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HL7 State Machine Lab States (StatusCodes) POLB_TE004007UV01

HL7 State Machine Lab States (StatusCodes) POLB_TE004007UV01.

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HL7 State Machine Lab States (StatusCodes) POLB_TE004007UV01

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  1. HL7 State MachineLab States (StatusCodes) POLB_TE004007UV01 The result has experienced some sort of state or status change. No distinction is made between changes to the focal act or the component acts. This trigger event is used to report any kind of changes that occur to a result to a tracker type application role.

  2. LifeCycle Requirement To represent LifeCycle [LC], CDA needs to associate any Entry with its history moving from creation to completion • Each Historical “snapshot” of Entry in LC should • Represent the LC state for the Entry using ProvenanceEvent Actcodes • Should be comparable to Record Entry Acts • Baseline =>DataOperations codes + GAP coded concepts • Optionally support relevant participations

  3. Entry Level Provenance Organizer + CDA Provenance Capability

  4. DataOperations => ProvenanceEvent.code Propose that DataOperations code system be made Act.code coded concepts • Enables use with Entry Act Provenance Organizer Template • ProvenanceOrganizer is composed of [1…*] ProvenanceEvents • Each has a SUCC (succeeds) Relationship to each predecessor ProvenanceEvent

  5. ActRelationship SUCC (succeeds)Among ProvenanceEvents Use SUCC to specify relationship among ProvenanceEvents LEAF CONCEPT:SUCC (succeeds) Definition: A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be 'completed'. The original act is the target act and the successor is the source act.

  6. RM-ES LifeCycle Actions/Events

  7. LifeCycle[LC] / LifeSpan [LS]Support in DataOperations Vocabulary • GAPS? • Annotate • Aggregate • Derive/Excerpt • Attest • De-identify • Pseudonymize • Legal Hold • Link/Unlink • De-identify • Pseudonymize • Legal Hold • Link/Unlink

  8. Data Operations HierarchyStrategy Way with Verbs Project is working toward Harmonization of the Action Verbs used by EHR FM and in Security RBAC • When project is complete, we can re-do the ProvenanceEvent codes • For Harmonization, we can propose some quick fixes to current Operations codes • Proposal approval needed for balloting DPROV CDA

  9. DataOperation Codes

  10. DataOperation Codes[2.16.840.1.113883.5.1123]Slide 1 of 3

  11. DataOperation CodesSlide 1 of 3

  12. DataOperation Codes

  13. LifeSpan [LS] Entry Level Business requirement is to enable exchange of Document and Entry Level LS • Support by adding ActRelationship codes needed to convey LS Provenance to following value sets:

  14. Provenance Organizer • Provenance Organizer has 1…* component Provenance Acts • Each component Provenance Act has entryRelationship = SUCC • Each component of Each Organizer may have 0…* author, attester, informant, custodian, participant participations

  15. Entry Level Provenance Organizer + CDA Provenance Capability

  16. ActRelationshipType Codes

  17. ActRelationship Value Sets

  18. X_ActRelationshipEntryRelationshipCurrent in CDA at Entry Level – GAPS? • COMP can be used to indicate non-specific aggregation or composition relationship • SAS could indicate succession at in Lifecycle – but would SUCC be better? • SUBJ can be used to relate an Entry to a Provenance Act • XCRPT can be used to indicate that one Entry is excerpted from another Entry GAP? • DRIV – What’s the diff with XCRPT • RPLC – What’s the use case • PERT – Might be useful for Trust Labels • XFORM – is there a use case for one Entry to be a Transform of another?

  19. Other ActRelationshipsSUCC LEAF CONCEPT: SUCC (succeeds) KC – Seems like best fit for AR from Last ProvenanceEvent to preceding for LifeCycle Description: Definition: A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be 'completed'. The original act is the target act and the successor is the source act.

  20. Other ActRelationships Of InterestUPDT LEAF CONCEPT:UPDT (updates (condition)) KC – Could be used for LS/LC Description: A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread.

  21. x_ActRelationshipExternalReference

  22. Reference ActRelationship 4.3.8.5 • CDA entries can reference external objects such as external images and prior reports. These external objects are not part of the authenticated document content. They contain sufficient attributes to enable an explicit reference rather than duplicating the entire referenced object. The CDA entry that wraps the external reference can be used to encode the specific portions of the external reference that are addressed in the narrative block. • Each object allows for an identifier and a code, and contains the RIM Act.text attribute, which can be used to store the URL and MIME type of the object. External objects always have a fixed moodCode of "EVN". • The reference class contains the attribute reference.seperatableInd, which indicates whether or not the source is intended to be interpreted independently of the target. The indicator cannot prevent an individual or application from separating the source and target, but indicates the author's desire and willingness to attest to the content of the source if separated from the target. Typically, where seperatableInd is "false", the exchanged package should include the target of the reference so that the recipient can render it. • A description of allowable reference.typeCode values are shown in the following table. As in the table above (CDA entryRelationship Types), the following table is a guideline for reasonable relationships between CDA entries and external objects, and is not a conformance constraint.

  23. ParticipationFunction Harmonization Proposal REVIEWER – Business Requirement • esMD requested a new ParticipationType REVIEWER • Request was [reportedly] declined because ParticipationType is fixed in CDA as a structural code • May be possible to extend CDA if cost/benefit pans out

  24. RIM Participation.functionCode Participation.functionCode :: CD (0..1)    Property conformance: U    Concept domain: ParticipationFunction Definition: Additional detail about the function that the Participation has in the Act, if such detail is not implied by the Participation.typeCode. Usage Constraint: No HL7 standard specification may be written to depend on the functionCode. When such a constraint is deemed necessary, it is to be defined in the Participation.typeCode. UsageNotes: This code can accommodate a variety of functions greater than that which can be managed in the tightly controlled typeCode. The numbers and kinds of functions applicable depend on the specific kind of act, e.g., each operation may require a different number of assistant surgeons or nurses. Since Participation functions refer to what people do in an Act, they are effectively sub-activities that may all occur in parallel. If more detail needs to be captured about these activities than who does them, component acts should be used instead.

  25. ParticipationFunction Harmonization Proposal REVIEWER - Recommendation May add fine detail with ParticipationFunction • However, no way to test conformance and receiver can ignore while maintaining Recommendation: • Add new REVIEWER ParticipationFunction • Usage Note to indicate that REVIEWER is to be used with the ParticipationType = VERIFER

  26. ReviewerDescription/Definition REVIEWER Description: • Specifies the exact function an actor is authorized to have as a verifier of an Act. • Usage Note: • Used to more fully specify the VERIFER ParticipationType

  27. ParticipationTypeVRF (verifier) REVIEWER adds specificity to VRF without connoting attestation SPECIALIZABLE CONCEPT:VRF (verifier) Description: A person who verifies the correctness and appropriateness of the service (plan, order, event, etc.) and hence takes on accountability.

  28. ABSTRACT CONCEPT:_AuthorizedParticipationFunction [abstract term] • Description: • <p>This code is used to specify the exact function an actor is authorized to have in a service in all necessary detail.</p> • Concept Properties: • internalId: 22338Concept Relationships: • Generalizes (derived): _AuthorizedReceiverParticipationFunction • Generalizes (derived): _ConsenterParticipationFunction • Generalizes (derived): _OverriderParticipationFunction • Generalizes (derived):Reviewer KC – could have truncated code, e.g., RWER but not necessary

  29. New ParticipationType/ParticipationFunction?ASSEMBLER [assembly software] • Business Need – convey Assembling Software that was used to generate Document or Entry • Could propose ASSEMBLER as new ParticipationType code but this would be an extension. • Proposed ASSEMBLER Definition: A device that operates on custodian’s algorithms for data extraction for purpose of generating an artifact.

  30. New ParticipationFunctionASSEMBLER [assembly software] Could make ParticipationFunction to SPECIALIZABLE CONCEPT: DEV (device) • Description: Participant used in performing the act without being substantially affected by the act (i.e. durable or inert with respect to that particular service). Examples: monitoring equipment, tools, but also access/drainage lines, prostheses, pace maker, etc.

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