A brief HL7 Version 3 Introduction for CIMI

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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_at_earthlink.net 1
510 593 3483
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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

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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.

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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.

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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
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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

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Structural metadata

• 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.

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The RIM is an extensional model

• 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.

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RIM Core Classes Attributes
Entity
Role
Participation
Act
classCode CS code CD determinerCode
CS statusCode CS
classCode CS code CE effectiveTime IVLltTSgt
typeCode CS time IVLltTSgt
classCode CS code CD moodCode CS statusCode
CS activityTime GTS
1
plays
0..
1
scopes
0..
Six kinds of attributes define semantics of each
backbone class typeCode(classCode), code,
time, mood(determiner), status, id
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RIM Core Structural Attribute Value Sets
Entity
Role
Participation
Act
classCode CS code CD determinerCode
CS statusCode CS
classCode CS code CE effectiveTime IVLltTSgt
typeCode CS time IVLltTSgt
classCode CS code CD moodCode CS statusCode
CS activityTime GTS
1
plays
0..
1
validates
0..
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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)
moodCodeEVN effectiveTime 10/1/07_at_
1pm PST (Observation) Valuexxx
moodCodeRQO effectiveTime 12/12/07_at_
2pm PST (No Value Attribute in this model)
moodCodeGoal effectiveTime
11/1/07 (Goal) Valueyyy
Wbc Observation of xxx made on 10/1/07_at_1pmPST
Wbc Order (Request) to occur on 12/12/07_at_2pmPST
Wbc goal of specific value of yyy to be
attained by 11/1/07
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Person (in role of Patient) participates as
subject of an Observation (lab test, performed)
Entity
Role
Participation
Act
classCode CS code CD determinerCode
CS statusCode CS
classCode CS code CE effectiveTime IVLltTSgt
typeCode CS time IVLltTSgt
classCode CS code CD moodCode CS statusCode
CS activityTime GTS
1
plays
0..
1
validates
0..
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Person in role of physician ltassigned entitygt
participates as author of an Observation (lab
test order)
Entity
Role
Participation
Act
classCode CS code CD determinerCode
CS statusCode CS
classCode CS code CE effectiveTime IVLltTSgt
typeCode CS time IVLltTSgt
classCode CS code CD moodCode CS statusCode
CS activityTime GTS
1
plays
0..
1
validates
0..
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A single act may have multiple participations
Participation
Role
Entity
typeCode CS time IVLltTSgt
classCode CS code CE effectiveTime IVLltTSgt
classCode CS code CD determinerCode
CS statusCode CS
1
0..
plays
0..
1
scopes
Person in role of physician ltassigned entitygt
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
typeCode CS time IVLltTSgt
1
classCode CS code CE effectiveTime IVLltTSgt
0..
plays
1
0..
scopes
Person (in role of Patient) participates as
subject of an Observation Order (lab test order)
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RIM Core Classes Attributes

• 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
classCode CS code CE effectiveTime IVLltTSgt
typeCode CS time IVLltTSgt
classCode CS code CD moodCode CS statusCode
CS activityTime GTS
1
plays
0..
1
scopes
0..

• Six kinds of attributes define semantics of
  each backbone class typeCode(classCode), code,
  time, mood(determiner), status, id

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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

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Two other critical RIM classes

• RoleLink A ltrarely usedgt 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.

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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)
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V3 and physical data

• Act, specialization observation
• Act.classOBS
• Act.codeltcode for observation typegt
• E.g. LOINC, SNOMED, etc. (per HL7 realm)
• Act.mood
• Event for actual measurement
• Request for order/request for measurement
• Act.IDinstance 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 patients life
  the observation was made)

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V3 and physical data

• Act/observation continued
• interpretationCode (SETltCEgt)
• 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 (SETltCEgt)
• Examples Blood pressure measurement method
  arterial puncture vs. sphygmomanometer
  (Riva-Rocci), sitting vs. supine position, etc.
  

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V3 and physical data

• Act/observation continued
• targetSiteCode (SETltCDgt)
• 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.

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Summary

• We have briefly reviewed
• an introduction to the RIM

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Further Discussion

• Other topics?...
• Questions?...