, NPfIT and the International Input into HL7 HL7 UK Annual Conference London Nov. 2nd 2004 NPfIT and the International Input into HL7 HL7 UK Annual Conference.

,

NPfIT and the

International Input

into HL7

HL7 UK Annual Conference

London Nov. 2nd 2004

NPfIT and the

International Input

into HL7

HL7 UK Annual Conference

London Nov. 2nd 2004

HL7v3 - A standard whose time has comeHL7v3 - A standard whose time has come

Dr. Tim JonesEnterprise Architect &Design Authority NHS Care RecordNational Programme for IT

AgendaAgenda

• HL7v3 - a standard whose time has come

• HL7 an International Organisation

• Real V3 projects around the world

• Additional areas of UK input

• How NPfIT is using HL7v3– Clinical Statements, Care Record

Elements, business objects & record architecture

• Questions

• HL7v3 - a standard whose time has come

• HL7 an International Organisation

• Real V3 projects around the world

• Additional areas of UK input

• How NPfIT is using HL7v3– Clinical Statements, Care Record

Elements, business objects & record architecture

• Questions

HL7v3A Standard whose time has come

HL7v3A Standard whose time has come

•Where have we come from with v3?– 2001

Initial Draft of HL7v3

– 2002 NPfIT commit to central role of HL7v3

– 2003 First normative Elements of HL7

– 2004 NPfIT Message Implementation manual

published 8th V3 ballot

•Where have we come from with v3?– 2001

Initial Draft of HL7v3

– 2002 NPfIT commit to central role of HL7v3

– 2003 First normative Elements of HL7

– 2004 NPfIT Message Implementation manual

published 8th V3 ballot

HL7 an International OrganisationHL7 an International Organisation

•Recent Working Group meeting in Atlanta– V3 coming of age party!– HL7 maturation into truly international

organisation HL7 affiliates in 28 Countries

– Tributes paid to the considerable international efforts

•HL7 Board Advisory Committee– Recognised the need to behave as an truly

international organisation

•Recent Working Group meeting in Atlanta– V3 coming of age party!– HL7 maturation into truly international

organisation HL7 affiliates in 28 Countries

– Tributes paid to the considerable international efforts

•HL7 Board Advisory Committee– Recognised the need to behave as an truly

international organisation

HL7v3 – It’s here, it’s real!HL7v3 – It’s here, it’s real!

• Canada– National e-claims project

• England– NPfIT Programme

• Netherlands– Pharmacy, GP Summary, Claims

• Mexico– Instituto Mexicano del Seguro Social eHR

• New Zealand– Health Event Summary

• US– CDC Public Health Information Network– National Cancer Institute Bioinformatics Grid

• Canada– National e-claims project

• England– NPfIT Programme

• Netherlands– Pharmacy, GP Summary, Claims

• Mexico– Instituto Mexicano del Seguro Social eHR

• New Zealand– Health Event Summary

• US– CDC Public Health Information Network– National Cancer Institute Bioinformatics Grid

eClaims in CanadaeClaims in Canada

• Right across Canada– All providers– All payors

Private and Public insurers

• Domains– Pharmacy– Chiropractic– Physiotherapy– Oral Health– Vision Care– Physicians (planned)

• Direct interface from practice management systems– Standard centrally provided HL7v3 API

• Generic claims, pharmacy and preferred accommodation – first messages to pass the HL7 v3 membership ballot

• Right across Canada– All providers– All payors

Private and Public insurers

• Domains– Pharmacy– Chiropractic– Physiotherapy– Oral Health– Vision Care– Physicians (planned)

• Direct interface from practice management systems– Standard centrally provided HL7v3 API

• Generic claims, pharmacy and preferred accommodation – first messages to pass the HL7 v3 membership ballot

NICTIZ in the NetherlandsNICTIZ in the Netherlands

• Objectives– Nationwide record of drug dispense information– GP professional summary– Claims and reimbursements

• Status– Pharmacy

First regions implementing

– GP Professional Summary 3 vendor developments

– Claims and reimbursements HL7v3 development work started

• Objectives– Nationwide record of drug dispense information– GP professional summary– Claims and reimbursements

• Status– Pharmacy

First regions implementing

– GP Professional Summary 3 vendor developments

– Claims and reimbursements HL7v3 development work started

IMSS in MexicoIMSS in Mexico• Healthcare Enterprise

– Serving 60million affiliates of a population of 100 million 1077 out-patient clinics 223 General Hospitals 40 Tertiary referral Centres

• Phase 1 – Oct 2002 to June 2004– Lab

Orders and results– Haemodialysis

Entrance, sessions and discharge events– Blood Bank

Observation order and event Eligibility Product storage and supply

• Planned– Out-patients– Transplants– Transfusions

• Healthcare Enterprise– Serving 60million affiliates of a population of 100 million

1077 out-patient clinics 223 General Hospitals 40 Tertiary referral Centres

• Phase 1 – Oct 2002 to June 2004– Lab

Orders and results– Haemodialysis

Entrance, sessions and discharge events– Blood Bank

Observation order and event Eligibility Product storage and supply

• Planned– Out-patients– Transplants– Transfusions

New Zealand CDANew Zealand CDA

• CDA Pilots– Counties Manukau district Health Board– Lakes District Health Board

• Health Event Summary – Basis of EHR– Dataset mapped to CDA– Extensive international harmonisation

• Initial Focuses– Electronic Discharge Summary– Guideline-based referral

• Driving development of CDA v2 development– in conjunction with Australia

• CDA Pilots– Counties Manukau district Health Board– Lakes District Health Board

• Health Event Summary – Basis of EHR– Dataset mapped to CDA– Extensive international harmonisation

• Initial Focuses– Electronic Discharge Summary– Guideline-based referral

• Driving development of CDA v2 development– in conjunction with Australia

Additional UK ParticipationAdditional UK Participation

• NPfIT and HL7 UK active in all relevant SIG and technical committees

• Highlights:– New Clinical Statement SIG

Continued evolution of standard Fortnightly conference calls

– New TermInfo SIG Focus on synergistic combined use of SNOMED CT and

HL7v3– Guideline SIG

HDM modelling of guidelines & other related areas– E.g. care pathways input from NHS

Tie in with Patient Care DMIM development– Templates

Substantial UK input from HL7 UK and NPfIT Being used at design and runtime

• NPfIT and HL7 UK active in all relevant SIG and technical committees

• Highlights:– New Clinical Statement SIG

Continued evolution of standard Fortnightly conference calls

– New TermInfo SIG Focus on synergistic combined use of SNOMED CT and

HL7v3– Guideline SIG

HDM modelling of guidelines & other related areas– E.g. care pathways input from NHS

Tie in with Patient Care DMIM development– Templates

Substantial UK input from HL7 UK and NPfIT Being used at design and runtime

How is the English NHS using v3?How is the English NHS using v3?

• Very clinically-focused– Based on the “Clinical Statement” model

allows very expressive representation of clinical language Tightly coupled with SNOMED CT

• Clinical Statement Message Pattern– Harmonisation with global HL7 communities:

Patient Care Structured Documents (CDA) Orders and Observations

• Persistent Clinical statements– basis of shared PSIS record as Care Record

Elements

• Very clinically-focused– Based on the “Clinical Statement” model

allows very expressive representation of clinical language Tightly coupled with SNOMED CT

• Clinical Statement Message Pattern– Harmonisation with global HL7 communities:

Patient Care Structured Documents (CDA) Orders and Observations

• Persistent Clinical statements– basis of shared PSIS record as Care Record

Elements

ClinicalStatementChoice

Note:This relationship is used for relationships betweenstatements that can be expressed as references tothe unique identifier of a target statement. The modelalso supports direct relationships to completeinstances of statements (see recursive sourceOf3)and these relationships are semantically identical. Arelationship to a reference is preferred where a directrelationship would lead to duplication.

Note:Used to support participation types that arenot specifically enumerated in the model.

Note:A document or a reference to a document that is notpart of the current communication but which isaccessible to the recipient.The text attribute is of type ED (Encapsulated Data),which permits the inclusion of a MIME type and eitheran inline representation of the data or a reference tothe location of the data (e.g. a URL).

Note:ActRef is used to refer to a full instance of anyclinical statement. The classCode and moodCodeof the reference shall have the same values as theact to which reference is being made.

According to the context of use the referenced Actmay be in the current communication or in apreviously communicated message and availablefrom a shared repository (PSIS).

Note:This sparse representation ofspecimen is for inclusion in aclinical record and relatedcommunications. It needsextension to support the needsof full laboratory result reporting.

Note:This is a sparse representation ofmedicinal products. It is intendedto identify a medication in a clinicalrecord or general communication.It would need extension to meetfull eTP requirements.

Note:Indicates a known author other thanthe author/originator of the message.

Note:Applicable where the subject of an observation orprocedure is not the patient who is the recordTargetof the message.

Note:All classes within the choice can be modified by mood toconvey information about an actual event or requests,goals, recommendations or plans for an event.

Note:This is a place holder for the specific act that is the focusof a particular communication. Where this event is thenotification of a clinical statement (eg. an encounter), thisact becomes little more than an ‘anchor’ to support theassociated classes.

Note:This association is used for direct relationships betweenstatements except the specific case of context rich containmentas specified in ENV13606. Relationships to references ratherthan complete instances are also supported (see ActRef) andthese relationships are semantically identical.

A direct relationship should be used only if one statement isonly relevant in the context of another statement.

Note:This relationship is used for context richcontainment of the type specified in ENV13606.The source of this must be a Organizer, but thetarget may be any type of clinical statement fromthe choice box.

Note:Additional information about patient demographicscould be added if required by adding an associatedPerson entity. However NPfIT assumes use of theNHS number to identify all patients, with PDS usedto provide patient demographics as necessary.

Generic Clinical Communication Pattern(XXXX_RM-NPfITUK13)

This entry point should be regarded as a prototypeentry point for a generic clinical communication. Inspecific messages the nature of the classes attachedto the entry point will be refined and potentially thegeneral component and participation links may beunwrapped and refined.

The pertinentInformation link is designed as a consistentway to convey clinical / EHR related information asrequired with any specific message.

MaterialclassCode*: <= MATdeterminerCode*: <= INSTANCEid: II [0..1]code: CE CNE [0..1] <= EntityCodequantity: PQ [0..1]desc: ED [0..1]statusCode: CS CNE [0..1] <= EntityStatusexistenceTime: IVL<TS> [0..1]riskCode: CE CNE [0..1] <= EntityRiskhandlingCode: CE CNE [0..1] <= EntityHandlingformCode: CE CNE [0..1] <= MaterialForm

ManufacturedMaterialclassCode*: <= MMATdeterminerCode*: <= EntityDeterminercode: CE CWE [0..1] <= DrugEntitylotNumberText: ST [0..1]expirationTime: TS [0..1]

SubjectPersonclassCode*: <= PSNdeterminerCode*: <= INSTANCEname: BAG<PN> [0..*]administrativeGenderCode: CV CNE [0..1] <= AdministrativeGenderbirthTime: TS [0..1]deceasedTime: TS [0..1]

0..1 specimenMaterial

SpecimenRoleclassCode*: <= SPECid: II [0..1]code: CE CWE [0..1] <= RoleCode

PatientclassCode*: <= PATid*: II [1..1]

1..1 manufacturedManufacturedMaterial

ManufacturedProductclassCode*: <= MANU

0..1 documentSubject

SubjectRoleclassCode*: <= x_DocumentSubjectid: II [0..1]code*: CE CNE [1..1] <= RoleCodeaddr: SET<AD> [0..*]telecom: SET<TEL> [0..*]

0..* referenceObservationCriterion

referenceRangetypeCode*: <= REFVcontextConductionInd*: BL [1..1] "true"seperatableInd*: BL [1..1] "true"

0..* target

sourceOf3typeCode*: <= ActRelationshipTypeinversionInd*: BL [1..1] "false"sequenceNumber: INT [0..1]negationInd*: BL [1..1] "false"seperatableInd*: BL [1..1] "true"templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf1"

1..* pertinentClinicalStatementChoice *

pertinentInformation1typeCode*: <= PERTcontextConductionInd*: BL [1..1] "true"sequenceNumber: INT [0..1]templateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation"

0..* referredToExternalDocument

referencetypeCode*: <= x_ActRelationshipExternalReferencecontextConductionInd*: BL [1..1] "false"sequenceNumber: INT [0..1]seperatableInd*: BL [1..1] "true"

0..* dosageCriterion

preconditiontypeCode*: <= PRCNcontextConductionInd*: BL [1..1] "true"seperatableInd*: BL [1..1] "true"

0..* specimenRole

specimentypeCode*: <= SPCcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

1..1 patient *

recordTargettypeCode*: <= RCT

0..1 participant

authortypeCode*: <= AUTfunctionCode: CS CNE [0..1] <= ParticipationFunctioncontextControlCode*: CS CNE [1..1] <= OPtime*: TS [1..1]signatureText: ED [0..1]

0..1 participant

locationtypeCode*: <= LOCcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

0..* informantRole

informanttypeCode*: <= INFcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"time: IVL<TS> [0..1]modeCode: CS CNE [0..1] <= ParticipationMode

0..* manufacturedProduct

consumabletypeCode*: <= CSMcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

0..1 subjectRole

subjecttypeCode*: <= SBJcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"

0..* participant

participanttypeCode*: <= ParticipationTypecontextControlCode*: CS CNE [1..1] <= ContextControl "OP"time: IVL<TS> [0..1]signatureText: ED [0..1]

0..* participant

performertypeCode*: <= PRFcontextControlCode*: CS CNE [1..1] <= ContextControl "OP"time: IVL<TS> [0..1]modeCode: CS CNE [0..1] <= ParticipationMode

component

2..* clinicalStatementChoice

typeCode*: <= COMPinversionInd*: BL [1..1] "false"contextConductionInd*: BL [1..1] "true"sequenceNumber: INT [0..1]seperatableInd*: BL [1..1] "false"templateId*: II [1..1] "CSAB_RM-NPfITUK10.component"

ObservationCriterionclassCode*: <= OBSmoodCode*: <= EVN.CRTtext: ED [0..1]value: ANY [0..1]interpretationCode: CE CNE [1..1] <= ObservationInterpretationNormality

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

FocusActOrEventclassCode*: <= ACTmoodCode*: <= ActMoodid*: LIST<II> [1..2]code: CD CNE [0..1] <= ActCodetitle: ST [0..1]text: ST [0..1]statusCode: CS CNE [0..1] <= ActStatuseffectiveTime: IVL<TS> [0..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CS CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityuncertaintyCode: CE CNE [0..1] <= ActUncertaintylanguageCode: CS CNE [0..1] <= HumanLanguage

SupplyclassCode*: <= SPLYmoodCode*: <= x_ActMoodIntentEventid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-Supplytitle: ST [0..1]statusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: IVL<TS> [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: SET<CE> CNE [0..*] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityrepeatNumber: IVL<INT> [0..1]interruptibleInd: BL [0..1]reasonCode: CV CNE [0..1] <= ActReasonlanguageCode: CE CNE [0..1] <= HumanLanguagequantity: PQ [0..1]expectedUseTime: IVL<TS> [0..1]

ObservationclassCode*: <= OBSmoodCode*: <= ActMoodid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-ObservationderivationExpr: ST [0..1]statusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: IVL<TS> [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CS CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityrepeatNumber: IVL<INT> [0..1]languageCode: CS CNE [0..1] <= HumanLanguagevalue: ANY [0..1]interpretationCode: CS CNE [0..1] <= ObservationInterpretation

SubstanceAdministrationclassCode*: <= SBADMmoodCode*: <= x_DocumentSubstanceMoodid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-AdministrationstatusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: GTS [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CS CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityrepeatNumber: IVL<INT> [0..1]interruptibleInd: BL [0..1]languageCode: CS CNE [0..1] <= HumanLanguagedoseQuantity: IVL<PQ> [0..1]rateQuantity: IVL<PQ> [0..1]doseCheckQuantity: SET<RTO<QTY,QTY>> [0..*]maxDoseQuantity: RTO<QTY,QTY> [0..1]

ProcedureclassCode*: <= PROCmoodCode*: <= x_ActMoodIntentEventid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-ProcedurestatusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: GTS [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CE CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityinterruptibleInd: BL [0..1]languageCode: CS CNE [0..1] <= HumanLanguage

DosageCriterionclassCode*: <= OBSmoodCode*: <= EVN.CRTcode: CD CWE [0..1] <= ActCodetext: ED [0..1]value: ANY [0..1]

EncounterclassCode*: <= ENCmoodCode*: <= x_ActMoodIntentEventid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-EncounterstatusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: GTS [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CE CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityinterruptibleInd: BL [0..1]languageCode: CE CNE [0..1] <= HumanLanguageadmissionReferralSourceCode: CE CNE [0..1] <= EncounterReferralSourcelengthOfStayQuantity: PQ [0..1]dischargeDispositionCode: CE CNE [0..1] <= EncounterDischargeDispositionacuityLevelCode: CE CNE [0..1] <= EncounterAcuitypreAdmitTestInd: BL [0..1]specialCourtesiesCode: SET<CE> CNE [0..*] <= EncounterSpecialCourtesyspecialArrangementCode: SET<CE> CNE [0..*] <= SpecialAccommodation

ExternalDocumentclassCode*: <= DOCmoodCode*: <= EVNid: II [0..1]code: CD CNE [0..1] <= DocumentTypetitle: ST [0..1]text: ED [0..1]setId: II [0..1]versionNumber: INT [0..1]

OrganizerclassCode*: <= ActContainermoodCode*: <= ActMoodid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-Organizertitle: ST [0..1]statusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: IVL<TS> [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: CS CNE [0..1] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialitylanguageCode: CS CNE [0..1] <= HumanLanguage

ConsentclassCode*: <= CONSmoodCode*: <= x_ActMoodIntentEventid*: LIST<II> [1..2]code*: CD CNE [1..1] <= SnomedCT-ConsentstatusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: IVL<TS> [1..1]activityTime: TS [0..1]availabilityTime: TS [0..1]confidentialityCode: SET<CE> CNE [0..*] <= ConfidentialitylanguageCode: CS CNE [0..1] <= HumanLanguage

SupportingInfoclassCode*: <= OBSmoodCode*: <= EVNcode: CV CNE [0..1] <= ActCodetext: ST [0..1]effectiveTime: IVL<TS> [0..1]value: ANY [0..1]

0..* pertinentSupportingInfo

typeCode*: <= PERTcontextConductionInd*: BL [1..1] "true"sequenceNumber: INT [0..1]seperatableInd*: BL [1..1] "true"

pertinentInformation

Note:Used to provide additional supporting informationthat can be seen as an extension of a specific clinicalstatement - code specifies the ‘type’ of the supportinginformation. All contextual information (id, author, dates etc)of the source statement apply to this commentary. The informationshall NOT be used to change the meaning of the statementto which it refers or to provide information that shouldproperly be a separate clinical statement.

0..*

specimen


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

product

0..*

participant

0..1 participant

typeCode*: <= AUT

author

Note:All Clinical Statements that relate directly tothe FocusActOrEvent arepertinentInformation and there shall be atleast one Clinical Statement of this type(otherwise there would be no need for thispattern to be used!).

StatementRelationshipclassCode*: <= OBSmoodCode*: <= EVNid*: LIST<II> [1..2]code*: CD CNE [1..1] <= Snomed-RelationshipeffectiveTime*: IVL<TS> [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]

CMET: (ROL) R_AgentNPFITPerson

[universal](UKCT_MT120201UK01)

CMET: (ROL) R_AgentNPFITDevice


AuthorChoice

CMET: (ROL) R_AgentNPFITOrganization


CMET: (ROL) R_AgentNPFIT


Note:Establishes a relationship (eg. Cause/Effect)between two or more other clinical statements.This separate statement shall be used whenthe context (eg. author, date etc.) differs fromthe context of the statements being related.





DocAuthorChoice

2..* target *

typeCode*: <= ActRelationshipTypeinversionInd*: BL [1..1]sequenceNumber: INT [0..1]negationInd*: BL [1..1] "false"seperatableInd*: BL [1..1] "false"templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf"

sourceOf1

sourceOf2

0..* target

typeCode*: <= ActRelationshipTypeinversionInd*: BL [1..1] "false"contextConductionInd*: BL [1..1] "true"sequenceNumber: INT [0..1]negationInd*: BL [1..1] "false"seperatableInd*: BL [1..1] "true"templateId*: II [1..1] "CSAB_RM-NPfITUK10.sourceOf2"

0..1 playingInformantPerson

InformantRoleclassCode*: <= ROLid: SET<II> [0..*]code: CE CNE [0..1] <= RoleCodeaddr: AD [0..1]telecom: TEL [0..1]

InformantPersonclassCode*: <= PSNdeterminerCode*: <= INSTANCEname: PN [0..1]

Note:InformantRole should only beused where the source of theinformation is not an HCP.

ActRef

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

0..1 priorMessageRef

typeCode*: <= RPLCreplacementOf

Note:Provides a mechanism for referring to amessage payload that this messagereplaces. Id is the classCode, moodCodeand id are those of the target Focal Act.

Note:At least one instance of inversionIndmust be “true” and at least one mustbe “false”

Note:FocalActCategory provides a mechanismfor informing the business recipient of themessage the ‘role’ of each clinicalstatement in supporting the focal act.

1..* pertinentCRECategory

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

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

1..* actRef

typeCode*: <= COMP

component

FocalActCategoryclassCode*: <= CATEGORYmoodCode*: <= EVNcode*: CV CNE [1..1] <= FocalActCategory

Note:Leaving this association asoptional, allows a positivestatement that ‘there are NOclinical statements in thiscategory’.

ActRef

0..* pertinentFocalActCategory

typeCode*: <= PERTtemplateId*: II [1..1] "CSAB_RM-NPfITUK10.pertinentInformation2"

pertinentInformation3

0..* actRef

typeCode*: <= COMP

component

ActRefNote:CareRecordElementCategory is a classificationof clinical statements that is required when theclinical statements may be of interest to PSIS.All clinical statements in the message shall becategorised in this way, either by directreference or by a reference to a ‘container’ of #which the act is a part.



SupplyInfoclassCode*: <= SPLYmoodCode*: <= x_ActMoodIntentEventcode*: CD CNE [1..1] <= SnomedCT-Supplytitle: ST [0..1]statusCode: CS CNE [0..1] <= ActStatuseffectiveTime*: IVL<TS> [1..1]activityTime: IVL<TS> [0..1]availabilityTime: TS [0..1]priorityCode: SET<CE> CNE [0..*] <= ActPriorityconfidentialityCode: SET<CE> CNE [0..*] <= ConfidentialityrepeatNumber: IVL<INT> [0..1]interruptibleInd: BL [0..1]reasonCode: CV CNE [0..1] <= ActReasonlanguageCode: CE CNE [0..1] <= HumanLanguagequantity: PQ [0..1]expectedUseTime: IVL<TS> [0..1]

0..*


Note:Shadow relationship toSupportingInfo

0..* target

typeCode*: <= ActRelationshipTypecontextConductionInd*: BL [1..1] "true"sequenceNumber: INT [0..1]seperatableInd*: BL [1..1] "true"

sourceOf

NPfIT Clinical Statement Message Pattern

NPFIT-FNT-TO-DPM-0053.01Version No. 1.4

13 October 2004 Draft

What is a Clinical Statement?What is a Clinical Statement?

• "An expression of a discrete item of clinical (or clinically related) information that is recorded because of its relevance to the care of a patient” – i.e. an elemental unit of clinical meaning

• An HL7 Act with an id whose attribute and relationship “signature” conforms to the Clinical Statement pattern– Including the Acts context and related id-less Acts

and inseparable Acts– i.e. a molecular unit of clinical meaning

Therefore potentially recursive and complicated

• "An expression of a discrete item of clinical (or clinically related) information that is recorded because of its relevance to the care of a patient” – i.e. an elemental unit of clinical meaning

• An HL7 Act with an id whose attribute and relationship “signature” conforms to the Clinical Statement pattern– Including the Acts context and related id-less Acts

and inseparable Acts– i.e. a molecular unit of clinical meaning

Therefore potentially recursive and complicated
































0..* target








0..* specimenRole


1..1 patient *


0..1 participant


0..1 participant


0..* informantRole




0..1 subjectRole


0..* participant


0..* participant


component




















0..*

specimen



product

0..*

participant

0..1 participant

typeCode*: <= AUT

author







AuthorChoice










DocAuthorChoice

2..* target *


sourceOf1

sourceOf2

0..* target






ActRef










1..* actRef

typeCode*: <= COMP

component



ActRef




0..* actRef

typeCode*: <= COMP

component





0..*



0..* target


sourceOf




Clinical Statement Relationships Clinical Statement Relationships

• Simple and rich links between Clinical Statements– E.g. fulfilment, causation, outcome

• Three mechanisms– ActRelationships

XML containment– ActRefs

Pointers– StatementRelationships

Observation of relationship between Acts More expressive SNOMED CT types Independent context from source Act

• Basis of update semantics– Through clinical statement supersession

• Simple and rich links between Clinical Statements– E.g. fulfilment, causation, outcome

• Three mechanisms– ActRelationships

XML containment– ActRefs

Pointers– StatementRelationships

Observation of relationship between Acts More expressive SNOMED CT types Independent context from source Act

• Basis of update semantics– Through clinical statement supersession
































0..* target








0..* specimenRole


1..1 patient *


0..1 participant


0..1 participant


0..* informantRole




0..1 subjectRole


0..* participant


0..* participant


component




















0..*

specimen



product

0..*

participant

0..1 participant

typeCode*: <= AUT

author







AuthorChoice










DocAuthorChoice

2..* target *


sourceOf1

sourceOf2

0..* target






ActRef










1..* actRef

typeCode*: <= COMP

component



ActRef




0..* actRef

typeCode*: <= COMP

component





0..*



0..* target


sourceOf




Clinical Statement Message PatternClinical Statement Message Pattern

•All messages based on harmonised Clinical Statement Message Pattern

•Use of templates– “templateId” attribute identifies elements

based on more abstract model Identifies a class in an HL7 Model template

(RMIM) to which a class conforms Permits swifter parsing of message instances

– Work underway on Templates as building blocks E.g. “Super CMETs with interfaces”

•All messages based on harmonised Clinical Statement Message Pattern

•Use of templates– “templateId” attribute identifies elements

based on more abstract model Identifies a class in an HL7 Model template

(RMIM) to which a class conforms Permits swifter parsing of message instances

– Work underway on Templates as building blocks E.g. “Super CMETs with interfaces”

Care Record ElementsCare Record Elements

•A common record structure underlying the NHS Care Record– Care Record Element Types– Care Record Element Relationships

•Flexible and extensible to facilitate views for:– all potential users– in all integrated care settings– for all types of event

•A common record structure underlying the NHS Care Record– Care Record Element Types– Care Record Element Relationships

•Flexible and extensible to facilitate views for:– all potential users– in all integrated care settings– for all types of event

Care Record Element TypesCare Record Element Types

• Personal Demographics• Care Events• Documents and Correspondence• Problems and Issues• Diagnoses• Findings• Social Context• Family History

• Personal Demographics• Care Events• Documents and Correspondence• Problems and Issues• Diagnoses• Findings• Social Context• Family History

• Procedures• Medication Record• Personal Preferences• Care Pathways• Goals and Outcomes• Risks and Warnings• Functioning and Wellbeing• Additional Record Locations

• Procedures• Medication Record• Personal Preferences• Care Pathways• Goals and Outcomes• Risks and Warnings• Functioning and Wellbeing• Additional Record Locations

cd NPfIT Logical Record Architecture Generalisation Model

RiskOrWarning

Care Relationship

AllergyOrAdv erseReation

Consent Functioning and Wellbeing

- derivationExpression: ST

FamilyHistory

PersonalPreference

Additional Record Location

Care Ev ent Clinical Correspondence

Diagnosis

Procedure

- CRECategory: = Procedures

Problem or Issue

MedicationItem

- prescriptionItemList: PrescriptionItem [0..* ordered]- dispensedItemFlag: BL- administrationItemList: AdministrationItem

SocialContext

LRARoot{root}

- id: LIST<II>- moodCode: CS- code: CD- statusCode: SET<CS>- effectiveTime: GTS- activityTime: IVL<TS>- availabilityTime: TS- priorityCode: SET<CE>- confidentialityCode: SET<CE>

ClinicalObserv ationOrFinding

Inv estigationResult

- derivationExpression: ST

Name: NPfIT Logical Record Architecture Generalisation ModelAuthor: Tim JonesVersion:Created: 28/10/2004 11:14:59Updated: 01/11/2004 22:21:23

activitytime isTS

Observation

- classCode: CS- value: ANY- CRECategory: - repeatNumber: IVL<INT>

ClinicalStatementRelationship

- ClinicalStatementRelationshipType: CD- SourceClass: ST- DestinationClass: ST

Treatment Inv estigation Administrativ eProcedure

CarePathway

Goal Outcome

NHSCR Record ArchitectureNHSCR Record Architecture

• Fundamental CREs– Basis of the record architecture across the NHS Care Record

• Two basic modes of access– Data transfer

Standard messaging and all updates

– User interactive e.g. user waiting for results

• ACRS abstraction layer– Business object based

i.e. useful chunks of clinical information

– Facilitates swift access to “current” data– Provides future support of declarative fine-grained query

access– Simplified XML return formats for rapid consumption

• Fundamental CREs– Basis of the record architecture across the NHS Care Record

• Two basic modes of access– Data transfer

Standard messaging and all updates

– User interactive e.g. user waiting for results

• ACRS abstraction layer– Business object based

i.e. useful chunks of clinical information

– Facilitates swift access to “current” data– Provides future support of declarative fine-grained query

access– Simplified XML return formats for rapid consumption

QuestionsQuestions