us standards for health record systems
DESCRIPTION
US Standards for Health Record Systems. James J. Cimino, M.D. Columbia University, New York For the Health Information Management Systems Society (HIMSS). The Need for Standards. Patient Safety Quality of Care Cost Effectiveness Patient Involvement Performance Evaluation Research - PowerPoint PPT PresentationTRANSCRIPT
US Standards for Health Record Systems
James J. Cimino, M.D.
Columbia University, New York
For the Health Information Management Systems Society (HIMSS)
The Need for Standards
• Patient Safety• Quality of Care• Cost Effectiveness• Patient Involvement• Performance Evaluation• Research• Health Surveillance• Disaster Response
Current State of Standards
• Reporting – mandatory, intrusive
• Terminology – incomplete, not mandatory
• Messaging – incomplete, not mandatory
• Integration – not at all
A Look at Some US Efforts
• Bottom-Up: Health Level 7 (HL7)
• Top-Down: Integrating the Healthcare Enterprise (IHE)
Bottom-Up: Health Level 7 (HL7)
• Need for information exchange standard
• Message is the unit of information
• One actor tells another actor about an event
• Began in 1986 with 14 members, now with 2000 members and worldwide chapters
HL7 Version 2 Message
MSH|^~\&|MENDONC|UPLAB|CICSU9|20000209025800||ORU|0000000001|P|2.1|||
PID|||3131313||SANDIEGO^CARMEN|||F|||||||||||||
OBR|||M09000HABC0000^1|59058^TROPONINI^L^32506|||20000209025800|||||||20000209025800|^|NOR||||||||HE|F||^^^^^R|^^|||||||||
OBX|1|NM|59058^TROPONIN I^MED|0|0.1|ng/ml|0-0.4|||||||||||||||
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Reference Information Model for HL7 Version 3 (RIM)
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11
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Reference Information Model for HL7 Version 3 (RIM)
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Master_calculated_observationderivation_rule_desc
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Consent Care_event Assessment
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HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0088
released January, 1999reflects agreements made through harmonization in November, 1998
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has1
0..1
0..1
is_the_prior_account_for0..1
has_as_a_prior_account
0..1
0..*0..* has_payment_guaranteed_by0..*
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..* contains0..*0..*
0..1
is_included_in0..*
includes0..1
0..*
1
is_housed_at0..*
houses1
1
0..*
is_requested_by1
requests0..*
1
0..*
is_entry_location_for1
is_entered_at0..*
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_target0..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..*
collects0..1
0..*
1
is_collected_by
0..*
collects1
0..1
0..*
is_target_of0..1
has_as_target0..*
Contact_personcontact_reason_cd
0..*
0..1
is_a_contact_for0..*
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_contact0..1
is_a_contact_for0..*
1
0..1
takes_on_role_of1
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_from0..*
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_by0..*
documents0..*
0..*0..1 has_as_evidence
0..*is_evidence_for0..1
0..*0..1 is_reason_for
0..*has_as_reason0..1
1
0..*
is_target_for1
has_as_target0..*
1
0..*
is_source_for
1
has_as_source0..*
0..1
0..*
is_fulfilled_by0..1
fulfills0..*
1
0..*
is_associated_with1
pertains_to0..*
0..*
0..1
participates_in0..*
has_as_active_participant0..1
0..1 0..*
has_charges_for
0..1 is_charged_to0..*
0..*
0..1
is_performed_at0..*
is_location_for0..1
0..*
0..1
is_target_of0..*
has_as_target0..1
1
0..*
is_delivered_during1
delivers0..*
Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id
0..11pertains_to0..1
has 1
0..*
1
pertains_to
0..*
has1
1
0..*
participates_in1
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..*
has1
is_for0..*
0..*
0..1
has_a_primary_provider0..*
is_the_primary_provider_for0..1
0..11 is_a_role_of0..1takes_on_role_of1
0..*
1
belongs_to0..*
has1
0..1
0..*
is_primary_facility_for0..1
has_as_primary_facility0..*
0..1
0..*
is_target_of0..1
has_as_target0..*
0..*
0..1
is_sourced_from0..*
is_source_for0..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
precedes0..*
follows0..1
0..*
1
pertains_to0..*
has1
1
1..*
has_parts1
is_part_of1..*1..*
0..1
is_authorized_by1..*
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_to0..*has_assigned_to_it0..1
0..*
1
involves0..*
is_involved_in1
Scheduleid
1
0..*
contains1
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..*
reserves0..*
0..*
1
participates_in
0..*
involves1
1..* 0..*is_scheduled_by1..*schedules0..*
1..*
0..*
contains
1..*
are_booked_in0..*
Reference Information Model for HL7 Version 3 (RIM)
Reference Information Model for HL7 Version 3 (RIM)
• Consensus view of the healthcare world
• Flexible structures
• Emphasizes meanings of health information
• Object-oriented
Allergyallergen_idallergy_cdallergy_reaction_cd
allergy_reaction_description_txtallergy_severity_cdallergy_type_cdassessment_dttmemployment_related_ind
Health_issuediagnosis_cdonset_dttm
billing_priority_amtseverity_cdclassification_cdconfirmation_status_cdpersistence_cd
probability_amtprobability_txtprognosis_descprognosis_awareness_desccd
Medicare_coverageeffective_dteligibility_cdidlifetime_res_delay_day_qty
lifetime_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_cd
preferred_coding_system_cdvalid_answer_cd
Master_calculated_observationderivation_rule_desc
Referralauthorized_visits_qty
descreason_txt
Dietary_intent_or_orderdiet_type_cd
dietary_instruction_descdietary_tray_type_cdservice_period_cdservice_type_cd
Observation_intent_or_orderpatient_hazard_cdreason_for_study_cd
relevant_clinical_information_txtreporting_priority_cdspecimen_action_cd
Treatment_service_eventprescription_idrefills_remaining_qtynotes_txtPTroutPTcompindication_cdexpiration_dttm
substance_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_cd
suppliers_special_dispensing_instruction_cdtotal_daily_dose_amt
Treatment_service_giveadministration_descgive_per_time_unit_cdgive_quantitytiming_qtgive_rate_amtmax_give_amtmin_give_amt
needs_human_review_indsubstitution_status_cd
supplier_special_administration_instruction_cd
Goalaction_cdaction_dttmclassification_cdcurrent_review_status_cdcurrent_review_status_dttmepisode_of_care_idestablished_dttmevaluation_cd
evaluation_comment_txtexpected_achievement_dttm
goal_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_dttm
observation_sub_idobservation_value_txtprobability_amtreferences_range_txt
universal_service_identifier_suffix_txtuser_defined_access_check_txt
value_type_cdvalue_units_cd
Consent Care_event Assessment
Master_specimen_requirementadditive_cdcontainer_desccontainer_preparation_desc
container_volume_amtderived_specimen_cd
minimum_collection_volume_amtnormal_collection_volume_amt
special_handling_descspecimen_priorities_cd
specimen_retention_time_amtspecimen_type_cd
Master_observation_serviceinstrument_idpermitted_data_type_cd
processing_time_qtyspecimen_required_ind
typical_turnaround_time_qty
1
0..*
has 1
is_specified_for0..*
0..*
0..*
is_basis_for0..*
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_ind
providers_treatment_instruction_txtrejection_reason_cd
requested_give_rate_amtrequested_give_strength_amt
substitution_allowed_indsupplier_special_dispensing_instruction_cdverification_required_ind
Treatment_intent_or_order_revisiondispense_package_method_cd
dispense_package_size_amtgive_indication_cdgive_per_time_unit_cd
give_rate_amtlast_refilled_dttm
max_give_amtmin_give_amtneeds_human_review_indorder_revision_PTcomporder_revision_PTroutorder_revision_quantitytiming_qtordered_administration_method_cd
prescription_idproviders_administration_instruction_cd
refills_allowed_qtyrefills_doses_dispensed_qtyrefills_remaining_qtysubstitution_status_cdsuppliers_dispensing_instruction_cd
total_daily_dose_amttotal_daily_dose_cd
0..1
0..*
is_ordered_on
0..1
orders0..*
1 1..*has_parts1 is_part_of1..*
Master_numeric_rangerange_type_cdcondition_desc
high_range_amthigh_gestation_age_amthigh_value_amtlow_age_amt
low_gestation_age_amtlow_value_amtrace_subspecies_txtsex_txtspecies_txt
Master_continuous_observationcorresponding_SI_unit_of_measure_cdcustomary_unit_of_measure
delta_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_cd
disclosure_level_cdlife_quality_descmortuary_preference_nmnotarization_dtassessment_dttmemployment_related_ind
Durable_medical_equipment_slot
Durable_medical_equipment_requestquantity_amttype_cd
Durable_medical_equipmentid
slot_size_increment_qtytype_cd
0..*
1
is_a_scheduleable_unit_for0..*
is_scheduled_by1
0..*
1
requests0..*
is_requested_by1
Durable_medical_equipment_groupid
0..*
0..1
may_request0..*
is_requested_by0..1
1..*
0..*
belongs_to1..*
contains0..*
Patient_departureactual_discharge_disposition_cd
discharge_dttmdischarge_location_id
expected_discharge_disp_cd
Patient_admissionadmission_dttmadmission_reason_cdadmission_referral_cdadmission_source_cdadmission_type_cdpatient_valuables_descpre_admit_test_indreadmission_ind
valuables_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_amt
capital_reimbursement_amtcost_weight_amt
idmajor_diagnostic_category_cdoperating_reimbursement_amtreimbursement_amtstandard_day_qty
standard_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_by1
preceded1
Resource_requestallowable_substitutions_cd
duration_qtystart_dttmstart_offset_qtystatus_cd
Bad_debt_collection_agency
0..*
1
is_assigned_to
0..*
is_assigned1
Encounter_drgapproval_indassigned_dttmconfidential_indcost_outlier_amtdesc
grouper_review_cdgrouper_version_idoutlier_days_qty
outlier_reimbursement_amtoutlier_type_cd
1
0..*
is_assigned_as
1
is_an_assignment_of0..*
0..*1
is_assigned_to0..*is_assigned1
Identifier_issuing_authorityeffective_dttermination_dt
Appointment_requestappointment_rqst_reason_cdappointment_rqst_type_cdequip_selection_criteria_pv
idlocation_selection_criteria_pv
occurence_idpriority_cd
repeating_interval_duration_qtyrequested_ri
rqst_event_reason_cdrqsted_duration_qtystart_dt
time_selection_criteria_pv
0..*1 is_requested_by0..*requests1
Stakeholder_affiliatefamily_relationship_cd
Stakeholder_affiliationaffiliation_type_cddesceffective_dttermination_dt
0..*
1
has_as_secondary_participant0..*
participates_as_secondary_in1
Stakeholder_identifiereffective_dtid
identifier_type_cdissued_dt
qualifying_information_txttermination_dt
1
0..*
issues 1
is_issued_by
0..*
Insurance_certification_contactparticipation_type_cd
Healthcare_document_authenticator
Person_employmentaddr
effective_dthazard_exposure_txtjob_class_cdjob_title_nmphon
protective_equipment_txtsalary_amtsalary_type_cdstatus_cdtermination_dtoccupation_cdjob_status_cd
Authenticationauthentication_dttype_cd
1
0..*
is_related_to1
is_related_to0..*
Document_recipient
Originator
Service_intent_or_order_relationshiprelationship_type_cd
reflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt
Organizationorganization_name_type_cdorganization_nm
standard_industry_class_cd
0..1
1
is_a_role_of0..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_of0..1
takes_on_role_of
1
Master_service_relationshiprelationship_type_cd
reflex_testing_trigger_rules_descconstraint_txtquantitytiming_qt
Healthcare_benefit_serviceaccess_protocol_desccapitation_indcoinsurance_indcoinsurance_pctcopayment_amtdeductible_amt
lower_coverage_limit_amtpay_cap_limit_amtpcp_referral_ind
primary_care_provider_indreview_ind
upper_coverage_limit_amt
Producer_of_master_serviceservice_producing_department_type_cd
Service_scheduling_requestallowable_substitutions_cd
duration_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_participant0..*
Health_chart_deficiencyassessment_dtdesclevel_cdtype_cd
Insurance_certificationappeal_reason_cdcertification_day_qtyeffective_dtid
insurance_verification_dttmmodification_dttmnon_concur_cd
non_concur_effective_dttmpenalty_amttermination_dtreport_of_eligibility_dtreport_of_eligibility_ind
1
1..*
has_as_a_contact1
is_a_contact_for1..*
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_cd
room_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..*
includes1
Employee
1
0..*
is_employee_in1
has_as_employee0..*
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_by1
affirms_insurance_coverage_for0..*
Healthcare_provider_organization0..1
1
is_a_role_of0..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_request0..*
Procedureanesthesia_cd
anesthesia_minutes_qtydelay_reason_txtincision_closed_dttmincision_open_dttmpriority_amtprocedure_cdprocedure_dttm
procedure_functional_type_cdprocedure_minute_qtymodifier_cd
Stakeholderaddrcredit_rating_cdemail_address_txtphontype_cd
0..1
1
is_a_role_of
0..1
takes_on_role_of1
0..* 1has_as_primary_participant0..* participates_as_primary_in1
0..*
1
is_assigned_to0..*
is_assigned1
1 0..1takes_on_role_of1 is_a_role_of0..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_cd
household_annual_income_amthousehold_size_qty
1
1..*
guarantees_payment_under
1
has_payment_guaranteed_by
1..*
0..1
1
is_a_role_of0..1
takes_on_role_of1
Employereffective_dttermination_dt
1
0..*
is_employer_of1
has_as_employer
0..*
0..1
1
is_a_role_of0..1
takes_on_role_of1
Health_benefit_plan_purchaser
0..1
1
is_a_role_of0..1
takes_on_role_of1
Condition_nodeactual_resolution_dttmestimated_resolution_dttmlife_cycle_status_dttmlifecycle_status_cdmanagement_discipline_cdonset_time_txtonset_dttmranking_amt
employment_related_ind
Insurereffective_dttermination_dt
1
0..1
takes_on_role_of1
is_a_role_of0..1
1
0..*
issues1
is_issued_by0..*
Accident_information_source
1
0..1
takes_on_role_of1
is_a_role_of0..1
Clinical_document_headerauthentication_dtavailability_status_cdchange_reason_cdcompletion_status_cdconfidentiality_status_cdcontent_presentation_cddocument_header_creation_dt
file_nmid
last_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_to0..*
is_related_to
1
0..1 0..*of0..1 has_been_received_by0..*
0..1 0..*of0..1 has_been_originated_by0..*
0..1
0..*
transcribes0..1
is_transcribed_by0..*
Service_reasondetermination_dttmdocumentation_dttmreason_txt
Service_event_relationshiprelationship_type_cd
Service_intent_or_ordercharge_type_cdclarification_phonend_condition_cdentering_device_cdescort_required_ind
expected_performance_time_qtyfiller_order_idfiller_txtorder_control_cdorder_control_reason_cdorder_effective_dttmorder_group_idorder_id
order_placed_dttmorder_quantitytiming_qtplacer_order_idplacer_txt
planned_patient_transport_cdreport_results_to_phonresponse_requested_cdservice_body_site_cd
service_body_site_modifier_cdservice_body_source_cdtarget_of_service_cdtransport_arranged_ind
transport_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_reason0..1
1
0..*
is_source_for
1
has_as_source0..*
1
0..*
is_target_for1
has_as_target0..*
0..1
0..*
may_be_referred_to_in0..1
is_related_to0..*
Financial_transactionalternate_descdesc
extended_amtfee_schedule_cdinsurance_amtposting_dtqty
transaction_batch_idtransaction_cdtransaction_dttransaction_idtransaction_type_cdunit_amtunit_cost_amt
0..1
0..*
categorizes0..1
is_categorized_by0..*
Active_participationbegin_dttmend_dttmduration_tm
participation_type_cd
0..1
0..*
participates_in0..1
has_as_participant0..*
0..*
0..1
participates_in0..*
has_as_participant0..1
Master_serviceallowable_processing_priority_cdallowable_reporting_priority_cdbilling_reference_txtchallenge_information_txtconfidentiality_cdeffective_dt
factors_that_may_affect_observation_descfee_amt
fixed_canned_message_cdimaging_measurement_modality_cdincompatible_change_dttm
instrument_identifier_coding_system_nminstrument_identifier_nm
interpretation_considerations_desckind_of_quantity_observed_cdlast_update_dttmmethod_cdmethod_descnature_of_service_cdobservation_id_suffix_txtorderable_service_indpatient_preparation_descpoint_versus_interval_cdportable_device_ind
preferred_ordering_method_txtpreferred_scheduling_method_txtprocedure_medication_cdreport_display_order_txtrequired_credentials_descservice_alternate_id
service_alternate_identifier_coding_system_nmservice_alternate_identifier_nmservice_alternate_name_use_cdservice_alternate_nmservice_contraindication_cdservice_desc
service_performance_schedule_cdservice_primary_nmservice_requirement_descservice_type_cd
standard_time_to_perform_dttmtarget_anatomic_site_cdtarget_of_service_cduniversal_service_id
universal_service_identifier_coding_system_nmuniversal_service_identifier_nmquantitytiming_qtjoin_cd
1
0..*
is_target 1
has_target0..*
10..*
is_source1has_source0..*
0..*
1..*
provides_coverage_for0..*
is_covered_by1..*
0..* 0..1produces0..* is_produced_by0..1
0..*
1
is_an_instance_of
0..*
is_instantiated_as1
1
1..*
is_requested_by1
requests1..*
Administrative_patient_deathdeath_certificate_id
death_certificate_recorded_dtdeath_classification_cddeath_dttmdeath_location_nm
death_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_in1
Disabilityeffective_dt
return_to_work_auth_dttermination_dt
unable_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..*
contains0..1
may_be_contained_in0..*
Healthcare_benefit_productassignment_of_benefits_indbenefit_product_descid
benefit_plan_nmbenefit_plan_type_cdbenefits_coordination_indcob_priority_amtcombine_baby_bill_indeffective_dt
eligibility_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_by0..*
1
0..*
is_the_purchaser_of1
has_as_purchaser0..*
10..*
has_parts
1is_part_of0..*
0..*
0..1
is_associated_with0..*
is_associated_with0..1
Individual_healthcare_practitionerdesc
fellowship_field_cdgraduate_school_nmgraduation_dtposition_cd
practitioner_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..*
contains0..*
0..*
1
is_provided_by0..*
provides1
Personbirth_dttmbirthplace_addr
citizenship_country_cdconfidentiality_constraint_cddeceased_dttmdeceased_inddisability_cdeducation_level_cdethnic_group_cdgender_cdlanguage_cd
marital_status_cdmilitary_branch_of_service_cdmilitary_rank_nmmilitary_status_cdnationality_cd
primary_name_representation_cdprimary_name_type_cdprimary_nmrace_cd
religious_affiliation_cdstudent_cd
very_important_person_cd
1
0..1
takes_on_role_of1is_a_role_of
0..1
1
0..1
takes_on_role_of1
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_cd
authorization_information_txtbilling_status_cdcertification_required_indcurrent_unpaid_balance_amt
delete_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_by0..*
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_dtdesc
email_addressid
licensed_bed_qtynmopening_dtphon
service_specialty_cdslot_size_increment_qtystatus_cdtype_cd
equipment_type_cd
1..*
0..*provides_patient_services_at
1..*
provides_services_on_behalf_of
0..*
0..*
1
is_a_scheduleable_unit_for0..*
is_scheduled_by1
1..* 0..*belongs_to1..* contains0..*0..*
0..1
is_included_in0..*
includes0..1
0..*
1
is_housed_at0..*
houses1
1
0..*
is_requested_by1
requests0..*
1
0..*
is_entry_location_for1
is_entered_at0..*
Target_participationbegin_dttmend_dttmduration_tm
participation_type_cd
0..1
0..*
is_target_for0..1
has_as_target0..*
1..*
0..1
is_target_of1..*
has_as_target0..1
Collected_specimen_samplebody_site_cd
collection_body_site_modifier_cdcollection_end_dttm
collection_method_modifier_cdcollection_scheduled_dttmcollection_start_dttmcollection_volume_amtcondition_cdhandling_cdid
method_of_collection_descnumber_of_sample_containers_qtyspecimen_additive_txtspecimen_danger_cdspecimen_source_cdtransport_logistics_cd
0..*
0..1
is_collected_during0..*
collects0..1
0..*
1
is_collected_by
0..*
collects1
0..1
0..*
is_target_of0..1
has_as_target0..*
Contact_personcontact_reason_cd
0..*
0..1
is_a_contact_for0..*
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_contact0..1
is_a_contact_for0..*
1
0..1
takes_on_role_of1
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
Episodedesc
episode_type_cdid
list_closed_indoutcome_txt
recurring_service_ind
0..*
0..1
specified_in0..*
specfies0..1Preauthorizationauthorized_encounters_amtauthorized_period_begin_dtauthorized_period_end_dt
idissued_dttmrequested_dttmrestriction_descstatus_cd
status_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_cd
birth_recorded_county_cdbirth_recorded_dtnewborn_days_qtystillborn_ind
0..1
1 pertains_to
0..1
has1
Administrative_patient_accidentaccident_death_indaccident_descaccident_dttm
accident_location_descaccident_state_cdaccident_type_cdjob_related_accident_indassessment_dttm
0..1
0..*
is_the_source_of0..1
is_obtained_from0..*
Service_eventattestation_dttmattestation_due_dtbegin_dttm
charge_to_practice_amtcharge_to_practice_cdpatient_sensitivity_cdconsent_cddeclined_indservice_descend_dttmfiller_id
filler_order_status_cdfiller_order_status_dttmrecurring_service_cdscheduled_start_dttmservice_event_descspecimen_received_dttmspecimen_action_cd
nmfamily_awareness_txtindividual_awareness_cdconfidential_ind
0..*
0..*
is_documented_by0..*
documents0..*
0..*0..1 has_as_evidence
0..*is_evidence_for0..1
0..*0..1 is_reason_for
0..*has_as_reason0..1
1
0..*
is_target_for1
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_with1
pertains_to0..*
0..*
0..1
participates_in0..*
has_as_active_participant0..1
0..1 0..*
has_charges_for
0..1 is_charged_to0..*
0..*
0..1
is_performed_at0..*
is_location_for0..1
0..*
0..1
is_target_of0..*
has_as_target0..1
1
0..*
is_delivered_during1
delivers0..*
Patientambulatory_status_cdbirth_order_amtliving_arrangement_cdliving_dependency_cdmultiple_birth_indnewborn_baby_indorgan_donor_indpreferred_pharmacy_id
0..11pertains_to0..1
has 1
0..*
1
pertains_to
0..*
has1
1
0..*
participates_in1
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..*
has1
is_for0..*
0..*
0..1
has_a_primary_provider0..*
is_the_primary_provider_for0..1
0..11 is_a_role_of0..1takes_on_role_of1
0..*
1
belongs_to0..*
has1
0..1
0..*
is_primary_facility_for0..1
has_as_primary_facility0..*
0..1
0..*
is_target_of0..1
has_as_target0..*
0..*
0..1
is_sourced_from0..*
is_source_for0..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_txt
cancellation_reason_cddescencounter_classification_cdend_dttm
expected_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
precedes0..*
follows0..1
0..*
1
pertains_to0..*
has1
1
1..*
has_parts1
is_part_of1..*1..*
0..1
is_authorized_by1..*
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_to0..*has_assigned_to_it0..1
0..*
1
involves0..*
is_involved_in1
Scheduleid
1
0..*
contains 1
is_managed_by0..*
Appointmentappointment_disposition_cd
appointment_duration_qtyappointment_reason_cdappointment_request_reason_cdappointment_timing_tqappointment_type_cdcancellation_dttmcancellation_reason_cd
estimated_duration_amtevent_reason_cdexpected_end_dttmexpected_service_descexpected_start_dttmidoccurence_idoverbook_indscheduling_begin_dttmscheduling_completed_dttmscheduling_status_cdstatus_cdurgency_cdvisit_type_cd
wait_list_priority_amt
0..*
0..*
is_reserved_by0..*
reserves0..*
0..*
1
participates_in
0..*
involves1
1..* 0..*is_scheduled_by1..*schedules0..*
1..*
0..*
contains
1..*
are_booked_in0..*
RIM Class Diagram V1.19
• 6 Primary Subject Areas• 72 Classes • 276 Attributes• 94 Relationships• 59 Data types (approx)
Observation
value : ANYinterpretationCode : SET<CE>
methodCode : SET<CE>targetSiteCode : SET<CD>
SubstanceAdministration
routeCode : CEapproachSiteCode : SET<CD>
doseQuantity : IVL<PQ>rateQuantity : IVL<PQ>
doseCheckQuantity : SET<RTO>maxDoseQuantity : SET<RTO>
substitutionCode : CE
Procedure
methodCode : SET<CE>approachSiteCode :
...
Supply
quantity : PQexpectedUseTime :
IVL<TS>
Diet
energyQuantity : PQcarbohydrateQuantity :
PQ
ClinicalDocument
setId : IIversionNumber : INT...
...
Container
capacityQ...
Access
app...
Device
manuf...
Employee
jobCode : ...
LivingSubject
administr...
Material
...
AssignedEntity
...
LicensedEntity
...
Place
mobileI...
ManufacturedMaterial
lotN...
NonPersonLivingSubject
...
Patient
...
Organization
...
Account
name : STbalanceAmt : MOcurrencyCode : CE
interestRateQuantity : RTO<MO,PQ>allowedBalanceQuantity : IVL<MO>
Person
addr : BAG<...
WorkingList
...
PublicHealthCase
detectionMethodCode : CEtransmissionModeCode :
...
PatientEncounter
preAdmitTestInd : BLadmissionReferralSourceCode : CE
lengthOfStayQuantity : PQdischargeDispositionCode : CE
...
SchedulableResource
...
Other
Acts
Infrastructure (Structured documents)
HEALTH LEVEL 7 REFERENCE INFORMATION MODEL
VERSION 1.18 (RIM_0118)
Provisionsal version reflects changes to RIM naming conventions approved in October 2002. Changes will be formally adopted in RIM
Harmonization Meeting 11/14-15/2002.
Billboard produced by:Rochester Outdoor Advertising
Roles
Guarantor
...
DiagnosticImage
subjectOrientationCode : CE
QueryAck
messageQueryCode : CEqueryResponseCode : CSresultTotalQuantity : INT
...
QueryContinuation
...
Table
summary : STwidth : STrules : CScellspacing :
...
TableStructure
char : STcharoff :
...
TableColumnStructure
...
TableCell
scope : CS...
LocalAttr
...
LocalMarkup
des...
LinkHtml
href : ...
ContextStructure
...
Infrastructure (Structured documents)
Infrastructure (Message control)
Enitites
Message Control
FinancialTransaction
amt : MOcreditExchangeRateQuantity : REALdebitExchangeRateQuantity : REAL
InvoiceElement
modifierCode : SET<CE>unitQuantity : RTO<PQ,PQ>unitPriceAmt : RTO<MO,PQ>...
netAmt : MOfactorNumber : REALpointsNumber : REAL
FinancialContract
paymentTermsCode : CE
RoleHeirEntityHeir
SortControl
seq...
QuerySpec
messageQueryCode : CEmodifyCode : CS
responseElementGroupId : SET<II>
responseModalityCode : CS...
0..n 10..n 1
RelationalExpression
ele...
QueryBySelectionSelectionExpression
0..n
1
0..n
1
LogicalExpression
...
0..n
0..1
userAsRight
0..n
rightSide 0..1
0..n
0..1
userAsLeft0..n
leftSide0..1
QueryByParameter
ParameterList
Parameter
... 0..n 0..10..n 0..1
0..1
0..n
0..1
0..n
ParameterItem
...
DeviceTask
parameterValue : LIST<ANY>...
Acknowledgement
typeCo...
Message
versionId : ST...
1..*
1
acknowledgement1..*
acknowledgedMessage1
1
1
payload1
acknowledgingMessage
1
QueryEvent
...
ControlAct
...0..1
0..n
0..1
payload
0..n
0..1
1
0..1
1
ManagedParticipation
...
ActHeir
ActRelationship
typeCode : CSinversionInd : BL
contextControlCode : CSsequenceNumber : INT
priorityNumber : INTpauseQuantity : PQcheckpointCode : CS
splitCode : CSjoinCode : CSnegationInd : BLconjunctionCode : CSlocalVariableName : ST
seperatableInd : BL
Act
classCode : CSmoodCode : CSid : SET<II>
code : CDnegationInd : BL
text : EDstatusCode : SET<CS>
effectiveTime : GTSderivationExpr : STavailabilityTime : TS
priorityCode : SET<CE>activityTime : GTS
repeatNumber : IVL<INT>confidentialityCode : SET<CE>
interruptibleInd : BLlevelCode : CE
independentInd : BLuncertaintyCode : CE
reasonCode : SET<CE>languageCode : CE
substitutionConditionCode : CE
0..n1
inboundRelationship
0..n
target
1
0..n
1
outboundRelationship
0..n
source
1
Participation
typeCode : CSfunctionCode : CDcontextControlCode :
CSsequenceNumber :
INT...
0..n
1
0..n
1
RoleLink
...Role
classCode : CS...
0..n
1
0..n
1
0..n1
outboundLink
0..n
source
1
0..n1
inboundLink
0..n
target
1
LanguageCommunication
langua...
AttentionLine
...
Batch
referen...
Entity
classCode : CSdeterm...
0..n0..1
playedRole
0..n
player
0..1
0..n0..1
scopedRole
0..n
scoper
0..1
10..n 10..n
Transmission
id : ...
0..n
1
0..n
1
0..1
0..n
0..1
0..n
CommunicationFunction
...
1..n
0..*
1..n
0..*1..*
0..*
1..*
0..*
LivingEntity
Entity
Person
Role Patient
HasRole
Terminology and Information Model
Information Model
Terminology
Bottom-Up: Status of HL7
• Version 2 widely used
• No standard for implementation
• Not mandatory
• RIM is in development
• Common Document Architecture (CDA)
For more information:www.hl7.org
Top-Down: Integrating the Healthcare Enterprise (IHE)
• Standards needed for implementing standards• IHE formed in 1997
– Health Information Management and Systems Society (HIMSS)
– Radiology Society of North America (RSNA)
• International participation: Canada, France, Germany, Italy, Japan, Korea, Netherlands, Norway, Spain, United Kingdom
• Includes: societies, users, vendors, consultants, standards development organizations
IHE: A Standard Process for Adoption of Standards
1. Interoperability Problem Identification: identify common interoperability problems (information access, clinical workflow, administration, underlying infrastructure)
2. Integration Profile Specification: chose standards that address the problems - document them in an IHE integration profile
3. Connect-a-thon Testing: Vendors implement one or more IHE integration profiles into their products and test them for mutual interoperability at the annual IHE Connect-a-thon
4. Integration Statements and Requests for Proposals (RFPs):• Vendors publish IHE integration statements to document
IHE integration profiles supported by their products• Users can reference the IHE integration profiles in requests
for proposals, greatly simplifying the systems acquisition process.
A Proven Standards Adoption Process
IHEIntegrationProfiles B
IHEIntegrationProfile A
Easy toIntegrateProducts
IHEConnect-a-thon
ProductWith IHE
IHEDemonstration
User Site
RFP
Standards(e.g. ASTM-CCR
HL7 CDA)
Product IHE IntegrationStatement
IHE Connect-a-thonResults
Requirements
IHE Integration Profiles - Radiology
• Scheduled Workflow• Patient information Reconciliation• Consistent Presentation of Images• Post-processing Workflow• Reporting Workflow• Evidence Documents Other profiles:
• information technology infrastructure• cardiology• laboratory
IHE Connect-a-thons
• Centerpiece of the IHE testing process
• Weeklong interoperability-testing event
• Validation of the participants' integration work
• Systems exchange information with complementary systems from multiple vendors
• Support of functions in the Integration Profiles
Massive yearly events :Massive yearly events :60-70 vendors60-70 vendors120-160 engineers120-160 engineersOver 100 systemsOver 100 systems…….integrated in 5 days.integrated in 5 days
IHE Connect-a-thons
Vendors do not pass…Vendors do not pass…until an IHE Project Manager attests it !until an IHE Project Manager attests it !
Participating and Contributing Vendors (America)
Agfa HealthCareAlgotec Systems, Ltd.BerdyCamtronicsCanon Medical SystemsCarefxCedara Software
CorporationCerner CorporationCSISTDictaphoneDR SystemsDynamic ImagingEastern InformaticsEastman Kodak
CompanyEmageonEclipsysFujifilm Medical Systems
ProcomPhilips Medical SystemsRASNA Imaging SystemsSectraSentillionSiemens Medical SolutionsSoftmedicalStentor, IncStorCOMM, IncSwissray International, IncTiani Medgraph AGToshiba America Medical
SystemsUltraVisual Medical
SystemsVital Images, Inc.Voxar LimitedWebMDXIMIS
GE HealthcareHeartlabHitachi Medical
CorporationHologic, IncIDX Systems CorporationIMCO TechnologiesInSiteOneINFINITTKonica Minolta Marotech, Inc.McKesson Information
SolutionsMedconMedical Manager Health
SystemsMediface Co., Ltd.Merge eFilmMortara
How to participate in IHE?
As a User or Vendor Contributor• Become a member of a Technical Committee• Become a member of Regional/National CommitteesAs a Vendor Participant• Comment on integration profiles• Attend Educational Workshops (September)• Participate to Connect-a-thonsAs a User/Consultant Participant• Comment on integration profiles• Attend Educational Workshops (September)• Attend Connect-a-thons • Include IHE Integration Profiles in your RFPs and
Integration Projects.
W W W . I H E . N E TW W W . I H E . N E T
Providers and VendorsProviders and Vendors
Working Together to DeliverWorking Together to Deliver
Interoperable Health Information SystemsInteroperable Health Information Systems
in the Enterprisein the Enterprise
and Across Care Settingsand Across Care Settings