationship_type_cd

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Preferred_provider_participationrole_cdeffective_dttermination_dt

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Patient_appointment_request

Patient_slot

Health_charthealth_chart_idhealth_chart_type_cdstatus_cd

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10..*

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Personbirth_dttmbirthplace_addrcitizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdgender_cdlanguage_cdmarital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cdprimary_name_representation_cdprimary_name_type_cdprimary_nmrace_cdreligious_affiliation_cdstudent_cdvery_important_person_cd

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Patient_billing_accountaccount_idadjustment_cdauthorization_information_txtbilling_status_cdcertification_required_indcurrent_unpaid_balance_amtdelete_dtdeleted_account_reason_cdexpected_insurance_plan_qtyexpected_payment_source_cdnotice_of_admission_dtnotice_of_admission_indpatient_financial_class_cdprice_schedule_idpurge_status_cdpurge_status_dtreport_of_eligibility_dtretention_indsignature_on_file_dtspecial_program_cdstoploss_limit_indsuspend_charges_indtotal_adjustment_amttotal_charge_amttotal_payment_amtseparate_bill_ind

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0..*

1

is_associated_with0..*

has 1

0..1

0..*

is_billed_from

0..1

is_billed_to0..*

Master_patient_service_locationaddrclosing_dtdescemail_addressidlicensed_bed_qtynmopening_dtphonservice_specialty_cdslot_size_increment_qtystatus_cdtype_cdequipment_type_cd

1..*

0..*provides_patient_services_at1..*

provides_services_on_behalf_of

0..*

0..*

1

is_a_scheduleable_unit_for0..*

is_scheduled_by1

1..* 0..*belongs_to1..* contains0..*0..*

0..1

is_included_in0..*

includes0..1

0..*

1

is_housed_at0..*

houses1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_entry_location_for1

is_entered_at0..*

Target_participationbegin_dttmend_dttmduration_tmparticipation_type_cd

0..1

0..*

is_target_for0..1

has_as_target0..*

1..*

0..1

is_target_of1..*

has_as_target0..1

Collected_specimen_samplebody_site_cdcollection_body_site_modifier_cdcollection_end_dttmcollection_method_modifier_cdcollection_scheduled_dttmcollection_start_dttmcollection_volume_amtcondition_cdhandling_cdidmethod_of_collection_descnumber_of_sample_containers_qtyspecimen_additive_txtspecimen_danger_cdspecimen_source_cdtransport_logistics_cd

0..*

0..1

is_collected_during0..*

collects0..1

0..*

1

is_collected_by

0..*

collects1

0..1

0..*

is_target_of0..1

has_as_target0..*

Contact_personcontact_reason_cd

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

0..1

0..*

has_as_a_contact

0..1

is_a_contact_for0..*

0..1

0..*

has_as_a_contact0..1

is_a_contact_for0..*

1

0..1

takes_on_role_of1

is_a_role_of0..1

Encounter_practitionerparticipation_type_cd

0..*

1

is_participant_for0..*

participates_as1

Patient_arrivalacuity_level_cdarrival_dttmarrival_type_cdmedical_service_idsource_of_arrival_cdmode_cd

Risk_management_incidentincident_cdincident_dttmincident_severity_cdincident_type_cd

Episodedescepisode_type_cdidlist_closed_indoutcome_txtrecurring_service_ind

0..*

0..1

specified_in0..*

specfies0..1Preauthorizationauthorized_encounters_amtauthorized_period_begin_dtauthorized_period_end_dtidissued_dttmrequested_dttmrestriction_descstatus_cdstatus_change_dttm

1

0..*

issues1

is_issued_by0..*

Location_encounter_roleaccommodation_cdeffective_dttmlocation_role_cdstatus_cdtermination_dttmtransfer_reason_cdtransfer_reason_descusage_approved_ind

1 0..*has1 pertains_to 0..*

Administrative_birth_eventbaby_detained_indbirth_certificate_idbirth_method_cdbirth_recorded_county_cdbirth_recorded_dtnewborn_days_qtystillborn_ind

0..1

1 pertains_to

0..1

has1

Administrative_patient_accidentaccident_death_indaccident_descaccident_dttmaccident_location_descaccident_state_cdaccident_type_cdjob_related_accident_indassessment_dttm

0..1

0..*

is_the_source_of0..1

is_obtained_from0..*

Service_eventattestation_dttmattestation_due_dtbegin_dttmcharge_to_practice_amtcharge_to_practice_cdpatient_sensitivity_cdconsent_cddeclined_indservice_descend_dttmfiller_idfiller_order_status_cdfiller_order_status_dttmrecurring_service_cdscheduled_start_dttmservice_event_descspecimen_received_dttmspecimen_action_cdnmfamily_awareness_txtindividual_awareness_cdconfidential_ind

0..*

0..*

is_documented_by0..*

documents0..*

0..*0..1 has_as_evidence

0..*is_evidence_for0..1

0..*0..1 is_reason_for

0..*has_as_reason0..1

1

0..*

is_target_for1

has_as_target0..*

1

0..*

is_source_for

1

has_as_source0..*

0..1

0..*

is_fulfilled_by0..1

fulfills0..*

1

0..*

is_associated_with1

pertains_to0..*

0..*

0..1

participates_in0..*

has_as_active_participant0..1

0..1 0..*

has_charges_for

0..1 is_charged_to0..*

0..*

0..1

is_performed_at0..*

is_location_for0..1

0..*

0..1

is_target_of0..*

has_as_target0..1

1

0..*

is_delivered_during1

delivers0..*

Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id

0..11pertains_to0..1

has 1

0..*

1

pertains_to

0..*

has1

1

0..*

participates_in1

has_as_care_recipient

0..*

0..*

1

pertains_to

0..*

has1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_scheduled_by1

is_a_scheduleable_unit_for

0..*

0..*

1

belongs_to0..*

has 1

1

0..*

has1

pertains_to

0..*

1

0..*

has1

is_for0..*

0..*

0..1

has_a_primary_provider0..*

is_the_primary_provider_for0..1

0..11 is_a_role_of0..1takes_on_role_of1

0..*

1

belongs_to0..*

has1

0..1

0..*

is_primary_facility_for0..1

has_as_primary_facility0..*

0..1

0..*

is_target_of0..1

has_as_target0..*

0..*

0..1

is_sourced_from0..*

is_source_for0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

Resource_slotoffset_qtyquantity_amtresource_type_cdslot_state_cdstart_dttm

Appointment_contact_personrole_cd

0..*

1 involves

0..*participates_in1

Patient_encounteradministrative_outcome_txtcancellation_reason_cddescencounter_classification_cdend_dttmexpected_insurance_plan_qtyfirst_similar_illness_dtfollow_up_type_cdidpatient_classification_cdpurpose_cdrecord_signing_dttmspecial_courtesies_cdstart_dttmstatus_cdtransport_requirement_cdurgency_cdtriage_classification_cdmedical_service_cdconfidentiality_constraint_cd

1..*

1

is_associated_with1..*

has_as_participant1

0..1

1

precedes0..1

is_preceded_by1

0..*

0..1

precedes0..*

follows0..1

0..*

1

pertains_to0..*

has1

1

1..*

has_parts1

is_part_of1..*1..*

0..1

is_authorized_by1..*

authorizes0..1

1..*

1

pertains_to1..*

has1

1

0..*

has_parts 1

is_part_of0..*

1..*

0..*

has 1..*

is_present_in0..*

0..*0..1 is_assigned_to0..*has_assigned_to_it0..1

0..*

1

involves0..*

is_involved_in1

Scheduleid

1

0..*

contains1

is_managed_by0..*

Appointmentappointment_disposition_cdappointment_duration_qtyappointment_reason_cdappointment_request_reason_cdappointment_timing_tqappointment_type_cdcancellation_dttmcancellation_reason_cdestimated_duration_amtevent_reason_cdexpected_end_dttmexpected_service_descexpected_start_dttmidoccurence_idoverbook_indscheduling_begin_dttmscheduling_completed_dttmscheduling_status_cdstatus_cdurgency_cdvisit_type_cdwait_list_priority_amt

0..*

0..*

is_reserved_by0..*

reserves0..*

0..*

1

participates_in

0..*

involves1

1..* 0..*is_scheduled_by1..*schedules0..*

1..*

0..*

contains

1..*

are_booked_in0..*

Reference Information Model for HL7 Version 3 (RIM)

Reference Information Model for HL7 Version 3 (RIM)

• Consensus view of the healthcare world

• Flexible structures

• Emphasizes meanings of health information

• Object-oriented

Allergyallergen_idallergy_cdallergy_reaction_cd

allergy_reaction_description_txtallergy_severity_cdallergy_type_cdassessment_dttmemployment_related_ind

Health_issuediagnosis_cdonset_dttm

billing_priority_amtseverity_cdclassification_cdconfirmation_status_cdpersistence_cd

probability_amtprobability_txtprognosis_descprognosis_awareness_desccd

Medicare_coverageeffective_dteligibility_cdidlifetime_res_delay_day_qty

lifetime_reserve_day_qtymedicare_coverage_type_cdprogram_type_cdrenal_cdtermination_dt

Medicaid_coverageaid_category_cd

Champus_coveragehandicapped_program_cdnon_avail_cert_on_file_indretirement_dtstation_id

Master_categorical_observationabnormal_result_cdallowed_value_type_cdcritical_result_cdnormal_result_cd

preferred_coding_system_cdvalid_answer_cd

Master_calculated_observationderivation_rule_desc

Referralauthorized_visits_qty

descreason_txt

Dietary_intent_or_orderdiet_type_cd

dietary_instruction_descdietary_tray_type_cdservice_period_cdservice_type_cd

Observation_intent_or_orderpatient_hazard_cdreason_for_study_cd

relevant_clinical_information_txtreporting_priority_cdspecimen_action_cd

Treatment_service_eventprescription_idrefills_remaining_qtynotes_txtPTroutPTcompindication_cdexpiration_dttm

substance_lot_number_txtsubstance_manufacturer_cd

Treatment_service_administrationadministered_rate_txtcompletion_status_cdsubstance_refusal_reason_cdsubstitution_cdsystem_entry_dttm

Treatment_service_dispensedispense_package_method_cddispense_package_size_amtneeds_human_review_indrejection_reason_txtsubstitution_cd

suppliers_special_dispensing_instruction_cdtotal_daily_dose_amt

Treatment_service_giveadministration_descgive_per_time_unit_cdgive_quantitytiming_qtgive_rate_amtmax_give_amtmin_give_amt

needs_human_review_indsubstitution_status_cd

supplier_special_administration_instruction_cd

Goalaction_cdaction_dttmclassification_cdcurrent_review_status_cdcurrent_review_status_dttmepisode_of_care_idestablished_dttmevaluation_cd

evaluation_comment_txtexpected_achievement_dttm

goal_list_priority_amtlife_cycle_dttmlife_cycle_status_cdmanagement_discipline_cdnext_review_dttmprevious_review_dttmreview_interval_cdtarget_txttarget_type_cdgoal_cd

Clinical_observationabnormal_result_indlast_observed_normal_values_dttmnature_of_abnormal_testing_cdclinically_relevant_begin_dttmclinically_relevant_end_dttmobservation_method_cdobservation_status_cdobservation_status_dttm

observation_sub_idobservation_value_txtprobability_amtreferences_range_txt

universal_service_identifier_suffix_txtuser_defined_access_check_txt

value_type_cdvalue_units_cd

Consent Care_event Assessment

Master_specimen_requirementadditive_cdcontainer_desccontainer_preparation_desc

container_volume_amtderived_specimen_cd

minimum_collection_volume_amtnormal_collection_volume_amt

special_handling_descspecimen_priorities_cd

specimen_retention_time_amtspecimen_type_cd

Master_observation_serviceinstrument_idpermitted_data_type_cd

processing_time_qtyspecimen_required_ind

typical_turnaround_time_qty

1

0..*

has 1

is_specified_for0..*

0..*

0..*

is_basis_for0..*

has_as_basis

0..*

Master_treatment_servicedea_level_cddrug_category_cdformulary_status_cdmedication_form_cdpharmaceutical_class_cdroute_cdtherapeutic_class_cd

Treatment_intent_or_orderdosage_txtearliest_dispense_dtIndication_cdnon_form_authorized_ind

providers_treatment_instruction_txtrejection_reason_cd

requested_give_rate_amtrequested_give_strength_amt

substitution_allowed_indsupplier_special_dispensing_instruction_cdverification_required_ind

Treatment_intent_or_order_revisiondispense_package_method_cd

dispense_package_size_amtgive_indication_cdgive_per_time_unit_cd

give_rate_amtlast_refilled_dttm

max_give_amtmin_give_amtneeds_human_review_indorder_revision_PTcomporder_revision_PTroutorder_revision_quantitytiming_qtordered_administration_method_cd

prescription_idproviders_administration_instruction_cd

refills_allowed_qtyrefills_doses_dispensed_qtyrefills_remaining_qtysubstitution_status_cdsuppliers_dispensing_instruction_cd

total_daily_dose_amttotal_daily_dose_cd

0..1

0..*

is_ordered_on

0..1

orders0..*

1 1..*has_parts1 is_part_of1..*

Master_numeric_rangerange_type_cdcondition_desc

high_range_amthigh_gestation_age_amthigh_value_amtlow_age_amt

low_gestation_age_amtlow_value_amtrace_subspecies_txtsex_txtspecies_txt

Master_continuous_observationcorresponding_SI_unit_of_measure_cdcustomary_unit_of_measure

delta_check_numeric_change_computation_method_txtdelta_check_numeric_change_threshold_amtdelta_check_numeric_high_value_amtdelta_check_numeric_low_value_amtdelta_check_numeric_retention_days_qtylength_and_decimal_precision_amtminimum_meaningful_increment_amtsi_conversion_factor_txt

0..*

1

applies_to0..*

conforms_to1

Healthcare_financesHealthcare_finances

Healthcare_financesHealthcare_stakeholders

Healthcare_financesMaster_tables

Healthcare_financesPatient_encounters

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL

RIM_0088

released January, 1999reflects agreements made through harmonization in November, 1998

Advance_directivecompetence_inddirective_cd

disclosure_level_cdlife_quality_descmortuary_preference_nmnotarization_dtassessment_dttmemployment_related_ind

Durable_medical_equipment_slot

Durable_medical_equipment_requestquantity_amttype_cd

Durable_medical_equipmentid

slot_size_increment_qtytype_cd

0..*

1

is_a_scheduleable_unit_for0..*

is_scheduled_by1

0..*

1

requests0..*

is_requested_by1

Durable_medical_equipment_groupid

0..*

0..1

may_request0..*

is_requested_by0..1

1..*

0..*

belongs_to1..*

contains0..*

Patient_departureactual_discharge_disposition_cd

discharge_dttmdischarge_location_id

expected_discharge_disp_cd

Patient_admissionadmission_dttmadmission_reason_cdadmission_referral_cdadmission_source_cdadmission_type_cdpatient_valuables_descpre_admit_test_indreadmission_ind

valuables_location_desc

Bad_debt_billing_accountbad_debt_recovery_amtbad_debt_transfer_amttransfer_to_bad_debt_dttransfer_to_bad_debt_reason_cd

Diagnostic_related_groupbase_rate_amt

capital_reimbursement_amtcost_weight_amt

idmajor_diagnostic_category_cdoperating_reimbursement_amtreimbursement_amtstandard_day_qty

standard_total_charge_amttrim_high_day_qtytrim_low_day_qty

Inpatient_encounteractual_days_qtyestimated_days_qty

1

0..1

is_terminated_by

1

terminates

0..1

1

1

is_preceded_by1

preceded1

Resource_requestallowable_substitutions_cd

duration_qtystart_dttmstart_offset_qtystatus_cd

Bad_debt_collection_agency

0..*

1

is_assigned_to

0..*

is_assigned1

Encounter_drgapproval_indassigned_dttmconfidential_indcost_outlier_amtdesc

grouper_review_cdgrouper_version_idoutlier_days_qty

outlier_reimbursement_amtoutlier_type_cd

1

0..*

is_assigned_as

1

is_an_assignment_of0..*

0..*1

is_assigned_to0..*is_assigned1

Identifier_issuing_authorityeffective_dttermination_dt

Appointment_requestappointment_rqst_reason_cdappointment_rqst_type_cdequip_selection_criteria_pv

idlocation_selection_criteria_pv

occurence_idpriority_cd

repeating_interval_duration_qtyrequested_ri

rqst_event_reason_cdrqsted_duration_qtystart_dt

time_selection_criteria_pv

0..*1 is_requested_by0..*requests1

Stakeholder_affiliatefamily_relationship_cd

Stakeholder_affiliationaffiliation_type_cddesceffective_dttermination_dt

0..*

1

has_as_secondary_participant0..*

participates_as_secondary_in1

Stakeholder_identifiereffective_dtid

identifier_type_cdissued_dt

qualifying_information_txttermination_dt

1

0..*

issues 1

is_issued_by

0..*

Insurance_certification_contactparticipation_type_cd

Healthcare_document_authenticator

Person_employmentaddr

effective_dthazard_exposure_txtjob_class_cdjob_title_nmphon

protective_equipment_txtsalary_amtsalary_type_cdstatus_cdtermination_dtoccupation_cdjob_status_cd

Authenticationauthentication_dttype_cd

1

0..*

is_related_to1

is_related_to0..*

Document_recipient

Originator

Service_intent_or_order_relationshiprelationship_type_cd

reflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Organizationorganization_name_type_cdorganization_nm

standard_industry_class_cd

0..1

1

is_a_role_of0..1

takes_on_role_of1

0..*0..1

is_a_subdivision_of

0..*

has_as_a_subdivision0..1

0..*

1

is_assigned_by

0..*

assigns1

0..1

1

is_a_role_of0..1

takes_on_role_of

1

Master_service_relationshiprelationship_type_cd

reflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Healthcare_benefit_serviceaccess_protocol_desccapitation_indcoinsurance_indcoinsurance_pctcopayment_amtdeductible_amt

lower_coverage_limit_amtpay_cap_limit_amtpcp_referral_ind

primary_care_provider_indreview_ind

upper_coverage_limit_amt

Producer_of_master_serviceservice_producing_department_type_cd

Service_scheduling_requestallowable_substitutions_cd

duration_qtystart_dttmstart_offset_qtystatus_cd

1

0..*

requests1

is_requested_by0..*

Patient_information_recipient

Healthcare_service_providerboard_certification_type_cdboard_certified_indcertification_dteffective_dtlicense_idrecertification_dtspecialty_cdtermination_dt

1

0..*

participates_as1

has_as_participant0..*

Health_chart_deficiencyassessment_dtdesclevel_cdtype_cd

Insurance_certificationappeal_reason_cdcertification_day_qtyeffective_dtid

insurance_verification_dttmmodification_dttmnon_concur_cd

non_concur_effective_dttmpenalty_amttermination_dtreport_of_eligibility_dtreport_of_eligibility_ind

1

1..*

has_as_a_contact1

is_a_contact_for1..*

Healthcare_benefit_coverageannual_limit_amtbenefit_descbenefit_product_nmdependent_coverage_inddependent_coverage_limit_amteffective_dttmlifetime_limit_amttermination_dttmagreement_type_cdbaby_coverage_indblood_deductible_amtcopay_limit_inddaily_deductible_amtnon_covered_insurance_cdpolicy_amount_class_cdpolicy_amtpolicy_category_cdpolicy_deductible_amtpolicy_limit_day_qtypolicy_scope_cd

room_coverage_type_amount_cd

1

0..*

has_parts

1

is_part_of0..*

Individual_healthcare_practitioner_slot

Individual_healthcare_practitioner_requestpractitioner_type_cd

Individual_healthcare_practitioner_groupid

0..1

0..*

is_requested_by0..1

may_request0..*

Certification_second_opinioneffective_dtstatus_cd

0..*

1

provides_opinion_on0..*

includes1

Employee

1

0..*

is_employee_in1

has_as_employee0..*

Notary_publiceffective_dtnotary_county_cdnotary_state_cdtermination_dt

Transcriptionist

Person_alternate_nameeffective_dtcdnmreason_cdtermination_dttype_cd

Billing_information_itemcondition_cdoccurrence_cdoccurrence_dtoccurrence_span_cdoccurrence_span_from_dtoccurrence_span_thru_dtquantity_amtquantity_type_cdvalue_amtvalue_cd

Guarantor_contractbilling_hold_indbilling_media_cdcharge_adjustment_cdcontract_duration_cdcontract_type_cdeffective_dtinterest_rate_amtperiodic_payment_amtpriority_ranking_cdtermination_dt

1

0..*

has_coverage_affirmed_by1

affirms_insurance_coverage_for0..*

Healthcare_provider_organization0..1

1

is_a_role_of0..1

takes_on_role_of1

Patient_service_location_slot

Patient_service_location_groupid

Patient_service_location_requesttype_cd

0..1

0..*

is_requested_by0..1

may_request0..*

Procedureanesthesia_cd

anesthesia_minutes_qtydelay_reason_txtincision_closed_dttmincision_open_dttmpriority_amtprocedure_cdprocedure_dttm

procedure_functional_type_cdprocedure_minute_qtymodifier_cd

Stakeholderaddrcredit_rating_cdemail_address_txtphontype_cd

0..1

1

is_a_role_of

0..1

takes_on_role_of1

0..* 1has_as_primary_participant0..* participates_as_primary_in1

0..*

1

is_assigned_to0..*

is_assigned1

1 0..1takes_on_role_of1 is_a_role_of0..11

0..1

may_act_as_a1

is_a0..1

1

0..1

takes_on_role_of1

is_a_role_of

0..1

0..1

1

is_a 0..1

takes_on_role_of1

0..1

1

is_a 0..1

takes_on_role_of1

0..*

0..*

refers_to_person_by0..*is_used_by0..*

Guarantorfinancial_class_cd

household_annual_income_amthousehold_size_qty

1

1..*

guarantees_payment_under

1

has_payment_guaranteed_by

1..*

0..1

1

is_a_role_of0..1

takes_on_role_of1

Employereffective_dttermination_dt

1

0..*

is_employer_of1

has_as_employer

0..*

0..1

1

is_a_role_of0..1

takes_on_role_of1

Health_benefit_plan_purchaser

0..1

1

is_a_role_of0..1

takes_on_role_of1

Condition_nodeactual_resolution_dttmestimated_resolution_dttmlife_cycle_status_dttmlifecycle_status_cdmanagement_discipline_cdonset_time_txtonset_dttmranking_amt

employment_related_ind

Insurereffective_dttermination_dt

1

0..1

takes_on_role_of1

is_a_role_of0..1

1

0..*

issues1

is_issued_by0..*

Accident_information_source

1

0..1

takes_on_role_of1

is_a_role_of0..1

Clinical_document_headerauthentication_dtavailability_status_cdchange_reason_cdcompletion_status_cdconfidentiality_status_cdcontent_presentation_cddocument_header_creation_dt

file_nmid

last_edit_dtorigination_dtreporting_priority_cdresults_report_dttmstorage_status_cdtranscription_dttype_cd

0..1

0..* is_parent_document_for

0..1

has_as_a_parent_document

0..*

0..* 1

is_related_to0..*

is_related_to

1

0..1 0..*of0..1 has_been_received_by0..*

0..1 0..*of0..1 has_been_originated_by0..*

0..1

0..*

transcribes0..1

is_transcribed_by0..*

Service_reasondetermination_dttmdocumentation_dttmreason_txt

Service_event_relationshiprelationship_type_cd

Service_intent_or_ordercharge_type_cdclarification_phonend_condition_cdentering_device_cdescort_required_ind

expected_performance_time_qtyfiller_order_idfiller_txtorder_control_cdorder_control_reason_cdorder_effective_dttmorder_group_idorder_id

order_placed_dttmorder_quantitytiming_qtplacer_order_idplacer_txt

planned_patient_transport_cdreport_results_to_phonresponse_requested_cdservice_body_site_cd

service_body_site_modifier_cdservice_body_source_cdtarget_of_service_cdtransport_arranged_ind

transport_arrangement_responsibility_cdtransport_mode_cdwhen_to_charge_dttmwhen_to_charge_txtresults_status_cdintent_or_order_cdjoin_cd

0..*

0..1

is_reason_for0..*

has_as_reason0..1

1

0..*

is_source_for

1

has_as_source0..*

1

0..*

is_target_for1

has_as_target0..*

0..1

0..*

may_be_referred_to_in0..1

is_related_to0..*

Financial_transactionalternate_descdesc

extended_amtfee_schedule_cdinsurance_amtposting_dtqty

transaction_batch_idtransaction_cdtransaction_dttransaction_idtransaction_type_cdunit_amtunit_cost_amt

0..1

0..*

categorizes0..1

is_categorized_by0..*

Active_participationbegin_dttmend_dttmduration_tm

participation_type_cd

0..1

0..*

participates_in0..1

has_as_participant0..*

0..*

0..1

participates_in0..*

has_as_participant0..1

Master_serviceallowable_processing_priority_cdallowable_reporting_priority_cdbilling_reference_txtchallenge_information_txtconfidentiality_cdeffective_dt

factors_that_may_affect_observation_descfee_amt

fixed_canned_message_cdimaging_measurement_modality_cdincompatible_change_dttm

instrument_identifier_coding_system_nminstrument_identifier_nm

interpretation_considerations_desckind_of_quantity_observed_cdlast_update_dttmmethod_cdmethod_descnature_of_service_cdobservation_id_suffix_txtorderable_service_indpatient_preparation_descpoint_versus_interval_cdportable_device_ind

preferred_ordering_method_txtpreferred_scheduling_method_txtprocedure_medication_cdreport_display_order_txtrequired_credentials_descservice_alternate_id

service_alternate_identifier_coding_system_nmservice_alternate_identifier_nmservice_alternate_name_use_cdservice_alternate_nmservice_contraindication_cdservice_desc

service_performance_schedule_cdservice_primary_nmservice_requirement_descservice_type_cd

standard_time_to_perform_dttmtarget_anatomic_site_cdtarget_of_service_cduniversal_service_id

universal_service_identifier_coding_system_nmuniversal_service_identifier_nmquantitytiming_qtjoin_cd

1

0..*

is_target 1

has_target0..*

10..*

is_source1has_source0..*

0..*

1..*

provides_coverage_for0..*

is_covered_by1..*

0..* 0..1produces0..* is_produced_by0..1

0..*

1

is_an_instance_of

0..*

is_instantiated_as1

1

1..*

is_requested_by1

requests1..*

Administrative_patient_deathdeath_certificate_id

death_certificate_recorded_dtdeath_classification_cddeath_dttmdeath_location_nm

death_notification_source_nmdeath_verification_cddeath_verification_dtdeath_verification_nm

Patient_information_disclosuredisclosure_dttminfo_disclosed_descinfo_requested_descreason_cdrequested_dttmurgency_cd

1

0..*

is_the_recipient_of1

is_provided_to

0..*

Preferred_provider_participationrole_cdeffective_dttermination_dt

0..*

1

has_as_care_provider0..*

participates_in1

Disabilityeffective_dt

return_to_work_auth_dttermination_dt

unable_to_work_effective_dt

Patient_appointment_request

Patient_slot

Health_charthealth_chart_idhealth_chart_type_cdstatus_cd

1

0..*

has_an_assessment_of1

is_assessed_against

0..*

0..1

0..*

contains0..1

may_be_contained_in0..*

Healthcare_benefit_productassignment_of_benefits_indbenefit_product_descid

benefit_plan_nmbenefit_plan_type_cdbenefits_coordination_indcob_priority_amtcombine_baby_bill_indeffective_dt

eligibility_source_cdgroup_benefit_indmail_claim_party_cdpolicy_source_cdrelease_information_cdstatus_cdtermination_dt

0..*

1

provides_validation_for0..*

is_validated_by1

0..1

0..*

governs0..1 is_governed_by

0..*

1

0..*

offers1

is_offered_by0..*

1

0..*

is_the_purchaser_of1

has_as_purchaser0..*

10..*

has_parts

1is_part_of0..*

0..*

0..1

is_associated_with0..*

is_associated_with0..1

Individual_healthcare_practitionerdesc

fellowship_field_cdgraduate_school_nmgraduation_dtposition_cd

practitioner_type_cdprimary_care_indresidency_field_cdslot_size_increment_qty

1

0..*

is_scheduled_by1

is_a_scheduleable_unit_for0..*

1

0..*

is_requested_by1

requests0..*

1..*

0..*

belongs_to1..*

contains0..*

0..*

1

is_provided_by0..*

provides1

Personbirth_dttmbirthplace_addr

citizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdgender_cdlanguage_cd

marital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cd

primary_name_representation_cdprimary_name_type_cdprimary_nmrace_cd

religious_affiliation_cdstudent_cd

very_important_person_cd

1

0..1

takes_on_role_of1is_a_role_of

0..1

1

0..1

takes_on_role_of1

is_a_role_of

0..1

0..1

1

is_a_role_of0..1

takes_on_role_of1

0..1

1

is_identified_as0..1

may_act_in_the_role_of

1 1

0..*

has1

is_for0..*

0..*

1

is_entered_by

0..*

enters 1

Patient_billing_accountaccount_idadjustment_cd

authorization_information_txtbilling_status_cdcertification_required_indcurrent_unpaid_balance_amt

delete_dtdeleted_account_reason_cdexpected_insurance_plan_qtyexpected_payment_source_cdnotice_of_admission_dtnotice_of_admission_indpatient_financial_class_cdprice_schedule_idpurge_status_cdpurge_status_dtreport_of_eligibility_dtretention_indsignature_on_file_dtspecial_program_cdstoploss_limit_indsuspend_charges_indtotal_adjustment_amttotal_charge_amttotal_payment_amtseparate_bill_ind

0..*

1

pertains_to0..*

has1

0..1

0..1

is_the_prior_account_for0..1

has_as_a_prior_account

0..1

0..*0..* has_payment_guaranteed_by0..*

provides_payment_guarantee_for

0..*

0..*

1

is_associated_with0..*

has 1

0..1

0..*

is_billed_from

0..1

is_billed_to0..*

Master_patient_service_locationaddrclosing_dtdesc

email_addressid

licensed_bed_qtynmopening_dtphon

service_specialty_cdslot_size_increment_qtystatus_cdtype_cd

equipment_type_cd

1..*

0..*provides_patient_services_at

1..*

provides_services_on_behalf_of

0..*

0..*

1

is_a_scheduleable_unit_for0..*

is_scheduled_by1

1..* 0..*belongs_to1..* contains0..*0..*

0..1

is_included_in0..*

includes0..1

0..*

1

is_housed_at0..*

houses1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_entry_location_for1

is_entered_at0..*

Target_participationbegin_dttmend_dttmduration_tm

participation_type_cd

0..1

0..*

is_target_for0..1

has_as_target0..*

1..*

0..1

is_target_of1..*

has_as_target0..1

Collected_specimen_samplebody_site_cd

collection_body_site_modifier_cdcollection_end_dttm

collection_method_modifier_cdcollection_scheduled_dttmcollection_start_dttmcollection_volume_amtcondition_cdhandling_cdid

method_of_collection_descnumber_of_sample_containers_qtyspecimen_additive_txtspecimen_danger_cdspecimen_source_cdtransport_logistics_cd

0..*

0..1

is_collected_during0..*

collects0..1

0..*

1

is_collected_by

0..*

collects1

0..1

0..*

is_target_of0..1

has_as_target0..*

Contact_personcontact_reason_cd

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

0..1

0..*

has_as_a_contact

0..1

is_a_contact_for0..*

0..1

0..*

has_as_a_contact0..1

is_a_contact_for0..*

1

0..1

takes_on_role_of1

is_a_role_of0..1

Encounter_practitionerparticipation_type_cd

0..*

1

is_participant_for0..*

participates_as1

Patient_arrivalacuity_level_cdarrival_dttmarrival_type_cdmedical_service_idsource_of_arrival_cdmode_cd

Risk_management_incidentincident_cdincident_dttmincident_severity_cdincident_type_cd

Episodedesc

episode_type_cdid

list_closed_indoutcome_txt

recurring_service_ind

0..*

0..1

specified_in0..*

specfies0..1Preauthorizationauthorized_encounters_amtauthorized_period_begin_dtauthorized_period_end_dt

idissued_dttmrequested_dttmrestriction_descstatus_cd

status_change_dttm

1

0..*

issues1

is_issued_by0..*

Location_encounter_roleaccommodation_cdeffective_dttmlocation_role_cdstatus_cdtermination_dttmtransfer_reason_cdtransfer_reason_descusage_approved_ind

1 0..*has1 pertains_to 0..*

Administrative_birth_eventbaby_detained_indbirth_certificate_idbirth_method_cd

birth_recorded_county_cdbirth_recorded_dtnewborn_days_qtystillborn_ind

0..1

1 pertains_to

0..1

has1

Administrative_patient_accidentaccident_death_indaccident_descaccident_dttm

accident_location_descaccident_state_cdaccident_type_cdjob_related_accident_indassessment_dttm

0..1

0..*

is_the_source_of0..1

is_obtained_from0..*

Service_eventattestation_dttmattestation_due_dtbegin_dttm

charge_to_practice_amtcharge_to_practice_cdpatient_sensitivity_cdconsent_cddeclined_indservice_descend_dttmfiller_id

filler_order_status_cdfiller_order_status_dttmrecurring_service_cdscheduled_start_dttmservice_event_descspecimen_received_dttmspecimen_action_cd

nmfamily_awareness_txtindividual_awareness_cdconfidential_ind

0..*

0..*

is_documented_by0..*

documents0..*

0..*0..1 has_as_evidence

0..*is_evidence_for0..1

0..*0..1 is_reason_for

0..*has_as_reason0..1

1

0..*

is_target_for1

has_as_target0..*

1

0..*

is_source_for

1

has_as_source0..*

0..1

0..*

is_fulfilled_by 0..1

fulfills0..*

1

0..*

is_associated_with1

pertains_to0..*

0..*

0..1

participates_in0..*

has_as_active_participant0..1

0..1 0..*

has_charges_for

0..1 is_charged_to0..*

0..*

0..1

is_performed_at0..*

is_location_for0..1

0..*

0..1

is_target_of0..*

has_as_target0..1

1

0..*

is_delivered_during1

delivers0..*

Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id

0..11pertains_to0..1

has 1

0..*

1

pertains_to

0..*

has1

1

0..*

participates_in1

has_as_care_recipient

0..*

0..*

1

pertains_to

0..*

has1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_scheduled_by1

is_a_scheduleable_unit_for

0..*

0..*

1

belongs_to0..*

has 1

1

0..*

has1

pertains_to

0..*

1

0..*

has1

is_for0..*

0..*

0..1

has_a_primary_provider0..*

is_the_primary_provider_for0..1

0..11 is_a_role_of0..1takes_on_role_of1

0..*

1

belongs_to0..*

has1

0..1

0..*

is_primary_facility_for0..1

has_as_primary_facility0..*

0..1

0..*

is_target_of0..1

has_as_target0..*

0..*

0..1

is_sourced_from0..*

is_source_for0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

Resource_slotoffset_qtyquantity_amtresource_type_cdslot_state_cdstart_dttm

Appointment_contact_personrole_cd

0..*

1 involves

0..*participates_in1

Patient_encounteradministrative_outcome_txt

cancellation_reason_cddescencounter_classification_cdend_dttm

expected_insurance_plan_qtyfirst_similar_illness_dtfollow_up_type_cdidpatient_classification_cdpurpose_cdrecord_signing_dttmspecial_courtesies_cdstart_dttmstatus_cdtransport_requirement_cdurgency_cdtriage_classification_cdmedical_service_cdconfidentiality_constraint_cd

1..*

1

is_associated_with1..*

has_as_participant1

0..1

1

precedes0..1

is_preceded_by1

0..*

0..1

precedes0..*

follows0..1

0..*

1

pertains_to0..*

has1

1

1..*

has_parts1

is_part_of1..*1..*

0..1

is_authorized_by1..*

authorizes0..1

1..*

1

pertains_to1..*

has1

1

0..*

has_parts 1

is_part_of0..*

1..*

0..*

has 1..*

is_present_in0..*

0..*0..1 is_assigned_to0..*has_assigned_to_it0..1

0..*

1

involves0..*

is_involved_in1

Scheduleid

1

0..*

contains 1

is_managed_by0..*

Appointmentappointment_disposition_cd

appointment_duration_qtyappointment_reason_cdappointment_request_reason_cdappointment_timing_tqappointment_type_cdcancellation_dttmcancellation_reason_cd

estimated_duration_amtevent_reason_cdexpected_end_dttmexpected_service_descexpected_start_dttmidoccurence_idoverbook_indscheduling_begin_dttmscheduling_completed_dttmscheduling_status_cdstatus_cdurgency_cdvisit_type_cd

wait_list_priority_amt

0..*

0..*

is_reserved_by0..*

reserves0..*

0..*

1

participates_in

0..*

involves1

1..* 0..*is_scheduled_by1..*schedules0..*

1..*

0..*

contains

1..*

are_booked_in0..*

RIM Class Diagram V1.19

• 6 Primary Subject Areas• 72 Classes • 276 Attributes• 94 Relationships• 59 Data types (approx)

Observation

value : ANYinterpretationCode : SET<CE>

methodCode : SET<CE>targetSiteCode : SET<CD>

SubstanceAdministration

routeCode : CEapproachSiteCode : SET<CD>

doseQuantity : IVL<PQ>rateQuantity : IVL<PQ>

doseCheckQuantity : SET<RTO>maxDoseQuantity : SET<RTO>

substitutionCode : CE

Procedure

methodCode : SET<CE>approachSiteCode :

...

Supply

quantity : PQexpectedUseTime :

IVL<TS>

Diet

energyQuantity : PQcarbohydrateQuantity :

PQ

ClinicalDocument

setId : IIversionNumber : INT...

...

Container

capacityQ...

Access

app...

Device

manuf...

Employee

jobCode : ...

LivingSubject

administr...

Material

...

AssignedEntity

...

LicensedEntity

...

Place

mobileI...

ManufacturedMaterial

lotN...

NonPersonLivingSubject

...

Patient

...

Organization

...

Account

name : STbalanceAmt : MOcurrencyCode : CE

interestRateQuantity : RTO<MO,PQ>allowedBalanceQuantity : IVL<MO>

Person

addr : BAG<...

WorkingList

...

PublicHealthCase

detectionMethodCode : CEtransmissionModeCode :

...

PatientEncounter

preAdmitTestInd : BLadmissionReferralSourceCode : CE

lengthOfStayQuantity : PQdischargeDispositionCode : CE

...

SchedulableResource

...

Other

Acts

Infrastructure (Structured documents)

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL

VERSION 1.18 (RIM_0118)

Provisionsal version reflects changes to RIM naming conventions approved in October 2002. Changes will be formally adopted in RIM

Harmonization Meeting 11/14-15/2002.

Billboard produced by:Rochester Outdoor Advertising

Roles

Guarantor

...

DiagnosticImage

subjectOrientationCode : CE

QueryAck

messageQueryCode : CEqueryResponseCode : CSresultTotalQuantity : INT

...

QueryContinuation

...

Table

summary : STwidth : STrules : CScellspacing :

...

TableStructure

char : STcharoff :

...

TableColumnStructure

...

TableCell

scope : CS...

LocalAttr

...

LocalMarkup

des...

LinkHtml

href : ...

ContextStructure

...

Infrastructure (Structured documents)

Infrastructure (Message control)

Enitites

Message Control

FinancialTransaction

amt : MOcreditExchangeRateQuantity : REALdebitExchangeRateQuantity : REAL

InvoiceElement

modifierCode : SET<CE>unitQuantity : RTO<PQ,PQ>unitPriceAmt : RTO<MO,PQ>...

netAmt : MOfactorNumber : REALpointsNumber : REAL

FinancialContract

paymentTermsCode : CE

RoleHeirEntityHeir

SortControl

seq...

QuerySpec

messageQueryCode : CEmodifyCode : CS

responseElementGroupId : SET<II>

responseModalityCode : CS...

0..n 10..n 1

RelationalExpression

ele...

QueryBySelectionSelectionExpression

0..n

1

0..n

1

LogicalExpression

...

0..n

0..1

userAsRight

0..n

rightSide 0..1

0..n

0..1

userAsLeft0..n

leftSide0..1

QueryByParameter

ParameterList

Parameter

... 0..n 0..10..n 0..1

0..1

0..n

0..1

0..n

ParameterItem

...

DeviceTask

parameterValue : LIST<ANY>...

Acknowledgement

typeCo...

Message

versionId : ST...

1..*

1

acknowledgement1..*

acknowledgedMessage1

1

1

payload1

acknowledgingMessage

1

QueryEvent

...

ControlAct

...0..1

0..n

0..1

payload

0..n

0..1

1

0..1

1

ManagedParticipation

...

ActHeir

ActRelationship

typeCode : CSinversionInd : BL

contextControlCode : CSsequenceNumber : INT

priorityNumber : INTpauseQuantity : PQcheckpointCode : CS

splitCode : CSjoinCode : CSnegationInd : BLconjunctionCode : CSlocalVariableName : ST

seperatableInd : BL

Act

classCode : CSmoodCode : CSid : SET<II>

code : CDnegationInd : BL

text : EDstatusCode : SET<CS>

effectiveTime : GTSderivationExpr : STavailabilityTime : TS

priorityCode : SET<CE>activityTime : GTS

repeatNumber : IVL<INT>confidentialityCode : SET<CE>

interruptibleInd : BLlevelCode : CE

independentInd : BLuncertaintyCode : CE

reasonCode : SET<CE>languageCode : CE

substitutionConditionCode : CE

0..n1

inboundRelationship

0..n

target

1

0..n

1

outboundRelationship

0..n

source

1

Participation

typeCode : CSfunctionCode : CDcontextControlCode :

CSsequenceNumber :

INT...

0..n

1

0..n

1

RoleLink

...Role

classCode : CS...

0..n

1

0..n

1

0..n1

outboundLink

0..n

source

1

0..n1

inboundLink

0..n

target

1

LanguageCommunication

langua...

AttentionLine

...

Batch

referen...

Entity

classCode : CSdeterm...

0..n0..1

playedRole

0..n

player

0..1

0..n0..1

scopedRole

0..n

scoper

0..1

10..n 10..n

Transmission

id : ...

0..n

1

0..n

1

0..1

0..n

0..1

0..n

CommunicationFunction

...

1..n

0..*

1..n

0..*1..*

0..*

1..*

0..*

LivingEntity

Entity

Person

Role Patient

HasRole

Terminology and Information Model

Information Model

Terminology

Bottom-Up: Status of HL7

• Version 2 widely used

• No standard for implementation

• Not mandatory

• RIM is in development

• Common Document Architecture (CDA)

For more information:www.hl7.org

Top-Down: Integrating the Healthcare Enterprise (IHE)

• Standards needed for implementing standards• IHE formed in 1997

– Health Information Management and Systems Society (HIMSS)

– Radiology Society of North America (RSNA)

• International participation: Canada, France, Germany, Italy, Japan, Korea, Netherlands, Norway, Spain, United Kingdom

• Includes: societies, users, vendors, consultants, standards development organizations

IHE: A Standard Process for Adoption of Standards

1. Interoperability Problem Identification: identify common interoperability problems (information access, clinical workflow, administration, underlying infrastructure)

2. Integration Profile Specification: chose standards that address the problems - document them in an IHE integration profile

3. Connect-a-thon Testing: Vendors implement one or more IHE integration profiles into their products and test them for mutual interoperability at the annual IHE Connect-a-thon

4. Integration Statements and Requests for Proposals (RFPs):• Vendors publish IHE integration statements to document

IHE integration profiles supported by their products• Users can reference the IHE integration profiles in requests

for proposals, greatly simplifying the systems acquisition process.

A Proven Standards Adoption Process

IHEIntegrationProfiles B

IHEIntegrationProfile A

Easy toIntegrateProducts

IHEConnect-a-thon

ProductWith IHE

IHEDemonstration

User Site

RFP

Standards(e.g. ASTM-CCR

HL7 CDA)

Product IHE IntegrationStatement

IHE Connect-a-thonResults

Requirements

IHE Integration Profiles - Radiology

• Scheduled Workflow• Patient information Reconciliation• Consistent Presentation of Images• Post-processing Workflow• Reporting Workflow• Evidence Documents Other profiles:

• information technology infrastructure• cardiology• laboratory

IHE Connect-a-thons

• Centerpiece of the IHE testing process

• Weeklong interoperability-testing event

• Validation of the participants' integration work

• Systems exchange information with complementary systems from multiple vendors

• Support of functions in the Integration Profiles

Massive yearly events :Massive yearly events :60-70 vendors60-70 vendors120-160 engineers120-160 engineersOver 100 systemsOver 100 systems…….integrated in 5 days.integrated in 5 days

IHE Connect-a-thons

Vendors do not pass…Vendors do not pass…until an IHE Project Manager attests it !until an IHE Project Manager attests it !

Participating and Contributing Vendors (America)

Agfa HealthCareAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCarefxCedara Software

CorporationCerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak

CompanyEmageonEclipsysFujifilm Medical Systems

ProcomPhilips Medical SystemsRASNA Imaging SystemsSectraSentillionSiemens Medical SolutionsSoftmedicalStentor, IncStorCOMM, IncSwissray International, IncTiani Medgraph AGToshiba America Medical

SystemsUltraVisual Medical

SystemsVital Images, Inc.Voxar LimitedWebMDXIMIS

GE HealthcareHeartlabHitachi Medical

CorporationHologic, IncIDX Systems CorporationIMCO TechnologiesInSiteOneINFINITTKonica Minolta Marotech, Inc.McKesson Information

SolutionsMedconMedical Manager Health

SystemsMediface Co., Ltd.Merge eFilmMortara

How to participate in IHE?

As a User or Vendor Contributor• Become a member of a Technical Committee• Become a member of Regional/National CommitteesAs a Vendor Participant• Comment on integration profiles• Attend Educational Workshops (September)• Participate to Connect-a-thonsAs a User/Consultant Participant• Comment on integration profiles• Attend Educational Workshops (September)• Attend Connect-a-thons • Include IHE Integration Profiles in your RFPs and

Integration Projects.

W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

in the Enterprisein the Enterprise

and Across Care Settingsand Across Care Settings