 HL7 PA, R2-2010 HL7 Version 3 Standard: Patient Administration, DSTU Release 2 Update February 2010 Update to DSTU Release 2 |
Content Last Edited: 2011-06-17T13:44:56
11.2 Storyboards
11.3 Application Roles
11.4 Trigger Events
11.5 Refined Message Information Models
11.6 Hierarchical Message Descriptions
11.7 Interactions
This topic covers messages about changing attending practitioner responsibility during a patient encounter. This type of message would only be exchanged between systems that are closely coupled with respect to attending practitioner assignments so the information model consists of little more than identifiers for the encounter, patient and practitioners plus the time intervals for the attending practitioner participations. In HL7 version 2.x terms, these messages represent the ADT^A54 (change attending doctor) and the ADT^A55 (cancel change attending doctor) events.
Note that these interactions are only for reporting changes. The initial participation is created by the interaction that begins the encounter and the final participation is completed by the interaction that ends the encounter.
The Patient Administration work group chose to limit scope in this release by:
- Limiting storyboards to the simplest cases
- Excluding order/request messages
- Including notification messages only for changes of attending practitioner (see diagram below; the unsupported states and transitions are grayed out in the diagram).
The Patient Administration Technical Committee invites implementers with additional requirements to submit content proposals for future releases of the standard.
This document was previously published as DSTU in 2007 and it is being issued as an updated DSTU again due to the lack of feedback from implementers. The Patient Administration work group wants to hear from implementers regarding the suitability for use of this content.
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For details on the interpretation of this section, see the storyboard discussion in the Version 3 Guide.
This storyboard demonstrates changing the attending practitioner assignment during an encounter.
| Attending Practitioner Changed |  PRPA_IN301011UV02 |
Mr. Adam Everyman was admitted on Monday to the Good Health Hospital Inpatient Unit for his hip replacement surgery with Dr. Sara Specialize as his attending practitioner. Dr. Specialize was called out of town on a family emergency before arriving at the hospital on Tuesday morning. The active attending practitioner for Mr. Everyman's encounter was changed from Dr. Sara Specialize to Dr. Aaron Attending as of Tuesday morning, 7am [Interaction Attending Practitioner Changed].
This storyboard demonstrates canceling a reported change of attending practitioner during an encounter.
| Attending Practitioner Change Canceled | PRPA_IN301012UV02 |
Mr. Adam Everyman was an inpatient in the Good Health Hospital Inpatient Unit. Dr. Sara Specialize was his attending physician. Dr. Specialize was called out of town on an emergency so she arranged for Dr. Aaron Attending to take over as Mr. Everyman's attending physician. The clerk recorded the change of Mr. Everyman's attending practitioner but a few minutes later Dr. Specialize called back to say she would not be going out of town after all and would continue responsibility for her patients. The clerk reversed the change in attending practitioner [Interaction Attending Practitioner Change Canceled].
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For details on the interpretation of this section, see the discussion of application roles and their relationships in the Version 3 Guide.
An Attending Practitioner Change Informer sends notification when the attending practitioner responsible for an encounter changes. It can also send cancelation notification if a reported change did not take place.
An Attending Practitioner Change Tracker receives notification when the attending practitioner responsible for an encounter changes. It can also receive cancelation notification if a reported change did not take place.
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For details on the interpretation of this section, see the discussion of trigger events in the Version 3 Guide.
| Type: | State-transition based |
| State Transition: | attender2 (PRPA_RM301011UV02) |
| attender1 (PRPA_RM301011UV02) |
This trigger event signals transfer of attending practitioner responsibility for an encounter from one practitioner to another.
The Change Assigned Attending Practitioner trigger event is most closely aligned with the HL7 2.4 ADT^A54 - change attending doctor event.
| Type: | State-transition based |
| State Transition: | attender2 (PRPA_RM301011UV02) |
| attender1 (PRPA_RM301011UV02) |
This trigger event signals that a previously reported transfer of attending practitioner responsibility for an encounter from one practitioner to another did not take place. The previous Change Assigned Attending Practitioner action was reversed.
The Cancel Change Assigned Attending Practitioner trigger event is most closely aligned with the HL7 2.4 ADT^A55 - cancel change attending doctor event.
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For details on the interpretation of this section, see the description of RMIMs in the Version 3 Guide.
| Parent: | Patient Administration (PRPA_DM000000UV) |
The Attending Practitioner Change R-MIM defines the message used to report that attending practitioner responsibility has been transferred from one practitioner to another during an active encounter.
EncounterEvent
The entry point is the focal encounter, EncounterEvent. The R-MIM assumes attending practitioner change messages would be exchanged between systems that are closely coupled with respect to attending practitioner assignments so only EncounterEvent.id and the subject association to R_Patient [identified] CMET are sent about the encounter.
attender1
The attender1 class describes the attending practitioner for the encounter following the change action. The attributes statusCode (set to "active") and time (populated with the assignment start date-time) are mandatory. The practitioner is sent in an R_AssignedPerson CMET.
attender2
The attender2 class describes the attending practitioner for the encounter prior to the change action. The attributes statusCode (with a value other than "active") and time are mandatory. For a statusCode other than "nullified" the time attribute should contain the time range (starting and ending date-time) for the assignment. For a statusCode of "nullified" time would contain the start date-time reported in the record that was nullified. The practitioner is sent in an R_AssignedPerson CMET.
| Attending Practitioner Change | PRPA_HD301011UV02 |
| Parent: | Patient Administration (PRPA_DM000000UV) |
The Attending Practitioner Change Cancel R-MIM defines the message used to notify systems that a previous attending practitioner change notification was sent in error and has been reversed.
EncounterEvent
The entry point to the R-MIM is the focal encounter, EncounterEvent. The R-MIM assumes attending practitioner change messages would be exchanged between systems that are closely coupled with respect to attending practitioner assignments so only the id and code attributes and the subject association to R_Patient [identified] CMET are included.
attender1
The attender1 participation is the correct attending practitioner assignment for the encounter. The attributes statusCode (default of "active") and time (populated with the assignment start date-time) are mandatory. The modeCode attribute can convey how the practitioner is participating as attender; for example, physically present, via telephone, via written communication. The practitioner is sent in an R_AssignedPerson CMET.
attender2
The attender2 participation is the nullified (erroneously reported) attending practitioner assignment for the encounter. Either the id or the time attribute must be valued so the receiving system knows exactly which attender participation is being nullified.
| Attending Practitioner Change Canceled | PRPA_HD301012UV02 |
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For details on the interpretation of this section, see the description of HMDs in the Version 3 Guide.
| R_PatientIdentified | COCT_MT050001UV07 |
| R_AssignedPersonContact | COCT_MT090103UV01 |
| Attending Practitioner Change Canceled | PRPA_MT301012UV02 | |
This HMD defines the message used report that attending practitioner responsibility has changed during an active encounter.
| R_PatientIdentified | COCT_MT050001UV07 |
| R_AssignedPersonContact | COCT_MT090103UV01 |
| Attending Practitioner Changed | PRPA_MT301011UV02 | |
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For details on the interpretation of this section, see the definition of Interactions in the Version 3 Guide.
This interaction occurs after the attending practitioner responsibility for an encounter is transferred from one practitioner to another. An informer sends to a tracker a small message identifying the encounter, the patient, the previous attending practitioner and assignment time range, and the new attending practitioner and start time.
| Trigger Event | Attending Practitioner Changed | PRPA_TE301011UV02 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Attending Practitioner Changed | PRPA_MT301011UV02 |
| Sender | Attending Practitioner Change Informer | PRPA_AR301011UV02 |
| Receiver | Attending Practitioner Change Tracker | PRPA_AR301012UV02 |
This interaction occurs after a previously reported change of attending practitioner is canceled. An informer sends to a tracker a small message identifying the encounter, the patient, the attending practitioner assignment to be reactivated, and attending practitioner assignment to be nullified.
| Trigger Event | Attending Practitioner Change Canceled | PRPA_TE301012UV02 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Attending Practitioner Change Canceled | PRPA_MT301012UV02 |
| Sender | Attending Practitioner Change Informer | PRPA_AR301011UV02 |
| Receiver | Attending Practitioner Change Tracker | PRPA_AR301012UV02 |
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