Transcript Introduction: Vocabulary domains • Marital Status – – – – single (never married) married divorced separated • “Vocabulary” to distinguish from “Subject Domains” in the RIM • Why Vocabulary Domains? – Increase interoperability –

Introduction: Vocabulary domains
• Marital Status
–
–
–
–
single (never married)
married
divorced
separated
• “Vocabulary” to distinguish from “Subject Domains” in
the RIM
• Why Vocabulary Domains?
– Increase interoperability
– Sharing of data (clinical care, outcomes, research)
– Sharing of decision logic
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Vocabulary domain
• “The set of all concepts that can be taken as valid
values in an instance of a coded field or attribute.”
• Concept - “A unit of thought constituted through
abstraction on the basis of characteristics common to a
set of objects.” ISO 1087
• Each concept in the domain can be represented using a
specific vocabulary/terminology
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Each coded attribute has a domain specification
Class: Patient
Description: A person who may receive, is
receiving, or has received healthcare services.
Associations
is_a_role_of (1,1) :: Person
is_source_for (0,n) :: Specimen_sample
Attributes
birth_order_number
birth_dttm (from Person)
gender_cd <Gender, Ext:CWE>
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Vocabulary Domain Specification
• One and only one for each coded RIM attribute
• General form:
– <domain name, list of domain qualifiers>
– <Gender, Ext:CWE>
• Currently two types of domain qualifiers
– Extensibility (Extensibility)
• CNE - Coded No Exceptions
• CWE - Coded With Exceptions
– Realm (RealmOfUse)
•
•
•
•
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Universal
USA?
Europe?
Others
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Specialization of Domains
• Used in specifying message
– MIM, MET, CMET, HMD, Clinical Templates(?)
• Example:
– MyGender = (“Gender:USA:HL7” - “Other:USA:HL7-001”)
• General Form
– “value set name” <set operator> “value set name”
• Value set name
– “Domain name:Realm:Terminology”
• Allowed set operators
– “+” Union ()
– “-” Difference (sometimes represented as “\”)
– “*” Intersection ()
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Validating Specifications and Constraints
• Validation can be time and resource intensive
• May want to do selective validiation
–
–
–
–
–
–
–
During testing and debugging
During conformance testing
During the creation of each message
During the decoding of each message
Only on some fields
Only when errors occur
Or all of the above
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General process of maintaining domains
• Follow pattern of RIM harmonization
• Vocabulary TC appoints facilitators
• Message development TCs have stewardship
– Ultimate authority for domain contents
– Follow RIM harmonization rules
• Vocabulary Facilitators
– Insure that good vocabulary practices are followed
– Actual maintenance of domain specification database
– Submit new concepts to vocabulary providers
• All vocabulary/terminology providers can provide
mappings to HL7 domains
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Domain specification table maintenance (plan)
• Available on HL7 web site
– All members can read tables
• Edit Permissions table
– who can edit which domains
– vocabulary co-chairs maintain permissions table
• Assigned persons make edits (proposed status)
• Entries reviewed by Vocab Review Committee
• Reports presented to RIM harmonization process
• Approved changes reflected by status chanages
• HL7 standard versions synch’ed with edit versions
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Local Vocabulary Use
• Can only be used with qualifier Strength:CWE
• The complete domain is a union of standard domain
plus local concepts (as a union of the two)
• Rules
– Local concept can not replace standard concept
– Local code system names must start with “99”
– Local codes should be submitted to HL7 for inclusion in
standard domain and forwarded to terminology developers
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The Domain Specification Database
The domain specification database
• This is only the first version. There will be future
enhancements to domain specifications and to the table
design
• Requirements: (UML model not shown)
–
–
–
–
–
–
–
–
–
Unique, non-sense identifier
Unique textual name
Description/definition
Edit note
Version tracking
Can be specific to a realm of use
Each “leaf” set is from a single vocabulary
Domains can be recursively defined
Set notation will be used to describe relationships
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Domain Specification Database Tables
• Value Set Definition Table
• Version Tracking Table
• Edit Permissions Table (not shown)
• Value Set Relationship Table
• Source Vocabulary Representation Table
• Observation Identifier to Value Set Linking Table
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Value Set Definition Table
HL7 Value Domain
Set ID
Name
1
Gender
10001
MyGender
Real
m
Root
Root
Code
System
HL7
HL7
60001
ClinicalDiagnosis
USA
SNM3
60002
ClinicalDiagnosis
USA
MED
70001
BillingDiagnosis
USA
IC9
5
50005
50006
20001
Race
Race
Race
AmericanIndian
OrAlaskaNative
Asian
BlackOrAfrican
American
NativeHawaiian
OrPacificIslander
WhiteRace
AmericanIndian
AlaskaNative
Root
USA
UK
USA
HL7
HL7
RC
HL7
USA
USA
HL7
HL7
USA
HL7
USA
USA
USA
HL7
HL7
HL7
20002
20003
20004
20005
30001
30002
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Value Set Description
Expression
Current
Status
A
A
Vin
The gender of a person.
The gender of a person.
Does not allow Unknown
or Other.
A clinical diagnosis or
syndrome.
Diagnosis or syndrome
that best explains the
patient's symptoms.
The billing diagnosis for
third party
reimbursement purposes.
The race of a person.
The race of a person.
A person's race.
American Indian or
Alaska Native Race
Asian Race
Black or African
American Race
Native Hawaiian or
Pacific Islande Racer
White Race
American Indian Race
Alaska Native Race
"Gender:Root:HL7"
("Gender:Root:HL7" - "O:HL70001")
ChildrenOf("D*")
A
3
SubTypes("1278")
A
3
Any("ICD-9CM")
A
2
"Race:Root:HL7"
"Race:USA:HL7"
ChildrenOf("Race")
"AmericanIndianOrAlaskaNativ
e:USA:HL7"
"Asian:USA:HL7"
"BlackOrAfricanAmerican:USA
:HL7"
"NativeHawaiianOrPacificIsland
e:USA:HL7"
"WhiteRace:USA:HL7"
"AmericanIndian:USA:HL7"
"Alaska Native:USA:HL7"
A
A
P
A
1
2
1
1
A
A
1
1
A
1
A
A
A
1
1
1
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Vout
1
1
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Value Set Definition Table (content 1)
HL7
Value Set
ID
1
10001
Domain
Name
Realm
Code
System
Value Set Description
Expression
Gender
MyGender
Root
Root
HL7
HL7
"Gender:Root:HL7"
("Gender:Root:HL7"
- "O:HL7-0001")
60001
ClinicalDiagnosis
USA
SNM3
60002
ClinicalDiagnosis
USA
MED
70001
BillingDiagnosis
USA
IC9
The gender of a person.
The gender of a person.
Does not allow Unknown
or Other.
A clinical diagnosis or
syndrome.
Diagnosis or syndrome
that best explains the
patient's symptoms.
The billing diagnosis for
third party
reimbursement purposes.
ChildrenOf("D*")
SubTypes("1278")
Any("ICD-9CM")
• A single row is a value set
– Each row gets a unique HL7 Value Set Id
– The primary key consists of Domain Name, Realm, Code System
• The union of all value sets with the same Domain Name is a
domain
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Value Set Definition Table (content 2)
HL7
Value Set
ID
1
10001
Domain
Name
Realm
Code
System
Value Set Description
Expression
Gender
MyGender
Root
Root
HL7
HL7
"Gender:Root:HL7"
("Gender:Root:HL7"
- "O:HL7-0001")
60001
ClinicalDiagnosis
USA
SNM3
60002
ClinicalDiagnosis
USA
MED
70001
BillingDiagnosis
USA
IC9
The gender of a person.
The gender of a person.
Does not allow Unknown
or Other.
A clinical diagnosis or
syndrome.
Diagnosis or syndrome
that best explains the
patient's symptoms.
The billing diagnosis for
third party
reimbursement purposes.
ChildrenOf("D*")
SubTypes("1278")
Any("ICD-9CM")
• Two kinds of mutually exclusive domains
– Domains maintained by HL7
– Domains maintained by external terminology providers
• An HL7 maintained domain can not have value sets defined
by reference to an external terminology
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Value Set Definition Table (content 3)
HL7
Value Set
ID
1
10001
Domain
Name
Realm
Code
System
Value Set Description
Expression
Gender
MyGender
Root
Root
HL7
HL7
"Gender:Root:HL7"
("Gender:Root:HL7"
- "O:HL7-0001")
60001
ClinicalDiagnosis
USA
SNM3
60002
ClinicalDiagnosis
USA
MED
70001
BillingDiagnosis
USA
IC9
The gender of a person.
The gender of a person.
Does not allow Unknown
or Other.
A clinical diagnosis or
syndrome.
Diagnosis or syndrome
that best explains the
patient's symptoms.
The billing diagnosis for
third party
reimbursement purposes.
ChildrenOf("D*")
SubTypes("1278")
Any("ICD-9CM")
• Expression contains the information that can be used to resolve
the value set to its individual elements
• The expression would be sent to a terminology service
• The semantics of the expression are specific to the terminology
service
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Value Set Definition Table - Version Tracking
HL7 Value
Set ID
1
10001
60001
60002
70001
Domain
Name
Gender
MyGender
ClinicalDiagnosis
ClinicalDiagnosis
BillingDiagnosis
Realm
Root
Root
USA
USA
USA
Code
System
HL7
HL7
SNM3
MED
IC9
Current
Status
A
A
A
A
A
Vin
Vout
1
1
3
3
2
• A value set gets a Vin number when it first becomes a
part of the table
• A value set gets a Vout number when it becomes
inactive
• A value set with a blank Vout is currently active
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Version Tracking Table
Version
1
Date/Time of Edit
199904142200
2
199904161000
3
199905181200
Who
1234
(Dan)
1234
(Dan)
8765
(Jim)
For Whom
4359
(PAFM)
922
(Vocab TC)
2566
(HL7)
Comment
Created entries for all composite race
vocabulary domains
After testing and review, changed the
status of the race domain to active.
Release of Version 2.3.1 of the standard.
• A new version get created each time there is a new
editting session
• The version number becomes part of each domain
specification table as edit are made
• A permissions table (not shown) controls who can edit
which value sets
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Value Set Relationship Table
HL7
Value
Set Id
50005
50005
50005
50005
50005
20001
20001
Value Set Name
Operator
Generality
Race:USA:HL7
Race:USA:HL7
Race:USA:HL7
Race:USA:HL7
Race:USA:HL7
AmericanIndianOrAlaskaNative
:USA:HL7
AmericanIndianOrAlaskaNative
:USA:HL7
Include
Include
Include
Include
Include
Include
Abstract
Specializable
Abstract
Abstract
Specializable
Specializable
HL7
Concept
Id
20001
20002
20003
20004
20005
30001
Include
Specializable
30002
HL7 Value Set/Concept Name
AmericanIndianOrAlaskaNative
Asian
BlackOrAfricanAmerican
NativeHawaiianOrPacificIslander
WhiteRace
AmericanIndian
AlaskaNative
• Value Set Name and Concept Name are only shown for
purposes of illustration
• Operator can be Include or Exclude
• Generality says whether to include the node itself in the
value set
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Source Vocabulary Representation Table
HL7 Value
Set Id
1
1
1
1
1
1
1
1
1
HL7
Concept
ID
40001
40002
40003
40004
40005
40001
40002
40003
40005
Code
Sys
CR
CR
CR
CR
CR
HL7
HL7
HL7
HL7
Source
Domain
Name
Sex
Sex
Sex
Sex
Sex
Gender
Gender
Gender
Gender
Table
ID
0220
0220
0220
0220
0220
0001
0001
0001
0001
Code
Sys
Vin
6
6
6
6
6
2.3.1
2.3.1
2.3.1
2.3.1
Code
Lang
Description
1
2
3
4
9
M
F
O
U
E
E
E
E
E
E
E
E
E
Male
Female
Other (Hermaphrodite)
Transsexual
Not Stated/Unknown
Male
Female
Other
Unknown
• Based on example from Wayne Tracy
• HL7 Concept ID asserts HL7’s view of synonyms
• HL7 Concept ID could be replaced by universal concept
identifier (UMLS CUI?)
• Supports multiple languages
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Observation Id to Value Set Linking Table
Code Sys
LN
Observation
Identifier
11882-8
(Fetal Gender)
Value Set
Id
1
Value Set
Name
Gender
• Used to connect value sets to observation identifiers when
used in name-value pairs like an OBX segment
• LOINC gives only examples, and is not prescriptive
• Allows for strong constraints when OBX like structures are
used in messages
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Using the Domain Specification Database
• Look in Value Set Definition Table
– Use domain name, realm, and code system
– Find and remember the Expression
• Pass the Expression to a terminology server (TQS)
• Knowledge of how to resolve HL7 Value Sets to
individual elements is available in the Value Set
Relationship Table and the Source Vocabulary
Representation Table
• Knowledge of how to resolve external Value Sets is the
responsibility of the terminology provider
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