NCVHS Subcommittee on Standards and Security

James J. Cimino, M.D.

Co-Chair, HL7 Vocabulary Technical Committee

Department of Medical Informatics

Columbia University

Selection Criteria for Message Standards

• Is there loss of information?

• Does it employ high-quality terminologies?

• How can the government support the standard?

Questions for SDOs - General

• Is there active participation by all interested parties?

• What evaluations have been done?

Questions for SDOs - Data Quality

• Does it alleviate duplication of data capture?

• Is there a data model that considers all users?

Patient

ambulatory_status_cd

birth_order_amt

living_arrangement_cdliving_dependency_cdmultiple_birth_ind

newborn_baby_ind

organ_donor_ind

preferred_pharmacy_id

has 1

has1

participates_in 1

has1

is_requested_by1

is_scheduled_by1

has 1

has1has 1

has_a_primary_provider0..*

is_a_role_of 0..1

has_as_primary_facility 0..*

is_target_of0..1

is_source_for 0..1

a_contacthas_as_ 0..1

is_involved_in1

Reference Information Model

Reference Information Model

11

11

11

11

11

11

11

11

11

11

11

11

11

effective_dtreturn_to_work_auth_dttermination_dtunable_to_work_effective_dt

11

11 11

11

11

Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id1has 1

1 has1

1participates_in1

0..*

1

pertains_to

0..*

has1

1 is_requested_by11 is_scheduled_by1

1has 1

111has1

0..*has_a_primary_provider0..*

0..1is_a_role_of0..1

1has1

0..*has_as_primary_facility0..*

0..1is_target_of0..1

0..1is_source_for0..1

0..1has_as_a_contact

0..1

11

11

11

11

11

11

Reference Information Model

Allergyallergen_idallergy_cdallergy_reaction_cdallergy_reaction_description_txtallergy_severity_cdallergy_type_cdassessment_dttmemployment_related_ind

Health_issuediagnosis_cdonset_dttmbilling_priority_amtseverity_cdclassification_cdconfirmation_status_cdpersistence_cdprobability_amtprobability_txtprognosis_descprognosis_awareness_desccd

Medicare_coverageeffective_dteligibility_cdidlifetime_res_delay_day_qtylifetime_reserve_day_qtymedicare_coverage_type_cdprogram_type_cdrenal_cdtermination_dt

Medicaid_coverageaid_category_cd

Champus_coveragehandicapped_program_cdnon_avail_cert_on_file_indretirement_dtstation_id

Master_categorical_observationabnormal_result_cdallowed_value_type_cdcritical_result_cdnormal_result_cdpreferred_coding_system_cdvalid_answer_cd

Master_calculated_observationderivation_rule_desc

Referralauthorized_visits_qtydescreason_txt

Dietary_intent_or_orderdiet_type_cddietary_instruction_descdietary_tray_type_cdservice_period_cdservice_type_cd

Observation_intent_or_orderpatient_hazard_cdreason_for_study_cdrelevant_clinical_information_txtreporting_priority_cdspecimen_action_cd

Treatment_service_eventprescription_idrefills_remaining_qtynotes_txtPTroutPTcompindication_cdexpiration_dttmsubstance_lot_number_txtsubstance_manufacturer_cd

Treatment_service_administrationadministered_rate_txtcompletion_status_cdsubstance_refusal_reason_cdsubstitution_cdsystem_entry_dttm

Treatment_service_dispensedispense_package_method_cddispense_package_size_amtneeds_human_review_indrejection_reason_txtsubstitution_cdsuppliers_special_dispensing_instruction_cdtotal_daily_dose_amt

Treatment_service_giveadministration_descgive_per_time_unit_cdgive_quantitytiming_qtgive_rate_amtmax_give_amtmin_give_amtneeds_human_review_indsubstitution_status_cdsupplier_special_administration_instruction_cd

Goalaction_cdaction_dttmclassification_cdcurrent_review_status_cdcurrent_review_status_dttmepisode_of_care_idestablished_dttmevaluation_cdevaluation_comment_txtexpected_achievement_dttmgoal_list_priority_amtlife_cycle_dttmlife_cycle_status_cdmanagement_discipline_cdnext_review_dttmprevious_review_dttmreview_interval_cdtarget_txttarget_type_cdgoal_cd

Clinical_observationabnormal_result_indlast_observed_normal_values_dttmnature_of_abnormal_testing_cdclinically_relevant_begin_dttmclinically_relevant_end_dttmobservation_method_cdobservation_status_cdobservation_status_dttmobservation_sub_idobservation_value_txtprobability_amtreferences_range_txtuniversal_service_identifier_suffix_txtuser_defined_access_check_txtvalue_type_cdvalue_units_cd

Consent Care_event Assessment

Master_specimen_requirementadditive_cdcontainer_desccontainer_preparation_desccontainer_volume_amtderived_specimen_cdminimum_collection_volume_amtnormal_collection_volume_amtspecial_handling_descspecimen_priorities_cdspecimen_retention_time_amtspecimen_type_cd

Master_observation_serviceinstrument_idpermitted_data_type_cdprocessing_time_qtyspecimen_required_indtypical_turnaround_time_qty

1

0..*

has 1

is_specified_for 0..*

0..*

0..*

is_basis_for 0..*

has_as_basis

0..*

Master_treatment_servicedea_level_cddrug_category_cdformulary_status_cdmedication_form_cdpharmaceutical_class_cdroute_cdtherapeutic_class_cd

Treatment_intent_or_orderdosage_txtearliest_dispense_dtIndication_cdnon_form_authorized_indproviders_treatment_instruction_txtrejection_reason_cdrequested_give_rate_amtrequested_give_strength_amtsubstitution_allowed_indsupplier_special_dispensing_instruction_cdverification_required_ind

Treatment_intent_or_order_revisiondispense_package_method_cddispense_package_size_amtgive_indication_cdgive_per_time_unit_cdgive_rate_amtlast_refilled_dttmmax_give_amtmin_give_amtneeds_human_review_indorder_revision_PTcomporder_revision_PTroutorder_revision_quantitytiming_qtordered_administration_method_cdprescription_idproviders_administration_instruction_cdrefills_allowed_qtyrefills_doses_dispensed_qtyrefills_remaining_qtysubstitution_status_cdsuppliers_dispensing_instruction_cdtotal_daily_dose_amttotal_daily_dose_cd

0..1

0..*

is_ordered_on

0..1

orders0..*

1 1..*has_parts1 is_part_of 1..*

Master_numeric_rangerange_type_cdcondition_deschigh_range_amthigh_gestation_age_amthigh_value_amtlow_age_amtlow_gestation_age_amtlow_value_amtrace_subspecies_txtsex_txtspecies_txt

Master_continuous_observationcorresponding_SI_unit_of_measure_cdcustomary_unit_of_measuredelta_check_numeric_change_computation_method_txtdelta_check_numeric_change_threshold_amtdelta_check_numeric_high_value_amtdelta_check_numeric_low_value_amtdelta_check_numeric_retention_days_qtylength_and_decimal_precision_amtminimum_meaningful_increment_amtsi_conversion_factor_txt

0..*

1

applies_to0..*

conforms_to1

Healthcare_financesHealthcare_finances

Healthcare_financesHealthcare_stakeholders

Healthcare_financesMaster_tables

Healthcare_financesPatient_encounters

HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0088

released January, 1999reflects agreements made through harmonization in November, 1998

Advance_directivecompetence_inddirective_cddisclosure_level_cdlife_quality_descmortuary_preference_nmnotarization_dtassessment_dttmemployment_related_ind

Durable_medical_equipment_slot

Durable_medical_equipment_requestquantity_amttype_cd

Durable_medical_equipmentidslot_size_increment_qtytype_cd

0..*

1

is_a_scheduleable_unit_for

0..*

is_scheduled_by1

0..*

1

requests0..*

is_requested_by 1

Durable_medical_equipment_groupid

0..*

0..1

may_request0..*

is_requested_by 0..1

1..*

0..*

belongs_to 1..*

contains0..*

Patient_departureactual_discharge_disposition_cddischarge_dttmdischarge_location_idexpected_discharge_disp_cd

Patient_admissionadmission_dttmadmission_reason_cdadmission_referral_cdadmission_source_cdadmission_type_cdpatient_valuables_descpre_admit_test_indreadmission_indvaluables_location_desc

Bad_debt_billing_accountbad_debt_recovery_amtbad_debt_transfer_amttransfer_to_bad_debt_dttransfer_to_bad_debt_reason_cd

Diagnostic_related_groupbase_rate_amtcapital_reimbursement_amtcost_weight_amtidmajor_diagnostic_category_cdoperating_reimbursement_amtreimbursement_amtstandard_day_qtystandard_total_charge_amttrim_high_day_qtytrim_low_day_qty

Inpatient_encounteractual_days_qtyestimated_days_qty

1

0..1

is_terminated_by

1

terminates

0..1

1

1

is_preceded_by 1

preceded1

Resource_requestallowable_substitutions_cdduration_qtystart_dttmstart_offset_qtystatus_cd

Bad_debt_collection_agency

0..*

1

is_assigned_to

0..*

is_assigned1

Encounter_drgapproval_indassigned_dttmconfidential_indcost_outlier_amtdescgrouper_review_cdgrouper_version_idoutlier_days_qtyoutlier_reimbursement_amtoutlier_type_cd

1

0..*

is_assigned_as

1

is_an_assignment_of0..*

0..*1

is_assigned_to 0..*is_assigned 1

Identifier_issuing_authorityeffective_dttermination_dt

Appointment_requestappointment_rqst_reason_cdappointment_rqst_type_cdequip_selection_criteria_pvidlocation_selection_criteria_pvoccurence_idpriority_cdrepeating_interval_duration_qtyrequested_rirqst_event_reason_cdrqsted_duration_qtystart_dttime_selection_criteria_pv

0..*1 is_requested_by 0..*requests1

Stakeholder_affiliatefamily_relationship_cd

Stakeholder_affiliationaffiliation_type_cddesceffective_dttermination_dt

0..*

1

has_as_secondary_participant0..*

participates_as_secondary_in 1

Stakeholder_identifiereffective_dtididentifier_type_cdissued_dtqualifying_information_txttermination_dt

1

0..*

issues 1

is_issued_by

0..*

Insurance_certification_contactparticipation_type_cd

Healthcare_document_authenticator

Person_employmentaddreffective_dthazard_exposure_txtjob_class_cdjob_title_nmphonprotective_equipment_txtsalary_amtsalary_type_cdstatus_cdtermination_dtoccupation_cdjob_status_cd

Authenticationauthentication_dttype_cd

1

0..*

is_related_to

1

is_related_to0..*

Document_recipient

Originator

Service_intent_or_order_relationshiprelationship_type_cdreflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Organizationorganization_name_type_cdorganization_nmstandard_industry_class_cd

0..1

1

is_a_role_of 0..1

takes_on_role_of1

0..*0..1

is_a_subdivision_of

0..*

has_as_a_subdivision0..1

0..*

1

is_assigned_by

0..*

assigns1

0..1

1

is_a_role_of 0..1

takes_on_role_of

1

Master_service_relationshiprelationship_type_cdreflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt

Healthcare_benefit_serviceaccess_protocol_desccapitation_indcoinsurance_indcoinsurance_pctcopayment_amtdeductible_amtlower_coverage_limit_amtpay_cap_limit_amtpcp_referral_indprimary_care_provider_indreview_indupper_coverage_limit_amt

Producer_of_master_serviceservice_producing_department_type_cd

Service_scheduling_requestallowable_substitutions_cdduration_qtystart_dttmstart_offset_qtystatus_cd

1

0..*

requests1

is_requested_by0..*

Patient_information_recipient

Healthcare_service_providerboard_certification_type_cdboard_certified_indcertification_dteffective_dtlicense_idrecertification_dtspecialty_cdtermination_dt

1

0..*

participates_as1

has_as_participant 0..*

Health_chart_deficiencyassessment_dtdesclevel_cdtype_cd

Insurance_certificationappeal_reason_cdcertification_day_qtyeffective_dtidinsurance_verification_dttmmodification_dttmnon_concur_cdnon_concur_effective_dttmpenalty_amttermination_dtreport_of_eligibility_dtreport_of_eligibility_ind

1

1..*

has_as_a_contact1

is_a_contact_for 1..*

Healthcare_benefit_coverageannual_limit_amtbenefit_descbenefit_product_nmdependent_coverage_inddependent_coverage_limit_amteffective_dttmlifetime_limit_amttermination_dttmagreement_type_cdbaby_coverage_indblood_deductible_amtcopay_limit_inddaily_deductible_amtnon_covered_insurance_cdpolicy_amount_class_cdpolicy_amtpolicy_category_cdpolicy_deductible_amtpolicy_limit_day_qtypolicy_scope_cdroom_coverage_type_amount_cd

1

0..*

has_parts

1

is_part_of0..*

Individual_healthcare_practitioner_slot

Individual_healthcare_practitioner_requestpractitioner_type_cd

Individual_healthcare_practitioner_groupid

0..1

0..*

is_requested_by0..1

may_request0..*

Certification_second_opinioneffective_dtstatus_cd

0..*

1

provides_opinion_on0..*

includes 1

Employee

1

0..*

is_employee_in 1

has_as_employee 0..*

Notary_publiceffective_dtnotary_county_cdnotary_state_cdtermination_dt

Transcriptionist

Person_alternate_nameeffective_dtcdnmreason_cdtermination_dttype_cd

Billing_information_itemcondition_cdoccurrence_cdoccurrence_dtoccurrence_span_cdoccurrence_span_from_dtoccurrence_span_thru_dtquantity_amtquantity_type_cdvalue_amtvalue_cd

Guarantor_contractbilling_hold_indbilling_media_cdcharge_adjustment_cdcontract_duration_cdcontract_type_cdeffective_dtinterest_rate_amtperiodic_payment_amtpriority_ranking_cdtermination_dt

1

0..*

has_coverage_affirmed_by 1

affirms_insurance_coverage_for0..*

Healthcare_provider_organization0..1

1

is_a_role_of 0..1

takes_on_role_of1

Patient_service_location_slot

Patient_service_location_groupid

Patient_service_location_requesttype_cd

0..1

0..*

is_requested_by0..1

may_request

0..*

Procedureanesthesia_cdanesthesia_minutes_qtydelay_reason_txtincision_closed_dttmincision_open_dttmpriority_amtprocedure_cdprocedure_dttmprocedure_functional_type_cdprocedure_minute_qtymodifier_cd

Stakeholderaddrcredit_rating_cdemail_address_txtphontype_cd

0..1

1

is_a_role_of

0..1

takes_on_role_of 1

0..* 1has_as_primary_participant0..* participates_as_primary_in 1

0..*

1

is_assigned_to0..*

is_assigned 1

1 0..1takes_on_role_of1 is_a_role_of 0..11

0..1

may_act_as_a1

is_a0..1

1

0..1

takes_on_role_of1

is_a_role_of

0..1

0..1

1

is_a 0..1

takes_on_role_of1

0..1

1

is_a 0..1

takes_on_role_of1

0..*

0..*

refers_to_person_by0..*is_used_by0..*

Guarantorfinancial_class_cdhousehold_annual_income_amthousehold_size_qty

1

1..*

guarantees_payment_under

1

has_payment_guaranteed_by

1..*

0..1

1

is_a_role_of 0..1

takes_on_role_of 1

Employereffective_dttermination_dt

1

0..*

is_employer_of1

has_as_employer

0..*

0..1

1

is_a_role_of0..1

takes_on_role_of 1

Health_benefit_plan_purchaser

0..1

1

is_a_role_of0..1

takes_on_role_of 1

Condition_nodeactual_resolution_dttmestimated_resolution_dttmlife_cycle_status_dttmlifecycle_status_cdmanagement_discipline_cdonset_time_txtonset_dttmranking_amtemployment_related_ind

Insurereffective_dttermination_dt

1

0..1

takes_on_role_of 1

is_a_role_of0..1

1

0..*

issues1

is_issued_by0..*

Accident_information_source

1

0..1

takes_on_role_of1

is_a_role_of 0..1

Clinical_document_headerauthentication_dtavailability_status_cdchange_reason_cdcompletion_status_cdconfidentiality_status_cdcontent_presentation_cddocument_header_creation_dtfile_nmidlast_edit_dtorigination_dtreporting_priority_cdresults_report_dttmstorage_status_cdtranscription_dttype_cd

0..1

0..* is_parent_document_for

0..1

has_as_a_parent_document

0..*

0..* 1

is_related_to

0..*

is_related_to

1

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

0..1 0..*of0..1 has_been_originated_by 0..*

0..1

0..*

transcribes0..1

is_transcribed_by 0..*

Service_reasondetermination_dttmdocumentation_dttmreason_txt

Service_event_relationshiprelationship_type_cd

Service_intent_or_ordercharge_type_cdclarification_phonend_condition_cdentering_device_cdescort_required_indexpected_performance_time_qtyfiller_order_idfiller_txtorder_control_cdorder_control_reason_cdorder_effective_dttmorder_group_idorder_idorder_placed_dttmorder_quantitytiming_qtplacer_order_idplacer_txtplanned_patient_transport_cdreport_results_to_phonresponse_requested_cdservice_body_site_cdservice_body_site_modifier_cdservice_body_source_cdtarget_of_service_cdtransport_arranged_indtransport_arrangement_responsibility_cdtransport_mode_cdwhen_to_charge_dttmwhen_to_charge_txtresults_status_cdintent_or_order_cdjoin_cd

0..*

0..1

is_reason_for0..*

has_as_reason 0..1

1

0..*

is_source_for

1

has_as_source0..*

1

0..*

is_target_for 1

has_as_target0..*

0..1

0..*

may_be_referred_to_in 0..1

is_related_to0..*

Financial_transactionalternate_descdescextended_amtfee_schedule_cdinsurance_amtposting_dtqtytransaction_batch_idtransaction_cdtransaction_dttransaction_idtransaction_type_cdunit_amtunit_cost_amt

0..1

0..*

categorizes0..1

is_categorized_by 0..*

Active_participationbegin_dttmend_dttmduration_tmparticipation_type_cd

0..1

0..*

participates_in0..1

has_as_participant0..*

0..*

0..1

participates_in0..*

has_as_participant 0..1

Master_serviceallowable_processing_priority_cdallowable_reporting_priority_cdbilling_reference_txtchallenge_information_txtconfidentiality_cdeffective_dtfactors_that_may_affect_observation_descfee_amtfixed_canned_message_cdimaging_measurement_modality_cdincompatible_change_dttminstrument_identifier_coding_system_nminstrument_identifier_nminterpretation_considerations_desckind_of_quantity_observed_cdlast_update_dttmmethod_cdmethod_descnature_of_service_cdobservation_id_suffix_txtorderable_service_indpatient_preparation_descpoint_versus_interval_cdportable_device_indpreferred_ordering_method_txtpreferred_scheduling_method_txtprocedure_medication_cdreport_display_order_txtrequired_credentials_descservice_alternate_idservice_alternate_identifier_coding_system_nmservice_alternate_identifier_nmservice_alternate_name_use_cdservice_alternate_nmservice_contraindication_cdservice_descservice_performance_schedule_cdservice_primary_nmservice_requirement_descservice_type_cdstandard_time_to_perform_dttmtarget_anatomic_site_cdtarget_of_service_cduniversal_service_iduniversal_service_identifier_coding_system_nmuniversal_service_identifier_nmquantitytiming_qtjoin_cd

1

0..*

is_target 1

has_target 0..*

10..*

is_source 1has_source 0..*

0..*

1..*

provides_coverage_for0..*

is_covered_by1..*

0..* 0..1produces0..* is_produced_by 0..1

0..*

1

is_an_instance_of

0..*

is_instantiated_as1

1

1..*

is_requested_by1

requests1..*

Administrative_patient_deathdeath_certificate_iddeath_certificate_recorded_dtdeath_classification_cddeath_dttmdeath_location_nmdeath_notification_source_nmdeath_verification_cddeath_verification_dtdeath_verification_nm

Patient_information_disclosuredisclosure_dttminfo_disclosed_descinfo_requested_descreason_cdrequested_dttmurgency_cd

1

0..*

is_the_recipient_of1

is_provided_to

0..*

Preferred_provider_participationrole_cdeffective_dttermination_dt

0..*

1

has_as_care_provider0..*

participates_in 1

Disabilityeffective_dtreturn_to_work_auth_dttermination_dtunable_to_work_effective_dt

Patient_appointment_request

Patient_slot

Health_charthealth_chart_idhealth_chart_type_cdstatus_cd

1

0..*

has_an_assessment_of1

is_assessed_against

0..*

0..1

0..*

contains 0..1

may_be_contained_in0..*

Healthcare_benefit_productassignment_of_benefits_indbenefit_product_descidbenefit_plan_nmbenefit_plan_type_cdbenefits_coordination_indcob_priority_amtcombine_baby_bill_indeffective_dteligibility_source_cdgroup_benefit_indmail_claim_party_cdpolicy_source_cdrelease_information_cdstatus_cdtermination_dt

0..*

1

provides_validation_for0..*

is_validated_by1

0..1

0..*

governs0..1 is_governed_by

0..*

1

0..*

offers1

is_offered_by 0..*

1

0..*

is_the_purchaser_of 1

has_as_purchaser 0..*

1

0..*

has_parts

1is_part_of 0..*

0..*

0..1

is_associated_with 0..*

is_associated_with0..1

Individual_healthcare_practitionerdescfellowship_field_cdgraduate_school_nmgraduation_dtposition_cdpractitioner_type_cdprimary_care_indresidency_field_cdslot_size_increment_qty

1

0..*

is_scheduled_by1

is_a_scheduleable_unit_for0..*

1

0..*

is_requested_by1

requests0..*

1..*

0..*

belongs_to1..*

contains 0..*

0..*

1

is_provided_by0..*

provides 1

Personbirth_dttmbirthplace_addrcitizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdgender_cdlanguage_cdmarital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cdprimary_name_representation_cdprimary_name_type_cdprimary_nmrace_cdreligious_affiliation_cdstudent_cdvery_important_person_cd

1

0..1

takes_on_role_of 1is_a_role_of

0..1

1

0..1

takes_on_role_of 1

is_a_role_of

0..1

0..1

1

is_a_role_of0..1

takes_on_role_of1

0..1

1

is_identified_as0..1

may_act_in_the_role_of

1 1

0..*

has1

is_for0..*

0..*

1

is_entered_by

0..*

enters 1

Patient_billing_accountaccount_idadjustment_cdauthorization_information_txtbilling_status_cdcertification_required_indcurrent_unpaid_balance_amtdelete_dtdeleted_account_reason_cdexpected_insurance_plan_qtyexpected_payment_source_cdnotice_of_admission_dtnotice_of_admission_indpatient_financial_class_cdprice_schedule_idpurge_status_cdpurge_status_dtreport_of_eligibility_dtretention_indsignature_on_file_dtspecial_program_cdstoploss_limit_indsuspend_charges_indtotal_adjustment_amttotal_charge_amttotal_payment_amtseparate_bill_ind

0..*

1

pertains_to0..*

has1

0..1

0..1

is_the_prior_account_for0..1

has_as_a_prior_account

0..1

0..*0..* has_payment_guaranteed_by 0..*

provides_payment_guarantee_for

0..*

0..*

1

is_associated_with0..*

has 1

0..1

0..*

is_billed_from

0..1

is_billed_to0..*

Master_patient_service_locationaddrclosing_dtdescemail_addressidlicensed_bed_qtynmopening_dtphonservice_specialty_cdslot_size_increment_qtystatus_cdtype_cdequipment_type_cd

1..*

0..*provides_patient_services_at1..*

provides_services_on_behalf_of

0..*

0..*

1

is_a_scheduleable_unit_for0..*

is_scheduled_by1

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

0..*

0..1

is_included_in 0..*

includes 0..1

0..*

1

is_housed_at0..*

houses 1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_entry_location_for1

is_entered_at 0..*

Target_participationbegin_dttmend_dttmduration_tmparticipation_type_cd

0..1

0..*

is_target_for0..1

has_as_target0..*

1..*

0..1

is_target_of1..*

has_as_target 0..1

Collected_specimen_samplebody_site_cdcollection_body_site_modifier_cdcollection_end_dttmcollection_method_modifier_cdcollection_scheduled_dttmcollection_start_dttmcollection_volume_amtcondition_cdhandling_cdidmethod_of_collection_descnumber_of_sample_containers_qtyspecimen_additive_txtspecimen_danger_cdspecimen_source_cdtransport_logistics_cd

0..*

0..1

is_collected_during0..*

collects 0..1

0..*

1

is_collected_by

0..*

collects1

0..1

0..*

is_target_of0..1

has_as_target 0..*

Contact_personcontact_reason_cd

0..*

0..1

is_a_contact_for 0..*

has_as_a_contact

0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

0..1

0..*

has_as_a_contact

0..1

is_a_contact_for0..*

0..1

0..*

has_as_a_contact 0..1

is_a_contact_for 0..*

1

0..1

takes_on_role_of 1

is_a_role_of0..1

Encounter_practitionerparticipation_type_cd

0..*

1

is_participant_for0..*

participates_as1

Patient_arrivalacuity_level_cdarrival_dttmarrival_type_cdmedical_service_idsource_of_arrival_cdmode_cd

Risk_management_incidentincident_cdincident_dttmincident_severity_cdincident_type_cd

Episodedescepisode_type_cdidlist_closed_indoutcome_txtrecurring_service_ind

0..*

0..1

specified_in0..*

specfies0..1Preauthorizationauthorized_encounters_amtauthorized_period_begin_dtauthorized_period_end_dtidissued_dttmrequested_dttmrestriction_descstatus_cdstatus_change_dttm

1

0..*

issues1

is_issued_by0..*

Location_encounter_roleaccommodation_cdeffective_dttmlocation_role_cdstatus_cdtermination_dttmtransfer_reason_cdtransfer_reason_descusage_approved_ind

1 0..*has1 pertains_to 0..*

Administrative_birth_eventbaby_detained_indbirth_certificate_idbirth_method_cdbirth_recorded_county_cdbirth_recorded_dtnewborn_days_qtystillborn_ind

0..1

1 pertains_to

0..1

has1

Administrative_patient_accidentaccident_death_indaccident_descaccident_dttmaccident_location_descaccident_state_cdaccident_type_cdjob_related_accident_indassessment_dttm

0..1

0..*

is_the_source_of0..1

is_obtained_from 0..*

Service_eventattestation_dttmattestation_due_dtbegin_dttmcharge_to_practice_amtcharge_to_practice_cdpatient_sensitivity_cdconsent_cddeclined_indservice_descend_dttmfiller_idfiller_order_status_cdfiller_order_status_dttmrecurring_service_cdscheduled_start_dttmservice_event_descspecimen_received_dttmspecimen_action_cdnmfamily_awareness_txtindividual_awareness_cdconfidential_ind

0..*

0..*

is_documented_by 0..*

documents0..*

0..*0..1 has_as_evidence

0..*is_evidence_for

0..1

0..*

0..1 is_reason_for

0..*has_as_reason

0..1

1

0..*

is_target_for

1

has_as_target0..*

1

0..*

is_source_for

1

has_as_source0..*

0..1

0..*

is_fulfilled_by 0..1

fulfills0..*

1

0..*

is_associated_with 1

pertains_to0..*

0..*

0..1

participates_in0..*

has_as_active_participant 0..1

0..1 0..*

has_charges_for

0..1 is_charged_to 0..*

0..*

0..1

is_performed_at 0..*

is_location_for0..1

0..*

0..1

is_target_of 0..*

has_as_target 0..1

1

0..*

is_delivered_during 1

delivers 0..*

Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id

0..11

pertains_to0..1has 1

0..*

1

pertains_to

0..*

has1

1

0..*

participates_in 1

has_as_care_recipient

0..*

0..*

1

pertains_to

0..*

has1

1

0..*

is_requested_by1

requests0..*

1

0..*

is_scheduled_by1

is_a_scheduleable_unit_for

0..*

0..*

1

belongs_to0..*

has 1

1

0..*

has1

pertains_to

0..*

1

0..*

has 1

is_for0..*

0..*

0..1

has_a_primary_provider0..*

is_the_primary_provider_for0..1

0..11 is_a_role_of 0..1takes_on_role_of1

0..*

1

belongs_to0..*

has 1

0..1

0..*

is_primary_facility_for0..1

has_as_primary_facility 0..*

0..1

0..*

is_target_of0..1

has_as_target0..*

0..*

0..1

is_sourced_from0..*

is_source_for 0..1

0..*

0..1

is_a_contact_for0..*

has_as_a_contact

0..1

Resource_slotoffset_qtyquantity_amtresource_type_cdslot_state_cdstart_dttm

Appointment_contact_personrole_cd

0..*

1 involves

0..*

participates_in1

Patient_encounteradministrative_outcome_txtcancellation_reason_cddescencounter_classification_cdend_dttmexpected_insurance_plan_qtyfirst_similar_illness_dtfollow_up_type_cdidpatient_classification_cdpurpose_cdrecord_signing_dttmspecial_courtesies_cdstart_dttmstatus_cdtransport_requirement_cdurgency_cdtriage_classification_cdmedical_service_cdconfidentiality_constraint_cd

1..*

1

is_associated_with1..*

has_as_participant1

0..1

1

precedes0..1

is_preceded_by1

0..*

0..1

precedes

0..*

follows0..1

0..*

1

pertains_to 0..*

has1

1

1..*

has_parts1

is_part_of1..*1..*

0..1

is_authorized_by 1..*

authorizes0..1

1..*

1

pertains_to1..*

has1

1

0..*

has_parts 1

is_part_of0..*

1..*

0..*

has 1..*

is_present_in0..*

0..*0..1 is_assigned_to 0..*has_assigned_to_it0..1

0..*

1

involves 0..*

is_involved_in1

Scheduleid

1

0..*

contains 1

is_managed_by0..*

Appointmentappointment_disposition_cdappointment_duration_qtyappointment_reason_cdappointment_request_reason_cdappointment_timing_tqappointment_type_cdcancellation_dttmcancellation_reason_cdestimated_duration_amtevent_reason_cdexpected_end_dttmexpected_service_descexpected_start_dttmidoccurence_idoverbook_indscheduling_begin_dttmscheduling_completed_dttmscheduling_status_cdstatus_cdurgency_cdvisit_type_cdwait_list_priority_amt

0..*

0..*

is_reserved_by0..*

reserves 0..*

0..*

1

participates_in

0..*

involves 1

1..* 0..*is_scheduled_by1..* schedules 0..*

1..*

0..*

contains

1..*

are_booked_in 0..*

Questions for SDOs - Data Quality

• Does it alleviate duplication of data capture?

• Is there a data model that considers all users?

• What criteria are used for selecting terminologies?

Principles for Adoption of HL7-Compliant Terminologies

1. The terminology must be compliant with the semantics of the HL7 structures

2. The terminology provider must be willing to participate in HL7-sanctioned interoperability efforts

3. There must be an organization committed to the timely maintenance and update of the terminology

4. Appropriateness of cost will be a consideration. (see “Principles for HL7-sanctioned Terminology Integration Efforts)

5. The terminology must be free from excessive license fees, yet HL7-sanctioned interoperability efforts must not jeopardize the business model of the terminology provider (see “Principles for HL7-sanctioned Terminology Integration Efforts)

6. The terminology should be comprehensive for the intended domain of use

7. Regulatory circumstances may require the adoption of specific terminologies. The use of such terminologies, provided that they are consistent with principle #1 above, shall not be considered a deviation from the HL7 standard

Transactions

• Alerts and Reminders

• Exchange of Logic and Guidelines

Additional Comments

• Should there be criteria for terminologies?

• Keep your eye on the doughnut