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

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Presentation on theme: "8/15/2012C. 2012 HL7 Int'l and Shafarman Consulting, Inc. A brief HL7 Version 3 Introduction for CIMI Mark Shafarman Past Chair HL7 with additional HL7."— Presentation transcript:

1 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 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

2 C HL7 Int'l and Shafarman Consulting, Inc. 2 8/15/2012 Agenda: Brief overview of the HL7 v 3 Reference Information Model –The HL7 RIM – model of clinical information content Some examples from the 2011 Normative edition Discussion/Questions

3 C HL7 Int'l and Shafarman Consulting, Inc. 3 8/15/2012 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 C HL7 Int'l and Shafarman Consulting, Inc. 4 8/15/2012 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 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 5 RIM Core Classes Entity Role Participation Financial Acts Living Subject PersonOrganizationMaterialPlace... PatientEmployee Assigned Entity Certified Entity Guarantor... PerformerAuthorWitnessSubjectDestination... ObservationProcedureSupply Substance Adm Adminis- trative Acts Clinical Acts Account,InvoiceElement,FinancialContract,FinancialTransaction Patient PatientEncounter,Registry

6 C HL7 Int'l and Shafarman Consulting, Inc. 6 8/15/2012 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 C HL7 Int'l and Shafarman Consulting, Inc. 7 Why are these named structural attributes? –because they use codes to represent concepts that would previously have been part of the model structure –Each structural attribute has a specific HL7 concept domain with an HL7-defined ‘fixed’ value set. In an ontological context, the formal code sets for the structural attributes form the RIM metadata ontology. Note that this now has a parallel in SNOMED CT, which also has a formal metadata ontology. Structural metadata

8 C HL7 Int'l and Shafarman Consulting, Inc. 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 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 9 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 RIM Core Classes & Attributes 1 0..* plays scopes Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id

10 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 10 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 RIM Core Structural Attribute Value Sets Entity. classCode Living SubjectLiving Subject PersonPerson OrganizationOrganization MaterialMaterial PlacePlace Role. classCode PatientPatient EmployeeEmployee Assigned EntityAssigned Entity Certified EntityCertified Entity GuarantorGuarantor Participation.typeCode PerformerPerformer AuthorAuthor WitnessWitness SubjectSubject DestinationDestination Act. moodCode DefinitionDefinition IntentIntent RequestRequest EventEvent CriterionCriterion Act. classCode ObservationObservation ProcedureProcedure SupplySupply Substance AdmSubstance Adm FinancialFinancial … Entity. determiner Code KindKind InstanceInstance Qualified GroupQualified Group 1 0..* plays validates

11 C HL7 Int'l and Shafarman Consulting, Inc. 11 8/15/2012 E.g. Value Set for moodCode (a Structural Attribute) Wbc Order (Request) to occur on Wbc Observation of ‘xxx’ made on Wbc goal of specific value of ‘yyy’ to be attained by 11/1/07 3 instances of Act, specialization OBServation, act.code attribute = “wbc” (actually = the corresponding LOINC code for White Blood Count) moodCode=RQO effectiveTime 2pm PST” (No Value Attribute in this model) moodCode=Goal effectiveTime =“11/1/07” (Goal) Value=“yyy” moodCode=EVN effectiveTime 1pm PST” (Observation) Value=“xxx”

12 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 12 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 Person (in role of Patient) participates as subject of an Observation (lab test, performed) Entity. classCode PersonPerson Role. classCode PatientPatient Participation.typeCode SubjectSubject Act. moodCode EventEvent Act. classCode ObservationObservation Entity. determiner Code InstanceInstance 1 0..* plays validates

13 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 13 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 Person in role of physician participates as author of an Observation (lab test order) Entity. classCode Living SubjectLiving Subject PersonPerson OrganizationOrganization MaterialMaterial PlacePlace Role. classCode PatientPatient EmployeeEmployee Assigned EntityAssigned Entity Certified EntityCertified Entity GuarantorGuarantor Participation.typeCode PerformerPerformer AuthorAuthor WitnessWitness SubjectSubject DestinationDestination Act. moodCode DefinitionDefinition IntentIntent RequestRequest EventEvent CriterionCriterion Act. classCode ObservationObservation ProcedureProcedure SupplySupply Substance AdmSubstance Adm FinancialFinancial … Entity. determiner Code KindKind InstanceInstance Qualified GroupQualified Group 1 0..* plays validates

14 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 14 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 A single act may have multiple participations 1 0..* plays Participation typeCode : CS time : IVL Role classCode : CS code : CE effectiveTime : IVL Entity classCode CS code : CD determinerCode : CS statusCode : CS 1 1 scopes plays 1 0..* scopes 0..* 1 Person (in role of Patient) participates as subject of an Observation Order (lab test order) Person in role of physician participates as author of an Observation (lab test order)

15 8/15/2012C HL7 Int'l and Shafarman Consulting, Inc. 15 Entity classCode CS code : CD determinerCode : CS statusCode : CS Role classCode : CS code : CE effectiveTime : IVL Participation typeCode : CS time : IVL Act classCode : CS code : CD moodCode : CS statusCode : CS activityTime : GTS 1 0..* 1 1 RIM Core Classes & Attributes 1 0..* plays scopes Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id We have shown parts of some of the basic HL7 defined value sets for structural attributes, but entity.code, role.code, and act.code are key attributes that use non-HL7 standard terminologies. E.g. for act.code, LOINC and SNOMED-CT, are key value sets for observation and procedure concept domains.

16 C HL7 Int'l and Shafarman Consulting, Inc. 16 8/15/2012 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 C HL7 Int'l and Shafarman Consulting, Inc. 17 RoleLink: A 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 C HL7 Int'l and Shafarman Consulting, Inc. 18

19 C HL7 Int'l and Shafarman Consulting, Inc. 19 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)

20 C HL7 Int'l and Shafarman Consulting, Inc. 20 8/15/2012 V3 and physical data Act, specialization “observation” –Act.class=“OBS” –Act.code= 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)

21 C HL7 Int'l and Shafarman Consulting, Inc. 21 8/15/2012 V3 and physical data Act/observation continued: – interpretationCode (SET ) 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 ) Examples: Blood pressure measurement method: arterial puncture vs. sphygmomanometer (Riva-Rocci), sitting vs. supine position, etc.

22 C HL7 Int'l and Shafarman Consulting, Inc. 22 8/15/2012 V3 and physical data Act/observation continued: – targetSiteCode (SET ) 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.

23 C HL7 Int'l and Shafarman Consulting, Inc. 23

24 C HL7 Int'l and Shafarman Consulting, Inc. 24 8/15/2012 Summary We have briefly reviewed –an introduction to the RIM

25 C HL7 Int'l and Shafarman Consulting, Inc. 25 8/15/2012 …Further Discussion… …Other topics?... …Questions?...


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