By: Dr.

Abbas Shojaee February, 2010
Faculty of paramedical sciences, Beheshti University of Medical Sciences

This presentation uses works of:
1. 2. 3.

4. 5.

Tim Benson W. Ted Klein Evangelos Milios Gunther Schadow Veli BICER

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This is an introduction and it does not go into the details of concepts and interactions. Introduces RIM in detail Does not teach how to design models Does not cover details of project issues (e.g., tools, coordination, balloting, etc.) Contains a simple practice on how to design a software architecture for imposed security needs by HL7.

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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Standards in Health care informatics
What is it? Why is needed?

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HL7 evolution and history HL7 standard version 3.0
Describe the models in Version 3 Show how they are used to develop the HL7 message specifications that make up the standard?

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Practicing development of a standard Practicing implementation of HL7 required functionalities for Security

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© 1999, 2000 Health Level 7

January 24, 2000

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Part I - Introduction
HL7, business problem, and how HL7 solves it What is Version 3? Why HL7 is making the move to Version 3

Part II - Technical Concepts
Background information

Part III - Methodology
Modeling process

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© 1999, 2000 Health Level 7

January 24, 2000

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What is a standard in medical informatics? Why and where is it needed? What urge them? The process of standard development in Medical Informatics?

January 24, 2000

© 1999, 2000 Health Level 7

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Migration Towards a Wellness Model

Managing Visit

Managing Care
Clinton¶s Reform

Managing Health

Initial Fee-forFee-for-service, onon-demand
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Transitional Capitated, casecase-based
© 1999, 2000 Health Level 7

Anticipated Preventive, episodal
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Present time

Client/Server, Internet, Multimedia
Centralized Computing (Batch)
Network Computing (RPC, ORBs, etc)

Digital

Dell
Micron

HP

Enterprise Computing (Client/Server)
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© 1999, 2000 Health Level 7 January 24, 2000 7

Business Strategy & Motivation

Methodology, Methodology, Measurement, Coordination

Planning & Enforcement
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Modeling & Voting
© 1999, 2000 Health Level 7 January 24, 2000 8

Evolution and history The structure Organization and methodology

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© 1999, 2000 Health Level 7

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Health care environment is a complex environment and a language to describe it needs to accommodate this complexity HL7 is such a language The result of an ad hoc effort to make HIS information exchangeable The HL7 organization was founded in 1987 In June 1994 HL7 was designated as an ANSI accredited standards development organization (SDO)

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© 1999, 2000 Health Level 7

January 24, 2000

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Implementation Technology Specification

"Send as ASCII string in XML format"

Hierarchical Message Definition

"Discontinue pharmacy order"

ITS for XML

Data

HL7 Message Creation HL7-Conformant Application

Message Instance

HL7 Message Parsing HL7-Conformant Application

Data

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© 1999, 2000 Health Level 7

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To provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services. ... the complete µlife cycle¶ of a standards specification -- development, adoption, market recognition, utilization and adherence.

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© 1999, 2000 Health Level 7

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A domain-specific, common protocol for the exchange of health care information.

Function

Communication

7 6 5 4 3 2 1

Application Presentation Session Transport Network Data Link Physical
© 1999, 2000 Health Level 7 January 24, 2000 13

ISOISO-OSI Communication Architecture Model
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2.0 (1988) 2.1 (1990) 2.2 (1994) 2.3 (1997) 2.3.1 (1999) 2.4 (2000) 3.0

Prototype First standard Widely Adopted In operation Current ANSI standard In Ballot

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© 1999, 2000 Health Level 7

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The HL7 RIM (Reference Information Model) specifies the grammar of V3 messages and, specifically, the basic building blocks of the language (nouns, verbs, etc.), their permitted relationships, and Data Types. The RIM is not a model of health care. It is not a model of any message, either. Although it is healthcare-specific and it is used in messages.

BUMS, Abbas Shojaee, Feb. 2010

Organization addr : BAG<AD> standardIndustryClassCode : CE

ActRelationship typeCode : CS inversionInd : BL outboundRelationship contextControlCode : CS Access LicensedEntity 0..n contextConductionInd : BL approachSiteCode : CD sequenceNumber : INT recertificationTime : TS Person targetSiteCode : CD 1 source priorityNumber : INT gaugeQuantity : PQ addr : BAG<AD> pauseQuantity : PQ Act Participation maritalStatusCode : CE checkpointCode : CS classCode : CS Entity educationLevelCode : CE typeCode : CS splitCode : CS moodCode : CS Role raceCode : SET<CE> functionCode : CD classCode : CS player joinCode : CS id : SET<II> classCode : CS disabilityCode : SET<CE> contextControlCode : CS ... determinerCode : CS negationInd : BL 0..1 code : CD 0..n id : SET<II> livingArrangementCode : CE sequenceNumber : INT id : SET<II> conjunctionCode : CS 0..n negationInd : BL 1 religiousAffiliationCode : CE negationInd : BL playedRole code : CE code : CE localVariableName : ST 1 derivationExpr : ST negationInd : BL ethnicGroupCode : SET<CE> quantity : SET<PQ> seperatableInd : BL 0..n noteText : ED text : ED time : IVL<TS> addr : BAG<AD> name : BAG<EN> inboundRelationship 0..n title : ST telecom : BAG<TEL> modeCode : CE desc : ED statusCode : SET<CS> statusCode : SET<CS> awarenessCode : CE statusCode : SET<CS> target scopedRole LivingSubject effectiveTime : GTS signatureCode : CE effectiveTime : IVL<TS> existenceTime : IVL<TS>... activityTime : GTS 0..n certificateText : ED 1 administrativeGenderCode : CE signatureText : ED telecom : BAG<TEL> 0..1 availabilityTime : TS birthTime : TS source performInd : BL quantity : RTO riskCode : CE ControlAct scoper deceasedInd : BL positionNumber : LIST<INT> 1 ... substitutionConditionCode : CE priorityCode : SET<CE> ... handlingCode : CE confidentialityCode : SET<CE>... deceasedTime : TS 1 target repeatNumber : IVL<INT> multipleBirthInd : BL 1 interruptibleInd : BL WorkingList multipleBirthOrderNumber : INT levelCode : CE Employee organDonorInd : BL outboundLink 0..n FinancialContract ownershipLevelCode : CE independentInd : BL 0..n jobCode : CE RoleLink paymentTermsCode : CE uncertaintyCode : CE jobTitleName : SC Material reasonCode : SET<CE> inboundLink typeCode : CS NonPersonLivingSubject jobClassCode : CE effectiveTime : IVL<TS> ... formCode : CE languageCode : CE strainText : ED salaryTypeCode : CE mobileInd : BL addr : AD directionsText : ED positionText : ED gpsText : ST ManagedParticipation id : SET<II> statusCode : SET<CS> genderStatusCode : CE ManufacturedMaterial lotNumberText : ST expirationTime : IVL<TS> stabilityTime : IVL<TS> salaryQuantity : MO hazardExposureText : ED protectiveEquipmentText : ED 0..n LanguageCommunication languageCode : CE modeCode : CE proficiencyLevelCode : CE preferenceInd : BL SubstanceAdministration routeCode : CE approachSiteCode : SET<CD> doseQuantity : IVL<PQ> rateQuantity : IVL<PQ> doseCheckQuantity : SET<RTO> maxDoseQuantity : SET<RTO> InvoiceElement modifierCode : SET<CE> unitQuantity : RTO<PQ,PQ> unitPriceAmt : RTO<MO,PQ> netAmt : MO factorNumber : REAL pointsNumber : REAL

Place

Patient confidentialityCode : CE veryImportantPersonCode : CE

Observation value : ANY interpretationCode : SET<CE> methodCode : SET<CE> targetSiteCode : SET<CD>

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

Device manufacturerModelName : SC softwareName : SC Container localRemoteControlStateCode... CE : capacityQuantity : PQ alertLevelCode : CE heightQuantity : PQ lastCalibrationTime : TS diameterQuantity : PQ capTypeCode : CE separatorTypeCode : CE barrierDeltaQuantity : PQ bottomDeltaQuantity : PQ

DiagnosticImage subjectOrientationCode : CE PatientEncounter preAdmitTestInd : BL admissionReferralSourceCode : CE lengthOfStayQuantity : PQ dischargeDispositionCode : CE specialCourtesiesCode : SET<CE> specialAccommodationCode : SET<CE> acuityLevelCode : CE PublicHealthCase detectionMethodCode : CE transmissionModeCode : CE diseaseImportedCode : CE Diet energyQuantity : PQ carbohydrateQuantity : PQ Supply quantity : PQ expectedUseTime : IVL<TS>

Account name : ST balanceAmt : MO currencyCode : CE interestRateQuantity : RTO<MO,PQ> allowedBalanceQuantity : IVL<MO> FinancialTransaction amt : MO creditExchangeRateQuantity : REAL debitExchangeRateQuantity : REAL

RIM 2.01 July 17,2003

DeviceTask parameterValue : LIST<ANY>

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Large pictorial representation of the clinical data (domains) Identifies the life cycle of events that a message or groups of related messages will carry. Shared model between all the domains and as such is the model from which all domains create their messages. Explicitly representing the connections that exist between the information carried in the fields of HL7 messages

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Specifies the grammar of HL7 messages
the basic building blocks of the language their permitted relationships.

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The RIM backbone has just three core classes and a number of permitted relationships between them. Specialization
specializations are only shown explicitly in the RIM when they add additional attributes to the general class

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Each class has a predefined set of attributes
HL7 V3 uses a graphical representation, called Refined Message Information Model (RMIM) to display the structure of a message as a color-coded diagram.

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ActRelationship typeCode : CS inversionInd : BL outboundRelationship contextControlCode : CS 0..n contextConductionInd : BL sequenceNumber : INT 1 source priorityNumber : INT pauseQuantity : PQ Act Participation checkpointCode : CS classCode : CS typeCode : CS splitCode : CS moodCode : CS Role functionCode : CD joinCode : CS id : SET<II> classCode : CS contextControlCode : CS ... negationInd : BL code : CD sequenceNumber : INT 0..n id : SET<II> conjunctionCode : CS negationInd : BL 1 code : CE negationInd : BL localVariableName : ST 1 derivationExpr : ST negationInd : BL 0..n noteText : ED seperatableInd : BL text : ED time : IVL<TS> addr : BAG<AD> inboundRelationship 0..n title : ST telecom : BAG<TEL> modeCode : CE statusCode : SET<CS> statusCode : SET<CS> target awarenessCode : CE effectiveTime : GTS effectiveTime : IVL<TS> signatureCode : CE activityTime : GTS 1 certificateText : ED signatureText : ED availabilityTime : TS source performInd : BL quantity : RTO positionNumber : LIST<INT> 1 ... substitutionConditionCode : CE priorityCode : SET<CE> ... confidentialityCode : SET<CE> 1 target repeatNumber : IVL<INT> interruptibleInd : BL levelCode : CE 0..n outboundLink independentInd : BL 0..n RoleLink uncertaintyCode : CE reasonCode : SET<CE> inboundLink typeCode : CS effectiveTime : IVL<TS> ... languageCode : CE

Entity classCode : CS determinerCode : CS id : SET<II> code : CE quantity : SET<PQ> name : BAG<EN> desc : ED statusCode : SET<CS> existenceTime : IVL<TS>... telecom : BAG<TEL> riskCode : CE handlingCode : CE player 0..1 0..n playedRole

scopedRole 0..n 0..1 scoper

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The RIM defines a set pre-defined Attributes for each class These are the only ones allowed in HL7 messages. Denoting attributes? E.g. Act.id Each attribute has a specified Data Type. These Attributes and Data Types become tags in HL7 XML messages.

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One common data type is the Instance Identifier (e.g. id), which is used to give unique identity to people, persons, organizations, things and information objects. The datatype for id is II(instance identifier)
II: Object Identifier (OID) Universal Unique Identifier (UUID)

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ClassCode to identify the type of Act
An structural attribute Obligatory

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Code to further identify a classcode
to specify precisely what the class means at a leaf level of granularity.
HL7 uses two main types of code.
1. 2. The first type covers the specialized codes used for structural attributes and are defined by HL7 itself. The second type covers externally defined terms and codes such as SNOMED CT (Clinical Terms).

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Used to specify more precisely what each RIM class means when used in a message. For example, Act has a class code and a mood code.
The class code states what sort of Act this is, such as an observation, an encounter, or the administration of a drug. Mood is analogous to the tense of a verb. Mood code indicates whether an Act has happened (an event), or is a request for something to happen, or a goal or even a criterion.

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For example,
"weight = 100kg" is an observation event; "measure weight daily" is a request; "reduce weight to 80Kg" is a goal "if weight is greater than 80Kg" is a criterion.

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Every happening is an Act, analogous to a verb in English. Each Act may have any number of Participations, in Roles, played by Entities. These are analogous to nouns. Act
Kind of act (what happens) Actor (who performs) Subject whom is affected (e.g. patient) Where (location) When (time) How (manner) Why (Reasons ) What for (motives)

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Each Act may also be related to other Acts, via ActRelationships.

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Acts.classCode specifies the type of act.
Event Observation Notification

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Times
ActivityTime EffectivityTime

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Acts.modeCode specifies the tense of act:
Fact (indicative mood) =EVN Command (imperative mood) = RQO Question (interrogative mood) Wish (optative mood) Conditionality (Subjunctive mood) Promise = PRMS Proposal = PRP

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Lets discuss act specializations
Observation, Procedure, Substance Administration, Supply, and PatientEncounter.

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Acts.StatusCode
New Active Completed Canceled Aborted

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Entity is anything, which has or will have existence.
Living Non living Abstract

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Structural attributes
Entity.classCode identifies the represented concept. Entity.determinerCode identifies the type of representation
x Individual instance x Collection x Generic class

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Either plays a Role or defines the scope for a Role Every Role is played just by a single Entity Some attributes of an Entity, are also found in the Role class. These include id, code, name, addr (address), telecom, statusCode, and quantity
What is the rule, how can I choose using Entity and Role overlapping attributes?

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Living subject
Person NonPersonLivingSubject

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Material Places Organization

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Role is defined as a competency of an Entity playing the Role
Whar are Roles for people What are Roles for inanimate objects

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Samples:
People, such as patient, practitioner, or employee Places, such as hospital, home, clinic, or place of birth Organizations, such as care provider, employer, or supplier

Things, such as drug, instrument, or computer system Responsible entities, such as parent, employer, or manufacturer
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The most important Role specialization is Patient.

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Are used to constrain and verify conformance to profiled HL7 Version 3 Refined Message Information Models (RMIMs). Expresses the data content needed in a specific clinical or administrative context

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Explicit connection between core classes are needed ActRelationship:
To link Acts together, from a Source Act to a Target Act ActRelationship .typeCode to specify the type of association
x x x x x Composition comprises entries Discharge summary documents a hospital visit Test report fulfills a test request Discharge summary refers to a referral Final report replaces a preliminary report

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Role Link:
Role Link is a relationship between two Roles.

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Participation:
It shows how an Entity, in a particular Role, functions during the scope of an Act Participants (entities) perform in an act as either actor (active) or target (passive) A participant in particular role, can contribute to an act in many ways. (e.g. a surgen) Participation.typeCode specifies the type of association between an Act and each participating Role
x x x x Performer of act (surgeons, observers, practitioners) Subject of act, such as the patient Location of act Author, informant, addressee, or information recipient

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Classification: ordered system of concepts related to a domain Clinical terminology: terminology needed to record all important aspects of health care in standardized form

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Entity Act
0..* participant 0..*participant / participation scopedRole Role typeCode *: <= ParticipationType classCode *: <= ROL functionCode: CD CWE [0..1] <= ParticipationFunction id: SET<II> [0..*] contextControlCode: CS CNE [0..1] <= ContextControl code: CE CWE [0..1] <= RoleCode sequenceNumber: INT [0..1] negationInd: BL [0..1] negationInd: BL [0..1] addr: BAG<AD> [0..*] noteText: ED [0..1] telecom: BAG<TEL> [0..*] time: IVL<TS> [0..1] statusCode: SET<CS> CNE [0..*] <= RoleStatus modeCode: CE CWE [0..1] <= ParticipationMode effectiveTime: IVL<TS> [0..1] awarenessCode: CE CWE [0..1] <= TargetAwareness certificateText: ED [0..1] signatureCode: CE CNE [0..1] <= ParticipationSignature quantity: RTO<QTY,QTY> [0..1] signatureText: ED [0..1] positionNumber: LIST<INT> [0..*] 0..* playedRole performInd: BL [0..1] 0..* act 0..1 playingEntity 0..1 scopingEntity classCode *: <= ACT m oodCode *: <= EVN id: SET<II> [0..*] code: CD CWE [0..1] <= ActCode negationInd: BL [0..1] derivationExpr: ST [0..1] text: ED [0..1] statusCode: SET<CS> CNE [0..*] <= ActStatus effectiveTime: GTS [0..1] activityTime: GTS [0..1] availabilityTime: TS [0..1] priorityCode: SET<CE> CWE [0..*] <= ActPriority confidentialityCode: SET<CE> CWE [0..*] <= Confidentiality repeatNumber: IVL<INT> [0..1] interruptibleInd: BL [0..1] levelCode: CE CWE [0..1] <= ActContextLevel independentInd: BL [0..1] uncertaintyCode: CE CNE [0..1] <= ActUncertainty reasonCode: SET<CE> CWE [0..*] <= ActReason languageCode: CE CWE [0..1] <= HumanLanguage

Entity
classCode *: <= ENT deter miner Code*: <= INSTANCE id: SET<II> [0..*] code: CE CWE [0..1] <= EntityCode quantity: SET<PQ> [0..*] name: BAG<EN> [0..*] desc: ED [0..1] statusCode: SET<CS> CNE [0..*] <= EntityStatus existenceTime: IVL<TS> [0..1] telecom: BAG<TEL> [0..*] riskCode: CE CWE [0..1] <= EntityRisk handlingCode: CE CWE [0..1] <= EntityHandling

sourceOf / targetOf
typeCode *: <= ActRelationshipType inversionInd: BL [0..1] contextControlCode: CS CNE [0..1] <= ContextControl contextConductionInd: BL [0..1] sequenceNumber: INT [0..1] priorityNumber: INT [0..1] pauseQuantity: PQ [0..1] checkpointCode: CS CNE [0..1] <= ActRelationshipCheckpoint splitCode: CS CNE [0..1] <= ActRelationshipSplit joinCode: CS CNE [0..1] <= ActRelationshipJoin negationInd: BL [0..1] conjunctionCode: CS CNE [0..1] <= RelationshipConjunction localVariableName: ST [0..1] seperatableInd: BL [0..1]

0..* source

0..* target

Act

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Organization
classCode *: <= OR G deter miner Code*: <= INSTANCE name: BAG<EN> [0..*] standardIndustryClassCode: CE CWE [0..1] <= OrganizationIndustryClass 0..1 researchSponsor

ObservationEvent ResearchSubject
0..* sponsoredSubject classCode *: <= RESBJ 0..* researchSubject id: SET<II> [0..*] subject code: CE CWE [0..1] <= RoleCode typeCode*: <= SBJ addr: BAG<AD> [0..*] telecom: BAG<TEL> [0..*] statusCode: SET<CS> CNE [0..*] <= RoleStatus effectiveTime: IVL<TS> [0..1] 0..* subjectOf classCode *: <= OBS m oodCode *: <= EVN id*: II [1..1] code*: CD CWE [1..1] <= ObservationType text: ED [0..1] statusCode*: CS CNE [1..1] <= completed effectiveTime*: IVL<TS> [1..1] confidentialityCode: SET<CE> CWE [0..*] <= Confidentiality

component
typeCode *: <= COMP 0..* observationEvent

0..1 subjectPerson

Person
classCode *: <= PSN deter miner Code*: <= INSTANCE id: SET<II> [0..*] code: CE CWE [0..1] <= EntityCode name: BAG<EN> [0..*] riskCode: CE CWE [0..1] <= EntityRisk handlingCode: CE CWE [0..1] <= EntityHandling administrativeGenderCode: CE CWE [0..1] <= AdministrativeGender birthTime: TS [0..1] deceasedTime: TS [0..1] maritalStatusCode: CE CWE [0..1] <= MaritalStatus educationLevelCode: CE CWE [0..1] <= EducationLevel disabilityCode: SET<CE> CWE [0..*] <= PersonDisabilityType livingArrangementCode: CE CWE [0..1] <= LivingArrangement religiousAffiliationCode: CE CWE [0..1] <= ReligiousAffiliation raceCode: SET<CE> CWE [0..*] <= Race ethnicGroupCode: SET<CE> CWE [0..*] <= Ethnicity

ObservationEvent
classCode *: <= OBS m oodCode *: <= EVN id*: II [1..1] code*: CD CWE [1..1] <= ObservationType statusCode: CS CNE [1..1] <= completed effectiveTime*: IVL<TS> [0..1] confidentialityCode: SET<CE> CWE [0..*] <= Confidentiality

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A model is a collection of subject areas, scenarios, classes, attributes, use cases, actors, trigger events, interactions, etc. that depict the information needed to specify HL7 Version3 messages. HL7 models are further divided into four specific models - a use case model, an information model, an interaction model, and a message design model.

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Decomposition
Divide-and-conquer

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Abstraction
Chunking the information

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Hierarchy
Increasing semantic content of individual chunks of information through reuse

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‡ Captures healthcare requirements

Use Case Model

‡ Defines scope for TSC approval

‡ Specifies data and its semantics

Information Model

‡ Specifies major state transitions ‡ Specifies vocabulary for domains ‡ Defines information flows

Interaction Model

‡ Defines communication roles ‡ Forms basis for conformance claims

2-nd Order 1 choice of 0-n Drug 0-1 Nursing

‡ Defines message contents

Message Specification

‡ Apply constraints to the information model and vocabulary
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HL7 Models

BUMS, Abbas Shojaee, Feb. 2010

Use Case Model

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Describes specific situations in which communication between healthcare entities is needed.

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Information Model

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A detailed and precise definition for the information from which all data content of HL7 messages are drawn. Classes, Attributes, and Relationships
Documented in the Reference Information Model, the Domain Information Model, and the Message Information Model

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State Transition Models for certain selected classes. Data Types and Constraints.

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Root of all information models. Provides a static view of the information. A HL7-wide common reference model that is result of the combined consensus view of information and integrates all Technical Committees¶ domain views. HL7 development methodology calls for creation of small subset of the RIM - called Domain specific Information Model or DIM and incremental refining to achieve Problem-areaspecific design models

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Foundation Classes
Acts Entities Roles

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Communication Infrastructure
Core Infrastructure Message Communications Control Structured Documents

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Interaction Model

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Specifies all Trigger Events and Message Flows. Specifies the Application Roles.

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Each Interaction consists of:
Trigger event
x Initiators of Interactions.

Message ID
x Each interaction sends one particular message

Sender role
x When trigger event detected, message is sent

Receiver role
x Receiver responsibility

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E nco un ter_m an ager : AR_ E nco u nt er_

E nco un ter_tracker : AR_ Enco un t er _

E nco un ter_archivist : AR_ E nco u nt er_

1: sched ule _encounter

2: delete _ scheduled _encounter

3: ad m it_p atient

4: adm it_patient

Application Role identifies an information management responsibility for one of the subject classes. Responsibilities typically are: Creator, Manager, Tracker and Archivist. applications are assumed to take on one or more application roles.

Interactio n
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Healthcare 5: adm it_patient

Interaction ID Interaction Name Trigger Event Name Event Dependency

PA231 Send Registration to Trackers Patient Registers for Encounter Account must be in the unregistered or pregistered state A01 Encounter Manager Encounter Tracker

PA232 Send Registration to Archivists Patient Registers for Encounter Account must be in the unregistered or pregistered state A02 Encounter Manager Encounter Archivist

Message ID Sender Receiver Receiver Responsibility

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Message Model

Domain Information Model Reference Information Model
P erson_ nam e_for_I HCP cd : CV purpos e_cd : CV t ype_cd : CV nm : P N 1 has 1 i s_for i s_particip ant_f or 0. .* P erson_ as_IHCP ph on : TIL 1 t akes _on_role_ of 1 part icipate s_as 1 I ndividual _heal th care_pra cti tioner E xactly one occurren ce has _as_parti ci pant 1 Enc ounter_prac ti ti oner part icipati on_t ype_cd i s_as sociat ed_wit h 1. .* i s _a_role_o f i d : TII P erson_ as_P ati ent 0. .1 i s_the_p ri m ary_provide r_f or 1 has bi rth_dtt m : TS 0. .* ha s _a_prim ary_provider bi rt hplac e_ad dr : S T decease d_dtt m : T S P atient edu cat ion_l evel_cd : CV 1. .1 i d : TII gen der_cd : C V t akes _on_role_ of 1 m arit al_st atus_c d : CV st atus_cd : CV 1. .1 newb orn _baby_i nd race_cd : CV i s_invo lved_i n i s_a_role_o f m ul tipl e_birth _ind reli gious _affi li ation_ cd : CV organ_ donor_ind ph on : TIL 1 has P atient_adm is sion P atient_bi lli ng_accoun t i d : TII s t atus_cd : CV 0. .1 bi lli ng_sta tus _cd : CV pat ient _fin anci al_clas s_cd : CV bel ongs_t o price_s chedu le_id : TII P atient_enco unter i d : TII s t atus_cd : CV encount er_cl as sif ic ati on_cd : CV s t art_dtt m i nvolves end _dttm expect ed_ins ura nce _plan_q ty : NM 1 f irs t_si m ilar_i llness _dtt m

Use Case Model
Hierarchical
Message

Interaction Model

Description
1. .* i s_for I npatient_enc ounter actua l_days _ qty est im ate d_days _q ty 1 i s_prece ded_by P erson_ nam e_for_P atient nm : P N ef fective_dt : T S cd : CV purpos e_cd : CV t erm i nati on_dt : T S t ype_cd : CV adm i ssion_ dttm adm i ssion_ re ason_cd adm i ssion_ re ferral_cd adm i ssion_ source_ cd adm i ssion_ type_c d pre_ad mi t_t est_i nd readm i ssion_ ind 1

Message Information Model

preceded

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The RIM must first be refined by subsetting and constraining it
Create a MIM with RIM classes needed Develop an R-MIM from these classes

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Collection of classes with some constraints Collection of attributes and associations to support the R-MIM

BUMS, Abbas Shojaee, Feb. 2010

Person_name effective_dt cd nm purpose_cd termination_dt type_cd 0..* is_for 1 has

Stakeholder addr credit_rating_cd email_address_txt phon type_cd real_id : SET<RWII> id : SET<II>

0..* participates_as_primary_in has_as_primary_participant 1 0..* participates_as_secondary_in 1 has_as_secondary_participant

Stakeholder_affiliation affiliation_type_cd desc effective_dt termination_dt

has_as_a_subdivision 0..1 Person Organization 0..* is_a_subdivision_of organization_name_type_cd organization_nm standard_industry_class_cd

Fewer attributes
BUMS, Abbas

birth_dttm birthplace_addr citizenship_country_cd confidentiality_constraint_cd deceased_dttm deceased_ind disability_cd 0..* participates_as_primary_in education_level_cd Stakeholder Person_name ethnic_group_cd 1..1 has_as_primary_participant Stakeholder_affiliation addr : ST nm : ST administrative_gender_cd email_address_txt : TEL participates_as_secondary_in 0..* affiliation_type_cd : CD type_cd : CD language_cd id : SET<II> 1..1 has_as_secondary_participant marital_status_cd military_branch_of_service_cd 0..* is_for military_rank_nm military_status_cd nationality_cd race_cd religious_affiliation_cd has_as_a_subdivision 1..1 student_cd has very_important_person_cd 0..1 status_cd Person Organization 0..* ambulatory_status_cd organization_nm : ST id education_level_cd : CD is_a_subdivision_of hispanic_ind birth_order_nbr 1..1 1..1 proposes 1..1 living_arrangement_cd has_as_role sponsors living_dependency_cd multiple_birth_ind Shojaee, Feb. 20100..* is_role_of organ_donor_ind Proposed_item Voting_member preferred_pharmacy_id

RIM content

MIM content

(a proper subset of the RIM)

draft_level_voting_ind : BL

0..*

ballot_period_tmr : IVL<TS>

` `

Constrain cardinality on Associations Constraints on Attributes
Some may be left out Sub-components may be individually constrained

` `

Classes are duplicated for different uses May modify the Inheritance structure
Some specializations may subsume the generalization Always inherit downwards to specializations

BUMS, Abbas Shojaee, Feb. 2010

Person_name nm : ST type_cd : CD 0..* is_for

0..* participates_as_primary_in Stakeholder 1..1 has_as_primary_participant Stakeholder_affiliation addr : ST email_address_txt : TEL participates_as_secondary_in 0..* affiliation_type_cd : CD id : SET<II> 1..1 has_as_secondary_participant

1..1 has Person education_level_cd : CD 1..1 has_as_role 0..* is_role_of Voting_member draft_level_voting_ind : BL 1..1 standard_level_voting_ind : BL casts sponsors

has_as_a_subdivision 0..1 Organization 0..* organization_nm : ST is_a_subdivision_of 1..1 1..1 proposes

Proposed_item ballot_period_tmr : IVL<TS> proposed_by content_txt : ED standard_level_ind : BL 0..* 1..1 receives_votes

0..* sponsored_by Individual_representative dues_current_ind : BL Organizational_representative

cast_by

BUMS, Abbas Shojaee, Feb. 2010

Ballot 0..* comments_txt : ST dttm : TS vote_cd : CV

votes_on 0..*

MIM

Person_name is_for nm : ST type_cd : CD 0..1 is_for 0..*

has_as_secondary_participant 0..* 0..* participates_as_secondary_in 1..1 has_as_primary_participant

Stakeholder_affiliation affiliation_type_cd : CD

has 1..1 Person_as_Committee_contact email_address_txt : TEL

has

1..1

Person_as_Voter education_level_cd : CD email_address_txt : TEL 1..1 has_as_role is_role_of 0..* Voting_member draft_level_voting_ind : BL 1..1 standard_level_voting_ind : BL casts

participates_as_primary_in has_as_a_subdivision 0..1 1..1 Organization_as_Committee organization_nm : ST 1..1 0..* is_a_subdivision_of

proposes

proposed_by Organization_as_HL7_member organization_nm : ST email_address_txt : TEL sponsors 0..1 0..* Proposed_item ballot_period_tmr : IVL<TS> content_txt : ED standard_level_ind : BL 1..1 receives_votes

Individual_representative dues_current_ind : BL

0..* sponsored_by Organizational_representative

cast_by

BUMS, Abbas Shojaee, Feb. 2010

votes_on Ballot 0..* 0..* comments_txt : ST dttm : TS vote_cd : CV

RMIM

Person_name is_for nm : ST type_cd : CD 0..1

has_as_secondary_participant 0..* 0..* participates_as_secondary_in has_as_primary_participant

5

Stakeholder_affiliation affiliation_type_cd : CD

3

is_for

0..*

1..1 has 1..1 Person_as_Committee_contact email_address_txt : TEL

4

has

1..1

Person_as_Voter education_level_cd : CD email_address_txt : TEL 1..1 has_as_role is_role_of 0..* Voting_member draft_level_voting_ind : BL 1..1 standard_level_voting_ind : BL casts

participates_as_primary_in has_as_a_subdivision 0..1 1..1 Organization_as_Committee organization_nm : ST 1..1 0..*

2a

2

is_a_subdivision_of

proposes

proposed_by Organization_as_HL7_member organization_nm : ST email_address_txt : TEL sponsors 0..1 0..* Proposed_item ballot_period_tmr : IVL<TS> content_txt : ED standard_level_ind : BL

1

1..1 receives_votes

Individual_representative dues_current_ind : BL

0..* sponsored_by Organizational_representative

cast_by

BUMS, Abbas Shojaee, Feb. 2010

votes_on Ballot 0..* 0..* comments_txt : ST dttm : TS vote_cd : CV

0

BUMS, Abbas Shojaee, Feb. 2010

BUMS, Abbas Shojaee, Feb. 2010

`

`

A method of encoding and sending HL7 messages. XML represents one of several ITS to be developed

BUMS, Abbas Shojaee, Feb. 2010

MSH|^~###BOT_TEXT###amp;|LABGL1||DMCRES||199812300100||ORU^R01|LABGL1199510221838581|P|2.3 |||NE|NE PID|||6910828^Y^C8||Newman^Alfred^E||19720812|M||W|25 Centscheap Ave^^ Whatmeworry^UT^85201^^P||(555)777-6666|(444)677-7777||M||773789090 OBR||110801^LABGL|387209373^DMCRES|18768-2^CELL COUNTS+DIFFERENTIAL TESTS (COMPOSITE)^LN|||199812292128||35^ML|||||||IN2973^Schadow^Gunther^^^^MD^UPIN ||||||||||^Once||||||CA20837^Spinosa^John^^^^MD^UPIN OBX||NM|4544-3^HEMATOCRIT (AUTOMATED)^LN||45||39-49 ||||F|||199812292128||CA20837 OBX||NM|789-8^ERYTHROCYTES COUNT (AUTOMATED)^LN||4.94|10*12/mm3 |4.30-5.90||||F|||199812292128||CA20837

BUMS, Abbas Shojaee, Feb. 2010

<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" «> <id root="" /> <code code="11488-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" « /> <statusCode code="completed" /> <effectiveTime value="20030506230256" /> <confidentialityCode code="N" /> <component> <documentBody> <component> <documentSectionEvent> <code code="10164-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" « /> <text /> </documentSectionEvent> </component> <component> <documentSectionEvent> <code code="11384-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" « /> <text /> <component> <observation> <id root="2.16.840.1.113883.9876.368.2" « /> «..
BUMS, Abbas Shojaee, Feb. 2010

<act classCode=³ACT´ moodCode=³«´> <id root=³1.3.6.1.4.1.12009.3´ extension=³A1234´/> <code code=³...´ codeSystem=³2.16.840.1.113883.6.1´/> <participant typeCode=³«´> <participant classCode=³ROL´> <id root=³1.3.6.1.4.1.12009.4´ extension=³1234567-8´/> <code code=³«´ codeSystem=³2.16.840.1.113883.6.21´/> <playingEntity classCode=³ENT´> <name>...</name> </playingEntity> <scopingEntity classCode=³ENT´> <name>...</name> </scopingEntity> </participant> </participant> <sourceOf typeCode=³REL´> <target classCode=³ACT´> <id root=³1.3.6.1.4.1.12009.3´ extension=³A1235´/> </target> </sourceOf> </act>
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67

Organization
classCode *: <= OR G deter miner Code*: <= INSTANCE name: BAG<EN> [0..*] standardIndustryClassCode: CE CWE [0..1] <= OrganizationIndustryClass 0..1 providerOrganization

Patient

0..* patient

ObservationEvent
classCode *: <= OBS m oodCode *: <= EVN id*: II [1..1] code*: CD CWE [1..1] <= ObservationType text: ED [0..1] statusCode*: CS CNE [1..1] <= completed effectiveTime*: IVL<TS> [1..1] confidentialityCode: SET<CE> CWE [0..*] <= Confidentiality

classCode *: <= PAT 0..* patient id: SET<II> [0..*] subject code: CE CWE [0..1] <= RoleCode addr: BAG<AD> [0..*] typeCode *: <= SBJ telecom: BAG<TEL> [0..*] awarenessCode: CE CWE [0..1] <= TargetAwareness statusCode: SET<CS> CNE [0..*] <= RoleStatus effectiveTime: IVL<TS> [0..1] confidentialityCode: CE CWE [0..1] <= Confidentiality veryImportantPersonCode: CE CWE [0..1] <= PatientImportance 0..* healthCareProvider 0..1 patientPerson

component
typeCode *: <= COMP 0..* observationEvent

Person
classCode *: <= PSN deter miner Code*: <= INSTANCE id: SET<II> [0..*] code: CE CWE [0..1] <= EntityCode name: BAG<EN> [0..*] riskCode: CE CWE [0..1] <= EntityRisk handlingCode: CE CWE [0..1] <= EntityHandling administrativeGenderCode: CE CWE [0..1] <= AdministrativeGender birthTime: TS [0..1] deceasedTime: TS [0..1] maritalStatusCode: CE CWE [0..1] <= MaritalStatus educationLevelCode: CE CWE [0..1] <= EducationLevel disabilityCode: SET<CE> CWE [0..*] <= PersonDisabilityType livingArrangementCode: CE CWE [0..1] <= LivingArrangement religiousAffiliationCode: CE CWE [0..1] <= ReligiousAffiliation raceCode: SET<CE> CWE [0..*] <= Race ethnicGroupCode: SET<CE> CWE [0..*] <= Ethnicity

ObservationEvent
classCode *: <= OBS m oodCode *: <= EVN id*: II [1..1] code*: CD CWE [1..1] <= ObservationType statusCode: CS CNE [1..1] <= completed effectiveTime*: IVL<TS> [0..1] confidentialityCode: SET<CE> CWE [0..*] <= Confidentiality

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68

<observationEvent classCode=³OBS´ moodCode=³EVN´> <id root=³1.3.6.1.4.1.12009.3´ extension=³A1234´/> <code code=³...´ codeSystem=³2.16.840.1.113883.6.1´/> <subject typeCode=³«´> <patient classCode=³ROL´> <id root=³1.3.6.1.4.1.12009.4´ extension=³1234567-8´/> <code code=³«´ codeSystem=³2.16.840.1.113883.6.21´/> <patientPerson classCode=³PSN´> <name><given>John</given><family>Doe</family></name> </patientPerson> <providerOrganization classCode=³ORG´> <name>St., Josephs Hospital</name> </providerOrganization> </patient> </subject> <component typeCode=³REL´> <observationEvent classCode=³ACT´> <id root=³1.3.6.1.4.1.12009.3´ extension=³A1235´/> </observationEvent> </component> </observationEvent>

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BUMS, Abbas Shojaee, Feb. 2010

BUMS, Abbas Shojaee, Feb. 2010

BUMS, Abbas Shojaee, Feb. 2010

Clinical Document Architecture

BUMS, Abbas Shojaee, Feb. 2010

` ` `

CDA: document model using XML tags RIM: defines the tags Why CDA is needed:
Difference between documents and databases x Documents carry meta data x persistence, stewardship, authentication, wholeness, and human readability.

`

CDA evolution history

BUMS, Abbas Shojaee, Feb. 2010

74

`

exchange model for clinical documents
Discharge Summary, Imaging Report, Admission & Physical, Pathology Report

`

Based on XML, HL7, RIM and coded vocabularies, CDA makes documents both
Machine readable Human readable

BUMS, Abbas Shojaee, Feb. 2010

75

` `

Users set their own level of compliance Minimal CDA:
small number of XML-encoded metadata fields Body in pdf, doc or scanned image file

`

High end CDA:
RIM Controlled vocabulary (LOINC, SNOMED, ICD, «

BUMS, Abbas Shojaee, Feb. 2010

76

`

CDA structure

BUMS, Abbas Shojaee, Feb. 2010

Limitations of Version 2.3 Benefits of Version 3 Version 3 Statement of Principles Goals Mission

BUMS, Abbas Shojaee, Feb. 2010

Complex integration: at least 2-4 months to install HL7 interfaces

`

Problem Honest misunderstanding of specifications
Misleading conformance claims

`

Cause Different implicit information models
No vocabulary to describe conformance concepts

BUMS, Abbas Shojaee, Feb. 2010

79

` ` `

Unmeasurable progress Unpredictable results Metastasizing optionality
Past V2 Process
Patient Care ADT/ Financ e

Outcome...

MnM
Control / BUMS, Abbas Shojaee, Feb. 2010 Query Orders Home Health
80

` ` ` ` ` ` `

Implicit information model, not explicit Events not tightly coupled to profiles Need for controlled vocabularies Limited to a single encoding syntax No explicit support for object technologies No explicit support for security functions Optionality is ubiquitous and troublesome

BUMS, Abbas Shojaee, Feb. 2010

81

`

Reduces optionality: results in more specific messages Uncovers hidden assumptions about application boundaries Facilitates defining clear, fine-grained, conformance claims
HL7 V3.0 Certified

`

`

BUMS, Abbas Shojaee, Feb. 2010

82

Deals with complexity of the HC environment: 
Facilitates

integration of heterogeneous systems
best-of-breed 

Increases choices of innovative solutions 



Provides support for legacy systems Allows reliable verification of vendors¶ conformance claims

BUMS, Abbas Shojaee, Feb. 2010

24, 2000

83 

Provides improved protocol for interconnecting heterogeneous systems installation effort 

Reduces
± ±

reduces site-specific negotiations simplifies interface programming 

Promotes

vendor specialization by allowing segmentation of product lines into niche market spaces
84

BUMS, Abbas Shojaee, Feb. 2010

`

` ` `

Provide a framework for coupling events, data elements and messages Improve clarity and precision of specification Improve adaptability of standards to change Begin to approach ³plug and play´

BUMS, Abbas Shojaee, Feb. 2010

85

` ` ` ` ` ` ` `

Explicit Scope, Target Users Support for Legacy Systems Loosely Coupled Systems Internationalization Compatibility with Versions 2.X (limited) Management - ANSI and by-laws Uniform Trigger Event Model Information System Role

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86

` ` ` ` ` ` ` ` `

Conformance Claims The Version 3 Development Process Project Scope Version 3 Methodology - MDF Quality Assurance Processes Process Support Confidentiality of Patient Information Authenticated Authorization for Services Security, Privacy, and Integrity

BUMS, Abbas Shojaee, Feb. 2010

87

`

To bring modern software engineering practices, such as Object Oriented Analysis and Design and formal modeling, to the standards development process To bring the highest level of quality, understandability, and flexibility to a messaging standard Incorporate concept abstractions and behavior modeling using roles in a rigorous set of work products Express the standard in widely accepted UML notation

`

`

`

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88

Chapters 2 and 8

Common Specs

ChapterChapterChapterSpecific Specific Specific Specs Specs Specs

Chapters 3, 4, 6, ...

Segment s and Fields

Trigger Event and Message s

BUMS, Abbas Shojaee, Feb. 2010

89

`

Trigger events
Actions or occurrences

`

Messages
Information content

`

Segments
Repeating structures

`

Data elements
Data representation

BUMS, Abbas Shojaee, Feb. 2010

90

HL7 Referenc e Model Commo n Specs

Chapter Specific Specs
*Future Considerati on

Use Case Model

Information Model

Interaction Model

Message Model

Implementable Message Implementable Specification Implementable Message 2-nd Order Message Specification 1 choice of XML/ER7/« Specification 0-n Drug OLE/CORBA 0-1 Nursing EDIFACT*
91

BUMS, Abbas Shojaee, Feb. 2010

`

The HL7 2.x specifications have:
Segments that imply information entities Events that indicate implied behaviors Descriptive content that suggests use cases but never formally documents these

`

Version 3 seeks to formalize this by applying object analytic methods and style
to improve the internal consistency of HL7 to provide sound semantic definitions to enable future architectures to produce an evolution not a revolution Done by applying MODELING to the HL7 process

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92

By demanding Dispense Manage Perform Lab Review Abstractions: analysis of the Medications Tests Utilization VersionCare focused its 2.x requirements and Activities energies at the information (Use Case communication level and content, Version 3 Model) covered the other assures Account Patient only loosely in abstractions Provider Encounter Order Objects consistency in and the specifications. (Information enhances the value Model) of the resulting messages. HL7 message HL7 message Communicatio n (Interaction
and Message Models)
BUMS, Abbas Shojaee, Feb. 2010

Finance

ADT

Pharmacy
93

`

Use case model
Hierarchy of tasks and actors

`

Message design model
Refined Message Information Model MIM) Abstract message definitions (HMDs) (R-

`

Interaction model
Trigger events, abstract messages & application profiles
`

Vocabulary
Domain definitions Representations and mappings

`

Information model
Classes, relationships, states, and lifecycles
`

Implementation
Implementation Technology Specification (ITS)

BUMS, Abbas Shojaee, Feb. 2010

94

Concepts Modeling

January 24, 2000

© 1999, 2000 Health Level 7

95

Process: Method: Model: Object:

Activities leading to the orderly construction of the models An approach to problem solving Abstract representation of a subject Domain specific concept
January 24, 2000

Operation

Attributes (Data)
Operation

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

96

Domain Analysis

Requirements Analysis

Release 3.0

Message Design
BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7

Message Specification
January 24, 2000 97

`

Decomposition
Divide-and-conquer

`

Abstraction
Chunking the information

`

Hierarchy
Increasing semantic content of individual chunks of information through reuse

BUMS, Abbas Shojaee, Feb. 2010

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98

`

Applying analysis techniques leads to solutions to integrate components Modeling provides the framework for the analysis steps and products Object Oriented Analysis and Modeling form the basis of the standard techniques adopted for Version 3

`

`

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© 1999, 2000 Health Level 7

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99

` `

`

`

`

The deliverables are expressed as models Each model leads to greater understanding of areas that influence content, structure, and behavior of messages Messages are defined when the models are merged The HL7 standard message specification will be derived from the models Models are expressed in UML

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

10 0 

Process Overview 
Model Deliverables and Phases Generation of Messages 

Process in Detail 
Methodology Activities Coordination of Parallel Committee Projects (Harmonization)

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© 1999, 2000 Health Level 7

January 24, 2000

10 1

Tasks Deliverables Phases

January 24, 2000

© 1999, 2000 Health Level 7

102

`

Analysis
Requirements Analysis Domain Analysis

Use Case Model (UCM) Information Model (RIM & DIM) Vocabulary Domain Specification

`

Design
Component and Object Interaction Design Message Design

`

Voting and Publishing Implementation Guide
Technology

Interaction Model (IM) Message Information Model (MIM) Hierarchical Message Description (HMD)

`

BUMS, Abbas Shojaee, Feb. 2010

Implementation Technology © 1999, 2000 Health Level 7 January 24, 2000 Specification (ITS)

10 3

Use Case Model

‡ Captures healthcare requirement ‡ Defines scope for TSC approval ‡ Specifies data and its

Information Model

semantics ‡ Specifies major state transitions ‡ Defines information flows ‡ Specifies vocabulary for ‡ Defines communication roles domains ‡ Forms basis for conformance cla ‡ Defines message contents

Interaction Model

2-nd Order 1 choice of 0-n Drug 0-1 Nursing

Message Specification ‡ Apply constraints to the
information model and
© 1999, 2000 Health Level 7

BUMS, Abbas Shojaee, Feb. 2010

vocabulary

January 24, 2000

10 4

` ` ` ` ` `

Is a Methodology for building HL7 models Is a description for defining HL7 standard messages Full instruction book for HL7 participants Basis for member training Five years in development Continues to evolve as we gain experience

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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10 5

Analysis
Requirements Analysis Domain Analysis

Design
Interaction Design Message Design

Voting
Approval

2-nd Order 1 choice of 0-n Drug 0-1 Nursing
Domain Information Model (DIM) Hierarchical Message Descriptions (HMD)

Use Case Model (UCM) RIM

Interaction Model (IM)

Ballots

BUMS, Abbas Shojaee, Feb. 2010

Reference Model Repository
© 1999, 2000 Health Level 7

January 24, 2000

10 6

Develop Scope Create Use Cases Identify Actors & Events

Information Model Use Case Model
Spec DIM Spec Class Diagram State Diagram UCM Spec Use Case Diagram Spec

Draw initial contents from RIM Model new concepts Harmonize with RIM

Define Trigger Events Define Application Roles Define Interactions Create Conformanc e Claims

Interaction Model
Spec

Message Design

Develop Message Information Mode Develop Message Object Diagram Specify HMD

Inter Spec Interaction Diagram

2-nd Order h//mt:50´d´ 1 choice of« 0-n Drug « 0-1 Nursing «

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

10 7

Reference Information Model

Domain Information Model

Use Case Model

Interaction Model Message Information Model

P erson_ nam e_for_I HCP cd : CV purpos e_cd : CV t ype_c d : CV nm : P N

1 has 1 i s_for

i s_partic ip ant_f or 0. .* P erson_ as_IHCP ph on : TIL 1 t akes _on_role_ of 1 part icipate s_as 1 I ndividual _heal th care_pra cti tioner

Enc ounter_prac ti ti oner part icipati on_t ype_cd

i s_assoc iat ed_wit h 1. .*

E xac tly one occurren ce has _as_parti ci pant 1

i s_a_role_o f i d : TII

1 has

1. .* i s_for

P erson_ as_P ati ent 0. .1 i s_the_p ri m ary_provide r_f or bi rth_dtt m : TS 0. .* ha s_a_prim ary_provider bi rt hplace_ad dr : S T decease d_dtt m : T S P atient edu cat ion_l evel_cd : CV 1. .1 i d : TII gen der_cd : C V t akes _on_role_ of 1 m arit al_st atus_cd : CV s t atus_cd : CV 1. .1 newb orn _baby_i nd race_c d : CV i s_invo lved_i n i s_a_role_o f m ul tipl e_birth _ind reli gious _affi li ation_ cd : CV organ_ donor_ind ph on : TIL 1 has P atient_adm is sion P atient_bi lli ng_accoun t i d : TII st atus_cd : CV 0. .1 bi lli ng_sta tus_c d : CV pat ient _fin anci al_clas s_cd : CV bel ongs_t o pric e_schedu le_id : TII

P atient_enco unter i d : TII st atus_cd : CV encount er_cl assif icati on_cd : CV st art_dtt m i nvolv es end _dttm expect ed_ins ura nce _plan_q ty : NM 1 f irst_si m ilar_i llness _dtt m

I npatient_enc ounter actua l_days_ qty est im ate d_days_q ty 1 i s _prece ded_by

P erson_ nam e_for_P atient nm : P N ef fective_dt : T S cd : CV purpos e_cd : CV t erm i nati on_dt : T S t ype_cd : CV

adm i ss ion_ dttm adm i ss ion_ re ason_cd adm i ss ion_ re ferral_cd adm i ss ion_ source_ cd adm i ss ion_ type_cd pre_ad mi t_t est_i nd readm i ss ion_ ind

1

preceded

Domain Specification Database Hierarchical Message Description Common Message Element Types
© 1999, 2000 Health Level 7 January 24, 2000 10 8

BUMS, Abbas Shojaee, Feb. 2010

Implementation Technology Specifications

"Send as ASCII string in XML format"

Hierarchical Message Definition

"Discontinue pharmacy order"

ITS

Data

HL7 Message Creation

Message Instance

HL7 Message Parsing

Data

HL7-Conformant Application

HL7-Conformant Application
10 9

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© 1999, 2000 Health Level 7

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Methodology Activities Coordination of Parallel Committee Projects (Harmonization)

110

Requirements Analysis
Define Scope Define Scope Create Use Cases Identify Actors & Events

Information Model Use Case Model
Spec DIM Spec Class Diagram State Diagram UCM Spec Use Case Diagram Spec

Draw initial contents from RIM Model new concepts Harmonize with RIM

Define Trigger Events Define Application Roles Define Interactions Create Conformanc e Claims

Interaction Model
Spec

Message Design

Develop Message Information Mode Develop Refined MIM

Inter Spec Interaction Diagram

2-nd Order h//mt:50´d´ 1 choice of« 0-n Drug « 0-1 Nursing «

Specify HMD
© 1999, 2000 Health Level 7 January 24, 2000

BUMS, Abbas Shojaee, Feb. 2010

11 1

`

Scope statement
A high level use case for the entire project

`

Use case
Describes specific situations in which communication between healthcare entities is needed

`

Actor
An entity which initiates or participates in the use case. Discovered in the process of developing use cases

`

Use Case Diagram
Provides a graphical form to develop the use case model from the business process analysis - UML notation Makes it easy to show the relationship between use cases
x Use cases can be decomposed x Use cases can be shared
January 24, 2000 11 2

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

`

Use Case Path
Single µthread¶ or µstoryboard¶ or µscenario¶ Longitudinal temporal description of a Use Case instance

`

Support for OO Concepts
Generalizes
x adds additional behavior

Includes
x uses another use case

Extends
x allows branch flow logic in use case execution

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

11 3

Health Care Enterprise

Manage Health Plans
Manage Health Plans
Manage Membership Manage Network

Provide Services
Provide Services
Perform Triage Treat Patient Schedule Service Order Service

Treat Patient Manage Enroll Member Membership Discharge
Member Approve Services Administer Procedure Evaluate Outcomes Record Results

Order Service
Create Order Status Order Sign Order

Manage Network
Evaluate Provider Market Services

Schedule Service
Create Appointment Monitor Appointment © 1999, 2000 Health Level 7 January 24, 2000

BUMS, Abbas Shojaee, Feb. 2010

11 4

Delete_patient_record

Billing

Authorized_user

The individual responsible for Various_support_ Manage_patient_encounter The inpatient encounter staff managing encounter becomes active when a patient information. Schedule_encounter is admitted. If the encounter has not been previously Start_encounter scheduled, it can be created at Start_scheduled_encounter the time of admission.
Admit_patient

Start_outpatient_encounter

Start_unscheduled_encounter

Discharge_patient

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

11 5

Develop Scope Create Use Cases Identify Actors & Events

Information Model Use Case Model
Spec DIM Spec Class Diagram State Diagram UCM Spec Use Case Diagram Spec

Draw initial contents from RIM Model new concepts Harmonize with RIM

Define Trigger Events Define Application Roles Define Interactions Create Conformanc e Claims

Interaction Model
Spec

Message Design

Develop Message Information Mode Develop Refined MIM

Inter Spec Interaction Diagram

2-nd Order h//mt:50´d´ 1 choice of« 0-n Drug « 0-1 Nursing «

Specify HMD
© 1999, 2000 Health Level 7 January 24, 2000

BUMS, Abbas Shojaee, Feb. 2010

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A detailed and precise definition for the information from which all data content of HL7 messages are drawn. Follows object-oriented modeling and diagramming techniques, and is centered on a depiction of the classes that form the basis for the objects in HL7 messages. Provides a means for expressing and reconciling differences in data definition independent of message structure. Forms a shared view of the information domain used across all HL7 messages.
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BUMS, Abbas Shojaee, Feb. 2010

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Classes, Attributes, and Relationships
Documented in the Reference Information Model, the Domain Information Model, and the Message Information Model Consistency ensured by a Style Guide

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State Transition Models
For certain selected classes (Subject Classes)

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Data Types and Constraints
Vocabulary definitions, Domains

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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Expresses the information content for the collective work of the HL7 Working Group in UML notation. A coherent, shared information model that is the source for the data content of all HL7 messages. Maintained by a collaborative, consensus building process involving all Technical Committees and Special Interest Groups. RIM change proposals are debated, enhanced, and reconciled by technical committee representatives and applied to the RIM during the model harmonization process
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BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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Classes
Have Committees as Stewards Some identified as Subject Classes

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Attributes
Have types constraining their domains

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Relationships
Express cardinality for their use in messages

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Subject Areas
Define broad areas of interest (eg Stakeholders, Patient_encounters, Master_tables)

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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Committees and SIGs generally work with a small subset of the RIM Each subset is focussed on a particular area of group interest; this area is referred to as a DOMAIN (subject domain) A subset of the RIM expressed using the same tools is known as a Domain Information Model or DIM The DIMs are completely under committee control - these are committee models

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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What is the RIM?
A HL7-wide common reference model that integrates all Technical Committees¶ domain views

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How will we coordinate these efforts?
Iterative reviews Harmonization meetings

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Who controls the RIM?
The M&M committee
x Format, syntax, style x Revision histories

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Why do we need a common model?
To ensure consistency of concepts To ensure consistent vocabulary

The Technical Steering Committee
x Dispute resolution x Overseer
© 1999, 2000 Health Level 7 January 24, 2000 12 2

BUMS, Abbas Shojaee, Feb. 2010

D TA TY P E A S << D at a_t ype >> A y_d ata_ type : A N n Y << D at a_t ype >> D scre e : D S R i t C << D at a_t ype >> Qua nti y : QTY t << D at a_t ype >> Order e d : OR D

T ex t

Th i ng

HEAL TH LEVEL 7 REFERENC E INFORMAT ION M ODEL RIM_00 94
A the nti ati on u c

<< D at a_t ype >> C on ce pt_rol e _rel ati on shi p : C R R C l n i al _d ocu men t i c
1

<< D at a_t ype >> E nc ap sul ated _d ata : E D

<< D at a_t ype >> C ha r ac e r_stri g : S t n T

<< D at a_t ype >> B ol ea n : B o L

<< D at a_t ype >> Ra io : R O t T

<< D at a_t ype >> P o i _ i _ti me : T S nt n

Ge ne ri c

has pa t s _ r i s par _of _ t 1 do c ment s u 0. * .

n ame : C V i nversi on_i nd : B L v u e :CD H al P

<< D at a_t ype >> C de _tr nsl a i o n : C D X o a t L << D at a_t ype >> C de _ph rase : C D H o P

<< D at a_t ype >> C o de_ val u e : C V

<< D at a_t ype >> N mbe r : N u

<< D at a_t ype >> P ysi ca l qu anti ty : P Q h _

D emo gra ph i c << D at a_t ype >> B na r y_d ata : B N i I

Q an ti y/ Ti me u t

rele ased J a nuary , 2000 r efl ec s agreeme n s made thro ughha r moniz tion in Novem ber, 1 999 t t a

aut he nt ca t on_ dt t : TS i i m t pe_ cd : C V y
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<< D at a_t ype >> S et_C R : S E <C R R R T >
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<< D at a_t ype >> R eal : R E A L

<< D at a_t ype >> N _i nforma ti n : N U LL o o

Ge ne a l i ati ons r z

l e H ea l h ea t h _fi _fan ces s t Hcare car i nance n

H t h car _f nance s ea l e P ati en t_en cou i nte rs cr eat d _ by e 1

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D o cume nt_re ci pi en t
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0. . 1

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Tra nsc i p i o ni st r t

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<< D at a_t ype >> U i versa l reso urce _i de nti i e r : U I n _ f R S ervi ce _sc he dul i ng _req ue st a l ow abl e_s ubst i t t on s_cd ui durat o n_q t i y st art _dt t m
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<< D at a_t ype >> IS O_o bj e ct_i den ti i er : OI D f

<< D at a_t ype >> Mon etary _am oun t : MO

<< D at a_t ype >> Gen eral _ti mi ng _spe ci fi ati on : GTS c

P ati nt_i n o rm ati on _di scl o sure e f di scl osu e _dt t m r i nf o_di sc os ed_d esc l n f _r eque st ed_d esc i o e ason _cd r requ est ed _dt t m u g enc y_cd r
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s_r equ est d_ by i e 0. * .

equ es s r t

<< D at a_t ype >> Te l eco mmu ni cati on _a dd e ss : T E r L T, S , R T << D at a_t ype >> C ol l ec i o n : C OLL t T ,R << D at a_t ype >> B g: B G a A << D at a_t ype >> I nterva l : I V L T

<< D at a_t ype >> I n e ge r : I N t T

<< D at a_t ype >> P stal _a nd_ resi de nti al _a dd e ss : A D o r

per t i n s_t a o 0. * .

st at u s_cd
equ es s r t

s_par e nt _docum e nt f or i _ 0. . 1

<< D at a_t ype >> U cer ta i _va l e-n arrati ve : U N n n u V T

<< D at a_t ype >> A ddre ss_p art : A D P X

<< D at a_t ype >> Orga ni za i o n_n ame : ON t t pe_ cd : C V y val ue : S T

I nd i i ua l _he al t hca re_p r ac i ti ne r_req ue st v d t o p a ct t o ner_t ype _cd r ii
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P ti nt_a pp oi ntme nt_req ue st a e
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P i e nt_se v i e_l o cati on _req ue st at r c t ype _cd
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T ,R << D at a_t ype >> L it : L IS s T T T ,R << D at a_t ype >> S et : S E T << D at a_t ype >> A no tated : A N n T

T << D at a_t ype >> H i o ry : H I S st T T

<< D at a_t ype >> U cer tai n _di sc e te_v al ue _us i g_p rob ab i i t y : U D P n r n l V T << D at a_t ype >> P aram etri _pro ba bi l i y_ di str b uti on : P D c t i P T << D at a_t ype >> N on-p aram etri _p o ba bi l i y_ D stri buti on : N P D c r t i P

ha sas _a_p ar nt _do cum ent _ e

<< D at a_t ype >> S et_O N : S T< ON E >

i s t e_ r eci ent _o f _ h p i

1

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<< D at a_t ype >> P erso n_n am e_p art : P N P X

S eh ol de r tak ad dr : S T< A D E >
1

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S take ho l der_ affi i ati on l af f i at o n_t ype _cd il i d esc ef f ct ve_ dt e i t mi nat i on_ dt er
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1 credi t _rat ng _cd i l 1 e mai _a ddress _t xt 1 1 T< 1 phon : S E TE L> 1 1 t ype _cd 1 1

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<< D at a_t ype >> P erso n_n ame _typ e : P N

E e r i ng_ pe rson nt
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t aks_o n_ ol e_of e r

1 cha g e_ad u st ent _cd r j m pr vde s_paym ent guar n t e_f o r o i _ a e cont ract _d urat o n_cd i c ont r act _t ype _cd e f ect i ve_t mr 0. * . n t e st _rat e_n br i er peri odi c_pa ymen t amt _ pri i t y_rank ng _cd or i

Fi na nc i l _tr nsa cti on a a al t ernat e_d esc d esc ext end ed_ amt f e_s ched ul e_cd e 0. * . i nsuran ce_ amt i scat e gor zed _by _ i post i ng_ dt y 0. * q t . t an sac t on_ bat ch _i r i d t ransa ct on _cd i 0. * t a nsa ct on _dt t m . cover s r i t a nsac t on _i r i d t rans act o n_t ype _cd i u ni t amt _ uni t _cos t amt _
s_ent e ed _by i r

C rt f i cati on _ad di ti na l _op i ni on e i o ef f ect ve _dt t m i st at u s_cd
0. * . s_pr ov ded _by i i

i a ih 0. * s_asso ci t ed_w t .

0. * .

per t i n s_t a o

pr ovi e scon t ct d _ a i s ol e _of _ r

0. . 1

H ea l hc are _be ne i t_p o du ct_p urch ase r t f r
0. . 1 1. . 1 i s_t e _pur haser _o f h c

1

i s vl i dat d _by _ a e

i sa_ o l e_of _ r

0. . 1

B a d_d eb _ col l ec i on _a ge ncy t t

1

s_assi ned i g

H ea l h ca e _b en efi _c ove rag e_i tem t r t se vi ce_ cat ego y _cd r r s ervi e _cd c se vi ce_ modi f er_cd r i aut ho i zat i on_ nd r i ne t ork_ nd w i as ser t o n_cd i c over ed_ part es _cd i qt y qu ant t y_ qua i f er_cd i li t i me_pe i od_ qua i f er_cd r li ran ge_ ow _q t l y a nge_ hi h_q t r g y a nge_ uni t s_cd r asse t i on_e f ect i ve_t mr r el gi bi i t _cd i ly po i cy_ source _cd l e i gi l t y_ source _cd l b ii co pay _l mi t nd i _i
0. * . nsur es i i s a_i st ance_of _ n 0. * . 0. * . s_a_co m ponent _o f i 1 i s_i st ant at d_as n i e

P e fer red _p o vi de r_pa rti i ati on r r c p
0. . 1 gover n s i s gov er ed _by _ n 0. * .

rol e_cd ef f ct ve_ dt e i t mi nat i on_ dt er
0. * .

h asa scar e_r eci i ent _ _ p 0. * .

ac coun t _i d ad us t e nt _cd j m a ut hori at o n_i nf ma t on _t xt z i o r i bi l n g_st at u s_cd i cert f c a t on _requi red_ nd ii i i cu r en t unp ai _bal anc e_q t _ d y de e t _dt t m l e de et ed _ac coun t e aso n_cd l _r e xpec t d_i nsu a nce_ pl n_q t e r a y has 1 e xpec t d_p aym en t sour c e_cd e _ no t ce_ of _admi ssi on _dt t m i not i ce_o f a dmi ssi on_ nd _ i pat i ent _f n anci al _cl as s_cd i pri e _sc hedu e _i c l d pu g e_st at u s_cd r purge _st at us _dt t m repo t _o f e i gi bi i t _dt t m r _ l l y ret ent i on_ nd i has_pa ym ent _gua a nt ed_ by r e si gna t e _on_ f e _dt t m ur il 0. * . s pec al _prog a m_cd i r st opl oss _l mi t nd i _i susp end _cha g es_ nd r i t t _a dj st ment _q t oal u y i sassi ned_t _ g o 0. * . t ot al _cha g e_q t r y B d_ deb t_bi l l i g_a cco un t a n t ot al _pa yment _q t y has_as _a_pr or _ac count i bad_ deb t e cover y_ amt _r sep ar at e_b l _ nd il i 0. . 1 bad_ debt _t rans f _ amt e r t an sf _ t _bad _de bt _dt t m r e r o 0. . 1 0. . 1 t rans f r_t o_ bad _deb t e ason _cd e _r
has_ch ar e sf or g _ i s_t e _pr or acc unt f or h i _ o _

c ondi t o n_cd i oc cur rence _cd occ ur rence _dt t m occ ur e nce_ spa n_cd r occ ur e nce_ span _f o m_dt t m r r o ccur renc e_sp an_ t u _dt t m hr quan t t y_n br i quan t t y_t yp e_cd i val ue_ amt va u e_cd l

s_r equ est d_ by i e

has pa t s _ r

1

i _au t or zed _by s h i . 1. *

i s_she dul d _by c e 0. . 1

E pi so de

L i t_ i em s t se que nce_ nmb : R E A L p i ori y_ nmb : R E A r t L not e_t xt : E D
i _ par _of s t 0. * . 0. * . r epr se nt s e 1

i s nvo l ved_i _ i n

P a i en t_bi l l i g_a cco un t t n
1 has

1

has

0. * . per t i n s_t a o

D i a bi l i y s t ef f ect ve _dt t m i ret urn_ t _w k _au t _dt t m o or h t ermi at on _dt t m n i unab e_ t _w ork_ef f ect ve _dt t m l o i

D i gn osti c_re l ted _gro up a a bas e_rat e_ amt c api t al e mbu s emen t am t _r i r _ cos t w gh t am t _ ei _ d i maj _ di gno st c_ cat ego ry_cd or a i ope a t ng_ e mbu s emen t amt r i r i r _ e mbu s emen t amt r i r _ st and ard_da y_q t y st an dard_t ot al _ch arge_ am t t ri _ hi h_da y_q t m g y t ri _l ow _da y_q t m y
s_assi ne d_as i g 1

d esc P a i en t_en co unte r t epi sod e_t yp e_cd admi ni st a t ve_o ut come _t xt r i d i can cel a t on_ e aso n_cd l i r i st _c os ed_ nd l l i d esc i _ par _of s t o ut come _t xt e nco unt er_cl ass f c at o n_cd ii i e curr ng _servi ce_ nd r i i 1. * . e xpec t d_i nsu a nce_ pl n_q t e r a y per t i n s_t a o 0. * . f s t si i l ar_i n ess _dt t m ir _ m ll A mi ni strati ve_p ati en t_ac ci den t d f ol ow _u p_t yp e_cd l has pa t s _ r 1 i d :II ac ci dent _d eat h_ nd i 1. * a cci dent _d esc . cl ass f c at o n_cd ii i E i o de _of_ care ps E i sod e_o f_co ndi ti on p p urpos e_cd acc de nt _dt t m i s_obt a ne d_f om i i r sp eci al _cou t es e s_cd r i acc de nt _l ocat i on_ desc i s_def n ed _by i i 0. . 1 act i ve_t mr _ a 0. * a cci den t s t t e_cd . 0. . 1 as_ass gn edt oi t i st at u s_cd ac ci ent _t ype _cd d i s_i e nt f ed by d ii u g enc y_cd r ob _rel t d_a cci dent _ nd j ae i t i ag e_cl ass f c at on _cd r ii i asse ssme nt _dt t m med c a _ servi e_cd i l c p ubl c t y_c onst rai nt _cd i i i s_pr s ent _i 0. * e n . e ason _cd r R sk_ man ag em e nt_i nc i en t i d e f rral _cd r e 1 has source _cd nc de nt _cd i i per t i n s_t i nci de nt _dt t m a o pa t en t v u abl es_d esc i _al has 1. * . pre_ad mi _t est _ nd t i 0. * i nci den t severi t _cd . _ y rea dm i ssi on_ nd i n ci ent _t yp e_cd i d val uab es _l ocat i on_d esc l acui t y_l evel _cd 1 ut i zes il a ct ual _di sch ar ge_d s posi t on _cd i i di scha g e_l oca t on _i r i d ex pect ed _di sch arge_d s p_cd i 0. * pr eced es . bi rt _enc ount e _ nd h r i
1 has 1 o s 0. . 1 f l l ow

nvol ve s i

0. * .

i s_sou ce_f or r

sp i t cd : C V l_ oi n_ cd : C V j ne gat i on_i nd : B L con un ct on _cd : B j i L
has_t r get a 0. . 1

S rvi ce e
epr ese nt d_as r e i s_doc um ent d _b y e i _assi ned_t s g o 1 0. * . 0. * .

A or ct t yp e_cd : S T< C V E >
0. * t r : I V <T S . m L > par t ci a t on_of i p i has 0. * f or . 1

not e : E D si nat ure_ cd : C V g

s_char ged_t o i s_asso ci t ed_w t i a ih i s_cov er d _by e

0. * . 1 1. * .

i d : S E <I I T > moo d_cd : S T< C > E V uni ver sal _se vi ce_ cd : C D r 1 i _t ar g et f or s _ d escr : E D st at us_ cd : C V t ot al _t me : GTS i cri i cal _t me : G TS t i me t od_ cd : C D h bo dy_s t e_ cd : C D i i nt erpret at o n_cd : S T< C V> i E R efe rr l a con f den t al t y_ cd : C V i i i aut hor i zed _vi i t s_q t s y max_ e peat _n m b : I N r T d esc n t r up t bl e_i nd : B i e i L rea son _t xt su bst t ut i on_ cd : C V i pri i t y_cd : S T< C V or E > o d er abl e_i nd : B r L
has 1 i s_ut i zed_dur ng il i 0. * .

P ced ure ro ent ry_s t e_ cd : C D i

S pp l u y qt y : P Q

Obse v ati on r val ue : A Y N deri vat on _exp r : S i T prope t y_ cd : C V r

Med i ati on c f m_ cd : C D or rout e_ cd : C D d ose_ qt y : P Q st rengt h_ qt y : P Q rat e_ qt y : P Q ch eck_ qt y : P Q

Di t e Tra nsp ortati on e nergy_ qt y : P Q carbo hydrat e_ qt y : P Q C on di ti on_ no de
1 d ef ne s i

C on sen t

n i par t ci a t on_of i p i has as p ar ci pant _ _ ti par t ci a t on_of i p i 0. * . 0. * .

0. * .

has_as _car _pr vi de r e o

i s_cov er d _by e

0. . 1

. 0. *

i sf or _ pr ovi es cver age _f or d _ o 0. * . s_an_a ssi n m _o f i g ent

T arge t t yp e_cd : S T< C V E > t mr : S T< C V E > aw arene ss_ cd : C V
0. * . par t ci a t on_of i p i has_t r get a 0. * .

Mas e r_he al thca re_ ben efi t_pro du ct t
0. * . h as a sp ur haser _ _ c

0. * .

i so f e ed _by _ r

a ssi gnme nt _of _be nef t s_ nd i i be nef t _p o duc t desc i r _ d i be nef t _p od uct _n m i r ben ef t _prod uct _t ype _cd i be nef t s_ coordi nat i on_ nd i i 0. * . cob _pri i t y_n br or comb ne _ba by_b l _ nd i il i e f ect i ve_t mr grou p_b enef t _ nd i i mai _ cl m_p ar t _cd l ai y rel eas e_i nf ormat on _cd i st at u s_cd coverag e_t yp e_cd agree ment _t yp e_cd po i cy_ cat ego r y_cd l acc ess _prot oco _ desc l
0. . 1

Ma e ri l _rel ati on shi p t a t pe_ cd : C V y i nversi on_i nd : B L t r : I V <T S m L > po si i on_ nmb : L I T<N > t S qt y : P Q
0. * . has_so ur e c

E cou nte _ drg n r
s_assi ned _by i g par t ci at es_i i p n has_as _com ponent s 0. . 1 1 0. * .

H al t hca re_s ervi ce _pro vi de r e boa d _cert f i cat o n_t ype _cd r i i boa d _ce t i f ed_i nd r r i cert f c at on _dt t m ii i e f ect i ve_t mr l ce nse _i i d e cert f ca t on _dt t m r ii i s peci al t y_cd
de nt f es i ii 1 know of s_ i s ko w o _ n n_t 0. * . 1. * .

P ati en _ pro vi der_ asso ci ati on t

approva _ nd l i as si ned _dt t m g c onf d ent a _ nd i i l i co st _out l e _ am t i r d esc g o uper_revi ew _cd r grou per_versi on _i d o ut i er_day s_n br l ou t e _ e mbu s emen t am t li r r i r _ out i er _t yp e_cd l

I n pa i en t_en co un e r t t
0. * . i sassi ned_t _ g o s_assi ned i g

ac t al e ngt h_o f s t y_q t u _l _ a y i y 1 e st m at ed _day s_q t
s_asso ci t ed_w t i a ih 1. * .

E nc oun ter_p r acti ti ne r o pa t i ci pat o n_t yp e_cd r i
i _t ar g et f or s _ 1

per t i n s_t a o

1. * .

0. * .

s_par t ci ant f or i i p _

R spo nsi bi l i y e t t pe_ cd : C V y 0. . 1 t r : I V <T S m L > ma t i al _i d : S E <I I e r T >
of 0. * . f or

Ma e ri l t a i d : S E <I I T > y par t ci at es_as 0. . 1 t pe_ cd : C D i p f m_ cd : C V or
i s_t e h 1 da nge _ cd : C D r 1 0. . 1 i _t ar g et f or s _ i s_sub ect _of j

Lo cat i on _e nco un e r_rol e t ac com mod at o n_cd i e f ect i ve_t mr l oc at on _rol _cd i e st at u s_cd t an sf _ e ason _cd r e r r u sage _app o ved_ nd r i

1

de nt f es i ii

i s_chi d_of l 0. * .

qt y : P Q
t kes_o n_r ol 1 a e 1 t kes_o n_r ol 1 a e D vi ce e 1. * . t kes_o n_r ol 1 a e 0. . 1 s ot _s ze _i ncremen t qt y : P Q l i _ t kes_o n_r ol 1 a e 1 i _a_ o l e_of s r 1

Master_ pati en t_serv i e_l o cati on c addr : A D
s_pr m ar y_f ci i t _f o r 0. . 1 ope n_t mr i i a ly i s ol e _of _ r or gi na t es i 0. . 1 0. . 1 houses 1 1 1 0. . 1 i s_she dul d _by c e has i sa_ o l e_of _ r per t i n s_t a o 0. * .

i spa e nt _of _ r

H ea l h care _p o vi de r_or g an i ati on t r z

1. * pr ovi e s_pat e nt ser vi es_at . d i _ c pr ovi esser vi es_ on_be hal _o f d _ c f 0. . 1 i s ol e _of _ r

C am pus _co vera ge h hand c appe d_pr og a m_cd i r n on_a vai _ce t _o n_f l e_ nd l r i i ret r em e nt _dt t m i s t t on _i ai d
i s_she dul d _by c e 1

I nd i i ua l he al h ca re_p racti ti ne r v d _ t o f el ow sh p_ f el d_cd l i i gradu at e_sc hoo _n m l gradua t on _dt t m i posi t o n_cd i p a ct t o ner_t ype _cd r ii pri ar y_ care_ nd m i resi den cy_ f el d_cd i sl ot _si ze_ nc e ment _q t i r y d i

d esc e mai _ad dress l i d :II l c ense d_be d_n br i 0. * n m . p hon servi e_s peci al t y_cd c sl ot _si ze_ nc e ment _q t i r y st at u s_cd t ype _cd eq ui ment _t yp e_cd p
i ncl ud es 0. . 1

i s_she dul d _by c e bel ong s_t o s_r equ est d_ by i e

t kes_o n_r ol a e t kes_o n_r ol 1 a e t aks_o n_ ol e_of 1 e r con t i ns a 0. * .

A ces s c
i _a_ o l e_of s r

1. * .

P ati en t_serv i e_l oc ati on _gro up c d i
s_r equ est d_ by i e 0. . 1

bel ong s_t o s_r equ est d_ by i e

C on t ai ne r ca pact y_ qt y : P Q he gh t qt y : P Q i _ d ame t _ qt y : P Q i er b arr er_d el a_ qt y : P Q i t bot t om _d el a_ qt y : P Q t sepe a t _ t pe_ cd : C D r or y cap_ t pe_ cd : C D y
i _a_ o l e_of s r 0. . 1

1

ga uge_ qt y : P Q ent ry_s t e_ cd : C D i 0. . 1 bo dy_s t e_ cd : C D i

i _a_ o l e_of s r

Fo od

i si ncl ded_i _ u n 0. * .

r e 0. . 1 p e f r en ce_ cd : C D
i _a_ o l e_of s r 0. . 1

0. . 1 1 1. * . 1

s_t he_ pr m ar _pr ov i der f or i i y _ par t ci at es_as i p bel ong s_t o s_r equ est d_ by i e s_sour e d_f om i c r s_sour e d_f om i c r

p ovi d es 1 r

Th era pe uti _ag en t c

0. * . 0. * .

S pec i men bo dy_s t e_ cd : C D i
i _a_ o l e_of s r 0. . 1

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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` ` ` ` ` `

114 Classes 536 Attributes 159 Association Relationships 27 Inheritance Relationships 2 Aggregation Relationships 37 Subject Areas
18 Domain, 8 Work-in-Progress, 11 Administrative

`

Maintained in an Access 97 database, expressed in UML, and annotated with literary and HTML expressions.
January 24, 2000 12 4

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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Stakeholders
Patient Person Stakeholder Healthcare_service_ provider Organization

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Patient_encounters
Pharmacy_service_event Scheduling Patient_service_location Patient_service_order Patient_encounter Patient_service_event Patient_clinical_pathway

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Master_tables
Clinical_pathway_master Service_catalog_item Observation_service_ catalog_item

Healthcare finances
Patient_billing_account Healthcare_benefit_plan Guarantor_contract

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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12 5

Description of: Inpatient_encounter A patient encounter involving an admission to an inpatient facility. Class: Encounter_practitioner HL7 steward: Patient Administration Associated with: Individual_healthcare_practitioner Patient_encounter Associations for: Inpatient_encounter is_assigned (0,M) :: Encounter_drg :: is_assigned_to (1,1)

is_preceded_by (1,1) :: Patient_admission :: preceded (1,1)

Description of: Encounter_practitioner An association between a Healthcare practitioner and a patient encounter. Associations for: Encounter_practitioner is_participant_for (1,1) :: Individual_healthcare_practitioner :: participates_as (0,M)

is_terminated_by (0,1) :: Patient_departure :: terminates (1,1)

Attributes of: Inpatient_encounter actual_days_qty The number of actual days of an inpatient stay. The actual days quantity can not be calculated from the admission and discharge dates because of possible leaves of absence.
|Datatype^NM | | PV2^11^00712^Actual Length of Inpatient Stay |

is_associated_with (1,1) :: Patient_encounter :: has_as_participant (1,M)

Attributes of: Encounter_practitioner participation_type_cd A code depicting the role of the type of participation the healthcare practitioner assumes in the encounter (e.g. attending physician, admitting physician, consulting physician, referring physician). Class: Inpatient_encounter HL7 steward: Patient Administration Subtype of: Associated with: Patient_encounter Encounter_drg Patient_admission Patient_departure

estimated_days_qty The estimated number of days in an inpatient encounter.
|Datatype^NM | | PV2^10^00711^Estimated Length of Inpatient Stay |

Class: Patient_encounter HL7 steward: Patient Administration Supertype of: Is part of: Composite of: Inpatient_encounter Episode Patient_service_event Person_birth_event Appointment Encounter_practitioner page 1

Associated with:

BUMS, Abbas Shojaee, Feb. 2010

DRAFT HL7 Reference Information Model

Version: V 0-84 19980103 Copyright 1998. All rights reserved.

© 1999, 2000 Health Level 7

January 24, 2000

12 6

Reference Information Model

E
(1,1)

(1,1) (0,M)

G

(0,M) (0,1)

B
(0,1)

(0,M)

(0,M)

C

A

X

D

A
(0,M)

(0,M) (1,1)

B

X
(0,M)

(0,M) (1,1)

B

A

(0,M) (0,1)

B
(1,1)

(0,M)

(0,M)

(0,M)

C
Domain Information Model BUMS, Abbas Shojaee, Feb. 2010

C
Domain Information Model
© 1999, 2000 Health Level 7

D
Domain Information Model
January 24, 2000 12 7

Change Proposal Preparation
Prepare RIM Change Proposal Review RIM Change Proposal w/ Stewards Document Rationale for not supporting RIM change proposal Revise or Withdraw RIM Proposal

Post RIM Change Proposals
Submit RIM Change Proposal Post RIM Change Proposal Notify HL7 Members of RIM Change Proposal Posting Provide Comment on RIM Change Proposals

Harmonization Meeting
Discuss the RIM Change Proposal Revise, withdraw, or Table RIM Change Proposal Vote on RIM Change Proposal Apply Approved Changes to RIM Apply Technical Coorections

Post Harmonization Meeting Review
Present RIM Harmonization Report to TSC Hold TSC and/or Board Appeals Finalize Revised RIM 12 8

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

Others

HL7 Technical Committe es

Information Model Use Case Model
Spec Spec

DIM Spec Class Diagram State Diagram

UCM Spec Use Case Diagram

Interaction Model
Spec

Inter Spec Interaction Diagram

2-nd Order 1 choice of 0-n Drug 0-1 Nursing

HL7 Member Organization s

Other Standard Development Organizations
BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7 January 24, 2000 12 9

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A team of model facilitators was recruited from within the HL7 working group. The model facilitators are provided focussed training in the HL7 modeling methods and tools. The model facilitators provide modeling assistance to the technical committees and special interest groups. The facilitators meet as a team at each working group meeting to update each other on progress and to identify modeling or process issues. The facilitators prepare change proposals for the RIM and attend RIM harmonization meetings.

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 0

`

`

`

`

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The members of the message producing technical committees and message content special interest groups are the domain specialists for the HL7 RIM. The technical committees are assigned stewardship responsibility for classes within the information model, based upon their domain expertise. The technical committee designates a domain specialist from among its members to represent their stewardship interest at RIM harmonization meetings. Data steward representatives and model facilitators collaborate with each other to prepare RIM change proposals. Data steward representatives attend RIM harmonization meetings.

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 1

Mayo Clinic, Roche ster, Minn.

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 2

`

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`

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The Subject Classes are those classes in the RIM that express the concepts that are central to managing healthcare, e.g. Patient, Order. Subject Classes are the focus for trigger events, use cases & application roles. State transition modeling of Subject Classes discovers potential trigger events. Subject Classes capture the domain behaviors that the HL7 committee feels are most important

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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13 3

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Identify States
From Use Cases

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Document States
Which attributes must be valued/unvalued? What are the constraints on the values? What associations must be established? What associations must not exist?

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Capture State Model
UML State Transition Model

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 4

Figure State diagram for Patient class.
Scheduled

delete_s cheduled_encounter ^C 00XMT006

D eleted

s chedule_encounter ^C 00XMT003 delete_ac tive_ encounter ^C 00XMT007 null s tart_encounter ^C 00XMT005 s tart_encounter ^C 00XMT004 delete_dis charged_encounter

Active

dis charge_patient ^C 00XMT008 D is charged canc el_d is c harge ^C0 0XMT009

State diagram for Patient_encounter class

Transitions include reference to the trigger event.
BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7 January 24, 2000 13 5

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Attributes in the RIM must be associated with a Domain to have meaning Domains are associated with Vocabularies
Held in the Domain Specification Database

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The vocabulary and domain define the values that may be taken on by an attribute in a defined message
Set of coded values or defined words/phrases Statements in a constraint language

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 6

Develop Scope Create Use Cases Identify Actors & Events

Information Model Use Case Model
Spec DIM Spec Class Diagram State Diagram UCM Spec Use Case Diagram Spec

Draw initial contents from RIM Model new concepts Harmonize with RIM

Define Trigger Events Define Application Roles Define Interactions Create Conformanc e Claims

Interaction Model
Spec

Message Design

Develop Message Information Mode Develop Refined MIM

Inter Spec Interaction Diagram

2-nd Order h//mt:50´d´ 1 choice of« 0-n Drug « 0-1 Nursing «

Specify HMD
© 1999, 2000 Health Level 7 January 24, 2000

BUMS, Abbas Shojaee, Feb. 2010

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` ` ` ` ` ` `

Derived from the leaf-level Use Cases Specifies all Trigger Events and Message Flows Does not define standard system or application functions, only messaging roles Fine-grained abstraction; every system will claim several roles Basis for contractual agreement: describes roles to which systems may claim conformance Potential basis for conformance testing Captured in an Interaction Diagram and an Application Role Diagram
January 24, 2000 13 8

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

`

Each Interaction consists of:
Trigger event
x Event dependency usually expressed as the state of one or more classes

Message ID
x Each interaction sends one particular message

Sender role
x When trigger event detected, message is sent

Receiver role
x Receiver responsibility - a specific functional responsibility for the receiver to initiate another (consequential) interaction

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

13 9

Figure Interactions for Patient subject class.b

AR _Patient_m anager : AR _Patient_m anager

AR _Patient_trac ker : AR _Patient_tracker

1: add_patient( tid)

2: add_patient(tidx)

3: delete_patient

4: del ete_ patient(tid x)

Interaction Trigger Event causes a Message to be sent by a Sending role to a Receiving role for which there may be a Receiver responsibility
BUMS, Abbas Shojaee, Feb. 2010

Application Role identifies an information management responsibility for one of the subject classes. Responsibilities typically are: Creator, Manager, Tracker and Archivist. Healthcare applications are assumed to take on one or more application roles.

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`

`

`

`

All Application Roles that participate in the interactions for a trigger event must be identified All trigger events that a particular application role participates in must be identified All Classes that participate in the interactions must be identified Captured in an Application Role Diagram

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Figure Application role diagram for example model.
Patient

SC_Application_role_root Patient_encounter

RIM Classes

SC_Patient

SC_Patient_encounter

AR _Encounte r_tra cke r schedule_encounter() admit_patient() activate_scheduled_encounter() delete_scheduled_encounter() delete_active_encounter() discharge_patient() cancel_discharge()

AR_Pa tie nt_m a na ge r add_patient() delete_patient()

AR_Encounte r_m a na ge r AR_Pa tie nt_tra cke r add_patient() d elete_pati ent() AR_Encounte r_a rchivist admit_patient() activate_scheduled_encounter() delete_active_encounter() discharge_patient() cancel_discharge() admit_patient() activate_scheduled_encounter() dele te_ac tive_en counter() discharge_patient() cancel_discharge()

Application role diagram for example model.
BUMS, Abbas Shojaee, Feb. 2010

Application Roles
January 24, 2000

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` `

A conformance claim is a commitment to fulfill one or more interactions relating to an Application Role For each Role, the application must send and receive all of the interactions (messages) specified for that Role:
At specified trigger events, obeying specifications about conditionality, required presence, etc. Upon receipt of certain messages, perform the receiver responsibilities

` `

Provides a consistent, unambiguous vocabulary for pre-contract understanding of vendor capabilities Grouped into a Conformance Claim Set

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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14 3

`

Formally defined declarations
Information_system_sponsor, Information_system_user, Healthcare_information_system, Function_point Trigger_event, Application_role, Interaction, Technical_conformance_claim, Conformance_message_element

`

Detailed and Explicit
For each Message Element, a conforming application:
x Can provide or accept it, requires it for full function, multimedia enabled free text level, message element interaction support, message type definition x Details still being worked out

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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Develop Scope Create Use Cases Identify Actors & Events

Information Model Use Case Model
Spec DIM Spec Class Diagram State Diagram UCM Spec Use Case Diagram Spec

Draw initial contents from RIM Model new concepts Harmonize with RIM

Define Trigger Events Define Application Roles Define Interactions Create Conformanc e Claims

Interaction Model
Spec

Message Design

Develop Message Information Mode Develop Refined MIM

Inter Spec Interaction Diagram

2-nd Order h//mt:50´d´ 1 choice of« 0-n Drug « 0-1 Nursing «

Specify HMD
© 1999, 2000 Health Level 7 January 24, 2000

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14 5

Domain Information Model Reference Information Model
P erson_ nam e_for_I HCP cd : CV purpos e_cd : CV t ype_cd : CV nm : P N 1 has 1 i s_for i s_particip ant_f or 0. .* P erson_ as_IHCP ph on : TIL 1 t akes _on_role_ of 1 part icipate s_as 1 I ndividual _heal th care_pra cti tioner E xactly one occurren ce has _as_parti ci pant 1 Enc ounter_prac ti ti oner part icipati on_t ype_cd i s_as sociat ed_wit h 1. .* i s _a_role_o f i d : TII 1 has P erson_ as_P ati ent 0. .1 i s_the_p ri m ary_provide r_f or bi rth_dtt m : TS 0. .* ha s _a_prim ary_provider bi rt hplac e_ad dr : S T decease d_dtt m : T S P atient edu cat ion_l evel_cd : CV 1. .1 i d : TII gen der_cd : C V t akes _on_role_ of 1 st atus_cd : CV m arit al_st atus_c d : CV 1. .1 newb orn _baby_i nd race_cd : CV i s_invo lved_i n i s_a_role_o f m ul tipl e_birth _ind reli gious _affi li ation_ cd : CV organ_ donor_ind ph on : TIL 1 has P atient_adm is sion P atient_bi lli ng_accoun t i d : TII s t atus_cd : CV 0. .1 bi lli ng_sta tus _cd : CV pat ient _fin anci al_clas s_cd : CV bel ongs_t o price_s chedu le_id : TII P atient_enco unter i d : TII s t atus_cd : CV encount er_cl as sif ic ati on_cd : CV s t art_dtt m i nvolves end _dttm expect ed_ins ura nce _plan_q ty : NM 1 f irs t_si m ilar_i llness _dtt m

Use Case Model Hierarchical Message Description
1. .* i s_for I npatient_enc ounter actua l_days _ qty est im ate d_days _q ty 1 i s_prece ded_by P erson_ nam e_for_P atient nm : P N ef fective_dt : T S cd : CV purpos e_cd : CV t erm i nati on_dt : T S t ype_cd : CV adm i ssion_ dttm adm i ssion_ re ason_cd adm i ssion_ re ferral_cd adm i ssion_ source_ cd adm i ssion_ type_c d pre_ad mi t_t est_i nd readm i ssion_ ind 1

Interaction Model

Message Information Model

preceded

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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14 6

`

The RIM must first be refined by subsetting and constraining it
Create a MIM with RIM classes needed Develop an R-MIM from these classes

`

Define the structure for the message
Tree walk the R-MIM (Define a Path) Identify Message Element Types (MET, CMET)

`

Document the Message Specification
Create the Heirarchical Message Definition (HMD)

`

HL7 Tooling to assist with these steps

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© 1999, 2000 Health Level 7

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`

Select the portion of the RIM that contains the classes of interest in the message
Classes that participate in the Use Cases as documented in the Use Case Model Classes that participate in interactions and application roles as documented in the Interaction Model Attributes of interest in these interactions

` ` `

Collection of classes with some constraints Collection of attributes and associations to support the R-MIM No need for high precision at this point, can be corrected later ± this is the first draft stage

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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`

Constrain cardinality on Associations
May be limited in the interactions for which messages are being designed

`

Constraints on Attributes
Some may be left out Sub-components may be individually constrained

` `

Classes are duplicated for different uses May modify the Inheritance structure
Some specializations may subsume the generalization Always inherit downwards to specializations

` `

One block for each class structure Defines patterns of constraints for each class
© 1999, 2000 Health Level 7 January 24, 2000 14 9

BUMS, Abbas Shojaee, Feb. 2010

`

Document the R-MIM in tabular form
Identify information not in graphical form
x Domains, Update Semantics, Conditionality, etc.

`

Contains all information needed for the HMD
But the classes are shown in arbitrary order Usually multiple class instances shown for some RIM classes

`

Tooling simplifies entire process

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

15 0

Person_name_for_IHCP 1 Person_as_IHCP cd : CV has purpose_cd : CV phon : TIL 1 type_cd : CV nm : PN is_for takes_on_role_of 1

is_participant_for

0..*

Encounter_practitioner is_associated_with participation_type_cd 1..* Exactly one occurrence has_as_participant 1

1 participates_as 1 Individual_healthcare_practitioner is_a_role_of id : TII

Patient_encounter id : TII s tatus_cd : CV encounter_classification_cd : CV start_dttm involves end_dttm expected_insurance_plan_qty : NM 1 first_similar_illness_dttm

Person_as_Patient 0..1 is_the_prim ary_provider_for birth_dttm : TS birthplace_addr : ST 0..* has_a_primary_provider 1 deceased_dttm : TS Patient education_level_cd : CV 1..1 id : TII gender_cd : CV takes_on_role_of has 1 s tatus_cd : CV marital_s tatus_cd : CV 1..1 newborn_baby_ind race_cd : CV is_involved_in is_a_role_of multiple_birth_ind religious_affiliation_cd : CV Inpatient_encounter organ_donor_ind phon : TIL 1 actual_days_qty 1..* has Patient_admission estimated_days_qty is_for admission_dttm Person_name_for_Patient admission_reason_cd Patient_billing_account 1 nm : PN admission_referral_cd id : TII is_preceded_by effective_dt : TS admission_source_cd 1 s tatus_cd : CV 0..1 cd : CV admission_type_cd billing_s tatus_cd : CV preceded purpose_cd : CV pre_admit_test_ind patient_financial_class_cd : CV belongs_to termination_dt : TS readmission_ind price_schedule_id : TII type_cd : CV

This example will include those messages requiring data from Patient and Patient_admission

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rmim class attr assoc assoc class assoc assoc assoc assoc class attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr assoc assoc class attr attr attr attr attr attr assoc assoc class attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr

C04_RIM_0092 Micro A TP_for_order_subject Target_participation participation_type_cd participation_type_cd CV has_as_target has_as_target Patient is_target_of is_target_of Observation_intent_or_order_as_service_order Patient is_a_role_of Person as patient is_source_for CSS_as_original_specimen is_target_of TP_for_order_subject is_target_of TP_for_superservice_subject Person as patient Person military_branch_of_service_cd CV birth_dttm TS student_cd CV status_cd CV religious_affiliation_cd CV race_cd CV nationality_cd CV military_rank_nm ST very_important_person_cd CV marital_status_cd CV deceased_dttm TS birthplace_addr AD military_status_cd CV confidentiality_constraint_cd CV language_cd CV deceased_ind BL disability_cd CV education_level_cd CV ethnic_group_cd CV gender_cd CV citizenship_country_cd CV credit_rating_cd Stakeholder as HCP CV type_cd Stakeholder as HCP CV real_id Stakeholder as HCP SET<RW II> phon Stakeholder as HCP TIL email_address_txt Stakeholder as HCP TIL addr Stakeholder as HCP AD id Stakeholder as HCP SET<TII> has Person_name takes_on_role_of Patient Person_name cd CV type_cd CV termination_dt TS purpose_cd CV effective_dt TS nm ST is_for Person as patient is_for Person_as_HCP Observation_intent_or_order_ Observation_intent_or_order response_requested_cd Service_intent_or_order CV status_cd Service_intent_or_order CV secondary_identification_txt Service_intent_or_order FTX status_dttm Service_intent_or_order TS status_reason_cd Service_intent_or_order CV report_results_to_phon Service_intent_or_order TIL when_to_charge_cd Service_intent_or_order CV when_to_charge_dttm Service_intent_or_order TS expected_performance_time_qty Service_intent_or_order PQ charge_type_cd Service_intent_or_order CV clarification_phon Service_intent_or_order TIL echo_back_txt Service_intent_or_order FTX order_id Service_intent_or_order TII filler_order_id Service_intent_or_order TII intent_or_order_cd Service_intent_or_order CV order_effective_dttm Service_intent_or_order TS order_placed_dttm Service_intent_or_order TS qt Service_intent_or_order placer_order_id Service_intent_or_order TII entering_device_cd Service_intent_or_order CV relevant_clinical_information_txt FTX

0..* 1..1 1..1 1..1 1..1 0..* 0..* 0..* 0..*

0..* 0..1

1..1 1..1 0..*

CW E CNE CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E CW E

{7821B3D3-7 {7821B3D4-731A-11D3{FB409E54-7 {FB409E66-7242-11D3{FB409E56-7 {FB409E58-7242-11D3{FB409E60-7 {FB409E64-7242-11D3{FB409E64-7 {4457CB6B{FB409E60-7 {FB409E66-7 {FB409E9B{FB409E54-7 {FB409E8C{FB409E7C-7242-11D3{FB409E7C{FB409E91-7 {FB409E8C{FB409E91-7 {4457CB2F-7 {FB409E7C{4457CB2F-7 {000141F3-7 {FB409E91-7 {FB409E9B{FB409F22-7 {FB409E66-7 {FB409EB5{FB409E9D-7242-11D3{FB409E9D{FB409EC3{FB409EB5{FB409EC3{FB409EC1{FB409E9D{FB409EC1{FB409EBF{FB409EC3{FB409EBF{FB409EBD{FB409EC1{FB409EBD{FB409EBB{FB409EBF{FB409EBB{FB409EB7{FB409EBD{FB409EB7{FB409EC5{FB409EBB{FB409EC5{FB409EB3{FB409EB7{FB409EB3{FB409EA5{FB409EC5{FB409EA5{FB409E9F{FB409EB3{FB409E9F{FB409EB9{FB409EA5{FB409EB9{FB409EA3{FB409E9F-7 {FB409EA3{FB409EB1{FB409EB9{FB409EB1{FB409EA7{FB409EA3{FB409EA7{FB409EA9{FB409EB1{FB409EA9{FB409EAB{FB409EA7{FB409EAB{FB409EAD{FB409EA9{FB409EAD{FB409EAF{FB409EAB{FB409EAF{FB409EA1{FB409EAD{FB409EA1{FB409F0D{FB409EAF{FB409F0D{FB409F12-7 {FB409EA1{FB409F12-7 {FB409F11-7 {FB409F0D-7 {FB409F11-7 {FB409F10-7 {FB409F12-7 {FB409F10-7 {FB409F0E{FB409F11-7 {FB409F0E{FB409F0C{FB409F10-7 {FB409F0C{FB409F0F-7 {FB409F0E-7 {FB409F0F-7242-11D3{FB409F0C-7 {FB409ED0{FB409ECE-7242-11D3 {FB409ECE{FB409EC7{FB409ED0{FB409F22-7 {FB40A103-7 {FB409E9B{FB409F24-7 {FB409F2E-7242-11D3{FB409F2E{FB409F2C{FB409F24-7 {FB409F2C{FB409F2A{FB409F2E-7 {FB409F2A{FB409F26-7 {FB409F2C-7 {FB409F26-7 {FB409F28-7 {FB409F2A-7 {FB409F28-7242-11D3{FB409F26-7 {FB409F2F-7 {4457C7F1-72AB-11D3{4457C7F1-7 {FB409F30-7 {FB409F2F-7 {FB40A103-7 {4457C5B8-7 {FB409F22-7 {FB40A11C{FB40A120-7242-11D3{FB40A120-7 {FB40A11D{FB40A11C{FB40A11D{FB40A121-7 {FB40A120-7 {FB40A121-7 {FB40A122-7 {FB40A11D{FB40A122-7 {FB40A11A{FB40A121-7 {FB40A11A{FB40A126-7 {FB40A122-7 {FB40A126-7 {FB40A127-7 {FB40A11A{FB40A127-7 {FB40A110-7 {FB40A126-7 {FB40A110-7 {FB40A10B{FB40A127-7 {FB40A10B{FB40A10C{FB40A110-7 {FB40A10C{FB40A10D{FB40A10B{FB40A10D{FB40A115-7 {FB40A10C{FB40A115-7 {FB40A111-7 {FB40A10D{FB40A111-7 {FB40A112-7 {FB40A115-7 {FB40A112-7 {FB40A114-7 {FB40A111-7 {FB40A114-7 {FB40A116-7 {FB40A112-7 {FB40A116-7 {FB40A119-7 {FB40A114-7 {FB40A119-7 {FB40A117-7 {FB40A116-7 {FB40A117-7 {FB40A10E{FB40A119-7 {FB40A10E{FB40A107-7 {FB40A117-7 {FB40A107-7 {FB40A105-7 {FB40A10E-

This is a very small one (part of the recent Microbiology proof-of-concept effort). They get BIG.
BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7 January 24, 2000 15 2

rmim class attr assoc assoc class assoc assoc assoc assoc class attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr

C04_RIM_0092 Micro A TP_for_order_subject Target_participation participation_type_cd participation_type_cd has_as_target has_as_target is_target_of is_target_of Patient is_a_role_of is_source_for is_target_of is_target_of Person as patient Person military_branch_of_service_cd birth_dttm student_cd status_cd religious_affiliation_cd race_cd nationality_cd military_rank_nm very_important_person_cd marital_status_cd deceased_dttm birthplace_addr military_status_cd confidentiality_constraint_cd language_cd deceased_ind disability_cd education_level_cd ethnic_group_cd gender_cd citizenship_country_cd credit_rating_cd Stakeholder as HCP type_cd Stakeholder as HCP

0..* CV 1..1 Patient 1..1 Observation_intent_or_order_as_service_o..1 1 Person as patient CSS_as_original_specimen TP_for_order_subject TP_for_superservice_subject CV TS CV CV CV CV CV ST CV CV TS AD CV CV CV BL CV CV CV CV CV CV CV 1..1 0..* 0..* 0..* 0..*

CWE CNE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE

{7821B3D3-7 {FB409E54-7 {FB409E56-7 {FB409E60-7 {FB409E64-7 {FB409E66-7 {FB409E8C{FB409E7C{FB409E91-7 {4457CB2F-7 {FB409E9B{FB409EB5{FB409E9D{FB409EC3{FB409EC1{FB409EBF{FB409EBD{FB409EBB{FB409EB7{FB409EC5{FB409EB3{FB409EA5{FB409E9F{FB409EB9{FB409EA3{FB409EB1{FB409EA7{FB409EA9{FB409EAB{FB409EAD{FB409EAF{FB409EA1{FB409F0D{FB409F12-7

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

15 3

`

`

The HMD combines the structure and semantics of the message contents Produced by performing a tree walk
Select nodes to start each tree based on the Interactions and Use Cases Follow the appropriate connections in the R-MIM Re-orders and structures the information in the R-MIM to follow a Path through the Information Model

`

Note each class instance block in the R-MIM is a MET; the entire table is the full message MET, which is the HMD
January 24, 2000 15 4

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

` ` ` ` ` ` ` ` `

How is all of this done? It is not as complicated as it sounds Significant tooling support RoseTree permits aided walkthrough of the RIM to generate the MIM and the R-MIM RoseTree generates output for set of Excel macros to generate the R-MIM and HMD easily Generates both Graphical and Tabular forms Set of usage guidelines to make Path definition easy RoseTreeII Version 20215.exe is most current PC/Windows ONLY

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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15 5

`

Some Message Element Types are unique
Used only for a specific message
x e.g. structure for an EKG waveform result

`

Some Message Element Types may be reused in many messages
Analogous to v2.x segments like PID, PV1, etc. May have finer granularity than v2.x Have certain constraints loosened for re-use CMETs (Common Message Element Types)

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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15 6

`

` ` ` `

All of the information of the MET and CMET is documented in the Hierarchical Message Description ± HMD Tabular Stored in the repository Final specification of a particular message Contains conformance parameters

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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15 7

Reference Information Model

Domain Information Model

Use Case Model

Interaction Model Message Information Model

P erson_ nam e_for_I HCP cd : CV purpos e_cd : CV t ype_c d : CV nm : P N

1 has 1 i s_for

i s_partic ip ant_f or 0. .* P erson_ as_IHCP ph on : TIL 1 t akes _on_role_ of 1 part icipate s_as 1 I ndividual _heal th care_pra cti tioner

Enc ounter_prac ti ti oner part icipati on_t ype_cd

i s_assoc iat ed_wit h 1. .*

E xac tly one occurren ce has _as_parti ci pant 1

i s_a_role_o f i d : TII

1 has

1. .* i s_for

P erson_ as_P ati ent 0. .1 i s_the_p ri m ary_provide r_f or bi rth_dtt m : TS 0. .* ha s_a_prim ary_provider bi rt hplace_ad dr : S T decease d_dtt m : T S P atient edu cat ion_l evel_cd : CV 1. .1 i d : TII gen der_cd : C V t akes _on_role_ of 1 m arit al_st atus_cd : CV s t atus_cd : CV 1. .1 newb orn _baby_i nd race_c d : CV i s_invo lved_i n i s_a_role_o f m ul tipl e_birth _ind reli gious _affi li ation_ cd : CV organ_ donor_ind ph on : TIL 1 has P atient_adm is sion P atient_bi lli ng_accoun t i d : TII st atus_cd : CV 0. .1 bi lli ng_sta tus_c d : CV pat ient _fin anci al_clas s_cd : CV bel ongs_t o pric e_schedu le_id : TII

P atient_enco unter i d : TII st atus_cd : CV encount er_cl assif icati on_cd : CV st art_dtt m i nvolv es end _dttm expect ed_ins ura nce _plan_q ty : NM 1 f irst_si m ilar_i llness _dtt m

I npatient_enc ounter actua l_days_ qty est im ate d_days_q ty 1 i s _prece ded_by

P erson_ nam e_for_P atient nm : P N ef fective_dt : T S cd : CV purpos e_cd : CV t erm i nati on_dt : T S t ype_cd : CV

adm i ss ion_ dttm adm i ss ion_ re ason_cd adm i ss ion_ re ferral_cd adm i ss ion_ source_ cd adm i ss ion_ type_cd pre_ad mi t_t est_i nd readm i ss ion_ ind

1

preceded

Domain Specification Database Hierarchical Message Description Common Message Element Types
© 1999, 2000 Health Level 7 January 24, 2000 15 8

BUMS, Abbas Shojaee, Feb. 2010

For a specific implementation, the profile specifies: ` Which of the optional segments to use ` When segments may repeat ` Which optional data elements to use for each segment ` Which data elements repeat ` Which tables (codes) to use

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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MSH EVN PID [PD1] [ { NK1 } ] PV1 [ PV2 ] « [ { GT1 } ] [ { IN1 [ IN2 ] [ IN3 ] } ] «

Message Header Event Type Patient Identification Additional Demographics Next of Kin /Associated Parties Patient Visit Patient Visit - Additional Info. Guarantor Insurance Insurance Additional Info. Insurance Add'l Info - Cert.

[ ] optional { } may repeat

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© 1999, 2000 Health Level 7

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16 0

SEQ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

LEN 1 4 180 180 180 180 26 40 7 20 3 8 15 180 2 2 2 6 60

DT ST ST HD HD HD HD TS ST CM ST PT ID NM ST ID ID ID ID CE

OPT RP/# TBL# ITEM # ELEMENT NAME R 00001 Field Separator R 00002 SEQ - position within Encoding Characters O 00003 Sending Application segment O 00004 Sending Facility LEN - length of field Receiving Application O 00005 O 00006 Receiving Facility DT - data type for00007 Date/Time Of Message field O O OPT - optionality 00008 Security for field R 00009 Message Type RP/# - repeatability R 00010 Message Control ID R 00011 Processing ID TBL# - table number for R 0104 00012 Version ID codes O 00013 Sequence Number O ITEM# - HL7 field 00014 Continuation Pointer number O 0155 00015 Accept Acknowledgment Type ELEMENT NAME 00016 Application Ack. Type - name O 0155 O 00017 Country Code O Y/3 0211 00692 Character Set O 00693 Principal Language Of Message
© 1999, 2000 Health Level 7 January 24, 2000

BUMS, Abbas Shojaee, Feb. 2010

16 1

The Version 3 Hierarchical Message Description (HMD) is a structure that combines the Version 2.x
Abstract Message Definition Segment tables Message profiles Abstract Segment Message + profiles HMD = Message + tables Definition
BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7 January 24, 2000 16 2

Information Model Mapping

Message Elements

Common Constraints

Dmi S e i ic to ( ) o an p cf ai n #

b

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 47 26 49 51 52 53 54 37 38 39 40 41 42 43 44 45 46

Information Model Mapping
Rw y e o Tp Class or Property of Class (Attribute or Association) 3 4 cla at t at t Pati e nt id Pati e nt Pat ient Pat ient 5 6 7 st at us_cd it m at t at t at t at t aso at t at t at t at t at t at t at t at t at t it m aso ambulat ory _st at us_cd newborn_baby _ind mult ip le_birt h_ind organ_donor_ind i s_a_role _of birth_dt t m birthp lace_addr deceas ed_dtt m educat ion_level_cd gender_cd marit al_st at us_cd race_cd religious _affiliat ion_cd p hon has Pat ient Pat ient Pat ient Pat ient Pat ient Pati e nt Person Person Person Person Person Person Person Person Stakeholder Stakeholder

Rw u b r o Nme

Fr e Rw omr o

Cr i ai y a d lt n

Rim Source Class Pati e nt id

Mes sage Ele ment Name

Mes sage Element Short Name

in Mes sage Element Type

of Mes sage Element Type Pt II Set <CV> CV CV

Pt id st at us _CV amblt ry St at us

Pt Pt Pt Pt

1 1 1 1 0..1 <@st at e, EXT :CNE> <@st at e, EXT :CNE> <amblt r Status> <clasfcn>

Mn aoy a dt r

Message Elements
st at us_cd _it em_CV ambulat ory _st at us_cd newborn_baby _ind mult ip le_birt h_ind organ_donor_ind i s_a_role _of_Person_as_pati e nt birth_dt t m birthp lace_addr deceas ed_dtt m educat ion_level_cd gender_cd marit al_st at us_cd race_cd religious _affiliat ion_cd p hon _it em_T IL nwbrnInd mult brt hInd orgnDonrInd PtPrsn brt hDtt m brt hp lcAddr decesdDt tm educnLevl gendr marit lSt at us race relgs Afilt n p hon _TIL PtName Pt Pt Pt Pt Pt Prsn Pt Prsn Pt Prsn Pt Prsn Pt Prsn Pt Prsn Pt Prsn Pt Prsn Pt Prsn Set <T IL> PtPrsn

Message Structure
M No V R R R R R R R M M No No R R
2

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

Ties every element of a message directly to a class, attribute or association in the Reference Information Model
Pe rson Person it m at t at t at t at t st c at t at t nm effect ive_dt cd p urp ose_cd value t erminat ion_dt t y p e_cd Person_name Person_name Person_name Person_name Person_name Person_name Person_name Pati e nt aso has_a_primary_provi der p hon at t r it m aso at t r at t r at t r at t r aso at t at t Stakeholder Stakeholder Pe rson_as_IHCP nm cd p urp ose_cd t y p e_cd has id st at us_cd it m at t at t at t aso at t at t billing_s tat us_cd p at ient _financial_clas s_cd p rice_schedule_id i s_invol ve d_i n id st at us_cd Person_name Person_name Person_name Person_name Pati e nt Pat ient _billing_accoun t Pat ient _billing_accoun t Pat ient _billing_accoun t Pat ient _billing_accoun t Pat ient _billing_accoun t Pat ient _billing_accoun t Pati e nt Pat ient _encount er Pat ient _encount er

has_S e t_Pe rson_name _for_Pati e nt _it em_P ers on_name_for_Pat ient

nm effect ive_dt cd p urp ose_cd value t erminat ion_dt t y p e_cd has_a_primary_provi der_Individual_he al thca re _practi ti oner p hon _it em_T IL has_Pers on_name _for_IHCP nm cd p urp ose_cd t y p e_cd has_Pati ent_bi l l ing_account id st at us_cd

_it em_CV

billing_s tat us_cd

p at ient _financial_clas s_cd p rice_schedule_id

i s_invol ve d_i n_Pati ent_encounte r id st at us_cd

BUMS, Abbas Shojaee, Feb. 2010

Equivalent to populating a V2.x Abstract Message Definition with each of the relevant Segment tables AND then adding the message profile specification for which segments to use and/or repeat, and which code domains to © 1999, 2000 Health Level 7 use.
BL BL BL PtPrsn TS ST TS CV CV CV CV CV Set <T IL> T IL S et <PtPrsnName > Pt PrsnName PN TS CV CV ST TS CV 0..1 0..1 0..1 1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..* 1 1..* 1 _PtP rsnName nm efect vDt cd p urp os valu t ermnt nDt typ Set <Pt PrsnName> Pt PrsnName Pt PrsnName Pt PrsnName Pt PrsnName Pt PrsnName Pt PrsnName Pt PrsnName Pt 0..1 0..1 0..1 0..1 1 0..1 0..1 pri mryIHCP IHCP 0..1 p hon _TIL PN_IHCP nm cd p urp os typ PtBi l l Acnt id IHCP Set <T IL> IHCP PN_IHCP PN_IHCP PN_IHCP PN_IHCP Pt Pt BillAcnt Set <TIL> T IL PN_IHCP PN CV CV CV PtBi l l Acnt II 0..* 1 1 1 0..1 0..1 0..1 0..1 1 st at us _CV Pt BillAcnt Set <CV> CV 1..* 1 Pt BillAcnt billngSt at us Pt BillAcnt Pt BillAcnt Pt BillAcnt Pt CV CV ST 0..1 0..1 p t FnanclClass p riceSchedId 0..1 PtEnctr id Pt Enctr* Pt Enctr PtEnctr & IptEnctr II CV 0..1 1 st at us 1

<edct nLevl>
14

<mart lStatus> <race> <relgsAfltn>

<p urp sCd>

<@st at e, EXT :CNE> <@st at e, EXT :CNE>

Provides the message profile specification s for the data elements in the message
R R R R R R R R R N R R N R R R R R R R R N R M No V R M M No No V V R R M No No R R R R

<bilngSt atus> <p t Fincl Class>

<@st at e, EXT :CNE>

M

Dmi S e i ic to ( ) o an p cf ai n #

Df u Ud t Md ea l p ae o e t

Cnomn eF g of r ac l a

Cn t an/ oe# o sr i tNt

Df u V l e ( ) ea l au # t

Ud t md s t p ae o e e

January 24, 2000

16 3

MIM and R-MIM
Person_name_for_IHCP 1 Person_as_IHCP cd : CV has purpos e_cd : CV phon : TIL 1 type_cd : CV nm : PN is_for takes _on_role_of 1 is_participant_for 0..* Encounter_pr actitioner participation_type_cd is_as sociated_with 1..* Exactly one occurrence has_as_participant 1 1 participates_as 1 Individual_healthcare_practitioner is _a_role_of id : TII 1 has 1..* is_for Person_as_Patient 0..1 is_the_prim ary_provider_for birth_dttm : TS birthplace _addr : ST 0..* has_a_prim ary_provider deceas ed_dttm : TS Patient education_level_cd : CV 1..1 id : TII gender_cd : CV takes_on_role_of 1 status _cd : CV marital_status_cd : CV 1..1 newborn_baby_ind race_cd : CV is_involve d_in is _a_role_of multiple_birth_ind religious_affiliation_cd : CV organ_donor_ind phon : TIL 1 has Patient_admission Patient_billing_account id : TII s tatus _cd : CV 0..1 billing_status_cd : CV patient_financial_clas s_cd : CV belongs _to price_schedule_id : TII Patient_encounter id : TII s tatus_cd : CV encounter_classification_cd : CV s tart_dttm involves end_dttm expected_ins urance_plan_qty : NM 1 first_similar_illnes s_dttm Inpatient_encounter actual_days _qty es timated_days_qty 1 is _preceded_by

Person_name_for_Patient nm : PN effective_dt : TS cd : CV purpose_cd : CV termination_dt : TS type_cd : CV

admiss ion_ dttm admis sion_reas on_cd admis sion_referral_cd admiss ion_source_cd admiss ion_type_cd pre_admit_tes t_ind readmiss ion_ind

1

preceded

rmim class attr assoc assoc class assoc assoc assoc assoc class attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr attr

C04_RIM_0092 Micro A TP_fo r_order_subject Target_partic ip ation participation_type_cd participation_type_cd has_as_target has_as_target is_target_of is_target_of Patient is_a_role_of is_source_for is_target_of is_target_of Person as patient Person military_branch_of_ service_cd birth_dttm student_cd status_cd religious_affiliation_cd race_cd natio nality_cd military_rank_nm very_important_person_cd marital_status_cd deceased_dttm birthplace_addr military_status_cd confidentialit y_constraint_cd language_cd deceased_ind disability_cd education_level_ cd ethnic_group_cd gender_cd citizenship_country_cd credit_rating_cd Stakehold er as HCP type_cd Stakehold er as HCP

0..* CV 1..1 Patient 1..1 Observation_in tent_or_order_as_service_o..1 1 Person as patient CSS_as_original_specimen TP_fo r_order_subject TP_fo r_superservice_subje ct CV TS CV CV CV CV CV ST CV CV TS AD CV CV CV BL CV CV CV CV CV CV CV 1..1 0..* 0..* 0..* 0..*

CWE CNE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE CWE

{7821B3D3-7 {FB409E54-7 {FB409E56-7 {FB409E60-7 {FB409E64-7 {FB409E66-7 {FB409E8C{FB409E7C{FB409E91-7 {4457CB2F-7 {FB409E9B{FB409EB5{FB409E9D{FB409EC3{FB409EC1{FB409EBF{FB409EBD{FB409EBB{FB409EB7{FB409EC5{FB409EB3{FB409EA5{FB409E9F{FB409EB9{FB409EA3{FB409EB1{FB409EA7{FB409EA9{FB409EAB{FB409EAD{FB409EAF{FB409EA1{FB409F0D{FB409F12-7

Information Model Mapping
DAT ATYPES
< <D at a_t ype>> A ny_d ata _typ e: AN Y < <D at a_t ype>> D i scr ete : DS CR < <D at a_t ype>> Q ua nti t y: QT Y < <D at a_t ype>> O r der ed : O RD Te x t Thin g < <D at a_t ype>> F r ee_t ext : FTX i s_c over d_by 1 . * e M a st r_servi ce e i s_p r d uced_b y 1 . 1 o < <D at a_t ype>> a l owa ble_ pr cessi ng_p r or ti y_cd o i C ode _tr ans at o n : CD XL l i a l owa ble_ r p or i ng_pr i or t y_cd e t i c hal eng e_in for m at on _tx t l i c onf den ti ali t y_cd i < <D at a_t ype>> e f ect ve_t m r i C ode _phr ase : C DP H f act or s_t hat _m ay_ aff ect _obse r at i on_des c v i s_r equ est ed_by 1 f i xed_ca nned_m e ssage_ cd < <D at a_t ype>> i m agi ng_m eas ur em ent _m odal ti y_cd I S O_o bjec t_i den ti fi er : OI D p i s_t ar get 1 i nco m ati bl e_cha nge_dt t m i nt er pr eta ti on_co nsi der ati ons_ desc k nd _of_ quant ti y_ obser ved_cd i h as_t ar get 0 . * < <D at a_t ype>> l ast _up dat e_dt tm M a st r_servi ce_ e la t on shi p e r i R eal _w or d_i nst ance _ide nti fi er : RW I l m e tho d_cd n at ur _of_ ser vce_ cd e i r el at on ship _ty pe_cd i T ,S ,R r ef e x_t est ng_ tr i gger _r ules _desc l i o bser vat on_ d_s uff x _tx t i i i c onst r aint _t xt o r er ble_ ser vce_ nd d a i i < <D at a_t ype>> p at ent _pr epa r t i on_de sc i a qt C ol ec ti on : C OL L l p oin t_ver sus _int er val _cd p or tab e_d evice_ nd l i T ,R h as_so ur e 0 . * c r ep or _di spl ay_o r e r t xt t d _ < <D at a_t ype>> i s_s our ce1 a tl er nat e_i d 1 B ag : B AG a tl er nat e_nam e_ use_c d i s_d eli ver d_dur i ng 1 a tl er nat e_nm e T ,R c ont r ndi cat o n_des c ai i d esc < <D at a_t ype>> p er for m ance_ sched ule_ cd L st : LI ST i M a st r_spec im e n_req ui remen t e p r m ar y_nm i a ddi ti ve_cd T ,R s ta ndar d_t m e_t o_ per for m _qt y i c ont ain er desc _ t ar get _an ato m c_s ti e_cd i c ont ain er pr par at on_ desc _ e i < <D at a_t ype>> u niver sal _ser vic e_i d c ont ain er v um e_ qty _ol S et : SE T qt d er ved_s peci m n_cd i e j oi n_cd m i ni m m coll ect i on_vol um e_qt y u _ w hen _to _char ge_ cd n or m _co l ect on _volum e_ qty al i c onsen t_r equ r ed_c d i s peci al_ handl ng _desc i p r or ti y_cd i 1 i s_i nst ant a ted _as i r et ent i on_t m e_q ty i t yp e_cd M a st r_t e at ment _se v ice e r r d ea_l evel_ cd d r g_cat egor y_c d u h as 1 M a st r_obse rvat i on_se rvic e e f or m ula r _ sta tus _cd y i nst r um ent _cd m e dica ti on_f or m _cd d e 0 . 1 i s_o r e r d _on p har m aceut c al_ clas s_cd i p er m t ted _dat a_t ype_ cd i r ou te_ cd M a st r_nume ric _rang e e o i h as_as _basi sp r cessi ng_t m e _qt y t he r p eut c_c as s_cd a i l t yp e_cd s peci m en_r equi r ed_i nd i 0 . * t yp cal _t ur nar ound_ ti m e_qt y c ondi ti on_d esc d er vat on _r e_d esc i i ul a ge_qt y g est at on_ age_q ty i 1 m e asur es va ue_ qty l 0 .* r ac e_subs peci es_t xt i s_b asis _for g ender _cd s peci es_t xt a ppl es_ to 0 . * i M a st r_qua nt it a t ve_ obse v at io n e i r c or r s pondi ng_S I_ unit _of _m eas ur _cd e e u nit _of _m easu r _cd e i c onf or s_ to 1 d elt a_c heck_c hange _com put at o n_m et hod_c d m d elt a_c heck_c hange _th r s hol d_qt y e d elt a_c heck_val ue_ r n ge_qt y a d elt a_c heck_n um er c_l ow _value _am t i d elt a_c heck_r et ent i on_per i od_qt y d sp ay_ eng th_ and_d ecim al _pr eci si on_cd i l l m i ni m m m ani ngfu _i ncr em ent _nbr u _ e l s _c onver sion _fa cto r e xpr i _ M a st r_qua li t at i ve_o bserva t on e i a bnor m al_ r s ult _cd e c r t cal _r esul t_ cd i i n or m _r esul t _cd al p r fer r ed_cod ng _syst em _cd e i va il d_answ er _cd i s_s peci fi ed_f or 0 . * < <D at a_t ype>> C har act er _st r ng : ST i < <D at a_t ype>> C ode _value : CV < <D at a_t ype>> C onc ept _descr i pt or : C D < <D at a_t ype>> T echni cal _in sta nce_i dent i fi er : T I < <D at a_t ype>> T echni cal _in sta nce_l ocat or : TI L T < <D at a_t ype>> I nt er val : I VL T < <D at a_t ype>> U nce r ai n_valu e- nar r t i v : UV N t a e T < <D at a_t ype>> U nce r ai n_di scr et e_valu e_usi ng_p r b abil ti y : U DV P t o T < <D at a_t ype>> P ar am et r c_pr ob abil ti y_d st r but i on : P PD i i i T < <D at a_t ype>> B ool ean : B L < <D at a_t ype>> R at o : RTO i < <D at a_t ype>> P hys cal _qua nti t y : PQ i < <D at a_t ype>> F o ati ng_p oint : F PN l < <D at a_t ype>> M o net ar _am ount : M O y < <D at a_t ype>> I nt eger : I NT < <D at a_t ype>> P oi nt _in_ ti m e: TS < <D at a_t ype>> B i nar y_dat a : BI N < <D at a_t ype>> N o_i nf or at i on : N ULL m G e ric ne

Message Elements

Common Constraints

D m S e i c ti n ) o a p c a o (# in fi

h as_as _par ti ci pant 0 . * A ut he nt ic at io n a ut hent ca ti on_d t m 0 . * i s_r el at ed_t o i t yp e_cd i s_s our ce_of 0 . * P rod ucer_o f mast er_servi ce _ s er vce_p r d ucin g_dep ar m ent _t ype_ cd i o t i s_r el at ed_t o 1 0 . * i s_r el at ed_t o C l in ic al _doc umen t hea der _ 0 . * d ocum ent s a vail abi il ty_ sta tu s_cd c hange _r ason_ cd e c om ple ti on_st at us_ cd c onf den ti ali t y_st at us_cd i c ont ent _pr esent at i on_cd P at i ent _i nf orma t on _di scl osure i d ocum ent _he ader _cr eat o n_dt tm i d sc osu r _ dtt m i l e f i e_n m l i nf o_di scl osed_d esc id i nf o_r eques ted _desc l ast _ed ti _dt tm r ea son_cd i i h as_be en_or g na ted _by 0 . * o r gi nat on_ dtt m i i p er tai ns_t o r eq uest ed_dt t m r ep or i ng_pr o r ty _cd t i i 0 .* u r ency_c d g r es ult s_r epor t _dt t m s to r g e_st at us_cd a i i i s_p r vi ded_t o 0 . * o h as_be en_r ecei ved_by 0 . * t r ansc r pt on_ dtt m t yp e_cd 0 .1 i s_t r anscr i bed_b y 0 . * d ocum ent _ch ange_ cd i s_p ar nt_ docum en t_f or e 0 .* c ont ain ed_i n 0 . * h as_as _a_par en t_d ocum ent i s_t he_ r c pi ent _of 1 e i P at i ent _i nf orma t on _reci pi en t i

0 . * p r duces o

D e ogra c m phi < <D at a_t ype>> N um be r : N Qu n / T e a tity im G e ra l z a ns ne i tio

Rw u b r o Nme

Fr e Rw omr o

releas ed September, 1999 r eflec ts agreement made through harmonization n June, 1999 s i
H eaHlt eal tare_f ie_f nan ces hc hcar nan ces i H ea lt hc are_st e_f nan ces H eal t hcar ak ieho ld ers M a st r_t t bl ese_f nan ces e eala hcar i H

c r ate d_by 1 e H ea lt hc are_d ocu ment _au t en t cat or h i P at i H eal t hcar e_f nan ces ent _e ncou nt iers 0 . 1 i s_a O ri gi nat or 0 . 1 i s_r ol e_of D oc umen t re ci pi ent 0 . 1 o f _ 0 . 1 i s_r ol e_of 0 .1 o f

D m S e i c ti n ) o a p c a o (# in fi

Df u V l e ( ) ea lt au #

< <D at a_t ype>> A nno tat ed : A NT

h as_as _pr m ar y_pa r c pan t i ti i S t ake hol de _ af f l ia t on 0 . * r i i a f li at i on_t ype_c d i d esc R ea l_ wo rld _in st ance _i den t f ie r i e f ect ve_d t i va ue_ txt : S T l t er m n ati on_d t i t yp e_cd : C V q ual fi er _t xt : ST i va il d_t m : I VL< TS> r h as_as _secon dar y_par t ci pan t 0 . * i i s_i ssue d_by 0 . *

1 t ak es_on_ r l e_o f o S t akeh ol der t ak es_on_ r l e_o f 1 o 1 t ak es_on_ r l e_o f o a ddr 1 a ct s_as e i p ar ti cip ate s_as_ pr m ar y_in 1 c r dit _r at ng_ cd i o e m ail _addr ess _t xt 1 t ak es_on_ r l e_o f t ak es_r ole _of p hon 1 1 . 1 p ar ti cip ate s_in t ak es_on_ r l e_o f 1 t yp e_cd o r ea _i d : SE T<R WI I> 0 . * r ef er s_t o_per son _by l t ak es_on_ r l e_o f 1 i d : S ET< TII > o 1 c oll ect s t ak es_on_ r l e_o f 1 o 1 t ak es_on_ r l e_o f o

Rw u b r o Nme

< <D at a_t ype>> H i sto r _ ti em : HX IT y

Fr e Rw omr o

C r i aiy a d lt n

r ep r s ent s 0 . * e i s_a _r e_o f 0 . 1 ol 0 . 1 i s_r ol e_of i s_u sed_by P erso n_na me 0 . * e f ect ve_d t i cd nm p ur pose_c d t er m n ati on_d t i t yp e_cd i s_f or 0 . * A cci de nt _i nf ormat i on_so urce c ont ain s 0 . 1 H ea lt h_ chart h eal th_ char t_ d i i s_t he_ sour ce_o f 0 . 1 h eal th_ char t_ typ e_cd 0 . * i s_h oused_ at s ta tus _cd 0 . * b elo ngs_t o

I n di vid ual _h eal t hca e _prac t t io ner_g roup r i id 0 . * c ont ain s

Rw y e o Tp

E nt eri ng_ perso n

1 e nt er s

p ar ti cip ate s_as_ second ar _in 1 y S t ake hol de _ af f l ia t r i e 0 . 1 i s_r ol e_of f am i y_r el at ons hip _cd l i 0 . 1 i s_r ol e_of E mpl oye r 1 . * i s_r epr ese nte d_by p r ivdes_ cont act 0 . 1 o e f ect ve_t m r i 1 i s_e m oye r o f pl _ 0 . * i s_c ont act _for C on t ct _perso n 0 . 1 i s_c ont act _for a i s_c ont act _for 0 . * c ont act _r eason_ cd 0 . 1 i s_a _cont act _f or 0 . * i s_a _cont act _f or 0 . 1 i s_a _r e_o f ol i s_c ont act _for 0 . *

i ssu es 0 . 1 O rga ni zat i on o r aniz ati on_n am e_t ype_c d g o r aniz ati on_n m g s ta ndar d_i ndust r y_cl ass_c d 0 . 1 c at egor ze s i 1 t ak es_on_ r l e_o f o 1 a ssi gns t ak es_on_ r l e_o f o 1 0 . * i s_a _subdi visi on_ of 1 t ak es_on_ r l e_o f0 . 1 o h as_as _a_sub divi sio n

h as_an _asses sm ent _of 1 H ea lt h_ chart _d ef ici en cy a ssess m nt_ dtt m e d esc 0 . * i s_a ssesse d_aga nst i l evel _cd t yp e_cd

R eso urce_ slo t o f set _qt y q uant ti y_a m t r es our ce_t ype_c d s ot _st at e_cd l s ta r _dt t m t 0 . * i s_m an aged_b y v 0 . * i s_r ese r ed_ by

i s_r equ est ed_by 0 . 1

1 i s_r equ est ed_by D ura bl e_med ic al _eq ui pmen t b elo ngs_t o 1 . * id s ot _si ze_i ncr em ent _qt y l t yp e_cd i s_s chedul ed_b y 1

Mn a r a dtoy

ol 0 . 1 i s_a _r e_o f

e nt er s

0 .1

i s_r equ est ed_by 0 . 1

< <D at a_t ype>> N on- par am et r c_ pr babi il ty_ Di st r but on : NP PD i o i i

12

7

at t

amb ulat ory_s tat us_cd

P at ient

amb ulat ory_s tat us_cd

amb ltry St at us

Pt

U dt md s t pae o e e

T ransc ir pt i oni st 0 . 1 i s_r ol e_of

Cn r a c F g ofomne la

0 . 1 t r ansc r bes i

T

C nt an/ o # osr i tN te

T

D f u U dte oe ea lt p a M d

< <D at a_t ype>> H i sto r : H IS T y

11

6

it m

P at ient

_it em_C V

_CV

Pt

M

No

D m S e i c ti n ) o a p c a o (# in fi

0 . * h as_as _cont act 0 . * r eq uest s A pp oi nt ment _re que st S ervi ce _sche dul i ng_ e que st r a ppoi nt m nt_ r s t_ r a son_cd e q e a l owa ble_ subst i tut i ons_cd R eso urce_ e qu est r a ppoi nt m nt_ r s t_ typ e_cd e q d ur ati on_q ty 1r eq uest s s ta r _dt t m t a l owa ble_ subst i tut i ons_cd e qui p_sel ect on _cr ti er a_ expr i i i s_r equ est ed_by 0 . * s ta r _of fse t_q ty t d ur ati on_q ty id s ta r _dt t m t l oca ti on_se ect i on_cr i ter i a_expr l s ta tus _cd s ta r _of fse t_q ty t p r or ti y_cd i i s_r equ est ed_by 0 . * s ta tus _cd r ep eat ng_ nt er val_ dur ati on_t m r 1 r eq uest s i i r ep eat _pat te r _ expr n r qs t_e v nt_ r a son_c d e e r qs ted _dur at on_ tm r i s ta r _t m r t t i m e_sel ect on _cr ti er a_ expr i i I n di vid ual _h eal t hca e _prac t t io ner_re que st D ura bl e_med ic al _eq ui pmen t e que st P at i ent _a ppo in t e nt _requ est P at i ent _se v ice _l oca t on _requ est r i r i e xpl ci t_ ti m e_in te r al _expr i v _r m p r cti t one r t ype _cd a i _ t yp e_cd q uant ti y_a m t t yp e_cd 0 . * i s_e nte r d _by e r eq uest s 0 . * r eq uest s 0 . * r eq uest s 0 . * 0 . * r eq uest s 0 . * r eq uest s r eq uest s 0 . * 0 . * r eq uest s

< <D at a_t ype>> P ost al _and_ r s de nti al _addr ess : AD e i < <D at a_t ype>> A ddr ess _par t : A D XP

< <D at a_t ype>> P er son_ nam e_var i ant : PN XV < <D at a_t ype>> P er son_ nam e_pa r : PN XP t < <D at a_t ype>> P er son_ nam e_t ype : P N

Information Model Mapping Pr ope rty of Cla s s
b 8 9 10 3 4 5 cla at t at t (Attribute or Ass oc iation) Rim Sourc e Cla s s Patien t Patien t id P at ient st at us _cd P at ient Patien t id st at us _cd

Cla s s or

Message Elements
Me ss a ge Ele me nt Na me

Me ss a ge in Ele me nt S hor t Me ss a ge Na m e Ele me nt Type Pt id st at us Pt Pt

T

0 . * c ont ain s D ura bl e_med ic al _eq ui pmen t group _ id

b

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 47 26 49 51 52 53 54 37 38 39 40 41 42 43 44 45

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

cla at t at t it m at t at t at t at t as o at t at t at t at t at t at t at t at t at t it m as o it m at t at t at t at t st c at t at t as o at t r it m as o at t r at t r at t r at t r as o at t at t it m at t at t at t as o at t at t

m a nages 1 P at i ent _sl ot 0 .* i s_a _sched ulea ble _uni t_f or P at i ent _se v ice _l oca t on _sl ot r i 0 .* i s_s chedul eabl e_u nit _f or b ooks 1 . * S ch edu le id

13 8 at t new born_ baby _ind 14 9 at t mult ip le_birt h_ind Cla 10 15 s s or t at org an_donor_ind Pr ope rty of as o s s s_a_role _of 16 11 Cla i (Attribute or Ass oc iation) Rim Sourc e Cla s s 17 12 at t birt h_dtt m Patien t 18 13 at t birt hplace_addr Patien t id 19 14 at t deceased_ ient P at dtt m 20 15 at t edu cat ion_level_cd st at us _cd P at ient 21 16 at t g ender_cd 22 17 at t 23 18 at t 24 19 at t amb ulat ory_s tat us_cd 25 20 at t new born_26 21 it m baby _ind mult ip le_birt h_ind 27 22 as o org an_donor_ind i s_a_role _of 28 23 it m birt h_dtt m marit al_s t at us_cd P at ient race_cd

I n di vid ual _h eal t hca e _prac t t io ner_sl ot r i 0 . * i s_s chedul eabl e_u nit _f or

D ura bl e_med ic al _eq ui pmen t slo t _ i s_s chedul eabl e_u nit _f or 0 . *

i s_i ssue d_by 0 . * h as 1 1 h as P erso n 1 L i vin g_su bj ect b r t h_dt tm i b r t hpla ce_add r i o r gi n_coun tr y_c d i t ax onom c _cla ssi fi cat on_ cd i i i s_s our ce_f or 0 . 1 b r ed_t xt e s tr ai n_t xt 0 . 1 p er tai ns_t o e ye_co or _cd l i s_s chedu A dmi ni st rat ive _bi rt h_ev ent c oat _or _fe ath er col or ng_t xt _ i l ed_ by c onf den ti ali t y_con str ai nt _cd i b aby_d eta ned _in d i 1 b r t h_cer t fi cat e_ d i i i d eceas ed_dt t m h as 1 d eceas ed_i nd P at i ent 0 . * i s_p ar _of t b r t h_m et hod_cd i h as 1 e ut hanasi a_i nd b r t h_r ecor ded_c ount y_cd i a m bula tor y_s tat us _cd b r t h_r ecor ded_d t m i h as_as _a_con ta ct 0 . 1 b r t h_or der _nbr g ender _cd i n ewb or _days_ nbr n h as 1 l i vng_a r ange m nt _cd g ender _st at us_c d i e p r m ar y_nam e_t yp e_cd i s ti l bor n_i nd i i s_a _r e_o f 0 . 1 l i vng_d epende ncy_c d p r m ar y_nm ol i i i h as 1 m u tl pl e_bi r th_ nd i m por t ance_s tat us _tx t n ewb or _baby_ nd n i q ty 0 . 1 i s_t ar get _of g _i p ar ti cip ate s_in 1 o r an_don or nd p r duct on _cla ss_cd o i p r fer r ed_pha r ac y_id e m h as 1 s ta tus _cd i s_s our ce_f or 0 . 1 h as_a_ pr m ar y_pr ovid er 0 . * i h as_as _pr m ar y_f aci il ty 0 . * i 1 h as 1 i s_r equ est ed_by 0 . 1 i s_t ar get _of 1 1 i s_i nvol v d_in e h as

a ct s_in _r e_o f ol b r t h_dt tm i 1 t ak es_on_ r l e_o f o b r t hpla ce_add r i c ti z enshi p_cou nt r _ cd i y A dmi ni st rat ive _pa t en t dea t i _ h N ot ary_ pub li c c onf den ti ali t y_con str ai nt _cd i d eat h_cer t fi ca te _id i e f ect ve_i nt er a _t m r i vl d eceas ed_dt t m d eat h_cer t fi ca te _r cor ded_dt t m i e t ak es_on_ r l e_o f 1 d eceas ed_i nd o n ot ar _count y_c d y d eat h_cl assi fi cat o n_cd i n ot ar _st ate _cd y d sa bil ti y_cd i d eat h_dt t m e ducat i on_l evel_ cd d eat h_l ocat on _t xt i I n sured e th nic_ gr up_cd o 0 . 1 i s_a _r e_o f ol d eat h_not i fi cat on _sour ce_n m i g ender _cd d eat h_ver fi ca ti on_c d i l ang uage_c d 1 t ak es_on_ r l e_o f o 0 . 1 i s_r ol e_of d eat h_ver fi ca ti on_d t m i m a r ta _st at us_c d i l d eat h_ver fi ca ti on_n m i m i il t ar _br anch_ of_s er i ce_cd y v 0 . 1 p er tai ns_t o m i il t ar _r nk_nm y a 1 t ak es_on_ r l e_o f o 1 o f er s t ak es_on_ r l e_o f 1 m i il t ar _st atu s_cd o y 0 . * h as_as _em plo yee I n suranc e_ce t i f ica t on _con t ct r i a n at ona il ty_ cd i p ar ti cip ati on_t yp e_cd r ac e_cd i s_i ssue d_by 0 . * t ak es_on_ r l e_o f 1 r el g ous _aff li a ti on_c d o E mpl oye e i i i B i l i ng_ in f m a t io n_i t m or e t ak es_on_ r l e_o f o 0 . 1 i s_r ol e_of s tu dent _cd I n suranc e_ce t i f ica t on r i i s_e m oye e_in 1 pl 0 . 1 i s_r ol e_of i s_c ont act _for 1 .* c ondi ti on_c d 1 ve r _ m por t ant _per son_ cd y i a ppeal _r eason _cd o ccur r ence_c d 0 . * p er tai ns_t o s ta tus _cd c er ti fi cat on _dur at on _qt y i i o ccur r ence_d t m e f ect ve_t m r i o ccur r ence_s pan_c d 1 h as_co nta ct id e nt er 1 s o ccur r ence_s pan_f r om _dt tm 1 .* 0 . * b elo ngs_t o h as 1 G u arant or_c ont ract i nsu r n ce_ver fi c ati on_d t m a i o ccur r ence_s pan_t hr u_dt t m h as_pa ym ent _guar ant eed _by p r ivdes_ paym ent _gu ar nte e_fo r o a P at i ent _b il l in g_a ccou nt m o dif ca ti on_dt t m i b li il ng_ho d_i nd l q uant ti y_n br n on_co ncur _cd q uant ti y_t ype _cd a ccoun t_i d b li il ng_m edi a_cd n on_co ncur _ef fec ti ve_dt tm 0 . * va ue_ am t l a dju stm en t_c d h as_co e r g e_af fi r ed _by 1 c har ge_ad ust m ent _cd 0 . * va m a f r m s_i nsur ance _cover age_f or i j a ut hor zat i on_i nfo r at o n_t xt i m i p enal ty _am t va ue_ cd l c ont r ct_ dur ati on_ cd a F i nan cia l_ t an sact i on r r ep or _of _el gi bi il ty _dt tm t i b li il ng_st at us_c d o v i 0 . * p r ivdes_ a il dat on _for a tl er nat e_des c 0 .* c ont r ct_ typ e_cd a r ep or _of _el gi bi il ty _ind t i c er ti fi cat on _r qui r d _ind i e e d esc e f ect ve_t m r i i s_e nte r d _by e e 0 . * e xt ended_ am t h as_pa ym ent _guar ant eed _by 0 . * c ur r n t_u npai d_bal ance _qt y i nt er est _r ate _nbr l p er odi c_pa ym ent _am t i d ele te_ dtt m i ncl udes 1 i s_c ate gor zed _by f ee_ schedu e_c d i e i nsu r n ce_am t a p r or ti y_r anki ng_ cd i h as 1 d ele ted _accou nt _r ason_c d e xpect ed_ nsu r nce_pl an_q ty i a 0 . * p r ivdes_ opin on _on o i p ost ng _dt i 0 . * i s_a ssoci at ed_w ti h e xpect ed_ paym ent _so ur e_cd c q ty C ert i f cat i on_ seco nd_o pi ni on i n ot ce_ of_a dm ss on_ dtt m i i i t r ansa cti on_b atc h_i d e f ect ve_d t m i 0 . * i s_p r vi ded_b y o n ot ce_ of_a dm ss on_ nd i i i i t r ansa cti on_c d s ta tus _cd p at ent _f na ncia _c ass _cd i i l l t r ansa cti on_d t m B ad _de bt _bi l i ng _acco unt t r ansa cti on_i d p r ce_s chedul e_i d i 0 . * p er tai ns_t o i s_a ssoci at ed_w ti h b ad_de bt_ r c over y_am t e p ur ge_st at us_cd t r ansa cti on_t ype _cd b ad_de bt_ tr ansf er _am t p ur ge_st at us_dt t m 0 . * u nit _am t t r ansf er _t o_bad_ debt _dt t m u nit _co st_ am t r ep or _of _el gi bi il ty _dt tm t i 1 i s_val d ate d_by i t r ansf er _t o_bad_ debt _r eason _cd r et ent i on_i nd C ov erage _i t m e s gn atu r _ on_f li e_dt t m i e 0 . * i s_f or s peci al_ pr gr m _cd o a s er ivce_c ate gor y_cd 0 . * i s_a ssig ned_t o s er ivce_c d s to plos s_li m ti _i nd p r ivdes_ cont act 0 . 1 o B ad _de bt _col l ect i on_a gen cy s er ivce_m od fi er _cd i s uspen d_char ge s_in d i s_a _r e_o f 0 . 1 ol 1 i s_a ssig ned r _ i s_r ol e_of 0 . 1 H ea lt h_ ben ef it _p o duc t p urch aser 0 .* 0 . 1 t ot al _adj ust m ent _qt y a ut hor zat i on_i nd i p r ivdes_ cover age_f or o h as_as _a_pr o r accoun t t ot al _char ge_ qty i _ n et wor k_i nd P ref erred _prov id er_pa t i ci pat i on r 1 i s_t he_ pur chase r o f _ a sser t on_ cd i t ot al _paym en t_q ty 0 . 1 g over ns i s_t he_ pr or _acc ount _fo r s epar at e_bi l _in d i i s_g over ed_by r ol e_cd n c over ed_par t es _cd i e f ect ve_d t i h as_as _car e_r eci pie nt 0 .1 q ty i 0 . * t er m n ati on_d t q uant ti y_q uali fi er _cd 0 .* 0 . 1 h as_ch ar es_f or g i s_b li ed_ fr om 0 . 1 l t i m e_per o d_qua il fi er cd i _ r an ge_l ow_q ty h as_as _car e_pr ovi der 0 . * r an ge_hi gh_qt y i s_a ssoci at ed_w ti h 0 . 1 r an ge_uni t s_cd M a st r_hea lt hc are_b ene f t _pro duct e i a sser t on_ eff ect ve_ tm r i i h as 0 . * e il gib li ti y_cd a ssi gnm ent _of _bene fi ts_ nd i 0 .* C ol l ect ed _spec im e n_sa mpl e p oli cy_s our ce_cd i s_c oll ect ed_by 0 . * b enef ti _pr oduc t_ desc e il gib li ti y_sou r e _cd c b ody_s ti e_cd h as_as _pur chas er id h as_as _com pon ent s c opay_ il m t _ind i c oll ect o n_body _si te_ m dif er _c d i o i b enef ti _pr oduc t_ nm n on_co e r d _ins ur ance_c d 0 . 1 ve c oll ect o n_t m i r b enef ti _pr oduc t_ typ e_cd 0 . * i s_s our ced fr om p ar ti cip ate s_in 1 c oll ect o n_m et hod_m od fi er _cd i i b enef ti s_co or na ti on_cd di c oll ect o n_sche dul ed_dt t m i 0 .* H ea lt hc are_se rvic e_pro vid er c ob_pr i or t y_nbr i 0 . * i s_s our ced_f r m o c oll ect o n_volu m e_qt y i c om bin e_baby _bi l _ind b oar d_cer t fi ca ti on_t ype _cd i i s_a _com pone nt _of c oll ect or s_com m en t_c d b oar d_cer t fi ed _in d i i i s_o f er d_by 0 . * e f ect ve_t m r e 1 i s_a ssoci at ed_w ti h h andl ng _cd i g r up_ben efi t_ nd o i p ar ti cip ate s_as 1 c er ti fi cat on _dt tm i id m a li _cla m _par t y_cd i e f ect ve_t m r i c oll ect o n_m et hod_d esc i 0 . 1 i s_t ar get _of l i cense_ d i r el ease _inf or m at on_ cd i i den ti fi es n um ber _of _sam pl e_con tai ner s_q ty s ta tus _cd r ec er i fi cat on_ dt tm t i 1 a ddi ti ve_desc c over age_t ype_ cd 0 . * i s_c oll ect ed_du r ng i s peci alt y_c d d anger _cd a gr eem ent _t ype_c d s our ce_cd i s_c hil d_of p oli cy_c ate gor y_cd t r ansp or _l ogi sti cs_ cd t a ccess _pr oto col _desc 0 .1 a ct on_ cd i t yp e_cd 0 .1 i s_p ar nt_ of e i s_r ol e_of H ea lt hc are_p o vi der_o rgan iz at io n r 0 .1 1 . * p r ivdes_ pat ent _s er i ces_a t o i v I n di vid ual _h eal t hca e _prac t t io ner r i i s_r ol e_of d esc l i 0 .1 i s_s chedul ed_b y 1 f el ow shi p_f el d_cd g r duat e_sch ool _nm a g r duat on _dt tm a i p osi ti on_cd p r cti t one r t ype _cd a i _ p ar ti cip ate s_as 1 p r ivdes 1 p r m ar y_car e_i nd o i 1 . * b elo ngs_t o r es den cy_f el d_cd i i i s_r equ est ed_by s ot _si ze_i ncr em ent _qt y l 1 0 .1 i s_t he_ pr m ar y_pr ovid er for i _

P erso n_emp lo ymen t a ddr 0 . * e f ect ve_d t i h as_as _em plo yer h azar d_ex posur e_t xt j ob_ clas s_cd G u arant or j ob_ ti tl e_nm 0 . 1 i s_r ol e_of p r ivdes_ cont act 0 . 1 f i nanci al_ clas s_cd o p hon p r tec ti ve_equi pm ent _t xt o h ouseh old_ annua _i ncom e_a m l t h ouseh old_ size _nbr s ala r _ qty y 1 g uar ant ees_p aym ent _und er s ala r _ typ e_cd y 0 . 1 p r ivdes_ cont act o s ta tus _cd 0 . 1 i s_r ol e_of t er m n ati on_d t i I n surer 1 o ccupa ti on_cd e f ect ve_t m r i ssu es i j ob_ sta tus _cd 1 i ssu es 0 . * i s_c ont act _for

P rea ut hori zat i on a ut hor zed _enco unt er _qt y i s a ut hor zed _per o d_begi n_dt i i a ut hor zed _per o d_end_ dt i i id i ssu ed_dt t m r eq uest ed_dt t m r es tr c ti on_de sc i s ta tus _cd s ta tus _chang e_dt t m a ut hor zes 0 . 1 i

0 . * h as_as _par ti ci pant A pp oi nt ment r es er es 0 . * a ppoi nt m nt_ dis posi ti on_cd v e a ppoi nt m nt_ dur at on_ tm r e i a ppoi nt m nt_ ti m ng _qt e i l i s_e nte r d _by 0 . * c ancel a ti on_dt t m e e vent _r ason_c d e h as_as _a_con ta ct 0 . * e xpect ed_ end_d t m e xpect ed_ ser vce_ desc i i s_p ar nt_ of e e xpect ed_ sta r _dt t m t id 0 .1 o ver ook_i nd b s chedu il ng_beg n_ dtt m i s ta tus _cd 0 .* g s chedu es 0 . * u r ency_c d l vi si t_t ype _cd i s_c hil d_of w ai t_ il st_ pr or ti y_a m i t s chedu il ng_com p et ed_d t m l i s_b ooked_ n 0 . * i A ct i ve_p art ci pa t on i i t mr p ar ti cip ati on_t yp e_cd 0 .* p ar ti cip ate s_in 0 .*

i s_a n_in sta nce_o f 0 . *

p ar ti cip ate s_in

0 . * i s_r eas on_f or S ervi ce _reaso n d et er i nat on _dt tm m i d ocum ent at o n_dt t m i r ea son_t xt 0 .* h as_as _evide nce 0 .* i s_r

D i sabi l it y i 0 . * e f ect ve_d t m p er tai ns_t o r et ur n_t o_w or k_aut h_d t m t er m n ati on_d t m i u nabl e_t o_w or _ef fect i v _dt tm k e D i agn ost ic _rel at ed_ group b ase_r at e_am t c api tal _r eim bu r em ent _am t s c ost _we ght _am t i id m a or _di agnos ti c_ca teg or _cd j y o per at ng_ r i m bur sem ent _am t i e r ei m bur sem ent _am t 1 i s_a ssig ned_as s ta ndar d_day _qt y s ta ndar d_t ot al_c har ge_am t t r m _h gh_ day_q ty i i t r m _l ow _day_q ty i

E pi sod e d esc e pis ode_t ype_ cd 1 . * i s_s chedul ed_b y i d i s_a uth or zed_ by 1 . * i l i st_ clos ed_i nd P at i ent _e ncou nt er o ut com e_t xt p er tai ns_t o 0 . * h as_pa r s 1 a dm ni st r ti ve_out com e_ txt t i a r ec ur i ng_ser vic e_i nd r A dmi ni st rat ive _pa t en t acci de nt i _ c ancel a ti on_r eas on_cd l d esc a cci dent _deat h_ nd i 1 . * a cci dent _desc i i nvol ves 0 . * e ncoun ter _cl ass fi cat i on_cd e nd_dt t m i s_o bta ned _fr om a cci dent _dt tm i E pi sod e_of _ca re E pi sod e_of _co nd it i on i a h as 1 . * e xpect ed_ nsu r nce_pl an_q ty a cci dent _lo cat on _desc i f i r t _si m li ar _il ne ss_dt t m s l a cci dent _st at e_cd 0 . * i s_p r s ent _in e f ol ow _up_ typ e_cd l 0 . * a cci dent _t ype_c d i s_p ar _of 1 t l i nks_co ndit i on 0 . 1 id i s_i dent i fi ed by j ob_ r l at ed_ac cid ent _ind e p at ent _cl assi fi cat i on_cd i 1 . * h as_pa r s t a ssess m nt_ dtt m e p ur pose_c d 0 . 1h as_as sign ed_t o_i t r ec or _sig ning _dt tm d 1 h as s peci al_ cour te sie s_cd s ta r _dt t m t P at i ent _a dmi ssio n 1 s ta tus _cd a dm ss on_ dtt m i i e 1 i s_p r c eded_b y t r ansp or _r equi r em ent _cd t a dm ss on_ r a son_c d i i e h as_as _par ti ci pant u r ency_c d g a dm ss on_ r f er r al_c d i i e P at i ent _d epa t u e r r t r a ge_cl assi fi cat o n_cd i i 0 . * p er tai ns_t o a dm ss on_ sour ce_c d i i a ct ual_ disc har ge_di spos ti on _cd i m e dica _se r i ce_cd l v a dm ss on_ typ e_cd i i 0 .1 d sc har ge_dt t m i R i sk_man age men t i nc id ent _ c onf den ti ali t y_con str ai nt _cd i p at ent _val uabl es_d esc i d sc har ge_l ocat o n_id i i f ol ow s l i nci dent _cd p r _adm ti _t est _i nd e e xpect ed_ disc har ge_di sp_c d i nci dent _dt t m 0 .* r ea dm ssi on_i nd i 1 i nci dent _se v r ty _cd ei h as p r cedes e va uab es_ oca ti on_d esc l l l i nci dent _t ype_ cd t er m n ate s 0 . 1 i p r ceded 1 e

0 . * + has_ as_t ar get h as_as _ta r e t 0 . * T arge t part ic ip at io n g _ i s_t ar get _of h as_as _ta r e t 0 . * t m r g h as_as _ta r e t 0 . * p ar ti cip ati on_t yp e_cd 1 . * g i s_t ar get _of 0 . *

eas on_f or

S ervi ce _in t nt _or_o rder e c har ge_t ype_ cd c ar i fi cat on_ phon l i e nt er ng_d evice_ cd i e scor t _r quir ed_ nd e i e xpect ed_ per for m ance _ti m e_qt y f i l er or er d _ d _i s ta tus _cd h as_as _par ti ci pant 0 . 1 s ta tus _r ason_c d e i s_r ef er r d _to _in 0 . 1 o r er eff ect ve_d t m e d _ i o r er d d _i e xpect s_p ati ent _l ocat ed_a t 0 . * o r er plac ed_dt t m d _ h as_as _ta r e t 0 . 1 q t g p ac er or er d l _ d _i i s_f ul fi l ed_by 0 . 1 e cho_b ack_t xt h as_as _r ason 0 . 1 p an ned_pa ti ent _t r nspor t _cd e l a t i s_s our ce_f or 1 r ep or _r esul t s_t o_pho n r es ponse_ r q uest ed_c d e s er vce_b ody_si t e_cd i h as_as _sour ce 0 . * s er vce_b ody_si t e_m odi fi er _cd i t r ansp or _ar r ange d_in d t S ervi ce _in t nt _or_o rder_re la t on shi p e i t r ansp or _ar r ange m nt_ r s ponsi bi il ty_ cd t e e r el at on ship _ty pe_cd i 0 . * i s_b li ed_ to l t r ansp or _m ode _cd t r ef e x_t est ng_ tr i gger _r ules _desc l i w hen _to _char ge_ dtt m c onst r aint _t xt w hen _to _char ge_ cd qt i nt ent _or _or der _cd j oi n_cd 0 . * h as_as _ta r e t g s ta tus _dt tm s econd ar _ide nt fi cat i on_t xt y i i s_t ar get _f or 1 r ep or i ng_pr o r ty _cd t i i i s_e nte r d _at 0 . * e

religious_affiliat ion_cd P at ient p hon P at ient P at ient h as P at ient Patien t P erson 29 24 at t nm birt hplace_addr P erson deceased_30 m dtt 25 at t effective_dt P erson edu cat ion_level_cd t 31 26 at cd P erson gender_cd32 27 at t p urpos e_cd P erson marit al_s t33us_cd st c at 28 valu e P erson race_cd 34 29 at t t erminat erson P ion_dt religious_affiliat ion_cd t yp e_cderson 35 30 at t P p hon St akeholder 36 31 as o h as_a_pri mary_provi der St akeholder 47 32 at t r p hon h as Pers on 26 33 it m 49 34 as o Pers on_a s_IHCP P erson 51 35 at t r nm cd P erson_name p urpos e_cd P erson_name t yp e_cderson_name P h as P erson_name P erson_name at t id P erson_name t yp e_cd P erson_name 39 41 at t st at us _cd h as_a_pri mary_provi der Patien t 40 42 it m p hon St akeholder St akeholder billing_st at us_cd Pers on_a41 43 s_IHCP at t nm 42 44 cd p urpos e_cd t yp e_cd 43 45 h as 44 46 id 45 47 st at us _cd 46 48 at t at t as o at t at t P erson_name p at ientP erson_name _financial_class _cd P erson_name p rice_s chedule_id P erson_name Patien t i s_i n vP at ient _billing_accoun ol v ed_i n t P at ient _billing_accoun st at us _cd t P at ient _billing_accoun t P at ient _billing_accoun t P at ient _billing_accoun t P at ient _billing_accoun t id Patien t P at ient _en count er P at ient _en count er nm 52 36 effective_dt 37 53 cd 54 38 p urpos e_cd 39 37 valu e 38 40 t erminat ion_dt at t r at t r at t r as o

i s_a ssig ned_by 0 . *

0 . * i s_a n_assi gnm en t_o f E nco unt er_d rg a ppr oval_ nd i a ssi gned_d t m c onf den ti al_ nd i i c ost _out il er _am t d esc g r uper _r eview _cd o 0 . * i s_a ssig ned_t o g r uper _ver sion _id o o ut il er days_n br _ o ut il er r i m bur sem ent _am t _e o ut il er typ e_cd _ P at i ent _a r i val a cui ty_ evel _cd l a r i v _dt t m al m e dica _se r i ce_i d l v s our ce_of _ar r val _cd i m o de_cd

T reat men t in t nt _or_o d er _ e r D i et ary_i nt en t or_orde r O b servat i on_i n t nt _or_ord er _ R ef erral f ul fi l s 0 . * e i ndi cat o n_id i d et _t ype_ cd i a ut hor zed _visi ts _qt y i i S ervi ce _eve nt 0 . 1 i s_e vdenc e_fo r p at ent _ha zar d_cd i o r er ng_p r vi der s_i nst r cti on_t xt i nst r uct on _desc d i o u h as_as _act ve_p ar ti cip ant 0 . 1 i i r el evant _cl ni cal _i nfor m at on _t xt d esc i i a t est at o n_dt tm i e 0 . 1 h as_as _r ason r eq uest ed_gi ve_st r engt h_qt y t r ay_t ype _cd r ea son_t xt s peci m en_act i on_cd t mr o r er d s s er vce_p er od_c d i i s ubst ti ut o n_al ow ed_i nd i l c har ge_t o_pr act i ce_qt y 0 .* i s_s our ce_f or d eli ver s 0 . * c har ge_t o_pr act i ce_cd T reat men t in t nt _or_o d er_rev isi on _ e r p at ent _se nsit i vt y_cd 1 i i 1 h as_pa r s 0 . * h as_as _sour ce t i s_a ssig ned_t o 0 . * c onsen t_c d d sp ense_p ackag e_m et hod_c d i d sp ense_p ackag e_si ze_qt y i S ervi ce _eve nt _rel at io nshi p s er vce_d esc i f i l er d _i r el at on ship _ty pe_cd i i i i s_p ar _of g ve_i ndi cat on _id t f i l er or er sta tu s_dt tm _ d _ g ve_p er ti m euni t_ cd i _ s chedu ed_ sta r _dt t m l t i 1 . * g ve_r at e_qt y h as_as _ta r e t 0 . * g s peci m en_r ecei ved_dt t m 1 l ast _r ef li ed_ dtt m l f am i y_a war enes s_t xt l m a x_gi v _qt y e i s_d ocum ent ed_ by 0 . * i ndi vidu al_a war ene ss_cd i s_t ar get _f or m i n_gi ve_qt y n eeds_ hum an_r evi ew_i nd c onf den ti al_ nd i i s ta tus _cd P Tco m p i s_p er or m ed_at 0 . * b li il ng_pr i or t y_nbr f i P Tr out J udg emen t li nk _ i s_c har ged_t o 0 . * s ta tus _r ason_c d R ul e_ li nk C on di t on al _l in k i e qt t yp e_cd p r or ti y_nb r i i s_a ssoci at ed_w ti h 1 p r scr pt o n_id e i i r ef li s _all ow ed_nb r l r ef li s _doses _dis pense d_nbr l r ef li s _r m ni ng_n br l e ai s ubst ti ut o n_st at us_cd i t r eat m ent _supp il er s_in str uct i on_cd A ssessme nt t ot al _dai y_ dose_ qty l C are _eve nt C on sent h as_as _ta r e t 0 . 1 g

P at ient new born_ baby _ind nwbrnInd Pt P at ient mult ip le_birt h_ind mult brthInd Pt Me ss a ge innDonrInd P at ient org an_donor_ind org Pof t Ele me nt MePtPrsn ss a ge Me ss a ge Patien t i s_a_role _of_Person _as_pa ti en t S hor t Pt Me ss a ge Ele me nt Na me Na m e Ele me nt Dtt m Ele metP rsn P erson birt h_dtt m brth Type P nt Type P erson t Patien birt hplace_addr Pt brth plcAddr P tP rsn Pt 1 P erson id deceased_ dtt m id Pt deces dDtt m P tP rsn II 1 P erson edu cat ion_level_cd edu cnLevl P tP rsn st at us _cd st at us Pt Set <CV> 1 P erson g ender_cd g endr P tP rsn P erson marit al_s t at us_cd marit lSt at us P tP rsn <@s tate, CV _it em_C V _CV Pt CV 1 EXT:C NE> P erson race_cd race P tP rsn CV P erson religious_affiliat ion_cd relgsAfiltn P tP rsn <amblt r CV amb ulat ory_s tat us_cd amb ltry St at us Pt CV 0..1 St akeholder p hon p hon P tP rsn Set St at us> <TIL> St akeholder baby _ind new born_ _it em_T IL nwbrnInd Pt _TIL Set <TIL> BL 0..1 <clasfcn> TIL mult ip le_birt h_ind mult brthInd Pt BL 0..1 S et Pers on h as_S et_ Person _n ame_for_Pati en t PtN ame PtPrsn org an_donor_ind org nDonrInd Pt BL 0..1 <PtPrs nN ame> i s_a_role _of_Person _as_pa ti en t PtPrsn Pt PtPrsn Set 1 P erson _it em_P ers on_name_for_P at ient _P t PrsnN ame P tP rsnName birt h_dtt m brth Dtt m P tP rsn TS 0..1 <Pt P rsnName> P erson_name nm nm P tP rsnName 0..1 PN birt hplace_addr brth plcAddr P tP rsn ST P erson_name dtt m deceased_ effective_dt deces dDtt m P tP rsn efect vDt P tP rsnName 0..1 TS TS P erson_name edu cat ion_level_cd cd edu cnLevl P tP rsn cd P tP rsnName 0..1 CV <edctnLev l> CV 14 P erson_name g ender_cd p urpos e_cd g endr P tP rsn urpos p P tP rsnName 0..1 CV CV P erson_namet at us_cd marit al_s valu e marit lSt at us P tP rsn valu P tP rsnName 0..1 CV <mart lStat us> ST P erson_name race_cd t erminat ion_dt race P tP rsnermnt nDt t P tP rsnName 0..1 CV <race> TS P erson_name religious_affiliat ion_cd t yp e_cd relgsAfiltn P tP rsnyp t P tP rsnName 0..1 CV <relg Aflt n> CV s p hon h as_a_pri mary_provi der_In divid ual _h eal th ca p hon P tP rsn Set <TIL> 0..* Patien t pri mryIHCP Pt IHCP _it em_T IL _TIL Set <TIL> TIL 1 re_ practi tion er St akeholder p hon p hon IHCP S et Set <TIL> h as_S et_ Person _n ame_for_Pati en t PtN ame PtPrsn 1..* St akeholder _it em_T IL _TIL Set ame> TIL <PtPrs nN <TIL> h as_Pers on _na me_for_I HC P Set PN_IHCP IHCP PN_IHCP _it em_P ers on_name_for_P at ient _P t PrsnN ame P tP rsnName 1 <Pt P rsnName> P erson_name nm nm P N_IHCP PN P erson_name nm cd nm P tP rsnName cd P N_IHCP PN 0..1 CV P erson_name effective_dt p urpos e_cd efect vDt P tP rsnName p urpos P N_IHCP TS 0..1 CV P erson_name cd t yp e_cd cd P tP rsnName t yp P N_IHCP CV 0..1 CV Patien t p urpos e_cd h as_Patie nt_bi l li n g_accou nt p urpos P tP rsnName PtB i ll Acn t Pt CV 0..1 PtB i ll Acnd> <pu rp sC t valu e valu P tP rsnName ST 1 P at ient _billing_accoun id id P tB illAcn t II t erminat ion_dt t ermnt nDt P tP rsnName TS 0..1 t t yp e_cd t yp P at ient _billing_accoun st at us _cd t h as_a_pri mary_provi der_In divid ual _h eal th ca pri mryIHCP P at ient _billing_accoun re_ practi tion er _it em_C V t p hon p hon _it em_T IL _TIL P at ient _billing_accoun billing_st at us_cd h as_Pers on _na me_for_I HC P PN_IHCP t nm nm P at ient _billing_accoun p at ient _financial_class _cd cd cd t p urpos e_cd p urpos P at ient _billing_accoun p rice_s chedule_id t yp e_cd t yp t h as_Patie nt_bi l li n g_accou nt PtB i ll Acn t Patien t i s_i n v v ol ed_i n _Pati en t_en cou nter id id P at ient _en count er id st at us _cd P at ient _en count er _it em_C V billing_st at us_cd p at ient _financial_class _cd p rice_s chedule_id i s_i n vol ved_i n _Pati en t_en cou nter id st at us _cd st at us _cd st at us _CV billngStatu s p tF nanclC lass p riceSchedId PtEn ctr id st at us P tP rsnName CV st at us P tB illAcn t Pt IHCP _CV P tB illAcn t IHCP Set <TIL> Set <TIL> TIL P tB illAcn t IHCPbillngStatu s PN_IHCP P N_IHCP PN p tF nanclC lass P tB illAcn t P N_IHCP CV P N_IHCP CV p riceSchedId P tB illAcn t P N_IHCP CV PtEn ctr P tB illAcn t id P tB illAcnus st at t P tB illAcn t P tB illAcn t P tB illAcn t P tB illAcn t Pt P tEnctr* P tEnctr Pt PtB i ll Acn t Pt II P tEnctr* Set P<CV> tEnctr CV CV CV ST PtEn ctr & IptEn ctr II CV 0..1 0..1 0..* 1 1 1 0..1 0..1 0..1 0..1 1 1..* 1 0..1 0..1 0..1 0..1 1 1 <@s tate, EXT:C NE> CV CV CV ST PtEn ctr & IptEn ctr II <@s tate, CV EXT:C NE> <@s tate, EXT:C NE> <bilng at us > St <pt F incl Class > Set <CV>

of Common Constraints Me ss a ge Ele me nt Type Pt 1 II 1 <@s tate, Set <CV> 1 EXT:C NE> <@s tate, CV 1 EXT:C NE> <amblt r CV 0..1 St at us> BL 0..1 <clasfcn> BL 0..1 BL 0..1 PtPrsn 1 TS 0..1 ST 0..1 TS 0..1 M No V <@s tate, CV 0..1 <edctnLev l> M No R 14 EXT:C NE> CV 0..1 0..1 M 0..1 0..1 0..* 1 1..* 1 0..1 0..1 0..1 0..1 1 0..1 0..1 0..1 0..* 1 1 1 0..1 0..1 0..1 0..1 1 1..* 1 0..1 0..1 0..1 0..1 M 1 M 1 M No V
2

M M

No No

V R R R R R R R R R R R R R R R N

R R R

2

R

R R R

<mart lStat us> No R <race> <relg Aflt n> s R R R R R R R R <pu rp sC d> R R R R R N

R

R R R R R R R R

N

R R N R

R R R R N R R <@s tate, R EXT:C NE> <@s tate, EXT:C NE> R N <bilngSt at us > <pt F incl Class >

M M M R

No No No

V V V

R R R

M M

R R R

No No

R R

R R

<@s tate, No V EXT:C NE> No V

i s_t er m na ted _by 1 i I n pat i ent _en cou nt er i s_p r c eded_b y 1 a ct ual_ days_q ty e e st m at ed_da ys_qt y i i s_a ssig ned 1

p r cedes 0 . 1 e

A dv ance _di rect i ve c om pet ence_ nd i d r ect ve_ cd i i d sc osu r _ evel _cd i l e l l i fe_q uali t y_desc m o r uar y_pr ef er ence_ nm t n ot ar zat o n_dt tm i i a ssess m nt_ dtt m e e m ploy m nt_ r l at ed_i nd e e

P roce dure a nest hesi a_cd a nest hesi a_t m r d ela y_r eason_ tx t i nci si on_ope n_t m r p r or ti y_nb r i p r cedur e_t m r o f unc ti onal _t ype_c d m o dif er _cd i

C ha mpus_ cove rage h andi cappe d_pr ogr am _cd n on_avai _ cer t_o n_f li e_in d l r et i r m en t_d t m e s ta ti on_i d

i s_p r m ar _fac li ti y_f or M a st r_pat i ent _se rvic e_l oca t on 1 i s_s chedul ed_b y i y e i 0 . 1a ddr o pen_t m r 1 h as d esc e m ail _addr ess h ouses 1 i d p r ivdes_ ser vces _on_be half _of 0 . * l i censed _bed_n br o i 1 . * b elo ngs_t o nm p hon s er vce_s peci alt y_c d i 1 i s_r equ est ed_by l i s_i ncl uded_ n 0 . * s ot _si ze_i ncr em ent _qt y i 0 . 1e xpect ed_ pat en t_l ocat i on_f or i s ta tus _cd t yp e_cd 0 . 1 i s_t ar get _f or e qui pm ent _ty pe_cd 1 i s_e ntr y_l ocat i on_f or 0 . 1 i s_l ocat i on_f or i ncl udes 0 . 1

p er tai ns_t o 1 . * L oca t on _en cou nt er_rol e i a ccom m odat i on_cd e f ect ve_t m r i l oca ti on_r ol e_cd p er tai ns_t o 0 . * s ta tus _cd t r ansf er _r eason_ cd u sage_ appr oved_i nd P at i ent _se v ice _l oca t on _grou p r i c ont ain s0 . * 0 id i s_r equ est ed_by 0 . 1

E nco unt er_p ract i t on er i 1 . * p ar ti cip ati on_t yp e_cd i s_a ssoci at ed_w ti h0 . * i s_p ar i cipa nt_ for t

c oll ect s 0 . 1

T reat men t servi ce_e ven t _ p r scr pt o n_id e i i r ef li s _r m ni ng_n br l e ai P Tr out P Tco m p i ndi cat o n_id i s ubst ance _expi r ati on_d t m s ubst ance _lot _n um ber _tx t s ubst ance _m anuf act ur er cd _ d osage _for m _cd s tr eng th_ qty a m ount _qt y r ou te_ cd b ody_s ti e_cd s ubst ti ut o n_cd i

C l in ic al _obse rvat i on a bnor m al_ r s ult _cd e l ast _ob ser v d_nor m al _value s_dt t m e n at ur _of_ abnor m al _te sti ng_c d e c il nic all y_r ele v nt _tm r a m e tho d_cd s ta tus _cd s ta tus _dt tm o bser vat on_ sub_i d i va l r ef er ences _r nge_val a u niver sal _ser vic e_i dent fi er _su f x_ txt i i u ser _def ne d_acc ess_ch eck_cd i va ue_ dat aty pe_cd l c onf r m ati on_s ta tus _cd i

G o al e xpect ed_ achi evem ent _dt tm g oal _li st _pr or ti y_ nbr i m a nagem ent _di sci pl ne_ cd i r evi ew_ nt er val_c d i g oal _value _cd i s_m ea sur ed_by 1 . *

C on di t on _no de i l i fe_c ycle _st ar _d t m t l i fecy cle_ sta tus _cd m a nagem ent _di sci pl ne_ cd i r an king _nbr e m ploy m nt_ r l at ed_i nd e e 1 d efi nes_ epis ode

billing_st at us_cd

p at ient _financial_class _cd p rice_s chedule_id i s_i n v v ol ed_i n id st at us _cd

M M

No No

R R

R R

T reat men t servi ce_d isp ens e _ T reat men t servi ce_g iv e T reat men t servi ce_a dmi ni st a t on _ _ r i d sp ense_p ackag e_m et hod_c d i g ve_p er ti m euni t_ cd i _ a dm ni st er ed_r at e_qt y i d sp ense_p ackag e_si ze_qt y i c om ple ti on_st at us_ cd qt n eeds_ hum an_r evi ew_i nd g ve_r at e_qt y i s ubst ance _r fus al_r eas on_cd e s uppl er s_s peci al_ disp ensi ng_i nst r cti on_c d n eeds_ hum an_r evi ew_i nd s yst em _ent r y_dt t m i u t ot al _dai y_ dose_ qty l a dm ni st r ti on_n br i a a dm ni st er ed_pe r t i m unit _cd i _ e a dm ni st r tor s_n ot es_cd i a

46

RIM
BUMS, Abbas Shojaee, Feb. 2010

Heirarchical Message Descriptions © 1999, 2000 Health Level 7

D m S e i c ti n ) o a p c a o (# in fi

D f u U dte o e ea lt p a M d

Cn r a c F g ofomne la

HEALTH L EVEL 7 REFERENCE INF ORMATION MO DEL RIM_00 92

C nt an/ o # osr i tN te

Df u V l e ( ) ea lt au #

U dt md s t pae o e e

C r i aiy a d lt n

Mn a r a dtoy

Rw y e o Tp

January 24, 2000

16 4

`

Built directly from the Tabular R-MIM
Defines a particular PATH through the model

`

Specify the type of object
Composite, primitive, etc. Previously defined MET (CMET)

` `

Which type (MET) the element is IN Which type (MET or datatype) the element is OF

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

16 5

Information Model Mapping

Message Elements

Row Number

Former Row

Row Type

b

Class or Property of Class (Attribute or Association) Rim Source Class Patient id status_cd Patient Patient Patient Patient ambulatory_status_cd newborn_baby_ind multiple_birth_ind organ_donor_ind is_a_role_of birth_dttm birthplace_addr deceased_dttm education_level_cd gender_cd marital_status_cd race_cd religious_affiliation_cd phon Patient Patient Patient Patient Patient Person Person Person Person Person Person Person Person Stakeholder Patient id status_cd

Message Element Name

Message in Element Short Message Name Element Type Pt id status _CV ambltryStatus nwbrnInd multbrthInd orgnDonrInd PtPrsn brthDttm brthplcAddr decesdDttm educnLevl gendr maritlStatus race relgsAfiltn phon Pt Pt Pt Pt Pt Pt Pt Pt PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn

of Message Element Type Pt II Set <CV> CV CV BL BL BL PtPrsn TS ST TS CV CV CV CV CV Set <TIL>

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

3 cla 4 att 5 att 6 itm 7 att 8 9 10 11 12 13 14 15 16 17 18 19 20 att att att aso att att att att att att att att att

_item_CV ambulatory_status_cd newborn_baby_ind multiple_birth_ind organ_donor_ind is_a_role_of_Person_as_patient birth_dttm birthplace_addr deceased_dttm education_level_cd gender_cd marital_status_cd race_cd religious_affiliation_cd phon

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

16 6

`

Specify the constraints on each element
Cardinality for this message Domain from which the data field will be drawn
x Vocabulary reference, constraint predicate, etc. x Coding strength

Mandatory Requirement Default Values Update parameters Conformance Flag Notes and comments

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

16 7

Encounter_manager : AR_ Encounter_manager
Trigger Event: Schedule Encounter

Encounter_tracker : AR_ Encounter_tracker

Encounter_archivist : AR_ Encounter_archivist

interaction #1, message structure A

Trigger Event: Delete Scheduled Encounter

interaction #2, message structure B

interaction #3, message structure C interaction #4, Message Structure C interaction #5, message structure D

Trigger Event: Admit Patient

Hierarchichal Message Description for Trigger Event "Admit Patient", Sending Application Role "Encounter Manager" Information Model Mapping
1 ro t o P tie t_ n o n r a n e c u te s tu _ d ta s c e c u te c s ific tio _ d n o n r_ la s a n c id ed d n _ ttm e p c d in u n e p n q x e te _ s ra c _ la _ ty firs s ila illn s _ t t_ im r_ e s d p tie t_ la s a n c a n c s ific tio _ d s rt_ ttm ta d 1 1 C E 1 C E 1 S T 1 VS T 1 N M 1 VS T 1 C E 1 VS T 1

Message Elements
EC N EC N s tu_ d ta s c e c u te_las a n c no n r c s ific tio _d id edd n _ ttm ep c d inua c _ la _ t x e te _ s r n e p n q y fir t_im r illn s _ t s s ila_ es d p tie t_ la s a n c a n c s ific tio _d srd tat_ ttm 1 1 2 3 4 5 6 7 8 1 3 3 2 6 1 2

Message Structures

C
M M M M R R R R 1 1 1 1 1 1 1 1 1 3

D
M M M M R R R R M 1 1 1 1 1 1 1 1 1

4

M

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

16 8

BUMS, Abbas Shojaee, Feb. 2010
© 1999, 2000 Health Level 7 January 24, 2000 16 9

0..1 0..1 0..1 1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..* <martlStatus> <race> <relgsAfltn> R <edctnLevl>
2 14

0..1

Ca rdinality

1 M No

1 M No

1 1 M No V

<@state, EXT:CNE> <@state, EXT:CNE> <ambltr Status> <clasfcn>

Common Constraints

Domain Specification (#)

Mandatory Constraint/Note # De fault Value (#) De fault Update Mode Update mode set Conformance Flag

R R R R R R R R R R

R R R

R

R R

R R

R

Domain Specification (#)

Mandatory Constraint/Note # De fault Value (#)

C00XMM011

Update Mode

Union: C00XXMM

Conformance Flag Ca rdinality

Domain Specification (#)

Mandatory Constraint/Note # De fault Value (#)

C00XMM013

Update Mode Conformance Flag Ca rdinality

`

Implementation technology is
A method of encoding and sending HL7 messages. Version 3 implementation technologies will initially be XML, and will eventually include ER7, other object-interfaces, and, perhaps, EDIFACT

`

Implementation Technology Specification
Describes how HL7 messages are sent using a specific implementation technology. It includes specifications of the method of encoding the messages, rules for the establishment of connections and transmission timing, procedures for dealing with errors, and it may include a specified application programming interface
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BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

The HMD definition of a message/method is technology neutral: it doesn¶t specify the form (encoding) of the message, nor the technology used to transport the message A V3 goal is to support at least 3 different ITS layers
x Character based interfaces
x XML Will be the initial technology for v3.0 x ER7, ASN.1

x Object Broker Technology
x CORBA x Active-X/DCOM

x Others
x EDIFACT is a possibility

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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Implementation Technology Specification

"Send as ASCII string in XML format"

Hierarchical Message Definition

"Discontinue pharmacy order"

ITS for XML

Data

HL7 Message Creation HL7-Conformant Application

Message Instance

HL7 Message Parsing HL7-Conformant Application

Data

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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MSH|^~###BOT_TEXT###amp;|LABGL1||DMCRES||199812300100||ORU^R01|LABGL1199 510221838581|P|2.3 |||NE|NE PID|||6910828^Y^C8||Newman^Alfred^E||19720812|M||W|25 Centscheap Ave^^ Whatmeworry^UT^85201^^P||(555)777-6666|(444)6777777||M||773789090 OBR||110801^LABGL|387209373^DMCRES|18768-2^CELL COUNTS+DIFFERENTIAL TESTS (COMPOSITE)^LN|||199812292128||35^ML|||||||IN2973^Sch adow^Gunther^^^^MD^UPIN ||||||||||^Once||||||CA20837^Spinosa^John^^^^MD^UPIN OBX||NM|4544-3^HEMATOCRIT (AUTOMATED)^LN||45||39-49 ||||F|||199812292128||CA20837 © 1999, BUMS, Abbas Shojaee, Feb. 2010 OBX||NM|789-8^ERYTHROCYTES COUNT 2000 Health Level 7 January 24, 2000 (AUTOMATED)^LN||4.94|10*12/mm3

A sample results message

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<Labrs3P00 T="Labrs3P00"> <Labrs3P00.PTP T="PTP"> <PTP.primrPrsnm T="PN"> <fmn T="ST">Sample</fmn> <gvn T="ST">George</gvn> <mdn T="ST">H</mdn> </PTP.primrPrsnm> </Labrs3P00.PTP> <Labrs3P00.SIOO_L T="SIOO_L"> <SIOO_L.item T="SIOO"> <SIOO.filrOrdId T="IID">LABGL110801</SIOO.filrOrdId> <SIOO.placrOrdId T="IID">DMCRES387209373</SIOO.placrOrdId> <SIOO.InsncOf T="MSRV"> <MSRV.unvSvcId T="CE">18768-2</MSRV.unvSvcId> <MSRV.svcDesc T="TX">CELL COUNTS+DIFFERENTIAL TESTS (COMPOSITE)</MSRV.svcDesc> </SIOO.InsncOf> <SIOO.SRVE_L T="SRVE_L"> <SRVE_L.item T="SRVE"> <SRVE.name T="CE">4544-3</SRVE.name> <SRVE.svcEvntDesc T="ST">HEMATOCRIT (AUTOMATED)</SRVE.svcEvntDesc> <SRVE.CLOB T="CLOB"> <CLOB.obsvnValu T="NM">45</CLOB.obsvnValu> <CLOB.refsRng T="ST">39-49</CLOB.refsRng> <CLOB.clnRlvnBgnDtm T="DTM">199812292128</CLOB.clnRlvnBgnDtm> </SRVE.CLOB> <SRVE.spcmRcvdDtm T="DTM">199812292315</SRVE.spcmRcvdDtm> </SRVE_L.item> </SIOO_L.item> </Labrs3P00.SIOO_L> </Labrs3P00> BUMS, Abbas Shojaee, Feb. 2010
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UML and the Rational Rose toolset is used to capture many models HL7 has developed a number of our own tools and templates to assist in the process - ROSETREE Detailed tools training tutorials are held during WG meetings and harmonization meetings MnM is the overseer of the tools and the process

URL to download Tooling: http://www.hl7.org/library/data-model/Rose_tooling/rose_index.htm (this includes a text file to describe what each downloadable file is) Or directly: http://www.hl7.org/library/data-model/Rose_tooling/RoseTree_II.zip

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

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Rational Rose98 (commercial product)
Version 4.5 or later

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RoseTree_II*
Current Version 20215

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HL7Tools.mdb*
not versioned useful for working with the repositories

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Microsoft Access and Excel (commercial product)
Office µ97 Versions
* have help files

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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Internal consistency - enforced in models Sound definitions - captured in a repository Enables variety of implementation technologies
ranging from ASCII to ORBs and EDIFACT to XML

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Eliminates rampant optionality in the messages
reduces implementation effort

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Application roles are a basis for component functional specifications Provides verifiable conformance claims

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Jacobson, I. Et Al, Object-Oriented Software Engineering: A Use Case Driven Approach, Addison-Wesley, Reading, MA, 1994. Rumbaugh, J. Et Al, Object-Oriented Modeling and Design, Prentice Hall International, Englewood Cliffs, NJ, 1991. Booch, G., Object-Oriented Analysis and Design with Applications, 2nd ed., The Benjamin/Cummings Publishing Company, Inc., Redwood City, CA, 1994.

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White, I., Using the Booch Method. A Rational Approach, The Benjamin/Cummings Publishing Company, Inc. Redwood City, CA, 1994. M. Fowler, UML Distilled. Applying the Standard Object Modeling Language, Addison-Wesley, Reading, MA, 1997. Vaskevitch, D., Client/Server Strategies, IDG Books, San Mateo, CA, 1993. Taylor, D.A., Object-Oriented Technology: A Manager¶s Guide, Addison-Wesley, Reading, MA, 1990. Taylor, D.A., Business Engineering with Object Technology, John Wiley & Sons, Inc.. New York, NY, 1995.

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© 1999, 2000 Health Level 7

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Object Magazine, SIGS Publication Distributed Object Computing (DOC) Journal of Object-Oriented Programming (JOOP)

BUMS, Abbas Shojaee, Feb. 2010

© 1999, 2000 Health Level 7

January 24, 2000

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BUMS, Abbas Shojaee, Feb. 2010