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A brief HL7 Version 3 Introduction for CIMI

A brief HL7 Version 3 Introduction for CIMI. Mark Shafarman Past Chair HL7 with additional HL7 “roles” of past co-chair International Council past co-chair Control/Query TC past member Architectural Review Board co-chair Templates WG.

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A brief HL7 Version 3 Introduction for CIMI

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  1. A brief HL7 Version 3 Introduction for CIMI Mark Shafarman Past Chair HL7 with additional HL7 “roles” of past co-chair International Council past co-chair Control/Query TC past member Architectural Review Board co-chair Templates WG CEO & Chief Information Architect Shafarman Consulting, Inc. mark.shafarman@earthlink.net +1 510 593 3483 C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  2. Agenda: Brief overview of the HL7 v 3 Reference Information Model The HL7 RIM – model of clinical information content Some examples from the 2011 Normative edition Discussion/Questions

  3. Core concepts of HL7 v3 RIM The “Act” class and its specializations represent every action of interest in health care. Specifically –“an action of interest that has happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. An act is an intentional action in the business domain of HL7. Healthcare (and any profession or business) is constituted of intentional actions. An HL7 Act instance is a record of such an intentional action.

  4. Core concepts of RIM Every happening is an Act Procedures, observations, medications, supply, registration, etc. Acts are related through an Act_relationship composition, preconditions, revisions, support, etc. • Participation defines the context for an Act author, performer, subject, location, etc. The participants are Roles patient, provider, practitioner, specimen, healthcare facility etc. Roles are played by Entities persons, organizations, material, places, devices, etc.

  5. RIM Core Classes Entity Participation Role Adminis- trativeActs FinancialActs Clinical Acts Observation Procedure Supply Substance Adm Performer Author Witness Subject Destination ... Living Subject Person Organization Material Place ... Patient Employee Assigned Entity Certified Entity Guarantor ... Account, Invoice Element, Financial Contract, Financial Transaction Patient Encounter, Registry C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  6. How does HL7 manage this abstraction? In the first HL7 RIM models, each concept had a visible (physical) class or association to represent it In current RIM: We only include a class when it adds new attributes and associations for the rest, use coded “structural” attributes – ‘class’ or ‘type’ codes ‘mood’ or ‘determiner’ codes

  7. Why are these named structural attributes? because they use codes to represent concepts that would previously have been part of the model structure Each structural attribute has a specific HL7 concept domain with an HL7-defined ‘fixed’ value set. In an ontological context, the formal code sets for the structural attributes form the RIM metadata ontology. Note that this now has a parallel in SNOMED CT, which also has a formal metadata ontology. Structural metadata

  8. But it also has the ability to have formal healthcare ontologies bound to specific attributes (linked to Intentional model world). For SNOMED CT there is the Terminfo implementation guide. LOINC is another standard terminology/ontology that is commonly bound to RIM models. These two aspects support applying description logic to the analysis of RIM model instances. The RIM is an extensional model

  9. RIM Core Classes & Attributes 1 1 0..* 0..* Entity Role Participation Act classCode CS code : CD determinerCode : CS statusCode : CS 1 classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS plays 0..* 1 scopes 0..* Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  10. RIM Core Structural Attribute Value Sets • Observation • Procedure • Supply • Substance Adm • Financial • … • Patient • Employee • Assigned Entity • Certified Entity • Guarantor • ... • Living Subject • Person • Organization • Material • Place • ... • Performer • Author • Witness • Subject • Destination • ... Act. classCode Role. classCode Entity. classCode Participation .typeCode 1 1 0..* 0..* • Definition • Intent • Request • Event • Criterion • ... • Kind • Instance • QualifiedGroup Entity. determiner Code Act. moodCode Entity Role Participation Act classCode CS code : CD determinerCode : CS statusCode : CS 1 classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS plays 0..* 1 validates 0..* C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  11. E.g. Value Set for moodCode (a Structural Attribute) 3 instances of Act, specialization OBServation, act.code attribute = “wbc” (actually = the corresponding LOINC code for White Blood Count) moodCode=EVN effectiveTime =“10/1/07@ 1pm PST” (Observation) Value=“xxx” moodCode=RQO effectiveTime =“12/12/07@ 2pm PST” (No Value Attribute in this model) moodCode=Goal effectiveTime =“11/1/07” (Goal) Value=“yyy” Wbc Observation of ‘xxx’ made on 10/1/07@1pmPST Wbc Order (Request) to occur on 12/12/07@2pmPST Wbc goal of specific value of ‘yyy’ to be attained by 11/1/07

  12. Person (in role of Patient) participates as subject of an Observation (lab test, performed) • Observation • Patient • Person • Subject Act. classCode Role. classCode Entity. classCode Participation .typeCode 1 1 0..* 0..* • Event • ... • Instance Entity. determiner Code Act. moodCode Entity Role Participation Act classCode CS code : CD determinerCode : CS statusCode : CS 1 classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS plays 0..* 1 validates 0..* C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  13. Person in role of physician <assigned entity> participates as author of an Observation (lab test order) • Observation • Procedure • Supply • Substance Adm • Financial • … • Patient • Employee • Assigned Entity • Certified Entity • Guarantor • ... • Living Subject • Person • Organization • Material • Place • ... • Performer • Author • Witness • Subject • Destination • ... Act. classCode Role. classCode Entity. classCode Participation .typeCode 1 1 0..* 0..* • Definition • Intent • Request • Event • Criterion • ... • Kind • Instance • QualifiedGroup Entity. determiner Code Act. moodCode Entity Role Participation Act classCode CS code : CD determinerCode : CS statusCode : CS 1 classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS plays 0..* 1 validates 0..* C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  14. A single act may have multiple participations 1 1 1 0..* 0..* 0..* 0..* Entity Role Participation classCode CS code : CD determinerCode : CS statusCode : CS 1 0..* classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> plays 0..* 1 scopes Person in role of physician <assigned entity> participates as author of an Observation (lab test order) 1 Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS Entity Role Participation classCode CS code : CD determinerCode : CS statusCode : CS 1 typeCode : CS time : IVL<TS> classCode : CS code : CE effectiveTime : IVL<TS> 0..* plays 1 0..* scopes Person (in role of Patient) participates as subject of an Observation Order (lab test order) C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  15. RIM Core Classes & Attributes 1 1 0..* 0..* • We have shown parts of some of the basic HL7 defined value sets for structural attributes, but entity.code, role.code, and act.code are key attributes that use non-HL7 standard terminologies. • E.g. for act.code, LOINC and SNOMED-CT, are key value sets for observation and procedure concept domains. Entity Role Participation Act classCode CS code : CD determinerCode : CS statusCode : CS 1 classCode : CS code : CE effectiveTime : IVL<TS> typeCode : CS time : IVL<TS> classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS plays 0..* 1 scopes 0..* • Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id C. 2012 HL7 Int'l and Shafarman Consulting, Inc.

  16. Two other critical RIM classes ActRelationship: creates formal relationships between acts, such as: E.g. (structural) — Comp, component, As in a CBC observation (complete blood count) has component acts RBC (red blood cell count); WBC, white blood cell count; etc. E.g. (causal) — RSON, reason; CIND: contraindication; PRCN, precondition And several types of qualifiers and modifiers

  17. RoleLink: A <rarely used> connection between two roles expressing a dependency between those roles and permitting the authorization or nullification of a dependent role based on status changes in its causal or directing role. E.g. A role of assignment or agency depends on another role of employment, such that when the employment role is terminated, the assignments are terminated as well. Two other critical RIM classes

  18. RIMBAA note The previous diagram, the “RIM on (just) one page.” Is the basic SQL design for RIMBAA systems. But this requires (see below) using the structural variables to navigate the RIM models. (another presentation)

  19. V3 and physical data Act, specialization “observation” Act.class=“OBS” Act.code=<code for observation type> E.g. LOINC, SNOMED, etc. (per HL7 “realm”) Act.mood Event for actual measurement Request for “order/request” for measurement Act.ID=“instance identifier” for the measurement Act.value= the physical observation DataType of act.value is, as in v 2.x, allowed to be any appropriate datatype (usually PQ, physical quantity; may be Set(PQ). Act.effectiveTime= “physiologically relevant time of observation” (e.g. “when in the patient’s life the observation was made)

  20. V3 and physical data Act/observation continued: interpretationCode (SET<CE>) One or more codes specifying a rough qualitative interpretation of the observation, such as "normal", "abnormal", "below normal", "change up", "resistant", "susceptible", etc Act/observation continued: methodCode (SET<CE>) Examples: Blood pressure measurement method: arterial puncture vs. sphygmomanometer (Riva-Rocci), sitting vs. supine position, etc.

  21. V3 and physical data Act/observation continued: targetSiteCode (SET<CD>) A code specifying detail about the anatomical site or system that is the focus of the observation if this information is not already implied by the observation definition or Act.code. Constraints: The targetSiteCode value, if specified, must not conflict with what is implied about the target site or system from the observation definition and the Act.code.

  22. Summary We have briefly reviewed an introduction to the RIM

  23. …Further Discussion… …Other topics?... …Questions?...

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