 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
13.2 Storyboards
13.3 Application Roles
13.4 Trigger Events
13.5 Refined Message Information Models
13.6 Hierarchical Message Descriptions
13.7 Interactions
This topic covers messages about changing responsibility for clinical care of the patient from one organization to another during a patient encounter. This type of message would only be exchanged between systems that are closely coupled with respect to responsible organization assignments so the information model consists of little more than identifiers for the encounter, patient and organizations plus the time intervals for the responsible organization assignments. HL7 version 2.x does not include any equivalent 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 responsible organization (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 organization holding clinical responsibility during an encounter
| Responsible Organization Changed |  PRPA_IN303011UV02 |
Mr. Adam Everyman was admitted on Monday to the Good Health Hospital Inpatient Unit for his hip replacement surgery as an Orthopedic Service patient. Several days after his surgery, his attending physician determined that Mr. Adam Everyman should be transferred to the Rehabilitation Medicine Service before being discharged [Interaction Responsible Organization Changed].
This storyboard demonstrates canceling a reported change of responsible organization during an encounter.
| Responsible Organization Change Canceled | PRPA_IN303012UV02 |
Mr. Adam Everyman was an inpatient in the Good Health Hospital Inpatient as an Orthopedic Service patient. Several days after his hip replacement surgery, his attending physician determined that Mr. Everyman should be transferred to the Rehabilitation Medicine Service to complete his recovery. The clerk recorded the organization responsible for Mr. Everyman's care changed from Orthopedic Service to Rehabilitation Medicine Service. But, Mr. Everyman developed a fever and his attending physician canceled the change. The clerk reversed the transfer to the Rehabilitation Medicine Service organization [Interaction Responsible Organization 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.
A Responsible Organization Informer sends notification messages about responsible organization changes for a patient encounter.
A Responsible Organization Tracker receives notification messages about responsible organization changes for a patient encounter.
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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: | responsibleParty2 (PRPA_RM303011UV02) |
| responsibleParty1 (PRPA_RM303011UV02) |
This trigger event signals transfer of organizational responsibility for a patient encounter from one organization to another.
The Change Assigned Responsible Organization trigger event is most closely aligned with the ADT^A08 event sent when the Hospital Service changes during an encounter.
| Type: | State-transition based |
| State Transition: | responsibleParty2 (PRPA_RM303011UV02) |
| responsibleParty1 (PRPA_RM303011UV02) |
This trigger event signals that a previously-reported transfer of encounter organization responsibility for an encounter from one organization to another did not take place. The previous Change Assigned Responsible Organization action was reversed.
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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 Responsible Organization Change R-MIM defines the message used to report that responsibility for clinical care of the patient has been transferred from one organization to another during an active encounter.
EncounterEvent
The entry point is the focal encounter, EncounterEvent. The R-MIM assumes responsible organization change messages would be exchanged between systems that are closely coupled with respect to responsible organization assignments so only EncounterEvent.id and the subject association to R_Patient [identified] CMET are sent about the encounter.
responsibleParty1
The responsibleParty1 class describes the organization responsible 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 organization is sent in an R_AssignedOrganization CMET.
responsibleParty2
The responsibleParty2 class describes the organization responsible 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 organization is sent in an R_AssignedOrganization CMET.
| Responsible Organization Change | PRPA_HD303011UV02 |
| Parent: | Patient Administration (PRPA_DM000000UV) |
The Responsible Organization Change Cancel R-MIM defines the message used to notify systems that a previous responsible organization 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 responsible organization change messages would be exchanged between systems that are closely coupled with respect to responsible organization assignments so only the id and code attributes and the subject association to R_Patient [identified] CMET are included.
responsibleParty1
The responsibleParty1 participation is the correct responsible organization assignment for the encounter. The attributes statusCode (default of "active") and time (populated with the assignment start date-time) are mandatory.
responsibleParty2
The responsibleParty2 participation is the nullified (erroneously reported) responsible assignment for the encounter. Either the id or the time attribute must be valued so the receiving system knows exactly which responsible organization participation is being nullified.
| Responsible Organization Change Canceled | PRPA_HD303012UV02 |
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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_AssignedOrganizationContact | COCT_MT090203UV01 |
| Responsible Organization Change Canceled | PRPA_MT303012UV02 | |
This HMD defines the message used report that the responsible organization was changed during an active encounter.
| R_PatientIdentified | COCT_MT050001UV07 |
| R_AssignedOrganizationContact | COCT_MT090203UV01 |
| Responsible Organization Changed | PRPA_MT303011UV02 | |
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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 clinical responsibility for an encounter is transferred from one organization to another. An informer sends to a tracker a small message identifying the encounter, the patient, the previous organization and assignment time range, and the new organization and start time.
| Trigger Event | Responsible Organization Changed | PRPA_TE303011UV02 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Responsible Organization Changed | PRPA_MT303011UV02 |
| Sender | Responsible Organization Informer | PRPA_AR303013UV02 |
| Receiver | Responsible Organization Tracker | PRPA_AR303014UV02 |
This interaction occurs after a previously reported transfer of clinical responsibility for an encounter from one organization to another is canceled. An informer sends to a tracker a small message identifying the encounter, the patient, the organization assignment to be reactivated, and organization assignment to be nullified.
| Trigger Event | Responsible Organization Change Canceled | PRPA_TE303012UV02 |
| Transmission Wrapper | Send Message Payload | MCCI_MT000100UV01 |
| Control Act Wrapper | Trigger Event Control Act | MCAI_MT700201UV01 |
| Message Type | Responsible Organization Change Canceled | PRPA_MT303012UV02 |
| Sender | Responsible Organization Informer | PRPA_AR303013UV02 |
| Receiver | Responsible Organization Tracker | PRPA_AR303014UV02 |
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