8/15/2012C. 2012 HL7 Int'l and Shafarman Consulting, Inc. A brief HL7 Version 3 Introduction for CIMI Mark Shafarman Past Chair HL7 with additional HL7.

8/15/2012 C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

A brief HL7 Version 3 Introduction

for CIMIMark ShafarmanPast Chair HL7

with additional HL7 “roles” of past co-chair International Council past co-chair Control/Query TC past member Architectural

Review Board co-chair Templates WG

CEO & Chief Information Architect Shafarman Consulting, [email protected] +1 510 593 3483

C. 2012 HL7 Int'l and Shafarman Consulting, Inc. 28/15/2012

Agenda:• Brief overview of the HL7 v 3 Reference Information

Model– The HL7 RIM – model of clinical information content

• Some examples from the 2011 Normative edition• Discussion/Questions


Core concepts of HL7 v3 RIM

• The “Act” class and its specializations represent every action of interest in health care.

• Specifically –“an action of interest that has happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. An act is an intentional action in the business domain of HL7. Healthcare (and any profession or business) is constituted of intentional actions. An HL7 Act instance is a record of such an intentional action.


Core concepts of RIM• Every happening is an Act

– Procedures, observations, medications, supply, registration, etc.

• Acts are related through an Act_relationship– composition, preconditions, revisions, support, etc.

• Participation defines the context for an Act– author, performer, subject, location, etc.

• The participants are Roles– patient, provider, practitioner, specimen, healthcare facility

etc.

• Roles are played by Entities– persons, organizations, material, places, devices, etc.


5

Referral

authorized_visits_qty : REAL

Observation

value : ANYinterpretation_cd : SET<CE>method_cd : SET<CE>target_site_cd : SET<CD>derivation_expr : ST

Substance_administration

route_cd : CEapproach_site_cd : SET<CD>dose_qty : IVL<PQ>rate_qty : IVL<PQ>dose_check_qty : SET<RTO>max_dose_qty : SET<RTO>potency_qty : PQsubstitution_cd : CE

Procedure

method_cd : SET<CE>approach_site_cd : SET<CD>target_site_cd : SET<CD>

Supply

qty : PQexpected_use_time : IVL<TS>

Diet

energy_qty : PQcarbohydrate_qty : PQ

Clinical_document

set_id : IIversion_nbr : INTcompletion_cd : CEstorage_cd : CEcopy_time : TS

Container

capacity_qty : PQheight_qty : PQdiameter_qty : PQcap_type_cd : CEseparator_type_cd : CEbarrier_delta_qty : PQbottom_delta_qty : PQ

Access

approach_site_cd : CDtarget_site_cd : CDgauge_qty : PQ

Device

manufacturer_model_nm : STsoftware_nm : STlocal_remote_control_state_cd : CEalert_level_cd : CElast_calibration_time : TS

Employee

job_cd : CEjob_title_nm : STjob_class_cd : CEsalary_type_cd : CEsalary_qty : MOhazard_exposure_txt : EDprotective_equipment_txt : ED

Living_subject

administrative_gender_cd : CEbirth_time : TSdeceased_ind : BLdeceased_time : TSmultiple_birth_ind : BLbirth_order_nbr : INTorgan_donor_ind : BL

Material

form_cd : CE

Assigned_entity

position_cd : CEprimary_care_ind : BL

Certified_entity

recertification_time : TS

Place

mobile_ind : BLaddr : ADdirections_txt : EDposition_txt : EDgps_txt : ST

Manufactured_material

lot_nm : STexpiration_time : TSstability_time : IVL<TS>

Non_Person_living_subject

taxonomic_classification_cd : CEbreed_cd : CEstrain_txt : EDgender_status_cd : CEeuthanasia_ind : BL

Patient

confidentiality_cd : CEvery_important_person_cd : CE

Organization

addr : BAG<AD>standard_industry_class_cd : CE

Account

nm : STcurrency_cd : CEinterest_rate_qty : RTO<MO,PQ>allowed_balance_qty : IVL<MO>

Financial_act

net_amt : MO

Person

addr : BAG<AD>marital_status_cd : CEeducation_level_cd : CEambulatory_status_cd : CEdisability_cd : CEliving_arrangement_cd : CEreligious_affiliation_cd : CEspecial_accommodation_cd : SET<CE>race_cd : SET<CE>ethnic_group_cd : SET<CE>

Working_list

ownership_level_cd : CE

Public_health_case

detection_method_cd : CEtransmission_mode_cd : CEdisease_imported_cd : CE

Patient_encounter

acuity_level_cd : CEadmission_source_cd : CEbirth_encounter_ind : BLdischarge_disposition_cd : CElength_of_stay_qty : PQpre_admit_test_ind : BLreferral_source_cd : CEspecial_courtesies_cd : SET<CE>urgency_cd : CEvaluables_desc : EDvaluables_location_desc : ED

Schedulable_resource

slot_size_increment_qty : PQ

Acts (Financial)

Acts (Clinical)

Infrastructure (Structured documents)

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL VERSION 1.15 (RIM_0115)

Version reflects RIM changes through Harmonization on 03/07/2002 that were approved for implementation following the release of the second committee-level ballot of Version 3.

Billboard produced by:Rochester Outdoor Advertising

Roles

Guarantor

credit_rating_cd : CE

Diagnostic_image

subject_orientation_cd : CE

Imaging_modality

pixel_intensity_relationship_cd : CEspacial_resolution_qty : PQpixel_padding_qty : PQ

Query_ack

query_response_cd : CSmessage_query_cd : CEresult_total_qty : INTresult_current_qty : INTresult_remaining_qty : INT

Query_continuation

continuation_qty : INTstart_result_nbr : INT

Table

rules : CScellspacing : STcellpadding : STsummary : STwidth : STborder : INTframe : CS

Table_structure

halign : CSchar : STcharoff : STvalign : CSlocal_id : ST

Table_column_structure

span : INTwidth : ST

Table_cell

rowspan : INTcolspan : INTabbr : STaxis : STheaders : SET<ED>scope : CS

Local_attr

name : STvalue : ST

Local_markup

ignore_cd : CSdescriptor : STrender : ST

Link_html

title : STname : SThref : EDrel : SET<CE>rev : SET<CE>

Context_structure

local_id : ST

Infrastructure (Structured documents)

Infrastructure (Message control)

Enitites

Message Control

Financial_transaction

credit_exchange_rate_qty : REALdebit_exchange_rate_qty : REALinterest_rate_qty : RTO

Invoice_element

modifier_cd : CEunit_qty : PQunit_price_amt : RTO<MO,PQ>factor_nbr : REALpoints_nbr : REALcoverage_source_cd : CEnotify_subject_ind : BL

Financial_contract

payment_terms_cd : CE

Role_heirEntity_heir

Sort_control

element_nm : STsequence_nbr : INTdirection_cd : CS

Query_spec

execution_and_delivery_time : TSinitial_qty : INTinitial_qty_cd : CEmessage_query_cd : CEmodify_cd : CSresponse_modality_cd : CSresponse_priority_cd : CSresponse_element_group_id : SET<II>

0..n 1

is_for

0..n

has

1

Relational_expression

element_nm : STvalue : STrelational_operator_cd : CS

Query_by_selection Selection_expression0..n1is_for

0..n

has_ex pression

1

Logical_expression

relational_conjunction_cd : CS

1

0..n

has_left_side1

is_lhs_for0..n

1

0..n

has_right_side

1

is_rhs_for0..n

Query_by_parameter

Parameter_list

Parameter

nm : STid : II 0..n 0...

is_parameter_of0..n

has

0...

0..1

0..n

may_contain 0..1

is_part_of

0..n

Parameter_item

value : ANYsemantics_txt : ST

Device_task

parameter_value : LIST<ANY>

Acknowledgement

type_cd : CSnote_txt : EDerror_detail_cd : CEexpected_sequence_nbr : INT

Message

accept_ack_cd : CSapplication_ack_cd : CSattachment_txt : EDinteraction_id : IIprocessing_cd : CSprocessing_mode_cd : CSprofile_id : SET<II>sequence_nbr : INTversion_id : ST

0..*

1

acknowledges0..*

is_acknowledged_by1

0..1

1

occurs_wi th0..1

has 1

Query_event

query_id : II

Control_event

structure_type_id : IIresponse_cd : CS

0..1

0..n

is_communicated_as

0..1

has_payload

0..n

0..1

1

occurs_with

0..1

may_have 1

Act_relationship

type_cd : CSinversion_ind : BLcontext_control_cd : CSsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS

Act_context

level_cd : CE

Act

class_cd : CSmood_cd : CSid : SET<II>cd : CDnegation_ind : BLtxt : EDstatus_cd : SET<CS>effective_time : GTSactivity_time : GTSavailability_time : TSpriority_cd : SET<CE>confidentiality_cd : SET<CE>repeat_nbr : IVL<INT>interruptible_ind : BLcontext_lock_ind : BLindependent_ind : BLreason_cd : SET<CE>language_cd : CE

0..n1

has_target

0..n

is_target_for

1

0..n1

has_source

0..n

is_source_for

1

1..*

0..*

originates_in_context_of

1..*

provides_context_for

0..*

Participation

type_cd : CSfunction_cd : CDcontext_control_cd : CSsequence_nbr : INTnote_txt : EDtime : IVL<TS>mode_cd : CEawareness_cd : CEsignature_cd : CSsignature_txt : ED

0..n 1

for

0..n

has

1

Role_link

type_cd : CSeffective_time : IVL<TS>

Role

class_cd : CSid : SET<II>cd : CEnegation_ind : BLaddr : BAG<AD>telecom : BAG<TEL>status_cd : SET<CS>effective_time : IVL<TS>certificate_txt : EDqty : RTOposition_nbr : LIST<INT>

0..n1

has_as_participant

0..n

participates_in

1

0..n1

has_source

0..n

is_source_for

1

0..n1

has_target

0..n

is_target_for

1

Language_communication

language_cd : CEmode_cd : CEproficiency_level_cd : CEpreference_ind : BL

Attention_line

key_word_txt : STvalue : ST

Batch

nm : STreference_control_id : IIbatch_total_nbr : SET<INT>batch_comment : SET<ST>transmission_qty : INT

Entity

class_cd : CSdeterminer_cd : CSid : SET<II>cd : CEqty : SET<PQ>nm : BAG<EN>desc : EDstatus_cd : SET<CS>existence_time : IVL<TS>telecom : BAG<TEL>risk_cd : CEhandling_cd : CEimportance_status_txt : ED

0..n0..1

is_played_by

0..n

plays

0..1

0..n0..1

is_scoped_by

0..n

scopes

0..1

10..n

communicates_with

1

used_by

0..n

Transmission

creation_time : TSid : IIsecurity_txt : ST

0..n1

can_accompany

0..n

can_include

1

0..1

0..n

contains 0..1

is_contained_by

0..n

Communication_function

type_cd : CStelecom : TEL

1..n

0..*

serves

1..n

served_by

0..*

1..*0..*

executed_by

1..*

executes

0..*

Managed_participation

id : SET<II>status_cd : SET<CS>

Act_heir

RIM Core Classes

Entity Role

Participation

FinancialActs

Living SubjectLiving SubjectPersonPersonOrganizationOrganizationMaterialMaterialPlacePlace......

PatientPatientEmployeeEmployeeAssigned EntityAssigned EntityCertified EntityCertified EntityGuarantorGuarantor......

PerformerPerformerAuthorAuthorWitnessWitnessSubjectSubjectDestinationDestination......

ObservationObservationProcedureProcedureSupplySupplySubstance AdmSubstance Adm

Adminis-trativeActs

ClinicalActs

Account,Account,Invoice Invoice Element,Element,Financial Financial Contract,Contract,Financial Financial

TransactionTransaction

PatientPatientEncounter, Encounter,

RegistryRegistry


How does HL7 manage this abstraction?• In the first HL7 RIM models, each concept had a

visible (physical) class or association to represent it• In current RIM:

– We only include a class when it adds new attributes and associations

– for the rest, use coded “structural” attributes – • ‘class’ or ‘type’ codes• ‘mood’ or ‘determiner’ codes

C. 2012 HL7 Int'l and Shafarman Consulting, Inc. 7

• Why are these named structural attributes? – because they use codes to represent concepts that

would previously have been part of the model structure

– Each structural attribute has a specific HL7 concept domain with an HL7-defined ‘fixed’ value set.

• In an ontological context, the formal code sets for the structural attributes form the RIM metadata ontology.

• Note that this now has a parallel in SNOMED CT, which also has a formal metadata ontology.

Structural metadata


• But it also has the ability to have formal healthcare ontologies bound to specific attributes (linked to Intentional model world).

• For SNOMED CT there is the Terminfo implementation guide.

• LOINC is another standard terminology/ontology that is commonly bound to RIM models.

• These two aspects support applying description logic to the analysis of RIM model instances.

The RIM is an extensional model


9

Entity

classCode CScode : CDdeterminerCode : CSstatusCode : CS

Role

classCode : CScode : CEeffectiveTime : IVL<TS>

Participation

typeCode : CStime : IVL<TS>

Act

classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS

1

0..* 1

0..*

1

0..*

RIM Core Classes & Attributes

1

0..*

plays

scopes

Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id


10

Entity


Role


Participation


Act


1

0..* 1

0..*

1

0..*

RIM Core Structural Attribute Value Sets

Entity.classCode

• Living SubjectLiving Subject• PersonPerson• OrganizationOrganization• MaterialMaterial• PlacePlace• ......

Role.classCode

• PatientPatient• EmployeeEmployee• Assigned EntityAssigned Entity• Certified EntityCertified Entity• GuarantorGuarantor• ......

Participation.typeCode

• PerformerPerformer• AuthorAuthor• WitnessWitness• SubjectSubject• DestinationDestination• ......

Act.moodCode

• DefinitionDefinition• IntentIntent• RequestRequest• EventEvent• CriterionCriterion• ......

Act. classCode

• ObservationObservation• ProcedureProcedure• SupplySupply• Substance AdmSubstance Adm• FinancialFinancial• ……

Entity.determinerCode

• KindKind• InstanceInstance• QualifiedQualified

GroupGroup

1

0..*

plays

validates


E.g. Value Set for moodCode (a Structural Attribute)

Wbc Order (Request) to occur on 12/12/07@2pmPST

Wbc Observation of ‘xxx’ made on 10/1/07@1pmPST

Wbc goal of specific value of ‘yyy’ to be attained by 11/1/07

3 instances of Act, specialization OBServation, act.code attribute = “wbc” (actually = the corresponding LOINC code for White Blood Count)

moodCode=RQO

effectiveTime =“12/12/07@ 2pm PST”

(No Value Attribute inthis model)

moodCode=Goal

effectiveTime =“11/1/07”

(Goal)Value=“yyy”

moodCode=EVN

effectiveTime =“10/1/07@ 1pm PST”

(Observation)Value=“xxx”


12

Entity


Role


Participation


Act


1

0..* 1

0..*

1

0..*

Person (in role of Patient) participates as subject of an Observation (lab test, performed)

Entity.classCode

• • PersonPerson•

Role.classCode

• PatientPatient•


• • • • SubjectSubject•

Act.moodCode

• • • • EventEvent• • ......

Act. classCode

• ObservationObservation•


• • InstanceInstance•

1

0..*

plays

validates


13

Entity


Role


Participation


Act


1

0..* 1

0..*

1

0..*

Person in role of physician <assigned entity> participates as author of an Observation (lab test order)

Entity.classCode

• Living SubjectLiving Subject• PersonPerson• OrganizationOrganization• MaterialMaterial• PlacePlace• ......

Role.classCode

• PatientPatient• EmployeeEmployee• Assigned EntityAssigned Entity• Certified EntityCertified Entity• GuarantorGuarantor• ......


• PerformerPerformer• AuthorAuthor• WitnessWitness• SubjectSubject• DestinationDestination• ......

Act.moodCode

• DefinitionDefinition• IntentIntent• RequestRequest• EventEvent• CriterionCriterion• ......

Act. classCode

• ObservationObservation• ProcedureProcedure• SupplySupply• Substance AdmSubstance Adm• FinancialFinancial• ……


• KindKind• InstanceInstance• QualifiedQualified

GroupGroup

1

0..*

plays

validates


14

Entity


Role


Participation


Act


1

0..*1

0..*

1

0..*

A single act may have multiple participations

1

0..*

plays

Participation


Role


Entity


1

1

scopes

plays

1

0..*

scopes

0..*

0..*

0..*

1

Person (in role of Patient) participates as subject of an Observation Order (lab test order)

Person in role of physician <assigned entity> participatesas author of an Observation (lab test order)


15

Entity


Role


Participation


Act


1

0..* 1

0..*

1

0..*

RIM Core Classes & Attributes

1

0..*

plays

scopes

• Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id

• We have shown parts of some of the basic HL7 defined value sets for structural attributes, but entity.code, role.code, and

act.code are key attributes that use non-HL7 standard terminologies.• E.g. for act.code, LOINC and SNOMED-CT, are key value sets for observation and procedure concept domains.


Two other critical RIM classes

• ActRelationship: creates formal relationships between acts, such as:– E.g. (structural) — Comp, component,

• As in a CBC observation (complete blood count) has component acts RBC (red blood cell count); WBC, white blood cell count; etc.

– E.g. (causal) — RSON, reason; CIND: contraindication; PRCN, precondition

– And several types of qualifiers and modifiers


• RoleLink: A <rarely used> connection between two roles expressing a dependency between those roles and permitting the authorization or nullification of a dependent role based on status changes in its causal or directing role.– E.g. A role of assignment or agency depends on another role of

employment, such that when the employment role is terminated, the assignments are terminated as well.

Two other critical RIM classes



RIMBAA note

The previous diagram, the “RIM on (just) one page.”Is the basic SQL design for RIMBAA systems.

But this requires (see below) using the structural variables to navigate the RIM models. (another presentation)


V3 and physical data• Act, specialization “observation”

– Act.class=“OBS”– Act.code=<code for observation type>

• E.g. LOINC, SNOMED, etc. (per HL7 “realm”)

– Act.mood • Event for actual measurement• Request for “order/request” for measurement

– Act.ID=“instance identifier” for the measurement– Act.value= the physical observation

• DataType of act.value is, as in v 2.x, allowed to be any appropriate datatype (usually PQ, physical quantity; may be Set(PQ).

– Act.effectiveTime= “physiologically relevant time of observation” (e.g. “when in the patient’s life the observation was made)


V3 and physical data

• Act/observation continued:– interpretationCode (SET<CE>)

• One or more codes specifying a rough qualitative interpretation of the observation, such as "normal", "abnormal", "below normal", "change up", "resistant", "susceptible", etc

• Act/observation continued:– methodCode (SET<CE>)

• Examples: Blood pressure measurement method: arterial puncture vs. sphygmomanometer (Riva-Rocci), sitting vs. supine position, etc.


V3 and physical data

• Act/observation continued:– targetSiteCode (SET<CD>)

• A code specifying detail about the anatomical site or system that is the focus of the observation if this information is not already implied by the observation definition or Act.code.

• Constraints: The targetSiteCode value, if specified, must not conflict with what is implied about the target site or system from the observation definition and the Act.code.



Summary

• We have briefly reviewed– an introduction to the RIM


…Further Discussion…

…Other topics?...

…Questions?...

8/15/2012C. 2012 HL7 Int'l and Shafarman Consulting, Inc. A brief HL7 Version 3 Introduction for CIMI Mark Shafarman Past Chair HL7 with additional HL7.

Documents

hl7 intl

chair hl7

hl7 rim models

hl7 act instance

business domain of hl7

brief hl7 version

additional hl7 roles

core concepts of hl7