january 30, 20001© 2000, hl7 cen/tc 251 health informatics joint working groups meeting stockholm,...

January 30, 2000 1© 2000, HL7

http://www.hl7.org

CEN/TC 251 Health InformaticsJoint Working Groups Meeting

Stockholm, Sweden2000-01-31 -- 2000-02-02

January 30, 2000 2© 2000, HL7

http://www.hl7.org

HL7 Version 3 Tutorial - taking the next step with standards

George W. Beeler, Jr., Ph.D.Past-Chair, Health Level Seven BoardChapter editor, HL7 Version 3 methodology

Division Chair

Information Services

Mayo Clinic

Rochester, MN USA

[email protected]

January 30, 2000 3© 2000, HL7

Why standards?• CHANGE

– Change due to medical needs– Change driven by technology– Change driven by growth

• AssertionAs the needs of health care have grown, and as technology has fragmented, it is no longer realistic for a health care provider to expectALL of its clinical systems to be on fully INTEGRATED computers at ALL TIMES.

• In that case, data interfaces are a reality to be dealt with.

• In order to manage interfaces between heterogeneous systems,

THERE MUST BE STANDARDS!

January 30, 2000 4© 2000, HL7

Our agenda

What is HL7?

Brief review of HL7 Version 2.x

Why undertake Version 3?

Version 3 - an overall standards strategy

Version 3 - Analysis StepsRIM - in Depth

Version 3 for Messages

January 30, 2000 5© 2000, HL7

QUICK history• Founded by healthcare providers early in 1987

• Produced Version 1.0 late in 1987

• Produced Version 2.0 late in 1988

• Versions 2.1, 2.2, 2.3 and 2.3.1 published in 1990, 1994, 1997 and 1999 -- the “production” standards

• Accredited as a Standards Developing Organization by the American National Standards Institute (ANSI) in 1994

• Version 2.2 through 2.3.1 are “American national standards”

• Work on Version 3 (and 2.4) is underway

January 30, 2000 6© 2000, HL7

HL7’s Mission (adopted 7/97)

• 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 mission of HL7 encompasses the complete ‘life cycle’ of a standards specification -- development, adoption, market recognition, utilization and adherence. The HL7 specifications are unified by shared reference models of the healthcare and technical domains

January 30, 2000 7© 2000, HL7

HL7 Activities

Develop & publish ANSI certified specifications

Promote the use of the standards

Provide education

Provide conformance certification services

Provide methodologies for extending standard

Encourage usage of HL7 world wide

Collaborate with developers of healthcare and information technology standards in leveraging our respective skills, knowledge and standards

January 30, 2000 8© 2000, HL7

Who is HL7?

• About 470 organizational members

• About 1000 total members

• Up to 500 attend the Working Group Meetings

• International affiliates in:– Australia -- Canada– Finland -- Germany– India -- Japan – Netherlands -- New Zealand– Southern Africa -- United Kingdom

January 30, 2000 9© 2000, HL7

Being ANSI accredited means:

• Consensus driven– Ballots must pass by 90%– With 60% quorum and “balance”– Open membership & one vote per member

Technical Steering CommitteeTechnical affairs

Appointed officers plus chairsof the committees & SIGs

Technical CommitteesCreate normative specifications

or chapters in the standard

Special Interest GroupsCollaborate in area of interest tocontribute to the work of the TCs

The Working GroupThe "real" HL7

Any member can registerfor any committee or SIG

Board of DirectorsBusiness affairs

Elected

January 30, 2000 10© 2000, HL7

Committees & SIGs of HL7CommitteesArchitectural Review Board

Clinical Decision Support & Arden Syntax

Control/Query

Education & Implementation

Medical Records

Modeling and Methodology

Orders and Observations

Patient Admin./Financial Management

Patient Care

Scheduling & Logistics

XML (PRA)

Visual Integration (CCOW)

Vocabulary

Special Interest Groups (SIG)Acountablity, Quality, Performance

Blood Banking

Claims Attachments

Community-based Health Systems

Component based messaging

Conformance

Data warehousing

Government Projects

Image management

Lab Automation

MPI Mediation

Secure transactionsRed - groups creatingspecifications

Blue - groups specifying infrastructure

Green - Groups defining HL7 process & methodology

January 30, 2000 11© 2000, HL7

Key to HL7 success - The Working Group

• Draws equally from providers, software vendors, and consultants

• Group sets aside their individual interests, rolls up their sleeves and collaborate to get the tough work done

• Most arguments stem either – violent agreement, but failure to see the agreement– passionate beliefs

• Fortunately there are also good facilitators in the working group that help to resolve these

• HARD WORK - five, 12-hour days, three times a year plus active electronic collaboration in between

January 30, 2000 12© 2000, HL7

Versions 2.x

• Widely used:– secondary and tertiary facilities (>90% use HL7)– large practices

• Broad functional coverage:– clinical: laboratory, pharmacy, radiology, dietary,

most other diagnostic services, patient care, public health

– clinical administrative: patient registration, admission; patient accounts; medical document life cycle; master file maintenance, HIPAA attachments

• Designed in 1987– Based on older messaging formats such as X12

January 30, 2000 13© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 14© 2000, HL7

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

1 Physical 1 Physical 2 Data Link 2 Data Link 3 Network 3 Network 4 Transport 4 Transport

Communication

5 Session 5 Session 6 Presentation 6 Presentation 7 Application 7 Application

Function

What does “HL7” stand for?

ISO-OSI Communication Architecture Model

January 30, 2000 15© 2000, HL7

(external) admitevent

trigger event

network

AdmissionSystem

Lab system

Receive A01

sendHL7 A01 msg

send ACK

receive ACK msg

Mr. Jones is admitted to the hospital

The HL7 basic transaction model

January 30, 2000 16© 2000, HL7

System A

ORM message

ORR (opt)

Application Ack

Accept ACK (opt)

Accept ACK (opt)

System B

HL7 acknowledgment paradigms

January 30, 2000 17© 2000, HL7

HL7 Admit Patient Example

• Admit patient Sam Jones, whose wife (and next-of-kin) is Barbara, and whose primary care physician is Dr. LeBauer, to the Emergency room because of trauma

• Question: how did we get from this business process to an HL7 message?

January 30, 2000 18© 2000, HL7

Sample Trigger Event definition • When

– “An A01 event is sent as a result of a patient undergoing the admission process which assigns the patient to a bed. It signals the beginning of a patient's stay in a healthcare facility.”

• What– “Normally, this information is entered in the primary Patient

Administration system and broadcast to the nursing units and ancillary systems.”

• Usage examples– “For example, an A01 event can be used to notify: the

pharmacy system that a patient has been admitted and may be legitimately prescribed drugs; …. the clinical repository that an admission has taken place for the EMR (electronic medical record).”

January 30, 2000 19© 2000, HL7

The anatomy of an HL7 V2.3 message

MSH|^~\&|ADT1|MCM|LABADT|MCM|199807201126||ADT^A01| MSG00001|P|2.3|<cr>

EVN|A01|199807201123|<cr>

PID|1||PATID1234^5^M11||Jones^Sam^Houston||19670329|M||C|1200 N ELM STREET^^GREENVILLE^NC^27401-1020|GL|

(919)379-1212|(919)271-3434||S||X454337 ^2^M10| 123456789|987654^NC|<cr>

NK1|1|JONES^BARBARA^K|WIFE||||CP^Contact person|<cr>

PV1|1|I|2000^2012^01|E||||004777^LEBAUER^SARA^J.|| TRMA||||ADM|A0|<cr>

A message is the unit of data transferred between information systems. It is composed of a group of segments in a defined sequence. Each message has a message type that defines its purpose. A three-character code contained within each message identifies its type. The first segment (MSH) in each message identifies the message type and the trigger event type that caused the message to be sent.

January 30, 2000 20© 2000, HL7


Segment

Message - segments, data fields, components

Data field

Component


EVN|A01|199807201123|<cr>


(919)379-1212|(919)271-3434||S||X454337 ^2^M10| 123456789|987654^NC|<cr>


A segment is a logical grouping of data fields. Segments of a message may be required or optional. They may occur only once in a message or they may be allowed to repeat. A name and a unique three-character code known as the Segment ID identify each segment. Segments are sent within messages as the Segment ID followed by a sequence of data fields. The last field ends with the end-of-segment character, a carriage return.

Data fields are transmitted as character strings separated by characters that are data field separators (the “|” character in the example). Each data field has an assigned datatype.

Many of the datatypes are compound – made up of components. (The “^” character is the usual component separator.)

January 30, 2000 21© 2000, HL7

An HL7 V2.3 Message


EVN|A01|199807201123|<cr>


(919)379-1212|(919)271-3434||S||X454337 ^2^M10| 123456789|987654^NC|<cr>



January 30, 2000 23© 2000, HL7

MSH Message HeaderEVN Event TypePID Patient Identification [PD1] Additional Demographics [{NK1}] Next of Kin /Associated PartiesPV1 Patient Visit[PV2] Patient Visit - Add’l Info.[{DB1}] Disability Information[{OBX}] Observation/Result . . . . . . . [{GT1}] Guarantor[{IN1 Insurance [IN2] Insurance Additional Info. [IN3] Insurance Add'l Info - Cert. }][ACC] Accident Information[UB1] Universal Bill Information[UB2] Universal Bill Information

V2.3 Abstract Message - ADT

[ ] optional

{ } may repeat

January 30, 2000 24© 2000, HL7

V2.3 Segment - MSH

SEQ - position within segment

LEN - length of field

DT - data type for field

OPT - optionality for field

RP/# - repeatability

TBL# - table number for codes

ITEM# - HL7 field number

ELEMENT NAME - name

January 30, 2000 25© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 26© 2000, HL7

Versions 2.x

Strengths– broad functional coverage– highly adaptable

• IS environments differ

• system capabilities variations

– vocabulary independent– least common denominator

technological base

Challenges– broad functional coverage– highly adaptable

• “Seen one? Seen one.”

• vendor capability mismatch

– vocabulary independent– least common denominator

technological base

January 30, 2000 27© 2000, HL7

Semanticinteroperability

Functionalinteroperability

What is computer interoperability?

• Although an intuitive answer is easy, a specific response is more complex

• Institute of Electrical and Electronics Engineers (IEEE) dictionary:

"The ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

[IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]

January 30, 2000 28© 2000, HL7

HL7 specificationsNouns

Things or entities that are

being communicated.

AdjectivesDescriptors and

relationships of the nouns.

VerbsActions being requested

or communicated.

What must be specified for communication?

The semantics of the communicationThe semantics convey the actual "meaning" of the message. The semantics is conveyed via a set of symbols contained within the communication. An external "dictionary", thesaurus,

or terminology explains the meaning of the symbols as they occur. A syntax for communication

The syntax defines the structure and layout of the communication. Common syntax representations include ASN.1, XML, X.12, HL7, IDL, etc.

Services to accomplish the communicationExamples include the post office, a telephone switchboard, SMTP, FTP, Telnet, RPC, ORB services, etc.

A channel to carry the communicationExamples of channels include written documents, telephones, network connections, satellite links, etc.

January 30, 2000 29© 2000, HL7

Object-based messaging methodology

January 30, 2000 30© 2000, HL7

Ancestry of message design methodology• IEEE P1157 - MEDIX

– Formed during 1986 MEDINFO Conference by an international group, representing both end users and systems vendors

– Scope: "Specify and establish a robust and flexible communications standard for the interchange of data between heterogeneous healthcare information systems."

– Goals:• Do not assume a particular decomposition of the healthcare system into

subsystems

• Structure the standard in a flexible manner, so that multiple subsets of features are allowed

– International participation

January 30, 2000 31© 2000, HL7

IEEE MEDIX - Base assumptions

• Will specify an Information Model -- an abstraction of the real healthcare environment defining the semantics of the domain of discourse

• Will specify a Computational/Communication Model which defines:– a) Requirements imposed upon the services which must be

offered to Healthcare IT applications to enable medical data interchange in the open environment.

– b) Interchange formats and the mapping rules from the information model to the interchange formats to the interchange formats

– c) Communications profiles based upon the ISO/OSI base standards

January 30, 2000 32© 2000, HL7

IEEE P1157 - MEDIX - Open Issues

By 1990, MEDIX still faced several critical questions:

• How to determine what sub-set of the objects and attributes in the information model should be part of a message

• How to specify when a message should be sent

• How to specify how to assemble the data into a message for communication

January 30, 2000 33© 2000, HL7

CEN Methodology

January 30, 2000 34© 2000, HL7

V-3 Methodology Use Case

Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model

Supports conformance testing

Supports design reuse

January 30, 2000 35© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 36© 2000, HL7

What is Version 3?

• New kinds of standards– Messaging standards that are logically consistent with

Versions 2.x, and have important semantic improvements – Document standards based on SGML/XML document

architecture– Component standards– Knowledge representation

AND

• A new process or methodology for developing those standards– A wholly new approach to the way HL7 develops its

standards

January 30, 2000 38© 2000, HL7

Version 3 as a methodology

• Is a new approach to developing HL7 standards. The

methodology:

– Is based on models and and a common repository, which

provides better control and consistency of the standards

– Defines trigger events using state diagrams in the information

model

– Includes more detail, clarity and precision of specification

– Decreases options by providing more messages

– Includes standard vocabularies, terminologies and code sets.

January 30, 2000 39© 2000, HL7

Reference Model RepositoryReference Model RepositoryReference Model RepositoryReference Model Repository

RequirementsRequirementsAnalysisAnalysis

Use CaseUse CaseModelModel(UCM)(UCM)

RequirementsRequirementsAnalysisAnalysis

Use CaseUse CaseModelModel(UCM)(UCM)

DomainDomainAnalysisAnalysis

Information Information Model &Model &

VocabularyVocabulary(RIM)(RIM)

DomainDomainAnalysisAnalysis

Information Information Model &Model &

VocabularyVocabulary(RIM)(RIM)

AnalysisAnalysisAnalysisAnalysis DesignDesignDesignDesign

InteractionInteractionDesignDesign

InteractionInteractionModelModel(IM)(IM)

InteractionInteractionDesignDesign

InteractionInteractionModelModel(IM)(IM)

MessageMessageDesignDesign

HierarchicalHierarchicalMessageMessage

DescriptionsDescriptions(HMD)(HMD)

MessageMessageDesignDesign

HierarchicalHierarchicalMessageMessage

DescriptionsDescriptions(HMD)(HMD)

ApplicationApplicationApplicationApplication

2-nd Order2-nd Order 1 choice of1 choice of 0-n Drug0-n Drug

0-1 Nursing0-1 Nursing

2-nd Order2-nd Order 1 choice of1 choice of 0-n Drug0-n Drug

0-1 Nursing0-1 Nursing

Medical logicMedical logic

VariableVariabledefinition for definition for Arden syntaxArden syntax

(AVD)(AVD)

Medical logicMedical logic

VariableVariabledefinition for definition for Arden syntaxArden syntax

(AVD)(AVD)

data:data:location_of_actionlocation_of_action := READ LAST := READ LAST MPSLOC ; MPSLOC ; ‘ ‘ {patient{patient location} location}

data:data:location_of_actionlocation_of_action := READ LAST := READ LAST MPSLOC ; MPSLOC ; ‘ ‘ {patient{patient location} location}

DocumentsDocuments

Document Document Types forTypes forHL7 PRAHL7 PRA

(DTD)(DTD)

DocumentsDocuments

Document Document Types forTypes forHL7 PRAHL7 PRA

(DTD)(DTD)

<!ENTITY %DT_MPSLOC<!ENTITY %DT_MPSLOC“MPSLOC.id,“MPSLOC.id, MPSLOC.name?, MPSLOC.name?, MPSLOC.addr?, MPSLOC.addr?, MPSLOC.phon?, MPSLOC.phon?, MPSLOC.emlAdr?"> MPSLOC.emlAdr?">

<!ENTITY %DT_MPSLOC<!ENTITY %DT_MPSLOC“MPSLOC.id,“MPSLOC.id, MPSLOC.name?, MPSLOC.name?, MPSLOC.addr?, MPSLOC.addr?, MPSLOC.phon?, MPSLOC.phon?, MPSLOC.emlAdr?"> MPSLOC.emlAdr?">

MessagingMessaging

Message TypesMessage Typesfor use with for use with

XML, ER7, etcXML, ER7, etc(MET)(MET)

MessagingMessaging

Message TypesMessage Typesfor use with for use with

XML, ER7, etcXML, ER7, etc(MET)(MET)

TYPE MPSLOC TYPE MPSLOC CONTAINS {CONTAINS {id[id].TYPE IIDid[id].TYPE IIDnm[name].TYPE STnm[name].TYPE STad[addr].TYPE XADad[addr].TYPE XADph[phon].TYPE XTN ph[phon].TYPE XTN email_addressemail_address [emlAdr].TYPE XTN [emlAdr].TYPE XTN}}

TYPE MPSLOC TYPE MPSLOC CONTAINS {CONTAINS {id[id].TYPE IIDid[id].TYPE IIDnm[name].TYPE STnm[name].TYPE STad[addr].TYPE XADad[addr].TYPE XADph[phon].TYPE XTN ph[phon].TYPE XTN email_addressemail_address [emlAdr].TYPE XTN [emlAdr].TYPE XTN}}

Methodology - Phases, Models & Applications

C Code c Codea artb bluec color

January 30, 2000 40© 2000, HL7

HL7 Version 3 Methodology in words1. Define a consensus reference information model (RIM) that defines

the data of interest in the healthcare domain.

2. Assemble the terminologies and data types necessary to express the attributes of the RIM

3. Apply the model, vocabulary and types to: messages, patient record DTDs, medical logic modules, component

specifications, etc.

4. For any particular application, draw from the RIM to construct an abstract message structure - the Hierarchical Message Description (HMD)

5. For any particular implementation technology, HL7 will define an implementation technology specification (ITS) for mapping the HMD to that technology.

6. When the message (or equivalent) is sent, the HMD is used to marshal the data, and the ITS is used to format the data for communication.

January 30, 2000 41© 2000, HL7

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 30, 2000 42© 2000, HL7

HL7 Version 3 Characteristics

• Design based on consensus Reference Information Model - ties message elements to explicit semantic definitions

• Adaptable to current and future technology bases - requires abstract expression of standard data structure

• Vocabulary-level interoperability - requires robust data type(s) for coded data

• Explicit conformance model - means that optional elements in the specification must be eliminated where ever possible

January 30, 2000 43© 2000, HL7

Version 3 is a change to the HL7 Architecture

• The HL7 2.x specifications have:– Segments that suggest information entities– Events that indicate implied behaviors– And descriptive content that suggests use cases but never formally documents these

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

January 30, 2000 44© 2000, HL7

HL7 Modeling

Abstractions:

ActivitiesActivities(Use Case (Use Case

Model)Model)

Dispense Medications

Manage Care

Perform Lab Tests

Review Utilization

Objects Objects (Information (Information

Model)Model)

AccountAccount PatientPatient ProviderProvider EncounterEncounter OrderOrder

Communication Communication (Interaction (Interaction

Model)Model)ADT Pharmacy

HL7 message HL7 message

Finance

HALHAL

Version 2.x focused its energies at the communication level and covered the other abstractions only loosely in the specifications.

By demanding analysis of the requirements and information content, Version 3 assures consistency in and enhances the value of the resulting messages.

January 30, 2000 45© 2000, HL7

HL7 V3 Deliverables

• Use case model– Hierarchy of tasks and actors

• Interaction model – Trigger events, abstract

messages & application profiles

• Information model– Classes, relationships, states,

and lifecycles

• Vocabulary– Domains for all coded

attributes– Enumerated codes for HL7

structural tables

• Message design model – Abstract message definitions

(HMDs)

• Implementation Specification– Implementation Technology– Specification (ITS)

January 30, 2000 46© 2000, HL7

Models developed in Phases

Use Case ModelUse Case ModelUse Case ModelUse Case Model

Use Case Diagram

Spec

UCM Spec

Information ModelInformation ModelInformation ModelInformation Model

Spec

DIM Spec

State DiagramClass Diagram

Message DesignMessage DesignMessage DesignMessage Design

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


h//mt:50”d”………

h//mt:50”d”………

Identify Actors & Events

Develop ScopeCreate Use Cases

Model new concepts

Harmonize withVocabulary Domains & RIM

Draw initial contents from RIM

Develop MessageInformation Model

Develop Refined Message Information ModelSpecify

HMD

Define Trigger Events

Define Application Roles

DefineInteractions

Create Conformance Claims

Interaction ModelInteraction ModelInteraction ModelInteraction Model

Interaction Diagram

Spec

Inter Spec

January 30, 2000 47© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 48© 2000, HL7

Domain Analysis


Use Case Diagram

Spec

UCM Spec


Spec

DIM Spec





h//mt:50”d”………

h//mt:50”d”………



Model new concepts




Develop Refined Message Information Model

Specify HMD



DefineInteractions



Interaction Diagram

Spec

Inter Spec

January 30, 2000 49© 2000, HL7

Domain Analysis


Spec

DIM Spec


Model new concepts



January 30, 2000 50© 2000, HL7

Observation_intent_or_orderpatient_hazard_codereason_for_study_cdrelevant_clinical_information_txtreporting_priority_cdspecimen_action_cd

Clinical_observation

abnormal_result_ind : IDlast_observed_normal_values_dttm : DTMnature_of_abnormal_test ing_cd : CEclinically_relevant_begin_dttm : DTMclinically_relevant_end_dttm : DTMobservation_value_txt : NMprobability_number : NMreferences_range_text : STvalue_units_code : CE

Assessment

Healthcare_service_providerspecialty_cd : CNE

Stakeholder_identifierid : STident if ier_type_cd : ID

Organizationorganization_name_type_cd : CNEorganization_nm : STstandard_industry_class_cd 0..*

0..1 is_a_subdivision_of

0..*

has_as_a_subdivision

0..1

Person

birth_dttm : DTMgender_cd : CNEmarital_status_cd : CNEprimary_name_representation_cd : CNEprimary_name_type_cd : CNEprimary_prsnm : PNrace_cd : CNE

Individual_healthcare_practitionerdesc : TXpractitioner_type_cd : CNE

1

0..1

takes_on_role_of1

is_a_role_of0..1

Stakeholderaddr : XADphon : XTN

0..*

1

is_assigned_to0..*

is_assigned1

Healthcare_provider_organization

0..1

1

is_a_role_of0..1

takes_on_role_of

1

Collected_specimen_samplebody_site_cd : CEcollection_end_dttm : DTMcollection_start_dttm : DTMcollection_volume_amt : CQhandling_cd : IDid : IIDmethod_of_collection_desc : TXspecimen_addit ive_txt : STspecimen_danger_cd : IDspecimen_source_cd : CE

0..*1

is_collected_by

0..*

collects

1

Patient

ambulatory_status_cdbirth_order_numberliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id

0..1

1

is_a_role_of

0..1takes_on_role_of

1

0..*

0..1

has_a_primary_provider

0..*is_the_primary_provider_for

0..1

0..*

0..1

is_sourced_from0..*

is_source_for0..1

Active_participation

participation_type_cd : ID

0..1

0..*

participates_in0..1

has_as_participant0..*

Master_patient_service_location

addr : XADemail_address : XTNid : IDnm : STphon : XTN

1..*

0..*provides_patient_services_at

1..*

provides_services_on_behalf_of0..*

0..*

0..1

is_included_in

0..*

includes 0..1

0..1

0..*

is_primary_facility_for0..1

has_as_primary_facility

0..*

Target_participationparticipation_type_cd : CE

0..1

0..*

is_target_of

0..1

has_as_target0..*

0..1

0..*

is_target_of

0..1

has_as_target

0..*

0..1

0..*

is_target_for0..1

has_as_target

0..*

Service_intent_or_orderfiller_order_id : IIDfiller_txt : TXorder_idorder_placed_dttm : DTMorder_quant itytiming_qt : TQplacer_order_id : IIDplacer_txt : TXreport_results_to_phone : XTNintent_or_order_cd : ID

0..* 0..1

participates_in

0..*

has_as_participant

0..1

1..*

0..1

is_target_of

1..*

has_as_target

0..1

1

0..*

is_entry_location_for

1

is_entered_at

0..*

Master_service

method_cd : CEmethod_desc : TXservice_desc : TXtarget_anatomic_site_cd : CEuniversal_service_id : CE

0..*

1

is_an_instance_of

0..*

is_instantiated_as

1

Service_event

service_desc : STservice_event_descspecimen_received_dttm : DTMname : CE

0..*

0..1

participates_in0..*

has_as_active_participant

0..1

0..*

0..1

is_performed_at

0..*

is_location_for

0..1

0..*

0..1

is_target_of

0..*

has_as_target

0..1

0..1

0..*

is_fulfilled_by0..1

fulfills0..*

1

0..*

is_delivered_during1

delivers

0..*

Table 18: Classes

Abbr Laboratory Term Classes Abbr Clinical Term ClassesABXBACT Antibiotic susceptibility BDYCRC Body circumferenceALLERGY Response to antigens BDYHGT Body heightBC Cell counts (blood, CSF,

pleuritic fluid)BDYSURF Body surface area

BLDBK Blood bank BDYTMP Body temperatureCELLMARK

Cell surface models BDYWGT Body weight

CHAL Challenge tests BP Blood pressureCHALSKIN Skin challenge tests BP.CENT Blood pressure – centralCHEM Chemistry BP.PSTN Blood pressure – positionalCOAG Coagulation study BP.TIMED Blood pressure – timedCYTO Cytology BP.VENOU

SBlood pressure – venous

DRUG Drug levels CLIN Clinical NECDRUGDOSE

Drug dose (for transmittingdoses for pharmacokinetics)

ED Emergency department

FERT Fertility EKG ElectrocardiogramHEM Hematology (excluding

coagulation & differentialcount)

EKG.IMP Electrocardiogramimpression

HLA HLA tissue typing antigens EKG.MEAS Electrocardiogram measuresMICRO Microbiology EYE EyePATH Pathology FUNCTION Functional status (e.g.

Glasgow)SERO Serology (antibodies and most

antigens except blood bank andinfectious agents)

H&P History and physical

SURGPATH

Sugical pathology HEMODYN Hemodynamics

TOX Toxicology HRTRATE Heart rateUA Urinalysis IO Input/OutputVET Veterinary Medicine NEONAT Neonatal measures

OB.US Obstetric ultrasoundOBGYN Obstetrics/gynecologyRESP RespirationSKNFLD Skinfold measurementsUS.URO Urological ultrasoundVOLUME Volume (specimens)

Information models Vocabularies

Observation_intent_or_orderpatient_hazard_codereason_for_study_cdrelevant_clinical_information_txtreporting_priority_cdspecimen_action_cd

Clinical_observation

abnormal_result_ind : IDlast_observed_normal_values_dttm : DTMnature_of_abnormal_test ing_cd : CEclinically_relevant_begin_dttm : DTMclinically_relevant_end_dttm : DTMobservation_value_txt : NMprobability_number : NMreferences_range_text : STvalue_units_code : CE

Assessment

Healthcare_service_providerspecialty_cd : CNE

Stakeholder_identifierid : STident if ier_type_cd : ID

Organizationorganization_name_type_cd : CNEorganization_nm : STstandard_industry_class_cd 0..*

0..1 is_a_subdivision_of

0..*

has_as_a_subdivision

0..1

Person

birth_dttm : DTMgender_cd : CNEmarital_status_cd : CNEprimary_name_representation_cd : CNEprimary_name_type_cd : CNEprimary_prsnm : PNrace_cd : CNE

Individual_healthcare_practitionerdesc : TXpractitioner_type_cd : CNE

1

0..1

takes_on_role_of1

is_a_role_of0..1

Stakeholderaddr : XADphon : XTN

0..*

1

is_assigned_to0..*

is_assigned1


0..1

1

is_a_role_of0..1

takes_on_role_of

1

Collected_specimen_samplebody_site_cd : CEcollection_end_dttm : DTMcollection_start_dttm : DTMcollection_volume_amt : CQhandling_cd : IDid : IIDmethod_of_collection_desc : TXspecimen_addit ive_txt : STspecimen_danger_cd : IDspecimen_source_cd : CE

0..*1

is_collected_by

0..*

collects

1

Patient

ambulatory_status_cdbirth_order_numberliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id

0..1

1

is_a_role_of

0..1takes_on_role_of

1

0..*

0..1

has_a_primary_provider

0..*is_the_primary_provider_for

0..1

0..*

0..1

is_sourced_from0..*

is_source_for0..1

Active_participation

participation_type_cd : ID

0..1

0..*

participates_in0..1

has_as_participant0..*


addr : XADemail_address : XTNid : IDnm : STphon : XTN

1..*

0..*provides_patient_services_at

1..*

provides_services_on_behalf_of0..*

0..*

0..1

is_included_in

0..*

includes 0..1

0..1

0..*

is_primary_facility_for0..1

has_as_primary_facility

0..*

Target_participationparticipation_type_cd : CE

0..1

0..*

is_target_of

0..1

has_as_target0..*

0..1

0..*

is_target_of

0..1

has_as_target

0..*

0..1

0..*

is_target_for0..1

has_as_target

0..*

Service_intent_or_orderfiller_order_id : IIDfiller_txt : TXorder_idorder_placed_dttm : DTMorder_quant itytiming_qt : TQplacer_order_id : IIDplacer_txt : TXreport_results_to_phone : XTNintent_or_order_cd : ID

0..* 0..1

participates_in

0..*

has_as_participant

0..1

1..*

0..1

is_target_of

1..*

has_as_target

0..1

1

0..*

is_entry_location_for

1

is_entered_at

0..*

Master_service

method_cd : CEmethod_desc : TXservice_desc : TXtarget_anatomic_site_cd : CEuniversal_service_id : CE

0..*

1

is_an_instance_of

0..*

is_instantiated_as

1

Service_event

service_desc : STservice_event_descspecimen_received_dttm : DTMname : CE

0..*

0..1

participates_in0..*

has_as_active_participant

0..1

0..*

0..1

is_performed_at

0..*

is_location_for

0..1

0..*

0..1

is_target_of

0..*

has_as_target

0..1

0..1

0..*

is_fulfilled_by0..1

fulfills0..*

1

0..*

is_delivered_during1

delivers

0..*

Table 18: Classes

Abbr Laboratory Term Classes Abbr Clinical Term ClassesABXBACT Antibiotic susceptibility BDYCRC Body circumferenceALLERGY Response to antigens BDYHGT Body heightBC Cell counts (blood, CSF,

pleuritic fluid)BDYSURF Body surface area

BLDBK Blood bank BDYTMP Body temperatureCELLMARK

Cell surface models BDYWGT Body weight

CHAL Challenge tests BP Blood pressureCHALSKIN Skin challenge tests BP.CENT Blood pressure – centralCHEM Chemistry BP.PSTN Blood pressure – positionalCOAG Coagulation study BP.TIMED Blood pressure – timedCYTO Cytology BP.VENOU

SBlood pressure – venous

DRUG Drug levels CLIN Clinical NECDRUGDOSE

Drug dose (for transmittingdoses for pharmacokinetics)

ED Emergency department

FERT Fertility EKG ElectrocardiogramHEM Hematology (excluding

coagulation & differentialcount)

EKG.IMP Electrocardiogramimpression

HLA HLA tissue typing antigens EKG.MEAS Electrocardiogram measuresMICRO Microbiology EYE EyePATH Pathology FUNCTION Functional status (e.g.

Glasgow)SERO Serology (antibodies and most

antigens except blood bank andinfectious agents)

H&P History and physical

SURGPATH

Sugical pathology HEMODYN Hemodynamics

TOX Toxicology HRTRATE Heart rateUA Urinalysis IO Input/OutputVET Veterinary Medicine NEONAT Neonatal measures

OB.US Obstetric ultrasoundOBGYN Obstetrics/gynecologyRESP RespirationSKNFLD Skinfold measurementsUS.URO Urological ultrasoundVOLUME Volume (specimens)

Domain expertise

HL7 committees, affiliates, members & collaborators

Domain expertise

Vocabulary developers, professional societies, government agencies, HL7 committees

Messaging, Document structures, Clinical templates, Arden syntax, Component specification, …..

Applications

HL7 core requirement - Common semantic models

January 30, 2000 51© 2000, HL7

The Information Model

• A detailed and precise definition for the information from which the 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 30, 2000 52© 2000, HL7

The Reference Information Model (RIM)

• Used to express the information content for the collective work of the HL7 Working Group.

• 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 30, 2000 53© 2000, HL7

Committee Vs. HL7 Model

• 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

• How will we coordinate these efforts?– Iterative reviews– Harmonization meetings

• Who controls RIM?– The M&M committee

• Format, syntax, style

• Revision histories– The Technical Steering

Committee

• Dispute resolution

• Overseer

January 30, 2000 54© 2000, HL7

RIM Class Diagram - v0.94

Champus_coverage

handicapped_program_cdnon_avail_cert_on_file_indretirement_dttmstation_id

Referral

authorized_visits_qtydescreason_txt

Heal thcare_financesHealthcare_finances

Heal thcare_financesPatient_encountersPatient_service_event

Heal thcare_financesPatient_encountersPatient_service_material

Heal thcare_financesPatient_encounters

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0094

released January, 2000reflects agreements made through harmonization in November, 1999

Episode

descepisode_type_cdidlist_closed_indoutcome_txtrecurring_service_ind

DATATYPES

Character_string : ST<<Data_type>>

Encapsulated_data : ED<<Data_type>>

ISO_object_identifier : OID<<Data_type>>

Instance_identifier : II<<Data_type>>

Concept_descriptor : CD<<Data_type>>

Code_translation : CDXL<<Data_type>>

Telecommunication_address : TEL<<Data_type>>

Code_value : CV<<Data_type>>

Code_phrase : CDPH<<Data_type>>

Boolean : BL<<Data_type>>

Binary_data : BIN<<Data_type>>

Real : REAL<<Data_type>>

Ratio : RTO<<Data_type>>

Physical_quantity : PQ<<Data_type>>

Monetary_amount : MO<<Data_type>>

No_information : NULL<<Data_type>>

Number : N<<Data_type>>

T

Interval : IVL<<Data_type>>

T

Annotated : ANT<<Data_type>>

T

History_item : HXIT<<Data_type>>

T

History : HIST<<Data_type>>

T

Uncertain_discrete_value_using_probability : UDVP<<Data_type>>

T

Non-parametric_probability_Distribution : NPPD<<Data_type>>

T

Parametric_probability_distribution : PPD<<Data_type>>

T

Uncertain_value-narrative : UVN<<Data_type>>

T, R

List : LIST<<Data_type>>

T, R

Set : SET<<Data_type>>

T, R

Bag : BAG<<Data_type>>

Point_in_time : TS<<Data_type>>

Postal_and_residential_address : AD<<Data_type>>

Address_part : ADXP<<Data_type>>

Person_name_type : PN<<Data_type>>

Person_name_part : PNXP<<Data_type>>

T, S, R

Collection : COLL<<Data_type>>

Quantity : QTY<<Data_type>>

Ordered : ORD<<Data_type>>

Discrete : DSCR<<Data_type>>

Any_data_type : ANY<<Data_type>>

Text

Thing

Generic

Demographic

Quantity/ Time

Generalizations

Integer : INT<<Data_type>>

Set_ON : SET<ON><<Data_type>>

Set_CRR : SET<CRR><<Data_type>>

Universal_resource_identifier : URI<<Data_type>>

Concept_role_relationship : CRR

name : CVinversion_ind : BLvalue : CDPH

<<Data_type>>

Organization_name : ON

type_cd : CVvalue : ST

<<Data_type>>

General_timing_specification : GTS<<Data_type>>

Observation

value : ANYderivation_expr : STproperty_cd : CV

Medication

form_cd : CDroute_cd : CDdose_qty : PQstrength_qty : PQrate_qty : PQcheck_qty : PQ

Procedure

entry_site_cd : CD

Supply

qty : PQ

Diet

energy_qty : PQcarbohydrate_qty : PQ

Condition_node

Episode_of_condition

1

0..1

defines1

is_defined_by 0..1

Consent

Message_ackMessage_header

0..*1 acknowledges0..*is_acknowledged_by1

Query_by_parameter_spec

Query_by_selection_spec

Response_conrol_spec

Query_subscription_spec

Security_authorization

Row_table_data

Query_ack

Bad_debt_billing_account

bad_debt_recovery_amtbad_debt_transfer_amttransfer_to_bad_debt_dttmtransfer_to_bad_debt_reason_cd

Diagnostic_related_group

base_rate_amtcapital_reimbursement_amtcost_weight_amtidmajor_diagnostic_category_cdoperating_reimbursement_amtreimbursement_amtstandard_day_qtystandard_total_charge_amttrim_high_day_qtytrim_low_day_qty

Inpatient_encounter

actual_length_of_stay_qtyestimated_days_qty

Durable_medical_equipment_slot

Durable_medical_equipment_request

requested_qtytype_cd

Durable_medical_equipment_group

id

0..*

0..1

requests 0..*

is_requested_by 0..1

Clinical_document

Authentication

authentication_dttm : TStype_cd : CV

Service_relationship

type_cd : CVinversion_ind : BLsequence_nmb : INTpriority_nmb : INTpause_qty : PQcheckpoint_cd : CVsplit_cd : CVjoin_cd : CVnegation_ind : BLconjunction_cd : BL

Material_relationship

type_cd : CVinversion_ind : BLtmr : IVL<TS>position_nmb : LIST<N>qty : PQ

Container

capacty_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseperator_type_cd : CDcap_type_cd : CD

Access

gauge_qty : PQentry_site_cd : CDbody_site_cd : CD

Food

preference_cd : CD

Therapeutic_agent

Device

slot_size_increment_qty : PQ

0..*

1

is_scheduleable_unit_for0..*

is_scheduled_by1

0..*

1

requests0..*

is_requested_by1

0..*

1..*

contains0..*

belongs_to1..*

Bad_debt_collection_agency

0..*

1

is_assigned_to 0..*

is_assigned1

Encounter_drg

approval_indassigned_dttmconfidential_indcost_outlier_amtdescgrouper_review_cdgrouper_version_idoutlier_days_nbroutlier_reimbursement_amtoutlier_type_cd

1

0..*

is_assigned_as 1

is_an_assignment_of0..*

0..*

1

is_assigned_to0..*

is_assigned 1

Stakeholder_affiliation

affiliation_type_cddesceffective_dttermination_dt

Healthcare_document_authenticator

1

0..*

created_by 1

is_source_of 0..*

Insurance_certification_contact

participation_type_cd

Stakeholder_affiliate

family_relationship_cd

0..*

1

has_as_secondary_participant 0..*

participates_as_secondary_in 1

Actor

type_cd : SET<CV>tmr : IVL<TS>note : EDsignature_cd : CV

Document_recipient

Responsibility

type_cd : CVtmr : IVL<TS>material_id : SET<II>

Language_ability

mode_cdproficiency_level_cd

List_item

sequence_nmb : REALpriority_nmb : REALnote_txt : ED

Living_subject

birth_dttmbirthplace_addrorigin_country_cdtaxonomic_classification_cdbreed_txtstrain_txteye_color_cdcoat_or_feather_coloring_txtconfidentiality_constraint_cddeceased_dttmdeceased_indeuthanasia_indgender_cdgender_status_cdprimary_name_type_cdprimary_nmimportance_status_txtqtyproduction_class_cd

Patient_information_recipient

Accident_information_source

Health_chart_deficiency

assessment_dttmdesclevel_cdtype_cd

Clinical_document_header

availability_status_cdchange_reason_cdcompletion_status_cdconfidentiality_status_cdcontent_presentation_cddocument_creation_dttm : TSfile_nm : STid : IIlast_edit_dttmreporting_priority_cdresults_report_dttmstorage_status_cdtranscription_dttmtype_cd : CDdocument_change_cd : CVversion_nbr : INTversion_dttm : TS

0..1

0..*

is_parent_document_for

0..1

has_as_a_parent_document0..*

11

is_part_of 1

has_parts

1

0..*1is_authenticated_by

0..* authenticates 1

0..1 0..*of0..1 has_been_received_by 0..*

Patient_service_location_group

id

Patient_service_location_request

type_cd

0..1

0..*


requests0..*


0..*

0..1

has_originating_organization 0..*

originates 0..1

Material

id : SET<II>type_cd : CDform_cd : CVdanger_cd : CDqty : PQ

0..*

1

has_source0..*

is_target_for1

0..*

1

has_target

0..*

is_target_for 1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

is_the 1

for0..1

Patient_service_location_slot

Healthcare_service_provider

board_certification_type_cdboard_certified_indcertification_dttmeffective_tmrlicense_idrecertification_dttmspecialty_cd

Billing_information_item

condition_cdoccurrence_cdoccurrence_dttmoccurrence_span_cdoccurrence_span_from_dttmoccurrence_span_thru_dttmquantity_nbrquantity_type_cdvalue_amtvalue_cd

Individual_healthcare_practitioner_slot

Individual_healthcare_practitioner_pool

id

Certification_additional_opinion

effective_dttmstatus_cd

Individual_healthcare_practitioner_request

practitioner_type_cd

0..1

0..*


requests 0..*

Risk_management_incident

incident_cdincident_dttmincident_severity_cdincident_type_cd

Episode_of_care

Location_encounter_role

accommodation_cdeffective_tmrlocation_role_cdstatus_cdtransfer_reason_cdusage_approved_ind

Encounter_practitioner


Transportation

Service

id : SET<II>mood_cd : SET<CV>universal_service_cd : CDdescr : EDstatus_cd : CVtotal_time : GTScritical_time : GTSmethod_cd : CDbody_site_cd : CDinterpretation_cd : SET<CV>confidentiality_cd : CVmax_repeat_nmb : INTinterruptible_ind : BLsubstitution_cd : CVpriority_cd : SET<CV>orderable_ind : BL

0..*

1

has_source

0..*

is_source_for 1

0..1

1

has_target 0..1

is_target_for1

1

0..*

represented_as 1

represents0..*

0..*

1

for0..*

has 1

0..*

0..*

is_documented_by 0..*

documents

0..*

Heal thcare_stakeholdersHealthcare_stakeholders

CONTROL_QUERY

Insurance_certification

appeal_reason_cdcertification_duration_qtyeffective_tmridinsurance_verification_dttmmodification_dttmnon_concur_cdnon_concur_effective_dttmpenalty_amtreport_of_eligibility_dttmreport_of_eligibility_ind

1

1..*

has_contact1

is_contact_for 1..*

0..*

1

provides_opinion_on0..*

includes 1

Organization

nm : SET<ON>standard_industry_class_cd

0..1

1

is_a_role_of 0..1

takes_on_role_of1

0..*

1

is_assigned_by 0..*

assigns1

0..*

0..1

is_a_subdivision_of0..*

has_as_a_subdivision0..1

0..1

1

is_role_of 0..1

takes_on_role_of1

Preauthorization

authorized_encounters_qtyauthorized_period_begin_dtauthorized_period_end_dtidissued_dttmrequested_dttmrestriction_descstatus_cdstatus_change_dttm

Guarantor_contract

billing_hold_indbilling_media_cdcharge_adjustment_cdcontract_duration_cdcontract_type_cdeffective_tmrinterest_rate_nbrperiodic_payment_amtpriority_ranking_cd

10..* has_coverage_affi rmed_by 1affirms_insurance_coverage_for0..*

Resource_request

allowable_substitutions_cdduration_qtystart_dttmstart_offset_qtystatus_cd

Service_scheduling_request


Person_employment

addreffective_dthazard_exposure_txtjob_class_cdjob_title_nmphonprotective_equipment_txtsalary_qtysalary_type_cdstatus_cdtermination_dtoccupation_cdjob_status_cd

Stakeholder

addr : SET<AD>credit_rating_cdemail_address_txtphon : SET<TEL>type_cdreal_id : SET<II>id : SET<II>

0..* 1has_as_primary_participant0..* participates_as_primary_in 1

0..1

1

is_a0..1

takes_on_role_of1

1

0..1

takes_on_role_of 1

is_role_of

0..1

0..1

1

is_role_of0..1

takes_on_role_of 11

0..*

participates_as1

participation_of

0..*

1

0..1

acts_as1

is_role_of0..1

1

0..*

has 1

of 0..*

1

0..1

takes_on_role_of1

is_a_role_of0..1

1

0..1

takes_role_of1

is_role_of0..1

Notary_public

effective_interval_tmrnotary_county_cdnotary_state_cd

Transcriptionist0..1

0..*

transcribes0..1

is_transcribed_by 0..*

Employee

1

0..*

is_employee_in 1

has_as_employee0..*

Financial_transaction

alternate_descdescextended_amtfee_schedule_cdinsurance_amtposting_dtqtytransaction_batch_idtransaction_cdtransaction_dttmtransaction_idtransaction_type_cdunit_amtunit_cost_amt

0..1

0..*

categorizes0..1

is_categorized_by

0..*

0..*

1

pertains_to0..*

is_associated_wi th 1

Person_name

effective_dtcdnmpurpose_cdtermination_dttype_cd

0..* 0..*refers_to_person_by0..* is_used_by 0..*

Target

type_cd : SET<CV>tmr : SET<CV>awareness_cd : CV

0..*

1

in 0..*

has 1

0..*

0..1

participation_of 0..*

participates_as0..1

0..1

0..*

participates_as 0..1

participation_of0..*

Language

0..*

1

specifies_abi lity_in 0..*

is_speci fied_by1

Service_list

id : SET<II>type_cd : CVname : STdesc : ED

1

0..*

has_parts 1

is_part_of 0..*

0..*

1

owned_by 0..*

owns1

0..*

0..1

is_about0..*

is_subject_of0..1

Administrative_birth_event

baby_detained_indbirth_certificate_idbirth_method_cdbirth_recorded_county_cdbirth_recorded_dttmnewborn_days_nbrstillborn_ind

Originator1..*1..* has_been_originated_by 1..*of1..*

Specimen

body_site_cd : CD

0..*

1

is_sourced_from 0..*

is_source_for1

1

0..1

takes_on_role 1

is_a_role_of

0..1

Administrative_patient_death

death_certificate_iddeath_certificate_recorded_dttmdeath_classification_cddeath_dttmdeath_location_txtdeath_notification_source_nmdeath_verification_cddeath_verification_dttmdeath_verification_nm

Patient_information_disclosure

disclosure_dttminfo_disclosed_descinfo_requested_descreason_cdrequested_dttmurgency_cd

1

0..*

is_the_recipient_of 1

is_provided_to 0..*

Disability

effective_dttmreturn_to_work_auth_dttmtermination_dttmunable_to_work_effective_dttm

Patient_appointment_request

Patient_slot

Preferred_provider_participation

role_cdeffective_dttermination_dt

0..*

1

has_as_care_provider0..*

participates_in 1

Administrative_patient_accident

accident_death_indaccident_descaccident_dttmaccident_location_descaccident_state_cdaccident_type_cdjob_related_accident_indassessment_dttm

1

0..*

identifies1

is_identified by

0..*

0..1

1..*

is_the_source_of 0..1

is_obtained_from

1..*

Health_chart

health_chart_idhealth_chart_type_cdstatus_cd

1

0..*

has_an_assessment_of 1

is_assessed_against0..*

0..1

0..*

contains 0..1

contained_in 0..*


addr : ADopen_tmrdescemail_addressid : IIlicensed_bed_nbrnmphonservice_specialty_cdslot_size_increment_qtystatus_cdtype_cdequipment_type_cd

1..* 0..*belongs_to1..* contains 0..*

1

0..*

is_requested_by1

requests0..*

0..*

0..1

is_included_in

0..*

includes 0..1

1..*

0..*

provides_patient_services_at1..*

provides_services_on_behal f_of 0..*

0..*

1

is_housed_at0..*

houses 1

1 0..*has1 pertains_to 0..*

1

0..1

takes_on_role_of 1

is_a_role_of0..1

0..*

1

is_scheduleable_unit_for 0..*

is_scheduled_by1

Patient_provider_association1 0..*knows_of1 is_known_to 0..*

Patient_billing_account

account_idadjustment_cdauthorization_information_txtbilling_status_cdcertification_required_indcurrent_unpaid_balance_qtydelete_dttmdeleted_account_reason_cdexpected_insurance_plan_qtyexpected_payment_source_cdnotice_of_admission_dttmnotice_of_admission_indpatient_financial_class_cdprice_schedule_idpurge_status_cdpurge_status_dttmreport_of_eligibility_dttmretention_indsignature_on_file_dttmspecial_program_cdstoploss_limit_indsuspend_charges_indtotal_adjustment_qtytotal_charge_qtytotal_payment_qtyseparate_bill_ind

0..*

1

pertains_to0..*

has 1

0..1

0..1

is_the_prior_account_for

0..1

has_as_a_prior_account

0..1

0..*

0..*

has_payment_guaranteed_by 0..*

provides_payment_guarantee_for

0..*

0..*

0..1

is_charged_to 0..*

has_charges_for

0..1

0..*

1

is_associated_wi th0..*

has 1

Healthcare_benefit_coverage_item

service_category_cdservice_cdservice_modifier_cdauthorization_indnetwork_indassertion_cdcovered_parties_cdqtyquantity_qualifier_cdtime_period_qualifier_cdrange_low_qtyrange_high_qtyrange_units_cdassertion_effective_tmreligibility_cdpolicy_source_cdeligibility_source_cdcopay_limit_ind

0..*

0..1 is_governed_by

0..*

governs0..1

0..1

0..*

has_as_components

0..1

is_a_component_of

0..*

0..*

1

provides_validation_for0..*

is_validated_by1

1..*

0..*

is_covered_by 1..*

provides_coverage_for0..*

Individual_healthcare_practitioner

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1

0..*

is_scheduled_by 1


1..*

0..*

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0..*

1

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provides 1

0..*

1

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participates_as1

1

0..*

is_requested_by1

requests 0..*

Master_healthcare_benefit_product

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0..1

is_child_of

0..*

is_parent_of

0..1

0..*

1

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is_instantiated_as1

0..*

0..1

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Resource_slot

offset_qtyallocated_qtyresource_type_cdstatus_cdstart_dttm

Schedule

id

1

0..*

manages 1

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Entering_person

Patient_encounter

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0..*

1

pertains_to

0..*

has1

1..*

1

is_part_of

1..*

has_parts 1

1..*

1

pertains_to 1..*

has1

0..*

0..1

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fol lows0..1

1..*

1

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has_as_participant

1

0..*

1

is_util ized_during 0..*

uti l izes1

0..1 0..*as_assigned to it0..1 is_assigned_to 0..*

1

0..*

has_parts1

is_part_of0..*

1..*

0..*

has 1..*

is_present_in 0..*

1..*

0..1

is_authorized_by

1..*

authorizes 0..1

Insurer

effective_tmr1

0..*

issues1

is_issued_by 0..*

1

0..1

takes_on_role_of1

is_role_of0..1

1

0..*

offers1

is_offered_by 0..*

1

0..*

issues1

is_issued_by 0..*

Guarantor

financial_class_cdhousehold_annual_income_amthousehold_size_nbr

1

1..*

guarantees_payment_under

1

has_payment_guaranteed_by

1..*

0..1

1

is_role_of0..1

takes_on_role_of 1

Healthcare_benefit_product_purchaser

0..1

1

is_role_of 0..1

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1..1

0..*

is_the_purchaser_of1..1

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0..*

Appointment_request

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0..*1 is_requested_by 0..*requests1

1

0..*

requests1

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0..1

0..*

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Employer

<>> effective_tmr 1

0..*

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has_as_employer

0..*

0..1

1

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0..*

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Person

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0..1

1

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1

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1

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1

0..1

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0..*

0..1


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1

0..*communicates_in

1 is_communicated_by

0..*

0..*

0..1

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0..1

1

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1

0..1

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0..1

1

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0..1

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0..*

1


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Patient

0..1

1

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0..*

1

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0..*

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0..*

1

pertains_to

0..*

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1

0..*

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1

0..*

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is_a_scheduleable_uni t_for 0..*

1

0..*

participates_in 1

has_as_care_recipient

0..*

1

0..*

has1

pertains_to 0..*

0..*

1

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has 1

0..1

0..*

is_primary_facil i ty_for 0..1

has_as_primary_facil i ty 0..*

1..*

1

identifies 1..*

is_known_by 1

0..*

1

belongs_to0..*

has 1

1

0..*

has 1

is_for0..*

0..*1 involves 0..*is_involved_in10..*

0..1

has_a_primary_provider 0..*

is_the_primary_provider_for0..1

0..1

1

is_a_role_of 0..1

takes_on_role_of10..*

0..*

is_insured_by 0..*

insures0..*

Appointment

appointment_duration_qtyappointment_timing_qtevent_reason_cdexpected_service_descexpected_start_dttmidstatus_cdurgency_cd

0..*

0..*

is_reserved_by0..*

reserves 0..*

1..*

0..*

books 1..*

is_booked_in 0..*

0..1

0..*

is_parent_of

0..1

is_child_of 0..*

0..*

1

is_entered_by 0..*

enters1

0..1

0..1

is_scheduled_by

0..1

schedules 0..1

Contact_person

contact_reason_cd

0..*

0..1

is_contact_for

0..*

provides_contact0..1

0..*

0..1

is_contact_for0..*

provides_contact

0..1

0..1

0..*

provides_contact 0..1

is_contact_for 0..*

0..*

0..1

has_as_contact0..*

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0..1

0..*

provides_contact

0..1

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1

0..1

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is_a_role_of0..1

0..*

0..1

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0..*

0..1

has_as_a_contact 0..*

is_a_contact_for0..1

January 30, 2000 55© 2000, HL7

Current 0.94 RIM Statistics

• 114 Classes

• 542 Attributes

• 160 Association Relationships

• 27 Inheritance Relationships

• 2 Aggregation Relationships

• 37 Subject Areas– 19 Domain, 8 Work-in-Progress, 10 Administrative

• 34 Data types

• Maintained in an Access database, expressed in UML, and annotated with a literary expression.

January 30, 2000 56© 2000, HL7

RIM Domain Subject Areas

• Stakeholders– Patient– Person– Stakeholder– Healthcare_service_

provider– Organization

• Healthcare finances– Patient_billing_account– Healthcare_benefit_plan– Guarantor_contract

• Patient_encounters– Clinical Documents– Scheduling– Patient_service_material– Patient_encounter– Patient_service_event

• Master_tables

• Message_control

January 30, 2000 57© 2000, HL7

RIM Literary Expression

January 30, 2000 58© 2000, HL7


Spec

DIM SpecClass Diagram State Diagram


Use Case Diagram

Spec

UCM Spec


Interaction Diagram

Spec

Inter Spec



HL7HL7Technical Technical

CommitteesCommittees

HL7HL7Member Member OrganizationsOrganizations

Other Standard Development Other Standard Development OrganizationsOrganizations

OthersOthers

Sources of Models for Harmonization

January 30, 2000 59© 2000, HL7

RIM Harmonization Process

Change Proposal Preparation

Prepare RIMChange Proposal

Prepare RIMChange Proposal

Review RIMChange Proposal

w/ Stewards

Review RIMChange Proposal

w/ Stewards

Document Rationalefor not supporting

RIM change proposal

Document Rationalefor not supporting

RIM change proposal

Revise or WithdrawRIM Proposal

Revise or WithdrawRIM Proposal

Post RIM Change Proposals

SubmitRIM Change

Proposal

SubmitRIM Change

Proposal

Post RIMChange Proposal

Post RIMChange Proposal

Notify HL7 Membersof RIM ChangeProposal Posting

Notify HL7 Membersof RIM ChangeProposal Posting

Provide Commenton RIM Change

Proposals

Provide Commenton RIM Change

Proposals

Harmonization Meeting

Discuss the RIMChange ProposalDiscuss the RIMChange Proposal

Revise, withdraw,or Table RIM

Change Proposal

Revise, withdraw,or Table RIM

Change Proposal

Vote on RIMChange Proposal

Vote on RIMChange Proposal

Apply ApprovedChanges to RIMApply ApprovedChanges to RIM

Apply TechnicalCoorections

Apply TechnicalCoorections

Post Harmonization Meeting Review

Present RIMHarmonization Report

to TSC

Present RIMHarmonization Report

to TSC

Hold TSC and/orBoard AppealsHold TSC and/orBoard Appeals

FinalizeRevised RIM

FinalizeRevised RIM

January 30, 2000 60© 2000, HL7

Information Model Facilitators

• A team of model facilitators was recruited from within the HL7 working group.

• The model facilitators are provided focused 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 30, 2000 61© 2000, HL7

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 components of 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 30, 2000 62© 2000, HL7

November 1999 Harmonization Meeeting

• What:– Physicians– Data administrators– System developers– Informaticists

• From:– Very large software companies– Five-person firms– Consultancies– Large provider organizations– Solo practices

January 30, 2000 63© 2000, HL7

State Transition Diagrams

null

Scheduled

Active

Deleted

Discharged

start_encounter ^C00XMT005

delete_scheduled_encounter ^C00XMT006

delete_discharged_encounter

cancel_discharge ^C00XMT009

delete_active_encounter ^C00XMT007

discharge_patient ̂ C00XMT008

schedule_encounter ^C00XMT003

start_encounter ^C00XMT004

State diagram: Patient_encounter

Transitions include reference to the trigger event.

January 30, 2000 64© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 65© 2000, HL7

RIM - 0.94 -- In depth

Champus_coverage


Referral


Heal thcare_financesHealthcare_finances

Heal thcare_financesPatient_encountersPatient_service_event

Heal thcare_financesPatient_encountersPatient_service_material

Heal thcare_financesPatient_encounters



Episode


DATATYPES


















T


T


T


T


T


T


T


T


T, R


T, R


T, R







T, S, R






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<<Data_type>>



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0..1

0..*

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0..*

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Insurer

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1

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1

0..*

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1

0..*

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Guarantor


1

1..*


1


1..*

0..1

1

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0..1

1

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1..1

0..*


has_as_purchaser

0..*

Appointment_request



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0..*

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0..1

0..*

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Employer

<>> effective_tmr 1

0..*

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0..*

0..1

1

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0..*communicates_in


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0..*

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1

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0..1

0..*

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1..*

1

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is_known_by 1

0..*

1

belongs_to0..*

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1

0..*

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is_for0..*


0..1



0..1

1

is_a_role_of 0..1


0..*

is_insured_by 0..*

insures0..*

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0..*

0..*

is_reserved_by0..*

reserves 0..*

1..*

0..*

books 1..*

is_booked_in 0..*

0..1

0..*

is_parent_of

0..1

is_child_of 0..*

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1

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1

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takes_on_role_of 1

is_a_role_of0..1

0..*

0..1



0..*

0..1



Champus_coverage


Referral


Healthcare_financesHealthcare_finances

Healthcare_financesPatient_encountersPatient_service_event

Healthcare_financesPatient_encountersPatient_service_material

Healthcare_financesPatient_encounters



Episode


DATATYPES


















T


T


T


T


T


T


T


T


T, R


T, R


T, R







T, S, R






Text

Thing

Generic

Demographic

Quantity/ Time

Generalizations







<<Data_type>>



<<Data_type>>


Observation


Medication


Procedure

entry_site_cd : CD

Supply

qty : PQ

Diet


Condition_node


1

0..1

defines1

is_defined_by 0..1

Consent








Row_table_data

Query_ack





Inpatient_encounter






id

0..*

0..1

requests 0..*


Clinical_document

Authentication






Container


Access


Food

preference_cd : CD

Therapeutic_agent

Device


0..*

1


is_scheduled_by1

0..*

1

requests0..*

is_requested_by1

0..*

1..*

contains0..*

belongs_to1..*


0..*

1

is_assigned_to 0..*

is_assigned1

Encounter_drg


1

0..*

is_assigned_as 1


0..*

1

is_assigned_to0..*

is_assigned 1




1

0..*

created_by 1

is_source_of 0..*





0..*

1



Actor


Document_recipient

Responsibility


Language_ability


List_item


Living_subject








0..1

0..*


0..1


11

is_part_of 1

has_parts

1





id


type_cd

0..1

0..*


requests0..*


0..*

0..1


originates 0..1

Material


0..*

1

has_source0..*

is_target_for1

0..*

1

has_target

0..*

is_target_for 1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

takes_on_role 1

is_a_role_of

0..1

1

0..1

is_the 1

for0..1








id





0..1

0..*


requests 0..*



Episode_of_care





Transportation

Service


0..*

1

has_source

0..*

is_source_for 1

0..1

1

has_target 0..1

is_target_for1

1

0..*

represented_as 1

represents0..*

0..*

1

for0..*

has 1

0..*

0..*


documents

0..*


CONTROL_QUERY



1

1..*

has_contact1

is_contact_for 1..*

0..*

1


includes 1

Organization


0..1

1

is_a_role_of 0..1

takes_on_role_of1

0..*

1

is_assigned_by 0..*

assigns1

0..*

0..1



0..1

1

is_role_of 0..1

takes_on_role_of1

Preauthorization


Guarantor_contract



Resource_request




Person_employment


Stakeholder



0..1

1

is_a0..1

takes_on_role_of1

1

0..1

takes_on_role_of 1

is_role_of

0..1

0..1

1

is_role_of0..1

takes_on_role_of 11

0..*

participates_as1

participation_of

0..*

1

0..1

acts_as1

is_role_of0..1

1

0..*

has 1

of 0..*

1

0..1

takes_on_role_of1

is_a_role_of0..1

1

0..1

takes_role_of1

is_role_of0..1

Notary_public



0..*

transcribes0..1


Employee

1

0..*

is_employee_in 1

has_as_employee0..*



0..1

0..*

categorizes0..1

is_categorized_by

0..*

0..*

1

pertains_to0..*

is_associated_with 1

Person_name



Target


0..*

1

in 0..*

has 1

0..*

0..1


participates_as0..1

0..1

0..*



Language

0..*

1


is_speci fied_by1

Service_list


1

0..*

has_parts 1

is_part_of 0..*

0..*

1

owned_by 0..*

owns1

0..*

0..1

is_about0..*

is_subject_of0..1




Specimen

body_site_cd : CD

0..*

1


is_source_for1

1

0..1

takes_on_role 1

is_a_role_of

0..1





1

0..*


is_provided_to 0..*

Disability



Patient_slot



0..*

1


participates_in 1



1

0..*

identifies1

is_identified by

0..*

0..1

1..*


is_obtained_from

1..*

Health_chart


1

0..*



0..1

0..*

contains 0..1

contained_in 0..*




1

0..*

is_requested_by1

requests0..*

0..*

0..1

is_included_in

0..*

includes 0..1

1..*

0..*



0..*

1

is_housed_at0..*

houses 1


1

0..1

takes_on_role_of 1

is_a_role_of0..1

0..*

1


is_scheduled_by1




0..*

1

pertains_to0..*

has 1

0..1

0..1


0..1


0..1

0..*

0..*



0..*

0..*

0..1

is_charged_to 0..*

has_charges_for

0..1

0..*

1

is_associated_with0..*

has 1



0..*

0..1 is_governed_by

0..*

governs0..1

0..1

0..*

has_as_components

0..1

is_a_component_of

0..*

0..*

1


is_validated_by1

1..*

0..*

is_covered_by 1..*




1

0..*

is_scheduled_by 1


1..*

0..*

belongs_to1..*

contains0..*

0..*

1

is_provided_by0..*

provides 1

0..*

1


participates_as1

1

0..*

is_requested_by1

requests 0..*



0..1

is_child_of

0..*

is_parent_of

0..1

0..*

1


is_instantiated_as1

0..*

0..1

covers 0..*

is_covered_by 0..1

Resource_slot


Schedule

id

1

0..*

manages 1

is_managed_by0..*

Entering_person

Patient_encounter


0..*

1

pertains_to

0..*

has1

1..*

1

is_part_of

1..*

has_parts 1

1..*

1

pertains_to 1..*

has1

0..*

0..1

precedes0..*

fol lows0..1

1..*

1

is_associated_with 1..*

has_as_participant

1

0..*

1


uti lizes1


1

0..*

has_parts1

is_part_of0..*

1..*

0..*

has 1..*

is_present_in 0..*

1..*

0..1

is_authorized_by

1..*

authorizes 0..1

Insurer

effective_tmr1

0..*

issues1

is_issued_by 0..*

1

0..1

takes_on_role_of1

is_role_of0..1

1

0..*

offers1

is_offered_by 0..*

1

0..*

issues1

is_issued_by 0..*

Guarantor


1

1..*


1


1..*

0..1

1

is_role_of0..1

takes_on_role_of 1


0..1

1

is_role_of 0..1

takes_on_role_of 1

1..1

0..*


has_as_purchaser

0..*

Appointment_request



1

0..*

requests1


0..1

0..*

enters0..1

is_entered_by0..*

Employer

<>> effective_tmr 1

0..*

is_employer_of1

has_as_employer

0..*

0..1

1

is_role_of0..1

takes_on_role_of 1

0..*

1..*

represents 0..*


Person


0..1

1

is_a_role_of 0..1

takes_on_role_of1

0..1

1

is_role_of 0..1

acts_in_role_of 1

1

0..1

takes_on_role_of 1

is_role_of0..1

0..*

1

is_entered_by

0..*

enters 1

1

0..*

has 1

is_for 0..*

1

0..1

takes_on_role_of1

is_role_of0..1

0..*

0..1


participates_as0..1

1

0..*communicates_in


0..*

0..*

0..1

is_about 0..*

is_subject_of0..1

0..1

1

pertains_to0..1

has1

1

0..1

takes_on_role_of1

is_a_role_of 0..1

0..1

1

is_role_of

0..1

takes_on_role_of 1

0..*

1


is_source_for 1

Patient

0..1

1

pertains_to0..1

has 1

0..*

1

pertains_to

0..*

has 1

0..*

1

pertains_to

0..*

has1

1

0..*

is_requested_by1

requests 0..*

1

0..*

is_scheduled_by 1


1

0..*

participates_in 1


0..*

1

0..*

has1

pertains_to 0..*

0..*

1

belongs_to0..*

has 1

0..1

0..*

is_primary_facili ty_for 0..1

has_as_primary_facili ty 0..*

1..*

1

identifies 1..*

is_known_by 1

0..*

1

belongs_to0..*

has 1

1

0..*

has 1

is_for0..*


0..1



0..1

1

is_a_role_of 0..1


0..*

is_insured_by 0..*

insures0..*

Appointment


0..*

0..*

is_reserved_by0..*

reserves 0..*

1..*

0..*

books 1..*

is_booked_in 0..*

0..1

0..*

is_parent_of

0..1

is_child_of 0..*

0..*

1

is_entered_by 0..*

enters1

0..1

0..1

is_scheduled_by

0..1

schedules 0..1

Contact_person

contact_reason_cd

0..*

0..1

is_contact_for

0..*


0..*

0..1

is_contact_for0..*

provides_contact

0..1

0..1

0..*


is_contact_for 0..*

0..*

0..1

has_as_contact0..*

is_contact_for0..1

0..1

0..*

provides_contact

0..1

is_contact_for0..*

1

0..1

takes_on_role_of 1

is_a_role_of0..1

0..*

0..1



0..*

0..1



USAM

Unified Service

Action Model

Data typemodel

January 30, 2000 66© 2000, HL7

Patient

name : PNDOB : Dateaddress : AD

Doctor

name : PNspecialty : CDphone : TEL

seeks care at

provides care for0..*

1..*

Information Modeling Language

• Class defines things

• Attributes are the data we record about classes

• Associations describe the way things relate

“Every Patient … seeks care at … 1 to many … Doctors”

“Reading” associations in plain English:

“Every Doctor … provides care for ... zero to many … Patients”

January 30, 2000 67© 2000, HL7

RIM - in-depth -- Unified Service Action Model

• USAM – is the Unified Service Action Model– has been introduced to the RIM in stages over the last 24

months– seeks to bind the core concepts underlying clinical care and

patient management into a unified set of classes– still a ‘work in progress’, although definitely nearing the

finish line

January 30, 2000 68© 2000, HL7

The Service Action Oriented Perspective

Condition_node

Procedure

entry_site_cd : CD

Service_list


Actor


List_item


1

0..*

has_parts1

is_part_of0..*



Target


Service


0..*1

for

0..*

has

1

1

0..*represented_as

1represents

0..*

0..*

1has_source

0..*

is_source_for

1

0..1

1

has_target

0..1

is_target_for1

0..*

1

in

0..*

has1

Observation


Medication


Transportation

Supply

qty : PQ

Diet


• Covers all health care related services.

• Unifies all services in a common “super-class.”

• Models the detail in specializations of the service.– observation: value– medication: dose, form, route

• Relates to actors, targets, and other services through the super-class.– tracking of responsibilities– tracking of resources– tracking of reason, etc.

January 30, 2000 69© 2000, HL7

Condition_node

Procedure

entry_site_cd : CD

Service_list


Actor


List_item


1

0..*

has_parts1

is_part_of0..*



Target


Service


0..*1

for

0..*

has

1

1

0..*represented_as

1represents

0..*

0..*

1has_source

0..*

is_source_for

1

0..1

1

has_target

0..1

is_target_for1

0..*

1

in

0..*

has1

Observation


Medication


Transportation

Supply

qty : PQ

Diet


Service and Context• who is the actor?

• provider, individual or organization• patient, relative, neighbors in home health

• what is the service?• observation, judgement, medication, surgery, physiotherapy• consents, advanced directives, education, consultation

• on whom or what (recipient)?• people: patient, relative, neighbor (caring person), community • things: specimen, food, environmental samples

– indirect recipient, beneficiary (“for whom”)• patient, community (population)

• when?

• where? (facility, location)

• with what? (material resources)

January 30, 2000 70© 2000, HL7

?? b-b-but where is

Condition_node

Procedure

entry_site_cd : CD

Service_list


Actor


List_item


1

0..*

has_parts1

is_part_of0..*



Target


Service


0..*1

for

0..*

has

1

1

0..*represented_as

1represents

0..*

0..*

1has_source

0..*

is_source_for

1

0..1

1

has_target

0..1

is_target_for1

0..*

1

in

0..*

has1

Observation


Medication


Transportation

Supply

qty : PQ

Diet


Service catalog entry?

Service order or plan?

Service event?

Result of service?

Clinical goal?

???

January 30, 2000 71© 2000, HL7

Service class & Mood code • A service is an intentional action ... A Service instance

is a record of such an intentional action.

• The mood of an action tells whether the action represents a fact (event) an order, a plan (intent), a goal, a risk, a potential (definition) or the like.

• A service instance represents an action in one and only one such mood. Thus, service definitions (master), orders, plans, and performance records (events) are all represented by an instance of class Service.

• Any instance of a Service assumes one and only one mood and will not change its mood along its life cycle. ... the mood of a service instance is static and not part of the state.

January 30, 2000 72© 2000, HL7

Examples of constructs enabled by USAM

• Condition Node and Condition Thread– Managing patient problems collaboratively and continuously.

• Representing Knowledge– Defining service concepts and semantic relationships– Take a stab at the vocabulary problem

• Workflow Management– Defining and managing collaborative processes.– Timed and conditioned care plans and clinical guidelines.

• Accountability, security, privacy– Application layer-based approaches– Integrated in the information model

January 30, 2000 73© 2000, HL7

Data types vis-à-vis Classes - the basics

• A data type is represented as a UML class

• Both have descriptions

• A primitive data type has no components and is defined solely by its description

• Data types may have components, as classes have attributes

• Components and attributes are each assigned a data type

• “Abstract” data types may not be assigned to attributes. They are reserved for use in defining other data types

January 30, 2000 74© 2000, HL7

Quantity data types

Null is not a type to be assigned an attribute, but rather one that is communicated (sent) when the information is missing

The flavor of the null value. Can be interpreted as the reason why the information is missing.

Integer : INT

Boolean : BL

Binary_data : BIN

Real : REAL

value : Nprecision : N

Ratio : RTO

numerator : QTYdenominator : QTY

Physical_quantity : PQ

value : REALunit : CV

Monetary_amount : MO

value : REALcurrency_unit : CV

No_information : NULL

flavor : CD

Number : N

January 30, 2000 75© 2000, HL7

Time-related data types• Point in time - very similar to the

Version 2.x time stamp -- a scalar defining a point on the axis of natural time.

• General timing specification is a primitive data type that is conceptually an arbitrary set of points in time. It is any combination of (1) a point in time, and/or (2) an interval of time. This includes uncertain points and intervals of time. Values are defined in terms of a literal expression syntax. Regardless of how complex the literal definition is, it will always decompose into an ordered sequence of points or intervals of time.

• Primarily used for scheduling of events to allow concepts like “the last Tuesday of each month” (Poker night)

Point_in_time : TS

General_timing_specification : GTS

January 30, 2000 76© 2000, HL7

Text-related data types

• Encapsulated data– media descriptor - MIME types– data - the pay-load– compression - code for compression algorithm– charset - character encoding if other than default– reference - the telecommunication address to the pay-load in

cases where the pay-load is too large to include– thumbnail - a logical precis of the pay-load– integrity_check - a cryptographically strong sum-check for

use in signing, authenticating, etc.– ic_algorithm - the algorithm used to create the integrity check

Character_string : ST

Encapsulated_data : ED

media_descriptor : CVdata : BINcompression : CVcharset : CVreference : TELthumbnail : BINintegrity_check : BINic_algorithm : CV

January 30, 2000 77© 2000, HL7

Demographic data types

• Postal address is a list ofaddress parts whose rolesare things like ZIP code, city, country, post box, etc.

• Person_name is a similarconstruct, where the classifiers are may express multiple dimensions such as given name vs. family name and name in public records vs. nickname.

Postal_and_residential_address : AD

purpose : CVbad_ind : BLvalue : LIST<ADXP>

Address_part : ADXP

value : STrole : CV

Person_name_type : PN

value : LIST<PNXP>

Person_name_part : PNXP

value : STclassifiers : SET<CV>



January 30, 2000 78© 2000, HL7

“Thing” data types (1)• OIDs - HL7 can issue OIDs and can

enable a member or user organization tocreate OIDs ‘underneath’ the HL7 root.

• In the Instance Identifier, thecombination of assigning_authority andvalue_text must be unique.

• The universal resource identifier isdefined and maintained by the IETF andW3C. Refers to addresses ofcommunicating entities used to transmit information. Might be: (a) Web servers (HTTP), (b) File Transfer Protocol servers (FTP), (c) Telephone numbers, (d) Telefax numbers, (e) Dialup Modem connections.

ISO_object_identifier : OID

Instance_identifier : II

assigning_authority : OIDassigning_authority_print_nm : STvalue_txt : STtype_cd : CVvalid_tmr : IVL<TS>

Telecommunication_address : TEL

address : URIuse_cd : SET<CV>valid_time : GTS

Code_value : CV

value : STcode_system : OIDcode_system_version : STprint_name : STreplacement : ST

Concept_descriptor : CD

translations : SET<CDXL>original_text : ED

Code_translation : CDXL

term : CDPHorigin : CDXLproducer : IIquality : REAL

Code_phrase : CDPH

primary_cd : CVmodifier_cd : SET<CRR>

Universal_resource_identifier : URI



January 30, 2000 79© 2000, HL7

“Thing” data types (2)• A code value is exactly one symbol in a code system. The

meaning of the symbol is defined exclusively and completely by the code system that the symbol is from.

• A concept descriptor communicates a real world concept (such as a finding or a diagnosis). A given concept may be expressed in multiple terms where each term is a translation of some other term, or is a (re-)encoding of the original human readable text.

• Code_translation is one translation in a set of translations describing a concept. Components point to the source code used in the translation process and describe who or what performed the translation and what the quality of this translation is.

• A code phrase is a list of code values which all together make up a meaning. This can be used for example in SNOMED, where you can combine multiple codes into a new composite meaning. HL7 V2.x combines codes and modifiers for the OBR specimen source.

ISO_object_identifier : OID

Instance_identifier : II

assigning_authority : OIDassigning_authority_print_nm : STvalue_txt : STtype_cd : CVvalid_tmr : IVL<TS>

Telecommunication_address : TEL

address : URIuse_cd : SET<CV>valid_time : GTS

Code_value : CV

value : STcode_system : OIDcode_system_version : STprint_name : STreplacement : ST

Concept_descriptor : CD

translations : SET<CDXL>original_text : ED

Code_translation : CDXL

term : CDPHorigin : CDXLproducer : IIquality : REAL

Code_phrase : CDPH

primary_cd : CVmodifier_cd : SET<CRR>

Universal_resource_identifier : URI



January 30, 2000 80© 2000, HL7

Generic data types• Provide a means for applying an operation (such as an

interval or a probability distribution) to values expressed in another data type.

• Examples - – interval - of time, of values, etc.– list - of addresses, of person name parts– set - of codes

• Interval applies to any ordered type

• List - an ordered collection of items

• Set - an unordered collection of unique items

• Bag - an unordered collection of items

T

Interval : IVL

low : Tlow_closed : BLhigh : Thigh_closed : BL

T

Annotated : ANT

value : Tnote : CD

T

History_item : HXIT

value : Tvalidity_period : IVL<TS>

T

History : HIST

alias : LIST<HXIT>

T

Uncertain_discrete_value_using_probability : UDVP

value : Tprobability : REAL

T

Non-parametric_probability_Distribution : NPPD

distribution : SET<UDVP<T>>

T

Parametric_probability_distribution : PPD

mean : Tstandard_deviation : Ttype : CVparameters : ANY

T

Uncertain_value-narrative : UVN

value : Tconfidence : CD

T, R

List : LIST

T, R

Set : SET

T, R

Bag : BAG

Set_CV : SET<CV>

Interval_of_integer : IVL<INT>

Set_CDXL : SET<CDXL>

Interval_of_time : IVL<TS>

Set_UDVP : SET<UDVP<T>>

List_ADXP : LIST<ADXP>

List_PNXP : LIST<PNXP>

Set_of_II : SET<II> Set_CRR : SET<CRR>

Set_ON : SET<ON>

List_N: LIST<N>

Set_TEL : SET<TEL>

Set_Address : SET<AD>

January 30, 2000 81© 2000, HL7

Our agenda

What is HL7?






January 30, 2000 82© 2000, HL7

Information Modeling Language

Patient

gender : CDdonor : BLV.I.P. : BL

Doctor

specialty : CDphone : TELprivileges: CV

Person

name : PNDOB : Dateaddress : AD

1

1..*

Encounter

type : CVtime : IVLTSreason : CD

1

0..*

0..10..1

follow-up

• Class defines things

• Objects are instances

• Associations relate things

• Associative classes

• Generalization classes

• Reflexive associations

• Reflexive associations structure instances of one class– chain (predecessor-successor,) hierarchy (parent-child,) or network

Coded attributes

Over 40% of RIM attributes are coded!

January 30, 2000 83© 2000, HL7

Goals of Vocabulary Technical Committee

• Decrease time and cost of implementations

• Approach “plug-and-play”

• Enable data sharing– Mergers due to managed care– Regional or national clinical studies– Disease prevention and control

• Enable sharing of decision support modules– Alerts– Protocols– Clinical pathways

January 30, 2000 84© 2000, HL7

HL7 Vocabulary Development Strategy

• Reference existing vocabularies

• Collaborate with other SDO’s– DICOM– ASTM– X12

• Add value by creating linkage between HL7 messages and existing vocabularies

• Only add items that do not already exist

• Collaborate with vocabulary developers

January 30, 2000 85© 2000, HL7

Vocabulary domain

• “The set of all concepts that can be taken as valid values in an instance of a coded field or attribute.”

• Concept - “A unit of thought constituted through abstraction on the basis of characteristics common to a set of objects.” ISO 1087

• Each concept in the domain can be represented using a specific vocabulary/terminology

January 30, 2000 86© 2000, HL7

Each coded attribute has a domain specification

Class: Patient

Description: A person who may receive, is receiving, or has received healthcare services.

Associationsis_a_role_of (1,1) :: Personis_source_for (0,n) :: Specimen_sample

Attributesbirth_order_numberbirth_dttm (from Person)gender_cd <Gender, Ext:CWE>

January 30, 2000 87© 2000, HL7

Vocabulary Domain Specification

• One and only one domain for each coded RIM attribute

• General form:– <domain name, list of domain qualifiers>– <Gender, Ext:CWE>

• Currently two types of domain qualifiers– Extensibility (Extensibility)

• CNE - Coded No Exceptions

• CWE - Coded With Exceptions

– Realm (RealmOfUse)• Universal

• USA?

• Europe?

• Others

January 30, 2000 88© 2000, HL7

Specialization of Domains• Used in specifying message

– MIM, MET, CMET, HMD, Clinical Templates(?)

• Example:– MyGender = (“Gender:USA:HL7” - “Other:USA:HL7-001”)

• General Form– “value set name” <set operator> “value set name”

• Value set name– “Domain name:Realm:Terminology”

• Allowed set operators– “+” Union ()– “-” Difference (sometimes represented as “\”) – “*” Intersection ()

January 30, 2000 89© 2000, HL7

General process of maintaining domains

• Follow pattern of RIM harmonization

• Vocabulary TC appoints facilitators

• Message development TCs have stewardship– Ultimate authority for domain contents– Follow RIM harmonization rules

• Vocabulary Facilitators– Insure that good vocabulary practices are followed– Actual maintenance of domain specification database– Submit new concepts to vocabulary providers

• All vocabulary/terminology providers can provide mappings to HL7 domains

January 30, 2000 90© 2000, HL7

Interaction Design


Use Case Diagram

Spec

UCM Spec


Spec

DIM Spec





h//mt:50”d”………

h//mt:50”d”………



Model new concepts




Develop Refined Message Information ModelSpecify HMD



DefineInteractions



Interaction Diagram

Spec

Inter Spec

January 30, 2000 91© 2000, HL7

Interaction Design



DefineInteractions



Interaction Diagram

Spec

Inter Spec

January 30, 2000 93© 2000, HL7

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– Receiver role– Receiver responsibility

• A specific functional responsibility for the receiver to initiate another (consequential) interaction

January 30, 2000 94© 2000, HL7

Interaction Model Example

Encounter_manager : AR_Encounter_

Encounter_tracker : AR_Encounter_

Encounter_archivist : AR_Encounter_

1: schedule_encounter

4: admit_patient

5: admit_patient

7: activate_scheduled_encounter

8: activate_scheduled_encounter (tid)

2: delete_scheduled_encounter

13: discharge_patient (tid)

3: admit_patient

6: activate_scheduled_encounter

9: delete_active_encounter (tid)





15: cancel_discharge (tid)



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.

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 30, 2000 97© 2000, HL7

Application Roles and Conformance Claims

• A conformance claim is a commitment to fulfill one or more Application Roles

• 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.

• Provides a consistent, unambiguous vocabulary for pre-contract understanding of vendor capabilities

• The collection of these roles is an Application Profile

January 30, 2000 99© 2000, HL7

Message Design


Use Case Diagram

Spec

UCM Spec


Spec

DIM Spec





h//mt:50”d”………

h//mt:50”d”………



Model new concepts




Develop Refined Message Information Model

Specify HMD



DefineInteractions



Interaction Diagram

Spec

Inter Spec

January 30, 2000 100© 2000, HL7

Message Design




h//mt:50”d”………

h//mt:50”d”………


Develop Refined Message Information ModelSpecify HMD

January 30, 2000 102© 2000, HL7

Problem statement• Domain facts:

– HL7 Voting Members are either: (a) individual members, or (b) sponsored by an organizational member, usually their employer.

– Items for balloting are proposed by HL7 Committees or Subcommittees, and the proposing committee designates an individual to serve as their contact for a particular proposal.

– Voting members submit ballots on items proposed as HL7 standards. – Each ballot may vote aye, nay or abstain, and all negative ballots must be

accompanied by a supporting comment.

• Messaging requirements:– HL7 has a ballot acceptance system, and a ballot notification system. – HL7 seeks a message to go from the ballot acceptance system to the ballot

notification system. – This message will be sent upon receipt of a completed ballot.– The message will allow the notification system to send a confirming e-mail to

each of: the voter, the voter’s sponsor organization (if any) and the contact person for the item being voted upon.

January 30, 2000 105© 2000, HL7

Message basics (1)• Every part of the message, from the entire message

down to the smallest subcomponent of a subcomponent of a data type, is a message element.

• Every message element has a type.

• Every message element that is an attribute of a RIM has a type that is an HL7 data type.

• Every message element that represents a component of an HL7 data type also has a type that is an HL7 data type.

• Every message that represents a class has a type that is based on that class or a Common Message Element Type.

January 30, 2000 106© 2000, HL7

Message basics (2)

• Every message element that represents an association has a type that is based on the distal class of the association or a Common Message Element Type.

• Every message element type is one of these four metatypes: primitive, composite, collection, or choice.

• Primitives have no subordinate components.

• Composites do have heterogeneous subordinate components, each with its own name.

• Collections have repetitions of a homogeneous message element. The name of the repeating message element is derived from its type.

January 30, 2000 107© 2000, HL7

V-3 Methodology - working the processUse Case

Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model

Subset &constrain

Specialize &constrain

Order, select& constrain

January 30, 2000 108© 2000, HL7

Message Information Model (MIM)

• Expressed as a UML model

• All parameters are same as an information model

• Constrained subset of the RIM

• Possible constraints:– Selected set of classes– Selected set of attributes for classes– Selected set of associations– Optionality reduces in attributes & associations

January 30, 2000 109© 2000, HL7

Refined-MIM - compared to the MIM

• Additional constraints on cardinality of attributes and associations

• Specialization - when a class will be used with different semantics, it may be shown as two separate classes (clones), with different constraints - – eg. Person_as_patient vs. Person_as_practitioner

• Attributes and associations of general classes may be subsumed into specializations, with different attributes or associations chosen

January 30, 2000 110© 2000, HL7

New parameters contained in R-MIM

• This has all the information of the HMD except the path resulting from the tree-walk

• Classes are in an arbitrary order; no semantic significance

• For each class and attribute, records:– domains - specification of the domain specification for

message elements that contain codes– default values - a value that the receiver should use when it

receives a message instance that does not contain the message element

– inclusion (following)– update (following)

January 30, 2000 111© 2000, HL7

RMIM -- Inclusion parameter

• Parameter determines when and how an element must be valued.

• Mandatory - element may never be null

• Required - element may be null

• Not required - a vendor may choose not to support, this element, must must so decalre as part of vendor’s conformance claim

• Not permitted - Element must always be null (occurs because multiple messages are defined from a single R-MIM and HMD)

January 30, 2000 112© 2000, HL7

Update semantics

• Defines the receiver's processing of the element as:– R replace– D Delete– I Ignore– K (Key) element is a key to a collection of elements– V (Verify) that this element matches a value already in

the receiving systems database– ESA Edit set add, add the element to the collection of items– ESD Edit set delete, delete item that corresponds to this

message element– ESC Edit set change, change the item that corresponds to this

message element– ESAC Edit set add or change, change the item or if a

matching element does not exist, add it

January 30, 2000 113© 2000, HL7

Hierarchical Message Description

• Reflects the– path through the R-MIM– choices – interpolated items for collections

• Special treatment for generalizations that are not subsumed in the R-MIM

• Other than the path, there is no additional semantic content in the HMD, when compared to the R-MIM (the other differences are algorithmically developed)

January 30, 2000 114© 2000, HL7

Message element Type definitions

• Determined by the order of selecting classes in R-MIM

• HMD expresses the type definitions for all message elements

• Sources for message types are:– N - new type defined in the HMD– D - an HL7 data type.– C - refers to an HL7 Common Message Element Type.– U - use same type as previously defined in this HMD– R - recursive reuse of the type that contains this row.– I - refers to a previous instance of the same type

January 30, 2000 115© 2000, HL7

HMD components (1)• The Information Model Mapping.

• The Message Element Type definitions.

• General constraints and defaults provides the ‘default’ for message-specific columns

• Message-specific constraints and defaults section repeats, once for each message type defined in the HMD. These describe one or more message types. Each message type is identified with one or more interactions in the interaction model. If a value in a column is left empty, it will be the same as in the general constraints section. Any particular row may be

excluded from the specific message type being defined.

Repeat this set of ninecolumns for each message type defined

January 30, 2000 116© 2000, HL7


Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model

January 30, 2000 117© 2000, HL7

Problem statement• Domain facts:

– HL7 Voting Members are either: (a) individual members, or (b) sponsored by an organizational member, usually their employer.

– Items for balloting are proposed by HL7 Committees or Subcommittees, and the proposing committee designates an individual to serve as their contact for a particular proposal.

– Voting members submit ballots on items proposed as HL7 standards. – Each ballot may vote aye, nay or abstain, and all negative ballots must be

accompanied by a supporting comment.

• Messaging requirements:– HL7 has a ballot acceptance system, and a ballot notification system. – HL7 seeks a message to go from the ballot acceptance system to the ballot

notification system. – This message will be sent upon receipt of a completed ballot.– The message will allow the notification system to send a confirming e-mail to

each of: the voter, the voter’s sponsor organization (if any) and the contact person for the item being voted upon.

January 30, 2000 118© 2000, HL7

Portion of Reference Information Model (RIM)

Organization

organization_name_type_cdorganization_nmstandard_industry_class_cd

0..*

0..1



Person

birth_dttmbirthplace_addrcitizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdadministrative_gender_cdlanguage_cdmarital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cdrace_cdreligious_affiliation_cdstudent_cdvery_important_person_cdstatus_cdambulatory_status_cdidhispanic_indbirth_order_nbrliving_arrangement_cdliving_dependency_cdmultiple_birth_indorgan_donor_indpreferred_pharmacy_id

Person_name


1

0..*

has1

is_for0..*



Stakeholder

addrcredit_rating_cdemail_address_txtphontype_cdreal_id : SET<RWII>id : SET<II>

0..*

1 has_as_primary_participant

0..*participates_as_primary_in

10..*

1 has_as_secondary_participant

0..*participates_as_secondary_in1

January 30, 2000 119© 2000, HL7

Initial message information model (MIM)

Organization

organization_nm : ST0..*

0..1

is_a_subdivision_of

0..*


Stakeholder

addr : STemail_address_txt : TELid : SET<II>


affiliation_type_cd : CD

1..1


1..1 has_as_primary_participant

0..*

1..10..*participates_as_secondary_in

1..1 has_as_secondary_participant0..*

Person

education_level_cd : CD

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

January 30, 2000 120© 2000, HL7

Message information model (MIM)

Organization

organization_name_type_cdorganization_nmstandard_industry_class_cd

0..*

0..1



Person

birth_dttmbirthplace_addrcitizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdadministrative_gender_cdlanguage_cdmarital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cdrace_cdreligious_affiliation_cdstudent_cdvery_important_person_cdstatus_cdambulatory_status_cdidhispanic_indbirth_order_nbrliving_arrangement_cdliving_dependency_cdmultiple_birth_indorgan_donor_indpreferred_pharmacy_id

Person_name


1

0..*

has1

is_for0..*



Stakeholder

addrcredit_rating_cdemail_address_txtphontype_cdreal_id : SET<RWII>id : SET<II>

0..*

1 has_as_primary_participant


10..*

1 has_as_secondary_participant

0..*participates_as_secondary_in1

RIMcontent

Individual_representative

dues_current_ind : BL

Organizational_representative

Organization

organization_nm : ST

0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Proposed_item

ballot_period_tmr : IVL<TS>content_txt : EDstandard_level_ind : BL

0..*

1..1

proposed_by

0..*

proposes1..1

Ballot

comments_txt : STdttm : TSvote_cd : CV

0..*

1..1

votes_on

0..*

receives_votes

1..1

Voting_member

draft_level_voting_ind : BLstandard_level_voting_ind : BL

0..*

1..1

cast_by

0..*

casts

1..1

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

MIMcontent

(a proper subsetof the RIM)

Fewerattributes

January 30, 2000 121© 2000, HL7

Add voters to MIM




Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Voting_member


Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

HL7 Voting Members are either: (a) individual members, or (b) sponsored by an organizational member, usually their employer.

Organization

organization_nm : ST0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Person


Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

January 30, 2000 122© 2000, HL7





Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Proposed_item


0..*

1..1

proposed_by

0..*

proposes1..1

Ballot


0..*

1..1

votes_on

0..*

receives_votes

1..1

Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

Items for balloting are proposed by HL7 Committees or Subcommittees, Voting members submit ballots on items. Each ballot may vote aye, nay or abstain, and all negative ballots must be accompanied by a supporting comment.




Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Voting_member


Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

January 30, 2000 123© 2000, HL7


Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model

January 30, 2000 124© 2000, HL7





Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Proposed_item


0..*

1..1

proposed_by

0..*

proposes1..1

Ballot


0..*

1..1

votes_on

0..*

receives_votes

1..1

Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

January 30, 2000 125© 2000, HL7

Partially morphed MIM



Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_name

nm : STtype_cd : CD

Person

education_level_cd : CDemail_address_txt : TEL

0..*

1..1

is_role_of0..*

has_as_role1..1

1..1

0..*

has1..1

is_for0..*

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1


Organization

organization_nm : STemail_address_txt : TEL

0..*

1..1

proposed_by

0..*

proposes1..1

0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..*

participates_as_secondary_in1..1

has_as_secondary_participant

0..*

1..1

0..*

participates_as_primary_in1..1

has_as_primary_participant

0..*

January 30, 2000 126© 2000, HL7

Remove inconsequential inheritance



Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_name

nm : STtype_cd : CD

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

1..1

0..*

has1..1

is_for0..*

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1


Organization


0..*

1..1

proposed_by

0..*

proposes1..1

0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..*



0..*

1..1

0..*



0..*




Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Proposed_item


0..*

1..1

proposed_by

0..*

proposes1..1

Ballot


0..*

1..1

votes_on

0..*

receives_votes

1..1

Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

Subsume inherited attributes Transfer inherited associations

January 30, 2000 127© 2000, HL7

Partially morphed MIM



Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_name

nm : STtype_cd : CD

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

1..1

0..*

has1..1

is_for0..*

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1


Organization


0..*

1..1

proposed_by

0..*

proposes1..1

0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..*



0..*

1..1

0..*



0..*

January 30, 2000 128© 2000, HL7

Refined Message Information Model (R-MIM)



Organization_as_HL7_member



0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*

Organization_as_Committee


0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*


Person_as_Committee_contact

email_address_txt : TEL

1..1

0..1

has 1..1

is_for

0..1



1..1

0..*

participates_as_primary_in

1..1


0..*

1..1

0..*

participates_as_secondary_in

1..1


0..*

January 30, 2000 129© 2000, HL7







0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*



0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..1

has 1..1

is_for

0..1



1..1

0..*


1..1


0..*

1..1

0..*


1..1


0..*



Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_name

nm : STtype_cd : CD

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

1..1

0..*

has1..1

is_for0..*

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1


Organization


0..*

1..1

proposed_by

0..*

proposes1..1

0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..*



0..*

1..1

0..*



0..*

Specialize cloned views of Person to meet specific requirements

Constrain navigability of associations

January 30, 2000 130© 2000, HL7







0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*



0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..1

has 1..1

is_for

0..1



1..1

0..*


1..1


0..*

1..1

0..*


1..1


0..*

January 30, 2000 131© 2000, HL7


Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model

January 30, 2000 132© 2000, HL7







0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*



0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..1

has 1..1

is_for

0..1



1..1

0..*


1..1


0..*

1..1

0..*


1..1


0..*

0

1

2

2a4

5 3

January 30, 2000 133© 2000, HL7







0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*



0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..1

has 1..1

is_for

0..1



1..1

0..*


1..1


0..*

1..1

0..*


1..1


0..*

0

6

7

89

10

January 30, 2000 135© 2000, HL7

HMD adds constraints, defaults, cardinality, etc.

Link to RIMVocab domain

constraints,cardinality,

etc.

January 30, 2000 136© 2000, HL7

Conversion from HMD to a DTD is algorithmic

<!ENTITY % V3DT SYSTEM "V3DT991006a.dtd">

%V3DT;



<!ENTITY % Ballt-cont.model "(commntsTxt?, dttm?, vote, votesOn_PropsdItm, castBy_VotngMembr)?"><!ENTITY % Ballt-attrib.list "

T CDATA #FIXED 'Ballt'NULL %null.code.set; #IMPLIEDNOTE CDATA #IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">

<!ENTITY % PropsdItm-cont.model "(balltPeriodTmr?, contntTxt?, standrdLevlInd?, propsdBy_OrgnztnAsCommtte)?"><!ENTITY % PropsdItm-attrib.list "

T CDATA #FIXED 'PropsdItm'NULL %null.code.set; #IMPLIEDNOTE CDATA #IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">

<!ENTITY % OrgnztnAsHL7Membr-cont.model "(nm, emailAddrssTxt?)?"><!ENTITY % OrgnztnAsHL7Membr-attrib.list "

T CDATA #FIXED 'OrgnztnAsHL7Membr'NULL %null.code.set; #IMPLIEDNOTE CDATA#IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">



<!ELEMENT Ballt %Ballt-cont.model;><!ATTLIST Ballt %Ballt-attrib.list; HL7_NAME CDATA #FIXED 'Ballot'>

<!ELEMENT IndvdlReprsntv %IndvdlReprsntv-cont.model;><!ATTLIST IndvdlReprsntv %IndvdlReprsntv-attrib.list; HL7_NAME CDATA #FIXED 'Individual_representative'>….<!ELEMENT balltPeriodTmr %IVL_TS-cont.model;><!ATTLIST balltPeriodTmr %IVL_TS-attrib.list; HL7_NAME CDATA #FIXED 'balltPeriodTmr'>

<!ELEMENT castBy_VotngMembr %VotngMembr-cont.model;><!ATTLIST castBy_VotngMembr %VotngMembr-attrib.list; HL7_NAME CDATA #FIXED 'castBy_VotngMembr'>

<!ELEMENT emailAddrssTxt %TEL-cont.model;><!ATTLIST emailAddrssTxt %TEL-attrib.list; HL7_NAME CDATA #FIXED 'emailAddrssTxt'>

<!ELEMENT vote %CV-cont.model;><!ATTLIST vote %CV-attrib.list; HL7_NAME CDATA #FIXED 'vote'>

January 30, 2000 137© 2000, HL7

HL7-Conformant

Application

HL7-Conformant

Application

Hierarchical

Message

Description

Implementation

Technology

Specifications

Data

HL7

Message

Creation

HL7

Message

ParsingData

ITS

Message

Instance

V-3 Methodology - sending a message instance

1. Use HMD to collect & structure data

2. Use ITS to format message instance

3. Communicate the instance

4. Use ITS to parse message instance

5. Use HMD to disassemble and store data

January 30, 2000 138© 2000, HL7

Message instance<?xml version="1.0"?><!DOCTYPE Ballt SYSTEM "Ballot_C00_RIM_0092Da_1.dtd" [ ]>

<Ballt> <dttm V="199912052357+0100"/> <vote V="A" S="HL7001" R="3.0" PN="Abstain"/> <votesOn_PropsdItm> <standrdLevlInd V='T'/> <propsdBy_OrgnztnAsCommtte> <nm V="Humble Task Group"/> <isAsubdvsnOf_OrgnztnAsCommtte> <nm V="Grand Committee"/> </isAsubdvsnOf_OrgnztnAsCommtte> <partcpesAsPrimryIn_StkhldrAffltn> <_StkhldrAffltn> <type V="X" S="HL7004" R="3.0" PN="XXX"/> <hasSecndryPartcpnt_PrsnAsCommtteContct> <has_PrsnName> <pnm> <G V="George" CLAS="R"/> <G V="Woody" CLAS="C"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> </hasSecndryPartcpnt_PrsnAsCommtteContct> </_StkhldrAffltn> </partcpesAsPrimryIn_StkhldrAffltn> </propsdBy_OrgnztnAsCommtte> </votesOn_PropsdItm>

<castBy_VotngMembr T="OrgnztnlReprsntv"> <OrgnztnlReprsntv> <isRoleOf_PrsnAsVotr> <has_PrsnName> <pnm> <G V="George" CLAS="R"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> <has_PrsnName> <pnm> <G V="Woody" CLAS="C"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> </isRoleOf_PrsnAsVotr> <sponsrdBy_OrgnztnAsHL7Membr> <nm V="Mayo Clinic"/> <emailAddrssTxt v=“[email protected]”/> </sponsrdBy_OrgnztnAsHL7Membr> </OrgnztnlReprsntv> </castBy_VotngMembr></Ballt>

January 30, 2000 139© 2000, HL7

Auditability - Message instance<?xml version="1.0"?><!DOCTYPE Ballt SYSTEM "Ballot_C00_RIM_0092Da_1.dtd" [ ]>

<Ballt> <dttm V="199912052357+0100"/> <vote V="A" S="HL7001" R="3.0" PN="Abstain"/> <votesOn_PropsdItm> <standrdLevlInd V='T'/> <propsdBy_OrgnztnAsCommtte> <nm V="Humble Task Group"/> <isAsubdvsnOf_OrgnztnAsCommtte> <nm V="Grand Committee"/> </isAsubdvsnOf_OrgnztnAsCommtte> <partcpesAsPrimryIn_StkhldrAffltn> <_StkhldrAffltn> <type V="X" S="HL7004" R="3.0" PN="XXX"/> <hasSecndryPartcpnt_PrsnAsCommtteContct> <has_PrsnName> <pnm> <G V="George" CLAS="R"/> <G V="Woody" CLAS="C"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> </hasSecndryPartcpnt_PrsnAsCommtteContct> </_StkhldrAffltn> </partcpesAsPrimryIn_StkhldrAffltn> </propsdBy_OrgnztnAsCommtte> </votesOn_PropsdItm>

<castBy_VotngMembr T="OrgnztnlReprsntv"> <OrgnztnlReprsntv> <isRoleOf_PrsnAsVotr> <has_PrsnName> <pnm> <G V="George" CLAS="R"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> <has_PrsnName> <pnm> <G V="Woody" CLAS="C"/> <G V="W." CLAS="R I"/> <F V="Beeler" CLAS="R"/> </pnm> </has_PrsnName> </isRoleOf_PrsnAsVotr> <sponsrdBy_OrgnztnAsHL7Membr> <nm V="Mayo Clinic"/> <emailAddrssTxt v=“[email protected]”/> </sponsrdBy_OrgnztnAsHL7Membr> </OrgnztnlReprsntv> </castBy_VotngMembr></Ballt>



<!ELEMENT Ballt %Ballt-cont.model;><!ATTLIST Ballt %Ballt-attrib.list; HL7_NAME CDATA #FIXED 'Ballot'>

<!ELEMENT IndvdlReprsntv %IndvdlReprsntv-cont.model;><!ATTLIST IndvdlReprsntv %IndvdlReprsntv-attrib.list; HL7_NAME CDATA #FIXED 'Individual_representative'>….<!ELEMENT balltPeriodTmr %IVL_TS-cont.model;><!ATTLIST balltPeriodTmr %IVL_TS-attrib.list; HL7_NAME CDATA #FIXED 'balltPeriodTmr'>

<!ELEMENT castBy_VotngMembr %VotngMembr-cont.model;><!ATTLIST castBy_VotngMembr %VotngMembr-attrib.list; HL7_NAME CDATA #FIXED 'castBy_VotngMembr'>

<!ELEMENT emailAddrssTxt %TEL-cont.model;><!ATTLIST emailAddrssTxt %TEL-attrib.list; HL7_NAME CDATA #FIXED 'emailAddrssTxt'>

<!ELEMENT vote %CV-cont.model;><!ATTLIST vote %CV-attrib.list; HL7_NAME CDATA #FIXED 'vote'>

Auditability - DTD Element definition

<!ENTITY % V3DT SYSTEM "V3DT991006a.dtd">

%V3DT;



<!ENTITY % Ballt-cont.model "(commntsTxt?, dttm?, vote, votesOn_PropsdItm, castBy_VotngMembr)?"><!ENTITY % Ballt-attrib.list "

T CDATA #FIXED 'Ballt'NULL %null.code.set; #IMPLIEDNOTE CDATA #IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">

<!ENTITY % PropsdItm-cont.model "(balltPeriodTmr?, contntTxt?, standrdLevlInd?, propsdBy_OrgnztnAsCommtte)?"><!ENTITY % PropsdItm-attrib.list "

T CDATA #FIXED 'PropsdItm'NULL %null.code.set; #IMPLIEDNOTE CDATA #IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">

<!ENTITY % OrgnztnAsHL7Membr-cont.model "(nm, emailAddrssTxt?)?"><!ENTITY % OrgnztnAsHL7Membr-attrib.list "

T CDATA #FIXED 'OrgnztnAsHL7Membr'NULL %null.code.set; #IMPLIEDNOTE CDATA#IMPLIEDUPDATE_MODE %update.mode.code.set; 'R'

">

Auditability - DTD Entity definitionsAuditability - Hierarchical Message Description






0..1

0..*

sponsors 0..1

sponsored_by0..*

Ballot


Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person_as_Voter


0..*

1..1

is_role_of 0..*

has_as_role1..1

Proposed_item


0..*

1..1

votes_on

0..*

receives_votes

1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has 1..1

is_for 0..*



0..*

1..1

proposed_by

0..*

proposes1..1

0..*

0..1

is_a_subdivision_of

0..*




1..1

0..1

has 1..1

is_for

0..1



1..1

0..*


1..1


0..*

1..1

0..*


1..1


0..*

Auditability - Refined Message Info. Model




Organization


0..*

1..1

sponsored_by0..*

sponsors1..1

0..*

0..1

is_a_subdivision_of

0..*


Stakeholder




1..1



0..*



Proposed_item


0..*

1..1

proposed_by

0..*

proposes1..1

Ballot


0..*

1..1

votes_on

0..*

receives_votes

1..1

Voting_member


0..*

1..1

cast_by

0..*

casts

1..1

Person


0..*

1..1

is_role_of0..*

has_as_role1..1

Person_name

nm : STtype_cd : CD

1..1

0..*

has1..1

is_for0..*

Auditability - Message Information Model

January 30, 2000 140© 2000, HL7

V-3 Methodology - defining abstract messageUse Case

Model

Interaction

Model

Hierarchical

Message

Description

Domain

Information

Model

Message

Information

Model

Refined

Message

Information

Model

Common

Message

Element

Definition

Reference

Information

Model