From: George Beeler [woody@beelers.com]
Sent: Saturday, May 10, 2003 2:30 PM
To: 'HL7-MNM list'
Subject: Harmonization Proposal for May 16, 2003

This proposal comes jointly from Woody Beeler (for M&M) and Heath Frankel,
of Patient Care.  On Thursday, May 1, in Cleveland, the Harmonization
proposed a change to the code and definition of the old "order (ORD)" mood
code.  This is a proposal to alter the code adopted on May 1 and provide
additional rationale in the definition.

The purpose of this amendment is to make it more clear that the change on
May 1 does NOT replace "order."  Indeed the objective of the May 1 change is
to make it clear that the concept has always represented both the concept of
"order" and "request."  We believe that the changes proposed here will make
this intention even more clear and will make it easier for people newly
introduced to the concept to understand it.   

In the following, we list the concept as it is currently represented, based
on the changes approved May 1, and then the proposed change.  (Note that the
core definition is unaltered.)  We wish this to be reviewed on the May 16,
2003 conference call in order that we can proceed to complete the
"normative" RIM.

CURRENT
=======
Code: REQ

PrintName: request

Description:

"A request or order for a service is an intent directed from a placer
(request author) to a fulfiller (service performer).

Discussion: It was decide that across realms that a stronger intent to
request, order was too subjective and is covered sufficiently under the
description of order."

PROPOSED CHANGE
===============
Code: RQO

PrintName: request

Description:
"A request or order for a service is an intent directed from a placer
(request author) to a fulfiller (service performer).

"Rationale: The concepts of a "request" and an "order" are viewed as
different, because there is an implication of a mandate associated with
order.  In practice, however, this distinction has no general functional
value in the inter-operation of health care computing.  "Orders" are
commonly refused for a variety of clinical and business reasons, and the
notion of a "request" obligates the recipient (the fulfiller) to respond to
the sender (the author).  Indeed, in many regions, including Australia and
Europe, the common term used is "request."

"Thus, the concept embodies both notions, as there is no useful distinction
to be made.  If a mandate is to be associated with a request, this will be
embodied in the "local" business rules applied to the transactions.  Should
HL7 desire to provide a distinction between these in the future, the
individual concepts could be added as specializations of this concept.

"The critical distinction here, is the difference between this concept and
an "intent", of which it is a specialization.  An intent involves decisions
by a single party, the author.  A request, however, involves decisions by
two parties, the author and the fulfiller, with an obligation on the part of
the fulfiller to respond to the request indicating that the fulfiller will
indeed fulfill the request."


George W. Beeler, Jr. Ph.D.
M&M

Heath Frankel 
Facilitator Patient Care

 



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