Transcript Document

EHR System Function and Information Model
(EHR-S FIM) Release 2.1
HL7 Project ID# 688
Executive Summary for EHR-S FIM Prototype on
Orders Management
[email protected] , EHR WG Modeling Facilitator
[email protected] , DoD-MHS Proponent
April 18, 2012 – Original Working-Draft
July 5, 2012 – Most Recent Working-Draft
Work in Progress
Call for Participation
7/20/2015
This work is being done by the HL7 EHR Interoperability Work-group,
meeting every Tuesday at 2 PM ET, dial-in: 1-770-657-9270, Passcode: 510269#
The most current artifacts are at: http://wiki.hl7.org/index.php?title=EHR_Interoperability_WG
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CP.4 Manage Orders
Statement: Provide the ability to manage clinical orders and results including medication, nonmedication, diagnostic tests, blood products, other biologics and referrals, using order sets as
appropriate.
Description: The provision of clinical care includes the need to order from a variety of
treatments using order sets as appropriate as well as reviewing the results of treatment. Orders
for treatments may include medications, non-medication therapies (e.g. physical therapy,
special diet, immunizations, non-allopathic regimens); diagnostic care (e.g., laboratory,
radiology); blood products and other biologics (e.g., blood transfusions, human growth
hormones). Patients are often referred to other health care providers for more specialized
diagnostic workup and/or treatment. An effective EHR-S must include support and
management of these processes and associated documentation.
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, orders or order-sets, based-on accepted
clinical practices and/or order set templates, may be created by the clinician. If an order or order-set is
created, discrete data elements associated with the order(s) are recorded and any appropriate order
related or patient-related information is noted. Patient orders and/or order-sets are reported-to or
coordinated with appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools,
registries, public health), according to scope of practice, organizational policy and/or jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
2
CP.4 Manage Orders
EHR-S Components Dependent-on Clinician-Activities
act CP.4 Manage Orders
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
Clinician Activities
Manage Records
Manage Trusts
Manage Business Rules
CP.4 Manage Orders
Manage
Schedules
Encounter
Start
EHR-S Components
Schedule
Manage
Events
Event
Patient
Information
Manage
Terminology
Manage
Lists
Manage
Documents &
Notes
Terminology
List
Document or
Note
Order Set
Orders
Schedule
Administrative
Information
Clinical
Information
Order
7/20/2015
RED: Recommend deletion, Blue: Recommended Insertion
End
is-a
Clinical Document
or Note
3
CP.4 Manage Orders
Conceptual Information Model (CIM)
class CP.4 CI M Manage Orders
EHR-S
ISSUE: data associated with CDS
CP, CPS & AS
Document or Note
Clinical
Document or
Note
List
Encounter
Order for
Diagnostic Test
Order
Order Set
Event
Order for
Non-medication
Report
Orders for Blood
Products and
Other Biologics
Order for
Referral
Order for
Medication
Schedule
Patient
I nformation
Orders Schedule
Terminology
Clinical
I nformation
Trust I nfrastructure
7/20/2015
Registry
Administrative
I nformation
Record I nfrastructure
DRAFT WORKING DOCUMENT
4
CP.4. Manage Orders
SHALL CCs have
bolded borders.
Conformance Criteria (CC) Applicable to this CDM
class CP.4 Manage Orders (attributes)
CP.4#10
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+ deactivate()
+ justify()
+ manage()
-
admission
discharge
post-operative
conditional
standing
CP.4#19
CP.4#21
CP.4#06
Order Lifecycle
Stage
Enumeration
-
new
cancellation
modification
renewal
discontinuation
conditional
other
CP.4#27
CP.4#03
-
annotation
comments & instructions (free text)
demographic information
indication/justification
order activation date & time
order set tag
oral verification :boolean
ordering clinician
Order Execution Time
Order Lifecycle Stage
Order Type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
CP.4#12
CP.4#15
CP.4#02
Order Type Enumeration
CP.4#26
CP.4#24
CP.4#07
-
diagnostic test
non-medication
medication
blood product & biologics
referral
CP.4#09
CP.4#08
CP.4#22
+ manage()
CP.4#01
CP.4#04
CP.4#13
CP.4#16
CP.4#20
7/20/2015
CP.4#11
Order
Order-Execution-Time
Enumeration
CP.4#18
CP.4#14
CP.4#25
CP.4#05
CP.4#17
DRAFT WORKING DOCUMENT
CP.4#23
CP.4#28
CPS.8.4 Support for
Communications Between
Provider and Patient and/or
the Patient Representative
5
EHR-S FIM
Action Verb Hierarches
Manage (Data)
Maintain
Capture
AutoPopulate
Enter
Import
Receive
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Exchange
Render
Store
Capture
Update
Remove
Archive
Backup
Decrypt
Encrypt
Recover
Restore
Save
Annotate
Attest
Edit
Harmonize
Integrate
Link
Tag
Delete
Purge
•
•
•
•
Extract
Present
Transmit
Export
Import
Receive
Transmit
Determine
Analyze
Decide
ManageDataVisibility
De-Identify
Hide
Mask
Re-Identify
Unhide
Unmask
CP.4. Manage Orders
Black Bold = Maps to Conformance Criteria (CC)
Blue Bold = included in CC; but missing in verb hierarchy
Orange – duplicate verbs
ISSUE: Some CC include compound verbs (e.g., capture & render”
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
6
CP.4 Manage Orders
Conformance Criteria (CC) Applicable to this CDM
1. CP.4#01 The system SHALL provide the ability to manage role-based, context-based and/or userbased order entry. (add reference TI role based function or remove here)
2. CP.4#02 The system SHALL provide the ability to manage the order lifecycle creation, renewal,
modification and discontinuation, etc. of orders.
3. CP.4#03 The system SHALL provide the ability to render relevant, relevant patient-specific laboratory
test results when entering an order.
4. CP.4#04 The system SHALL provide the ability to manage the status of an order (e.g. open, completed,
in process). (harmonize with CP.4.2)
5. CP.4#05 The system MAY provide the ability to capture, maintain and render order entry with an
appropriate registration process when the identity of the patient is unknown or in an urgent situation.
6. CP.4#06 The system SHOULD provide the ability to manage standing orders or orders that may be
submitted by providers other than licensed providers according to scope of practice, organizational
policy and/or jurisdictional law. (standing order = pre-established conditional set of order = CPS 4.1,
CPS.4.1 CC#4, CC#11) Verbal orders?
7. CP.4#07 The system SHALL provide the ability to capture and render problem/diagnosis as a required
element of an order.
8. CP.4#08 The system MAY provide the ability to capture, maintain and render, as discrete data, a
diagnosis/problem code and/or description associated with an order of any type (including prescriptions
and medications ordered for administration).
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
7
CP.4 Manage Orders
Conformance Criteria (CC) Applicable to this CDM
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
CP.4#09 The system MAY provide the ability to link an order of any type (including medication order)
with a related clinical problem(s) and/or diagnosis code(s) and description.
CP.4#10 The system SHALL provide the ability to annotate and render comments and instructions with
an order. {same as CC11?)
CP.4#11 The system SHOULD provide the ability to annotate and render free text comments and
instructions with an order. (same as CC10? )
CP.4#12 The system SHOULD provide the ability to tag frequently used and institutionally-approved
order sets as “favorites” or “preferences” to facilitate retrieval and ordering.
CP.4#13 The system MAY provide the ability to manage orders submitted to or received from external
organizations and/or facilities such as Health Information Exchanges (HIE) or regional Electronic Health
Record Systems (EHR-S).
CP.4#14 The system SHALL render the patient name, identification number, and age or date of birth
on all order screens.
CP.4#15 The system SHALL provide the ability to capture, maintain and render an indicator of oral
verification ("read-back") of the complete order by the person receiving the telephone or verbal order.
CP.4#16 The system SHALL provide the ability to capture and render the urgency status (e.g., AsSoon-As-Possible or STAT) associated with an order.
CP.4#17 The system SHOULD provide the ability to render order history for any order, including the
ordering clinician, order details, date, and time.
CP.4#18 The system SHOULD provide the ability to tag and render a field as required for a complete
order by order type.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
8
CP.4 Manage Orders
Conformance Criteria (CC) Applicable to this CDM
19. CP.4#19 The system SHOULD provide the ability to tag orders to be activated at a future date and time
including admission orders, discharge orders, and post-operative orders.
20. CP.4#20 The system SHOULD provide the ability to render orders for all order types.
21. CP.4#21 The system MAY provide the ability to manage conditional orders that can be activated when
certain criteria and conditions are met.
22. CP.4#22 The system SHOULD provide the ability to capture, store and render the identity of all
providers who signed an order.
23. CP.4#23 The system SHOULD provide the ability to render a list of active orders for a patient.
24. CP.4#24 The system SHOULD provide the ability to render a list of orders by similar or comparable
type (e.g., all radiology or all laboratory orders).
25. CP.4#25 The system SHOULD provide the ability to render a list of outstanding orders for multiple
patients (as opposed to outstanding orders for a single patient).
26. CP.4#26 The system SHOULD provide the ability to capture the provider's order-cancellation request.
27. CP.4#27 The system SHOULD provide the ability to transmit an order-cancellation request.
28. CP.4#28 The system SHALL conform to function CPS.8.4 (Support for Communication between
Provider and Patient and/or the Patient Representative) to manage information regarding orders.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
9
Conformance Criteria (CC)
Conclusion
•
Conformance Criteria will only be mapped to the data attributes they impact;
Conformance Criteria will NOT be mapped to operations.
–
•
In general, we will assume all classes have the “Manage” operation.
JUSTIFICATION: EHR-S FM does not use the verb hierarchy consistently .
–
–
7/20/2015
Often compound verbs are used (e.g., capture and render)
Often, on CC calls our “manage” AND another CC calls out sub-verbs (e.g., render”)
DRAFT WORKING DOCUMENT
10
CP.4.1 Use Manage Order Set
Statement: Use Order Set templates to facilitate order entry by rendering the appropriate
orders based on provider request, provider input or system configuration.
Description: Predefined order set templates may include medication and non-medication
orders (e.g., diet, activities, nursing care, prescriptions and requests for investigations). They
allow a care provider to choose and render common orders for a particular circumstance or
disease state according to standards or other criteria such as provider preference, context,
patient related data. Recommended order set templates may be presented based on patient
data or other contexts. Order Set templates may also allow the provider to modify
(add/remove/change) orders during order entry for a particular patient.
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, orders or order-sets, based on accepted
clinical practices and/or order set templates, may be created by the clinician. If an order or order-set is
created, discrete data elements associated with the order(s) are recorded and any appropriate order
related or clinical information is noted. Patient orders and/or order-sets are reported-to or coordinated with
appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools, registries, public
health), according to scope of practice, organizational policy and/or jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
11
CP.4.1 Use Manage Order Set
Conformance Criteria (CC) Applicable to this CDM
SHALL CCs have
bolded borders.
class RT Order Set
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+
+
+
deactivate()
justify()
manage()
Order for
Non-medication
-
Medication Order
order type
task duration
task interval
Orders for Blood
Products and Other
Biologics
-
product information
Storage Request
+
manage()
7/20/2015
Patient
Information
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
CP.4.1#04
Order Set
CP.4.1#10
-
Order
order tag
problem list link
+
+
+
+
+
capture & integrate orders()
delete order()
integrate multiple order templates()
manage order set()
render order set()
CP.4.1#12
CP.4.1#08
CP.4.1#09
CP.4.1#11
CP.4.1#02
Clinical
Information
-
type
Terminology
CP.4.1#05
CP.4.1#03
CP.4.1#01
CP.4.1#07
Administrative
Information
CPS.4.1 Manage Order Set
Templates
CP.4.1#06
Order for Referral
-
Clinical Information
+
+
+
+
+
capture()
link()
manage referrals()
render()
determine & render()
Order for Diagnostic Test
-
Prior Diagnostic Results
Standard Diagnostic Test Detail
+
manage()
DRAFT WORKING DOCUMENT
Order for Medication
-
comment(s) :char
duration :char
justification for medication
frequency :char
order status
patient's preference :char
patient weight
prescription drug eligibility
problem, diagnosis, condition
patient's consent
route :char
SIG :char
units of medication
+
manage()
12
CP.4.1 Use Manage Order Set
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.1#01 The system SHALL provide the ability to capture a set of actions and/or items to be ordered
for a patient using a predefined order set template.
2. CP.4.1#02 The system SHALL provide the ability to manage a patient's orders as an order set.
3. CP.4.1#03 The system SHOULD provide the ability to render a patient's orders as an order set.
4. CP.4.1#04 The system SHOULD provide the ability to integrate patient information and order set
templates to render orders.
5. CP.4.1#05 The system SHALL conform to function CPS.4.1 (Manage Order Set Templates).
6. CP.4.1#06 The system SHOULD provide the ability to determine and render the appropriate order set
template based on various contexts (e.g., by disease, care setting, or medications used).
7. CP.4.1#07 The system MAY render order set templates to providers based on diagnoses, conditions, or
symptoms to aid decision support.
8. CP.4.1#08 The system SHALL provide the ability to capture and integrate in an order set, various types
of orders for a patient (e.g., medications, laboratory tests, imaging studies, procedures and referrals).
9. CP.4.1#09 The system SHOULD provide the ability to delete individual orders from an instance of an
order set for an individual patient according to scope of practice, organizational policy and/or
jurisdictional law.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
13
CP.4.1 Use Manage Order Set
Conformance Criteria (CC) Applicable to this CDM
10. CP.4.1#10 The system SHOULD provide the ability to tag as deleted an individual order(s) from an
instance of an order set for an individual patient according to scope of practice, organizational policy
and/or jurisdictional law.
11. CP.4.1#11 The system MAY provide the ability to integrate multiple order set templates, customizing
and storing it as a new order set template according to scope of practice, organizational policy and/or
jurisdictional law.
12. CP.4.1#12 The system SHOULD provide the ability to link order set(s) with condition(s) on the patient's
Problem List.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
14
CP.4.2 Manage Medication Orders
Statement: Create prescriptions or other medication orders with detail adequate for correct filling and
administration. Provide information regarding compliance of medication orders with formularies. Provide
Clinical Decision Support (CDS) drug utilization review functionality including alerts regarding drug
interactions and allergies.
Description: Medications include prescribed and over the counter (OTC) drugs, allergy shots, oxygen,
anesthetics, chemotherapy, and dietary supplements that were ordered, supplied, administered, or
continued. Different medication orders, including new, discontinue, refill/continue, and renew require
different levels and kinds of detail, as do medication orders placed in different situations. Administration or
patient instructions are available for selection by the ordering clinicians, or the ordering clinician is
facilitated in creating such instructions. The system may allow for the creation of common content for
prescription details. Appropriate time stamps for all medication related activity are generated. This includes
series of orders that are part of a therapeutic regimen, e.g. Renal Dialysis, Oncology. When it comes to
capturing the medication rationale, it is not mandatory that the provider always provide this information). In
addition, the system should present the clinician with clinical decision support functionality (such as the
presentation of allergies, drug-drug- interactions) during the medication ordering process.
When a clinician places an order for a medication, that order may or may not comply with a formulary
specific to the patient’s location or insurance coverage, if applicable. Whether the order complies with the
formulary should be communicated to the ordering clinician at an appropriate point to allow the ordering
clinician to decide whether to continue with the order. Formulary-compliant alternatives to the medication
being ordered may also be presented.
7/20/2015
15
RED: Recommended deletion, Blue: Recommended Insertion
CP.4.2 Manage Medication Orders
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, one or more medication orders, based on
formulary availability and accepted clinical practices, may be initiated by the clinician. During the
medication ordering process, the system presents the clinician with clinical decision support functionality
(such as allergy and/or drug-drug- interaction alerts and the presentation of formulary alternatives). If a
medication order is created, discrete data elements associated with the order(s) are recorded and any
appropriate order related or clinical information is noted. Patient medication orders are reported-to or
coordinated with appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools,
registries, public health), according to scope of practice, organizational policy and/or jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
16
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
ss RT Order for Medication
Event
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
CP.4.2#19
CP.4.2#18
7/20/2015
Medication List
CP.4.2.1 Medication
Interaction and Allergy
Checking
CP.4.2#05
CP.1.3 Manage Medication
List
CP.4.2#17
CP.4.2#14
CP.4.2#04
CP.4.2.4 Medication Alert
Overrides
AS.9.2 Support Financial
Eligibility Verification
+ manage()
CP.4.2#02
CP.4.2.2 Patient Specific
Medication Dosing &
Warnings
CP.4.2#31
CP.4.2#29
CP.4.2#20
CPS.4.2.4 Support for
Medication
Recommendations
CP.4.2.3 Medication Order
Efficiencies
CP.4.2#03
-
CP.4.2#01
CP.4.2#21
+ receive (external)()
CP.4.2#24
comment(s) :char
duration :char
justification for medication
frequency :char
order status
patient's preference :char
patient weight
prescription drug eligibility
problem, diagnosis, condition
patient's consent
route :char
SIG :char
units of medication
CP.4.2#15
CP.4.2#07
CP.4.2#11
CP.4.2#13
CP.4.2#30
CP.4.2#38
CP.4.2#36
CP.4.2#12
CP.4.2#06
CP.4.2#10
CP.4.2#26
CP.4.2#33
CP.4.2#22
CP.4.2#32
CP.4.2#08
CP.4.2#35
CP.4.2#25
The following were
collapsed under manage:
 enter order (external)
 maintain
 order supplies
 render
 receive (external)
 verify insurance
eligibility
CP.4.2#16
Order for Medication
CP.4.2#28
CP.4.2#37
CP.4.2#40
CP.4.2#23
CP.4.2#39
CP.4.2#34
CP.4.2#09
CP.4.2#27
CP.4.2#41
ISSUES:
 Inconsistent Verb hierarchy
 multiple requirements in one conformance criteria
RED: Recommended deletion, Blue: Recommended Insertion
17
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.2#01 The System SHALL conform to CP.4.2.1 (Medication Interaction and Allergy
Checking).
2. CP.4.2#02 The System SHALL conform to CP.4.2.2 (Patient Specific Medication Dosing &
Warnings).
3. CP.4.2#03 The System SHALL conform to CP.4.2.3 (Medication Order Efficiencies).
4. CP.4.2#04 The system SHALL conform to CP.4.2.4 (Medication Alert Overrides).
5. CP.4.2#05 The system SHALL provide the ability to capture medication order details as
discrete data (e.g., for correct filling, dispensing and administration of drug, dose, route,
duration, SIG).
6. CP.4.2#06 The system SHALL provide the ability to maintain and render as discrete data,
medication orders including all the details adequate for correct filling, dispensing and
administration. (e.g. Drug, dose, route, SIG)
7. CP.4.2#09 The system SHOULD render fixed text (e.g., "Bio-hazard Warning") as part of a
medication order according to organizational policy and/or jurisdictional law.
8. CP.4.2#07 The system SHOULD provide the ability to capture medication order details
including dose, route, frequency and comments as free text.
9. CP.4.2#08 The system SHOULD provide the ability to manage free text as part of a
medication order or prescription (e.g., "this patient is unable to swallow large pills").
10. CP.4.2#10 The system SHALL determine and render a notification to the provider that
information required to compute a dose is missing or invalid.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
18
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
11. CP.4.2#11 The system SHOULD provide the ability to capture patient's preference for
medication usage (e.g., oral vs. injectable, generic vs. brand name) and present it to a
provider at the time of medication ordering.
12. CP.4.2#12 The system SHOULD provide the ability to manage prescriptions using fractional
units of medications (e.g., 1/2 tsp., 1/2 tablet).
13. CP.4.2#13 The system SHALL provide the ability to capture and maintain documentation
regarding patient weight, including such terms as "unknown", before entering medication
orders.
14. CP.4.2#14 The system SHOULD provide the ability to capture the administrative or clinical
reasons/indications/rationale for the medication(s) selected during order entry.
15. CP.4.2#15 The system SHALL provide the ability to determine and render the status (e.g., for
outpatient medication ordering: captured, verified, filled, dispensed to patient; for inpatient:
captured, verified, filled, administered) of a medication order.
16. CP.4.2#16 The system MAY provide the ability to determine and render the status of
medication dispensing.
17. CP.4.2#17 The system SHALL conform to function CP.1.3 (Manage Medication List) and
update the appropriate medication list with the prescribed medications (in case of multiple
medication lists).
18. CP.4.2#18 The system SHALL provide the ability to enter and maintain medication
information brought in by the patient.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
19
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
19. CP.4.2#19 The system MAY provide the ability to electronically capture medication
information brought in by the patient (e.g., scan in a bar code from an Rx label).
20. CP.4.2#20 The system SHOULD conform to function CPS.4.2.4 (Support for Medication
Recommendations).
21. CP.4.2#21 The system SHOULD provide the ability to enter and maintain prescription
information from an external source (e.g., transcribed information from a non-network
provider) to fill or renew a prescription.
22. CP.4.2#22 The system MAY provide the ability to receive and maintain prescription
information from an external source (e.g., electronically from a non-network provider) to fill
or renew a prescription.
23. CP.4.2#23 The system SHOULD provide the ability to manage medication orders for uncoded
and non-formulary medications.
24. CP.4.2#24 The system MAY provide the ability to receive the patient's Current Medication
List from Pharmacy (directly) or via an intermediary network.
25. CP.4.2#25 The system SHALL provide the ability to order supplies associated with medication
orders according to scope of practice, organizational policy and/or jurisdictional law.
26. CP.4.2#26 The system SHOULD render a list of frequently-used patient medication
administration instructions and capture the ordering clinician's selection.
27. CP.4.2#27 The system MAY render a list of medication administration instructions common
to multiple orders for the patient, and capture the ordering clinician's selection.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
20
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
28. CP.4.2#28 The system SHOULD provide the ability to render patient instructions that are
linked to an ordered medication.
29. CP.4.2#29 The system SHOULD conform to function AS.9.2 (Support Financial Eligibility
Verification) to capture and render the results of electronic prescription eligibility and health
plan/payer formulary checking.
30. CP.4.2#30 The system SHOULD provide the ability to transmit a request for a patient's
prescription drug insurance eligibility verification.
31. CP.4.2#31 The system SHALL provide the ability to determine and capture co-signatures for
orders based upon roles (i.e., consulting physician) according to scope of practice,
organizational policy and/or jurisdictional law.
32. CP.4.2#32 The system SHALL provide the ability to manage orders that contain discrete
medication components to create combination drugs or compounds (e.g., Butalbital
compound).
33. CP.4.2#33 The system MAY provide the ability to render prescriptions for limited re-printing,
subject according to scope of practice, organizational policy and/or jurisdictional law (e.g.,
limited to three times).
34. CP.4.2#34 The system MAY provide the ability to render prescriptions for re-printing,
according to scope of practice, organizational policy and/or jurisdictional law (e.g., limited to
three times).
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
21
CP.4.2 Manage Medication Orders
Conformance Criteria (CC) Applicable to this CDM
35. CP.4.2#35 The system MAY provide the ability to render prescriptions for re-faxing, according
to scope of practice, organizational policy and/or jurisdictional law (e.g., limited to three
times).
36. CP.4.2#36 The system MAY provide the ability to render the associated problem, diagnosis or
condition (indication) on the printed prescription according to scope of practice,
organizational policy and/or jurisdictional law.
37. CP.4.2#37 The system SHOULD provide the ability to render a list of transmission options for
a prescription/medication order to a specified pharmacy (e.g., printing, faxing, eprescribing).
38. CP.4.2#38 The system SHOULD provide the ability to capture, maintain, and present the
patient's consent to have restricted medications administered (e.g., Risk Evaluation and
Mitigation Strategy (REMS) for research protocol and experimental drugs).
39. CP.4.2#39 The system SHOULD provide the ability to present information received through
health plan/payer formulary checking (e.g., formulary alternatives, formulary status, co-pay
and coverage types, prior authorization requirements, step therapy require
40. CP.4.2#40 The system SHOULD provide the ability to capture and render an indicator of an
explicit route for the administration of specific medications during the ordering process.
41. CP.4.2#41 The system SHOULD render available alternate medication administration routes
during the medication ordering process when multiple routes exist and none was specified.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
22
CP.4.3 Manage Non-Medication Patient Care Orders
Statement: Enable the origination, documentation, capture, transmission, tracking and
maintenance of non-medication patient care orders.
Description: Non-medication orders that request actions or items can be captured and tracked
including new, renewal and discontinue orders. Examples include orders to transfer a patient
between units, to ambulate a patient, for medical supplies, wound care, durable medical
equipment, home IV, and diet or therapy orders. Additionally, psychotherapy and other mental
health counseling, other surgical and non-surgical procedures, and complementary alternative
medicine are included in non-medication treatments. Each item ordered includes the
appropriate detail, such as order identification and instructions. Orders should be
communicated to the correct service provider for completion.
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, non-medication patient care orders or
order-sets, based on accepted clinical practices and/or order set templates, may be created by the
clinician. If an order or order-set is created, discrete data elements associated with the order(s) are
recorded and any appropriate order related or clinical information is noted. Patient orders and/or order-sets
are reported-to or coordinated with appropriate sources, appropriate clinicians and organizations (e.g.,
PHRs, schools, registries, public health), according to scope of practice, organizational policy and/or
jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
23
CP.4.3 Manage Non-Medication Patient Care Orders
Conformance Criteria (CC) Applicable to this CDM
class RT Order for Non-medication
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+
+
+
deactivate()
justify()
manage()
CP.4.3# 04 The system
SHOULD provide the ability
to assign a future date for an
ordered action or item.
7/20/2015
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
Order for
Non-medication
-
Medication Order
order type
task duration
task interval
CP.4.3# 08
CP.4.3# 01
CP.4.3# 09
CP.4.3# 05
CP.4.3# 10
CPS.4.3 Support for
Non-Medication Ordering
CP.4.3# 02
RECOMMENDATION:

Collapse all manage verbs to just manage

Eliminate compound verbs (capture & render)

Update verb hierarchy to be consistent with verbs here
CP.4.3# 03
CP.4.3# 06
CP.4.3# 07
RED: Recommended deletion, Blue: Recommended Insertion
24
CP.4.3 Manage Non-Medication Patient Care Orders
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.3#01 The system SHALL provide the ability to manage non-medication patient care
orders for an action or item.
2. CP.4.3#02 The system SHALL provide the ability to capture and render order detail for
correct order fulfillment.
3. CP.4.3#03 The system SHALL provide the ability to manage the status (e.g., active,
discontinued, requisitioned, completed) of the ordered action or item.
4. CP.4.3#04 The system SHOULD provide the ability to assign a future date for an ordered
action or item.
5. CP.4.3#05 The system SHOULD provide the ability to capture a set of patient instructions that
will be provided to the patient for correct order fulfillment.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
25
CP.4.3 Manage Non-Medication Patient Care Orders
Conformance Criteria (CC) Applicable to this CDM
6. CP.4.3#06 The system SHOULD provide the ability to render a set of patient instructions that
will be provided to the patient for correct order fulfillment.
7. CP.4.3#07 The system SHOULD provide the ability to transmit the order to the recipient(s) for
order fulfillment.
8. CP.4.3#08 The system SHOULD provide the ability to link non-medication orders to a
medication order (e.g., ordering an intravenous pump in coordination with intravenous
medication).
9. CP.4.3#10 The system SHALL conform to function CPS.4.3 (Support for Non-Medication
Ordering).
10. CP.4.3#09 The system SHOULD provide the ability to store a task to be recurrent at a defined
interval for a specified length of time.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
26
CP.4.4 Manage Orders for Diagnostic Tests
Statement: Enable the origination, documentation, transmission, tracking and maintenance of
orders for diagnostic tests..
Description: Orders for diagnostic tests (e.g. diagnostic radiology, laboratory) are captured and
tracked including new, renewal and discontinue orders. Each order includes appropriate detail,
such as order identification, instructions and clinical information necessary to perform the test.
Orders and supporting detailed documentation shall be communicated to the service provider
for completion of the diagnostic test(s).
Some systems may contain instructions, but in some settings, instructions may be provided
from external sources (e.g., handouts).
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, diagnostic test orders or order-sets, based
on accepted clinical practices and/or order set templates, may be created by the clinician. If an order or
order-set is created, discrete data elements, associated with the order(s) are recorded and any appropriate
order related or clinical information is noted. Patient orders and/or order-sets are reported-to or
coordinated with appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools,
registries, public health), according to scope of practice, organizational policy and/or jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
27
CP.4.4 Manage Orders for Diagnostic Tests
Conformance Criteria (CC) Applicable to this CDM
class RT Order for Diagnostic Test
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+
+
+
deactivate()
justify()
manage()
7/20/2015
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
CP.4.4#11
CP.4.4#12
CPS.4.3 Support for
Non-Medication Ordering
CP.4.4#08
Order for Diagnostic Test
CP.4.4#05
CP.4.4#04
-
Prior Diagnostic Results
Standard Diagnostic Test Detail
CP.4.4#10
+
manage()
CP.4.4#06
CP.4.4#07
CP.4.4#01
CP.4.4#09
CP.4.4#03
CP.4.4#02
TODO: remove manage
variations from object
RED: Recommended deletion, Blue: Recommended Insertion
28
CP.4.4 Manage Orders for Diagnostic Tests
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.4#06 The system SHALL provide the ability to transmit orders to the recipient (s) for
order fulfillment of the diagnostic test.
2. CP.4.4#01 The system SHALL provide the ability to manage orders for diagnostic tests.
3. CP.4.4#02 The system SHALL provide the ability to capture and render standard order detail
for diagnostic test order fulfillment.
4. CP.4.4#03 The system SHOULD provide the ability to capture and maintain user-created
instructions and/or prompts when ordering diagnostic tests or procedures.
5. CP.4.4#04 The system SHALL provide the ability to manage the status (e.g., requisitioned,
completed, in process) of diagnostic test(s).
6. CP.4.4#05 The system SHOULD provide the ability to capture and render patient instructions
relevant to the diagnostic test ordered.
7. CP.4.4#07 The system SHOULD provide the ability to transmit supporting detailed
documentation to the recipient (s) for order fulfillment of the diagnostic test.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
29
CP.4.4 Manage Orders for Diagnostic Tests
Conformance Criteria (CC) Applicable to this CDM
8. CP.4.4#08 The system SHALL conform to function CPS.4.3 (Support for Non-Medication
Ordering).
9. CP.4.4#09 The system MAY provide the ability to transmit order activity to public health
authorities according to scope of practice, organizational policy and/or jurisdictional law.
10. CP.4.4#10 IF subsequent orders are being captured, THEN the system SHOULD provide the
ability to render prior diagnostic results for a given patient.
11. CP.4.4#11 The system SHOULD capture and render complete demographic information for
diagnostic orders according to scope of practice, organizational policy and/or jurisdictional
law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
30
CP.4.5 Manage Orders for Blood Products and Other Biologics
Statement: Communicate with appropriate sources or registries to manage orders for blood
products or other biologics.
Description: Interact with a blood bank system or other source to support orders for blood
products or other biologics including discontinuance orders. Use of such products in the
provision of care is captured. Blood bank or other functionality that may come under
jurisdictional law or other regulation (e.g. by the FDA in the United States) is not required;
functional communication with such a system is required..
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, orders or order-sets for Blood Products
and Other Biologics, based on accepted clinical practices and/or order set templates, may be created by
the clinician. If an order or order-set is created, discrete data elements associated with the order(s) are
recorded and any appropriate order related or clinical information is noted. Patient orders and/or order-sets
are reported-to or coordinated with appropriate sources, appropriate clinicians and organizations (e.g.,
PHRs, schools, registries, public health), according to scope of practice, organizational policy and/or
jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
31
CP.4.5 Manage Orders for Blood Products and Other Biologics
Conformance Criteria (CC) Applicable to this CDM
class RT Order for Blood Products and Other Biologics
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+
+
+
deactivate()
justify()
manage()
7/20/2015
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
CP.4.5# 01
Orders for Blood
Products and Other
Biologics
CP.4.5# 06
CP.4.5# 07
-
product information
Storage Request
CP.4.5# 08
+
manage()
CP.4.5# 03
CP.4.5# 05
CPS.9.2 Support for
Inter-Provider
Communication
CP.4.5# 04
CP.4.5# 02
RED: Recommended deletion, Blue: Recommended Insertion
32
CP.4.5 Manage Orders for Blood Products and Other Biologics
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.5#01 The system SHALL provide the ability to manage orders for blood products and
biological products.
2. CP.4.5#02 The system SHALL provide the ability to manage the status (e.g., requisitioned,
completed, in process) of blood product and/or biological product orders.
3. CP.4.5#03 The system SHALL provide the ability to manage storage request orders for blood
products and/or biological products.
4. CP.4.5#04 The system SHALL provide the ability to manage the status of storage request
orders (e.g., requisitioned, completed, in process) for blood products and/or biological
products.
5. CP.4.5#05 The system SHALL conform to function CPS.9.2 (Support for Inter-Provider
Communication) to enable exchange of manage information regarding blood products and
biological products between to members of the care team.
6. CP.4.5#06 The system SHALL provide the ability to manage the use of blood products and
other biologics in the provision of care.
7. CP.4.5#07 The system MAY provide the ability to manage units for orders of blood products
appropriate to age specific care (e.g., pediatric care such as ml/kg, “Pedi packs” and other
aliquots).
8. CP.4.5#08 The system SHOULD provide the ability to manage information associated with
the collection and administration of non-blood biologics (e.g., breast milk products),
including donor and recipient and/or patient-identifying data, aliquot-identifying
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
33
CP.4.6 Manage Orders for Referral
Statement: Enable the origination, documentation and tracking of referrals between care
providers or healthcare organizations, including clinical and administrative details of the
referral, and consents and authorizations for disclosures as required.
Description: Documentation and tracking of a referral from one care provider to another is
supported, whether the referred to or referring providers are internal or external to the
healthcare organization.
Guidelines for whether a particular referral for a particular patient is appropriate in a clinical
context and with regard to administrative factors such as insurance may be provided to the care
provider at the time the referral is created. The EHR-S provides the ability to receive and act
upon referral responses from providers. The EHR-S may provide the ability to capture
completion of the referral appointment.
Example: (notional scenario based on conformance criteria) During an encounter, patient problems,
previous treatments, care plans and results are reviewed; then, orders or order-sets for referral, based on
accepted clinical practices and/or order set templates, may be created by the clinician. If an order or orderset is created, discrete data elements associated with the order(s) are recorded and any appropriate order
related or clinical information is noted. Patient orders and/or order-sets are reported-to or coordinated with
appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools, registries, public
health), according to scope of practice, organizational policy and/or jurisdictional law.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
34
CP.4.6 Manage Orders for Referral
Conformance Criteria (CC) Applicable to this CDM
class RT Order for Referral
Event
+
-
date & time (occurence)
change justification
circumstances
Clinical Information
date (entry)
date (review)
description
duration
information reviewed
information source
information validator
location
mechanism
metadata
person-role
status
trigger
type
+ deactivate()
+ justify()
+ manage()
7/20/2015
Patient
Information
Order
-
annotation
comments
demographic information
indication/justification
instructions
order activation date
order set tag
oral verification :boolean
ordering clinician
order type
problem/diagnosis
patient name
patient identification number
patient DOB or age
patient instructions
problem/diagnosis code link
problem/diagnosis code or description
Signature
status
supporting documentation
usgency status
user-created instructions or system prompts
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
Clinical
Information
-
Administrative
Information
type
Terminology
CP.4.6#02
CP.4.6#03
Order for Referral
-
Clinical Information
Administrative Information
+
+
+
+
+
capture()
link()
manage referrals()
render()
determine & render()
CP.4.6#04
CP.4.6#05
CP.4.6#06
CP.4.6#07
CP.4.6#08
CP.4.6#09
CP.4.6#01
CP.4.6#10
CP.4.6#12
RED: Recommended deletion, Blue: Recommended Insertion
CP.4.6#11
35
CP.4.6 Manage Orders for Referral
Conformance Criteria (CC) Applicable to this CDM
1. CP.4.6#01 The system SHALL provide the ability to manage outbound referral(s), whether
internal or external to the organization.
2. CP.4.6#02 The system SHALL provide the ability to capture clinical details necessary for the
referral according to the scope of practice of the referral recipient.
3. CP.4.6#03 The system SHALL provide the ability to link (e.g. link to image stored in PACS)
clinical details as necessary for the referral according to the scope of practice of the referral
recipient.
4. CP.4.6#05 The system SHOULD provide the ability to capture administrative details (e.g.,
insurance information, consents and authorizations for disclosure) as necessary for the
referral.
5. CP.4.6#06 The system SHOULD provide the ability to link to administrative details (e.g.,
insurance information, consents and authorizations for disclosure) as necessary for the
referral.
6. CP.4.6#07 The system SHOULD provide the ability to render administrative details (e.g.,
insurance information, consents and authorizations for disclosure) as necessary for the
referral.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
36
CP.4.6 Manage Orders for Referral
Conformance Criteria (CC) Applicable to this CDM
7. CP.4.6#08 The system SHALL provide the ability to capture, store and render an inbound
referral response (e.g., referral accepted, referral denied or more information needed).
8. CP.4.6#09 The system SHALL provide the ability to determine and render recommended
actions based on an inbound referral response (e.g., referral accepted, referral denied or
more information needed).
9. CP.4.6#10 The system MAY provide the ability to capture a notification that the patient
fulfilled a referred appointment.
10. CP.4.6#11 The system SHOULD provide the ability to determine and render diagnosis-based
clinical guidelines for making a referral.
11. CP.4.6#12 The system SHOULD provide the ability to determine the contents of a referral
order by rendering order sets for review by the provider.
7/20/2015
RED: Recommended deletion, Blue: Recommended Insertion
37
Backup Slides
Background Information
7/20/2015
DRAFT WORKING DOCUMENT
38
EHR System Function and Information Model
EHR-S FIM Vision
The EHR-S FIM vision is that analysts, engineers or testers
can efficiently compose and refine the architecture-andworkflow agnostic EHR-S FIM into interoperability-
specifications, which meet their system acquisition,
implementation or test needs.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
39
EHR-S FM Release 2.0
Contents
•
•
•
•
•
•
•
Overarching (O) – 2 major subsections
Care Provision (CP) - 9 major subsections
Care Provision Support (CPS) – 9 major subsections
Population Health Support (POP) – 10 major subsections
Administrative Support (AS) – 9 major subsections
Record Infrastructure (RI) – 3 major subsections
Trust Infrastructure (TI) – 9 major subsections
EHR-S FM R2 ballot package can be downloaded at:
http://wiki.hl7.org/index.php?title=December_2011_Ballot_Package
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
40
PART 1: Executive Summary
For EHR-S FIM Release 2.1, this prototype has the purpose to
1) Add conceptual information and data models for each EHR-S function
• make the EHR-S FM easier to use for analysts and engineers
• verify and validate EHR-S FM Release 2.0
2) Demonstrate Service Aware Interoperability Framework (SAIF) use
3) Support specific profiles (e.g., DAMs, DIMs, DCMs).
The DoD-VA Joint Immunization Capability (JIC), Pharm-Lab-Rad, and than ISO
13940 Continuity-of-Care System-of Concepts-and-Glossary harmonization are
proposed as a set of demonstration prototypes of increasing complexity.
7/20/2015
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
DOCUMENT
41
EHR-FIM
Model Legend
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
class Legend
Clinician Activities
Dependency is a model-element relationship between a Dependent-Client ---> I ndependent-Supplier (e.g. sales cart --> product producer, client sends a message to
a supplier). A Dependency is NOT a run-time relationship ... the arrow representing a dependency specifies the direction of the relationship, NOT the direction of a process.
Business Activity Corresponding to EHR-S Function
control
flow
Task 1 within
Activity
Start Activity
EHR-S Component
Encounter
Capitalized Attribute or Operation
implies that it is implemented by
an external entity.
Attribute 1
Data Structure
Task 2 within
Activity
EHR-S Component ::
Syatem Component 3
EHR-S Component ::
System Component 1
-
control
flow
End Activity
-
EHR-S Component ::
System Component 4
Attribute 1
has-a (part)
aggregation
«SHALL»
+ attribute 2
implements
EHR-S Functions and Requirements
Task 4 within
Activity
depends on
operation # xx()
association
«SHALL»
+ operation # yy()
7/20/2015
Task 3 within
Activity
is-a (type)
generalization
EHR-S Component ::
System Component 2
EHR-S Function depends-on a Business Activity (e.g., Without a business requirement, the function would not exist.).
FEATURE:
EHR-S Function
depends-on
FEATURE 2:
EHR-S Function
requirement-for
<<SHALL>> REQUIREMENT
Conformance Criteria # 05
requirement-for
requirement-for
<<SHALL>> REQUIREMENT:
Conformance Criteria (CC) # xx
<<SHOULD or MAY>> REQUIREMENT
Conformance Criteria # yy
DRAFT WORKING DOCUMENT
42
EHR-S FIM
Action Verb Hierarches
Manage (Data)
Capture
Maintain
AutoStore
Populate
Enter
Archive
Import
Backup
Receive
Decrypt
Encrypt
Recover
Restore
Save
Update
Remove
Annotate
Attest
Edit
Harmonize
Integrate
Link
Tag
Delete
Purge
7/20/2015
Render
Extract
Present
Exchange
Transmit
Export
Import
Receive
Transmit
Determine
Analyze
NOTE: EHR-S FIM is NOT
intended
to imply
a specific architecture or workflow!
DRAFT
WORKING
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43
CP.4. Manage Orders
SHALL CCs have
bolded borders.
Conformance Criteria (CC) Applicable to this CDM
class CP.4 Manage Orders (operations)
CP.4#19
CP.4#06
Order
CP.4#11
CP.4#10
CP.4#21
CP.4#01
CP.4#17
CP.4#13
CP.4#20
CP.4#03
CP.4#18
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manage()
annotate & render()
capture & render order()
capture & store order()
capture signature()
manage conditional orders()
manage order entry()
manage orders (external)()
manage order (internal)()
manage future orders()
manage order status()
manage standing orders()
render()
tag order field()
transmit order()
transmit order cancellation request()
CP.4#22
CP.4#02
CP.4#14
CP.4#12
CP.4#15
CP.4#04
CP.4#25
CP.4#07
CP.4#09
CP.4#26
CP.4#05
CP.4#23
CP.4#08
CP.4#24
CP.4#27
CP.4#16
CP.4#28
RECOMMENDATION: Do not show CC mapping to “operations”
7/20/2015
DRAFT WORKING DOCUMENT
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