V3 Modeling Methodology

HL7 Introduction to HL7 Version 3 W. Ted Klein Chief Scientist, cMore Medical Solutions, Inc. HL7 Modeling and Methodology Committee Co-Chair January 24, 2000 © 1999, 2000 Health Level 7 1 Goals of this Tutorial • Overview of Version 3 – What is it? How are the work products built? • Motivation for this new methodology – Why HL7 needs a new standard and approach • To prepare you for Version 3 activities – Describe the models in Version 3 – Show how they are used to develop the HL7 message specifications that make up the standard? • Introductory information to prepare you for the more detailed tutorials to follow January 24, 2000 © 1999, 2000 Health Level 7 2 Topics Outside of this Tutorial Scope • Does not go into the details of each step (Intermediate and Advanced Tutorials) • Does not teach how to design models • Does not review current models (e.g., RIM) • Does not cover details of project issues (e.g., tools, coordination, balloting, etc.) • Does not explain how to design a software architecture January 24, 2000 © 1999, 2000 Health Level 7 3 Tutorial Outline • 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 January 24, 2000 © 1999, 2000 Health Level 7 4 Part I Introduction  What is HL7?  Business problem  Motivation for a new methodology January 24, 2000 © 1999, 2000 Health Level 7 5 What Is HL7? • The HL7 organization was founded in 1987 • In June 1994 HL7 was designated as an ANSI accredited standards development organization (SDO) January 24, 2000 © 1999, 2000 Health Level 7 6 HL7 Mission Statement • 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 ‘life cycle’ of a standards specification -- development, adoption, market recognition, utilization and adherence. January 24, 2000 © 1999, 2000 Health Level 7 7 Standard Development Participants M&M Executive Committee Business Strategy & Motivation Methodology, Measurement, Coordination V3.0 Technical Steering Committee Planning & Enforcement January 24, 2000 © 1999, 2000 Health Level 7 Technical Committees Modeling & Voting 8 HL7 Standard Versions • • • • • • • 2.0 (1988) 2.1 (1990) 2.2 (1994) 2.3 (1997) 2.3.1 (1999) 2.4 (2000) 3.0 January 24, 2000 Prototype First standard Widely Adopted In operation Current ANSI standard In ballot Balloting of Prototype in 2000, balloting of formal specifications in 2001 © 1999, 2000 Health Level 7 9 What does “HL7” stand for? 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 ISO-OSI Communication Architecture Model January 24, 2000 © 1999, 2000 Health Level 7 10 Increasing Pace of Business Change Migration Towards a Wellness Model Managing Visit Managing Care Managing Health Clinton’s Reform Initial Transitional Anticipated Fee-for-service, on-demand Capitated, case-based Preventive, episodal Present time January 24, 2000 © 1999, 2000 Health Level 7 11 Increased IS Complexity Client/Server, Internet, Multimedia Centralized Computing (Batch) Network Computing (RPC, ORBs, etc) Digital Dell Micron HP Enterprise Computing (Client/Server) January 24, 2000 © 1999, 2000 Health Level 7 12 Motivation for a New Methodology  Limitations of Version 2.3  Benefits of Version 3  Version 3 Statement of Principles  Goals  Mission January 24, 2000 © 1999, 2000 Health Level 7 13 Current Implementation Problems with Version 2.x Complex integration: at least 2-4 months to install HL7 interfaces Problem • Honest misunderstanding of specifications Cause • Different implicit information models • Misleading conformance claims • No vocabulary to describe conformance concepts January 24, 2000 © 1999, 2000 Health Level 7 14 Lack of a rigorous documented Methodology leads to: • Unmeasurable progress Outcome... • Unpredictable results • Metastasizing optionality Past V2 Process Patient Care ADT/ Finance MnM Orders January 24, 2000 Control/ Query Home Health © 1999, 2000 Health Level 7 15 Limitations of Version 2.x • • • • • • • 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 January 24, 2000 © 1999, 2000 Health Level 7 16 Benefits of V3 to HL7 • Reduces optionality: results in more specific messages • Uncovers hidden assumptions about application boundaries • Facilitates defining clear, fine-grained, conformance claims HL7 V3.0 Certified January 24, 2000 © 1999, 2000 Health Level 7 17 Benefits of V3 to Providers Deals with complexity of the HC environment:  Facilitates integration of heterogeneous systems  Increases choices of innovative best-of-breed solutions  Provides support for legacy systems  Allows reliable verification of vendors’ conformance claims January 24, 2000 © 1999, 2000 Health Level 7 18 Benefits of V3 to Vendors  Provides improved protocol for interconnecting heterogeneous systems  Reduces installation effort – reduces site-specific negotiations – simplifies interface programming  Promotes vendor specialization by allowing segmentation of product lines into niche market spaces January 24, 2000 © 1999, 2000 Health Level 7 19 Version 3 Goals • 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 “plug and play” January 24, 2000 © 1999, 2000 Health Level 7 20 Approved Statement of Principles • • • • • • • • 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 January 24, 2000 © 1999, 2000 Health Level 7 21 Version 3 Principles (continued) • • • • • • • • • 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 January 24, 2000 © 1999, 2000 Health Level 7 22 Methodology Mission • 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 January 24, 2000 © 1999, 2000 Health Level 7 23 An HL7 Version 2.X Spec Chapters 2 and 8 Common Specs ChapterChapterChapterSpecific Specific Specific Specs Specs Specs Segments and Fields January 24, 2000 © 1999, 2000 Health Level 7 Chapters 3, 4, 6, ... Trigger Event and Messages 24 Contents of Existing HL7 V2.3 • Trigger events – Actions or occurrences • Messages – Information content • Segments – Repeating structures • Data elements – Data representation January 24, 2000 © 1999, 2000 Health Level 7 25 An HL7 Version 3.X Spec HL7 Reference Model Common Specs ChapterSpecific Specs *Future Consideration Use Case Model Information Model January 24, 2000 Interaction Model Message Model 2-nd Order 1 choice of 0-n Drug 0-1 Nursing © 1999, 2000 Health Level 7 Implementable Message Implementable Specification Implementable Message Message Specification XML/ER7/… Specification OLE/CORBA EDIFACT* 26 Version 3 is a change to the HL7 Architecture • 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 to to to improve the internal consistency of HL7 provide sound semantic definitions enable future architectures produce an evolution not a revolution Done by applying MODELING to the HL7 process January 24, 2000 © 1999, 2000 Health Level 7 27 HL7 Modeling Abstractions: Activities (Use Case Model) Objects (Information Model) By demanding Perform Lab Review Tests Utilization analysis of the Version 2.x focused its requirements and energies at the communication information level and covered the other content, Version 3inassures abstractions only loosely the Account Encounter Order Patient Provider consistency in and specifications. enhances the value of the resulting messages. Dispense Medications Communication (Interaction and Message Models) January 24, 2000 Manage Care HL7 message Finance © 1999, 2000 Health Level 7 HL7 message ADT Pharmacy 28 HL7 V3 Deliverables • Message design model • Use case model – Hierarchy of tasks and actors • Interaction model – Trigger events, abstract messages & application profiles • Information model – Classes, relationships, states, and lifecycles January 24, 2000 – Refined Message Information Model (R-MIM) – Abstract message definitions (HMDs) • Vocabulary – Domain definitions – Representations and mappings • Implementation – Implementation Technology Specification (ITS) © 1999, 2000 Health Level 7 29 Part II - Technical Background  Concepts  Modeling January 24, 2000 © 1999, 2000 Health Level 7 30 Software Engineering Concepts Process: Activities leading to the orderly construction of the models Operation Attributes (Data) Method: An approach to problem solving Model: Abstract representation of a subject Object: Domain specific concept Operation January 24, 2000 © 1999, 2000 Health Level 7 31 Iterative Lifecycle Domain Analysis Requirements Analysis Release 3.0 Message Design January 24, 2000 Message Specification © 1999, 2000 Health Level 7 32 Modeling is a Technique for Managing Complexity • Decomposition – Divide-and-conquer • Abstraction – Chunking the information • Hierarchy – Increasing semantic content of individual chunks of information through reuse January 24, 2000 © 1999, 2000 Health Level 7 33 Modeling leads to solutions • 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 January 24, 2000 © 1999, 2000 Health Level 7 34 Version 3 Is Mostly Modeling • 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 January 24, 2000 © 1999, 2000 Health Level 7 35 Part III Methodology  Process Overview Model Deliverables and Phases Generation of Messages  Process in Detail Methodology Activities Coordination of Parallel Committee Projects (Harmonization) January 24, 2000 © 1999, 2000 Health Level 7 36 Process Overview  Tasks  Deliverables  Phases January 24, 2000 © 1999, 2000 Health Level 7 37 HL7 and engineering tasks • Analysis – Requirements Analysis – Domain Analysis Use Case Model (UCM) Information Model (RIM & DIM) Vocabulary Domain Specification • Design Interaction Model (IM) – Component and Object Message Information Model (MIM) Interaction Design Hierarchical Message Description – Message Design (HMD) • Voting and Publishing • Implementation Guide – Technology January 24, 2000 Implementation Technology Specification (ITS) © 1999, 2000 Health Level 7 38 V3 process is documented in the Message Development Framework (MDF) Use Case Model • Captures healthcare requirements • Defines scope for TSC approval • Specifies data and its semantics Information Model • Specifies major state transitions • Specifies vocabulary for domains Interaction Model • Defines information flows • 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 January 24, 2000 © 1999, 2000 Health Level 7 39 Message Development Framework (MDF) • 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 January 24, 2000 © 1999, 2000 Health Level 7 40 MDF Model Relationships Analysis Requirements Analysis Domain Analysis Voting Design Interaction Design Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing Use Case Model (UCM) RIM January 24, 2000 Domain Information Model (DIM) Interaction Model (IM) Hierarchical Message Descriptions (HMD) Reference Model Repository © 1999, 2000 Health Level 7 Approval    Ballots 41 Models developed in Phases Develop Scope Create Use Cases Identify Actors & Events Information Model Use Case Model Spec Spec DIM Spec Class Diagram State Diagram Define Interactions Create Conformance Claims January 24, 2000 Model new concepts UCM Spec Use Case Diagram Harmonize with RIM Define Trigger Events Define Application Roles Draw initial contents from RIM Interaction Model Spec Inter Spec Interaction Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … … … Develop Message Information Model Develop Message Object Diagram Specify HMD © 1999, 2000 Health Level 7 42 Models are used to build the HMD Reference Information Model Domain Information Model Use Case Model Interaction Model 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..* Message Information Model Encounter_practitioner is_associated_with participation_type_cd 1..* Exactly one occurrence 1 participates_as has_as_participant 1 1 Individual_healthcare_practitioner is_a_role_of id : TII Patient_encounter id : TII s tatus_cd : CV encounter_classification_cd : CV Person_as_Patient 0..1 is_the_primary_provider_for start_dttm birth_dttm : TS involves end_dttm birthplace_addr : ST 0..* has_a_primary_provider expected_insurance_plan_qty : NM 1 deceased_dttm : TS 1 first_similar_illness_dttm 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 Patient_billing_account admission_reason_cd 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 Domain Specification Database Common Message Element Types Hierarchical Message Description January 24, 2000 © 1999, 2000 Health Level 7 43 The HMD & ITS then give messages Implementation Technology Specifications "Send as ASCII string in XML format" Hierarchical Message Definition "Discontinue pharmacy order" ITS Data HL7 Message Creation Message Instance HL7-Conformant Application January 24, 2000 © 1999, 2000 Health Level 7 HL7 Message Parsing Data HL7-Conformant Application 44 Process In Detail  Methodology Activities  Coordination of Parallel Committee Projects (Harmonization) January 24, 2000 © 1999, 2000 Health Level 7 45 Requirements Analysis Activities by Phase Define Scope Define Scope Create Create Use Cases Use Cases Identify Identify Actors && Actors Events Events Information Model Use Case Model Spec Spec DIM Spec Class Diagram State Diagram Define Interactions Create Conformance Claims January 24, 2000 Model new concepts UCM Spec Use Case Diagram Harmonize with RIM Define Trigger Events Define Application Roles Draw initial contents from RIM Interaction Model Spec Inter Spec Interaction Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … … … Develop Message Information Model Develop Refined MIM Specify HMD © 1999, 2000 Health Level 7 46 Use Case Model: Definitions • 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 • Use cases can be decomposed • Use cases can be shared January 24, 2000 © 1999, 2000 Health Level 7 47 Use Case Definitions (cont’d) • Use Case Path – Single ‘thread’ or ‘storyboard’ or ‘scenario’ – Longitudinal temporal description of a Use Case instance • Support for OO Concepts – Generalizes • adds additional behavior – Includes • uses another use case – Extends • allows branch flow logic in use case execution January 24, 2000 © 1999, 2000 Health Level 7 48 Sample Use Case Model Health Care Enterprise Manage Health Plans Provide Services Provide Services Manage Health Plans Perform Triage Manage Network Manage Membership Order Service Treat Patient Schedule Service Treat Patient Order Service Administer Procedure Manage Membership Enroll Member Create Order Evaluate Outcomes Discharge Member Sign Order Status Order Record Results Approve Services Manage Network Evaluate Provider Create Appointment Market Services January 24, 2000 Schedule Service Monitor Appointment © 1999, 2000 Health Level 7 49 Use Case Diagram Fragment Delete_patient_record Authorized_user The individual Manage_patient_encounter responsible for managing The inpatient encounter becomes encounter information. active when a patient is admitted. If Schedule_encounter the encounter has not been Start_encounter previously scheduled, it can be created at the time of admission. Bil Various_support_ staff Start_scheduled_encounter Admit_patient Start_outpatient_encounter Start_unscheduled_encounter Discharge_patient January 24, 2000 © 1999, 2000 Health Level 7 50 Domain Analysis Develop Scope Create Use Cases Identify Actors & Events Information Model Use Case Model Spec Spec DIM Spec Class Diagram State Diagram Define Interactions Create Conformance Claims January 24, 2000 Model new concepts UCM Spec Use Case Diagram Harmonize with RIM Define Trigger Events Define Application Roles Draw initial contents from RIM Interaction Model Spec Inter Spec Interaction Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … … … Develop Message Information Model Develop Refined MIM Specify HMD © 1999, 2000 Health Level 7 51 The Information Model • 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. January 24, 2000 © 1999, 2000 Health Level 7 52 Parts of the Information Model • 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 • State Transition Models – For certain selected classes (Subject Classes) • Data Types and Constraints – Vocabulary definitions, Domains January 24, 2000 © 1999, 2000 Health Level 7 53 The Reference Information Model (RIM) • 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 January 24, 2000 © 1999, 2000 Health Level 7 54 RIM Content • Classes – Have Committees as Stewards – Some identified as Subject Classes • Attributes – Have types constraining their domains • Relationships – Express cardinality for their use in messages • Subject Areas – Define broad areas of interest (eg Stakeholders, Patient_encounters, Master_tables) January 24, 2000 © 1999, 2000 Health Level 7 55 Domain Information Models • 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 January 24, 2000 © 1999, 2000 Health Level 7 56 Committee Vs. HL7 RIM • What is the RIM? – A HL7-wide common reference model that integrates all Technical Committees’ domain views • Why do we need a common model? – To ensure consistency of concepts – To ensure consistent vocabulary January 24, 2000 • How will we coordinate these efforts? – Iterative reviews – Harmonization meetings • Who controls the RIM? – The M&M committee • Format, syntax, style • Revision histories – The Technical Steering Committee © 1999, 2000 Health Level 7 • Dispute resolution • Overseer 57 RIM Class Diagram - v094 DA TA TY P ES << D at a_t ype >> An y_d ata_ type : A NY << D at a_t ype >> Qua nti ty : QTY << D at a_t ype >> Di scre te : D SC R T ex t << D at a_t ype >> Ordere d : OR D Th i ng HEALTH LEVEL 7 REFERENC E INFORMATION MODEL RIM_00 94 Au t he ntic ati on released January, 2000 r eflect s agreeme nt s made thro ughhar monization in November, 1999 is _ part _of aut he nt ica ti on_ dt tm : TS ty pe_ cd : C V 0.. * is _sour ce_of 0.. * i s_authe nti cated _by 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ype >> Orga ni za ti o n_n ame : ON << D at a_t ype >> A ddre ss_p art : A DX P << D at a_t ype >> Un certa in _va lu e-n arrati ve : UV N T T ,R t ype _cd re ques te d_q ty t ype _cd 0.. * << D at a_t ype >> Po stal _a nd_ resi de nt i al _a dd re ss : A D T << D at a_t ype >> I nterva l : I VL o wns 1 is _f or f ami ly_ re la ti ons hi p_cd Ge ne ra l iz ati ons << D at a_t ype >> Gen eral _ti mi ng _spe ci fic ati on : GTS << D at a_t ype >> I n te ge r : I NT << D at a_t ype >> Ba g : BA G I nd iv id ua l _he al t hca re_p rac ti tio ne r_req ue st e nter s 0. . 1 0.. * r epresent s t akes _ rol e_of Qu an tit y/ Ti me << D at a_t ype >> No _i nf orma tio n : N U LL T, S , R << D at a_t ype >> C ol l ec ti o n : C OLL T ,R is _a_ rol e_of 0. . 1 t ak es_on_ rol e_of 1 0.. * p art ic i pat es _as_secondar y_i n << D at a_t ype >> Mon etary _am oun t : MO << D at a_t ype >> Te l eco mmu ni cati on _a dd re ss : T EL 0.. * is _r equested_ by is _ent ered _by 0.. * 1 1 1 R eso urce _req ue st a l ow abl e_s ubst i tu ti on s_cd durat io n_q ty st ar t _dt t m s ta rt _o f set _q ty st at u s_cd t ak es_on_ rol e_of a c t s_as 1 1 1 << D at a_t ype >> R eal : R E AL << D at a_t ype >> In stan ce_ id en ti f i er : I I << D at a_t ype >> I SO_o bj e ct_i den tif i er : OI D S ervi ce _sc he dul i ng _req ue st a l ow abl e_s ubst i tu ti on s_cd durat io n_q ty st ar t _dt t m s ta rt _o f set _q ty st at u s_cd requ es ts 0.. * << D at a_t ype >> C onc ep t_ de scri ptor : C D << D at a_t ype >> Un i versa l_ reso urce _i de nti fi e r : UR I P at i en t_i nforma ti o n_re ci pi en t S take ho l der_ affil i ati on af fi li at io n_t ype _cd d esc ef fe ct ive_ dt te rmi nat i on_ dt << D at a_t ype >> Co de _ph rase : C DP H << D at a_t ype >> Bi na ry_d ata : BI N h as _a s _ con tact A pp oi ntme nt_req ue st di scl osu re _dt t m i nf o_di sc los ed_d esc in fo _reque st ed_d esc re ason _cd requ est ed _dt t m is _par ent _docum ent_f or u rg enc y_cd D emo gra ph ic << D at a_t ype >> Ph ysi ca l_ qu anti t y : P Q << D at a_t ype >> C o de_ val u e : C V << D at a_t ype >> Nu mbe r : N Ge ne ric << D at a_t ype >> P o in t_ in _ti me : T S << D at a_t ype >> Co de _tra nsl a ti o n : C D XL << D at a_t ype >> S et_C RR : S ET <C R R> do c u ment s 0.. * << D at a_t ype >> R a ti o : RT O << D at a_t ype >> Bo ol ea n : BL 1 1 tr anscri bes 0. . 1 << D at a_t ype >> C ha rac te r_strin g : ST << D at a_t ype >> E nc ap sul ated _d at a : ED << D at a_t ype >> C on ce pt_rol e _rel ati on shi p : CR R 0. . 1 has_as_a_subdi vis ion 0.. * is _cont act_f or 0.. * is _cont act_f or 0.. * Co nt a ct_ pe rson cont ac t_ re ason _cd is _cont act_f or is _a_cont act_f or is _cont act_f or is _a_cont act_f or 0. . 1 0. . 1 0. . 1 0.. * R es pon se_ con rol _sp ec is _a_ rol e_of has 0.. * is _cont act_f or has_as _ empl oyer Gua ran to r 0. . 1 pr ovide s _ con tact 0.. * 0. . 1 i s _ rol e_of f in anci al _cl as s_cd guaran h ous ehol d_a nnu al_ inc ome_ amt hou seho ld_ si ze_n br tees_paym ent _under 1 pr ovide s _ con tact 0. . 1 i s _ rol e_of In sure r e f ect i ve_t mr 1 1 is sues 1 is sues of fer s I sura nc e_c ert if i ca ti on _co nta ct n pa rt i ci pat io n_t yp e_cd ad dr ef fe ct ive_ dt haza rd _ex posu re _t xt jo b_cl ass _cd jo b_t it l e_n m p hon p ro te ct ive_ equi pme nt _t xt sal ary_q ty sal ary_t yp e_cd st at u s_cd te rmi nat i on_ dt o ccup at ion _cd jo b_st at u s_cd 0. . 1 0.. * 0.. * is _cont act_f or has_as_em plo y ee 0. . 1 i ncl udes 0.. * 1 t ak es_on_ rol e_of 1 t ak es_on_ rol e_of 1 i s_sourc e_f or 1 1 e nter s is _ rol e_of 1 E mpl oy ee 1.. * I n suran ce _ce rti fic ati on a ppe al_ re aso n_cd c erti fi ca ti on_ durat io n_q ty e f ect i ve_t mr d i i nsu ra nce_ verif ica ti on _dt t m mod if ica ti on _dt t m non_ conc ur_cd non _con cur_ef f ect ive _dt t m pena lt y_ amt r epo rt _o f_e li gi bil i ty _dt t m repor t _of _el i gib il it y_ ind a c t s_in_ rol e_of t ak es_on_ rol e_of is _ rol e_of is _i ss ued _by 1 t ak es_on_ rol e_of 0. . 1 i s_subject _of 1 Pe rson bi rt h_ dt tm : TS bir t hpl ace _ad dr c it iz ens hip _cou nt ry _cd con fi dent i al it y_c onst rai nt _cd d ece ased _dt t m de ceas ed_ ind d is abi li t y_cd edu cat io n_l evel _cd e th nic _group _cd ad mini st rat ive_ gend er_cd marit al _st at us _cd mi li ta ry _bran ch_o f_s ervice _cd mil it ary_ra nk_n m mi li t ar y_st at u s_cd na ti ona li t y_cd race _cd re li gi ous_ aff i li at ion _cd st ude nt _cd ver y_ impo rt an t_ person _cd st at u s_cd a mbul at or y_st at u s_cd bi rt h_ order_n br l ivi ng_ arra ngeme nt _cd li ving _de pend ency _cd mul t ip le_ bir t h_ ind o rg an_d onor_ ind pref erre d_ph armacy _id P erso n_e mpl oy men t 0. . 1 is _em pl oyee_i n 1 1 ha s _ con tact 1.. * has_paym ent _guara nteed_ by 0.. * 0.. * a f ir ms_i nsurance_cover age_f or h as _cover age_af f ir med _by provi des_vali dat ion_f or 1 1 Gu aran t or_c on tr a ct bil li ng _hol d_ ind bi l i ng_me di a_cd cha rg e_ad ju stm ent _cd cont ract _d urat io n_cd c ont r act _t ype _cd e f ect i ve_t mr in te re st _rat e_n br peri odi c_pa ymen t_ amt prio ri t y_rank ing _cd Fi na nc ia l _tra nsa cti on al t ernat e_d esc d esc ext end ed_ amt fe e_s ched ul e_cd i nsuran ce_ amt post i ng_ dt q ty tr an sac ti on_ bat ch _id t ransa ct ion _cd t ra nsa cti on _dt t m t ra nsac ti on _id t rans act io n_t ype _cd u ni t_ amt uni t _cos t_ amt pro v i des_paym ent_ guaran tee_f or 0.. * is _ent ered _by 0.. * is _cat egor iz ed _by provi des_opi nion_o n 0.. * Ce rti f i cati on _ad di tio na l _op i ni on 0.. * ef f ect ive _dt t m st at u s_cd is _pr ovided _by cover s 0.. * P rea utho riz ati on 1 has com m uni c a tes_i n 1 0.. * La ng ua ge 1 i s_specif ied _by No tary_p ub l ic is _a_ rol e_of de at h_c erti fi ca te _id dea th _ce rt i fi cat e_rec orded _dt t m de at h_cl ass if ic at ion _cd dea th _dt t m d eat h_l oca ti on _t xt d eat h_n ot if ic at ion _sou rc e_n m dea th _verif ic at io n_cd deat h_ verif ica ti on _dt t m de at h_ver i fi cat io n_n m speci fi es _ abil it y_i n 0.. * ef fe ct ive_ int erval _t mr not ary_ coun ty _cd not ary_s ta te _cd Lan gu ag e_a bi l i ty mode _cd pr of ici enc y_l evel _cd 0. . 1 i_ s rol e_of 0. . 1 H ea lt hc are _be ne fi t_p ro du ct _p urch ase r 1 is _a_ rol e_of is _ v al i dated _by t ak es_on_ rol e_of 1 t ak es_on_ rol e_of 1. . 1 se rvi ce_ cat ego ry _cd s ervice _cd se rvi ce_ modi fi er_cd aut ho ri zat i on_ ind ne tw ork_ ind as sert io n_cd c overed_ part ies _cd q ty qu ant it y_ qua li fi er_cd t i me_pe ri od_ qua li fi er_cd ran ge_ low _q ty ra nge_ hig h_q ty ra nge_ uni t s_cd asse rt i on_e f ect i ve_t mr eli gi bi li ty _cd po li cy_ sour ce _cd e li gib il it y_ sour ce _cd co pay _li mi t_ ind i s_the _purc haser _of i s_covered _by 0. . 1 Mas te r_he al thca re_ ben efi t_pro du ct 0.. * h as _ as _p urc haser is _o f ered _by 0.. * a ssi gnme nt _of _be nef it s_ ind be nef it _p ro duc t_ desc d i be nef it _p rod uct _n m ben ef it _prod uct _t ype _cd be nef it s_ coor di nat i on_ ind cob _prio ri t y_n br comb ine _ba by_b il l_ ind e f ect i ve_t mr grou p_b enef it _ ind mai l_ cla im_p arty _cd rel eas e_i nf ormat ion _cd st at u s_cd coverag e_t yp e_cd agree ment _t yp e_cd po li cy_ cat ego ry_cd acc ess _pr ot oco l_ desc 0.. * insur es 1 i s_inst anti ate d_as is _ a_inst ance_of 0.. * gover ns is _ governed _by 0.. * 0.. * is _f or 0.. * pr ovid es _ c over age_f or 1 has_as_a_cont act 0. . 1 has 1 0. . 1 0.. * c ondi t io n_cd oc currence _cd occ urrence _dt t m occ urre nce_ spa n_cd occ urre nce_ span _f ro m_dt t m o ccurrenc e_sp an_ th ru _dt t m quan ti t y_n br quan ti t y_t yp e_cd val ue_ amt va lu e_cd par ti cip at es_as t ak es_on_ rol e_of has 0.. * per tai ns_to has_a_pr im ar y_provi der has 1 per tai ns_to 1 P re ferred _p ro vi de r_pa rtic ip ati on r ol e_cd ef fe ct ive_ dt te rmi nat i on_ dt 0.. * is _assigned 0.. * Ba d_ deb t _bi l l in g_a cco un t h as _a s _ car e_r ecipi ent 0.. * bad_ deb t_ re cover y_ amt bad_ debt _t rans fe r_ amt tr an sfe r_ to _bad _de bt _dt t m t rans fer_t o_ bad _deb t_ re ason _cd 0.. * bel ongs_to has_as_a_pr ior _account per tai ns_to Ad mi ni strati ve_ bi rth _e ven t bab y_d et ain ed_i nd b ir t h_c erti fi ca te _id bi rth _met ho d_cd b ir t h_rec orded_ coun ty _cd bir t h_rec orded _dt t m new bo rn _day s_n br st i l born_ ind aut hori zes 0.. * reser ves 0.. * Ap po i ntmen t 0.. * has_as_a_cont act 0.. * schedul es 0. . 1 a ppo int men t_ durat io n_q ty app oin tme nt _t imi ng_ qt even t_ re aso n_cd ex pect ed _servi ce_d esc exp ect ed _st ar t _dt t m d i st at u s_cd u rg enc y_cd is _pa rent _of 0. . 1 0.. * owned _by 1 S erv ic e_l i st i d : S ET ty pe_ cd : C V name : ST de sc : E D 0.. * i s_chil d_of 0. . 1 par ti cip at es_as i s_about i s_sourc e_f or 0.. * 1 has _ part s is _r equested_ by has _ part s 1 0.. * 1 is _ invol ved_in invol ves P a ti en t _en co unte r admi ni st ra ti ve_o ut come _t xt can cel la ti on_ re aso n_cd d esc e nco unt er _cl ass if ic at io n_cd e xpec te d_i nsu ra nce_ pla n_q ty fi rs t_ simi l ar_il ln ess _dt t m f ol low _u p_t yp e_cd i d :II cl ass if ic at io n_cd p urpos e_cd sp eci al _cou rt es ie s_cd act i ve_t mr st at u s_cd u rg enc y_cd t ri ag e_cl ass if ic at ion _cd med ica l_ servic e_cd p ubl ic it y_c onst rai nt _cd re ason _cd re fer ral _cd sour ce _cd pa ti en t_ v a lu abl es_d esc pre_ad mit _t est _ ind rea dmi ssi on_ ind val uab les _l ocat i on_d esc acui t y_l evel _cd a ct ual _di sch ar ge_d is posi t ion _cd di scha rg e_l oca ti on _id ex pect ed _di sch arge_d is p_cd bi rth _enc ount e r_ ind has per tai ns_to 0.. * D isa bi l i ty ef f ect ive _dt t m ret urn_ to _wo rk _au th _dt t m t ermin ati on _dt t m unab le_ to _w ork_ef f ect ive _dt t m 1.. * is _obt aine d_fr om 0.. * i s_ide nti fi ed by D ia gn osti c_re la ted _gro up bas e_rat e_ amt c api t al_ re imbu rs emen t_ amt cos t_ wei gh t_ amt d i majo r_ dia gno st ic_ cat ego ry_cd ope ra ti ng_ re imbu rs emen t_ amt re imbu rs emen t_ amt st and ard_da y_q ty st an dard_t ot al _ch arge_ amt t rim_ hig h_da y_q ty t rim_l ow _da y_q ty 0.. * Ad mi ni strati ve_p ati en t_ac ci den t ac ci dent _d eat h_ ind a cci dent _d esc acc ide nt _dt t m acc ide nt _l ocat i on_ desc a cci den t_s ta t e_cd ac cid ent _t ype _cd job _rela te d_a cci dent _ ind asse ssme nt _dt t m i s_pre sent _in 0.. * has 1.. * 1 is _assig ne d_as i s_s c he duled _by 0. . 1 d esc epi sod e_t yp e_cd d i li st _c los ed_ ind o ut come _t xt re curring _servi ce_ ind is _ part _of 1.. * is _ part _of 1 0.. * Ep i sod e_o f_co ndi ti on Ep iso de _of _ care 0. . 1 is _a_com ponent _of id e nti fi es 1 1 is _ k n o wn_to knows_of 0.. * 1.. * P ati en t_ pro vi der_ asso ci ati on 0.. * is _assig ned_to Ac to r 0.. * par ti cipa ti on_of 1 has per tai ns_to 0.. * Ri sk_ man ag eme nt_i nc id en t i c ide nt _cd n i nci de nt _dt t m i nci den t_ sever i ty _cd in cid ent _t yp e_cd t yp e_cd : SE T< C V> tmr : I VL <T S> not e : E D sig nat ure_ cd : C V is _char ged_t o is _associat ed_wi th or igi nat es houses 0. . 1 H ea l th care _p ro vi de r_org an iz ati on Ch am pus _co vera ge pr ovid es _ser vic es_on_be half _of hand ic appe d_prog ra m_cd n on_a vail _ce rt _o n_f il e_ ind ret ir eme nt _dt t m s ta ti on _id 0. . 1 is _ rol e_of I nd iv id ua l_ he al th ca re_p racti tio ne r i s_s c he duled _by 1 p rovi des 1 1 1.. * pr ovides_pat ie nt_ser vic es_at f el low sh ip_ fi el d_cd gradu at e_sc hoo l_n m gradua ti on _dt t m posi t io n_cd p ra ct it io ner_t ype _cd primary_ care_ ind r esi den cy_ fi el d_cd sl ot _si ze_ inc re ment _q ty d i 0.. * addr : A D ope n_t mr d esc e mail _ad dress i d :II l ic ense d_be d_n br nm p hon ser vic e_s peci al t y_cd sl ot _si ze_ inc re ment _q ty st at u s_cd t ype _cd eq uip ment _t yp e_cd is _assigned 1 is _t he_pr im ary _pr ovi der_f or par ti cip at es_as i ncl udes 1.. * 1 R efe rra l Pro ced ure Su pp ly Obse rv ati on Med ic ati on aut hori zed _visi t s_q ty d esc rea son _t xt ent ry_s it e_ cd : C D qt y : P Q val ue : AN Y deri vat ion _exp r : ST prope rt y_ cd : C V f rm_ cd : C D o 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 1.. * has Tra nsp ortati on 1 i s_uti li zed_dur ing 1 1 0. . 1 par ti cipa ti on_of is _associat ed_wi th 0.. * 0.. * 1 t yp e_cd : SE T< C V> t mr : SE T< C V> aw arene ss_ cd : C V per tai ns_to 0.. * 1.. * ac commod at io n_cd e f ect i ve_t mr l oc at ion _r ole _cd st at u s_cd tr an sfe r_ re ason _cd u sage _app ro ved_ ind 1.. * ty pe_ cd : C V i nversi on_i nd : BL tmr : I VL <T S> po sit i on_ nmb : L IS T<N > qt y : P Q E nc oun ter_p racti tio ne r 0.. * is _t ar get_f or t pe_ cd : C V y tmr : I VL <T S> ma te ri al _i d : S ET of 0.. * 1 0. . 1 par ti cip at es_as 0. . 1 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: R E AL p ri orit y_ nmb : R E AL not e_t xt : E D has_charge s _f or has_as_care _provi der is _assig ned _by par ti cip at es_in 0.. * L ist _ it em E pi so de 0.. * has 1 per tai ns_to 0. . 1 is _ au thor iz ed _by 1.. * 1 0. . 1 0. . 1 i s_booked_in is _ent ered _by 0. . 1 is _ part _of 0.. * 0.. * has _ as _p ri mar y_fa cil it y ac coun t _id ad jus tme nt _cd a ut horiz at io n_i nfo rma ti on _t xt bi l in g_st at u s_cd cert if ica ti on _requi r ed_ ind cu r en t_ unp aid _bal anc e_q ty de le te _dt t m de let ed _ac coun t_ re aso n_cd e xpec te d_i nsu ra nce_ pla n_q ty e xpec te d_p aymen t_ sour c e_cd no ti ce_ of _admi ssi on _dt t m not i ce_o f_a dmi ssi on_ ind pat i ent _f in anci al _cl as s_cd price _sc hedu le _id pu rg e_st at u s_cd purge _st at us _dt t m r epo rt _o f_e li gi bil i ty _dt t m r et ent i on_ ind si gna tu re _on_ fi le _dt t m s pec ial _prog ra m_cd st opl oss _li mi t_ ind susp end _cha rg es_ ind to ta l_a dju st ment _q ty t ot al _cha rg e_q ty t ot al _pa yment _q ty sep arat e_b il l_ ind 0. . 1 0.. * S ervi ce _rel ati on shi p 1 1 P a ti en t _bi l l in g_a cco un t has B a d_d eb t_ col l ec ti on _a ge ncy 1 1 is _i ss ued _by 1 is _known _by 0.. * is _associat ed_wi th 0.. * 1 has B i l i ng _i nforma tio n_i tem 0. . 1 1 P ati en t per tai ns_to par ti cip at es_in 0. . 1 0.. * 1 has is _a_ rol e_of is _assig ned_to 0. . 1 has is _i nsured _by H ea l th ca re _b en efit _c ove rag e_i tem 0. . 1 i s_s c he duled _by 0. . 1 1 bi rth _dt t m bir t hpl ace _ad dr ori gin _cou nt ry _cd t axon omi c_cl ass if ic at io n_cd breed _t xt st ra in _t xt eye_ col or_cd coa t_ or_f eat her_c olo r ing _t xt con fi dent i al it y_c onst rai nt _cd d ece ased _dt t m de ceas ed_ ind eut ha nasi a_ ind gend er_cd gen der_st at us _cd pri mary_na me_t ype _cd pri mary_n m i mport ance _st at us _t xt q ty produ ct io n_cl ass _cd A dmi ni strati ve_ pa ti e nt_d eath i s_comm uni cated_ by 1 au th oriz ed_e ncou nt ers_q ty aut ho ri zed _pe ri od_ begi n_ dt aut hori zed _peri od_e nd_ dt d i iss ued _dt t m requ est ed _dt t m rest rict i on_d esc st at u s_cd st at us _cha nge _dt t m Li vi n g_s ubj e ct has_paym ent _guara nteed_ by pr ovide s _ con tact Se curi ty_a utho riz ati on 0. . 1 is _a_ rol e_of 0. . 1 Fo od is _a_ rol e_of 0. . 1 is _a_ rol e_of p re feren ce_ cd : C D Th era pe utic _ag en t 0. . 1 bel ongs_to is _r equested_ by is _sour c e d_fr om 0.. * S pec i men is _sour c e d_fr om 0.. * bo dy_s it e_ cd : C D is _a_ rol e_of 0. . 1 January 24, 2000 © 1999, 2000 Health Level 7 58 Current 094 RIM Statistics • • • • • • 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 © 1999, 2000 Health Level 7 59 RIM Domain Subject Areas • Stakeholders • Patient_encounters – – – – Patient Person Stakeholder Healthcare_service_ provider – Organization • Healthcare finances – Patient_billing_account – Healthcare_benefit_plan – Guarantor_contract January 24, 2000 – – – – – – – Pharmacy_service_event Scheduling Patient_service_location Patient_service_order Patient_encounter Patient_service_event Patient_clinical_pathway • Master_tables – Clinical_pathway_master – Service_catalog_item – Observation_service_ catalog_item © 1999, 2000 Health Level 7 60 RIM Literary Expression Description of: Inpatient_encounter A patient encounter involving an admission to an inpatient facility. Class: Encounter_practitioner Associations for: Inpatient_encounter HL7 steward: Patient Administration Associated with: is_assigned (0,M) :: Encounter_drg :: is_assigned_to (1,1) Individual_healthcare_practitioner Patient_encounter is_preceded_by (1,1) :: Patient_admission :: preceded (1,1) Description of: Encounter_practitioner An association between a Healthcare practitioner and a patient encounter. is_terminated_by (0,1) :: Patient_departure :: terminates (1,1) Associations for: Encounter_practitioner Attributes of: Inpatient_encounter is_participant_for (1,1) :: Individual_healthcare_practitioner :: participates_as (0,M) 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. is_associated_with (1,1) :: Patient_encounter :: has_as_participant (1,M) |Datatype^NM | | PV2^11^00712Âctual Length of Inpatient Stay | estimated_days_qty The estimated number of days in an inpatient encounter. Attributes of: Encounter_practitioner |Datatype^NM | | PV2^10^00711Êstimated Length of Inpatient Stay | 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: Patient_encounter HL7 steward: Patient Administration Class: Inpatient_encounter Supertype of: Inpatient_encounter HL7 steward: Patient Administration Is part of: Episode Subtype of: Patient_encounter Composite of: Patient_service_event Person_birth_event Associated with: Encounter_drg Patient_admission Patient_departure Associated with: Appointment Encounter_practitioner DRAFT HL7 Reference Information Model January 24, 2000 Version: V 0-84 19980103 Copyright 1998. All rights reserved. © 1999, 2000 Health Level 7 page 1 61 Model Harmonization Reference Information Model E (1,1) G (0,M) (0,M) (0,1) B (1,1) (0,1) (0,M) (0,M) C A (0,M) (1,1) B A X (0,M) (0,M) X (0,M) (1,1) D B Domain Information Model January 24, 2000 (0,M) (0,1) B (0,M) (0,M) C A C (1,1) (0,M) D Domain Information Model Domain Information Model © 1999, 2000 Health Level 7 62 RIM Harmonization Process Change Proposal Preparation Review RIM Change Proposal w/ Stewards Prepare RIM Change Proposal Document Rationale for not supporting RIM change proposal Revise or Withdraw RIM Proposal Notify HL7 Members of RIM Change Proposal Posting Provide Comment on RIM Change Proposals Post RIM Change Proposals Submit RIM Change Proposal Post RIM Change Proposal Harmonization Meeting Discuss the RIM Change Proposal Revise, withdraw, or Table RIM Change Proposal Vote on RIM Change Proposal Apply Approved Changes to RIM Hold TSC and/or Board Appeals Finalize Revised RIM Apply Technical Coorections Post Harmonization Meeting Review Present RIM Harmonization Report to TSC January 24, 2000 © 1999, 2000 Health Level 7 63 Sources of Models for Harmonization Others Information Model Use Case Model HL7 Technical Committees 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 Organizations Other Standard Development Organizations January 24, 2000 © 1999, 2000 Health Level 7 64 Information Model Facilitators • 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. January 24, 2000 © 1999, 2000 Health Level 7 65 Domain Specialists and Data Stewards • 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. January 24, 2000 © 1999, 2000 Health Level 7 66 November ‘99 Harm. Meeting Mayo Clinic, Rochester, Minn. January 24, 2000 © 1999, 2000 Health Level 7 67 RIM Subject Classes • 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 January 24, 2000 © 1999, 2000 Health Level 7 68 State Transition Modeling • Identify States – From Use Cases • 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? • Capture State Model – UML State Transition Model January 24, 2000 © 1999, 2000 Health Level 7 69 State Transition Diagrams Figure State diagram for Patient class. S c h e d u le d d e l e te _ s c h e d u l e d _ e n c o u n te r ^C 0 0 X M T 0 0 6 D e l e te d s c h e d u l e _ e n c o u n te r ^C 0 0 X M T 0 0 3 d e l e te _ a c ti ve _ e n c o u n te r ^ C 0 0 X M T 0 0 7 n u ll s ta r t_ e n c o u n te r ^C 0 0 X M T 0 0 5 d e l e te _ d i s c h a r g e d _ e n c o u n te r s ta r t_ e n c o u n te r ^C 0 0 X M T 0 0 4 A c ti ve d i s c h a r g e _ p a ti e n t ^C 0 0 X M T 0 0 8 D is c h a rg e d c a n c e l _ d is c h a r g e ^ C 0 0 X M T 0 0 9 State diagram for Patient_encounter class Transitions include reference to the trigger event. January 24, 2000 © 1999, 2000 Health Level 7 70 Vocabulary and Domains • Attributes in the RIM must be associated with a Domain to have meaning • Domains are associated with Vocabularies – Held in the Domain Specification Database • 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 January 24, 2000 © 1999, 2000 Health Level 7 71 Interaction Design Develop Scope Create Use Cases Identify Actors & Events Information Model Use Case Model Spec Spec DIM Spec Class Diagram State Diagram Define Interactions Create Conformance Claims January 24, 2000 Model new concepts UCM Spec Use Case Diagram Harmonize with RIM Define Trigger Events Define Application Roles Draw initial contents from RIM Interaction Model Spec Inter Spec Interaction Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … … … Develop Message Information Model Develop Refined MIM Specify HMD © 1999, 2000 Health Level 7 72 Modeling Interactions • 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 © 1999, 2000 Health Level 7 73 Interaction Model Contents • Each Interaction consists of: – Trigger event • Event dependency usually expressed as the state of one or more classes – Message ID • Each interaction sends one particular message – Sender role • When trigger event detected, message is sent – Receiver role • Receiver responsibility - a specific functional responsibility for the receiver to initiate another (consequential) interaction January 24, 2000 © 1999, 2000 Health Level 7 74 Interaction Model Diagram Figure Interactions for Patient subject class.b A R _ P a ti e n t_ m a n a g e r : A R _ P a ti e n t_ tr a c ke r : A R _ P a ti e n t_ m a n a g e r A R _ P a ti e n t_ tr a c k e r 1 : a d d _ p a t i e n t( ti d ) 2 : a d d _ p a ti e n t( ti d x) 3 : d e l e te _ p a ti e n t 4 : d e l e te _ p a ti e n t (t id 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 January 24, 2000 © 1999, 2000 Health Level 7 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. 75 Application Roles • 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 January 24, 2000 © 1999, 2000 Health Level 7 76 Application Role Diagram Figure Application role diagram for example model. S C _ A p p l i c a ti o n _ r o l e _ r o o t P a ti e n t_ e n c o u n te r P a ti e n t RIM Classes S C _ P a ti e n t S C _ P a ti e n t_ e n c o u n te r A R _ E n co u n t e r _t r a ck e r s c h e d u le _ e n c o u n t e r() a d m it _ p a t ie n t () a c t iva t e _ s c h e d u le d _ e n c o u n t e r() A R _ P a ti e n t_ m a n a g e r d e le t e _ s c h e d u le d _ e n c o u n t e r() d e le t e _ a c t ive _ e n c o u n t e r() a d d _ p a t ie n t () d is c h a rg e _ p a t ie n t () d e le t e _ p a t ie n t () c a n c e l_ d is c h a rg e () A R _ E n c o u n te r _ m a n a g e r A R _ P a ti e n t_t r a ck e r A R _ E n c o u n te r _ a r c h i v i st a d m it _ p a t ie n t () a d d _ p a t ie n t () a d m it _ p a t ie n t () a c t iva t e _ s c h e d u le d _ e n c o u n t e r() d e le t e _ p a t i e nt () a c t iva t e _ s c h e d u le d _ e n c o u n t e r() d e le te _ a c tive _ e n c o u n t e r() d e le t e _ a c t ive _ e n c o u n t e r() d is c h a rg e _ p a t ie n t () d is c h a rg e _ p a t ie n t () c a n c e l_ d is c h a rg e () c a n c e l_ d is c h a rg e () Application role diagram for example model. Application Roles January 24, 2000 © 1999, 2000 Health Level 7 77 Application Roles and Conformance Claims • 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 January 24, 2000 © 1999, 2000 Health Level 7 78 Conformance Claim Structure • 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: • Can provide or accept it, requires it for full function, multimedia enabled free text level, message element interaction support, message type definition • Details still being worked out January 24, 2000 © 1999, 2000 Health Level 7 79 Message Design Develop Scope Create Use Cases Identify Actors & Events Information Model Use Case Model Spec Spec DIM Spec Class Diagram State Diagram Define Interactions Create Conformance Claims January 24, 2000 Model new concepts UCM Spec Use Case Diagram Harmonize with RIM Define Trigger Events Define Application Roles Draw initial contents from RIM Interaction Model Spec Inter Spec Interaction Diagram Message Design 2-nd Order 1 choice of 0-n Drug 0-1 Nursing h//mt:50”d” … … … Develop Message Information Model Develop Refined MIM Specify HMD © 1999, 2000 Health Level 7 80 Message Specification Domain Information Model Use Case Model Reference Information Model Hierarchical Message Description 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..* Interaction Model Encounter_practitioner is_associated_with participation_type_cd 1..* Exactly one occurrence 1 participates_as has_as_participant 1 1 Individual_healthcare_practitioner is_a_role_of id : TII Message Information Model Patient_encounter id : TII s tatus_cd : CV encounter_classification_cd : CV Person_as_Patient 0..1 is_the_primary_provider_for start_dttm birth_dttm : TS involves end_dttm birthplace_addr : ST 0..* has_a_primary_provider expected_insurance_plan_qty : NM 1 deceased_dttm : TS 1 first_similar_illness_dttm 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 Patient_billing_account admission_reason_cd 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 January 24, 2000 © 1999, 2000 Health Level 7 81 Message Specification • 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 January 24, 2000 © 1999, 2000 Health Level 7 82 Subset the RIM  MIM • 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 January 24, 2000 © 1999, 2000 Health Level 7 83 Convert the MIM  R-MIM • 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 January 24, 2000 © 1999, 2000 Health Level 7 84 Refine and Document R-MIM • Document the R-MIM in tabular form – Identify information not in graphical form • 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 January 24, 2000 © 1999, 2000 Health Level 7 85 Message Information Model (MIM) 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 1 participates_as 1 Individual_healthcare_practitioner is_a_role_of id : TII has_as_participant 1 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_primary_provider_for birth_dttm : TS birthplace_addr : ST 0..* has_a_primary_provider deceased_dttm : TS 1 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 Patient_billing_account admission_reason_cd 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 January 24, 2000 © 1999, 2000 Health Level 7 86 Sample Tabular R-MIM 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 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 real_id Stakeholder as HCP phon Stakeholder as HCP email_address_txt Stakeholder as HCP addr Stakeholder as HCP id Stakeholder as HCP has takes_on_role_of Person_name cd type_cd termination_dt purpose_cd effective_dt nm is_for is_for Observation_intent_or_order_as_service_order Observation_intent_or_order response_requested_cd Service_intent_or_order status_cd Service_intent_or_order secondary_identification_txt Service_intent_or_order status_dttm Service_intent_or_order status_reason_cd Service_intent_or_order report_results_to_phon Service_intent_or_order when_to_charge_cd Service_intent_or_order when_to_charge_dttm Service_intent_or_order expected_performance_time_qty Service_intent_or_order charge_type_cd Service_intent_or_order clarification_phon Service_intent_or_order echo_back_txt Service_intent_or_order order_id Service_intent_or_order filler_order_id Service_intent_or_order intent_or_order_cd Service_intent_or_order order_effective_dttm Service_intent_or_order order_placed_dttm Service_intent_or_order qt Service_intent_or_order placer_order_id Service_intent_or_order entering_device_cd Service_intent_or_order relevant_clinical_information_txt 0..* CV 1..1 Patient 1..1 Observation_intent_or_order_as_service_order 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 SET<RWII> TIL TIL AD SET<TII> Person_name Patient CV CV TS CV TS ST Person as patient Person_as_HCP CV CV FTX TS CV TIL CV TS PQ CV TIL FTX TII TII CV TS TS TII CV FTX 1..1 0..* 0..* 0..* 0..* 0..* 0..1 1..1 1..1 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 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 CWE CWE CWE CWE CWE CWE CWE {7821B3D3-731A-11D3-AD23-005004953E1E} {7821B3D4-731A-11D3-AD23-005004953E1E} {FB409E54-7242-11D3-AD20-005004953E1E} {FB409E66-7242-11D3-AD20-005004953E1E} {FB409E56-7242-11D3-AD20-005004953E1E} {FB409E58-7242-11D3-AD20-005004953E1E} {FB409E60-7242-11D3-AD20-005004953E1E} {FB409E64-7242-11D3-AD20-005004953E1E} {FB409E64-7242-11D3-AD20-005004953E1E} {4457CB6B-72AB-11D3-AD21-00C04FFA6C93} {FB409E60-7242-11D3-AD20-005004953E1E} {FB409E66-7242-11D3-AD20-005004953E1E} {FB409E9B-7242-11D3-AD20-005004953E1E} {FB409E54-7242-11D3-AD20-005004953E1E} {FB409E8C-7242-11D3-AD20-005004953E1E} {FB409E7C-7242-11D3-AD20-005004953E1E} {FB409E7C-7242-11D3-AD20-005004953E1E} {FB409E91-7242-11D3-AD20-005004953E1E} {FB409E8C-7242-11D3-AD20-005004953E1E} {FB409E91-7242-11D3-AD20-005004953E1E} {4457CB2F-72AB-11D3-AD21-00C04FFA6C93} {FB409E7C-7242-11D3-AD20-005004953E1E} {4457CB2F-72AB-11D3-AD21-00C04FFA6C93} {000141F3-730F-11D3-AD23-005004953E1E} {FB409E91-7242-11D3-AD20-005004953E1E} {FB409E9B-7242-11D3-AD20-005004953E1E} {FB409F22-7242-11D3-AD20-005004953E1E} {FB409E66-7242-11D3-AD20-005004953E1E} {FB409EB5-7242-11D3-AD20-005004953E1E} {FB409E9D-7242-11D3-AD20-005004953E1E} {FB409E9D-7242-11D3-AD20-005004953E1E} {FB409EC3-7242-11D3-AD20-005004953E1E} {FB409EB5-7242-11D3-AD20-005004953E1E} {FB409EC3-7242-11D3-AD20-005004953E1E} {FB409EC1-7242-11D3-AD20-005004953E1E} {FB409E9D-7242-11D3-AD20-005004953E1E} {FB409EC1-7242-11D3-AD20-005004953E1E} {FB409EBF-7242-11D3-AD20-005004953E1E} {FB409EC3-7242-11D3-AD20-005004953E1E} {FB409EBF-7242-11D3-AD20-005004953E1E} {FB409EBD-7242-11D3-AD20-005004953E1E} {FB409EC1-7242-11D3-AD20-005004953E1E} {FB409EBD-7242-11D3-AD20-005004953E1E} {FB409EBB-7242-11D3-AD20-005004953E1E} {FB409EBF-7242-11D3-AD20-005004953E1E} {FB409EBB-7242-11D3-AD20-005004953E1E} {FB409EB7-7242-11D3-AD20-005004953E1E} {FB409EBD-7242-11D3-AD20-005004953E1E} {FB409EB7-7242-11D3-AD20-005004953E1E} {FB409EC5-7242-11D3-AD20-005004953E1E} {FB409EBB-7242-11D3-AD20-005004953E1E} {FB409EC5-7242-11D3-AD20-005004953E1E} {FB409EB3-7242-11D3-AD20-005004953E1E} {FB409EB7-7242-11D3-AD20-005004953E1E} {FB409EB3-7242-11D3-AD20-005004953E1E} {FB409EA5-7242-11D3-AD20-005004953E1E} {FB409EC5-7242-11D3-AD20-005004953E1E} {FB409EA5-7242-11D3-AD20-005004953E1E} {FB409E9F-7242-11D3-AD20-005004953E1E} {FB409EB3-7242-11D3-AD20-005004953E1E} {FB409E9F-7242-11D3-AD20-005004953E1E} {FB409EB9-7242-11D3-AD20-005004953E1E} {FB409EA5-7242-11D3-AD20-005004953E1E} {FB409EB9-7242-11D3-AD20-005004953E1E} {FB409EA3-7242-11D3-AD20-005004953E1E} {FB409E9F-7242-11D3-AD20-005004953E1E} {FB409EA3-7242-11D3-AD20-005004953E1E} {FB409EB1-7242-11D3-AD20-005004953E1E} {FB409EB9-7242-11D3-AD20-005004953E1E} {FB409EB1-7242-11D3-AD20-005004953E1E} {FB409EA7-7242-11D3-AD20-005004953E1E} {FB409EA3-7242-11D3-AD20-005004953E1E} {FB409EA7-7242-11D3-AD20-005004953E1E} {FB409EA9-7242-11D3-AD20-005004953E1E} {FB409EB1-7242-11D3-AD20-005004953E1E} {FB409EA9-7242-11D3-AD20-005004953E1E} {FB409EAB-7242-11D3-AD20-005004953E1E} {FB409EA7-7242-11D3-AD20-005004953E1E} {FB409EAB-7242-11D3-AD20-005004953E1E} {FB409EAD-7242-11D3-AD20-005004953E1E} {FB409EA9-7242-11D3-AD20-005004953E1E} {FB409EAD-7242-11D3-AD20-005004953E1E} {FB409EAF-7242-11D3-AD20-005004953E1E} {FB409EAB-7242-11D3-AD20-005004953E1E} {FB409EAF-7242-11D3-AD20-005004953E1E} {FB409EA1-7242-11D3-AD20-005004953E1E} {FB409EAD-7242-11D3-AD20-005004953E1E} {FB409EA1-7242-11D3-AD20-005004953E1E} {FB409F0D-7242-11D3-AD20-005004953E1E} {FB409EAF-7242-11D3-AD20-005004953E1E} {FB409F0D-7242-11D3-AD20-005004953E1E} {FB409F12-7242-11D3-AD20-005004953E1E} {FB409EA1-7242-11D3-AD20-005004953E1E} {FB409F12-7242-11D3-AD20-005004953E1E} {FB409F11-7242-11D3-AD20-005004953E1E} {FB409F0D-7242-11D3-AD20-005004953E1E} {FB409F11-7242-11D3-AD20-005004953E1E} {FB409F10-7242-11D3-AD20-005004953E1E} {FB409F12-7242-11D3-AD20-005004953E1E} {FB409F10-7242-11D3-AD20-005004953E1E} {FB409F0E-7242-11D3-AD20-005004953E1E} {FB409F11-7242-11D3-AD20-005004953E1E} {FB409F0E-7242-11D3-AD20-005004953E1E} {FB409F0C-7242-11D3-AD20-005004953E1E} {FB409F10-7242-11D3-AD20-005004953E1E} {FB409F0C-7242-11D3-AD20-005004953E1E} {FB409F0F-7242-11D3-AD20-005004953E1E} {FB409F0E-7242-11D3-AD20-005004953E1E} {FB409F0F-7242-11D3-AD20-005004953E1E} {FB409F0C-7242-11D3-AD20-005004953E1E} {FB409ED0-7242-11D3-AD20-005004953E1E} {FB409ECE-7242-11D3-AD20-005004953E1E} {FB409ECE-7242-11D3-AD20-005004953E1E} {FB409EC7-7242-11D3-AD20-005004953E1E} {FB409ED0-7242-11D3-AD20-005004953E1E} {FB409F22-7242-11D3-AD20-005004953E1E} {FB40A103-7242-11D3-AD20-005004953E1E} {FB409E9B-7242-11D3-AD20-005004953E1E} {FB409F24-7242-11D3-AD20-005004953E1E} {FB409F2E-7242-11D3-AD20-005004953E1E} {FB409F2E-7242-11D3-AD20-005004953E1E} {FB409F2C-7242-11D3-AD20-005004953E1E} {FB409F24-7242-11D3-AD20-005004953E1E} {FB409F2C-7242-11D3-AD20-005004953E1E} {FB409F2A-7242-11D3-AD20-005004953E1E} {FB409F2E-7242-11D3-AD20-005004953E1E} {FB409F2A-7242-11D3-AD20-005004953E1E} {FB409F26-7242-11D3-AD20-005004953E1E} {FB409F2C-7242-11D3-AD20-005004953E1E} {FB409F26-7242-11D3-AD20-005004953E1E} {FB409F28-7242-11D3-AD20-005004953E1E} {FB409F2A-7242-11D3-AD20-005004953E1E} {FB409F28-7242-11D3-AD20-005004953E1E} {FB409F26-7242-11D3-AD20-005004953E1E} {FB409F2F-7242-11D3-AD20-005004953E1E} {4457C7F1-72AB-11D3-AD21-00C04FFA6C93} {4457C7F1-72AB-11D3-AD21-00C04FFA6C93} {FB409F30-7242-11D3-AD20-005004953E1E} {FB409F2F-7242-11D3-AD20-005004953E1E} {FB40A103-7242-11D3-AD20-005004953E1E} {4457C5B8-72AB-11D3-AD21-00C04FFA6C93} {FB409F22-7242-11D3-AD20-005004953E1E} {FB40A11C-7242-11D3-AD20-005004953E1E} {FB40A120-7242-11D3-AD20-005004953E1E} {FB40A120-7242-11D3-AD20-005004953E1E} {FB40A11D-7242-11D3-AD20-005004953E1E} {FB40A11C-7242-11D3-AD20-005004953E1E} {FB40A11D-7242-11D3-AD20-005004953E1E} {FB40A121-7242-11D3-AD20-005004953E1E} {FB40A120-7242-11D3-AD20-005004953E1E} {FB40A121-7242-11D3-AD20-005004953E1E} {FB40A122-7242-11D3-AD20-005004953E1E} {FB40A11D-7242-11D3-AD20-005004953E1E} {FB40A122-7242-11D3-AD20-005004953E1E} {FB40A11A-7242-11D3-AD20-005004953E1E} {FB40A121-7242-11D3-AD20-005004953E1E} {FB40A11A-7242-11D3-AD20-005004953E1E} {FB40A126-7242-11D3-AD20-005004953E1E} {FB40A122-7242-11D3-AD20-005004953E1E} {FB40A126-7242-11D3-AD20-005004953E1E} {FB40A127-7242-11D3-AD20-005004953E1E} {FB40A11A-7242-11D3-AD20-005004953E1E} {FB40A127-7242-11D3-AD20-005004953E1E} {FB40A110-7242-11D3-AD20-005004953E1E} {FB40A126-7242-11D3-AD20-005004953E1E} {FB40A110-7242-11D3-AD20-005004953E1E} {FB40A10B-7242-11D3-AD20-005004953E1E} {FB40A127-7242-11D3-AD20-005004953E1E} {FB40A10B-7242-11D3-AD20-005004953E1E} {FB40A10C-7242-11D3-AD20-005004953E1E} {FB40A110-7242-11D3-AD20-005004953E1E} {FB40A10C-7242-11D3-AD20-005004953E1E} {FB40A10D-7242-11D3-AD20-005004953E1E} {FB40A10B-7242-11D3-AD20-005004953E1E} {FB40A10D-7242-11D3-AD20-005004953E1E} {FB40A115-7242-11D3-AD20-005004953E1E} {FB40A10C-7242-11D3-AD20-005004953E1E} {FB40A115-7242-11D3-AD20-005004953E1E} {FB40A111-7242-11D3-AD20-005004953E1E} {FB40A10D-7242-11D3-AD20-005004953E1E} {FB40A111-7242-11D3-AD20-005004953E1E} {FB40A112-7242-11D3-AD20-005004953E1E} {FB40A115-7242-11D3-AD20-005004953E1E} {FB40A112-7242-11D3-AD20-005004953E1E} {FB40A114-7242-11D3-AD20-005004953E1E} {FB40A111-7242-11D3-AD20-005004953E1E} {FB40A114-7242-11D3-AD20-005004953E1E} {FB40A116-7242-11D3-AD20-005004953E1E} {FB40A112-7242-11D3-AD20-005004953E1E} {FB40A116-7242-11D3-AD20-005004953E1E} {FB40A119-7242-11D3-AD20-005004953E1E} {FB40A114-7242-11D3-AD20-005004953E1E} {FB40A119-7242-11D3-AD20-005004953E1E} {FB40A117-7242-11D3-AD20-005004953E1E} {FB40A116-7242-11D3-AD20-005004953E1E} {FB40A117-7242-11D3-AD20-005004953E1E} {FB40A10E-7242-11D3-AD20-005004953E1E} {FB40A119-7242-11D3-AD20-005004953E1E} {FB40A10E-7242-11D3-AD20-005004953E1E} {FB40A107-7242-11D3-AD20-005004953E1E} {FB40A117-7242-11D3-AD20-005004953E1E} {FB40A107-7242-11D3-AD20-005004953E1E} {FB40A105-7242-11D3-AD20-005004953E1E} {FB40A10E-7242-11D3-AD20-005004953E1E} This is a very small one (part of the recent Microbiology proof-ofconcept effort). They get BIG. January 24, 2000 © 1999, 2000 Health Level 7 87 A small piece of it… 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 January 24, 2000 0..* CV 1..1 Patient 1..1 Observation_intent_or_order_as_service_order 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 © 1999, 2000 Health Level 7 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 {7821B3D3-731A-1 {FB409E54-7242-1 {FB409E56-7242-1 {FB409E60-7242-1 {FB409E64-7242-1 {FB409E66-7242-1 {FB409E8C-7242-1 {FB409E7C-7242-1 {FB409E91-7242-1 {4457CB2F-72AB{FB409E9B-7242-1 {FB409EB5-7242-1 {FB409E9D-7242-1 {FB409EC3-7242-1 {FB409EC1-7242-1 {FB409EBF-7242{FB409EBD-7242{FB409EBB-7242{FB409EB7-7242-1 {FB409EC5-7242-1 {FB409EB3-7242-1 {FB409EA5-7242-1 {FB409E9F-7242-1 {FB409EB9-7242-1 {FB409EA3-7242-1 {FB409EB1-7242-1 {FB409EA7-7242-1 {FB409EA9-7242-1 {FB409EAB-7242{FB409EAD-7242{FB409EAF-7242{FB409EA1-7242-1 {FB409F0D-7242-1 {FB409F12-7242-1 88 Construct the HMD (defines the METs) • 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 © 1999, 2000 Health Level 7 89 How in the world… • • • • • • • • • 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 January 24, 2000 © 1999, 2000 Health Level 7 90 MET and CMET • Some Message Element Types are unique – Used only for a specific message • 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) January 24, 2000 © 1999, 2000 Health Level 7 91 Build the HMD • 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 January 24, 2000 © 1999, 2000 Health Level 7 92 The MET Incorporates all previous work and is documented in the HMD Reference Information Model Domain Information Model Use Case Model Interaction Model 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..* Message Information Model Encounter_practitioner is_associated_with participation_type_cd 1..* Exactly one occurrence 1 participates_as has_as_participant 1 1 Individual_healthcare_practitioner is_a_role_of id : TII Patient_encounter id : TII s tatus_cd : CV encounter_classification_cd : CV Person_as_Patient 0..1 is_the_primary_provider_for start_dttm birth_dttm : TS involves end_dttm birthplace_addr : ST 0..* has_a_primary_provider expected_insurance_plan_qty : NM 1 deceased_dttm : TS 1 first_similar_illness_dttm 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 Patient_billing_account admission_reason_cd 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 Domain Specification Database Common Message Element Types Hierarchical Message Description January 24, 2000 © 1999, 2000 Health Level 7 93 V2.3 Message Profiles 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 January 24, 2000 © 1999, 2000 Health Level 7 94 V2.3 Abstract Message - ADT MSH EVN PID [PD1] [ { NK1 } ] PV1 [ PV2 ] … [ { GT1 } ] [ { IN1 [ IN2 ] [ IN3 ] } ] … January 24, 2000 Message Header Event Type Patient Identification Additional Demographics Next of Kin /Associated Parties Patient Visit Patient Visit - Additional Info. Guarantor [ ] optional Insurance Insurance Additional Info. Insurance Add'l Info - Cert. { } may repeat © 1999, 2000 Health Level 7 95 HL7 2.3 Segment Definition 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 January 24, 2000 OPT RP/# TBL# ITEM # ELEMENT NAME R 00001 Field Separator R 00002 Encoding Characters SEQ - position within segment O 00003 Sending Application LEN - length of field O 00004 Sending Facility O 00005 Receiving Application DT data type for field O 00006 Receiving Facility O 00007 OPT - optionality for fieldDate/Time Of Message O 00008 Security RP/# - repeatability00009 Message Type R R 00010 Message Control ID TBL# - table number for codes R 00011 Processing ID R 0104 00012 Version ID ITEM# - HL7 field number O 00013 Sequence Number ELEMENT NAME - nameContinuation Pointer O 00014 O 0155 00015 Accept Acknowledgment Type O 0155 00016 Application Ack. Type O 00017 Country Code O Y/3 0211 00692 Character Set O 00693 Principal Language Of Message © 1999, 2000 Health Level 7 96 Version 2.3 - 3.0 Equivalence • 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 HMD = Message + tables + profiles Definition January 24, 2000 © 1999, 2000 Health Level 7 97 Hierarchical Message Description Information Model Mapping Message Elements Common Constraints status_cd Patient 11 6 itm 12 7 att ambulatory _status_cd Patient 13 14 15 16 17 18 19 20 21 22 23 24 25 26 8 9 10 11 12 13 14 15 16 17 18 19 20 21 att att att aso att att att att att att att att att itm newborn_baby _ind multip le_birth_ind organ_donor_ind is_a_role_of birth_dttm birthp lace_addr deceased_dttm education_level_cd gender_cd marital_status_cd race_cd religious_affiliation_cd p hon Patient Patient Patient Patient Person Person Person Person Person Person Person Person Stakeholder Stakeholder 27 22 aso has Person 28 23 itm 29 30 31 32 33 34 35 24 25 26 27 28 29 30 att att att att stc att att nm effective_dt cd p urp ose_cd value termination_dt ty p e_cd Person_name Person_name Person_name Person_name Person_name Person_name Person_name 36 31 aso has_a_primary_provider Patient 47 26 49 51 52 53 54 37 32 33 34 35 36 37 38 39 attr itm aso attr attr attr attr aso p hon Stakeholder Stakeholder 38 40 att id 39 41 att status_cd 40 42 itm 41 43 att billing_status_cd 42 44 att p atient_financial_class_cd 43 45 att p rice_schedule_id 44 46 aso is_involved_in Patient 45 47 att id Patient_encounter id 46 48 att status_cd Patient_encounter status_cd Patient Ties every element of a message directly to a class, attribute or association in the Reference Information Model Pt Pt II status Pt Set <CV> 1 _CV Pt CV 1 ambulatory _status_cd ambltry Status Pt CV 0..1 newborn_baby _ind multip le_birth_ind organ_donor_ind is_a_role_of_Person_as_patient birth_dttm birthp lace_addr deceased_dttm education_level_cd gender_cd marital_status_cd race_cd religious_affiliation_cd p hon _item_TIL nwbrnInd multbrthInd orgnDonrInd PtPrsn brthDttm brthp lcAddr decesdDttm educnLevl gendr maritlStatus race relgsAfiltn p hon _TIL Pt Pt Pt Pt PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn Set <TIL> 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 PtName PtPrsn BL BL BL PtPrsn TS ST TS CV CV CV CV CV Set <TIL> TIL S et <PtPrsnName> status_cd _item_CV has_S et_Person_name_for_Patient Person_name Person_name Person_name Person_name Patient Patient_billing_accoun t Patient_billing_accoun t Patient_billing_accoun t Patient_billing_accoun t Patient_billing_accoun t Patient_billing_accoun t January 24, 2000 1..* <@state, EXT:CNE> <@state, EXT:CNE> <ambltr Status> <clasfcn> 14 Pt IHCP Set <TIL> IHCP PN_IHCP PN_IHCP PN_IHCP PN_IHCP Pt id PtBillAcnt II 1 status PtBillAcnt Set <CV> 1..* _CV PtBillAcnt CV 1 billing_status_cd billngStatus PtBillAcnt CV 0..1 <bilngStatus> p atient_financial_class_cd p tFnanclClass PtBillAcnt CV 0..1 p rice_schedule_id p riceSchedId PtBillAcnt ST 0..1 PtEnctr Pt id PtEnctr* status PtEnctr id status_cd _item_CV is_involved_in_Patient_encounter © 1999, 2000 Health Level 7 PtPrsnName 1 PN TS CV CV ST TS CV 0..1 0..1 0..1 0..1 1 0..1 0..1 IHCP 0..1 Set <TIL> TIL PN_IHCP PN CV CV CV PtBillAcnt 0..* 1 1 1 0..1 0..1 0..1 0..1 PtEnctr & IptEnctr II CV R M No R R R R R R R R R R R R R R R N <martlStatus> <race> <relgsAfltn> p hon _TIL PN_IHCP nm cd p urp os ty p PtBillAcnt _PtPrsnName R R Provides the message profile specifications for the data elements in the message primryIHCP nm effective_dt cd p urp ose_cd value termination_dt ty p e_cd has_a_primary_provider_Individual_healthca re_practitioner p hon _item_TIL has_Person_name_for_IHCP nm cd p urp ose_cd ty p e_cd has_Patient_billing_account V No <edctnLevl> Set <PtPrsnName> PtPrsnName PtPrsnName PtPrsnName PtPrsnName PtPrsnName PtPrsnName PtPrsnName _item_Person_name_for_Patient No M 2 nm efectvDt cd p urp os valu termntnDt ty p Person Person_as_IHCP nm cd p urp ose_cd ty p e_cd has 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 use. M Message Structure Domain Specification (#) att 1 1 Pt id Conformance Flag 5 10 Patient id Update mode set Patient Patient of Message Element Type Default Update Mode Patient id in Message Element Type Default Value (#) cla att Message Element Short Name Constraint/Note # 3 4 Message Element Name Mandatory Row Type 8 9 Rim Source Class Cardinality Row Number Message Elements Former Row Information Model Mapping Class or Property of Class (Attribute or Association) b Domain Specification (#) C N <@state, EXT:CNE> <@state, EXT:CNE> R R R R R R R R R R N R M No V R M No V R M No V R M No R R M No R R 0..1 1 1 <@state, EXT:CNE> 98 Information Model Mapping MIM and R-MIM 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 1 participates_as 1 Individual_healthcare_practitioner is_a_role_of id : TII has_as_participant 1 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_primary_provider_for birth_dttm : TS birthplace_addr : ST 0..* has_a_primary_provider 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 Patient_billing_account admission_reason_cd 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 1 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_order 1..1 Person as patient CSS_as_original_specimen TP_for_order_subject TP_for_superservice_subject {7821B3D3-731A-11D3-AD23-005004953E1E} {FB409E54-7242-11D3-AD20-005004953E1E} {FB409E56-7242-11D3-AD20-005004953E1E} {FB409E60-7242-11D3-AD20-005004953E1E} {FB409E64-7242-11D3-AD20-005004953E1E} {FB409E66-7242-11D3-AD20-005004953E1E} {FB409E8C-7242-11D3-AD20-005004953E1E} {FB409E7C-7242-11D3-AD20-005004953E1E} {FB409E91-7242-11D3-AD20-005004953E1E} {4457CB2F-72AB-11D3-AD21-00C04FFA6C93} {FB409E9B-7242-11D3-AD20-005004953E1E} {FB409EB5-7242-11D3-AD20-005004953E1E} {FB409E9D-7242-11D3-AD20-005004953E1E} {FB409EC3-7242-11D3-AD20-005004953E1E} {FB409EC1-7242-11D3-AD20-005004953E1E} {FB409EBF-7242-11D3-AD20-005004953E1E} {FB409EBD-7242-11D3-AD20-005004953E1E} {FB409EBB-7242-11D3-AD20-005004953E1E} {FB409EB7-7242-11D3-AD20-005004953E1E} {FB409EC5-7242-11D3-AD20-005004953E1E} {FB409EB3-7242-11D3-AD20-005004953E1E} {FB409EA5-7242-11D3-AD20-005004953E1E} {FB409E9F-7242-11D3-AD20-005004953E1E} {FB409EB9-7242-11D3-AD20-005004953E1E} {FB409EA3-7242-11D3-AD20-005004953E1E} {FB409EB1-7242-11D3-AD20-005004953E1E} {FB409EA7-7242-11D3-AD20-005004953E1E} {FB409EA9-7242-11D3-AD20-005004953E1E} {FB409EAB-7242-11D3-AD20-005004953E1E} {FB409EAD-7242-11D3-AD20-005004953E1E} {FB409EAF-7242-11D3-AD20-005004953E1E} {FB409EA1-7242-11D3-AD20-005004953E1E} {FB409F0D-7242-11D3-AD20-005004953E1E} {FB409F12-7242-11D3-AD20-005004953E1E} 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 1..1 0..* 0..* 0..* 0..* CV TS CV CV CV CV CV ST CV CV TS AD CV CV CV BL CV CV CV CV CV CV CV Information Model Mapping DATATYPES <<Data_type>> Any_data_type : ANY <<Data_type>> Quantity : QTY <<Data_type>> Discrete : DSCR <<Data_type>> Ordered : ORD Message Elements Common Constraints Union: Text C00XMM011 Thing 0..* Patient_service_location_request type_cd Patient_appointment_request requests 0..* 0..* requests requests 0..* 0..* requests 0..* requests Patient_information_recipient 1 takes_on_role_of Stakeholder takes_on_role_of 1 addr acts_as 1 participates_as_primary_in 1 credit_rating_cd 1 takes_on_role_of email_address_txt 1 phon takes_role_of takes_on_role_of 1 type_cd 1..1 participates_in real_id : SET<RWII> 0..* refers_to_person_by takes_on_role_of 1 id : SET<TII> 1 collects takes_on_role_of 1 1 takes_on_role_of takes_on_role_of 1 0..* has_as_primary_participant Real_world_instance_identifier value_txt : ST type_cd : CV qualifier_txt : ST valid_tmr : IVL<TS> provides_contact 0..1 represents 0..* Person_name 0..* effective_dt cd nm purpose_cd termination_dt type_cd contains 0..1 0..* contains Accident_information_source Health_chart health_chart_id is_the_source_of 0..1 health_chart_type_cd 0..* is_housed_at status_cd 0..* belongs_to 1 enters has_an_assessment_of 1 Health_chart_deficiency assessment_dttm desc 0..* is_assessed_against level_cd type_cd is_for 0..* Organization organization_name_type_cd organization_nm standard_industry_class_cd 0..1 is_role_of Employer 1..* is_represented_by effective_tmr 1 is_employer_of 1 is_requested_by Individual_healthcare_practitioner_group id is_a_role_of 0..1 issues 0..1 Stakeholder_affiliate 0..1 is_role_of family_relationship_cd is_requested_by 0..1 Entering_person 0..1 is_role_of is_used_by is_issued_by 0..* participates_as_secondary_in 1 enters 0..1 0..1 is_a_role_of 0..1 categorizes 1 takes_on_role_of assigns 1 takes_on_role_of 1 is_requested_by 0..1 Resource_slot offset_qty quantity_amt resource_type_cd slot_state_cd 0..* is_managed_by start_dttm 0..* is_reserved_by Durable_medical_equipment belongs_to 1..* id slot_size_increment_qty type_cd 0..* contains Durable_medical_equipment_group id is_scheduled_by 1 Patient_service_location_slot 0..* is_scheduleable_unit_for Schedule books 1..* id Durable_medical_equipment_slot is_scheduleable_unit_for 0..* 1 takes_on_role_of 0..1 has_as_a_subdivision 0..* is_contact_for Contact_person 0..1 is_contact_for 0..1 is_a_contact_for is_contact_for 0..* contact_reason_cd 0..* is_a_contact_for is_issued_by 0..* 0..1 is_a_role_of has 1 1 has 1 Person acts_in_role_of birth_dttm 1 takes_on_role_of birthplace_addr citizenship_country_cd Administrative_patient_death Notary_public confidentiality_constraint_cd death_certificate_id deceased_dttm effective_interval_tmr death_certificate_recorded_dttm notary_county_cd takes_on_role_of 1 deceased_ind death_classification_cd disability_cd notary_state_cd death_dttm education_level_cd death_location_txt ethnic_group_cd Insured 0..1 is_a_role_of death_notification_source_nm gender_cd death_verification_cd language_cd 1 takes_on_role_of 0..1 is_role_of death_verification_dttm marital_status_cd death_verification_nm military_branch_of_service_cd 1 issues 0..1 pertains_to military_rank_nm 1 takes_on_role_of 1 offers takes_on_role_of 1 military_status_cd 0..* has_as_employee Insurance_certification_contact nationality_cd race_cd participation_type_cd is_issued_by 0..* takes_on_role_of 1 religious_affiliation_cd Employee Billing_information_item takes_on_role_of 0..1 is_role_of student_cd Insurance_certification is_employee_in 1 0..1 is_role_of is_contact_for condition_cd 1..* very_important_person_cd 1 appeal_reason_cd occurrence_cd status_cd 0..* pertains_to certification_duration_qty occurrence_dttm effective_tmr occurrence_span_cd 1 has_contact id enters 1 occurrence_span_from_dttm 1..* 0..* belongs_to has 1 insurance_verification_dttm Guarantor_contract occurrence_span_thru_dttm provides_payment_guarantee_for has_payment_guaranteed_by modification_dttm Patient_billing_account quantity_nbr billing_hold_ind non_concur_cd account_id quantity_type_cd billing_media_cd 0..* non_concur_effective_dttm 0..* affirms_insurance_coverage_for adjustment_cd value_amt has_coverage_affirmed_by 1 charge_adjustment_cd penalty_amt authorization_information_txt Financial_transaction value_cd contract_duration_cd report_of_eligibility_dttm billing_status_cd alternate_desc contract_type_cd 0..* provides_validation_for 0..* report_of_eligibility_ind certification_required_ind desc effective_tmr 0..* is_entered_by has_payment_guaranteed_by 0..* current_unpaid_balance_qty extended_amt interest_rate_nbr is_categorized_by fee_schedule_cd delete_dttm includes 1 periodic_payment_amt insurance_amt priority_ranking_cd has 1 deleted_account_reason_cd 0..* provides_opinion_on expected_insurance_plan_qty posting_dt 0..* is_associated_with expected_payment_source_cd qty Certification_second_opinion notice_of_admission_dttm transaction_batch_id 0..* is_provided_by effective_dttm notice_of_admission_ind transaction_cd status_cd patient_financial_class_cd transaction_dttm Bad_debt_billing_account price_schedule_id 0..* pertains_to is_associated_with transaction_id bad_debt_recovery_amt purge_status_cd transaction_type_cd bad_debt_transfer_amt 0..* unit_amt purge_status_dttm transfer_to_bad_debt_dttm report_of_eligibility_dttm 1 is_validated_by unit_cost_amt transfer_to_bad_debt_reason_cd retention_ind Coverage_item signature_on_file_dttm 0..* is_for service_category_cd special_program_cd 0..* is_assigned_to service_cd stoploss_limit_ind provides_contact 0..1 Bad_debt_collection_agency service_modifier_cd is_a_role_of 0..1 1 is_assigned suspend_charges_ind is_role_of 0..1 Health_benefit_product_purchaser 0..* 0..1 total_adjustment_qty authorization_ind provides_coverage_for network_ind has_as_a_prior_account total_charge_qty Preferred_provider_participation 1 is_the_purchaser_of assertion_cd total_payment_qty is_the_prior_account_for 0..1 governs covered_parties_cd is_governed_by role_cd separate_bill_ind has_as_care_recipient effective_dt qty 0..1 0..* termination_dt quantity_qualifier_cd 0..* 0..1 has_charges_for is_billed_from 0..1 time_period_qualifier_cd range_low_qty has_as_care_provider 0..* range_high_qty is_associated_with 0..1 range_units_cd assertion_effective_tmr Master_healthcare_benefit_product has 0..* eligibility_cd 0..* assignment_of_benefits_ind policy_source_cd Collected_specimen_sample benefit_product_desc is_collected_by 0..* eligibility_source_cd body_site_cd id has_as_components has_as_purchaser copay_limit_ind collection_body_site_modifier_cd benefit_product_nm non_covered_insurance_cd 0..1 collection_tmr benefit_product_type_cd 0..* is_sourced from participates_in 1 collection_method_modifier_cd benefits_coordination_cd Person_employment addr 0..* effective_dt has_as_employer hazard_exposure_txt job_class_cd job_title_nm phon protective_equipment_txt salary_qty salary_type_cd status_cd termination_dt occupation_cd job_status_cd 0..* is_contact_for Guarantor 0..1 is_role_of provides_contact 0..1 financial_class_cd household_annual_income_amt household_size_nbr 1 guarantees_payment_under 0..1 provides_contact 0..1 is_role_of Insurer effective_tmr 1 issues 0..* cob_priority_nbr combine_baby_bill_ind effective_tmr is_offered_by 0..* group_benefit_ind mail_claim_party_cd release_information_cd status_cd coverage_type_cd agreement_type_cd policy_category_cd access_protocol_desc is_a_component_of 1 is_associated_with Healthcare_service_provider board_certification_type_cd board_certified_ind participates_as 1 certification_dttm effective_tmr license_id identifies recertification_dttm 1 specialty_cd is_child_of 0..1 0..1 collection_scheduled_dttm 0..* is_sourced_from collection_volume_qty collectors_comment_cd handling_cd id collection_method_desc 0..1 is_target_of number_of_sample_containers_qty additive_desc 0..* is_collected_during danger_cd source_cd transport_logistics_cd action_cd type_cd is_parent_of is_role_of Champus_coverage handicapped_program_cd non_avail_cert_on_file_ind retirement_dttm station_id Healthcare_provider_organization 0..1 1..* provides_patient_services_at Individual_healthcare_practitioner is_role_of desc 0..1 fellowship_field_cd graduate_school_nm graduation_dttm position_cd practitioner_type_cd participates_as 1 provides 1 primary_care_ind 1..* belongs_to residency_field_cd is_requested_by 1 slot_size_increment_qty 0..1 is_the_primary_provider_for is_scheduled_by 1 Living_subject birth_dttm birthplace_addr origin_country_cd taxonomic_classification_cd is_source_for 0..1 breed_txt strain_txt eye_color_cd is_schedu coat_or_feather_coloring_txt led_by confidentiality_constraint_cd 1 deceased_dttm has 1 deceased_ind Patient has 1 euthanasia_ind ambulatory_status_cd gender_cd has_as_a_contact 0..1 birth_order_nbr has 1 living_arrangement_cd gender_status_cd primary_name_type_cd is_a_role_of 0..1 living_dependency_cd primary_nm multiple_birth_ind has 1 importance_status_txt newborn_baby_ind qty 0..1 participates_in 1 organ_donor_ind production_class_cd preferred_pharmacy_id has 1 status_cd 0..1 pertains_to Preauthorization authorized_encounters_qty authorized_period_begin_dt authorized_period_end_dt id issued_dttm requested_dttm restriction_desc status_cd status_change_dttm Administrative_birth_event baby_detained_ind birth_certificate_id birth_method_cd 0..* is_part_of birth_recorded_county_cd birth_recorded_dttm newborn_days_nbr stillborn_ind authorizes 0..1 is_booked_in 0..* Appointment reserves 0..* appointment_disposition_cd appointment_duration_tmr appointment_timing_qt is_entered_by 0..* cancellation_dttm event_reason_cd expected_end_dttm has_as_a_contact 0..* expected_service_desc is_parent_of expected_start_dttm id 0..1 overbook_ind scheduling_begin_dttm status_cd 0..* schedules 0..* urgency_cd visit_type_cd is_child_of wait_list_priority_amt scheduling_completed_dttm has_as_primary_facility 0..* 1 is_involved_in 1 has 0..* is_reason_for 0..* +has_as_target is_authorized_by 1..* 1 has Disability 0..* effective_dttm pertains_to return_to_work_auth_dttm termination_dttm unable_to_work_effective_dttm Diagnostic_related_group base_rate_amt capital_reimbursement_amt cost_weight_amt id major_diagnostic_category_cd operating_reimbursement_amt reimbursement_amt 1 is_assigned_as standard_day_qty standard_total_charge_amt trim_high_day_qty trim_low_day_qty 1..* is_scheduled_by Patient_encounter pertains_to 0..* has_parts 1 administrative_outcome_txt cancellation_reason_cd Administrative_patient_accident desc accident_death_ind involves 0..* encounter_classification_cd 1..* accident_desc end_dttm is_obtained_from accident_dttm Episode_of_condition Episode_of_care accident_location_desc has 1..* expected_insurance_plan_qty first_similar_illness_dttm accident_state_cd 0..* is_present_in 0..* follow_up_type_cd accident_type_cd is_part_of 1 links_condition 0..1 id is_identified by job_related_accident_ind patient_classification_cd 1..* has_parts assessment_dttm purpose_cd 0..1 has_assigned_to_it record_signing_dttm 1 has special_courtesies_cd start_dttm Patient_admission 1 status_cd admission_dttm 1 is_preceded_by transport_requirement_cd admission_reason_cd has_as_participant urgency_cd admission_referral_cd Patient_departure triage_classification_cd 0..* pertains_to admission_source_cd actual_discharge_disposition_cd medical_service_cd admission_type_cd 0..1 Risk_management_incident discharge_dttm confidentiality_constraint_cd patient_valuables_desc follows discharge_location_id incident_cd pre_admit_test_ind expected_discharge_disp_cd incident_dttm readmission_ind 0..* 1 incident_severity_cd valuables_location_desc has precedes incident_type_cd terminates 0..1 preceded 1 is_assigned_by 0..* 0..* is_an_assignment_of Encounter_drg approval_ind assigned_dttm confidential_ind cost_outlier_amt desc 0..* is_assigned_to grouper_review_cd grouper_version_id outlier_days_nbr outlier_reimbursement_amt outlier_type_cd is_terminated_by 1 is_preceded_by 1 precedes 0..1 Inpatient_encounter actual_days_qty estimated_days_qty Patient_arrival acuity_level_cd arrival_dttm medical_service_id source_of_arrival_cd mode_cd is_assigned 1 has_as_target 0..* Target_participation is_target_of has_as_target 0..* tmr has_as_target 0..* participation_type_cd 1..* Encounter_practitioner 1..* participation_type_cd Service_reason determination_dttm documentation_dttm reason_txt 0..* has_as_evidence is_target_of 0..* 0..* is_reason_for collects 0..1 Procedure anesthesia_cd anesthesia_tmr delay_reason_txt incision_open_tmr priority_nbr procedure_tmr functional_type_cd modifier_cd Treatment_service_event prescription_id refills_remaining_nbr PTrout PTcomp indication_id substance_expiration_dttm substance_lot_number_txt substance_manufacturer_cd dosage_form_cd strength_qty amount_qty route_cd body_site_cd substitution_cd <<Data_type>> Annotated : ANT <<Data_type>> History_item : HXIT 0..1 is_ordered_on is_an_instance_of 0..* Goal expected_achievement_dttm goal_list_priority_nbr management_discipline_cd review_interval_cd goal_value_cd is_measured_by 1..* Condition_node life_cycle_start_dttm lifecycle_status_cd management_discipline_cd ranking_nbr employment_related_ind 1 defines_episode is_associated_with0..* is_participant_for Treatment_service_dispense Treatment_service_give Treatment_service_administration administered_rate_qty dispense_package_method_cd give_per_timeunit_cd completion_status_cd dispense_package_size_qty qt substance_refusal_reason_cd needs_human_review_ind give_rate_qty suppliers_special_dispensing_instruction_cd needs_human_review_ind system_entry_dttm administration_nbr total_daily_dose_qty administered_per_timeunit_cd administrators_notes_cd _item_CV ambulatory _status_cd 13 8 att newborn_baby _ind 14 9 att multip le_birth_ind Class 15 10 or att organ_donor_ind Property of aso Class 16 11 is_a_role_of (Attribute Association) Rim Source Class 17or12 att birth_dttm 8 9 3 4 cla att Patient id 10 5 att status_cd 6 itm 7 att 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 8 9 10 11 12 13 14 15 16 17 18 19 20 21 att att att aso att att att att att att att att att itm 27 22 aso 28 23 itm 29 30 31 32 33 34 35 24 25 26 27 28 29 30 att att att att stc att att 36 31 aso 47 26 49 51 52 53 54 37 32 33 34 35 36 37 38 39 attr itm aso attr attr attr attr aso 38 40 att 39 41 att 40 42 itm 41 43 att 42 44 att 43 45 att 44 46 aso 18 13 att 19 14 att 20 15 att 21 16 att 22 17 att 23 18 att 24 19 att ambulatory _status_cd 25 20 att 26 21 itm newborn_baby _ind multip le_birth_ind 27 22 aso organ_donor_ind is_a_role_of 28 23 itm birth_dttm 29 24 att birthp lace_addr 30 25 att deceased_dttm 31 26 att education_level_cd att gender_cd32 27 33 28 stc marital_status_cd 34 29 att race_cd 35 30 att religious_affiliation_cd p hon 36 31 aso 47 32 26 33 49 34 51 35 52 36 nm 53 37 effective_dt 54 38 cd 37 39 p urp ose_cd value 38 40 termination_dt has attr itm aso attr attr attr attr aso birthp lace_addr Patient deceased_dttm Patient education_level_cd Patient gender_cd marital_status_cd Patient race_cd religious_affiliation_cd Patient p hon Patient Patient has Patient Patient Person nm Person effective_dt Person cd Person p urp ose_cd Person value Person termination_dt Person ty p e_cd Person Stakeholder has_a_primary_provider Stakeholder p hon Person Person_as_IHCP Person nm cd Person_name p urp ose_cd Person_name ty p e_cd Person_name has Person_name Person_name att id Person_name ty p e_cd Person_name 39 41 att status_cd has_a_primary_provider Patient 40 42 itm p hon Stakeholder Stakeholder 41 43 att billing_status_cd Person_as_IHCP nm 42 cd p urp ose_cd 43 ty p e_cd Patient Pt II Pt Set <CV> _CV Pt CV ambltry Status Pt CV att Patient_billing_accoun nm t cd 45 att Patient_billing_accoun p urp ose_cd t ty p e_cd is_involved_in Patient nwbrnInd Pt multbrthInd Pt in of orgnDonrInd Pt Message Message PtPrsn Pt Element Type Element Type brthDttm PtPrsn nm p atient_financial_class_cd cd p urp os p rice_schedule_id ty p has_Patient_billing_account PtBillAcnt Patient is_involved_in_Patient_encounter id id Patient_encounter id Patient_encounter status_cd status_cd PN_IHCP p tFnanclClass PN_IHCP PN_IHCP p riceSchedId PN_IHCP 0..1 0..1 0..1 0..1 1 0..1 0..1 Pt PtEnctr PtBillAcnt id PN PtBillAcnt CV CV PtBillAcnt CV PtBillAcnt Pt II PtEnctr* SetPtEnctr <CV> 1..* 1 0..1 0..1 0..1 0..1 1 0..1 0..1 IHCP Set <TIL> TIL PN_IHCP PN CV CV CV PtBillAcnt 1 0..1 0..* 1 1 1 0..1 0..1 0..1 0..1 1 CV 0..1 0..1 ST 0..1 PtEnctr & IptEnctr II <@state, CV EXT:CNE> status PtBillAcnt PtBillAcnt CV 1 <@state, EXT:CNE> billngStatus PtBillAcnt CV 0..1 <bilngStatus> p tFnanclClass PtBillAcnt CV 0..1 p riceSchedId PtBillAcnt Pt 45 47 att id Patient_encounter id id PtEnctr* 46 48 att status_cd Patient_encounter status_cd status PtEnctr ST PtEnctr & IptEnctr II CV 1..* 1 CV CV 0..1 M 1 1 M M V R R R No 2 R R R R R R R R R N R R <@state, EXT:CNE> <@state, EXT:CNE> R N <bilngStatus> Domain Specification (#) R R R R R R R R R R N R R N N R R R R R R R R R R R R R R R R R R R N R R R R R R R 2 0..* 1 1 1 0..1 0..1 0..1 0..1 1..* status PtEnctr 0..1 II _CV p rice_schedule_id <relgsAfltn> R 1 No No M 14 <martlStatus> No R <race> 0..1 0..* 1 1..* M M No V <edctnLevl> No R 0..1 M 0..1 Set <CV> p atient_financial_class_cd is_involved_in_Patient_encounter 1 PN TS CV <edctnLevl> 14 CV ST <martlStatus> TS <race> CV <relgsAfltn> 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..* 1 C00XMM011 <@state, EXT:CNE> <@state, EXT:CNE> <ambltr Status> <clasfcn> 1 0..1 0..1 0..1 1 0..1 0..1 0..1 M 0..1 M 0..1 billing_status_cd _item_CV Constraints 1 1 0..1 BL BL BL PtPrsn TS PtPrsn ST Pt 1 PtPrsn TS II 1 PtPrsn CV <@state, Set <CV> 1 PtPrsn CV EXT:CNE> PtPrsn CV <@state, CV 1 PtPrsn CV EXT:CNE> PtPrsn CV <ambltr CV 0..1 PtPrsn Set Status> <TIL> Set TIL BL <TIL> 0..1 <clasfcn> S et BL 0..1 PtPrsn BL 0..1 <PtPrsnName> Set PtPrsn 1 PtPrsnName <PtPrsnName> TS 0..1 brthp lcAddr decesdDttm Pt educnLevl Pt gendr maritlStatus Pt race Person religious_affiliation_cd relgsAfiltn ambulatory _status_cd ambltry Status Pt Stakeholder p hon p hon Stakeholder _item_TIL _TIL newborn_baby _ind nwbrnInd Pt multip le_birth_ind multbrthInd Pt Person has_S et_Person_name_for_Patient PtName organ_donor_ind orgnDonrInd Pt is_a_role_of_Person_as_patient PtPrsn Pt Person _item_Person_name_for_Patient _PtPrsnName birth_dttm brthDttm PtPrsn Person_name nm nm PtPrsnName birthp lace_addr brthp lcAddr PtPrsn ST Person_name effective_dt efectvDt PtPrsnName deceased_dttm decesdDttm PtPrsn TS Person_name cd cd PtPrsnName education_level_cd educnLevl PtPrsn CV Person_name p urp ose_cd p urp os PtPrsnName gender_cd gendr PtPrsn CV Person_name value valu PtPrsnName marital_status_cd maritlStatus PtPrsn CV Person_name termination_dt termntnDt PtPrsnName race_cd race PtPrsn CV Person_name ty p e_cd ty p PtPrsnName religious_affiliation_cd relgsAfiltn PtPrsn CV has_a_primary_provider_Individual_healthca p hon p hon PtPrsn Set <TIL> Patient primryIHCP Pt re_practitioner _item_TIL _TIL Set <TIL> TIL Stakeholder p hon p hon IHCP S et has_S et_Person_name_for_Patient PtName PtPrsn Stakeholder _item_TIL _TIL Set <TIL> <PtPrsnName> has_Person_name_for_IHCP PN_IHCP IHCP Set _item_Person_name_for_Patient _PtPrsnName PtPrsnName Person_name nm nm PN_IHCP <PtPrsnName> Person_name cd cd PN_IHCP nm nm PtPrsnName PN Person_name p urp ose_cd p urp os PN_IHCP effective_dt efectvDt PtPrsnName TS Person_name ty p e_cd ty p PN_IHCP cd cd PtPrsnName CV Patientp urp ose_cd has_Patient_billing_account PtBillAcnt Pt p urp os PtPrsnName CV Patient_billing_accoun value valu PtPrsnName ST id id PtBillAcnt t termination_dt termntnDt PtPrsnName TS Patient_billing_accoun ty p e_cd ty p PtPrsnName CV status_cd status PtBillAcnt t has_a_primary_provider_Individual_healthca primryIHCP Pt IHCP Patient_billing_accoun re_practitioner _item_CV _CV PtBillAcnt t p hon p hon IHCP Set <TIL> Patient_billing_accoun _item_TIL _TIL Set <TIL> TIL billing_status_cd billngStatus PtBillAcnt t has_Person_name_for_IHCP PN_IHCP IHCP PN_IHCP 44 Person_name p atient_financial_class_cd Person_name Person_name p rice_schedule_id Person_name has Patient 44 46 aso is_involved_in Patient_billing_accoun id 45 47 att id t Patient_billing_accoun att status_cd status_cd 46 48 t Patient_billing_accoun t Patient_billing_accoun billing_status_cd t Patient_billing_accoun p atient_financial_class_cd t Patient_billing_accoun p rice_schedule_id t ambulatory _status_cd Patient newborn_baby _ind Patient multip le_birth_ind Message Patient organ_donor_ind Element Short Patient is_a_role_of_Person_as_patient Message Element Name Name Person birth_dttm Person birthp lace_addr Patient Pt Person deceased_dttm id id Person education_level_cd status_cd status Person gender_cd Person marital_status_cd _item_CV _CV Person race_cd of Common Message Element Type Pt status Conformance Flag in Message Element Type Pt id Update mode set att status_cd Default Update Mode 7 Message Element Name Patient id Default Value (#) 12 Message Element Short Name Message Elements Rim Source Class Patient Constraint/Note # Patient Class or Mandatory Patient Patient status_cd itm R M No V R M No V R No V R No R R No R R M R No V <@state, No V EXT:CNE> No V M M R R R 0..1 0..1 1 1 <@state, EXT:CNE> M No R R M No R R Heirarchical Message Descriptions RIM January 24, 2000 Patient id att 6 T <<Data_type>> Non-parametric_probability_Distribution : NPPD Service_intent_or_order charge_type_cd clarification_phon entering_device_cd escort_required_ind expected_performance_time_qty filler_order_id status_cd has_as_participant 0..1 status_reason_cd is_referred_to_in 0..1 order_effective_dttm order_id expects_patient_located_at 0..* order_placed_dttm has_as_target 0..1 qt placer_order_id is_fulfilled_by 0..1 echo_back_txt has_as_reason 0..1 planned_patient_transport_cd report_results_to_phon is_source_for 1 response_requested_cd service_body_site_cd has_as_source 0..* service_body_site_modifier_cd transport_arranged_ind Service_intent_or_order_relationship transport_arrangement_responsibility_cd relationship_type_cd 0..* is_billed_to transport_mode_cd reflex_testing_trigger_rules_desc when_to_charge_dttm constraint_txt when_to_charge_cd qt intent_or_order_cd join_cd 0..* has_as_target status_dttm secondary_identification_txt is_target_for 1 reporting_priority_cd Clinical_observation abnormal_result_cd last_observed_normal_values_dttm nature_of_abnormal_testing_cd clinically_relevant_tmr method_cd status_cd status_dttm observation_sub_id val references_range_val universal_service_identifier_suffix_txt user_defined_access_check_cd value_datatype_cd confirmation_status_cd cla att 5 b <<Data_type>> Person_name_part : PNXP <<Data_type>> Person_name_type : PN is_entered_at 0..* Advance_directive competence_ind directive_cd disclosure_level_cd life_quality_desc mortuary_preference_nm notarization_dttm assessment_dttm employment_related_ind 3 4 11 Information Model Mapping Property of Class <<Data_type>> Person_name_variant : PNXV T <<Data_type>> Parametric_probability_distribution : PPD Treatment_intent_or_order Dietary_intent_or_order Observation_intent_or_order Referral has_as_target 0..1 fulfills 0..* indication_id diet_type_cd authorized_visits_qty patient_hazard_cd Service_event 0..1 is_evidence_for has_as_active_participant 0..1 ordering_providers_instruction_txt instruction_desc relevant_clinical_information_txt desc attestation_dttm 0..1 has_as_reason requested_give_strength_qty tray_type_cd reason_txt specimen_action_cd tmr orders substitution_allowed_ind service_period_cd charge_to_practice_qty 0..* is_source_for delivers 0..* charge_to_practice_cd Treatment_intent_or_order_revision patient_sensitivity_cd 1 0..* has_as_source 1 has_parts is_assigned_to 0..* consent_cd dispense_package_method_cd dispense_package_size_qty Service_event_relationship service_desc filler_id relationship_type_cd is_part_of give_indication_id give_per_timeunit_cd filler_order_status_dttm scheduled_start_dttm 1..* give_rate_qty has_as_target 0..* last_refilled_dttm specimen_received_dttm 1 max_give_qty family_awareness_txt is_target_for is_documented_by 0..* min_give_qty individual_awareness_cd needs_human_review_ind confidential_ind PTcomp status_cd is_performed_at 0..* PTrout billing_priority_nbr Judgement_link Rule_link Conditional_link is_charged_to 0..* status_reason_cd qt type_cd priority_nbr is_associated_with 1 prescription_id refills_allowed_nbr refills_doses_dispensed_nbr refills_remaining_nbr substitution_status_cd treatment_suppliers_instruction_cd Assessment Care_event total_daily_dose_qty Consent pertains_to 1..* Location_encounter_role is_primary_facility_for Master_patient_service_location 1 is_scheduled_by accommodation_cd 0..1 addr effective_tmr open_tmr location_role_cd desc pertains_to 0..* status_cd 1 has email_address transfer_reason_cd houses 1 id usage_approved_ind Patient_service_location_group provides_services_on_behalf_of 0..* licensed_bed_nbr 1..* belongs_to contains 0..* nm id phon is_requested_by 0..1 service_specialty_cd 1 is_requested_by is_included_in 0..* slot_size_increment_qty 0..1 expected_patient_location_for status_cd type_cd 0..1 is_target_for equipment_type_cd 1 is_entry_location_for 0..1 is_location_for includes 0..1 <<Data_type>> Address_part : ADXP T <<Data_type>> Uncertain_discrete_value_using_probability : UDVP T 1 measures Master_qualitative_observation abnormal_result_cd critical_result_cd normal_result_cd preferred_coding_system_cd valid_answer_cd (Attribute or Association) 8 9 10 <<Data_type>> Postal_and_residential_address : AD <<Data_type>> Uncertain_value-narrative : UVN T <<Data_type>> History : HIST 0..* is_target_of Episode desc episode_type_cd id list_closed_ind outcome_txt recurring_service_ind <<Data_type>> Integer : INT T T <<Data_type>> Interval : IVL T is_basis_for Master_quantitative_observation corresponding_SI_unit_of_measure_cd unit_of_measure_cd conforms_to 1 delta_check_change_computation_method_cd delta_check_change_threshold_qty delta_check_value_range_qty 0..* has_as_participant delta_check_numeric_low_value_amt Active_participation delta_check_retention_period_qty tmr display_length_and_decimal_precision_cd participation_type_cd minimum_meaningful_increment_nbr si_conversion_factor_expr 0..* 0..* participates_in participates_in 1 is_requested_by 0..1 is_target_of is_source_for 0..1 has_a_primary_provider 0..* Master_treatment_service dea_level_cd drug_category_cd formulary_status_cd medication_form_cd pharmaceutical_class_cd route_cd therapeutic_class_cd Master_observation_service instrument_cd permitted_data_type_cd has_as_basis processing_time_qty specimen_required_ind 0..* typical_turnaround_time_qty derivation_rule_desc applies_to 0..* is_contact_for 0..* <<Data_type>> Monetary_amount : MO <<Data_type>> Technical_instance_locator : TIL b has 1 Individual_healthcare_practitioner_slot 0..* is_scheduleable_unit_for is_specified_for 0..* Master_numeric_range type_cd condition_desc age_qty gestation_age_qty value_qty race_subspecies_txt gender_cd species_txt manages 1 Patient_slot 0..* is_a_scheduleable_unit_for 0..* is_a_subdivision_of <<Data_type>> Technical_instance_identifier : TII Domain Specification (#) Resource_request allowable_substitutions_cd duration_qty start_dttm start_offset_qty status_cd Domain Specification (#) Transcriptionist 0..1 is_role_of is_requested_by Durable_medical_equipment_request quantity_amt type_cd requests 0..* Conformance Flag requests 0..* Update mode set practitioner_type_cd 0..* is_entered_by Cardinality 0..* requests Appointment_request Service_scheduling_request appointment_rqst_reason_cd allowable_substitutions_cd appointment_rqst_type_cd duration_qty 1 requests equip_selection_criteria_expr start_dttm is_requested_by 0..* id start_offset_qty location_selection_criteria_expr status_cd priority_cd repeating_interval_duration_tmr 1 requests repeat_pattern_expr rqst_event_reason_cd rqsted_duration_tmr start_tmr time_selection_criteria_expr explicit_time_interval_expr Individual_healthcare_practitioner_request Default Update Mode 0..* Constraint/Note # 0..* has_as_contact pertains_to is_the_recipient_of 1 Quantity/ Time Generalizations Mandatory has_as_a_parent_document 0..1 transcribes <<Data_type>> Binary_data : BIN <<Data_type>> No_information : NULL Domain Specification (#) 0..1 is_role_of <<Data_type>> Floating_point : FPN Cardinality Document_recipient 0..1 of <<Data_type>> Physical_quantity : PQ Row Number Originator 0..1 of 0..1 is_role_of Stakeholder_affiliation affiliation_type_cd desc effective_dt termination_dt Generic <<Data_type>> Point_in_time : TS Demographic <<Data_type>> Number : N Row Type created_by 1 Healthcare_document_authenticator 0..1 is_a has_as_secondary_participant 0..* <<Data_type>> Ratio : RTO <<Data_type>> Boolean : BL <<Data_type>> Code_value : CV <<Data_type>> Concept_descriptor : CD Former Row Patient_encounters Healthcare_finances Master_service <<Data_type>> allowable_processing_priority_cd Code_translation : CDXL allowable_reporting_priority_cd challenge_information_txt confidentiality_cd <<Data_type>> effective_tmr Code_phrase : CDPH factors_that_may_affect_observation_desc is_requested_by 1 fixed_canned_message_cd <<Data_type>> imaging_measurement_modality_cd ISO_object_identifier : OID is_target 1 incompatible_change_dttm interpretation_considerations_desc kind_of_quantity_observed_cd has_target 0..* <<Data_type>> last_update_dttm Real_world_instance_identifier : RWII Master_service_relationship method_cd relationship_type_cd nature_of_service_cd T, S, R reflex_testing_trigger_rules_desc observation_id_suffix_txt constraint_txt orderable_service_ind <<Data_type>> qt patient_preparation_desc Collection : COLL point_versus_interval_cd portable_device_ind T, R has_source 0..* report_display_order_txt <<Data_type>> is_source 1 alternate_id Bag : BAG alternate_name_use_cd alternate_nm T, R is_delivered_during 1 contraindication_desc desc <<Data_type>> Master_specimen_requirement performance_schedule_cd List : LIST primary_nm additive_cd T, R standard_time_to_perform_qty container_desc target_anatomic_site_cd container_preparation_desc <<Data_type>> universal_service_id container_volume_qty Set : SET qt derived_specimen_cd join_cd minimum_collection_volume_qty when_to_charge_cd normal_collection_volume_qty consent_required_cd special_handling_desc priority_cd 1 is_instantiated_as retention_time_qty type_cd is_produced_by 1..1 0..* produces Row Type Master_tables Healthcare_finances Healthcare_stakeholders Healthcare_finances 1 0..* is_related_to Clinical_document_header 0..* documents availability_status_cd change_reason_cd completion_status_cd confidentiality_status_cd content_presentation_cd Patient_information_disclosure document_header_creation_dttm disclosure_dttm file_nm info_disclosed_desc id info_requested_desc last_edit_dttm reason_cd has_been_originated_by 0..* origination_dttm requested_dttm reporting_priority_cd urgency_cd results_report_dttm storage_status_cd is_provided_to 0..* has_been_received_by 0..* transcription_dttm type_cd 0..1 is_transcribed_by 0..* document_change_cd is_parent_document_for contained_in 0..* 0..* Row Number is_source_of 0..* Healthcare_finances Healthcare_finances Producer_of_master_service service_producing_department_type_cd is_related_to Former Row has_as_participant 0..* Authentication authentication_dttm 0..* is_related_to type_cd Default Value (#) <<Data_type>> Character_string : ST <<Data_type>> Free_text : FTX is_covered_by 1..* HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0092 released September, 1999 reflects agreements made through harmonization in June, 1999 © 1999, 2000 Health Level 7 99 Union: C00XXM M Build the Message Element Section • 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 January 24, 2000 © 1999, 2000 Health Level 7 100 Sample Information Model Mapping and Message Elements Row Type Row Number b Former Row Information Model Mapping Class or Property of Class (Attribute or Association) Rim Source Class 8 9 3 cla 4 att Patient id Patient Patient 10 5 att status_cd Patient 11 6 itm 12 7 att 13 14 15 16 17 18 19 20 21 22 23 24 25 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 Message Elements Patient Message Element Name Patient id status_cd _item_CV Message in Element Short Message Name Element Type Pt id Pt Pt II status Pt Set <CV> _CV Pt CV CV ambulatory_status_cd Patient ambulatory_status_cd ambltryStatus Pt 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 Person Person Person Person Person Person Person Person Stakeholder 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 nwbrnInd multbrthInd orgnDonrInd PtPrsn brthDttm brthplcAddr decesdDttm educnLevl gendr maritlStatus race relgsAfiltn phon Pt Pt Pt Pt PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn PtPrsn January 24, 2000 © 1999, 2000 Health Level 7 of Message Element Type BL BL BL PtPrsn TS ST TS CV CV CV CV CV Set <TIL> 101 Finish With Message Structure • Specify the constraints on each element – Cardinality for this message – Domain from which the data field will be drawn • Vocabulary reference, constraint predicate, etc. • Coding strength – – – – – Mandatory Requirement Default Values Update parameters Conformance Flag Notes and comments January 24, 2000 © 1999, 2000 Health Level 7 102 Interactions and Message Structures Section Encounter_manager : AR_ Encounter_manager Encounter_tracker : AR_ Encounter_tracker Encounter_archivist : AR_ Encounter_archivist interaction #1, message structure A Trigger Event: Schedule Encounter interaction #2, message structure B Trigger Event: Delete Scheduled Encounter interaction #3, message structure C interaction #4, Message Structure C Trigger Event: Admit Patient interaction #5, message structure D Hierarchichal Message Description for Trigger Event "Admit Patient", Sending Application Role "Encounter Manager" Inf ormation Model Mapping 1 root January 24, 2000 Patient_encounter 1 Message Structures Message Elements 1 ENC ENC C 1 D M 1 status_cd 1 CE status_cd 1 26 M 1 M 1 encounter_classification_cd 1 CE encounter_classification_cd 2 12 M 1 M 1 id 1 ST id 3 M 1 M 1 end_dttm 1 VTS end_dttm 4 R 1 R 1 expected_insurance_plan_qty 1 NM expected_insurance_plan_qt 5 y R 1 R 1 first_similar_illness_dt 1 VTS first_similar_illness_dt 6 R 1 R 1 patient_classification_cd 1 CE patient_classification_cd 7 R 1 R 1 start_dttm 1 VTS start_dttm 8 M 1 M 1 3 13 4 M 1 3 © 1999, 2000 Health Level 7 103 1 1 0..1 0..1 0..1 0..1 1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..1 0..* M No V R M No R R M No R R 2 <edctnLevl> <martlStatus> <race> <relgsAfltn> 14 January 24, 2000 R R R R R R R R R © 1999, 2000 Health Level 7 Cardinality Conformance Flag Update Mode Default Value (#) Constraint/Note # C00XMM011 Mandatory Domain Specification (#) Cardinality Conformance Flag Common Constraints Update Mode Default Value (#) Constraint/Note # Mandatory Domain Specification (#) Conformance Flag Update mode set Constraint/Note # Default Update Mode <@state, EXT:CNE> <@state, EXT:CNE> <ambltr Status> <clasfcn> Default Value (#) 1 1 Mandatory Domain Specification (#) Cardinality Message Structures Union: C00XXMM C00XMM013 R R R R R R 104 Implementation Technology Specification • 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 objectinterfaces, 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 January 24, 2000 © 1999, 2000 Health Level 7 105 Implementation Technology Specification – 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 • Character based interfaces – XML Will be the initial technology for v3.0 – ER7, ASN.1 • Object Broker Technology – CORBA – Active-X/DCOM • Others – EDIFACT is a possibility January 24, 2000 © 1999, 2000 Health Level 7 106 Putting the pieces together Implementation Technology Specification "Send as ASCII string in XML format" Hierarchical Message Definition "Discontinue pharmacy order" ITS for XML Data HL7 Message Creation Message Instance HL7-Conformant Application January 24, 2000 © 1999, 2000 Health Level 7 HL7 Message Parsing Data HL7-Conformant Application 107 An HL7 V2.3 Message MSH|^~\&|LABGL1||DMCRES||199812300100||ORU^R01|LABGL1199510221838581|P|2.3 |||NE|NE PID|||6910828^Y^C8||NewmanÂlfredÊ||19720812|M||W|25 Centscheap Ave^^ WhatmeworryÛT^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^^^^MDÛPIN ||||||||||Ônce||||||CA20837^Spinosa^John^^^^MDÛPIN OBX||NM|4544-3^HEMATOCRIT (AUTOMATED)^LN||45||39-49 ||||F|||199812292128||CA20837 OBX||NM|789-8ÊRYTHROCYTES COUNT (AUTOMATED)^LN||4.94|10*12/mm3 |4.30-5.90||||F|||199812292128||CA20837 A sample results message January 24, 2000 © 1999, 2000 Health Level 7 108 V3 XML Prototype - same data <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> January 24, 2000 © 1999, 2000 Health Level 7 109 So how is all this done? • 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 January 24, 2000 © 1999, 2000 Health Level 7 110 Tools that are used • Rational Rose98 (commercial product) – Version 4.5 or later • RoseTree_II* – Current Version 20215 • HL7Tools.mdb* – not versioned – useful for working with the repositories • Microsoft Access and Excel (commercial product) – Office ‘97 Versions * have help files January 24, 2000 © 1999, 2000 Health Level 7 111 Summary of V3 Features • 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 • Eliminates rampant optionality in the messages – reduces implementation effort • Application roles are a basis for component functional specifications • Provides verifiable conformance claims January 24, 2000 © 1999, 2000 Health Level 7 112 Credits This innovative approach was developed through significant contributions by the following people (listed alphabetically): • • • • • • • • • Woody Beeler, Mayo Foundation Norman Daoust, Partners Healthcare Gary Dickenson Yakov Golder, Consultant Jack Harrington, Hewlett Packard Stan Huff, IHC Clem McDonald, Regenstreif Institute Ted Klein, cMore Medical Solutions Charlie Mead, CareCentric Solutions January 24, 2000 • • • • • • • • • • Linda Quade, Eli Lilly and Company Larry Reis, Wizdom Systems Wes Rishel, Wes Rishel Consulting Mark Shafarman Oacis Healthcare Systems Gunther Schadow, Regenstreif Institute Rob Seliger, Sentillion Abdul-Malik Shakir, The Huntington Group Mark Tucker, Regenstreif Institute Karen Van Hentenryck, HL7 Mead Walker, The Huntington Group © 1999, 2000 Health Level 7 113 Bibliography (classics) • 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. January 24, 2000 © 1999, 2000 Health Level 7 114 Bibliography (additional) • 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. January 24, 2000 © 1999, 2000 Health Level 7 115 Bibliography (periodicals) • Object Magazine, SIGS Publication • Distributed Object Computing (DOC) • Journal of Object-Oriented Programming (JOOP) January 24, 2000 © 1999, 2000 Health Level 7 116 Thank You! E-mail: tedk@cmoremedical.com Presentation: http://www.hl7.org/library/general/V3introtutorial.ppt January 24, 2000 © 1999, 2000 Health Level 7 117

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