Transcript V3 Modeling Methodology

HL7
Introduction to
HL7 Version 3
W. Ted Klein
Chief Scientist, cMore Medical Solutions, Inc.
HL7 Modeling and Methodology Committee Co-Chair
January 24, 2000
© 1999, 2000 Health Level 7
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Goals of this Tutorial
• Overview of Version 3
– What is it? How are the work products built?
• Motivation for this new methodology
– Why HL7 needs a new standard and approach
• To prepare you for Version 3 activities
– Describe the models in Version 3
– Show how they are used to develop the HL7
message specifications that make up the standard?
• Introductory information to prepare you for the
more detailed tutorials to follow
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© 1999, 2000 Health Level 7
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Topics Outside of this
Tutorial Scope
• Does not go into the details of each step
(Intermediate and Advanced Tutorials)
• Does not teach how to design models
• Does not review current models (e.g., RIM)
• Does not cover details of project issues
(e.g., tools, coordination, balloting, etc.)
• Does not explain how to design a software
architecture
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Tutorial Outline
• Part I - Introduction
– HL7, business problem, and how HL7 solves it
– What is Version 3?
– Why HL7 is making the move to Version 3
• Part II - Technical Concepts
– Background information
• Part III - Methodology
– Modeling process
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Part I
Introduction
 What is HL7?
 Business problem
 Motivation for a new methodology
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What Is HL7?
• The HL7 organization was founded in 1987
• In June 1994 HL7 was designated as an
ANSI accredited standards development
organization (SDO)
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HL7 Mission Statement
• To provide standards for the exchange,
management and integration of data that
supports clinical patient care and the
management, delivery and evaluation of
healthcare services.
• ... the complete ‘life cycle’ of a standards
specification -- development, adoption,
market recognition, utilization and
adherence.
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Standard Development
Participants
M&M
Executive Committee
Business Strategy &
Motivation
Methodology,
Measurement,
Coordination
V3.0
Technical Steering Committee
Planning & Enforcement
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Technical Committees
Modeling & Voting
8
HL7 Standard Versions
•
•
•
•
•
•
•
2.0 (1988)
2.1 (1990)
2.2 (1994)
2.3 (1997)
2.3.1 (1999)
2.4 (2000)
3.0
January 24, 2000
Prototype
First standard
Widely Adopted
In operation
Current ANSI standard
In ballot
Balloting of Prototype in 2000,
balloting of formal
specifications in 2001
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What does “HL7” stand for?
A domain-specific, common protocol for the
exchange of health care information.
Function
Communication
7
6
5
4
3
2
1
Application
Presentation
Session
Transport
Network
Data Link
Physical
ISO-OSI Communication Architecture Model
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Increasing Pace of Business
Change
Migration Towards a Wellness Model
Managing
Visit
Managing
Care
Managing
Health
Clinton’s Reform
Initial
Transitional
Anticipated
Fee-for-service,
on-demand
Capitated,
case-based
Preventive,
episodal
Present time
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Increased IS Complexity
Client/Server, Internet, Multimedia
Centralized Computing
(Batch)
Network Computing
(RPC, ORBs, etc)
Digital
Dell
Micron
HP
Enterprise Computing
(Client/Server)
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Motivation for a New
Methodology
 Limitations of Version 2.3
 Benefits of Version 3
 Version 3 Statement of Principles
 Goals
 Mission
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Current Implementation
Problems with Version 2.x
Complex integration: at least 2-4 months to install HL7 interfaces
Problem
• Honest misunderstanding
of specifications
Cause
• Different implicit
information models
• Misleading conformance
claims
• No vocabulary to
describe conformance
concepts
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Lack of a rigorous
documented Methodology
leads
to:
• Unmeasurable progress
Outcome...
• Unpredictable results
• Metastasizing optionality
Past V2 Process
Patient
Care
ADT/
Finance
MnM
Orders
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Control/
Query
Home
Health
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Limitations of Version 2.x
•
•
•
•
•
•
•
Implicit information model, not explicit
Events not tightly coupled to profiles
Need for controlled vocabularies
Limited to a single encoding syntax
No explicit support for object technologies
No explicit support for security functions
Optionality is ubiquitous and troublesome
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Benefits of V3 to HL7
• Reduces optionality:
results in more specific messages
• Uncovers hidden assumptions about
application boundaries
• Facilitates defining clear, fine-grained,
conformance claims
HL7 V3.0
Certified
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Benefits of V3 to Providers
Deals with complexity of the HC environment:
 Facilitates
integration of
heterogeneous systems
 Increases
choices of innovative
best-of-breed solutions
 Provides support for legacy systems
 Allows
reliable verification of
vendors’ conformance claims
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Benefits of V3 to Vendors

Provides improved protocol for
interconnecting heterogeneous systems
 Reduces
installation effort
–
reduces site-specific negotiations
–
simplifies interface programming
 Promotes
vendor specialization by
allowing segmentation of product
lines into niche market spaces
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Version 3 Goals
• Provide a framework for coupling events,
data elements and messages
• Improve clarity and precision of specification
• Improve adaptability of standards to change
• Begin to approach “plug and play”
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Approved Statement of Principles
•
•
•
•
•
•
•
•
Explicit Scope, Target Users
Support for Legacy Systems
Loosely Coupled Systems
Internationalization
Compatibility with Versions 2.X (limited)
Management - ANSI and by-laws
Uniform Trigger Event Model
Information System Role
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Version 3 Principles (continued)
•
•
•
•
•
•
•
•
•
Conformance Claims
The Version 3 Development Process
Project Scope
Version 3 Methodology - MDF
Quality Assurance Processes
Process Support
Confidentiality of Patient Information
Authenticated Authorization for Services
Security, Privacy, and Integrity
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Methodology Mission
• To bring modern software engineering practices, such
as Object Oriented Analysis and Design and formal
modeling, to the standards development process
• To bring the highest level of quality, understandability,
and flexibility to a messaging standard
• Incorporate concept abstractions and behavior
modeling using roles in a rigorous set of work products
• Express the standard in widely accepted UML notation
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An HL7 Version 2.X Spec
Chapters
2 and 8
Common
Specs
ChapterChapterChapterSpecific
Specific
Specific
Specs
Specs
Specs
Segments
and Fields
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Chapters
3, 4, 6, ...
Trigger
Event and
Messages
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Contents of Existing HL7 V2.3
• Trigger events
– Actions or occurrences
• Messages
– Information content
• Segments
– Repeating structures
• Data elements
– Data representation
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An HL7 Version 3.X Spec
HL7
Reference
Model
Common
Specs
ChapterSpecific
Specs
*Future
Consideration
Use Case
Model
Information
Model
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Interaction
Model
Message Model
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
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Implementable
Message
Implementable
Specification
Implementable
Message
Message
Specification
XML/ER7/…
Specification
OLE/CORBA
EDIFACT*
26
Version 3 is a change to the
HL7 Architecture
• The HL7 2.x specifications have:
– Segments that imply information entities
– Events that indicate implied behaviors
– Descriptive content that suggests use cases
but never formally documents these
• Version 3 seeks to formalize this by applying
object analytic methods and style
–
–
–
–
to
to
to
to
improve the internal consistency of HL7
provide sound semantic definitions
enable future architectures
produce an evolution not a revolution
Done by applying MODELING to the HL7 process
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HL7 Modeling
Abstractions:
Activities
(Use Case
Model)
Objects
(Information
Model)
By demanding
Perform Lab
Review
Tests
Utilization
analysis
of
the
Version 2.x focused its
requirements and
energies at the communication
information
level and covered
the other content,
Version
3inassures
abstractions
only
loosely
the
Account
Encounter
Order
Patient Provider
consistency
in
and
specifications.
enhances the value
of the resulting
messages.
Dispense
Medications
Communication
(Interaction and
Message Models)
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Manage
Care
HL7 message
Finance
© 1999, 2000 Health Level 7
HL7 message
ADT
Pharmacy
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HL7 V3 Deliverables
• Message design model
• Use case model
– Hierarchy of tasks and
actors
• Interaction model
– Trigger events, abstract
messages & application
profiles
• Information model
– Classes, relationships,
states, and lifecycles
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– Refined Message
Information Model
(R-MIM)
– Abstract message
definitions (HMDs)
• Vocabulary
– Domain definitions
– Representations and
mappings
• Implementation
– Implementation
Technology Specification
(ITS)
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Part II - Technical
Background
 Concepts
 Modeling
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Software Engineering
Concepts
Process:
Activities leading to the orderly
construction of the models
Operation
Attributes
(Data)
Method:
An approach to problem solving
Model:
Abstract representation of a subject
Object:
Domain specific concept
Operation
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Iterative Lifecycle
Domain
Analysis
Requirements
Analysis
Release 3.0
Message
Design
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Message
Specification
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Modeling is a Technique for
Managing Complexity
• Decomposition
– Divide-and-conquer
• Abstraction
– Chunking the information
• Hierarchy
– Increasing semantic content of individual chunks
of information through reuse
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Modeling leads to solutions
• Applying analysis techniques leads to
solutions to integrate components
• Modeling provides the framework for the
analysis steps and products
• Object Oriented Analysis and Modeling form
the basis of the standard techniques
adopted for Version 3
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Version 3 Is Mostly Modeling
• The deliverables are expressed as models
• Each model leads to greater understanding
of areas that influence content, structure,
and behavior of messages
• Messages are defined when the models are
merged
• The HL7 standard message specification will
be derived from the models
• Models are expressed in UML
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Part III
Methodology
 Process Overview
Model Deliverables and Phases
Generation of Messages
 Process in Detail
Methodology Activities
Coordination of Parallel Committee
Projects (Harmonization)
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Process Overview
 Tasks
 Deliverables
 Phases
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HL7 and engineering tasks
• Analysis
– Requirements Analysis
– Domain Analysis
Use Case Model (UCM)
Information Model
(RIM & DIM)
Vocabulary Domain Specification
• Design
Interaction Model (IM)
– Component and Object Message Information Model (MIM)
Interaction Design
Hierarchical Message Description
– Message Design
(HMD)
• Voting and Publishing
• Implementation Guide
– Technology
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Implementation Technology
Specification (ITS)
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V3 process is documented in the Message
Development Framework (MDF)
Use Case Model
• Captures healthcare requirements
• Defines scope for TSC approval
• Specifies data and its semantics
Information Model
• Specifies major state transitions
• Specifies vocabulary for domains
Interaction Model
• Defines information flows
• Defines communication roles
• Forms basis for conformance claims
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
• Defines message contents
Message Specification
• Apply constraints to the
information model and vocabulary
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Message Development
Framework (MDF)
• Is a Methodology for building HL7 models
• Is a description for defining HL7 standard
messages
• Full instruction book for HL7 participants
• Basis for member training
• Five years in development
• Continues to evolve as we gain experience
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MDF Model Relationships
Analysis
Requirements
Analysis
Domain
Analysis
Voting
Design
Interaction
Design
Message
Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
Use Case
Model
(UCM)
RIM
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Domain
Information
Model
(DIM)
Interaction
Model
(IM)
Hierarchical
Message
Descriptions
(HMD)
Reference
Model
Repository
© 1999, 2000
Health Level
7
Approval



Ballots
41
Models developed in Phases
Develop Scope
Create
Use Cases
Identify
Actors &
Events
Information Model
Use Case Model
Spec
Spec
DIM Spec
Class Diagram State Diagram
Define
Interactions
Create
Conformance
Claims
January 24, 2000
Model new
concepts
UCM Spec
Use Case Diagram
Harmonize with
RIM
Define Trigger
Events
Define Application
Roles
Draw initial
contents from
RIM
Interaction Model
Spec
Inter Spec
Interaction Diagram
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Message
Information Model
Develop
Message Object
Diagram
Specify HMD
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Models are used to build the HMD
Reference
Information Model
Domain
Information
Model
Use Case Model
Interaction
Model
Person_name_for_IHCP
1
Person_as_IHCP
cd : CV
has
purpose_cd : CV
phon : TIL
1
type_cd : CV
nm : PN
is_for
takes_on_role_of
1
is_participant_for
0..*
Message
Information
Model
Encounter_practitioner
is_associated_with
participation_type_cd
1..*
Exactly one
occurrence
1 participates_as
has_as_participant
1
1 Individual_healthcare_practitioner
is_a_role_of id : TII
Patient_encounter
id : TII
s tatus_cd : CV
encounter_classification_cd : CV
Person_as_Patient
0..1 is_the_primary_provider_for
start_dttm
birth_dttm : TS
involves end_dttm
birthplace_addr : ST
0..* has_a_primary_provider
expected_insurance_plan_qty : NM
1 deceased_dttm : TS
1 first_similar_illness_dttm
Patient
education_level_cd : CV
1..1
id : TII
gender_cd : CV
takes_on_role_of
has
1
s tatus_cd : CV
marital_s tatus_cd : CV
1..1 newborn_baby_ind
race_cd : CV
is_involved_in
is_a_role_of multiple_birth_ind
religious_affiliation_cd : CV
Inpatient_encounter
organ_donor_ind
phon : TIL
1
actual_days_qty
1..*
has
Patient_admission
estimated_days_qty
is_for
admission_dttm
Person_name_for_Patient
Patient_billing_account
admission_reason_cd
1
nm : PN
admission_referral_cd
id : TII
is_preceded_by
effective_dt : TS
admission_source_cd 1
s tatus_cd : CV
0..1
cd : CV
admission_type_cd
billing_s tatus_cd : CV
preceded
purpose_cd : CV
pre_admit_test_ind
patient_financial_class_cd : CV
belongs_to
termination_dt : TS
readmission_ind
price_schedule_id : TII
type_cd : CV
Domain Specification Database
Common
Message
Element
Types
Hierarchical
Message
Description
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The HMD & ITS then give messages
Implementation
Technology
Specifications
"Send as ASCII
string in XML
format"
Hierarchical
Message
Definition
"Discontinue
pharmacy order"
ITS
Data
HL7
Message
Creation
Message
Instance
HL7-Conformant
Application
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HL7
Message
Parsing
Data
HL7-Conformant
Application
44
Process In Detail
 Methodology Activities
 Coordination of Parallel
Committee Projects
(Harmonization)
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Requirements
Analysis
Activities by Phase
Define
Scope
Define Scope
Create
Create
Use Cases
Use
Cases
Identify
Identify
Actors &&
Actors
Events
Events
Information Model
Use Case Model
Spec
Spec
DIM Spec
Class Diagram State Diagram
Define
Interactions
Create
Conformance
Claims
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Model new
concepts
UCM Spec
Use Case Diagram
Harmonize with
RIM
Define Trigger
Events
Define Application
Roles
Draw initial
contents from
RIM
Interaction Model
Spec
Inter Spec
Interaction Diagram
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Message
Information Model
Develop
Refined MIM
Specify HMD
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Use Case Model: Definitions
• Scope statement
– A high level use case for the entire project
• Use case
– Describes specific situations in which communication between
healthcare entities is needed
• Actor
– An entity which initiates or participates in the use case.
Discovered in the process of developing use cases
• Use Case Diagram
– Provides a graphical form to develop the use case model from
the business process analysis - UML notation
– Makes it easy to show the relationship between use cases
• Use cases can be decomposed
• Use cases can be shared
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Use Case Definitions (cont’d)
• Use Case Path
– Single ‘thread’ or ‘storyboard’ or ‘scenario’
– Longitudinal temporal description of a Use Case
instance
• Support for OO Concepts
– Generalizes
• adds additional behavior
– Includes
• uses another use case
– Extends
• allows branch flow logic in use case execution
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Sample Use Case Model
Health Care Enterprise
Manage Health
Plans
Provide Services
Provide Services
Manage Health Plans
Perform Triage
Manage
Network
Manage
Membership
Order
Service
Treat Patient
Schedule
Service
Treat Patient
Order Service
Administer
Procedure
Manage Membership
Enroll Member
Create Order
Evaluate
Outcomes
Discharge
Member
Sign
Order
Status Order
Record Results
Approve Services
Manage Network
Evaluate Provider
Create
Appointment
Market
Services
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Schedule Service
Monitor
Appointment
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Use Case Diagram Fragment
Delete_patient_record
Authorized_user
The individual
responsible for managing
Manage_patient_encounter
The inpatient
encounter
becomes
encounter
information.
active when a patient
is admitted. If
Schedule_encounter
the encounter has not been
Start_encounter
previously scheduled,
it can be
created at the time of admission.
Bill
Various_support_
staff
Start_scheduled_encounter
Admit_patient
Start_outpatient_encounter
Start_unscheduled_encounter
Discharge_patient
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Domain Analysis
Develop Scope
Create
Use Cases
Identify
Actors &
Events
Information Model
Use Case Model
Spec
Spec
DIM Spec
Class Diagram State Diagram
Define
Interactions
Create
Conformance
Claims
January 24, 2000
Model new
concepts
UCM Spec
Use Case Diagram
Harmonize with
RIM
Define Trigger
Events
Define Application
Roles
Draw initial
contents from
RIM
Interaction Model
Spec
Inter Spec
Interaction Diagram
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Message
Information Model
Develop
Refined MIM
Specify HMD
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The Information Model
• A detailed and precise definition for the information
from which all data content of HL7 messages are
drawn.
• Follows object-oriented modeling and diagramming
techniques, and is centered on a depiction of the
classes that form the basis for the objects in HL7
messages.
• Provides a means for expressing and reconciling
differences in data definition independent of
message structure.
• Forms a shared view of the information domain
used across all HL7 messages.
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Parts of the Information
Model
• Classes, Attributes, and Relationships
– Documented in the Reference Information
Model, the Domain Information Model, and the
Message Information Model
– Consistency ensured by a Style Guide
• State Transition Models
– For certain selected classes (Subject Classes)
• Data Types and Constraints
– Vocabulary definitions, Domains
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The Reference Information
Model (RIM)
• Expresses the information content for the collective
work of the HL7 Working Group in UML notation.
• A coherent, shared information model that is the
source for the data content of all HL7 messages.
• Maintained by a collaborative, consensus building
process involving all Technical Committees and
Special Interest Groups.
• RIM change proposals are debated, enhanced, and
reconciled by technical committee representatives
and applied to the RIM during the model
harmonization process
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RIM Content
• Classes
– Have Committees as Stewards
– Some identified as Subject Classes
• Attributes
– Have types constraining their domains
• Relationships
– Express cardinality for their use in messages
• Subject Areas
– Define broad areas of interest (eg Stakeholders,
Patient_encounters, Master_tables)
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Domain Information Models
• Committees and SIGs generally work with a
small subset of the RIM
• Each subset is focussed on a particular area
of group interest; this area is referred to as
a DOMAIN (subject domain)
• A subset of the RIM expressed using the
same tools is known as a Domain
Information Model or DIM
• The DIMs are completely under committee
control - these are committee models
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Committee Vs. HL7 RIM
• What is the RIM?
– A HL7-wide common
reference model that
integrates all Technical
Committees’ domain
views
• Why do we need a
common model?
– To ensure consistency
of concepts
– To ensure consistent
vocabulary
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• How will we coordinate
these efforts?
– Iterative reviews
– Harmonization meetings
• Who controls the RIM?
– The M&M committee
• Format, syntax, style
• Revision histories
– The Technical Steering
Committee
© 1999, 2000 Health Level 7
• Dispute resolution
• Overseer
57
RIM Class Diagram - v094
DA TA TY P ES
<< D at a_t ype >>
An y_d ata_ type : A NY
<< D at a_t ype >>
Qua nti ty : QTY
<< D at a_t ype >>
Di scre te : D SC R
T ex t
<< D at a_t ype >>
Ordere d : OR D
Th i ng
HEALTH LEVEL 7
REFERENC E INFORMATION MODEL
RIM_00 94
Au t he ntic ati on
released January, 2000
r eflect s agreeme nt s made thro ughhar monization in November, 1999
is
_ part _of
aut he nt ica ti on_ dt tm : TS
ty pe_ cd : C V
0.. *
is
_sour ce_of
0.. *
i s_authe nti cated _by
Heat_en
lt hcarcou
e_f i nte
nances
P at i en
rs
lt hcar
i nances
H ea lt hHea
care
_fien_fan
ces
aut hent ic at es
1
h as
_o ri ginat i ng_org aniz at io n
0.. *
1
cr eated_ by
He al thca re_ doc ume nt_a uthe nt i ca to r
Heat_en
lt hcar
e_f i nte
nances
P at i en
cou
rs
P at i ent_s ervi ce _ma te ria l
Heal
e_sta _st
e h ak
k
older
s l de r
H
eathltcar
h care
eho
s
0. . 1 i s
_ a
D o cume nt_re ci pi en t
Heat_en
lt hcar
e_f i nte
nances
P at i en
cou
rs
P ati en t_serv ice _e ven t
0. . 1
0. . 1
is
_ rol e_of
of
0.. *
has_been_r eceiv ed _by
of
1.. *
1.. *
has_bee n_ori gi nated _by
Orig i na to r
is
_ rol e_of
0. . 1
is _t ranscr ibed _by
Tra nsc ri p ti o ni st
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n ame : C V
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C li n ic al _d ocu men t
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Cl i ni ca l_ do cume nt_h ea de r
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Hi story _i te m : H XI T
<< D at a_t ype >>
P erso n_n am e_p art : P NX P
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<< D at a_t ype >>
P erso n_n ame _typ e : P N
<< D at a_t ype >>
N on- p aram etric _p ro ba bi l it y_ Di stri but i on : N PP D
In di vi du al _h ea lt h care _pra ctit i on er_p oo l
0.. *
e nter s
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is
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0.. *
i s_housed_at
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Re sou rce_ slo t
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D ura bl e_ med ic al _e qu ip men t_gro up
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An no tated : A NT
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<< D at a_t ype >>
S et : S ET
H eal th_ cha rt_ de fi ci e ncy
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is
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A cci de nt_i n fo rmat i on _so urce
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Stak eh ol de r_af fil i ate
<< D at a_t ype >>
H is to ry : H I ST
requ es
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is _r equested_ by
<< D at a_t ype >>
Un certai n _di sc re te_v al ue _us in g_p rob ab il i ty : U DV P
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<< D at a_t ype >>
L ist : L I ST
0.. *
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<< D at a_t ype >>
Orga ni za ti o n_n ame : ON
<< D at a_t ype >>
A ddre ss_p art : A DX P
<< D at a_t ype >>
Un certa in _va lu e-n arrati ve : UV N
T
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Gen eral _ti mi ng _spe ci fic ati on : GTS
<< D at a_t ype >>
I n te ge r : I NT
<< D at a_t ype >>
Ba g : BA G
I nd iv id ua l _he al t hca re_p rac ti tio ne r_req ue st
e nter s
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0.. *
r epresent s
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<< D at a_t ype >>
No _i nf orma tio n : N U LL
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<< D at a_t ype >>
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<< D at a_t ype >>
Mon etary _am oun t : MO
<< D at a_t ype >>
Te l eco mmu ni cati on _a dd re ss : T EL
0.. *
is _r equested_ by
is _ent ered _by
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R eal : R E AL
<< D at a_t ype >>
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<< D at a_t ype >>
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S ervi ce _sc he dul i ng _req ue st
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<< D at a_t ype >>
C onc ep t_ de scri ptor : C D
<< D at a_t ype >>
Un i versa l_ reso urce _i de nti fi e r : UR I
P at i en t_i nforma ti o n_re ci pi en t
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<< D at a_t ype >>
Ph ysi ca l_ qu anti t y : P Q
<< D at a_t ype >>
C o de_ val u e : C V
<< D at a_t ype >>
Nu mbe r : N
Ge ne ric
<< D at a_t ype >>
P o in t_ in _ti me : T S
<< D at a_t ype >>
Co de _tra nsl a ti o n : C D XL
<< D at a_t ype >>
S et_C RR : S ET <C R R>
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<< D at a_t ype >>
R a ti o : RT O
<< D at a_t ype >>
Bo ol ea n : BL
1
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<< D at a_t ype >>
C ha rac te r_strin g : ST
<< D at a_t ype >>
E nc ap sul ated _d at a : ED
<< D at a_t ype >>
C on ce pt_rol e _rel ati on shi p : CR R
0. . 1
has_as_a_subdi vis ion
0.. *
is _cont act_f or
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Co nt a ct_ pe rson
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Fi na nc ia l _tra nsa cti on
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P rea utho riz ati on
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majo r_ dia gno st ic_ cat ego ry_cd
ope ra ti ng_ re imbu rs emen t_ amt
re imbu rs emen t_ amt
st and ard_da y_q ty
st an dard_t ot al _ch arge_ amt
t rim_ hig h_da y_q ty
t rim_l ow _da y_q ty
0.. *
Ad mi ni strati ve_p ati en t_ac ci den t
ac ci dent _d eat h_ ind
a cci dent _d esc
acc ide nt _dt t m
acc ide nt _l ocat i on_ desc
a cci den t_s ta t e_cd
ac cid ent _t ype _cd
job _rela te d_a cci dent _ ind
asse ssme nt _dt t m
i s_pre sent _in
0.. *
has
1.. *
1
is _assig ne d_as
i s_s
c he duled _by
0. . 1
d esc
epi sod e_t yp e_cd
d
i
li st _c los ed_ ind
o ut come _t xt
re curring _servi ce_ ind
is
_ part _of
1.. *
is
_ part _of
1
0.. *
Ep i sod e_o f_co ndi ti on
Ep iso de _of _ care
0. . 1
is _a_com ponent _of
id e nti fi es
1
1
is
_ k
n o wn_to
knows_of
0.. *
1.. *
P ati en t_ pro vi der_ asso ci ati on
0.. *
is
_assig ned_to
Ac to r
0.. *
par ti cipa ti on_of
1
has
per tai ns_to
0.. *
Ri sk_ man ag eme nt_i nc id en t
i c ide nt _cd
n
i nci de nt _dt t m
i nci den t_ sever i ty _cd
in cid ent _t yp e_cd
t yp e_cd : SE T< C V>
tmr : I VL <T S>
not e : E D
sig nat ure_ cd : C V
is _char ged_t o
is _associat ed_wi th
or igi nat es
houses
0. . 1
H ea l th care _p ro vi de r_org an iz ati on
Ch am pus _co vera ge
pr ovid es
_ser vic es_on_be half _of
hand ic appe d_prog ra m_cd
n on_a vail _ce rt _o n_f il e_ ind
ret ir eme nt _dt t m
s ta ti on _id
0. . 1
is
_ rol e_of
I nd iv id ua l_ he al th ca re_p racti tio ne r
i s_s
c he duled _by
1
p rovi des 1
1
1.. * pr ovides_pat ie nt_ser vic es_at
f el low sh ip_ fi el d_cd
gradu at e_sc hoo l_n m
gradua ti on _dt t m
posi t io n_cd
p ra ct it io ner_t ype _cd
primary_ care_ ind
r esi den cy_ fi el d_cd
sl ot _si ze_ inc re ment _q ty
d
i
0.. *
addr : A D
ope n_t mr
d esc
e mail _ad dress
i d :II
l ic ense d_be d_n br
nm
p hon
ser vic e_s peci al t y_cd
sl ot _si ze_ inc re ment _q ty
st at u s_cd
t ype _cd
eq uip ment _t yp e_cd
is _assigned
1
is _t he_pr im ary _pr ovi der_f or
par ti cip at es_as
i ncl udes
1.. *
1
R efe rra l
Pro ced ure
Su pp ly
Obse rv ati on
Med ic ati on
aut hori zed _visi t s_q ty
d esc
rea son _t xt
ent ry_s it e_ cd : C D
qt y : P Q
val ue : AN Y
deri vat ion _exp r : ST
prope rt y_ cd : C V
f rm_ cd : C D
o
rout e_ cd : C D
d ose_ qt y : P Q
st rengt h_ qt y : P Q
rat e_ qt y : P Q
ch eck_ qt y : P Q
1.. *
has
Tra nsp ortati on
1
i s_uti li zed_dur ing
1
1
0. . 1
par ti cipa ti on_of
is _associat ed_wi th
0.. *
0.. *
1
t yp e_cd : SE T< C V>
t mr : SE T< C V>
aw arene ss_ cd : C V
per tai ns_to
0.. *
1.. *
ac commod at io n_cd
e f ect i ve_t mr
l oc at ion _r ole _cd
st at u s_cd
tr an sfe r_ re ason _cd
u sage _app ro ved_ ind
1.. *
ty pe_ cd : C V
i nversi on_i nd : BL
tmr : I VL <T S>
po sit i on_ nmb : L IS T<N >
qt y : P Q
E nc oun ter_p racti tio ne r
0.. *
is
_t ar get_f or
t pe_ cd : C V
y
tmr : I VL <T S>
ma te ri al _i d : S ET <I I>
of
0.. *
1
0. . 1
par ti cip at es_as 0. . 1
f or
i s_the
1
i d : S ET <I I>
t pe_ cd : C D
y
fo rm_ cd : C V
da nge r_ cd : C D
qt y : P Q
1
is
_t ar get_f or
0. . 1
i s_subject _of
0.. *
takes_on_r ole 1
takes_on_r ole 1
takes_on_r ole 1
0. . 1
takes_on_r ole 1
is
_a_ rol e_of
takes_on_r ole 1
takes_on_r ole 1
De vi ce
s lot _s ize _i ncremen t_ qt y : P Q
1
is _r equested_ by
con tai ns
0.. *
P ati en t_serv ic e_l oc ati on _gro up
1
i s_s
c he duled _by
1.. *
bel ongs_to
1
is _r equested_ by
Ac ces s
t ak
es_on_ rol e_of 1
bel ongs_to
has_sour c
e
Ma te ria l
Re spo nsi bi l i ty
is _par ti cip ant_f or
is
_a_ rol e_of
1.. *
C on sen t
d efi nes
Ma te ria l _rel ati on shi p
par ti cipa ti on_of
pa rt i ci pat io n_t yp e_cd
i s_s
c he duled _by
C on di ti on_ no de
0.. *
T arge t
0.. *
Lo cati on _e nco un te r_rol e
has
e ner gy_ qt y : P Q
carbo hydrat e_ qt y : P Q
0.. *
pr ecedes
has_tar get
per tai ns_to
0. . 1
is
_t ar get_f or
1
D ie t
uti li zes
0.. *
0. . 1 fol l ows
ga uge_ qt y : P Q
ent ry_s it e_ cd : C D
0. . 1
bo dy_s it e_ cd : C D
is
_a_ rol e_of
d
i
is _r equested_ by
C on tai ne r
0. . 1
ca pact y_ qt y : P Q
he igh t_ qt y : P Q
d iame te r_ qt y : P Q
b arri er_d elt a_ qt y : P Q
bot t om_d elt a_ qt y : P Q
sepe ra to r_ ty pe_ cd : C D
cap_ ty pe_ cd : C D
is
_i nclu ded_in
0.. *
0. . 1
1
has_tar get
I n pa ti en t _en co un te r
ac tu al_ le ngt h_o f_s ta y_q ty
e st imat ed _day s_q ty
Master_ pat i en t_serv ic e_l o cati on
is _pr im ar y_faci li ty _f or 0. . 1
0. . 1
0.. *
1
i s_covered _by
1
1
has
f or
0.. *
0.. *
0.. *
is
_assig ned_to
i s_chil d_of
0.. *
is
_pa rent _of
is
_ rol e_of
0.. *
0. . 1
as_assign edt oi t
i d : S ET <I I>
moo d_cd : SE T< CV >
uni versal _se rvi ce_ cd : C D
d escr : E D
st at us_ cd : C V
t ot al _t ime : GTS
crit i cal _t ime : GTS
me th od_ cd : C D
bo dy_s it e_ cd : C D
i nt erpret at io n_cd : SE T< C V>
con fi den ti al it y_ cd : C V
max_ re peat _n mb : I NT
in te r up ti bl e_i nd : BL
su bst it ut i on_ cd : C V
prio ri t y_cd : SE T< C V>
o rd erabl e_i nd : BL
is _an_assign ment _of
approva l_ ind
as sig ned _dt t m
c onf id ent ia l_ ind
co st _out l ie r_ amt
d esc
g ro uper_revi ew _cd
grou per_versi on _id
o ut li er_day s_n br
ou tl ie r_ re imbu rs emen t_ amt
out li er_t yp e_cd
id e nti fi es
0. . 1
1
i s_docum ented _by
is _def ined _by
0. . 1
par ti cipa ti on_of
0.. *
1
Se rvi ce
repr esente d_as
has
_ as
_p art ic i pant
He al thca re_s ervi ce _pro vi de r
boa rd _cer t if i cat io n_t ype _cd
boa rd _ce rt i fi ed_i nd
cert if ic ati on _dt t m
e f ect i ve_t mr
l ice nse _id
re cert if ica ti on _dt t m
s peci al t y_cd
0.. *
r epresent s
1
En cou nte r_ drg
0.. *
1
ty pe_ cd : C V
i nversi on_i nd : BL
seq uen ce_n mb : I NT
pri orit y_n mb : I NT
pa use_ qt y : P Q
che ckpo in t_ cd : C V
sp li t_ cd : C V
joi n_ cd : C V
ne gat i on_i nd : BL
con jun ct ion _cd : BL
has_sour c
e
0.. *
i s_sourc e_f or
has
_ part s
n
i
1
has
i s_the _pri or_ acc
o unt_f or
0.. *
has_as_com ponent s
i s_about
se que nce_ nmb : R E AL
p ri orit y_ nmb : R E AL
not e_t xt : E D
has_charge s
_f or
has_as_care _provi der
is _assig ned _by
par ti cip at es_in
0.. *
L ist _ it em
E pi so de
0.. *
has
1
per tai ns_to
0. . 1
is
_ au thor iz ed _by
1.. *
1
0. . 1
0. . 1
i s_booked_in
is _ent ered _by
0. . 1
is
_ part _of
0.. *
0.. *
has
_ as
_p ri mar y_fa cil it y
ac coun t _id
ad jus tme nt _cd
a ut horiz at io n_i nfo rma ti on _t xt
bi l in g_st at u s_cd
cert if ica ti on _requi r ed_ ind
cu r en t_ unp aid _bal anc e_q ty
de le te _dt t m
de let ed _ac coun t_ re aso n_cd
e xpec te d_i nsu ra nce_ pla n_q ty
e xpec te d_p aymen t_ sour c e_cd
no ti ce_ of _admi ssi on _dt t m
not i ce_o f_a dmi ssi on_ ind
pat i ent _f in anci al _cl as s_cd
price _sc hedu le _id
pu rg e_st at u s_cd
purge _st at us _dt t m
r epo rt _o f_e li gi bil i ty _dt t m
r et ent i on_ ind
si gna tu re _on_ fi le _dt t m
s pec ial _prog ra m_cd
st opl oss _li mi t_ ind
susp end _cha rg es_ ind
to ta l_a dju st ment _q ty
t ot al _cha rg e_q ty
t ot al _pa yment _q ty
sep arat e_b il l_ ind
0. . 1
0.. *
S ervi ce _rel ati on shi p
1
1
P a ti en t _bi l l in g_a cco un t
has
B a d_d eb t_ col l ec ti on _a ge ncy
1
1
is _i ss
ued _by
1
is _known _by
0.. * is _associat ed_wi th
0.. *
1
has
B i l i ng _i nforma tio n_i tem
0. . 1
1
P ati en t
per tai ns_to
par ti cip at es_in
0. . 1
0.. *
1
has
is
_a_ rol e_of
is
_assig ned_to
0. . 1
has
is _i nsured _by
H ea l th ca re _b en efit _c ove rag e_i tem
0. . 1
i s_s
c he duled _by
0. . 1
1
bi rth _dt t m
bir t hpl ace _ad dr
ori gin _cou nt ry _cd
t axon omi c_cl ass if ic at io n_cd
breed _t xt
st ra in _t xt
eye_ col or_cd
coa t_ or_f eat her_c olo r ing _t xt
con fi dent i al it y_c onst rai nt _cd
d ece ased _dt t m
de ceas ed_ ind
eut ha nasi a_ ind
gend er_cd
gen der_st at us _cd
pri mary_na me_t ype _cd
pri mary_n m
i mport ance _st at us _t xt
q ty
produ ct io n_cl ass _cd
A dmi ni strati ve_ pa ti e nt_d eath
i s_comm uni cated_ by
1
au th oriz ed_e ncou nt ers_q ty
aut ho ri zed _pe ri od_ begi n_ dt
aut hori zed _peri od_e nd_ dt
d
i
iss ued _dt t m
requ est ed _dt t m
rest rict i on_d esc
st at u s_cd
st at us _cha nge _dt t m
Li vi n g_s ubj e ct
has_paym ent _guara nteed_ by
pr ovide s
_ con tact
Se curi ty_a utho riz ati on
0. . 1
is
_a_ rol e_of
0. . 1
Fo od
is
_a_ rol e_of
0. . 1
is
_a_ rol e_of
p re feren ce_ cd : C D
Th era pe utic _ag en t
0. . 1
bel ongs_to
is _r equested_ by
is _sour c
e d_fr om
0.. *
S pec i men
is _sour c
e d_fr om
0.. *
bo dy_s it e_ cd : C D
is
_a_ rol e_of
0. . 1
January 24, 2000
© 1999, 2000 Health Level 7
58
Current 094 RIM Statistics
•
•
•
•
•
•
114 Classes
536 Attributes
159 Association Relationships
27 Inheritance Relationships
2 Aggregation Relationships
37 Subject Areas
– 18 Domain, 8 Work-in-Progress, 11 Administrative
• Maintained in an Access 97 database, expressed in
UML, and annotated with literary and HTML
expressions.
January 24, 2000
© 1999, 2000 Health Level 7
59
RIM Domain Subject Areas
• Stakeholders
• Patient_encounters
–
–
–
–
Patient
Person
Stakeholder
Healthcare_service_
provider
– Organization
• Healthcare finances
– Patient_billing_account
– Healthcare_benefit_plan
– Guarantor_contract
January 24, 2000
–
–
–
–
–
–
–
Pharmacy_service_event
Scheduling
Patient_service_location
Patient_service_order
Patient_encounter
Patient_service_event
Patient_clinical_pathway
• Master_tables
– Clinical_pathway_master
– Service_catalog_item
– Observation_service_
catalog_item
© 1999, 2000 Health Level 7
60
RIM Literary Expression
Description of: Inpatient_encounter
A patient encounter involving an admission to an inpatient facility.
Class: Encounter_practitioner
Associations for: Inpatient_encounter
HL7 steward: Patient Administration
Associated with:
is_assigned (0,M) :: Encounter_drg :: is_assigned_to (1,1)
Individual_healthcare_practitioner
Patient_encounter
is_preceded_by (1,1) :: Patient_admission :: preceded (1,1)
Description of: Encounter_practitioner
An association between a Healthcare practitioner and a patient
encounter.
is_terminated_by (0,1) :: Patient_departure :: terminates (1,1)
Associations for: Encounter_practitioner
Attributes of: Inpatient_encounter
is_participant_for (1,1) :: Individual_healthcare_practitioner ::
participates_as (0,M)
actual_days_qty
The number of actual days of an inpatient stay. The actual days
quantity can not be calculated from the admission and discharge
dates because of possible leaves of absence.
is_associated_with (1,1) :: Patient_encounter :: has_as_participant
(1,M)
|Datatype^NM |
| PV2^11^00712^Actual Length of Inpatient Stay |
estimated_days_qty
The estimated number of days in an inpatient encounter.
Attributes of: Encounter_practitioner
|Datatype^NM |
| PV2^10^00711^Estimated Length of Inpatient Stay |
participation_type_cd
A code depicting the role of the type of participation the healthcare
practitioner assumes in the encounter (e.g. attending physician,
admitting physician, consulting physician, referring physician).
Class: Patient_encounter
HL7 steward: Patient Administration
Class: Inpatient_encounter
Supertype of:
Inpatient_encounter
HL7 steward: Patient Administration
Is part of:
Episode
Subtype of:
Patient_encounter
Composite of:
Patient_service_event
Person_birth_event
Associated with:
Encounter_drg
Patient_admission
Patient_departure
Associated with:
Appointment
Encounter_practitioner
DRAFT HL7 Reference Information Model
January 24, 2000
Version: V 0-84 19980103 Copyright 1998. All rights reserved.
© 1999, 2000 Health Level 7
page 1
61
Model Harmonization
Reference Information Model
E
(1,1)
G
(0,M)
(0,M)
(0,1)
B
(1,1)
(0,1)
(0,M)
(0,M)
C
A
(0,M)
(1,1)
B
A
X
(0,M)
(0,M)
X
(0,M)
(1,1)
D
B
Domain Information Model
January 24, 2000
(0,M)
(0,1)
B
(0,M)
(0,M)
C
A
C
(1,1)
(0,M)
D
Domain Information Model
Domain Information Model
© 1999, 2000 Health Level 7
62
RIM Harmonization Process
Change Proposal Preparation
Review RIM
Change Proposal
w/ Stewards
Prepare RIM
Change Proposal
Document Rationale
for not supporting
RIM change proposal
Revise or Withdraw
RIM Proposal
Notify HL7 Members
of RIM Change
Proposal Posting
Provide Comment
on RIM Change
Proposals
Post RIM Change Proposals
Submit
RIM Change
Proposal
Post RIM
Change Proposal
Harmonization Meeting
Discuss the RIM
Change Proposal
Revise, withdraw,
or Table RIM
Change Proposal
Vote on RIM
Change Proposal
Apply Approved
Changes to RIM
Hold TSC and/or
Board Appeals
Finalize
Revised RIM
Apply Technical
Coorections
Post Harmonization Meeting Review
Present RIM
Harmonization Report
to TSC
January 24, 2000
© 1999, 2000 Health Level 7
63
Sources of Models for
Harmonization
Others
Information Model
Use Case Model
HL7
Technical
Committees
Spec
Spec
DIM Spec
Class Diagram State Diagram
UCM Spec
Use Case Diagram
Interaction Model
Spec
Inter Spec
Interaction Diagram
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
HL7
Member
Organizations
Other Standard Development
Organizations
January 24, 2000
© 1999, 2000 Health Level 7
64
Information Model Facilitators
• A team of model facilitators was recruited from within
the HL7 working group.
• The model facilitators are provided focussed training in
the HL7 modeling methods and tools.
• The model facilitators provide modeling assistance to
the technical committees and special interest groups.
• The facilitators meet as a team at each working group
meeting to update each other on progress and to
identify modeling or process issues.
• The facilitators prepare change proposals for the RIM
and attend RIM harmonization meetings.
January 24, 2000
© 1999, 2000 Health Level 7
65
Domain Specialists and Data Stewards
• The members of the message producing technical
committees and message content special interest
groups are the domain specialists for the HL7 RIM.
• The technical committees are assigned stewardship
responsibility for classes within the information model,
based upon their domain expertise.
• The technical committee designates a domain specialist
from among its members to represent their stewardship
interest at RIM harmonization meetings.
• Data steward representatives and model facilitators
collaborate with each other to prepare RIM change
proposals.
• Data steward representatives attend RIM harmonization
meetings.
January 24, 2000
© 1999, 2000 Health Level 7
66
November ‘99 Harm. Meeting
Mayo
Clinic,
Rochester,
Minn.
January 24, 2000
© 1999, 2000 Health Level 7
67
RIM Subject Classes
• The Subject Classes are those classes in the RIM
that express the concepts that are central to
managing healthcare, e.g. Patient, Order.
• Subject Classes are the focus for trigger events,
use cases & application roles.
• State transition modeling of Subject Classes
discovers potential trigger events.
• Subject Classes capture the domain behaviors that
the HL7 committee feels are most important
January 24, 2000
© 1999, 2000 Health Level 7
68
State Transition Modeling
• Identify States
– From Use Cases
• Document States
–
–
–
–
Which attributes must be valued/unvalued?
What are the constraints on the values?
What associations must be established?
What associations must not exist?
• Capture State Model
– UML State Transition Model
January 24, 2000
© 1999, 2000 Health Level 7
69
State Transition Diagrams
Figure State diagram for Patient class.
S c h e d u le d
d e l e te _ s c h e d u l e d _ e n c o u n te r ^C 0 0 X M T 0 0 6
D e l e te d
s c h e d u l e _ e n c o u n te r ^C 0 0 X M T 0 0 3
d e l e te _ a c ti ve _ e n c o u n te r ^ C 0 0 X M T 0 0 7
n u ll
s ta r t_ e n c o u n te r ^C 0 0 X M T 0 0 5
d e l e te _ d i s c h a r g e d _ e n c o u n te r
s ta r t_ e n c o u n te r ^C 0 0 X M T 0 0 4
A c ti ve
d i s c h a r g e _ p a ti e n t ^C 0 0 X M T 0 0 8
D is c h a rg e d
c a n c e l _ d is c h a r g e ^ C 0 0 X M T 0 0 9
State diagram for Patient_encounter class
Transitions include reference
to the trigger event.
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70
Vocabulary and Domains
• Attributes in the RIM must be associated
with a Domain to have meaning
• Domains are associated with Vocabularies
– Held in the Domain Specification Database
• The vocabulary and domain define the
values that may be taken on by an attribute
in a defined message
– Set of coded values or defined words/phrases
– Statements in a constraint language
January 24, 2000
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71
Interaction Design
Develop Scope
Create
Use Cases
Identify
Actors &
Events
Information Model
Use Case Model
Spec
Spec
DIM Spec
Class Diagram State Diagram
Define
Interactions
Create
Conformance
Claims
January 24, 2000
Model new
concepts
UCM Spec
Use Case Diagram
Harmonize with
RIM
Define Trigger
Events
Define Application
Roles
Draw initial
contents from
RIM
Interaction Model
Spec
Inter Spec
Interaction Diagram
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Message
Information Model
Develop
Refined MIM
Specify HMD
© 1999, 2000 Health Level 7
72
Modeling Interactions
• Derived from the leaf-level Use Cases
• Specifies all Trigger Events and Message Flows
• Does not define standard system or application
functions, only messaging roles
• Fine-grained abstraction; every system will claim
several roles
• Basis for contractual agreement: describes roles to
which systems may claim conformance
• Potential basis for conformance testing
• Captured in an Interaction Diagram and an
Application Role Diagram
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73
Interaction Model Contents
• Each Interaction consists of:
– Trigger event
• Event dependency usually expressed as the state
of one or more classes
– Message ID
• Each interaction sends one particular message
– Sender role
• When trigger event detected, message is sent
– Receiver role
• Receiver responsibility - a specific functional
responsibility for the receiver to initiate another
(consequential) interaction
January 24, 2000
© 1999, 2000 Health Level 7
74
Interaction Model Diagram
Figure Interactions for Patient subject class.b
A R _ P a ti e n t_ m a n a g e r :
A R _ P a ti e n t_ tr a c ke r :
A R _ P a ti e n t_ m a n a g e r
A R _ P a ti e n t_ tr a c k e r
1 : a d d _ p a t i e n t( ti d )
2 : a d d _ p a ti e n t( ti d x)
3 : d e l e te _ p a ti e n t
4 : d e l e te _ p a ti e n t (t id x)
Interaction Trigger Event causes a Message
to be sent by a Sending role to a
Receiving role for which there may
be a Receiver responsibility
January 24, 2000
© 1999, 2000 Health Level 7
Application Role identifies an information
management responsibility for
one of the subject classes.
Responsibilities typically are:
Creator, Manager, Tracker
and Archivist.
Healthcare applications are
assumed to take on one or
more application roles.
75
Application Roles
• All Application Roles that participate in the
interactions for a trigger event must be
identified
• All trigger events that a particular
application role participates in must be
identified
• All Classes that participate in the
interactions must be identified
• Captured in an Application Role Diagram
January 24, 2000
© 1999, 2000 Health Level 7
76
Application Role Diagram
Figure Application role diagram for example model.
S C _ A p p l i c a ti o n _ r o l e _ r o o t
P a ti e n t_ e n c o u n te r
P a ti e n t
RIM
Classes
S C _ P a ti e n t
S C _ P a ti e n t_ e n c o u n te r
A R _ E n co u n t e r _t r a ck e r
s c h e d u le _ e n c o u n t e r()
a d m it _ p a t ie n t ()
a c t iva t e _ s c h e d u le d _ e n c o u n t e r()
A R _ P a ti e n t_ m a n a g e r
d e le t e _ s c h e d u le d _ e n c o u n t e r()
d e le t e _ a c t ive _ e n c o u n t e r()
a d d _ p a t ie n t ()
d is c h a rg e _ p a t ie n t ()
d e le t e _ p a t ie n t ()
c a n c e l_ d is c h a rg e ()
A R _ E n c o u n te r _ m a n a g e r
A R _ P a ti e n t_t r a ck e r
A R _ E n c o u n te r _ a r c h i v i st
a d m it _ p a t ie n t ()
a d d _ p a t ie n t ()
a d m it _ p a t ie n t ()
a c t iva t e _ s c h e d u le d _ e n c o u n t e r()
d e le t e _ p a t i e nt ()
a c t iva t e _ s c h e d u le d _ e n c o u n t e r()
d e le te _ a c tive _ e n c o u n t e r()
d e le t e _ a c t ive _ e n c o u n t e r()
d is c h a rg e _ p a t ie n t ()
d is c h a rg e _ p a t ie n t ()
c a n c e l_ d is c h a rg e ()
c a n c e l_ d is c h a rg e ()
Application role diagram for example model.
Application Roles
January 24, 2000
© 1999, 2000 Health Level 7
77
Application Roles and
Conformance Claims
• A conformance claim is a commitment to fulfill one or
more interactions relating to an Application Role
• For each Role, the application must send and receive
all of the interactions (messages) specified for that
Role:
– At specified trigger events, obeying specifications about
conditionality, required presence, etc.
– Upon receipt of certain messages, perform the receiver
responsibilities
• Provides a consistent, unambiguous vocabulary for
pre-contract understanding of vendor capabilities
• Grouped into a Conformance Claim Set
January 24, 2000
© 1999, 2000 Health Level 7
78
Conformance Claim Structure
• Formally defined declarations
– Information_system_sponsor, Information_system_user,
Healthcare_information_system, Function_point
– Trigger_event, Application_role, Interaction,
Technical_conformance_claim,
Conformance_message_element
• Detailed and Explicit
– For each Message Element, a conforming application:
• Can provide or accept it, requires it for full function,
multimedia enabled free text level, message element
interaction support, message type definition
• Details still being worked out
January 24, 2000
© 1999, 2000 Health Level 7
79
Message Design
Develop Scope
Create
Use Cases
Identify
Actors &
Events
Information Model
Use Case Model
Spec
Spec
DIM Spec
Class Diagram State Diagram
Define
Interactions
Create
Conformance
Claims
January 24, 2000
Model new
concepts
UCM Spec
Use Case Diagram
Harmonize with
RIM
Define Trigger
Events
Define Application
Roles
Draw initial
contents from
RIM
Interaction Model
Spec
Inter Spec
Interaction Diagram
Message Design
2-nd Order
1 choice of
0-n Drug
0-1 Nursing
h//mt:50”d”
…
…
…
Develop Message
Information Model
Develop
Refined MIM
Specify HMD
© 1999, 2000 Health Level 7
80
Message Specification
Domain
Information
Model
Use Case
Model
Reference
Information
Model
Hierarchical
Message
Description
Person_name_for_IHCP
1
Person_as_IHCP
cd : CV
has
purpose_cd : CV
phon : TIL
1
type_cd : CV
nm : PN
is_for
takes_on_role_of
1
is_participant_for
0..*
Interaction
Model
Encounter_practitioner
is_associated_with
participation_type_cd
1..*
Exactly one
occurrence
1 participates_as
has_as_participant
1
1 Individual_healthcare_practitioner
is_a_role_of id : TII
Message
Information
Model
Patient_encounter
id : TII
s tatus_cd : CV
encounter_classification_cd : CV
Person_as_Patient
0..1 is_the_primary_provider_for
start_dttm
birth_dttm : TS
involves end_dttm
birthplace_addr : ST
0..* has_a_primary_provider
expected_insurance_plan_qty : NM
1 deceased_dttm : TS
1 first_similar_illness_dttm
Patient
education_level_cd : CV
1..1
id : TII
gender_cd : CV
takes_on_role_of
has
1
s tatus_cd : CV
marital_s tatus_cd : CV
1..1 newborn_baby_ind
race_cd : CV
is_involved_in
is_a_role_of multiple_birth_ind
religious_affiliation_cd : CV
Inpatient_encounter
organ_donor_ind
phon : TIL
1
actual_days_qty
1..*
has
Patient_admission
estimated_days_qty
is_for
admission_dttm
Person_name_for_Patient
Patient_billing_account
admission_reason_cd
1
nm : PN
admission_referral_cd
id : TII
is_preceded_by
effective_dt : TS
admission_source_cd 1
s tatus_cd : CV
0..1
cd : CV
admission_type_cd
billing_s tatus_cd : CV
preceded
purpose_cd : CV
pre_admit_test_ind
patient_financial_class_cd : CV
belongs_to
termination_dt : TS
readmission_ind
price_schedule_id : TII
type_cd : CV
January 24, 2000
© 1999, 2000 Health Level 7
81
Message Specification
• The RIM must first be refined by subsetting
and constraining it
– Create a MIM with RIM classes needed
– Develop an R-MIM from these classes
• Define the structure for the message
– Tree walk the R-MIM (Define a Path)
– Identify Message Element Types (MET, CMET)
• Document the Message Specification
– Create the Heirarchical Message Definition (HMD)
• HL7 Tooling to assist with these steps
January 24, 2000
© 1999, 2000 Health Level 7
82
Subset the RIM  MIM
• Select the portion of the RIM that contains the
classes of interest in the message
– Classes that participate in the Use Cases as documented
in the Use Case Model
– Classes that participate in interactions and application
roles as documented in the Interaction Model
– Attributes of interest in these interactions
• Collection of classes with some constraints
• Collection of attributes and associations to support
the R-MIM
• No need for high precision at this point, can be
corrected later – this is the first draft stage
January 24, 2000
© 1999, 2000 Health Level 7
83
Convert the MIM  R-MIM
• Constrain cardinality on Associations
– May be limited in the interactions for which messages are
being designed
• Constraints on Attributes
– Some may be left out
– Sub-components may be individually constrained
• Classes are duplicated for different uses
• May modify the Inheritance structure
– Some specializations may subsume the generalization
– Always inherit downwards to specializations
• One block for each class structure
• Defines patterns of constraints for each class
January 24, 2000
© 1999, 2000 Health Level 7
84
Refine and Document R-MIM
• Document the R-MIM in tabular form
– Identify information not in graphical form
• Domains, Update Semantics, Conditionality, etc.
• Contains all information needed for the HMD
– But the classes are shown in arbitrary order
– Usually multiple class instances shown for some
RIM classes
• Tooling simplifies entire process
January 24, 2000
© 1999, 2000 Health Level 7
85
Message Information Model (MIM)
Person_name_for_IHCP
1
Person_as_IHCP
cd : CV
has
purpose_cd : CV
phon : TIL
1
type_cd : CV
nm : PN
is_for
takes_on_role_of
1
is_participant_for
0..*
Encounter_practitioner
is_associated_with
participation_type_cd
1..*
Exactly one
occurrence
1 participates_as
1 Individual_healthcare_practitioner
is_a_role_of id : TII
has_as_participant
1
Patient_encounter
id : TII
s tatus_cd : CV
encounter_classification_cd : CV
start_dttm
involves end_dttm
expected_insurance_plan_qty : NM
1 first_similar_illness_dttm
Person_as_Patient
0..1 is_the_primary_provider_for
birth_dttm : TS
birthplace_addr : ST
0..* has_a_primary_provider
deceased_dttm
:
TS
1
Patient
education_level_cd : CV
1..1
id
:
TII
gender_cd : CV
takes_on_role_of
has
1
s tatus_cd : CV
marital_s tatus_cd : CV
1..1 newborn_baby_ind
race_cd : CV
is_involved_in
is_a_role_of multiple_birth_ind
religious_affiliation_cd : CV
Inpatient_encounter
organ_donor_ind
phon : TIL
1
actual_days_qty
1..*
has
Patient_admission
estimated_days_qty
is_for
admission_dttm
Person_name_for_Patient
Patient_billing_account
admission_reason_cd
1
nm : PN
admission_referral_cd
id : TII
is_preceded_by
effective_dt : TS
admission_source_cd 1
s tatus_cd : CV
0..1
cd : CV
admission_type_cd
billing_s tatus_cd : CV
preceded
purpose_cd : CV
pre_admit_test_ind
patient_financial_class_cd : CV
belongs_to
termination_dt : TS
readmission_ind
price_schedule_id : TII
type_cd : CV
This example will
include those
messages requiring
data from Patient and
Patient_admission
January 24, 2000
© 1999, 2000 Health Level 7
86
Sample Tabular R-MIM
rmim
class
attr
assoc
assoc
class
assoc
assoc
assoc
assoc
class
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
assoc
assoc
class
attr
attr
attr
attr
attr
attr
assoc
assoc
class
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
C04_RIM_0092
Micro
A
TP_for_order_subject
Target_participation
participation_type_cd
participation_type_cd
has_as_target
has_as_target
is_target_of
is_target_of
Patient
is_a_role_of
is_source_for
is_target_of
is_target_of
Person as patient
Person
military_branch_of_service_cd
birth_dttm
student_cd
status_cd
religious_affiliation_cd
race_cd
nationality_cd
military_rank_nm
very_important_person_cd
marital_status_cd
deceased_dttm
birthplace_addr
military_status_cd
confidentiality_constraint_cd
language_cd
deceased_ind
disability_cd
education_level_cd
ethnic_group_cd
gender_cd
citizenship_country_cd
credit_rating_cd
Stakeholder as HCP
type_cd
Stakeholder as HCP
real_id
Stakeholder as HCP
phon
Stakeholder as HCP
email_address_txt
Stakeholder as HCP
addr
Stakeholder as HCP
id
Stakeholder as HCP
has
takes_on_role_of
Person_name
cd
type_cd
termination_dt
purpose_cd
effective_dt
nm
is_for
is_for
Observation_intent_or_order_as_service_order
Observation_intent_or_order
response_requested_cd
Service_intent_or_order
status_cd
Service_intent_or_order
secondary_identification_txt
Service_intent_or_order
status_dttm
Service_intent_or_order
status_reason_cd
Service_intent_or_order
report_results_to_phon
Service_intent_or_order
when_to_charge_cd
Service_intent_or_order
when_to_charge_dttm
Service_intent_or_order
expected_performance_time_qty
Service_intent_or_order
charge_type_cd
Service_intent_or_order
clarification_phon
Service_intent_or_order
echo_back_txt
Service_intent_or_order
order_id
Service_intent_or_order
filler_order_id
Service_intent_or_order
intent_or_order_cd
Service_intent_or_order
order_effective_dttm
Service_intent_or_order
order_placed_dttm
Service_intent_or_order
qt
Service_intent_or_order
placer_order_id
Service_intent_or_order
entering_device_cd
Service_intent_or_order
relevant_clinical_information_txt
0..*
CV
1..1
Patient
1..1
Observation_intent_or_order_as_service_order 1..1
Person as patient
CSS_as_original_specimen
TP_for_order_subject
TP_for_superservice_subject
CV
TS
CV
CV
CV
CV
CV
ST
CV
CV
TS
AD
CV
CV
CV
BL
CV
CV
CV
CV
CV
CV
CV
SET<RWII>
TIL
TIL
AD
SET<TII>
Person_name
Patient
CV
CV
TS
CV
TS
ST
Person as patient
Person_as_HCP
CV
CV
FTX
TS
CV
TIL
CV
TS
PQ
CV
TIL
FTX
TII
TII
CV
TS
TS
TII
CV
FTX
1..1
0..*
0..*
0..*
0..*
0..*
0..1
1..1
1..1
0..*
CWE
CNE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
{7821B3D3-731A-11D3-AD23-005004953E1E}
{7821B3D4-731A-11D3-AD23-005004953E1E}
{FB409E54-7242-11D3-AD20-005004953E1E}
{FB409E66-7242-11D3-AD20-005004953E1E}
{FB409E56-7242-11D3-AD20-005004953E1E}
{FB409E58-7242-11D3-AD20-005004953E1E}
{FB409E60-7242-11D3-AD20-005004953E1E}
{FB409E64-7242-11D3-AD20-005004953E1E}
{FB409E64-7242-11D3-AD20-005004953E1E}
{4457CB6B-72AB-11D3-AD21-00C04FFA6C93}
{FB409E60-7242-11D3-AD20-005004953E1E}
{FB409E66-7242-11D3-AD20-005004953E1E}
{FB409E9B-7242-11D3-AD20-005004953E1E}
{FB409E54-7242-11D3-AD20-005004953E1E}
{FB409E8C-7242-11D3-AD20-005004953E1E}
{FB409E7C-7242-11D3-AD20-005004953E1E}
{FB409E7C-7242-11D3-AD20-005004953E1E}
{FB409E91-7242-11D3-AD20-005004953E1E}
{FB409E8C-7242-11D3-AD20-005004953E1E}
{FB409E91-7242-11D3-AD20-005004953E1E}
{4457CB2F-72AB-11D3-AD21-00C04FFA6C93}
{FB409E7C-7242-11D3-AD20-005004953E1E}
{4457CB2F-72AB-11D3-AD21-00C04FFA6C93}
{000141F3-730F-11D3-AD23-005004953E1E}
{FB409E91-7242-11D3-AD20-005004953E1E}
{FB409E9B-7242-11D3-AD20-005004953E1E}
{FB409F22-7242-11D3-AD20-005004953E1E}
{FB409E66-7242-11D3-AD20-005004953E1E}
{FB409EB5-7242-11D3-AD20-005004953E1E}
{FB409E9D-7242-11D3-AD20-005004953E1E}
{FB409E9D-7242-11D3-AD20-005004953E1E}
{FB409EC3-7242-11D3-AD20-005004953E1E}
{FB409EB5-7242-11D3-AD20-005004953E1E}
{FB409EC3-7242-11D3-AD20-005004953E1E}
{FB409EC1-7242-11D3-AD20-005004953E1E}
{FB409E9D-7242-11D3-AD20-005004953E1E}
{FB409EC1-7242-11D3-AD20-005004953E1E}
{FB409EBF-7242-11D3-AD20-005004953E1E}
{FB409EC3-7242-11D3-AD20-005004953E1E}
{FB409EBF-7242-11D3-AD20-005004953E1E}
{FB409EBD-7242-11D3-AD20-005004953E1E}
{FB409EC1-7242-11D3-AD20-005004953E1E}
{FB409EBD-7242-11D3-AD20-005004953E1E}
{FB409EBB-7242-11D3-AD20-005004953E1E}
{FB409EBF-7242-11D3-AD20-005004953E1E}
{FB409EBB-7242-11D3-AD20-005004953E1E}
{FB409EB7-7242-11D3-AD20-005004953E1E}
{FB409EBD-7242-11D3-AD20-005004953E1E}
{FB409EB7-7242-11D3-AD20-005004953E1E}
{FB409EC5-7242-11D3-AD20-005004953E1E}
{FB409EBB-7242-11D3-AD20-005004953E1E}
{FB409EC5-7242-11D3-AD20-005004953E1E}
{FB409EB3-7242-11D3-AD20-005004953E1E}
{FB409EB7-7242-11D3-AD20-005004953E1E}
{FB409EB3-7242-11D3-AD20-005004953E1E}
{FB409EA5-7242-11D3-AD20-005004953E1E}
{FB409EC5-7242-11D3-AD20-005004953E1E}
{FB409EA5-7242-11D3-AD20-005004953E1E}
{FB409E9F-7242-11D3-AD20-005004953E1E}
{FB409EB3-7242-11D3-AD20-005004953E1E}
{FB409E9F-7242-11D3-AD20-005004953E1E}
{FB409EB9-7242-11D3-AD20-005004953E1E}
{FB409EA5-7242-11D3-AD20-005004953E1E}
{FB409EB9-7242-11D3-AD20-005004953E1E}
{FB409EA3-7242-11D3-AD20-005004953E1E}
{FB409E9F-7242-11D3-AD20-005004953E1E}
{FB409EA3-7242-11D3-AD20-005004953E1E}
{FB409EB1-7242-11D3-AD20-005004953E1E}
{FB409EB9-7242-11D3-AD20-005004953E1E}
{FB409EB1-7242-11D3-AD20-005004953E1E}
{FB409EA7-7242-11D3-AD20-005004953E1E}
{FB409EA3-7242-11D3-AD20-005004953E1E}
{FB409EA7-7242-11D3-AD20-005004953E1E}
{FB409EA9-7242-11D3-AD20-005004953E1E}
{FB409EB1-7242-11D3-AD20-005004953E1E}
{FB409EA9-7242-11D3-AD20-005004953E1E}
{FB409EAB-7242-11D3-AD20-005004953E1E}
{FB409EA7-7242-11D3-AD20-005004953E1E}
{FB409EAB-7242-11D3-AD20-005004953E1E}
{FB409EAD-7242-11D3-AD20-005004953E1E}
{FB409EA9-7242-11D3-AD20-005004953E1E}
{FB409EAD-7242-11D3-AD20-005004953E1E}
{FB409EAF-7242-11D3-AD20-005004953E1E}
{FB409EAB-7242-11D3-AD20-005004953E1E}
{FB409EAF-7242-11D3-AD20-005004953E1E}
{FB409EA1-7242-11D3-AD20-005004953E1E}
{FB409EAD-7242-11D3-AD20-005004953E1E}
{FB409EA1-7242-11D3-AD20-005004953E1E}
{FB409F0D-7242-11D3-AD20-005004953E1E}
{FB409EAF-7242-11D3-AD20-005004953E1E}
{FB409F0D-7242-11D3-AD20-005004953E1E}
{FB409F12-7242-11D3-AD20-005004953E1E}
{FB409EA1-7242-11D3-AD20-005004953E1E}
{FB409F12-7242-11D3-AD20-005004953E1E}
{FB409F11-7242-11D3-AD20-005004953E1E}
{FB409F0D-7242-11D3-AD20-005004953E1E}
{FB409F11-7242-11D3-AD20-005004953E1E}
{FB409F10-7242-11D3-AD20-005004953E1E}
{FB409F12-7242-11D3-AD20-005004953E1E}
{FB409F10-7242-11D3-AD20-005004953E1E}
{FB409F0E-7242-11D3-AD20-005004953E1E}
{FB409F11-7242-11D3-AD20-005004953E1E}
{FB409F0E-7242-11D3-AD20-005004953E1E}
{FB409F0C-7242-11D3-AD20-005004953E1E}
{FB409F10-7242-11D3-AD20-005004953E1E}
{FB409F0C-7242-11D3-AD20-005004953E1E}
{FB409F0F-7242-11D3-AD20-005004953E1E}
{FB409F0E-7242-11D3-AD20-005004953E1E}
{FB409F0F-7242-11D3-AD20-005004953E1E}
{FB409F0C-7242-11D3-AD20-005004953E1E}
{FB409ED0-7242-11D3-AD20-005004953E1E}
{FB409ECE-7242-11D3-AD20-005004953E1E}
{FB409ECE-7242-11D3-AD20-005004953E1E}
{FB409EC7-7242-11D3-AD20-005004953E1E}
{FB409ED0-7242-11D3-AD20-005004953E1E}
{FB409F22-7242-11D3-AD20-005004953E1E}
{FB40A103-7242-11D3-AD20-005004953E1E}
{FB409E9B-7242-11D3-AD20-005004953E1E}
{FB409F24-7242-11D3-AD20-005004953E1E}
{FB409F2E-7242-11D3-AD20-005004953E1E}
{FB409F2E-7242-11D3-AD20-005004953E1E}
{FB409F2C-7242-11D3-AD20-005004953E1E}
{FB409F24-7242-11D3-AD20-005004953E1E}
{FB409F2C-7242-11D3-AD20-005004953E1E}
{FB409F2A-7242-11D3-AD20-005004953E1E}
{FB409F2E-7242-11D3-AD20-005004953E1E}
{FB409F2A-7242-11D3-AD20-005004953E1E}
{FB409F26-7242-11D3-AD20-005004953E1E}
{FB409F2C-7242-11D3-AD20-005004953E1E}
{FB409F26-7242-11D3-AD20-005004953E1E}
{FB409F28-7242-11D3-AD20-005004953E1E}
{FB409F2A-7242-11D3-AD20-005004953E1E}
{FB409F28-7242-11D3-AD20-005004953E1E}
{FB409F26-7242-11D3-AD20-005004953E1E}
{FB409F2F-7242-11D3-AD20-005004953E1E}
{4457C7F1-72AB-11D3-AD21-00C04FFA6C93}
{4457C7F1-72AB-11D3-AD21-00C04FFA6C93}
{FB409F30-7242-11D3-AD20-005004953E1E}
{FB409F2F-7242-11D3-AD20-005004953E1E}
{FB40A103-7242-11D3-AD20-005004953E1E}
{4457C5B8-72AB-11D3-AD21-00C04FFA6C93}
{FB409F22-7242-11D3-AD20-005004953E1E}
{FB40A11C-7242-11D3-AD20-005004953E1E}
{FB40A120-7242-11D3-AD20-005004953E1E}
{FB40A120-7242-11D3-AD20-005004953E1E}
{FB40A11D-7242-11D3-AD20-005004953E1E}
{FB40A11C-7242-11D3-AD20-005004953E1E}
{FB40A11D-7242-11D3-AD20-005004953E1E}
{FB40A121-7242-11D3-AD20-005004953E1E}
{FB40A120-7242-11D3-AD20-005004953E1E}
{FB40A121-7242-11D3-AD20-005004953E1E}
{FB40A122-7242-11D3-AD20-005004953E1E}
{FB40A11D-7242-11D3-AD20-005004953E1E}
{FB40A122-7242-11D3-AD20-005004953E1E}
{FB40A11A-7242-11D3-AD20-005004953E1E}
{FB40A121-7242-11D3-AD20-005004953E1E}
{FB40A11A-7242-11D3-AD20-005004953E1E}
{FB40A126-7242-11D3-AD20-005004953E1E}
{FB40A122-7242-11D3-AD20-005004953E1E}
{FB40A126-7242-11D3-AD20-005004953E1E}
{FB40A127-7242-11D3-AD20-005004953E1E}
{FB40A11A-7242-11D3-AD20-005004953E1E}
{FB40A127-7242-11D3-AD20-005004953E1E}
{FB40A110-7242-11D3-AD20-005004953E1E}
{FB40A126-7242-11D3-AD20-005004953E1E}
{FB40A110-7242-11D3-AD20-005004953E1E}
{FB40A10B-7242-11D3-AD20-005004953E1E}
{FB40A127-7242-11D3-AD20-005004953E1E}
{FB40A10B-7242-11D3-AD20-005004953E1E}
{FB40A10C-7242-11D3-AD20-005004953E1E}
{FB40A110-7242-11D3-AD20-005004953E1E}
{FB40A10C-7242-11D3-AD20-005004953E1E}
{FB40A10D-7242-11D3-AD20-005004953E1E}
{FB40A10B-7242-11D3-AD20-005004953E1E}
{FB40A10D-7242-11D3-AD20-005004953E1E}
{FB40A115-7242-11D3-AD20-005004953E1E}
{FB40A10C-7242-11D3-AD20-005004953E1E}
{FB40A115-7242-11D3-AD20-005004953E1E}
{FB40A111-7242-11D3-AD20-005004953E1E}
{FB40A10D-7242-11D3-AD20-005004953E1E}
{FB40A111-7242-11D3-AD20-005004953E1E}
{FB40A112-7242-11D3-AD20-005004953E1E}
{FB40A115-7242-11D3-AD20-005004953E1E}
{FB40A112-7242-11D3-AD20-005004953E1E}
{FB40A114-7242-11D3-AD20-005004953E1E}
{FB40A111-7242-11D3-AD20-005004953E1E}
{FB40A114-7242-11D3-AD20-005004953E1E}
{FB40A116-7242-11D3-AD20-005004953E1E}
{FB40A112-7242-11D3-AD20-005004953E1E}
{FB40A116-7242-11D3-AD20-005004953E1E}
{FB40A119-7242-11D3-AD20-005004953E1E}
{FB40A114-7242-11D3-AD20-005004953E1E}
{FB40A119-7242-11D3-AD20-005004953E1E}
{FB40A117-7242-11D3-AD20-005004953E1E}
{FB40A116-7242-11D3-AD20-005004953E1E}
{FB40A117-7242-11D3-AD20-005004953E1E}
{FB40A10E-7242-11D3-AD20-005004953E1E}
{FB40A119-7242-11D3-AD20-005004953E1E}
{FB40A10E-7242-11D3-AD20-005004953E1E}
{FB40A107-7242-11D3-AD20-005004953E1E}
{FB40A117-7242-11D3-AD20-005004953E1E}
{FB40A107-7242-11D3-AD20-005004953E1E}
{FB40A105-7242-11D3-AD20-005004953E1E}
{FB40A10E-7242-11D3-AD20-005004953E1E}
This is a very small one (part of the recent Microbiology proof-ofconcept effort). They get BIG.
January 24, 2000
© 1999, 2000 Health Level 7
87
A small piece of it…
rmim
class
attr
assoc
assoc
class
assoc
assoc
assoc
assoc
class
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
C04_RIM_0092
Micro
A
TP_for_order_subject
Target_participation
participation_type_cd
participation_type_cd
has_as_target
has_as_target
is_target_of
is_target_of
Patient
is_a_role_of
is_source_for
is_target_of
is_target_of
Person as patient
Person
military_branch_of_service_cd
birth_dttm
student_cd
status_cd
religious_affiliation_cd
race_cd
nationality_cd
military_rank_nm
very_important_person_cd
marital_status_cd
deceased_dttm
birthplace_addr
military_status_cd
confidentiality_constraint_cd
language_cd
deceased_ind
disability_cd
education_level_cd
ethnic_group_cd
gender_cd
citizenship_country_cd
credit_rating_cd
Stakeholder as HCP
type_cd
Stakeholder as HCP
January 24, 2000
0..*
CV
1..1
Patient
1..1
Observation_intent_or_order_as_service_order
1..1
Person as patient
CSS_as_original_specimen
TP_for_order_subject
TP_for_superservice_subject
CV
TS
CV
CV
CV
CV
CV
ST
CV
CV
TS
AD
CV
CV
CV
BL
CV
CV
CV
CV
CV
CV
CV
© 1999, 2000 Health Level 7
1..1
0..*
0..*
0..*
0..*
CWE
CNE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
{7821B3D3-731A-1
{FB409E54-7242-1
{FB409E56-7242-1
{FB409E60-7242-1
{FB409E64-7242-1
{FB409E66-7242-1
{FB409E8C-7242-1
{FB409E7C-7242-1
{FB409E91-7242-1
{4457CB2F-72AB{FB409E9B-7242-1
{FB409EB5-7242-1
{FB409E9D-7242-1
{FB409EC3-7242-1
{FB409EC1-7242-1
{FB409EBF-7242{FB409EBD-7242{FB409EBB-7242{FB409EB7-7242-1
{FB409EC5-7242-1
{FB409EB3-7242-1
{FB409EA5-7242-1
{FB409E9F-7242-1
{FB409EB9-7242-1
{FB409EA3-7242-1
{FB409EB1-7242-1
{FB409EA7-7242-1
{FB409EA9-7242-1
{FB409EAB-7242{FB409EAD-7242{FB409EAF-7242{FB409EA1-7242-1
{FB409F0D-7242-1
{FB409F12-7242-1
88
Construct the HMD (defines the METs)
• The HMD combines the structure and
semantics of the message contents
• Produced by performing a tree walk
– Select nodes to start each tree based on the Interactions
and Use Cases
– Follow the appropriate connections in the R-MIM
– Re-orders and structures the information in the R-MIM to
follow a Path through the Information Model
• Note each class instance block in the R-MIM
is a MET; the entire table is the full message
MET, which is the HMD
January 24, 2000
© 1999, 2000 Health Level 7
89
How in the world…
•
•
•
•
•
•
•
•
•
How is all of this done?
It is not as complicated as it sounds
Significant tooling support
RoseTree permits aided walkthrough of the RIM to
generate the MIM and the R-MIM
RoseTree generates output for set of Excel macros to
generate the R-MIM and HMD easily
Generates both Graphical and Tabular forms
Set of usage guidelines to make Path definition easy
RoseTreeII Version 20215.exe is most current
PC/Windows ONLY
January 24, 2000
© 1999, 2000 Health Level 7
90
MET and CMET
• Some Message Element Types are unique
– Used only for a specific message
• e.g. structure for an EKG waveform result
• Some Message Element Types may be
reused in many messages
–
–
–
–
Analogous to v2.x segments like PID, PV1, etc.
May have finer granularity than v2.x
Have certain constraints loosened for re-use
CMETs (Common Message Element Types)
January 24, 2000
© 1999, 2000 Health Level 7
91
Build the HMD
• All of the information of the MET and CMET
is documented in the Hierarchical Message
Description – HMD
• Tabular
• Stored in the repository
• Final specification of a particular message
• Contains conformance parameters
January 24, 2000
© 1999, 2000 Health Level 7
92
The MET Incorporates all previous
work and is documented in the HMD
Reference
Information Model
Domain
Information
Model
Use Case Model
Interaction
Model
Person_name_for_IHCP
1
Person_as_IHCP
cd : CV
has
purpose_cd : CV
phon : TIL
1
type_cd : CV
nm : PN
is_for
takes_on_role_of
1
is_participant_for
0..*
Message
Information
Model
Encounter_practitioner
is_associated_with
participation_type_cd
1..*
Exactly one
occurrence
1 participates_as
has_as_participant
1
1 Individual_healthcare_practitioner
is_a_role_of id : TII
Patient_encounter
id : TII
s tatus_cd : CV
encounter_classification_cd : CV
Person_as_Patient
0..1 is_the_primary_provider_for
start_dttm
birth_dttm : TS
involves end_dttm
birthplace_addr : ST
0..* has_a_primary_provider
expected_insurance_plan_qty : NM
1 deceased_dttm : TS
1 first_similar_illness_dttm
Patient
education_level_cd : CV
1..1
id : TII
gender_cd : CV
takes_on_role_of
has
1
s tatus_cd : CV
marital_s tatus_cd : CV
1..1 newborn_baby_ind
race_cd : CV
is_involved_in
is_a_role_of multiple_birth_ind
religious_affiliation_cd : CV
Inpatient_encounter
organ_donor_ind
phon : TIL
1
actual_days_qty
1..*
has
Patient_admission
estimated_days_qty
is_for
admission_dttm
Person_name_for_Patient
Patient_billing_account
admission_reason_cd
1
nm : PN
admission_referral_cd
id : TII
is_preceded_by
effective_dt : TS
admission_source_cd 1
s tatus_cd : CV
0..1
cd : CV
admission_type_cd
billing_s tatus_cd : CV
preceded
purpose_cd : CV
pre_admit_test_ind
patient_financial_class_cd : CV
belongs_to
termination_dt : TS
readmission_ind
price_schedule_id : TII
type_cd : CV
Domain Specification Database
Common
Message
Element
Types
Hierarchical
Message
Description
January 24, 2000
© 1999, 2000 Health Level 7
93
V2.3 Message Profiles
For a specific implementation, the profile
specifies:
• Which of the optional segments to use
• When segments may repeat
• Which optional data elements to use for
each segment
• Which data elements repeat
• Which tables (codes) to use
January 24, 2000
© 1999, 2000 Health Level 7
94
V2.3 Abstract Message - ADT
MSH
EVN
PID
[PD1]
[ { NK1 } ]
PV1
[ PV2 ]
…
[ { GT1 } ]
[
{ IN1
[ IN2 ]
[ IN3 ]
}
]
…
January 24, 2000
Message Header
Event Type
Patient Identification
Additional Demographics
Next of Kin /Associated Parties
Patient Visit
Patient Visit - Additional Info.
Guarantor
[ ] optional
Insurance
Insurance Additional Info.
Insurance Add'l Info - Cert.
{ } may repeat
© 1999, 2000 Health Level 7
95
HL7 2.3 Segment Definition
SEQ
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
LEN
1
4
180
180
180
180
26
40
7
20
3
8
15
180
2
2
2
6
60
DT
ST
ST
HD
HD
HD
HD
TS
ST
CM
ST
PT
ID
NM
ST
ID
ID
ID
ID
CE
January 24, 2000
OPT RP/# TBL# ITEM # ELEMENT NAME
R
00001 Field Separator
R
00002
Encoding Characters
SEQ - position within
segment
O
00003 Sending Application
LEN - length of field
O
00004 Sending Facility
O
00005 Receiving Application
DT
data
type
for
field
O
00006 Receiving Facility
O
00007
OPT - optionality for
fieldDate/Time Of Message
O
00008 Security
RP/# - repeatability00009 Message Type
R
R
00010 Message Control ID
TBL# - table number
for codes
R
00011 Processing ID
R
0104
00012 Version ID
ITEM# - HL7
field number
O
00013 Sequence Number
ELEMENT
NAME
- name
O
00014
Continuation Pointer
O
0155
00015 Accept Acknowledgment Type
O
0155
00016 Application Ack. Type
O
00017 Country Code
O
Y/3
0211
00692 Character Set
O
00693 Principal Language Of Message
© 1999, 2000 Health Level 7
96
Version 2.3 - 3.0 Equivalence
• The Version 3 Hierarchical Message
Description (HMD) is a structure that
combines the Version 2.x
– Abstract Message Definition
– Segment tables
– Message profiles
Abstract
Segment
Message
HMD = Message + tables + profiles
Definition
January 24, 2000
© 1999, 2000 Health Level 7
97
Hierarchical Message Description
Information Model Mapping
Message Elements
Common Constraints
status_cd
Patient
11
6
itm
12
7
att
ambulatory _status_cd
Patient
13
14
15
16
17
18
19
20
21
22
23
24
25
26
8
9
10
11
12
13
14
15
16
17
18
19
20
21
att
att
att
aso
att
att
att
att
att
att
att
att
att
itm
newborn_baby _ind
multip le_birth_ind
organ_donor_ind
is_a_role_of
birth_dttm
birthp lace_addr
deceased_dttm
education_level_cd
gender_cd
marital_status_cd
race_cd
religious_affiliation_cd
p hon
Patient
Patient
Patient
Patient
Person
Person
Person
Person
Person
Person
Person
Person
Stakeholder
Stakeholder
27
22
aso
has
Person
28
23
itm
29
30
31
32
33
34
35
24
25
26
27
28
29
30
att
att
att
att
stc
att
att
nm
effective_dt
cd
p urp ose_cd
value
termination_dt
ty p e_cd
Person_name
Person_name
Person_name
Person_name
Person_name
Person_name
Person_name
36
31
aso
has_a_primary_provider
Patient
47
26
49
51
52
53
54
37
32
33
34
35
36
37
38
39
attr
itm
aso
attr
attr
attr
attr
aso
p hon
Stakeholder
Stakeholder
38
40
att
id
39
41
att
status_cd
40
42
itm
41
43
att
billing_status_cd
42
44
att
p atient_financial_class_cd
43
45
att
p rice_schedule_id
44
46
aso
is_involved_in
Patient
45
47
att
id
Patient_encounter
id
46
48
att
status_cd
Patient_encounter
status_cd
Patient
Ties every element
of a message
directly to a class,
attribute or
association in the
Reference
Information Model
Pt
Pt
II
status
Pt
Set <CV>
1
_CV
Pt
CV
1
ambulatory _status_cd
ambltry Status
Pt
CV
0..1
newborn_baby _ind
multip le_birth_ind
organ_donor_ind
is_a_role_of_Person_as_patient
birth_dttm
birthp lace_addr
deceased_dttm
education_level_cd
gender_cd
marital_status_cd
race_cd
religious_affiliation_cd
p hon
_item_TIL
nwbrnInd
multbrthInd
orgnDonrInd
PtPrsn
brthDttm
brthp lcAddr
decesdDttm
educnLevl
gendr
maritlStatus
race
relgsAfiltn
p hon
_TIL
Pt
Pt
Pt
Pt
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
Set <TIL>
0..1
0..1
0..1
1
0..1
0..1
0..1
0..1
0..1
0..1
0..1
0..1
0..*
1
PtName
PtPrsn
BL
BL
BL
PtPrsn
TS
ST
TS
CV
CV
CV
CV
CV
Set <TIL>
TIL
S et
<PtPrsnName>
status_cd
_item_CV
has_S et_Person_name_for_Patient
Person_name
Person_name
Person_name
Person_name
Patient
Patient_billing_accoun
t
Patient_billing_accoun
t
Patient_billing_accoun
t
Patient_billing_accoun
t
Patient_billing_accoun
t
Patient_billing_accoun
t
January 24, 2000
1..*
<@state,
EXT:CNE>
<@state,
EXT:CNE>
<ambltr
Status>
<clasfcn>
14
Pt
IHCP
Set <TIL>
IHCP
PN_IHCP
PN_IHCP
PN_IHCP
PN_IHCP
Pt
id
PtBillAcnt
II
1
status
PtBillAcnt
Set <CV>
1..*
_CV
PtBillAcnt
CV
1
billing_status_cd
billngStatus
PtBillAcnt
CV
0..1
<bilngStatus>
p atient_financial_class_cd
p tFnanclClass
PtBillAcnt
CV
0..1
<p tFincl
Class>
p rice_schedule_id
p riceSchedId
PtBillAcnt
ST
0..1
PtEnctr
Pt
id
PtEnctr*
status
PtEnctr
id
status_cd
_item_CV
is_involved_in_Patient_encounter
© 1999, 2000 Health Level 7
PtPrsnName
1
PN
TS
CV
CV
ST
TS
CV
0..1
0..1
0..1
0..1
1
0..1
0..1
IHCP
0..1
Set <TIL>
TIL
PN_IHCP
PN
CV
CV
CV
PtBillAcnt
0..*
1
1
1
0..1
0..1
0..1
0..1
PtEnctr &
IptEnctr
II
CV
R
M
No
R
R
R
R
R
R
R
R
R
R
R
R
R
R
R
N
<martlStatus>
<race>
<relgsAfltn>
p hon
_TIL
PN_IHCP
nm
cd
p urp os
ty p
PtBillAcnt
_PtPrsnName
R
R
Provides the
message
profile
specifications
for the data
elements in
the message
primryIHCP
nm
effective_dt
cd
p urp ose_cd
value
termination_dt
ty p e_cd
has_a_primary_provider_Individual_healthca
re_practitioner
p hon
_item_TIL
has_Person_name_for_IHCP
nm
cd
p urp ose_cd
ty p e_cd
has_Patient_billing_account
V
No
<edctnLevl>
Set
<PtPrsnName>
PtPrsnName
PtPrsnName
PtPrsnName
PtPrsnName
PtPrsnName
PtPrsnName
PtPrsnName
_item_Person_name_for_Patient
No
M
2
nm
efectvDt
cd
p urp os
valu
termntnDt
ty p
Person
Person_as_IHCP
nm
cd
p urp ose_cd
ty p e_cd
has
Equivalent to populating a
V2.x Abstract Message
Definition with each of the
relevant Segment tables
AND then
adding the message profile
specification for which
segments to use and/or
repeat, and which code
domains to use.
M
Message
Structure
Domain Specification (#)
att
1
1
Pt
id
Conformance Flag
5
10
Patient
id
Update mode set
Patient
Patient
of
Message
Element Type
Default Update Mode
Patient
id
in
Message
Element Type
Default Value (#)
cla
att
Message
Element Short
Name
Constraint/Note #
3
4
Message Element Name
Mandatory
Row Type
8
9
Rim Source Class
Cardinality
Row Number
Message Elements
Former Row
Information Model
Mapping
Class or
Property of Class
(Attribute or Association)
b
Domain Specification (#)
C
<p urp sCd>
N
<@state,
EXT:CNE>
<@state,
EXT:CNE>
R
R
R
R
R
R
R
R
R
R
N
R
M
No
V
R
M
No
V
R
M
No
V
R
M
No
R
R
M
No
R
R
0..1
1
1
<@state,
EXT:CNE>
98
Information Model Mapping
MIM and R-MIM
Person_name_for_IHCP
1
Person_as_IHCP
cd : CV
has
purpose_cd : CV
phon : TIL
1
type_cd : CV
nm : PN
is_for
takes_on_role_of
1
is_participant_for
0..*
Encounter_practitioner
is_associated_with
participation_type_cd
1..*
Exactly one
occurrence
1 participates_as
1 Individual_healthcare_practitioner
is_a_role_of id : TII
has_as_participant
1
Patient_encounter
id : TII
s tatus_cd : CV
encounter_classification_cd : CV
start_dttm
involves end_dttm
expected_insurance_plan_qty : NM
1 first_similar_illness_dttm
Person_as_Patient
0..1 is_the_primary_provider_for
birth_dttm : TS
birthplace_addr : ST
0..* has_a_primary_provider
deceased_dttm : TS
Patient
education_level_cd : CV
1..1
id : TII
gender_cd : CV
takes_on_role_of
has
1
s tatus_cd : CV
marital_s tatus_cd : CV
1..1 newborn_baby_ind
race_cd : CV
is_involved_in
is_a_role_of multiple_birth_ind
religious_affiliation_cd : CV
Inpatient_encounter
organ_donor_ind
phon : TIL
1
actual_days_qty
1..*
has
Patient_admission
estimated_days_qty
is_for
admission_dttm
Person_name_for_Patient
Patient_billing_account
admission_reason_cd
1
nm : PN
admission_referral_cd
id : TII
is_preceded_by
effective_dt : TS
admission_source_cd 1
s tatus_cd : CV
0..1
cd : CV
admission_type_cd
billing_s tatus_cd : CV
preceded
purpose_cd : CV
pre_admit_test_ind
patient_financial_class_cd : CV
belongs_to
termination_dt : TS
readmission_ind
price_schedule_id : TII
type_cd : CV
1
rmim
class
attr
assoc
assoc
class
assoc
assoc
assoc
assoc
class
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
attr
C04_RIM_0092
Micro
A
TP_for_order_subject Target_participation
participation_type_cd participation_type_cd
has_as_target
has_as_target
is_target_of
is_target_of
Patient
is_a_role_of
is_source_for
is_target_of
is_target_of
Person as patient
Person
military_branch_of_service_cd
birth_dttm
student_cd
status_cd
religious_affiliation_cd
race_cd
nationality_cd
military_rank_nm
very_important_person_cd
marital_status_cd
deceased_dttm
birthplace_addr
military_status_cd
confidentiality_constraint_cd
language_cd
deceased_ind
disability_cd
education_level_cd
ethnic_group_cd
gender_cd
citizenship_country_cd
credit_rating_cd
Stakeholder as HCP
type_cd
Stakeholder as HCP
0..*
CV
1..1
Patient
1..1
Observation_intent_or_order_as_service_order
1..1
Person as patient
CSS_as_original_specimen
TP_for_order_subject
TP_for_superservice_subject
{7821B3D3-731A-11D3-AD23-005004953E1E}
{FB409E54-7242-11D3-AD20-005004953E1E}
{FB409E56-7242-11D3-AD20-005004953E1E}
{FB409E60-7242-11D3-AD20-005004953E1E}
{FB409E64-7242-11D3-AD20-005004953E1E}
{FB409E66-7242-11D3-AD20-005004953E1E}
{FB409E8C-7242-11D3-AD20-005004953E1E}
{FB409E7C-7242-11D3-AD20-005004953E1E}
{FB409E91-7242-11D3-AD20-005004953E1E}
{4457CB2F-72AB-11D3-AD21-00C04FFA6C93}
{FB409E9B-7242-11D3-AD20-005004953E1E}
{FB409EB5-7242-11D3-AD20-005004953E1E}
{FB409E9D-7242-11D3-AD20-005004953E1E}
{FB409EC3-7242-11D3-AD20-005004953E1E}
{FB409EC1-7242-11D3-AD20-005004953E1E}
{FB409EBF-7242-11D3-AD20-005004953E1E}
{FB409EBD-7242-11D3-AD20-005004953E1E}
{FB409EBB-7242-11D3-AD20-005004953E1E}
{FB409EB7-7242-11D3-AD20-005004953E1E}
{FB409EC5-7242-11D3-AD20-005004953E1E}
{FB409EB3-7242-11D3-AD20-005004953E1E}
{FB409EA5-7242-11D3-AD20-005004953E1E}
{FB409E9F-7242-11D3-AD20-005004953E1E}
{FB409EB9-7242-11D3-AD20-005004953E1E}
{FB409EA3-7242-11D3-AD20-005004953E1E}
{FB409EB1-7242-11D3-AD20-005004953E1E}
{FB409EA7-7242-11D3-AD20-005004953E1E}
{FB409EA9-7242-11D3-AD20-005004953E1E}
{FB409EAB-7242-11D3-AD20-005004953E1E}
{FB409EAD-7242-11D3-AD20-005004953E1E}
{FB409EAF-7242-11D3-AD20-005004953E1E}
{FB409EA1-7242-11D3-AD20-005004953E1E}
{FB409F0D-7242-11D3-AD20-005004953E1E}
{FB409F12-7242-11D3-AD20-005004953E1E}
CWE
CNE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
CWE
1..1
0..*
0..*
0..*
0..*
CV
TS
CV
CV
CV
CV
CV
ST
CV
CV
TS
AD
CV
CV
CV
BL
CV
CV
CV
CV
CV
CV
CV
Information Model Mapping
DATATYPES
<<Data_type>>
Any_data_type : ANY
<<Data_type>>
Quantity : QTY
<<Data_type>>
Discrete : DSCR
<<Data_type>>
Ordered : ORD
Message Elements
Common Constraints
Union:
Text
C00XMM011
Thing
0..*
Patient_service_location_request
type_cd
Patient_appointment_request
requests 0..*
0..* requests
requests 0..*
0..* requests
0..* requests
Patient_information_recipient
1
takes_on_role_of
Stakeholder
takes_on_role_of
1
addr
acts_as
1
participates_as_primary_in 1 credit_rating_cd
1
takes_on_role_of
email_address_txt
1
phon
takes_role_of
takes_on_role_of 1 type_cd
1..1 participates_in
real_id : SET<RWII> 0..* refers_to_person_by
takes_on_role_of 1
id : SET<TII>
1
collects
takes_on_role_of 1
1 takes_on_role_of
takes_on_role_of 1
0..* has_as_primary_participant
Real_world_instance_identifier
value_txt : ST
type_cd : CV
qualifier_txt : ST
valid_tmr : IVL<TS>
provides_contact 0..1
represents 0..*
Person_name
0..* effective_dt
cd
nm
purpose_cd
termination_dt
type_cd
contains 0..1
0..* contains
Accident_information_source
Health_chart
health_chart_id
is_the_source_of 0..1
health_chart_type_cd 0..* is_housed_at
status_cd
0..* belongs_to
1 enters
has_an_assessment_of 1
Health_chart_deficiency
assessment_dttm
desc
0..* is_assessed_against
level_cd
type_cd
is_for 0..*
Organization
organization_name_type_cd
organization_nm
standard_industry_class_cd
0..1 is_role_of
Employer
1..* is_represented_by
effective_tmr
1 is_employer_of
1 is_requested_by
Individual_healthcare_practitioner_group
id
is_a_role_of 0..1
issues 0..1
Stakeholder_affiliate
0..1 is_role_of
family_relationship_cd
is_requested_by 0..1
Entering_person
0..1 is_role_of
is_used_by
is_issued_by 0..*
participates_as_secondary_in 1
enters 0..1
0..1 is_a_role_of
0..1 categorizes
1
takes_on_role_of
assigns
1
takes_on_role_of
1
is_requested_by 0..1
Resource_slot
offset_qty
quantity_amt
resource_type_cd
slot_state_cd
0..* is_managed_by
start_dttm
0..* is_reserved_by
Durable_medical_equipment
belongs_to 1..*
id
slot_size_increment_qty
type_cd
0..* contains
Durable_medical_equipment_group
id
is_scheduled_by 1
Patient_service_location_slot
0..* is_scheduleable_unit_for
Schedule
books 1..*
id
Durable_medical_equipment_slot
is_scheduleable_unit_for 0..*
1 takes_on_role_of 0..1
has_as_a_subdivision
0..* is_contact_for
Contact_person 0..1 is_contact_for
0..1 is_a_contact_for
is_contact_for 0..* contact_reason_cd
0..* is_a_contact_for
is_issued_by 0..*
0..1 is_a_role_of
has 1 1 has 1
Person
acts_in_role_of
birth_dttm
1 takes_on_role_of
birthplace_addr
citizenship_country_cd
Administrative_patient_death
Notary_public
confidentiality_constraint_cd
death_certificate_id
deceased_dttm
effective_interval_tmr
death_certificate_recorded_dttm
notary_county_cd
takes_on_role_of 1 deceased_ind
death_classification_cd
disability_cd
notary_state_cd
death_dttm
education_level_cd
death_location_txt
ethnic_group_cd
Insured
0..1 is_a_role_of
death_notification_source_nm
gender_cd
death_verification_cd
language_cd
1 takes_on_role_of
0..1 is_role_of
death_verification_dttm
marital_status_cd
death_verification_nm
military_branch_of_service_cd
1 issues
0..1 pertains_to
military_rank_nm
1 takes_on_role_of
1 offers
takes_on_role_of 1 military_status_cd
0..* has_as_employee
Insurance_certification_contact
nationality_cd
race_cd
participation_type_cd
is_issued_by 0..*
takes_on_role_of 1 religious_affiliation_cd
Employee
Billing_information_item
takes_on_role_of
0..1 is_role_of
student_cd
Insurance_certification
is_employee_in 1
0..1 is_role_of
is_contact_for
condition_cd
1..*
very_important_person_cd
1
appeal_reason_cd
occurrence_cd
status_cd
0..* pertains_to
certification_duration_qty
occurrence_dttm
effective_tmr
occurrence_span_cd
1 has_contact
id
enters 1
occurrence_span_from_dttm
1..*
0..* belongs_to
has 1
insurance_verification_dttm
Guarantor_contract
occurrence_span_thru_dttm
provides_payment_guarantee_for
has_payment_guaranteed_by
modification_dttm
Patient_billing_account
quantity_nbr
billing_hold_ind
non_concur_cd
account_id
quantity_type_cd
billing_media_cd
0..*
non_concur_effective_dttm 0..* affirms_insurance_coverage_for
adjustment_cd
value_amt
has_coverage_affirmed_by 1 charge_adjustment_cd
penalty_amt
authorization_information_txt
Financial_transaction
value_cd
contract_duration_cd
report_of_eligibility_dttm
billing_status_cd
alternate_desc
contract_type_cd
0..* provides_validation_for
0..*
report_of_eligibility_ind
certification_required_ind
desc
effective_tmr
0..*
is_entered_by
has_payment_guaranteed_by 0..* current_unpaid_balance_qty
extended_amt
interest_rate_nbr
is_categorized_by fee_schedule_cd
delete_dttm
includes 1
periodic_payment_amt
insurance_amt
priority_ranking_cd
has 1 deleted_account_reason_cd
0..* provides_opinion_on
expected_insurance_plan_qty
posting_dt
0..* is_associated_with
expected_payment_source_cd
qty
Certification_second_opinion
notice_of_admission_dttm
transaction_batch_id
0..* is_provided_by
effective_dttm
notice_of_admission_ind
transaction_cd
status_cd
patient_financial_class_cd
transaction_dttm
Bad_debt_billing_account
price_schedule_id
0..* pertains_to
is_associated_with transaction_id
bad_debt_recovery_amt
purge_status_cd
transaction_type_cd
bad_debt_transfer_amt
0..* unit_amt
purge_status_dttm
transfer_to_bad_debt_dttm
report_of_eligibility_dttm
1 is_validated_by
unit_cost_amt
transfer_to_bad_debt_reason_cd
retention_ind
Coverage_item
signature_on_file_dttm
0..* is_for
service_category_cd
special_program_cd
0..* is_assigned_to
service_cd
stoploss_limit_ind
provides_contact 0..1
Bad_debt_collection_agency
service_modifier_cd
is_a_role_of 0..1
1 is_assigned
suspend_charges_ind
is_role_of 0..1 Health_benefit_product_purchaser
0..*
0..1 total_adjustment_qty
authorization_ind
provides_coverage_for
network_ind
has_as_a_prior_account total_charge_qty
Preferred_provider_participation
1 is_the_purchaser_of
assertion_cd
total_payment_qty
is_the_prior_account_for
0..1 governs
covered_parties_cd
is_governed_by role_cd
separate_bill_ind
has_as_care_recipient
effective_dt
qty
0..1
0..* termination_dt
quantity_qualifier_cd
0..*
0..1 has_charges_for
is_billed_from 0..1
time_period_qualifier_cd
range_low_qty
has_as_care_provider 0..*
range_high_qty
is_associated_with 0..1
range_units_cd
assertion_effective_tmr
Master_healthcare_benefit_product
has 0..* eligibility_cd
0..* assignment_of_benefits_ind
policy_source_cd
Collected_specimen_sample
benefit_product_desc
is_collected_by 0..*
eligibility_source_cd
body_site_cd
id
has_as_components
has_as_purchaser
copay_limit_ind
collection_body_site_modifier_cd
benefit_product_nm
non_covered_insurance_cd 0..1
collection_tmr
benefit_product_type_cd
0..* is_sourced from
participates_in 1
collection_method_modifier_cd
benefits_coordination_cd
Person_employment
addr
0..* effective_dt
has_as_employer hazard_exposure_txt
job_class_cd
job_title_nm
phon
protective_equipment_txt
salary_qty
salary_type_cd
status_cd
termination_dt
occupation_cd
job_status_cd
0..* is_contact_for
Guarantor
0..1 is_role_of
provides_contact 0..1 financial_class_cd
household_annual_income_amt
household_size_nbr
1 guarantees_payment_under
0..1 provides_contact
0..1 is_role_of
Insurer
effective_tmr 1 issues
0..*
cob_priority_nbr
combine_baby_bill_ind
effective_tmr
is_offered_by 0..*
group_benefit_ind
mail_claim_party_cd
release_information_cd
status_cd
coverage_type_cd
agreement_type_cd
policy_category_cd
access_protocol_desc
is_a_component_of
1 is_associated_with
Healthcare_service_provider
board_certification_type_cd
board_certified_ind
participates_as 1 certification_dttm
effective_tmr
license_id
identifies
recertification_dttm
1
specialty_cd
is_child_of
0..1
0..1
collection_scheduled_dttm
0..* is_sourced_from
collection_volume_qty
collectors_comment_cd
handling_cd
id
collection_method_desc
0..1 is_target_of
number_of_sample_containers_qty
additive_desc
0..* is_collected_during
danger_cd
source_cd
transport_logistics_cd
action_cd
type_cd
is_parent_of
is_role_of
Champus_coverage
handicapped_program_cd
non_avail_cert_on_file_ind
retirement_dttm
station_id
Healthcare_provider_organization
0..1
1..* provides_patient_services_at
Individual_healthcare_practitioner
is_role_of
desc
0..1
fellowship_field_cd
graduate_school_nm
graduation_dttm
position_cd
practitioner_type_cd
participates_as
1
provides 1 primary_care_ind
1..* belongs_to
residency_field_cd
is_requested_by
1
slot_size_increment_qty
0..1
is_the_primary_provider_for
is_scheduled_by 1
Living_subject
birth_dttm
birthplace_addr
origin_country_cd
taxonomic_classification_cd
is_source_for 0..1 breed_txt
strain_txt
eye_color_cd
is_schedu
coat_or_feather_coloring_txt
led_by
confidentiality_constraint_cd
1
deceased_dttm
has 1
deceased_ind
Patient
has 1
euthanasia_ind
ambulatory_status_cd gender_cd
has_as_a_contact 0..1
birth_order_nbr
has 1 living_arrangement_cd gender_status_cd
primary_name_type_cd
is_a_role_of 0..1 living_dependency_cd
primary_nm
multiple_birth_ind
has 1
importance_status_txt
newborn_baby_ind
qty
0..1
participates_in 1 organ_donor_ind
production_class_cd
preferred_pharmacy_id
has 1 status_cd
0..1 pertains_to
Preauthorization
authorized_encounters_qty
authorized_period_begin_dt
authorized_period_end_dt
id
issued_dttm
requested_dttm
restriction_desc
status_cd
status_change_dttm
Administrative_birth_event
baby_detained_ind
birth_certificate_id
birth_method_cd
0..* is_part_of
birth_recorded_county_cd
birth_recorded_dttm
newborn_days_nbr
stillborn_ind
authorizes 0..1
is_booked_in 0..*
Appointment
reserves 0..* appointment_disposition_cd
appointment_duration_tmr
appointment_timing_qt
is_entered_by 0..* cancellation_dttm
event_reason_cd
expected_end_dttm
has_as_a_contact 0..*
expected_service_desc
is_parent_of
expected_start_dttm
id
0..1
overbook_ind
scheduling_begin_dttm
status_cd
0..*
schedules 0..* urgency_cd
visit_type_cd
is_child_of
wait_list_priority_amt
scheduling_completed_dttm
has_as_primary_facility 0..*
1
is_involved_in
1
has
0..* is_reason_for
0..* +has_as_target
is_authorized_by 1..*
1 has
Disability
0..* effective_dttm
pertains_to return_to_work_auth_dttm
termination_dttm
unable_to_work_effective_dttm
Diagnostic_related_group
base_rate_amt
capital_reimbursement_amt
cost_weight_amt
id
major_diagnostic_category_cd
operating_reimbursement_amt
reimbursement_amt
1 is_assigned_as
standard_day_qty
standard_total_charge_amt
trim_high_day_qty
trim_low_day_qty
1..* is_scheduled_by
Patient_encounter
pertains_to 0..*
has_parts 1 administrative_outcome_txt
cancellation_reason_cd
Administrative_patient_accident
desc
accident_death_ind
involves 0..* encounter_classification_cd
1..* accident_desc
end_dttm
is_obtained_from accident_dttm
Episode_of_condition
Episode_of_care
accident_location_desc
has 1..* expected_insurance_plan_qty
first_similar_illness_dttm
accident_state_cd
0..* is_present_in
0..*
follow_up_type_cd
accident_type_cd
is_part_of 1
links_condition 0..1
id
is_identified by job_related_accident_ind
patient_classification_cd
1..* has_parts
assessment_dttm
purpose_cd
0..1 has_assigned_to_it
record_signing_dttm
1 has
special_courtesies_cd
start_dttm
Patient_admission
1
status_cd
admission_dttm
1 is_preceded_by
transport_requirement_cd
admission_reason_cd
has_as_participant
urgency_cd
admission_referral_cd
Patient_departure
triage_classification_cd
0..* pertains_to
admission_source_cd
actual_discharge_disposition_cd
medical_service_cd
admission_type_cd
0..1
Risk_management_incident
discharge_dttm
confidentiality_constraint_cd
patient_valuables_desc
follows
discharge_location_id
incident_cd
pre_admit_test_ind
expected_discharge_disp_cd
incident_dttm
readmission_ind
0..*
1
incident_severity_cd
valuables_location_desc
has precedes
incident_type_cd
terminates 0..1
preceded 1
is_assigned_by 0..*
0..* is_an_assignment_of
Encounter_drg
approval_ind
assigned_dttm
confidential_ind
cost_outlier_amt
desc
0..* is_assigned_to
grouper_review_cd
grouper_version_id
outlier_days_nbr
outlier_reimbursement_amt
outlier_type_cd
is_terminated_by 1
is_preceded_by 1
precedes 0..1
Inpatient_encounter
actual_days_qty
estimated_days_qty
Patient_arrival
acuity_level_cd
arrival_dttm
medical_service_id
source_of_arrival_cd
mode_cd
is_assigned 1
has_as_target 0..* Target_participation
is_target_of
has_as_target 0..* tmr
has_as_target 0..* participation_type_cd 1..*
Encounter_practitioner
1..* participation_type_cd
Service_reason
determination_dttm
documentation_dttm
reason_txt
0..*
has_as_evidence
is_target_of 0..*
0..*
is_reason_for
collects 0..1
Procedure
anesthesia_cd
anesthesia_tmr
delay_reason_txt
incision_open_tmr
priority_nbr
procedure_tmr
functional_type_cd
modifier_cd
Treatment_service_event
prescription_id
refills_remaining_nbr
PTrout
PTcomp
indication_id
substance_expiration_dttm
substance_lot_number_txt
substance_manufacturer_cd
dosage_form_cd
strength_qty
amount_qty
route_cd
body_site_cd
substitution_cd
<<Data_type>>
Annotated : ANT
<<Data_type>>
History_item : HXIT
0..1 is_ordered_on
is_an_instance_of 0..*
Goal
expected_achievement_dttm
goal_list_priority_nbr
management_discipline_cd
review_interval_cd
goal_value_cd
is_measured_by 1..*
Condition_node
life_cycle_start_dttm
lifecycle_status_cd
management_discipline_cd
ranking_nbr
employment_related_ind
1 defines_episode
is_associated_with0..* is_participant_for
Treatment_service_dispense
Treatment_service_give Treatment_service_administration
administered_rate_qty
dispense_package_method_cd
give_per_timeunit_cd
completion_status_cd
dispense_package_size_qty
qt
substance_refusal_reason_cd
needs_human_review_ind
give_rate_qty
suppliers_special_dispensing_instruction_cd needs_human_review_ind system_entry_dttm
administration_nbr
total_daily_dose_qty
administered_per_timeunit_cd
administrators_notes_cd
_item_CV
ambulatory _status_cd
13
8
att
newborn_baby _ind
14
9
att
multip le_birth_ind
Class
15
10 or
att
organ_donor_ind
Property
of aso
Class
16 11
is_a_role_of
(Attribute
Association)
Rim Source Class
17or12
att
birth_dttm
8
9
3
4
cla
att
Patient
id
10
5
att
status_cd
6
itm
7
att
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
8
9
10
11
12
13
14
15
16
17
18
19
20
21
att
att
att
aso
att
att
att
att
att
att
att
att
att
itm
27
22
aso
28
23
itm
29
30
31
32
33
34
35
24
25
26
27
28
29
30
att
att
att
att
stc
att
att
36
31
aso
47
26
49
51
52
53
54
37
32
33
34
35
36
37
38
39
attr
itm
aso
attr
attr
attr
attr
aso
38
40
att
39
41
att
40
42
itm
41
43
att
42
44
att
43
45
att
44
46
aso
18 13
att
19 14
att
20 15
att
21 16
att
22 17
att
23 18
att
24 19
att
ambulatory _status_cd
25 20
att
26 21
itm
newborn_baby
_ind
multip le_birth_ind
27 22 aso
organ_donor_ind
is_a_role_of
28 23
itm
birth_dttm
29 24
att
birthp lace_addr
30 25
att
deceased_dttm
31 26
att
education_level_cd
att
gender_cd32 27
33 28 stc
marital_status_cd
34 29
att
race_cd
35 30
att
religious_affiliation_cd
p hon
36 31 aso
47 32
26 33
49 34
51 35
52 36
nm
53 37
effective_dt
54 38
cd
37 39
p urp ose_cd
value
38 40
termination_dt
has
attr
itm
aso
attr
attr
attr
attr
aso
birthp lace_addr
Patient
deceased_dttm
Patient
education_level_cd
Patient
gender_cd
marital_status_cd
Patient
race_cd
religious_affiliation_cd
Patient
p hon
Patient
Patient
has
Patient
Patient
Person
nm
Person
effective_dt
Person
cd
Person
p urp ose_cd
Person
value Person
termination_dt
Person
ty p e_cd
Person
Stakeholder
has_a_primary_provider
Stakeholder
p hon
Person
Person_as_IHCP
Person
nm
cd
Person_name
p urp ose_cd
Person_name
ty p e_cd
Person_name
has
Person_name
Person_name
att
id
Person_name
ty p e_cd
Person_name
39 41
att
status_cd
has_a_primary_provider
Patient
40 42 itm
p hon
Stakeholder
Stakeholder
41 43
att
billing_status_cd
Person_as_IHCP
nm
42
cd
p urp ose_cd
43
ty p e_cd
Patient
Pt
II
Pt
Set <CV>
_CV
Pt
CV
ambltry Status
Pt
CV
att
Patient_billing_accoun
nm
t
cd
45
att
Patient_billing_accoun
p urp ose_cd
t
ty p e_cd
is_involved_in
Patient
nwbrnInd
Pt
multbrthInd
Pt
in
of
orgnDonrInd
Pt
Message
Message
PtPrsn
Pt
Element
Type
Element
Type
brthDttm
PtPrsn
nm
p atient_financial_class_cd
cd
p urp os
p rice_schedule_id
ty p
has_Patient_billing_account
PtBillAcnt
Patient
is_involved_in_Patient_encounter
id
id
Patient_encounter
id
Patient_encounter
status_cd
status_cd
PN_IHCP
p tFnanclClass
PN_IHCP
PN_IHCP
p riceSchedId
PN_IHCP
0..1
0..1
0..1
0..1
1
0..1
0..1
Pt
PtEnctr
PtBillAcnt
id
PN
PtBillAcnt
CV
CV
PtBillAcnt
CV
PtBillAcnt
Pt
II
PtEnctr*
SetPtEnctr
<CV>
1..*
1
0..1
0..1
0..1
0..1
1
0..1
0..1
IHCP
Set <TIL>
TIL
PN_IHCP
PN
CV
CV
CV
PtBillAcnt
<p urp sCd>
1
0..1
0..*
1
1
1
0..1
0..1
0..1
0..1
1
CV
0..1
0..1
ST
0..1
PtEnctr &
IptEnctr
II
<@state,
CV
EXT:CNE>
status
PtBillAcnt
PtBillAcnt
CV
1
<@state,
EXT:CNE>
billngStatus
PtBillAcnt
CV
0..1
<bilngStatus>
p tFnanclClass
PtBillAcnt
CV
0..1
<p tFincl
Class>
p riceSchedId
PtBillAcnt
Pt
45
47
att
id
Patient_encounter
id
id
PtEnctr*
46
48
att
status_cd
Patient_encounter
status_cd
status
PtEnctr
ST
PtEnctr &
IptEnctr
II
CV
1..*
1
CV
CV
0..1
M
1
1
M
M
V
R
R
R
No
2
R
R
R
R
R
R
R
R
R
N
R
R
<@state,
EXT:CNE>
<@state,
EXT:CNE> R
N
<bilngStatus>
Domain Specification (#)
R
R
R
R
R
R
R
R
R
R
N
R
R
N
N
R
R
R
R
R
R
R
R
R
R
R
R
R
R
<p urp sCd> R
R
R
R
R
N
R
R
R
R
R
R
R
2
0..*
1
1
1
0..1
0..1
0..1
0..1
1..*
status
PtEnctr
0..1
II
_CV
p rice_schedule_id
<relgsAfltn>
R
1
No
No
M
14
<martlStatus>
No
R
<race>
0..1
0..*
1
1..*
M
M
No
V
<edctnLevl>
No
R
0..1
M
0..1
Set <CV>
p atient_financial_class_cd
is_involved_in_Patient_encounter
1
PN
TS
CV
<edctnLevl>
14
CV
ST
<martlStatus>
TS
<race>
CV
<relgsAfltn>
0..1
0..1
0..1
0..1
0..1
0..1
0..1
0..*
1
C00XMM011
<@state,
EXT:CNE>
<@state,
EXT:CNE>
<ambltr
Status>
<clasfcn>
1
0..1
0..1
0..1
1
0..1
0..1
0..1
M
0..1
M
0..1
billing_status_cd
_item_CV
Constraints
1
1
0..1
BL
BL
BL
PtPrsn
TS
PtPrsn
ST
Pt
1
PtPrsn
TS
II
1
PtPrsn
CV
<@state,
Set <CV>
1
PtPrsn
CV
EXT:CNE>
PtPrsn
CV
<@state,
CV
1
PtPrsn
CV
EXT:CNE>
PtPrsn
CV
<ambltr
CV
0..1
PtPrsn
Set Status>
<TIL>
Set
TIL
BL <TIL>
0..1
<clasfcn>
S et
BL
0..1
PtPrsn
BL
0..1 <PtPrsnName>
Set
PtPrsn
1
PtPrsnName
<PtPrsnName>
TS
0..1
brthp lcAddr
decesdDttm
Pt
educnLevl
Pt
gendr
maritlStatus
Pt
race
Person
religious_affiliation_cd
relgsAfiltn
ambulatory _status_cd
ambltry Status
Pt
Stakeholder
p hon
p hon
Stakeholder
_item_TIL
_TIL
newborn_baby _ind
nwbrnInd
Pt
multip le_birth_ind
multbrthInd
Pt
Person
has_S et_Person_name_for_Patient
PtName
organ_donor_ind
orgnDonrInd
Pt
is_a_role_of_Person_as_patient
PtPrsn
Pt
Person
_item_Person_name_for_Patient
_PtPrsnName
birth_dttm
brthDttm
PtPrsn
Person_name
nm
nm
PtPrsnName
birthp lace_addr
brthp lcAddr
PtPrsn
ST
Person_name
effective_dt
efectvDt
PtPrsnName
deceased_dttm
decesdDttm
PtPrsn
TS
Person_name
cd
cd
PtPrsnName
education_level_cd
educnLevl
PtPrsn
CV
Person_name
p urp ose_cd
p urp os
PtPrsnName
gender_cd
gendr
PtPrsn
CV
Person_name
value
valu
PtPrsnName
marital_status_cd
maritlStatus
PtPrsn
CV
Person_name
termination_dt
termntnDt
PtPrsnName
race_cd
race
PtPrsn
CV
Person_name
ty p e_cd
ty p
PtPrsnName
religious_affiliation_cd
relgsAfiltn
PtPrsn
CV
has_a_primary_provider_Individual_healthca
p hon
p hon
PtPrsn
Set <TIL>
Patient
primryIHCP
Pt
re_practitioner
_item_TIL
_TIL
Set <TIL>
TIL
Stakeholder
p hon
p hon
IHCP
S et
has_S et_Person_name_for_Patient
PtName
PtPrsn
Stakeholder
_item_TIL
_TIL
Set <TIL>
<PtPrsnName>
has_Person_name_for_IHCP
PN_IHCP
IHCP
Set
_item_Person_name_for_Patient
_PtPrsnName
PtPrsnName
Person_name
nm
nm
PN_IHCP
<PtPrsnName>
Person_name
cd
cd
PN_IHCP
nm
nm
PtPrsnName
PN
Person_name
p urp ose_cd
p urp os
PN_IHCP
effective_dt
efectvDt
PtPrsnName
TS
Person_name
ty p e_cd
ty p
PN_IHCP
cd
cd
PtPrsnName
CV
Patientp urp ose_cd
has_Patient_billing_account
PtBillAcnt
Pt
p urp os
PtPrsnName
CV
Patient_billing_accoun
value
valu
PtPrsnName
ST
id
id
PtBillAcnt
t
termination_dt
termntnDt
PtPrsnName
TS
Patient_billing_accoun
ty p e_cd
ty p
PtPrsnName
CV
status_cd
status
PtBillAcnt
t has_a_primary_provider_Individual_healthca
primryIHCP
Pt
IHCP
Patient_billing_accoun
re_practitioner
_item_CV
_CV
PtBillAcnt
t
p hon
p hon
IHCP
Set <TIL>
Patient_billing_accoun
_item_TIL
_TIL
Set <TIL>
TIL
billing_status_cd
billngStatus
PtBillAcnt
t
has_Person_name_for_IHCP
PN_IHCP
IHCP
PN_IHCP
44
Person_name
p atient_financial_class_cd
Person_name
Person_name
p rice_schedule_id
Person_name
has
Patient
44 46 aso
is_involved_in
Patient_billing_accoun
id
45 47
att
id
t
Patient_billing_accoun
att
status_cd
status_cd 46 48
t
Patient_billing_accoun
t
Patient_billing_accoun
billing_status_cd
t
Patient_billing_accoun
p atient_financial_class_cd
t
Patient_billing_accoun
p rice_schedule_id
t
ambulatory _status_cd
Patient
newborn_baby _ind
Patient
multip le_birth_ind
Message
Patient
organ_donor_ind
Element Short
Patient
is_a_role_of_Person_as_patient
Message Element
Name
Name
Person
birth_dttm
Person
birthp lace_addr
Patient
Pt
Person
deceased_dttm
id
id
Person
education_level_cd
status_cd
status
Person
gender_cd
Person
marital_status_cd
_item_CV
_CV
Person
race_cd
of
Common
Message
Element Type
Pt
status
Conformance Flag
in
Message
Element Type
Pt
id
Update mode set
att
status_cd
Default Update Mode
7
Message Element Name
Patient
id
Default Value (#)
12
Message
Element Short
Name
Message Elements
Rim Source Class
Patient
Constraint/Note #
Patient
Class or
Mandatory
Patient
Patient
status_cd
itm
R
M
No
V
R
M
No
V
R
No
V
R
No
R
R
No
R
R
M
R
<p tFincl
Class>
No
V
<@state,
No
V
EXT:CNE>
No
V
M
M
R
R
R
0..1
0..1
1
1
<@state,
EXT:CNE>
M
No
R
R
M
No
R
R
Heirarchical Message
Descriptions
RIM
January 24, 2000
Patient
id
att
6
T
<<Data_type>>
Non-parametric_probability_Distribution : NPPD
Service_intent_or_order
charge_type_cd
clarification_phon
entering_device_cd
escort_required_ind
expected_performance_time_qty
filler_order_id
status_cd
has_as_participant 0..1
status_reason_cd
is_referred_to_in 0..1 order_effective_dttm
order_id
expects_patient_located_at 0..*
order_placed_dttm
has_as_target 0..1 qt
placer_order_id
is_fulfilled_by 0..1 echo_back_txt
has_as_reason 0..1 planned_patient_transport_cd
report_results_to_phon
is_source_for 1
response_requested_cd
service_body_site_cd
has_as_source 0..*
service_body_site_modifier_cd
transport_arranged_ind
Service_intent_or_order_relationship
transport_arrangement_responsibility_cd
relationship_type_cd
0..* is_billed_to
transport_mode_cd
reflex_testing_trigger_rules_desc
when_to_charge_dttm
constraint_txt
when_to_charge_cd
qt
intent_or_order_cd
join_cd
0..* has_as_target
status_dttm
secondary_identification_txt
is_target_for 1 reporting_priority_cd
Clinical_observation
abnormal_result_cd
last_observed_normal_values_dttm
nature_of_abnormal_testing_cd
clinically_relevant_tmr
method_cd
status_cd
status_dttm
observation_sub_id
val
references_range_val
universal_service_identifier_suffix_txt
user_defined_access_check_cd
value_datatype_cd
confirmation_status_cd
cla
att
5
b
<<Data_type>>
Person_name_part : PNXP
<<Data_type>>
Person_name_type : PN
is_entered_at 0..*
Advance_directive
competence_ind
directive_cd
disclosure_level_cd
life_quality_desc
mortuary_preference_nm
notarization_dttm
assessment_dttm
employment_related_ind
3
4
11
Information Model
Mapping
Property of Class
<<Data_type>>
Person_name_variant : PNXV
T
<<Data_type>>
Parametric_probability_distribution : PPD
Treatment_intent_or_order
Dietary_intent_or_order Observation_intent_or_order
Referral
has_as_target 0..1
fulfills 0..*
indication_id
diet_type_cd
authorized_visits_qty
patient_hazard_cd
Service_event
0..1 is_evidence_for
has_as_active_participant 0..1
ordering_providers_instruction_txt instruction_desc
relevant_clinical_information_txt desc
attestation_dttm
0..1 has_as_reason
requested_give_strength_qty
tray_type_cd
reason_txt
specimen_action_cd
tmr
orders
substitution_allowed_ind
service_period_cd
charge_to_practice_qty
0..*
is_source_for
delivers 0..* charge_to_practice_cd
Treatment_intent_or_order_revision
patient_sensitivity_cd
1
0..* has_as_source
1 has_parts
is_assigned_to 0..* consent_cd
dispense_package_method_cd
dispense_package_size_qty
Service_event_relationship
service_desc
filler_id
relationship_type_cd
is_part_of give_indication_id
give_per_timeunit_cd
filler_order_status_dttm
scheduled_start_dttm
1..* give_rate_qty
has_as_target 0..*
last_refilled_dttm
specimen_received_dttm 1
max_give_qty
family_awareness_txt
is_target_for
is_documented_by 0..*
min_give_qty
individual_awareness_cd
needs_human_review_ind
confidential_ind
PTcomp
status_cd
is_performed_at 0..*
PTrout
billing_priority_nbr
Judgement_link
Rule_link
Conditional_link
is_charged_to 0..* status_reason_cd
qt
type_cd
priority_nbr
is_associated_with 1
prescription_id
refills_allowed_nbr
refills_doses_dispensed_nbr
refills_remaining_nbr
substitution_status_cd
treatment_suppliers_instruction_cd
Assessment
Care_event
total_daily_dose_qty
Consent
pertains_to 1..*
Location_encounter_role
is_primary_facility_for Master_patient_service_location 1 is_scheduled_by
accommodation_cd
0..1 addr
effective_tmr
open_tmr
location_role_cd
desc
pertains_to 0..* status_cd
1 has
email_address
transfer_reason_cd
houses 1 id
usage_approved_ind
Patient_service_location_group
provides_services_on_behalf_of 0..* licensed_bed_nbr
1..* belongs_to
contains 0..*
nm
id
phon
is_requested_by 0..1
service_specialty_cd
1 is_requested_by
is_included_in 0..* slot_size_increment_qty
0..1 expected_patient_location_for
status_cd
type_cd
0..1 is_target_for
equipment_type_cd
1 is_entry_location_for
0..1 is_location_for
includes 0..1
<<Data_type>>
Address_part : ADXP
T
<<Data_type>>
Uncertain_discrete_value_using_probability : UDVP
T
1 measures
Master_qualitative_observation
abnormal_result_cd
critical_result_cd
normal_result_cd
preferred_coding_system_cd
valid_answer_cd
(Attribute or Association)
8
9
10
<<Data_type>>
Postal_and_residential_address : AD
<<Data_type>>
Uncertain_value-narrative : UVN
T
<<Data_type>>
History : HIST
0..*
is_target_of
Episode
desc
episode_type_cd
id
list_closed_ind
outcome_txt
recurring_service_ind
<<Data_type>>
Integer : INT
T
T
<<Data_type>>
Interval : IVL
T
is_basis_for
Master_quantitative_observation
corresponding_SI_unit_of_measure_cd
unit_of_measure_cd
conforms_to 1 delta_check_change_computation_method_cd
delta_check_change_threshold_qty
delta_check_value_range_qty
0..* has_as_participant
delta_check_numeric_low_value_amt
Active_participation
delta_check_retention_period_qty
tmr
display_length_and_decimal_precision_cd
participation_type_cd
minimum_meaningful_increment_nbr
si_conversion_factor_expr
0..*
0..*
participates_in
participates_in
1 is_requested_by
0..1 is_target_of
is_source_for 0..1
has_a_primary_provider 0..*
Master_treatment_service
dea_level_cd
drug_category_cd
formulary_status_cd
medication_form_cd
pharmaceutical_class_cd
route_cd
therapeutic_class_cd
Master_observation_service
instrument_cd
permitted_data_type_cd
has_as_basis processing_time_qty
specimen_required_ind
0..* typical_turnaround_time_qty
derivation_rule_desc
applies_to 0..*
is_contact_for 0..*
<<Data_type>>
Monetary_amount : MO
<<Data_type>>
Technical_instance_locator : TIL
b
has 1
Individual_healthcare_practitioner_slot
0..*
is_scheduleable_unit_for
is_specified_for 0..*
Master_numeric_range
type_cd
condition_desc
age_qty
gestation_age_qty
value_qty
race_subspecies_txt
gender_cd
species_txt
manages 1
Patient_slot
0..*
is_a_scheduleable_unit_for
0..* is_a_subdivision_of
<<Data_type>>
Technical_instance_identifier : TII
Domain Specification (#)
Resource_request
allowable_substitutions_cd
duration_qty
start_dttm
start_offset_qty
status_cd
Domain Specification (#)
Transcriptionist 0..1 is_role_of
is_requested_by
Durable_medical_equipment_request
quantity_amt
type_cd
requests 0..*
Conformance Flag
requests 0..*
Update mode set
practitioner_type_cd
0..* is_entered_by
Cardinality
0..* requests
Appointment_request
Service_scheduling_request
appointment_rqst_reason_cd
allowable_substitutions_cd
appointment_rqst_type_cd
duration_qty
1 requests
equip_selection_criteria_expr
start_dttm
is_requested_by 0..*
id
start_offset_qty
location_selection_criteria_expr
status_cd
priority_cd
repeating_interval_duration_tmr 1 requests
repeat_pattern_expr
rqst_event_reason_cd
rqsted_duration_tmr
start_tmr
time_selection_criteria_expr
explicit_time_interval_expr
Individual_healthcare_practitioner_request
Default Update Mode
0..*
Constraint/Note #
0..* has_as_contact
pertains_to
is_the_recipient_of 1
Quantity/ Time
Generalizations
Mandatory
has_as_a_parent_document
0..1 transcribes
<<Data_type>>
Binary_data : BIN
<<Data_type>>
No_information : NULL
Domain Specification (#)
0..1 is_role_of
<<Data_type>>
Floating_point : FPN
Cardinality
Document_recipient 0..1 of
<<Data_type>>
Physical_quantity : PQ
Row Number
Originator 0..1 of
0..1 is_role_of
Stakeholder_affiliation
affiliation_type_cd
desc
effective_dt
termination_dt
Generic
<<Data_type>>
Point_in_time : TS
Demographic
<<Data_type>>
Number : N
Row Type
created_by 1
Healthcare_document_authenticator
0..1 is_a
has_as_secondary_participant 0..*
<<Data_type>>
Ratio : RTO
<<Data_type>>
Boolean : BL
<<Data_type>>
Code_value : CV
<<Data_type>>
Concept_descriptor : CD
Former Row
Patient_encounters
Healthcare_finances
Master_service
<<Data_type>>
allowable_processing_priority_cd
Code_translation : CDXL
allowable_reporting_priority_cd
challenge_information_txt
confidentiality_cd
<<Data_type>>
effective_tmr
Code_phrase : CDPH
factors_that_may_affect_observation_desc
is_requested_by 1 fixed_canned_message_cd
<<Data_type>>
imaging_measurement_modality_cd
ISO_object_identifier : OID
is_target 1 incompatible_change_dttm
interpretation_considerations_desc
kind_of_quantity_observed_cd
has_target 0..*
<<Data_type>>
last_update_dttm
Real_world_instance_identifier : RWII
Master_service_relationship
method_cd
relationship_type_cd
nature_of_service_cd
T, S, R
reflex_testing_trigger_rules_desc
observation_id_suffix_txt
constraint_txt
orderable_service_ind
<<Data_type>>
qt
patient_preparation_desc
Collection : COLL
point_versus_interval_cd
portable_device_ind
T, R
has_source 0..*
report_display_order_txt
<<Data_type>>
is_source 1 alternate_id
Bag : BAG
alternate_name_use_cd
alternate_nm
T, R
is_delivered_during 1
contraindication_desc
desc
<<Data_type>>
Master_specimen_requirement
performance_schedule_cd
List : LIST
primary_nm
additive_cd
T, R
standard_time_to_perform_qty
container_desc
target_anatomic_site_cd
container_preparation_desc
<<Data_type>>
universal_service_id
container_volume_qty
Set : SET
qt
derived_specimen_cd
join_cd
minimum_collection_volume_qty
when_to_charge_cd
normal_collection_volume_qty
consent_required_cd
special_handling_desc
priority_cd
1 is_instantiated_as
retention_time_qty
type_cd
is_produced_by 1..1
0..* produces
Row Type
Master_tables
Healthcare_finances
Healthcare_stakeholders
Healthcare_finances
1
0..* is_related_to
Clinical_document_header
0..* documents
availability_status_cd
change_reason_cd
completion_status_cd
confidentiality_status_cd
content_presentation_cd
Patient_information_disclosure
document_header_creation_dttm
disclosure_dttm
file_nm
info_disclosed_desc
id
info_requested_desc
last_edit_dttm
reason_cd
has_been_originated_by 0..* origination_dttm
requested_dttm
reporting_priority_cd
urgency_cd
results_report_dttm
storage_status_cd
is_provided_to 0..*
has_been_received_by 0..* transcription_dttm
type_cd
0..1
is_transcribed_by 0..* document_change_cd
is_parent_document_for
contained_in 0..*
0..*
Row Number
is_source_of 0..*
Healthcare_finances
Healthcare_finances
Producer_of_master_service
service_producing_department_type_cd
is_related_to
Former Row
has_as_participant 0..*
Authentication
authentication_dttm 0..* is_related_to
type_cd
Default Value (#)
<<Data_type>>
Character_string : ST
<<Data_type>>
Free_text : FTX
is_covered_by 1..*
HEALTH LEVEL 7
REFERENCE INFORMATION MODEL
RIM_0092
released September, 1999
reflects agreements made through harmonization in June, 1999
© 1999, 2000 Health Level 7
99
Union: C00XXM M
Build the Message Element Section
• Built directly from the Tabular R-MIM
– Defines a particular PATH through the model
• Specify the type of object
– Composite, primitive, etc.
– Previously defined MET (CMET)
• Which type (MET) the element is IN
• Which type (MET or datatype) the element
is OF
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100
Sample Information Model Mapping and Message Elements
Row Type
Row Number
b
Former Row
Information Model Mapping
Class or
Property of Class
(Attribute or Association) Rim Source Class
8
9
3 cla
4 att
Patient
id
Patient
Patient
10
5 att
status_cd
Patient
11
6 itm
12
7 att
13
14
15
16
17
18
19
20
21
22
23
24
25
8
9
10
11
12
13
14
15
16
17
18
19
20
att
att
att
aso
att
att
att
att
att
att
att
att
att
Message Elements
Patient
Message Element Name
Patient
id
status_cd
_item_CV
Message
in
Element Short
Message
Name
Element Type
Pt
id
Pt
Pt
II
status
Pt
Set <CV>
_CV
Pt
CV
CV
ambulatory_status_cd
Patient
ambulatory_status_cd
ambltryStatus
Pt
newborn_baby_ind
multiple_birth_ind
organ_donor_ind
is_a_role_of
birth_dttm
birthplace_addr
deceased_dttm
education_level_cd
gender_cd
marital_status_cd
race_cd
religious_affiliation_cd
phon
Patient
Patient
Patient
Patient
Person
Person
Person
Person
Person
Person
Person
Person
Stakeholder
newborn_baby_ind
multiple_birth_ind
organ_donor_ind
is_a_role_of_Person_as_patient
birth_dttm
birthplace_addr
deceased_dttm
education_level_cd
gender_cd
marital_status_cd
race_cd
religious_affiliation_cd
phon
nwbrnInd
multbrthInd
orgnDonrInd
PtPrsn
brthDttm
brthplcAddr
decesdDttm
educnLevl
gendr
maritlStatus
race
relgsAfiltn
phon
Pt
Pt
Pt
Pt
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
PtPrsn
January 24, 2000
© 1999, 2000 Health Level 7
of
Message
Element Type
BL
BL
BL
PtPrsn
TS
ST
TS
CV
CV
CV
CV
CV
Set <TIL>
101
Finish With Message Structure
• Specify the constraints on each element
– Cardinality for this message
– Domain from which the data field will be drawn
• Vocabulary reference, constraint predicate, etc.
• Coding strength
–
–
–
–
–
Mandatory Requirement
Default Values
Update parameters
Conformance Flag
Notes and comments
January 24, 2000
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102
Interactions and Message Structures Section
Encounter_manager : AR_
Encounter_manager
Encounter_tracker : AR_
Encounter_tracker
Encounter_archivist : AR_
Encounter_archivist
interaction #1,
message structure A
Trigger Ev ent:
Sc hedule Enc ounter
interaction #2,
message structure B
Trigger Ev ent:
D elete Sc heduled Enc ounter
interaction #3,
message structure C
interaction #4,
Message Structure C
Trigger Ev ent:
Admit Patient
interaction #5,
message structure D
Hierarchichal Message Description
for Trigger Event "Admit Patient", Sending
Application Role "Encounter Manager"
Information
Model Mapping
1 root
January 24, 2000
Patient_encounter
Message
Structures
Message
Elements
1
1
ENC
ENC
C
1
D
M
1
status_cd
1 CE
status_cd
1
26
M
1
M
1
encounter_classification_cd
1 CE
encounter_classification_cd
2
12
M
1
M
1
id
1 ST
id
3
M
1
M
1
end_dttm
1 VTS
end_dttm
4
R
1
R
1
expected_insurance_plan_qty
1 NM
expected_insurance_plan_qt
y
5
R
1
R
1
first_similar_illness_dt
1 VTS
first_similar_illness_dt
6
R
1
R
1
patient_classification_cd
1 CE
patient_classification_cd
7
R
1
R
1
start_dttm
1 VTS
start_dttm
8
M
1
M
1
3
13
4
M
1
3
© 1999, 2000 Health Level 7
103
1
1
0..1
0..1
0..1
0..1
1
0..1
0..1
0..1
0..1
0..1
0..1
0..1
0..1
0..*
M
No
V
R
M
No
R
R
M
No
R
R
2
<edctnLevl>
<martlStatus>
<race>
<relgsAfltn>
14
January 24, 2000
R
R
R
R
R
R
R
R
R
© 1999, 2000 Health Level 7
Cardinality
Conformance Flag
Update Mode
Default Value (#)
Constraint/Note #
C00XMM011
Mandatory
Domain Specification (#)
Cardinality
Conformance Flag
Common Constraints
Update Mode
Default Value (#)
Constraint/Note #
Mandatory
Domain Specification (#)
Conformance Flag
Update mode set
Constraint/Note #
Default Update Mode
<@state,
EXT:CNE>
<@state,
EXT:CNE>
<ambltr
Status>
<clasfcn>
Default Value (#)
1
1
Mandatory
Domain Specification (#)
Cardinality
Message Structures
Union: C00XXMM
C00XMM013
R
R
R
R
R
R
104
Implementation Technology
Specification
• Implementation technology is
– A method of encoding and sending HL7 messages.
Version 3 implementation technologies will initially be
XML, and will eventually include ER7, other objectinterfaces, and, perhaps, EDIFACT
• Implementation Technology Specification
– Describes how HL7 messages are sent using a specific
implementation technology. It includes specifications of
the method of encoding the messages, rules for the
establishment of connections and transmission timing,
procedures for dealing with errors, and it may include a
specified application programming interface
January 24, 2000
© 1999, 2000 Health Level 7
105
Implementation Technology
Specification
– The HMD definition of a message/method is technology
neutral: it doesn’t specify the form (encoding) of the message,
nor the technology used to transport the message
– A V3 goal is to support at least 3 different ITS layers
• Character based interfaces
– XML Will be the initial technology for v3.0
– ER7, ASN.1
• Object Broker Technology
– CORBA
– Active-X/DCOM
• Others
– EDIFACT is a possibility
January 24, 2000
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106
Putting the pieces together
Implementation
Technology
Specification
"Send as ASCII
string in XML
format"
Hierarchical
Message
Definition
"Discontinue
pharmacy order"
ITS
for
XML
Data
HL7
Message
Creation
Message
Instance
HL7-Conformant
Application
January 24, 2000
© 1999, 2000 Health Level 7
HL7
Message
Parsing
Data
HL7-Conformant
Application
107
An HL7 V2.3 Message
MSH|^~\&|LABGL1||DMCRES||199812300100||ORU^R01|LABGL1199510221838581|P|2.3
|||NE|NE
PID|||6910828^Y^C8||Newman^Alfred^E||19720812|M||W|25 Centscheap Ave^^
Whatmeworry^UT^85201^^P||(555)777-6666|(444)677-7777||M||773789090
OBR||110801^LABGL|387209373^DMCRES|18768-2^CELL COUNTS+DIFFERENTIAL TESTS
(COMPOSITE)^LN|||199812292128||35^ML|||||||IN2973^Schadow^Gunther^^^^MD^UPIN
||||||||||^Once||||||CA20837^Spinosa^John^^^^MD^UPIN
OBX||NM|4544-3^HEMATOCRIT (AUTOMATED)^LN||45||39-49
||||F|||199812292128||CA20837
OBX||NM|789-8^ERYTHROCYTES COUNT (AUTOMATED)^LN||4.94|10*12/mm3
|4.30-5.90||||F|||199812292128||CA20837
A sample results message
January 24, 2000
© 1999, 2000 Health Level 7
108
V3 XML Prototype - same data
<Labrs3P00 T="Labrs3P00">
<Labrs3P00.PTP T="PTP">
<PTP.primrPrsnm T="PN">
<fmn T="ST">Sample</fmn>
<gvn T="ST">George</gvn>
<mdn T="ST">H</mdn>
</PTP.primrPrsnm>
</Labrs3P00.PTP>
<Labrs3P00.SIOO_L T="SIOO_L">
<SIOO_L.item T="SIOO">
<SIOO.filrOrdId T="IID">LABGL110801</SIOO.filrOrdId>
<SIOO.placrOrdId T="IID">DMCRES387209373</SIOO.placrOrdId>
<SIOO.InsncOf T="MSRV">
<MSRV.unvSvcId T="CE">18768-2</MSRV.unvSvcId>
<MSRV.svcDesc T="TX">CELL COUNTS+DIFFERENTIAL TESTS (COMPOSITE)</MSRV.svcDesc>
</SIOO.InsncOf>
<SIOO.SRVE_L T="SRVE_L">
<SRVE_L.item T="SRVE">
<SRVE.name T="CE">4544-3</SRVE.name>
<SRVE.svcEvntDesc T="ST">HEMATOCRIT (AUTOMATED)</SRVE.svcEvntDesc>
<SRVE.CLOB T="CLOB">
<CLOB.obsvnValu T="NM">45</CLOB.obsvnValu>
<CLOB.refsRng T="ST">39-49</CLOB.refsRng>
<CLOB.clnRlvnBgnDtm T="DTM">199812292128</CLOB.clnRlvnBgnDtm>
</SRVE.CLOB>
<SRVE.spcmRcvdDtm T="DTM">199812292315</SRVE.spcmRcvdDtm>
</SRVE_L.item>
</SIOO_L.item>
</Labrs3P00.SIOO_L>
</Labrs3P00>
January 24, 2000
© 1999, 2000 Health Level 7
109
So how is all this done?
• UML and the Rational Rose toolset is used to
capture many models
• HL7 has developed a number of our own tools and
templates to assist in the process - ROSETREE
• Detailed tools training tutorials are held during WG
meetings and harmonization meetings
• MnM is the overseer of the tools and the process
URL to download Tooling:
http://www.hl7.org/library/data-model/Rose_tooling/rose_index.htm
(this includes a text file to describe what each downloadable file is)
Or directly:
http://www.hl7.org/library/data-model/Rose_tooling/RoseTree_II.zip
January 24, 2000
© 1999, 2000 Health Level 7
110
Tools that are used
• Rational Rose98 (commercial product)
– Version 4.5 or later
• RoseTree_II*
– Current Version 20215
• HL7Tools.mdb*
– not versioned
– useful for working with the repositories
• Microsoft Access and Excel (commercial product)
– Office ‘97 Versions
* have help files
January 24, 2000
© 1999, 2000 Health Level 7
111
Summary of V3 Features
• Internal consistency - enforced in models
• Sound definitions - captured in a repository
• Enables variety of implementation technologies
– ranging from ASCII to ORBs and EDIFACT to XML
• Eliminates rampant optionality in the messages
– reduces implementation effort
• Application roles are a basis for component
functional specifications
• Provides verifiable conformance claims
January 24, 2000
© 1999, 2000 Health Level 7
112
Credits
This innovative approach was developed through significant contributions by
the following people (listed alphabetically):
•
•
•
•
•
•
•
•
•
Woody Beeler,
Mayo Foundation
Norman Daoust, Partners
Healthcare
Gary Dickenson
Yakov Golder, Consultant
Jack Harrington, Hewlett Packard
Stan Huff, IHC
Clem McDonald, Regenstreif
Institute
Ted Klein, cMore Medical
Solutions
Charlie Mead, CareCentric
Solutions
January 24, 2000
•
•
•
•
•
•
•
•
•
•
Linda Quade,
Eli Lilly and Company
Larry Reis, Wizdom Systems
Wes Rishel,
Wes Rishel Consulting
Mark Shafarman
Oacis Healthcare Systems
Gunther Schadow, Regenstreif Institute
Rob Seliger, Sentillion
Abdul-Malik Shakir, The Huntington
Group
Mark Tucker, Regenstreif Institute
Karen Van Hentenryck, HL7
Mead Walker, The Huntington Group
© 1999, 2000 Health Level 7
113
Bibliography (classics)
• Jacobson, I. Et Al, Object-Oriented Software
Engineering: A Use Case Driven Approach,
Addison-Wesley, Reading, MA, 1994.
• Rumbaugh, J. Et Al, Object-Oriented Modeling and
Design, Prentice Hall International, Englewood
Cliffs, NJ, 1991.
• Booch, G., Object-Oriented Analysis and Design
with Applications, 2nd ed., The Benjamin/Cummings
Publishing Company, Inc., Redwood City, CA, 1994.
January 24, 2000
© 1999, 2000 Health Level 7
114
Bibliography (additional)
• White, I., Using the Booch Method. A Rational Approach,
The Benjamin/Cummings Publishing Company, Inc.
Redwood City, CA, 1994.
• M. Fowler, UML Distilled. Applying the Standard Object
Modeling Language, Addison-Wesley, Reading, MA, 1997.
• Vaskevitch, D., Client/Server Strategies, IDG Books, San
Mateo, CA, 1993.
• Taylor, D.A., Object-Oriented Technology: A Manager’s
Guide, Addison-Wesley, Reading, MA, 1990.
• Taylor, D.A., Business Engineering with Object Technology,
John Wiley & Sons, Inc.. New York, NY, 1995.
January 24, 2000
© 1999, 2000 Health Level 7
115
Bibliography (periodicals)
• Object Magazine, SIGS Publication
• Distributed Object Computing (DOC)
• Journal of Object-Oriented Programming (JOOP)
January 24, 2000
© 1999, 2000 Health Level 7
116
Thank You!
E-mail: [email protected]
Presentation:
http://www.hl7.org/library/general/V3introtutorial.ppt
January 24, 2000
© 1999, 2000 Health Level 7
117