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OMG HL7 "Integrated" Service Descriptions Document

From
"Fd Eodds"
Date
2005-02-16T13:52:08+00:00
ID
000001c5142e$a9c52d50$894541cf@emachine
Thread
OMG HL7 "Integrated" Service Descriptions Document
Title: Message

  
  

    From: 
    Rubin, Ken (EDS) 
      [SMTP:]   

  

    To: 
    ; 
        

  

    Cc: 
      

  

    

  

    Subject: 
    "Integrated" Service Descriptions 
      Document  

  

    Sent: 
    2/16/05 12:46 
      AM 

    Importance: 
    Normal  
      

  
  

    
      
All: 

      
Okay, here is what we have in to date.  Thanks to 
      Virinder, Heath, 
Scott, Alan for providing 
      input.  I have promises that other 
descriptions are on the way, but at least this gives us a starting 
      point 
to compare and contrast some of what people 
      are thinking regarding these 
services. 

      
Note that in some cases we have competing submissions that 
      will need to 
be reconciled.  I made no 
      attempt to do so.  We need to discuss an 
approach for this on our next call. 

      
I expect that we will have a few more descriptions trickle 
      in over the 
coming days, and I'll get them 
      integrated and posted. 

      
We also have what appears to be positive movement on the 
      collaborative 
tooling front, and hope to be able 
      to provide more details soon.  

      
- Ken 

      
 <<Integrated Service Specification 
      Descriptions v1.0.doc>> 

 

  
  

    
      
Service “Short” Name

    
      
Organizations with Registered 
      Interest

    
      
Description

  

    
      
Collaboration/Coordination 
      of Terminology

    
      
NLM

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Provider Directory

    
      
HL7 
      Australia 
      Submission

    
      
Service “Short” Name: 

      
Provider 
      Directory 

      
 

      
Organizations with 
      Registered Interest:

      
HL7 
      Australia, 
      U.S. Department of Defense 
      (Health Affairs), 
      Canada 
      Health Infoway, Kaiser Permanente

      
 

      
Purpose:

      
A directory 
      holding details of healthcare providers including their identifiers, 
      credentials and contact information that enables the provider to be 
      contacted including delivery or collection of electronic health 
      messages.

      
 

      
In 
      Scope:

      
The Provider 
      Director is responsible for maintaining the contact information about a 
      healthcare provider along with their associated identifiers and 
      credentials.  It allows users 
      to interrogate the directory to uniquely identify a provider and retrieve 
      contacts details to enable communication such as electronic health 
      messaging requiring digital authentication certificates.  The Provider Directory should also 
      support replication capabilities to enable federated systems to have local 
      access to a set of provider details.

      
 

      
Out of 
      Scope:

      
The provider 
      directory is not intended to be used for role-based access control or 
      authorization, nor is it intended to maintain the kinds of services the 
      provider is capable of performing.

      
 

      
Description/Example/Use 
      Case:

      
A Provider 
      Directory should allow the addition of a new healthcare provider providing 
      a master repository for maintaining contact and credential 
      information.  The Provider 
      Directory will be used to uniquely identify the provider allowing their 
      contact information to be used to communicate with the provider including 
      electronic health messaging.

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
Provider 
      Directory would depend upon other services to perform 
      authentication/authorization/ access control

      
 

      
Functional 
      Capabilities:

      
FindCandidates: 

      
RegisterProvider:

      
GetProvider:

      
UpdateProvider:

      
CreateIdentifier:

      
 

      
 

  

    
      
Provider Directory

    
      
HealthConnect (Australia)

      
U.S. Department of Defense (Health 
      Affairs)

      
Canada Health Infoway

      
Kaiser Permanente

      
 

      
Kaiser-Permanente 
      Submission

    
      
Purpose:

      
The Provider 
      Directory is an authoritative source for information on groups and 
      individuals that provide healthcare services.  This can be considered as an 
      specialization of a generalized directory service, adding or supporting 
      features and information that are applicable to healthcare providers but 
      not to the general population. 

      
 

      
Note that the 
      authoritativeness of any Directory may be relative:  while a given set of applications 
      may see Provider Directory A as an authoritative source for all 
      information it provides (e.g., licensure), Provider Directory A may, in 
      fact, obtain some of the information it supplies from other sources that 
      it considers authoritative (e.g., a licensing authority).  The scope of authority may be 
      asserted by a Provider Directory within the contexts of defined working 
      relationships.

      
 

      
In 
      Scope:

      
The Provider 
      Directory exposes services to allow consumer applications to:

      
·         
      Retrieve provider information by 
      identifier

      
·         
      Identify provider(s) based upon 
      identification criteria

      
·         
      Identify candidate providers based upon 
      non-identification criteria

      
·         
      Subscribe to provider update 
      notification service

      
·         
      Request provider information 
      update

      
Out of 
      Scope:

      
·         
      Establish new provider.  It is possible for a valid 
      healthcare provider to be unknown to a given Provider Directory.  A consumer application should be 
      able to assert the existence of such a provider to the Provider Directory 
      for subsequent validation by the Directory.  However, this functionality is not 
      in scope at this time.

      
Description/Example/Use 
      Case:

      
·         
      Retrieve provider information by 
      identifier

      
o        
      A laboratory application receives an 
      order with a provider identifier that is unknown to the lab 
      application.  The lab 
      application requests provider information from the Provider Directory in 
      order to process the order.

      
o        
      (question:  do we need to define limited vs. 
      detailed response services, or can they just be criteria-driven versions 
      of the one service?)

      
·         
      Identify provider(s) based upon 
      identification criteria

      
o        
      A patient requests that a pharmacy call 
      her dentist for a prescription related to an upcoming appointment.  The patient can only describe the 
      dentist as Dr Smith, a woman, on Western 
      Ave in Los 
      Angeles.  
      Using these identification criteria, the pharmacy application 
      queries the Provider Directory to find the appropriate dentist to 
      contact.

      
o        
      (it is possible that more than one 
      provider may be returned by this service, the consumer application, or the 
      human interface, will need to resolve the question of which is the 
      "correct" provider.)

      
·         
      Identify candidate providers based upon 
      non-identification criteria

      
o        
      A physician needs to refer a patient to 
      a hematologist; however the patient requests that they be male, in 
      Ventura 
      County, in a solo practice, and 
      at least 40 years old.  Via 
      the physician's office practice application, the Provider Directory is 
      queried and a list of candidate providers is presented for 
      selection.

      
·         
      Subscribe to provider update 
      notification service

      
o        
      To meet business and regulatory 
      requirements, a pharmacy application must maintain a minimum data content 
      within the application.  In 
      order to ensure that this minimum data content is up-to-date, the pharmacy 
      application registers itself with the Provider Directory using the 
      Subscribe to provider update notification service.  The pharmacy application maintains 
      a listening service which receives information updates from the Provider 
      Directory (for the providers known to the directory). 

      
·         
      Request provider information 
      update

      
o        
      A Visiting Nurse association 
      periodically reviews the information provided by the Provider Directory 
      for its members.  Upon noting 
      discrepancies between their membership information (as updated by the 
      members) and that retrieved from the directory, the association sends 
      requests to the Provider Directory to update and/or revalidate the 
      directory's information from its sources.

      
o        
      (this may invoke both automated and 
      manual updates/validation) 

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
(to be 
      done)

      
Dependencies:

      
Provider Directory services would depend other 
      services to perform authentication/authorization/access control (is the 
      requestor allowed to request that service or view the associated 
      information).

      
 

      
The "Identify 
      provider(s) based upon identification criteria" service is dependent upon 
      Identity Management services.  
      It may be that the this Provider Directory service is the Identity 
      Management services applied to the Provider Directory data.

      
 

      
The "subscription to provider update notification 
      service" requires that the subscribing application expose an appropriate 
      "listener" service.

      
Functional Capabilities:

      
 

  

    
      
Consumer Directory

    
      
HealthConnect (Australia)

      
U.S. Department of Defense (Health 
      Affairs)

      
Canada Health Infoway

      
Kaiser Permanente

    
      
Purpose:

      
The Consumer 
      Directory is an authoritative source for information individuals that 
      utilize healthcare services.  
      

      
 

      
Note that the 
      authoritativeness of any Directory may be relative:  while a given set of applications 
      may see Provider Directory A as an authoritative source for all 
      information it provides (e.g., licensure), Provider Directory A may, in 
      fact, obtain some of the information it supplies from other sources that 
      it considers authoritative (e.g., a licensing authority).  The scope of authority may be 
      asserted by a Directory within the context(s) of defined working 
      relationships.

      
 

      
In 
      Scope:

      
The Consumer 
      Directory exposes services to allow consumer applications to:

      
·         
      Retrieve consumer information by 
      identifier

      
·         
      Identify consumers(s) based upon 
      identification criteria

      
·         
      Identify candidate consumers based upon 
      non-identification criteria

      
·         
      Subscribe to consumer update 
      notification service

      
·         
      Request consumer information 
      update

      
Out of 
      Scope:

      
·         
      Establish new consumer.  It is possible for a valid 
      healthcare consumer to be unknown to a given Consumer Directory.  An application should be able to 
      assert the existence of such a consumer to the Directory for subsequent 
      validation by the Directory.  
      However, this functionality is not in scope at this 
time.

      
Description/Example/Use 
      Case:

      
·         
      Retrieve consumer information by 
      identifier

      
o        
      A laboratory application receives an 
      order with a consumer identifier that is unknown to the lab 
      application.  The lab 
      application requests consumer information from the Consumer Directory in 
      order to process the order.

      
o        
      (question:  do we need to define limited vs. 
      detailed response services, or can they just be criteria-driven versions 
      of the one service?)

      
·         
      Identify consumer(s) based upon 
      identification criteria

      
o        
      A pharmacy receives a verbal order from 
      a dentist for a patient.  The 
      dentist has assorted demographic information (e.g., name, dob, address, 
      phone) for the patient, but does not have the patient's healthcare 
      identifier.  No match is found 
      in the pharmacy system for the demographics.  Using these demographics as 
      identification criteria, the pharmacy application queries the Consumer 
      Directory to find the appropriate patient and healthcare 
      identifier.

      
o        
      (it is possible that more than one 
      consumer may be returned by this service, the pharmacy application, or the 
      human interface, will need to resolve the question of which is the 
      "correct" consumer.)

      
·         
      Identify candidate consumers based upon 
      non-identification criteria

      
o        
      A County Health Service has received 
      anecdotal reports suggesting that 18 – 25 year old males in a particular 
      city are more likely to contract a particular infectious disease.  To follow up on that assertion, 
      the County Health Service needs to identify specific populations that, and 
      surrounding, cities.  These 
      criteria are submitted to the Consumer Directory which returns candidate 
      lists for the submitted criteria.

      
·         
      Subscribe to consumer update 
      notification service

      
o        
      To meet business and regulatory 
      requirements, a pharmacy application must maintain a minimum data content 
      within the application.  In 
      order to ensure that this minimum data content is up-to-date, the pharmacy 
      application registers itself with the Consumer Directory using the 
      Subscribe to consumer update notification service.  The pharmacy application maintains 
      a listening service which receives information updates from the Consumer 
      Directory (for the consumers known to the directory). 

      
·         
      Request consumer information 
      update

      
o        
      Subsequent to a dialysis encounter, 
      staff at the dialysis center notes discrepancies on a patient's 
      demographic information.  
      After verifying the discrepancy with the patient, the staff enters 
      the updated information into their patient management system.  Since the patient management 
      system assumes the Consumer Directory to be the authoritative source for 
      this information, a Request consumer information update is sent.  

      
o        
      (while sending the "known correct" 
      information to the Directory may not be directly applied to the Directory 
      data, it would assist Directory management, particularly if manual 
      intervention became necessary.)

      
o        
      (this may invoke both automated and 
      manual updates/validation) 

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
(to be 
      done)

      
Dependencies:

      
Consumer Directory services would depend other 
      services to perform authentication/authorization/access control (is the 
      requestor allowed to request that service or view the associated 
      information).

      
 

      
The "Identify 
      consumer(s) based upon identification criteria" service is dependent upon 
      Identity Management services.  
      It may be that this Consumer Directory service is the Identity 
      Management services applied to the Consumer Directory data.

      
 

      
The "subscription to consumer update notification 
      service" requires that the subscribing application expose an appropriate 
      "listener" service.

      
 

      
Question: Is there a distinction between this and the 
      concept of a generalized directory service?  What features or attributes of a 
      healthcare consumer are not pertinent to the general 
population?

      
 

      
Question:  
      does access to "consumer" information in health care need to define 
      two, or more, levels of access, or would that be a function of 
      authentication/authorization/access control?

      
Functional Capabilities:

      
 

  

    
      
Consumer Directory

    
      
HL7 
      Australia 
      Submission

    
      
Service “Short” Name: 

      
Consumer 
      Directory 

      
 

      
Alias:

      
Master Patient 
      Index, Identity Management, Person Identity 

      
 

      
Organizations with 
      Registered Interest:

      
HL7 
      Australia, 
      U.S. Department of Defense 
      (Health Affairs), 
      Canada 
      Health Infoway, Kaiser Permanente

      
 

      
Purpose:

      
A directory 
      holding a healthcare consumer’s set of identifiers assigned by various 
      authorities and demographic information, which can be used to establish 
      the consumer’s identity.  
      Additionally, the Consumer Directory maintains consumer contact 
      details and other relevant administrative information including next of 
      kin, insurance status, power of attorney and health record surrogates[HKF1] .  

      
 

      
In 
      Scope:

      
The Consumer 
      Director is responsible for maintaining the demographic and administrative 
      information about a healthcare consumer along with their associated 
      identifiers.  It allows users 
      to interrogate the directory to uniquely identify a consumer, verify 
      consumer’s identity and retrieve consumer demographic and administrative 
      details.  The Consumer 
      Directory should also support replication capabilities to enable federated 
      systems to have local access to a set of consumer details.

      
 

      
Out of 
      Scope:

      
The Consumer 
      Directory should not include consumer based health record access control 
      list.

      
 

      
Description/Example/Use 
      Case:

      
A Consumer 
      Directory should allow the addition of a new healthcare consumer for which 
      an electronic health record has been created providing a master repository 
      for maintaining demographic and administrative information separate from 
      the EHR.  The Consumer 
      Directory will be used to uniquely identify the consumer allowing their 
      unique identifier to be used to access their health record.

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
 

      
Dependencies:

      
Consumer 
      Directory would depend upon other services to perform 
      authentication/authorization/ access control

      
 

      
Functional 
      Capabilities:

      
FindCandidates: 

      
RegisterConsumer:

      
GetConsumer:

      
UpdateConsumer:

      
LinkConsumer:

      
CreateIdentifier:

      
 

      
 

  

    
      
Workflow

    
      
Ocean Informatics

      
Veterans Health 
      Administration

      
 

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Health Record 
      Access/Retrieval

    
      
HealthConnect (Australia)

      
U.S. Department of Defense (Health 
      Affairs)

      
SerAPI Project (Finland)

      
MedicAlert Foundation

      
Veterans Health 
      Administration

      
Ocean Informatics

      
 

      
HL7 
      Australia 
      Submission

    
      
Service “Short” Name: 

      
Health Record 
      Access/Retrieval

      
 

      
Organizations with 
      Registered Interest:

      
HL7 
      Australia, 
      U.S. Department of Defense 
      (Health Affairs), SerAPI Project 
      (Finland), 
      MedicAlert Foundation, Veterans Health Administration, Ocean 
      Informatics

      
 

      
Purpose:

      
A service for 
      recording, retrieving, and manipulating information in a consumers’ 
      electronic health record.  
      

      
 

      
In 
      Scope:

      
The Health Record 
      Access service is responsible for storing, retrieving, and manipulating 
      healthcare consumers’ health record information.  It allows users to submit and 
      maintain health profile or event information and retrieving this 
      information in a variety of views such as the original entries submitted 
      or composed from multiple entries.

      
 

      
Out of 
      Scope:

      
The Health 
      Record Access service is not intended to control the access to the health 
      record.

      
 

      
Description/Example/Use 
      Case:

      
A Health 
      Record Access service would be used to submit a summary of a hospital 
      visit on or soon after a patient is discharged.  The primary care provider could 
      retrieve the details of the hospital visit along with follow up laboratory 
      results the next time the healthcare consumer presents at his clinic.  The PCP can retrieve the current 
      medication list and which will be resubmit with the new prescriptions 
      written along with other summarized information associated with the 
      consultation.

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
The Health 
      Record Access service would depend upon another service to identify the 
      individual or subject of an inquiry.

      
 

      
The Health 
      Record Access service would depend upon another service to locate the 
      instance of the heath record access services for the kind of information 
      required

      
 

      
Health Record 
      Access service would depend upon other services to perform 
      authentication/authorization/ access control

      
 

      
Functional 
      Capabilities:

      
SubmitComposition:

      
FindComposition: 

      
GetComposition:

      
UpdateComposition:

      
NullifyComposition:

      
GetEntireRecord:

      
GetRecordView:

      

  

    
      
Role-Based Query Access 
    

    
      
Blue Cross/Blue Shield

      
Canada Health Infoway

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Privacy/Security/Consent

    
      
Canada Health Infoway

      
MedicAlert Foundation

      
NLM

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Record 
      Location/Federation

    
      
Canada Health Infoway

      
IBM

      
U.S. Department of Defense (Health 
      Affairs)

      
SerAPI Project (Finland)

      
Veterans Health 
      Administration

      
 

      
Veterans Health Administration 
      Submission

    
      
Purpose:

      
The Record 
      Locator Service (RLS) provides the ability to determine where information 
      is located between or with health enterprises.  It provides insight into metadata about information of 
      interest, including items such as creator, category, source, size, format, 
      language, dates, etc.  
      

      
 

      
In 
      Scope:

      
The RLS is 
      responsible for the bookkeeping and ability to identify which server 
      instances contain categories of registered information about a 
      person.  The Locator Service 
      maintains the following knowledge:

      
 

      
·         
      What categories of information (HL7 
      Templates) a given location knows about.

      
·         
      What categories of information (topics) 
      a given location wants to receive messages.

      
·         
      For which persons is information 
      stored.  

      
 

      
Out of 
      Scope:

      
It is 
      important to note that the RLS does not provide visibility into the 
      content of the information it is seeking, rather it is limited to 
      searching the form, structure, and metadata.  For example, RLS cannot locate 
      only those results for a particular lab test that resulted as 
      positive.  It could, however, 
      determine where laboratory records of that type exist for a particular 
      patient.  
      

      
 

      
Description/Example/Use 
      Case:

      
For instance, 
      the RLS may be used to determine if there are any nuclear images 
      for a particular person/patient role that have been made available in the 
      past 30 days.   This 
      provides the ability to dynamically discover servers/services with 
      relevant content to a query or situation.  

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping

      
(still needs 
      to be done)

      
 

      
 

      
Dependencies:

      
The RLS would 
      depend upon another service to identify the individual or subject of an 
      inquiry.

      
 

      
The RLS would 
      depend upon another service to perform the retrieval of record instances 
      (e.g., RLS could return metadata but not data)

      
 

      
RLS would 
      depend upon other services to perform authentication/authorization/ access 
      control

      
 

      
Functional Capabilities:

      
 

      
ð      
      FindLocations – Provides a list of systems/services in which 
      relevant data resides for a designated set of input criteria.  The result of a GetLocations 
      invocation is a list of the locations containing data matching the query 
      criteria, and optionally the type of information available at those 
      locations.  This would be 
      similar to the “treating facility list”.  Examples 
      include:

      
ð      
      Records of a certain 
      type by server instance (could be used for 
      Epidemiology)

      
ð      
      Locations of all 
      records for a certain person

      
ð      
      Locations where any 
      records exist for a person

      
 

      
(based in part upon the OMG Health Information 
      Locator Service, RFP and [draft] initial 
    submission)

  

    
      
Record Locator

    
      
Submission from IBM

    
      
Description

      
The Records 
      Locator (RL) is the set of all health related data records associated with 
      a Person ID and the associated functions that can create / retrieve / 
      update / delete / search for the records.  All actions on the RL must be 
      authorized for the actor and for the role in which the actor is performing 
      the action.

      
Terms

      
•               
      Location – a uniquely identifiable place where health information 
      regarding a person is stored.

      
•               
      Location Entry – a single entry in the Records Locator that is 
      associated with a Person ID and can fully resolve the Location of the 
      health data.

      
•               
      Location Attributes – the metadata associated with a Location Entry 
      that describes the health data stored at the 
      Location.

      
•               
      Location ID – an identifier that is uniquely assigned to each 
      Location Entry

      
Use 
      cases

      
•               
      Create a Location 

      
o              
      Creates a new Location Entry in the RL.  A Person ID and Location 
      Attributes must be provided and no collisions are allowed.  A unique Location ID is 
      created.

      
•               
      Retrieve Location

      
o              
      Returns a particular Location Entry when provided a Location 
      ID.  

      
•               
      Update Location

      
o              
      Changes the attributes associated with a Location ID.  This should only be called when 
      health data records are moved to a new location.

      
•               
      Retrieve a Person’s Locations

      
o              
      Returns a list of all of the currently active health data records 
      along with the metadata associated with each 
      Location.

      
•               
      Re-assign Location

      
o              
      When provided a Location ID and a Person ID, this action will 
      associate the Location Entry with the specified person.  This action can be used when a 
      duplicate Person record was created (i.e. a person who had a Person ID was 
      not identified and had a new Person ID created in the MPI and records were 
      associated with the new Person ID – this action would allow the records to 
      be merged under a single Person ID)

      
•               
      Archive Location

      
o              
      Allows the Location Entry associated with a Location ID to be 
      accessed in a less time sensitive manner than other Location Entries.  Useful for maintaining information 
      for clinical research or for moving older, less useful Location Entries to 
      slower access media.

      
•               
      Delete a Location

      
o              
      Marks a Location Entry as being deleted.  This action does not physically 
      delete the entry, but removes the Location from activity.  Once deleted, the only two valid 
      actions on the Location Entry are Undelete or Purge.  

      
•               
      Undelete a Location

      
o              
      Makes a previously ‘deleted’ Location Entry active.  This action effectively undoes a 
      ‘Delete a Location.

      
•               
      Purge A Location

      
o              
      Physically removes a Location Entry from the RL.  This is an irrevocable action.

  

    
      
Document Exchange

    
      
HL7 Australia Submission

    
      
Service “Short” Name: 

      
Document 
      Exchange

      
 

      
Organizations with 
      Registered Interest:

      
HL7 
      Australia

      
 

      
Purpose:

      
A service for 
      managing the exchange of documents between healthcare providers.  

      
 

      
In 
      Scope:

      
The Document 
      Exchange service is responsible for securely storing and forwarding 
      healthcare documents in transit between healthcare providers.  It is intended to be a generic 
      service to support a variety of healthcare documents which may need to be 
      exchanged between providers.  
      The service may notify (using insecure communication) the intended 
      recipient (when known) that a document is awaiting collection with a link 
      provided to allow direct access.  
      Alternatively a document can be located using a search on metadata 
      indexed at the time of the document being submitted to the document 
      repository.  This search may 
      be based on unique identifiers encoded within bar codes or composite 
      details such as healthcare consumer demographics and provider 
      details.

      
 

      
Out of 
      Scope:

      
The Document 
      Exchange service is not intended as a replacement of an electronic health 
      Record or persistent document repository.

      
 

      
Description/Example/Use 
      Case:

      
A Document 
      Exchange service is used to send an electronic pharmacy prescription to be 
      held until healthcare consumer presents at the pharmacy where they have 
      chosen to have their prescription filled.  The Pharmacist scans the barcode 
      encoding document identifier or searches for the prescription using 
      demographics details take from the consumers’ photo identification.  The prescription is identified in 
      document registry that returns the actual location of the prescription, 
      which is then retrieved, from the document repository.  The prescription is filled as 
      required and the document repository is updated to indicate the items that 
      remain to be filled.  Expired 
      or filled prescriptions will be purged as required.

      
 

      
Other use 
      cases may include Referral, Pathology Orders and Diagnostic Investigation 
      Results.

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
The Document 
      Exchange service would depend upon other services to perform 
      authentication/authorization/ access control

      
 

      
Functional 
      Capabilities:

      
StoreDocument:

      
FindDocument: 

      
GetDocument:

      
RegisterDocument:

      
NullifyDocument:

      
UpdateDocument:

      
 

      
 

  

    
      
MPI/Person 
      Identity/Identity Management

    
      
IBM

      
Canada Health Infoway

      
Inter-Mountain Healthcare

      
NLM

      
 

      
 

      
Submission from IBM

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

      
 

      
Description

      
The MPI is a directory of Persons and the 
      associated functions that can create / retrieve / update / delete / search 
      Person Entries in the directory.  
      All actions on the MPI must be authorized for the actor and for the 
      role in which the actor is performing the action.

      
Terms

      
•               
      Person – an individual whose information is maintained in the MPI 
      directory within a Person Entry

      
•               
      Person Entry – an single entry in the MPI directory corresponding 
      to a Person

      
•               
      Person Attributes – the set of characteristics that, hopefully, 
      uniquely identify a Person

      
•               
      Person ID – the unique identifier assigned to a Person Entry (see 
      also: Records Locator)

      
Use cases

      
•               
      Search for a Person Entry

      
o              
      Provides an ordered list of Person Entries that match the given 
      criteria.  The order of the 
      list is dependent on the weights assigned given Person 
      Entry

      
•               
      Create a Person

      
o              
      Creates a new Person Entry in the MPI directory.  A minimum set of Person Entry 
      attributes must be present in order for the entry to be created.  A unique Person ID is 
      assigned.

      
•               
      Retrieve Person Attributes

      
o              
      Returns all of the attributes for a Person Entry corresponding to 
      the Person ID provided by the caller.  

      
•               
      Update Person Attributes

      
o              
      Changes the attributes associated with a Person Entry.  This action permanently alters how 
      a Person Entry can be retrieved through a search.

      
•               
      Archive a Person

      
o              
      Moves the Person Entry to a non-active state while retaining all 
      other information about the Person.  
      Useful for maintaining information for clinical research while 
      removing the Person from active searches.  This action should only be 
      performed when a Person has left the healthcare 
      system.

      
•               
      Delete a Person

      
o              
      Marks a Person Entry as being deleted.  This action does not physically 
      delete the entry, but removes the Person from activity.  Once deleted, the only two valid 
      actions on the Person Entry are Undelete or Purge.  This action should not succeed if 
      there are records associated with the Person ID in the Records 
      Locator.

      
•               
      Undelete a Person

      
o              
      Makes a previously ‘deleted’ Person Entry active.  This action effectively undoes a 
      ‘Delete a Person’.

      
•               
      Purge A Person

      
o              
      Physically removes a Person Entry from the MPI directory.  This is an irrevocable 
      action.

      
 

  

    
      
Resource Scheduling 

    
      
(Keith Campbell)

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Terminology Services

    
      
Mayo Clinic

      
Department of Defense (Health 
      Affairs)

      
Veterans Health 
      Administration

      
SerAPI (Finland)

      
MedicAlert Foundation

      
Kaiser-Permanente

      
InterMountain Health

      
 

      
Kaiser-Permanente 
      Submission

    
      
Purpose:

      
Terminology 
      Services provides definition and translation between, and within, 
      term/concept sets.  Available 
      information includes metadata for the term/concept sets such as copyright, 
      publication date, version/revision, structure, and languages 
      supported.

      
In 
      Scope:

      
Terminology 
      Services exposes the following services:

      
·         
      Translate code to concept.  Supplied with a specific code and 
      a designated terminology (e.g. code system), this service returns the 
      associated concept information (e.g., definition, display string, 
      comments, source attribution).  
      If the terminology supports multiple languages, all language forms 
      will be returned unless a specific language is specified in the 
      request.

      
·         
      Retrieve child concept service.  For hierarchically structured 
      terminologies, this service returns any child concepts of the supplied 
      code/concept.  Depth of return 
      (how many child generations) may be specified in the request.

      
·         
      Retrieve parent concept service.  For hierarchically structured 
      terminologies, this service returns the parent concept(s) of the supplied 
      code/concept.  Depth of return 
      (how many parent generations) may be specified in the request.

      
·         
      Translate coded concept to alternate 
      terminology (Simple).  
      Supplied with a concept coded in a particular terminology, and an 
      alternative terminology, this service returns all "mapped" concepts in the 
      alternative terminology.  Each 
      returned concept will also include an indication if it uniquely maps back 
      to the original concept (e.g., is the mapping bi-directional)

      
·         
       

      
Out of 
      Scope:

      
·         
      Locate coded concept.  Based upon supplied, non-coded, 
      criteria (e.g., description), identify the related coded concept(s) in the 
      specified terminology/concept sets. 

      
Description/Example/Use 
      Case:

      
·         
      Translate code to concept.  Supplied with the coded concept of 
      "F" in code system HL70001, the service would return a description of 
      "Female", and an attribution of "Health Level 7, User-defined table 0001, 
      Administrative Sex" (and possibly other metadata, to be defined).  
Supplied with the coded 
      concept of "LIV" and code system 2.16.840.1.113883.5.41, the service would 
      return a display string of "Living Subject", a description of " Anything 
      that essentially has the property of life, independent of current state (a 
      dead human corpse is still essentially a living subject)", an attribution 
      of "Health Level 7", a terminology description of "EntityClass" (and 
      possibly other metaday, to be defined).

      
·         
      Retrieve child concept 
      service.  Supplied with 
      the coded concept of "LIV" and code system 2.16.840.1.113883.5.41 with one 
      generation requested, the service would return two terms:  concept "PSN", display "Person" 
      and concept "NLIV", display "non-person living subject" [additional data 
      would include description, attribution, etc, not included here for 
      brevity].

      
·         
      Retrieve parent concept 
      service.  Supplied with 
      the coded concept of "LIV" and code system 2.16.840.1.113883.5.41 with one 
      generation requested, the service would return one term:  concept "ENT", display "Entity" 
      [additional data would include description, attribution, etc, not included 
      here for brevity].

      
·         
      Translate coded concept to alternate 
      terminology (Simple).  
      Supplied with the coded concept of "F" in code system HL70001, and 
      a target terminology of SNOMED-CT the service would return concept " 
      248152002", description "Female" [and additional information or metadata 
      not included here for brevity].

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
How are terminologies are identified?  OIDs?

      
Functional Capabilities:

      
 

      
 

  

    
      
Service Locator

    
      
Queensland Health

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Decision Support/Rule 
      Interpretation

    
      
Partners Healthcare

      
Intermountain Health

      
Ocean Informatics

      
Duke University

      
Mayo Clinic

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Record/Data Element Query 
      

    
      
Partners Health

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Action 
      Invocation/Notification Service

    
      
Partners Health

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Care Plan Management 

    
      
Blue Cross/Blue Shield

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Service 
      Events/Encounters

    
      
Canadian Institute for Health Informatics 
      (CIHI)

    
      
Purpose:

      
 

      
In 
      Scope:

      
 

      
Out of 
      Scope:

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
 

      
Functional Capabilities:

      
 

  

    
      
Benefits Management

    
      
Kaiser 
      Permanente Submission

      
 

    
      
Purpose:

      
Benefits 
      Management provides

      
In 
      Scope:

      
Benefits 
      management exposes the following services:

      
·         
      Retrieve benefit summary for 
      patient.  For a specified 
      patient, the service returns basic benefits information (subscriber, 
      payor, plan description, etc, including multiple accounts) for all 
      benefits providers known to the service.  The service request may include 
      identification of the benefit provider to limit the returned 
      information.

      
·         
      Retrieve benefit details for 
      patient.  For a specified 
      patient, the service returns detailed benefits information (summary 
      information as well as details on coverage, copayments and accumulated 
      payments for all benefits services) for all benefits providers known to 
      the service.  The service 
      request may include identification of the benefit provider and/or benefits 
      services (e.g., Lab, Pharmacy, Dental) to limit the returned 
      information.

      
Out of 
      Scope:

      
·         
      Adjudicate service for patient.  For a specified patient and health 
      care service, the service returns information on whether the service would 
      be a covered benefit.  No 
      implication of performance is included in the service request.

      
·         
      Pre-authorize service for patient.  For a specific patient and health 
      care service, the service returns either an authorization to perform the 
      service, denial of coverage for the specified service, or a request for 
      additional information needed to authorize the service.

      
·         
      Subscribe to benefit update notification 
      for patient.  For a specified 
      patient and health care benefit provider, this service registers the 
      requestor to receive notifications of changes to the benefit information 
      for this patient under this service provider.  The requesting application must 
      expose a service to receive these updated.

      
·         
      Request validation of benefits for 
      patient.  This service 
      provides a means for the health care provider (requestor) to initiate a 
      review of the benefit information for a particular patient.  For example, if a patient insists 
      that their coverage include a specific service benefit, this service would 
      allow the provider to request review of the patient's benefits generally 
      or specifically to the service benefit in question.  The health care provider would 
      have to have business processes to deal with the immediate issue as t is 
      not expected that this will be a fully automated service, but rather 
      trigger some human intervention.  
      

      
 

      
Description/Example/Use 
      Case:

      
 

      
Functional 
      Requirements/EHR Functional Model Mapping:

      
 

      
Dependencies:

      
Benefit management services depends on other 
      services to perform authentication/authorization/access control (is the 
      requestor allowed to request that service or view the associated 
      information).

      
 

      
Benefit 
      management services, as described here, presuppose proper, authoritative 
      identification of the patient.  
      This may not be the case and these services may utilize Identity 
      Management services in order to uniquely identify the patient.

      
 

      
Functional Capabilities:

      
 

  

    
      
 

    
      
 

    
      
 

 

 [HKF1]Is this part of an access control 
service
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