ActClass    

A code specifying the major type of Act that this Act-instance represents.

Constraints: The classCode domain is a tightly controlled vocabulary, not an external or user-defined vocabulary.

Every Act-instance must have a classCode. If the act class is not further specified, the most general Act.classCode (ACT) is used.

The Act.classCode must be a generalization of the specific Act concept (e.g., as expressed in Act.code), in other words, the Act concepts conveyed in an Act must be specializations of the Act.classCode. Especially, Act.code is not a "modifier" that can alter the meaning of a class code. (See Act.code for contrast.)

This table controls values for structural elements of the HL7 Reference Information Model. Therefore, it is part of the Normative Ballot for the RIM.

This concept represents a domain containing all possible values of the ActClass code. system

An agreement of obligation between two or more parties that is subject to contractual law and enforcement.

A contract whose value is measured in monetary terms.

A health care insurance policy or plan that is contractually binding between two or more parties.

An act representing a system action such as the change of state of another act or the initiation of a query. All control acts represent trigger events in the HL7 context. ControlActs may occur in different moods.

Sender asks addressee to do something depending on the focal Act of the payload. An example is "fulfill this order". Addressee has responsibilities to either reject the message or to act on it in an appropriate way (specified by the specific receiver responsibilities for the interaction).

Sender sends payload to addressee as information. Addressee does not have responsibilities beyond serving addressee's own interest (i.e., read and memorize if you see fit). This is equivalent to an FYI on a memo.

Sender transmits a status change pertaining to the focal act of the payload. This status of the focal act is the final state of the state transition. This can be either a request or a command, according to the mood of the control act.

Observations are actions performed in order to determine an answer or result value. Observation result values (Observation.value) include specific information about the observed object. The type and constraints of result values depend on the kind of action performed.

Clinical documents commonly have 'Subjective' and 'Objective' findings, both of which are kinds of Observations. In addition, clinical documents commonly contain 'Assessments', which are also kinds of Observations. Thus, the establishment of a diagnosis is an Observation.

An observable finding or state that persists over time and tends to require intervention or management, and, therefore, distinguished from an Observation made at a point in time; may exist before an Observation of the Condition is made or after interventions to manage the Condition are undertaken. Examples: equipment repair status, device recall status, a health risk, a financial risk, public health risk, pregnancy, health maintenance, chronic illness

A public health case is an Observation representing a condition or event that has a specific significance for public health. Typically it involves an instance or instances of a reportable infectious disease or other condition. The public health case can include a health-related event concerning a single individual or it may refer to multiple health-related events that are occurrences of the same disease or condition of interest to public health. An outbreak involving multiple individuals may be considered as a type of public health case. A public health case definition (Act.moodCode = "definition") includes the description of the clinical, laboratory, and epidemiologic indicators associated with a disease or condition of interest to public health. There are case definitions for conditions that are reportable, as well as for those that are not. There are also case definitions for outbreaks. A public health case definition is a construct used by public health for the purpose of counting cases, and should not be used as clinical indications for treatment. Examples include AIDS, toxic-shock syndrome, and salmonellosis and their associated indicators that are used to define a case.

An outbreak represents a series of public health cases. The date on which an outbreak starts is the earliest date of onset among the cases assigned to the outbreak, and its ending date is the last date of onset among the cases assigned to the outbreak.

Container for Correlated Observation Sequences sharing a common frame of reference. All Observations of the same cd must be comparable and relative to the common frame of reference. For example, a 3-channel ECG device records a 12-lead ECG in 4 steps (3 leads at a time). Each of the separate 3-channel recordings would be in their own "OBSCOR". And, all 4 OBSCOR would be contained in one OBSSER because all the times are relative to the same origin (beginning of the recording) and all the ECG signals were from a fixed set of electrodes.

Container for Observation Sequences (Observations whose values are contained in LIST<>'s) having values correlated with each other. Each contained Observation Sequence LIST<> must be the same length. Values in the LIST<>'s are correlated based on index. E.g. the values in position 2 in all the LIST<>'s are correlated. This is analogous to a table where each column is an Observation Sequence with a LIST<> of values, and each row in the table is a correlation between the columns. For example, a 12-lead ECG would contain 13 sequences: one sequence for time, and a sequence for each of the 12 leads.

Regions of Interest (ROI) within a subject Act. Primarily used for making secondary observations on a subset of a subject observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.

A Region of Interest (ROI) specified for a multidimensional observation, such as an Observation Series (OBSSER). The ROI is specified using a set of observation criteria, each delineating the boundary of the region in one of the dimensions in the multidimensional observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type subject (SUBJ), which must always be present. Each of the boundary criteria observations is connected with the ROI using ActRelationships of type "has component" (COMP). In each boundary criterion, the Act.code names the dimension and the Observation.value specifies the range of values inside the region. Typically the bounded dimension is continuous, and so the Observation.value will be an interval (IVL) data type. The Observation.value need not be specified if the respective dimension is only named but not constrained. For example, an ROI for the QT interval of a certain beat in ECG Lead II would contain 2 boundary criteria, one naming the interval in time (constrained), and the other naming the interval in ECG Lead II (only named, but not constrained).

A Region of Interest (ROI) specified for an image using an overlay shape. Typically used to make reference to specific regions in images, e.g., to specify the location of a radiologic finding in an image or to specify the site of a physical finding by "circling" a region in a schematic picture of a human body. The units of the coordinate values are in pixels. The origin is in the upper left hand corner, with positive X values going to the right and positive Y values going down. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.

An observation identifying a potential adverse outcome as a result of an Act or combination of Acts.

Examples: Detection of a drug-drug interaction; Identification of a late-submission for an invoice; Requesting discharge for a patient who does not meet hospital-defined discharge criteria.

Discussion: This class is commonly used for identifying 'business rule' or 'process' problems that may result in a refusal to carry out a particular request. In some circumstances it may be possible to 'bypass' a problem by modifying the request to acknowledge the issue and/or by providing some form of mitigation.

Constraints: the Act or Acts that may cause the the adverse outcome are the target of a subject ActRelationship. The subbtypes of this concept indicate the type of problem being detected (e.g. drug-drug interaction) while the Observation.value is used to repesent a specific problem code (e.g. specific drug-drug interaction id).

The set of actions that define an experiment to assess the effectiveness and/or safety of a biopharmaceutical product (food, drug, device, etc.). In definition mood, this set of actions is often embodied in a clinical trial protocol; in event mood, this designates the aggregate act of applying the actions to one or more subjects.

An instance of Observation of a Condition at a point in time that includes any Observations or Procedures associated with that Condition as well as links to previous instances of Condition Node for the same Condition

Class for holding attributes unique to diagnostic images.

An official inquiry into the circumstances surrounding a particular unplanned event or potential event for the purposes of identifying possible causes and contributing factors for the event. This investigation could be conducted at a local institutional level or at the level of a local or national government.

An observation on a specimen in a laboratory environment that may affect processing, analysis or result interpretation

Supply orders and deliveries are simple Acts that focus on the delivered product. The product is associated with the Supply Act via Participation.typeCode="product". With general Supply Acts, the precise identification of the Material (manufacturer, serial numbers, etc.) is important. Most of the detailed information about the Supply should be represented using the Material class. If delivery needs to be scheduled, tracked, and billed separately, one can associate a Transportation Act with the Supply Act. Pharmacy dispense services are represented as Supply Acts, associated with a SubstanceAdministration Act. The SubstanceAdministration class represents the administration of medication, while dispensing is supply.

Diet services are supply services, with some aspects resembling Medication services: the detail of the diet is given as a description of the Material associated via Participation.typeCode="product". Medically relevant diet types may be communicated in the Diet.code attribute using domain ActDietCode, however, the detail of the food supplied and the various combinations of dishes should be communicated as Material instances.

Used to group a set of acts sharing a common context. Container structures can nest within other context structures - such as where a document is contained within a folder, or a folder is contained within an EHR extract.

Open issue: There is a clear conflict between this act and the use of the more general "component" ActRelationship. The question that must be resolved is what should be the class code of the parent (or containing) Act.

A context representing a grouped commitment of information to the EHR. It is considered the unit of modification of the record, the unit of transmission in record extracts, and the unit of attestation by authorizing clinicians.

A composition represents part of a patient record originating from a single interaction between an authenticator and the record.

Unless otherwise stated all statements within a composition have the same authenticator, apply to the same patient and were recorded in a single session of use of a single application.

A composition contains organizers and entries.

The notion of a document comes particularly from the paper world, where it corresponds to the contents recorded on discrete pieces of paper. In the electronic world, a document is a kind of composition that bears resemblance to their paper world counter-parts. Documents typically are meant to be human-readable.

HL7's notion of document differs from that described in the W3C XML Recommendation, in which a document refers specifically to the contents that fall between the root element's start-tag and end-tag. Not all XML documents are HL7 documents.

A clinical document is a documentation of clinical observations and services, with the following characteristics:

1. Persistence - A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements;

2. Stewardship - A clinical document is maintained by a person or organization entrusted with its care;

3. Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated;

4. Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without the full context of the document;

5. Human readability - A clinical document is human readable.

A clinical document that conforms to Level One of the HL7 Clinical Document Architecture (CDA)

This context represents the information acquired and recorded for an observation, a clinical statement such as a portion of the patient's history or an inference or assertion, or an action that might be intended or has actually been performed. This class may represent both the actual data describing the observation, inference, or action, and optionally the details supporting the clinical reasoning process such as a reference to an electronic guideline, decision support system, or other knowledge reference.

A battery specifies a set of observations. These observations typically have a logical or practical grouping for generally accepted clinical or functional purposes, such as observfations that are fun together because of automation. A battery can define required and optional components and, in some cases, will define complex rules that determine whether or not a particular observation is made. Examples include "Blood pressure", "Full blood count", "Chemistry panel".

A group of entries within a composition, topic or category that have a logical association with one another.

The representation of a single observation or action might itself be multi-part. The data might need to be represented as a nested set of values, as a table, list, or as a time series. The Cluster class permits such aggregation within an entry for such compound data.

Examples include "Haematology investigations" which might include two or more distinct batteries.

A cluster may contain batteries and/or individual entries

This context represents the part of a patient record conveyed in a single communication. It is drawn from a providing system for the purposes of communication to a requesting process (which might be another repository, a client application or a middleware service such as an electronic guideline engine), and supporting the faithful inclusion of the communicated data in the receiving system.

An extract may be the entirety of the patient record as held by the sender or it may be a part of that record (e.g. changes since a specified date).

An extract contains folders or compositions.

An extract cannot contain another extract.

A context that comprises all compositions. The EHR is an extract that includes the entire chart.

NOTE: In an exchange scenario, an EHR is a specialization of an extract.

Organizer of entries. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "organizer tree".

The record entries relating to a single clinical session are usually grouped under headings that represent phases of the encounter, or assist with layout and navigation. Clinical headings usually reflect the clinical workflow during a care session, and might also reflect the main author's reasoning processes. Much research has demonstrated that headings are used differently by different professional groups and specialties, and that headings are not used consistently enough to support safe automatic processing of the E H R.

A group of entries within a composition or topic that have a common characteristic - for example, Examination, Diagnosis, Management OR Subjective, Objective, Analysis, Plan.

The distinction from Topic relates to value sets. For Category there is a bounded list of things like "Examination", "Diagnosis" or SOAP categories. For Topic the list is wide open to any clinical condition or reason for a part of an encounter.

A CATEGORY MAY CONTAIN ENTRIES.

A context that distinguishes the body of a document from the document header. This is seen, for instance, in HTML documents, which have discrete qltqhead> and qltqbody> elements.

A context that subdivides the body of a document. Document sections are typically used for human navigation, to give a reader a clue as to the expected content. Document sections are used to organize and provide consistency to the contents of a document body. Document sections can contain document sections and can contain entries.

A group of entries within a composition that are related to a common clinical theme - such as a specific disorder or problem, prevention, screening and provision of contraceptive services.

A topic may contain categories and entries.

A context representing the high-level organization of an extract e.g. to group parts of the record by episode, care team, clinical specialty, clinical condition, or source application. Internationally, this kind of organizing structure is used variably: in some centers and systems the folder is treated as an informal compartmentalization of the overall health record; in others it might represent a significant legal portion of the EHR relating to the originating enterprise or team.

A folder contains compositions.

Folders may be nested within folders.

This concept represents a domain containing all possible values of the ActClass code. system

An accommodation is a service provided for a Person or other LivingSubject in which a place is provided for the subject to reside for a period of time. Commonly used to track the provision of ward, private and semi-private accommodations for a patient.

The Consent class represents informed consents and all similar medico-legal transactions between the patient (or his legal guardian) and the provider. Examples are informed consent for surgical procedures, informed consent for clinical trials, advanced beneficiary notice, against medical advice decline from service, release of information agreement, etc.

The details of consents vary. Often an institution has a number of different consent forms for various purposes, including reminding the physician about the topics to mention. Such forms also include patient education material. In electronic medical record communication, consents thus are information-generating acts on their own and need to be managed similar to medical activities. Thus, Consent is modeled as a special class of Act.

The "signatures" to the consent document are represented electronically through Participation instances to the consent object. Typically an informed consent has Participation.typeCode of "performer", the healthcare provider informing the patient, and "consenter", the patient or legal guardian. Some consent may associate a witness or a notary public (e.g., living wills, advanced directives). In consents where a healthcare provider is not required (e.g. living will), the performer may be the patient himself or a notary public.

Some consent has a minimum required delay between the consent and the service, so as to allow the patient to rethink his decisions. This minimum delay can be expressed in the act definition by the ActRelationship.pauseQuantity attribute that delays the service until the pause time has elapsed after the consent has been completed.

An identified point during a clinical trial at which one or more actions are scheduled to be performed (definition mood), or are actually performed (event mood). The actions may or may not involve an encounter between the subject and a healthcare professional.

An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.

The act of transmitting information and understanding about a topic to a subject.

Discussion: This act may be used to request that a patient or provider be informed about an Act, or to indicate that a person was informed about a particular act.

A care provision is the taking on of the responsibility by a performer for care activities of a subject of care.

Discussion: The care event can exist without any care actions having taken place. The scope of the care is identified by Act.code.

Examples

1. preferred primary care provision: the primary care physician being the primary performer participation, author being the patient

2. referral from general practitioner to specialist (a PCPR in request mood, where the author participant is the GP, and the primary performer participation is the specialist)

3. a case manager to a patient or group of patients

4. care of a herd of animals

5. care of a contaminated environmental site

6. care of a device

Represents the act of maintaining information about the registration of its associated registered subject. The subject can be either an Act or a Role, and includes subjects such as lab exam definitions, drug protocol definitions, prescriptions, persons, patients, practitioners, and equipment.

Usage notes: The registration may have a unique identifier - separate from the unique identification of the subject - as well as a core set of related participations and act relationships that characterize the registration event and aid in the disposition of the subject information by a receiving system.

A procedure or treatment performed on a specimen to prepare it for analysis

A battery specifies a set of observations. These observations typically have a logical or practical grouping for generally accepted clinical or functional purposes, such as observfations that are fun together because of automation. A battery can define required and optional components and, in some cases, will define complex rules that determine whether or not a particular observation is made. Examples include "Blood pressure", "Full blood count", "Chemistry panel".

A group of entries within a composition, topic or category that have a logical association with one another.

The representation of a single observation or action might itself be multi-part. The data might need to be represented as a nested set of values, as a table, list, or as a time series. The Cluster class permits such aggregation within an entry for such compound data.

Examples include "Haematology investigations" which might include two or more distinct batteries.

A cluster may contain batteries and/or individual entries

An accommodation is a service provided for a Person or other LivingSubject in which a place is provided for the subject to reside for a period of time. Commonly used to track the provision of ward, private and semi-private accommodations for a patient.

A financial account established to track the net result of financial acts.

A unit of work, a grouper of work items as defined by the system performing that work. Typically some laboratory order fulfillers communicate references to accessions in their communications regarding laboratory orders. Often one or more specimens are related to an accession such that in some environments the accession number is taken as an identifier for a specimen (group).

A transformation process where a requested invoice is transformed into an agreed invoice. Represents the adjudication processing of an invoice (claim). Adjudication results can be adjudicated as submitted, with adjustments or refused.

Adjudication results comprise 2 components: the adjudication processing results and a restated (or adjudicated) invoice or claim

The Consent class represents informed consents and all similar medico-legal transactions between the patient (or his legal guardian) and the provider. Examples are informed consent for surgical procedures, informed consent for clinical trials, advanced beneficiary notice, against medical advice decline from service, release of information agreement, etc.

The details of consents vary. Often an institution has a number of different consent forms for various purposes, including reminding the physician about the topics to mention. Such forms also include patient education material. In electronic medical record communication, consents thus are information-generating acts on their own and need to be managed similar to medical activities. Thus, Consent is modeled as a special class of Act.

The "signatures" to the consent document are represented electronically through Participation instances to the consent object. Typically an informed consent has Participation.typeCode of "performer", the healthcare provider informing the patient, and "consenter", the patient or legal guardian. Some consent may associate a witness or a notary public (e.g., living wills, advanced directives). In consents where a healthcare provider is not required (e.g. living will), the performer may be the patient himself or a notary public.

Some consent has a minimum required delay between the consent and the service, so as to allow the patient to rethink his decisions. This minimum delay can be expressed in the act definition by the ActRelationship.pauseQuantity attribute that delays the service until the pause time has elapsed after the consent has been completed.

An Act where a container is registered either via an automated sensor, such as a barcode reader, or by manual receipt

An identified point during a clinical trial at which one or more actions are scheduled to be performed (definition mood), or are actually performed (event mood). The actions may or may not involve an encounter between the subject and a healthcare professional.

An action taken with respect to a subject Entity by a regulatory or authoritative body with supervisory capacity over that entity. The action is taken in response to behavior by the subject Entity that body finds to be undesirable.

Examples: Suspension, license restrictions, monetary fine, letter of reprimand, mandated training, mandated supervision, etc.

An interaction between a patient and healthcare participant(s) for the purpose of providing patient service(s) or assessing the health status of a patient. For example, outpatient visit to multiple departments, home health support (including physical therapy), inpatient hospital stay, emergency room visit, field visit (e.g., traffic accident), office visit, occupational therapy, telephone call.

An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.

The act of transmitting information and understanding about a topic to a subject.

Discussion: This act may be used to request that a patient or provider be informed about an Act, or to indicate that a person was informed about a particular act.

Represents concepts related to invoice processing in health care

Working list collects a dynamic list of individual instances of Act via ActRelationship which reflects the need of an individual worker, team of workers, or an organization to manage lists of acts for many different clinical and administrative reasons. Examples of working lists include problem lists, goal lists, allergy lists, and to-do lists.

An officially or unofficially instituted program to track acts of a particular type or categorization.

A care provision is the taking on of the responsibility by a performer for care activities of a subject of care.

Discussion: The care event can exist without any care actions having taken place. The scope of the care is identified by Act.code.

Examples

1. preferred primary care provision: the primary care physician being the primary performer participation, author being the patient

2. referral from general practitioner to specialist (a PCPR in request mood, where the author participant is the GP, and the primary performer participation is the specialist)

3. a case manager to a patient or group of patients

4. care of a herd of animals

5. care of a contaminated environmental site

6. care of a device

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Represents the act of maintaining information about the registration of its associated registered subject. The subject can be either an Act or a Role, and includes subjects such as lab exam definitions, drug protocol definitions, prescriptions, persons, patients, practitioners, and equipment.

Usage notes: The registration may have a unique identifier - separate from the unique identification of the subject - as well as a core set of related participations and act relationships that characterize the registration event and aid in the disposition of the subject information by a receiving system.

The act of examining and evaluating the subject, usually another act. For example, "This prescription needs to be reviewed in 2 months."

The act of introducing or otherwise applying a substance to the subject.

Discussion: The effect of the substance is typically established on a biochemical basis, however, that is not a requirement. For example, radiotherapy can largely be described in the same way, especially if it is a systemic therapy such as radio-iodine. This class also includes the application of chemical treatments to an area.

Examples: Chemotherapy protocol; Drug prescription; Vaccination record

A procedure or treatment performed on a specimen to prepare it for analysis

Definition: Indicates that the subject Act has undergone or should undergo substitution of a type indicated by Act.code.

Rationale: Used to specify "allowed" substitution when creating orders, "actual" susbstitution when sending events, as well as the reason for the substitution and who was responsible for it.

Transportation is the moving of a payload (people or material) from a location of origin to a destination location. Thus, any transport service has the three target instances of type payload, origin, and destination, besides the targets that are generally used for any service (i.e., performer, device, etc.)

An act which describes the process whereby a 'verifying party' validates either the existence of the Role attested to by some Credential or the actual Vetting act and its details.

A sub-class of Act representing any transaction between two accounts whose value is measured in monetary terms.

In the "intent" mood, communicates a request for a transaction to be initiated, or communicates a transfer of value between two accounts.

In the "event" mood, communicates the posting of a transaction to an account.