A record of something that is being done, has been done, can be done, or is intended or requested to be done.

See RIM class Act.

Rationale: Provides an abstract root class for laboratory observations

A notification used to indicate whether a request or inquiry has been confirmed.

A notification used to indicate whether an intent to perform a billable act has been approved for coverage under the terms of an insurance plan or policy.

A notification used to indicate whether a beneficiary is eligible for coverage under the terms of an insurance plan or policy.

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

Examples: Employment agreement; Confidentiality agreement; Insurance coverage

A contract whose value is measured in monetary terms.

Examples: Insurance; Purchase agreement

An insurance policy or plan that is contractually binding between two or more parties.

Examples: Dental coverage; Health plan; Coverage extension

An act covering the core information for all acts primarily related to money and finance.

Discussion: This class is 'abstract' and is not intended to be implemented directly. More specialized classes (or classCodes) are used to address specific concepts such as accounts, insurance and financial transactions

An Act representing a statement and justification of an 'amount owed'.

Discussion: This represents the 'justification' portion of an invoice. It is frequently combined with a financial transaction representing the amount requested to be paid/agreed to be paid or actually paid.

A recursive relationship can be used to break a single InvoiceElement into constituent elements.

In definition mood, it represents 'possible' justification for future billing. In request mood it is a request to determine the amount owed. In event mood, this class represents the determination of a specific amount owed by a particular Entity.

A piece of supporting information or detail that does not alter the financial total of an invoice.

An Act representing a category of financial transactions that are tracked and reported together with a single balance.

Discussion:

This can be used to represent the accumulated total of billable amounts for goods or services received, payments made for goods or services, and debit and credit accounts between which financial transactions flow.

Examples: Patient accounts; Encounter accounts; Cost centers; Accounts receivable

This type covers both the healthcare benefit product policy, and the coverage item, until such time as the mapping is complete.

An act covering the core information for all acts primarily related to money and finance.

Discussion: This class is 'abstract' and is not intended to be implemented directly. More specialized classes (or classCodes) are used to address specific concepts such as accounts, insurance and financial transactions

An Act of recognizing and noting information about the subject, and whose immediate and primary outcome (post-condition) is new data about a subject. Observations often involve measurement or other elaborate methods of investigation, but may also be simply assertive statements.

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.

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.

The Referenced_coordinate class is used to make reference to specific coordinates in images, waveforms or other datasets, for example, to specify the location of a radiologic finding or to identify the region on which a finding was based. For instance, clinicians can include graphical images in their notes, and "circle" a particular region of interest. This region of interest is than specifically referred to in their note. The relationship between a Referenced_coordinate and its referenced image is specified through an ActRelationship (using an ActRelationship.typeCode value of "REFV"). Referenced_coordinates are only meaningful in connection with a data object whose contents they reference. The units of the coordinate values are those of the referenced data object. For example, if the referenced object is a bitmapped image, the coordinates would be in pixel units. The presence of scaling parameters as attributes in a bitmapped image does not change the sampling coordinates: they remain in units of pixels. If the referenced object is a vector graphic figure specified in centimeters, the coordinate values are specified in centimeters.

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 multideimensional 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 to be 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 EKG 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.)

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.

An observation identifying a potential negative occurrence as a result of an Act or combination of Acts.

Observation on a condition at a point in time that includes any observations or procedures associated with that condition as well as links to previous conditions nodes on a related condition

Experience or observable finding persistent over time that tends to require intervention or management; more complex than a simple observation made at a point in time; may exist before an observation or intervention is made; Examples: a health risk, a financial risk, public health risk, pregnancy, health maintenance, illness

Class for holding attributes unique to diagnostic images.

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

The Referenced_coordinate class is used to make reference to specific coordinates in images, waveforms or other datasets, for example, to specify the location of a radiologic finding or to identify the region on which a finding was based. For instance, clinicians can include graphical images in their notes, and "circle" a particular region of interest. This region of interest is than specifically referred to in their note. The relationship between a Referenced_coordinate and its referenced image is specified through an ActRelationship (using an ActRelationship.typeCode value of "REFV"). Referenced_coordinates are only meaningful in connection with a data object whose contents they reference. The units of the coordinate values are those of the referenced data object. For example, if the referenced object is a bitmapped image, the coordinates would be in pixel units. The presence of scaling parameters as attributes in a bitmapped image does not change the sampling coordinates: they remain in units of pixels. If the referenced object is a vector graphic figure specified in centimeters, the coordinate values are specified in centimeters.

An act that involves transfer of a material from one entity to another. It does not necessarily involve a transfer of ownership.

Discussion: 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.

Examples: Ordering bed sheets; Dispensing of a drug; Issuing medical supplies from storage

An Act representing a statement and justification of an 'amount owed'.

Discussion: This represents the 'justification' portion of an invoice. It is frequently combined with a financial transaction representing the amount requested to be paid/agreed to be paid or actually paid.

A recursive relationship can be used to break a single InvoiceElement into constituent elements.

In definition mood, it represents 'possible' justification for future billing. In request mood it is a request to determine the amount owed. In event mood, this class represents the determination of a specific amount owed by a particular Entity.

A dynamic list of individual instances of Act which reflect the needs of an individual worker, team of workers, or an organization to view groups of Acts for clinical or administrative reasons.

Discussion: The grouped Acts are related to the WorkingList via an ActRelationship of type 'COMP' (component).

Examples:problem lists, goal lists, allergy lists, to-do lists, etc.

OpenIssue: The name is too generic. This needs to be harmonized with Scheduling.

A collections of any kinds of services as issues that need to be resolved.

A patient's goal list as seen by a particular provider.

A patient's problem list as seen by a particular provider.

A diary of past services.

A work-list, a schedule, or a personal to-do list of items intended to be done.

A structure is a container within a document. Structures have captions which can be coded. Structures can nest, and structures can contain entries.

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)

A list of items

Specifies whether a list is "ordered" or "unordered". Use an ordered list when the ordering of list items is meaningful.

A table structure is either a column structure, a row structure, or a table cell.

A cell in a table.

A data cell in a table

A header cell in a table

A table column or column group.

A column in a table

A defined group of columns in a table

A table row

A defined group of rows in a table

Segment types specify table header, table footer, or table body, as defined within the XHTML 4.0 Table Model

Table body, as defined within the XHTML 4.0 Table Model

Table footer, as defined within the XHTML 4.0 Table Model

Table header, as defined within the XHTML 4.0 Table Model

A row in a table

Represents the body of a document on the Clinical Document Architecture standards.

A non-semantic wrapper for plain text in a clinical document

An item in a list

A paragraph in a clinical document

Represents a section in a document on the Clinical Document Architecture standards.

A container consisting of multiple cells arranged in rows and columns.

A link using an HTML anchor tag

An XML attribute used when local semantics have no corresponding representation in the CDA specification

XML markup used when local semantics have no corresponding representation in the CDA specification.

An act in which a place is provided for the subject to reside for a period of time.

Discussion: This is commonly used to track the provision of ward, private and semi-private accommodations for a patient as part of an inpatient encounter.

A unit of work, a grouper of work items as defined by the system performing that work.

Discussion: Some laboratory order fulfillers typically 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 an invoice that has been submitted is transformed into an invoice that is agreed to be paid.

Discussion: An Adjudication represents the adjudication processing of an invoice (claim). Adjudication transformation types include: "adjudicated as submitted", "adjudicated with adjustments" or "refused".

Adjudication results generally contain two components: the adjudication event (representing the transformation that occurred) and a restated (or adjudicated) invoice or claim.

An act representing a system action such as the change of state of another act or the initiation of a query.

Discussion: All control acts represent trigger events in the HL7 context. ControlActs may occur in different moods. Order mood is used for requests. Promise mood is used for accept acknowledgments. Event is used for notifications. Proposed is used for suggestions.

Control acts are always related to their subject act with an ActRelationship of ITGT (interaction target). The ControlAct.code is the trigger event that has occurred.

Control acts may also be used to show the 'event history' of a particular act by providing a set of ActRelationships pointing to ControlActs hanging off of a source act. Each control act represents a transaction that has been performed on that act.

Examples: Notify about the discharge a patient; Suggest the renewal of a prescription; Request a lab test

An informed agreement whereby a subject (or responsible agent) agrees to an action being performed.

Examples: consent for surgical procedures, consent for clinical trials, advanced beneficiary notice, against medical advice decline from service, release of information agreement, etc.

Discussion: 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.

Consents may also be used between providers or other non-patients.

Rationale: 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 are information-generating acts and need to be managed similar to medical activities. Thus, Consent is modeled as a special class of Act.

An activity of an automated system.

Discussion: Such activities are invoked either by an outside command or are scheduled and executed spontaneously by the device (e.g., regular calibration or flushing.) The command to execute the task has moodCode &lt;= ORD; an executed task (including a task in progress) has moodCode &lt;= EVN, an automatic task on the schedule has moodCode &lt;= APT.

An interaction between a patient and care provider(s) for the purpose of providing healthcare-related service(s). Healthcare services include health assessment.

Examples: 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.

Examples: adverse patient events, workplace accidents, etc.

A practitioner designated by a person as their healthcare practioner of preference (independent of any particular healthcare organization).

A practitioner who is responsible for managing and/or coordinating the healthcare of a patient (for a period of time longer than an individual patient encounter) with respect to a single healthcare organization.

A planned alteration or manipulation of the structure of the body. This may require the disruption of some body surface, usually through an incision (i.e. "surgical procedure" or "operative procedure").

Examples: Appendectomy, Back massage, Dental filling

An introduction of a patient from a source caregiver to a target caregiver or provider institution, typically for the purpose of obtaining the target caregiver's assessment and treatment recommendations.

Discussion: A referral may be accompanied by an authorizion for specified quantity of a particular kind or level of service. A referral may also simply be a recommendation or introduction.

Examples: Referral for specialist consultation, referral for second opinion

Represents the act of maintaining information about an entity or role in a registry.

The class is most general, designed to support a variety of registries for persons, patients, practitioners, equipment, etc. If required, specific registry types will be treated as specializations of this class.

Examples: Patient registry, provider registry, facility registry, lab test definition registry

An act involving the introduction of a generally therapeutic material into or onto a subject.

Discussion: The effect of the therapeutic 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

Examples: Antibiotic Removal Device (ARD); Incubation; Precipitation via centrifuge.

The moving of a payload (people or material) from a location of origin to a destination location.

Discussion: Any transport service usually has at least the three main participations of payload, origin, and destination, in addition to the participations that are generally used for any act (i.e., performer, device, etc.)