Chapter8ConstrainedInformationModels AcentralideaoftheHL7V3approachisthatofconstrainingorrefiningageneralmodel,for thespecificusecasebeingconsidered,bylimitingoptionality.Thisideaofconstraininga generalmodeltocreateanagreedsubsetandinterpretationofthespecificationis widespreadinthestandardsworld.Suchconstrainedspecificationsarecalledprofiles. Manystandardshavealargenumberofoptionalaspectsandifdifferentsuppliersdonot implementthesamesubsettheywillfailtointeroperate.Theuseofprofilesisawayto enforceaparticularinterpretationtoensureinteroperability. Theideaofconstrainedinformationmodelscreatesatreelikehierarchyofpossiblemodels. AttherootliestheRIM.EverythingelseisaconstraintontheRIM. TypesofConstrainedInformationModel ThefollowingtypesofconstrainedmodelarerecognisedwithinHL7V3,startingwiththe broadest,proceedingtothenarrowest.

. DMIMDomainMessageInformationModel RMIMRefinedMessageInformationModel HMDHierarchicalMessageDescription MTMessageType DomainMessageInformationModel DomainMessageInformationModels(DMIM)havebeendefinedformanysubjectareas. ADMIMisageneralmodelofadomain,inHL7notation,fromwhicharelatedfamilyof messagespecificationscanbederived.ADMIMmaybecreatedtopdownfromdomain experienceorbottomupasasupersetofmessagesinadomain.OncecreatedaDMIMcan beusedareferencefromwhichfurthermessagesmaybedefined. ADMIMdoesnothaveahierarchicalstructureandcannotbeserialised,whichmeansthatit cannotbeimplementedasitisbutneedstobefurtherconstrainedasRMIMs.Notall projectsuseDMIMs,buttheirpurposeistoprovideacommonpointofreferencetoensure compatibilitybetweenallRMIMsinthesamedomain. RefinedMessageInformationModel ThemostwidelyusedconstrainedinformationmodelistheRMIM(RefinedMessage InformationModel),whichisadiagramofamessagespecification.RMIMsandDMIMsuse thesamenotation.OneimportantdifferenceisthatanRMIMcanonlyhaveonepointof entryandcanbeexpressedinaserialisedformat,whichisessentialifamessageistobe transmittedasastringofbitsoverawire. HierarchicalMessageDescription AnRMIMcanalsobeexpressedinatabularformat,knownasahierarchicalmessage description(HMD).HMDsandRMIMscancontainthesameinformation,butmostpeople findthatRMIMsareeasiertouseandunderstand. MessageType Amessagetype(MT)isaspecificspecificationofamessagewhichcanbeusedinadata interchange.AnyoneRMIMorHMDcanbefurtherconstrainedinvariouswaystocreatea setofcloselyrelatedmessagetypes,whicharethenexchangedasalinearstringofXMLand validatedusinganXMLschema.
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TypesofConstraint TheRIM,DMIMsandRMIMscanbeconstrainedinseveraldifferentways. OmissionandCloning Thesimplestformofconstraintisbyomission.Classesorattributeswithclassesaresimply leftout.Allclassesandallattributes(apartfromstructuralattributes)intheRIMare optional,soyouonlyusetheonesyouneed. Cloning ThesameRIMclasscanbeusedmanytimesindifferentwaysinDMIMsandRMIMs.This processisreferredtoascloningandtheclassesselectedforuseinconstrainedmodelsare referredtoasclones. ThemetaphorbeingthatyoutakeacloneofaclassfromtheRIMandthenconstrainthat cloneintheconstrainedinformationmodel.Cloninglimitsthenumberofclassesthatneed tobedefinedintheRIM,leadingtoasmallstableRIM. MultiplicityandOptionality Thenextformofconstraintistoconstrainmultiplicitiesintermsofrepeatabilityand optionality.MostassociationsandattributesintheRIMareoptionalandallowanynumber ofrepeats. Thesecanbeconstrainedbymakingsuchmultiplicitiesnonrepeatablemandatory(1..1) youneedtohaveone,butonlyone;ornonrepeatableoptional(0..1)ifyouhaveany,you canonlyhaveone. InHL7Version3specifications,thecorrectverbformforindicatingarequirementis "SHALL."Thecorrectverbformforindicatingarecommendationis"SHOULD."Thecorrect verbformforanoptionis"MAY."Universallyacceptedstandardizationterminologydoesnot recognize"must"."SHALL"isusedtoindicateamandatoryaspectoranaspectonwhich thereisnooption.ThenegativesareSHALLNOT,SHOULDNOT,MAYNOT. DataTypesConstraint Thethirdtypeofconstraintinvolvesconstrainingdatatypes.TheHL7V3datatypeshave beendesignedwithahierarchicalstructure.Forexampletherearefourcodedatatypes:CS (codesimple),CV(codedvalue),CE(codewithequivalents)andCD(conceptdescriptor)in increasingorderofcomplexity.Amorecomplexdatatype,suchasCDcanbeconstrainedto asimpledatatypesuchasCV.SimilarlythedatatypeGTS(GeneralTimeSpecification)can beconstrainedtoIVL<TS>(TimeInterval)ortoTS(Timestamp). CodeBinding Thefinaltypeofconstraintinvolvescodebindingspecifyingwhatcodevaluesetsshallbe used.ThecodingstrengthofacodemayalsoberestrictedtoCNE(CodedNoExceptions)or maybespecifiedasCWE(CodedWithExceptions) Thismayallsoundquitecomplexbutisalotsimplerthanitsounds.Thesimpleruleisthat youonlyspecifywhatyouneed,leaveouteverythingelseormakeitasimpleaspossible. VocabularyandValuesets TheHL7V3standardstalkaboutvocabularydomainsandvaluesetsanditisimportantto understandthedifferencebetweenthem. Avaluesetisthesetofcodesthatmaybeusedtopopulateaspecificattributeinamessage instance,andisusuallyspecifiedbythemessagedesigner.Avaluesetmaybeasinglecode
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only,forexampletospecifyastructuralattribute,asubsetofanHL7definedcode,orallor partofanexternallydefinedcodingsystem Avocabularydomainisthesetofcodesavailabletothemessagedesignerforaspecific attribute.Forexample,thevocabularydomainfortheAct.moodCodeisthesetofallmood codevaluesdefinedandmaintainedbyHL7. Messageusersareconcernedwithvaluesets,messagedesignersneedtothinkabout vocabularydomainsandselecttheirvaluesetsfromthese. TheconceptofvocabularydomainsismostapplicabletoHL7sowninternallydefined vocabularytables,whicharequiteextensive.Thesemustbeusedforstructuralattributes andarewidelyusedwithinDataTypes. Eachconceptnormallyhasamnemoniccode,whichisthecodevalueused,aprintname whichexplainsitsmeaningaconceptID,usedforinternalreference,alevelandtype. Mnemoniccodesareuniqueforaparticularcodingscheme.Thesetableshavea hierarchicalstructure,witheachconceptbeingallocatedalevel,soalevel2conceptisthe childoftheprecedinglevel1conceptandsoon.Thecodetypemaybe Abstract(A)doesnothaveacode,butdoescontainchildconcepts Specialised(S)hasacodeandcontainschildconcepts Leaf(L)hasacode,butnochildconcepts

ArtifactNaming HL7V3artifactsareidentifiedusingacommonnamingscheme,whichisatfirstsightabit complex.TheformatisSSDD_AAnnnnnnRRVV, Thefirstfourcharactersidentifythesubsectionsanddomains. COCT COMT FIAB FICR MCAI MCCI MFMI POLB PORX PRPA PRPM PRSC QUQI RCMR CommonMessageElements CommonMessageContent Accounting&Billing Claims&Reimbursement MessageActInfrastructure MessageControlInfrastructure MasterFileManagementInfrastructure Laboratory Pharmacy PatientAdministration PersonnelManagement Scheduling QueryInfrastructure MedicalRecords

Thefirstfourcharactersarefollowedbyanunderscorecharacter_andthentheartefact type,identifiedwithatwocharacteracronym. ARApplicationRole DMDMIM(DomainMessageInformationModel) DODomain EXExample HDHMD(HierarchicalMessageDescriptor) INInteraction MTMessageType NCNarrativeContent RMRMIM(RefinedMessageImplementationModel)
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STStoryboard STStoryboardNarrative TETriggerEvent Theartifacttypeisfollowedbyasixdigitidentifierallocatedbythecommitterresponsible. Thefinalcharactersarea2characterRealmCode,wheretheidentifyingwhichinternational affiliateofHL7isresponsibleforthis.ThedefaultisUV(Universal)followedbyaversion numberintherange(0099). Forexample:PRPA_RM001234UV00mayberecognisedasanRMIMinthePatient Administration,useduniversally,revision00.Thisartifactnamingconventionisabit awkward,butitisworthtakingthetroubletomemorizethemainacronyms. ThenameofeachclonedclassinanRMIMisderivedfromitsstructuralattributes.

Fig81ConstrainedInformationModels

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ASimpleExample Figure82showsasimpleRMIMforaninvestigationreport.

Fig82SimpleRMIM TheentrypointorfocalclassisanObservationEvent.ThisisthedefaultnameforanyAct withclassCode=OBS(observation)andmoodCode=EVN(event).Thishasthreeother attributes:auniqueidentifierid(suchasaUUID),acode,whichstatesthetypeofreport andaneffectivetime,whichreferstothedate/timeoftheobservation. ThisreportcontainsoneormoreInvestigationEvents(classCode=INVSTG,moodCode= EVN),eachofwhichhasanid(suchasaUUIDoralinenumber),acode(inthiscaseaCPT4 codetoindicatewhatitis)andavalue,whichisasimpletextstring(ST). ThereporthastwoParticipations:SubjectandAuthor.ThewaytoreadtheParticipationsis thattheObservationEventhassubjectPatientandhasauthorAgent ThesubjectisaPatient,withanid,suchasahospitalnumber.ThePatientisscopedbyan Organization,whichhasanagreedidentifier(id).ThecombinationoftheOrganizationidand thePatientidshouldbegloballyunique. Thepatienthasanoptionalname,inthePersonclass(Entity).Theplayingassociation (patientPerson)betweenPersonandPatientisindicatedas[0..1],andisnotinboldfont, indicatingthatthisisnotmandatory.SimilarlythenameattributeinPersonisnotinbold fontandisannotatedas[0..1]. TheauthorisanAgent,whichcouldbeaclinician,technicianoramachine.TheAgenthasa uniqueidentifier. InthisRMIMallelementsaremandatory(andthereforerequired),whichiswhytheyareall writteninboldfontandsuffixedwiththe*indicator.

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DiagramNotation Classes HL7usesaspecialgraphicalnotationforspecifyingRMIMsandDMIMs. EachActisrepresentedasaredrectangle; Roleasayellowrectangle Entityasagreenrectangle. ActRelationshipisusuallyshownaspink(salmon)arrowshapedpentagon Participationasacyan(lightblue)pentagon RoleLinkasalightyellowpentagon.

Eachofthearrowshapedpentagonshasasourcefortherelationshipandatarget.The directionofthearrowindicatesthemeaningoftheassociation,butthisisnotalwaysthe waythatthediagramshouldbenavigated. Thedirectionofnavigation(thewayyoureadthediagram)isindicatedbythelocationofthe multiplicityshownjustoutsidetheclass.Thismaysoundconfusing,buttheimportantthing torememberisthatthedirectionofthearrowsisnotalwaysthewaythatthediagram shouldberead. ActRelationshipandRoleLinkmayberecursive,thatis,pointbacktoitself.Thisisindicated byapigsearboxwithanotchedoutcornerwhichfitsaroundonecornertheActorRole. Attributes EachattributeusesexactlythesameattributenameasisintheRIM.Theattributesselected foruseinRMIMsareformedbyconstrainingorlimitingtheattributesasdefinedintheRIM. ThisallowscheckingandvalidationandisisthekeyreasonwhytheRIMmaynotbe changed. TheattributenameinanRMIMdiagrammaybeinboldprint.Thisindicatesthatthis attributeismandatory,itmustalwaysbepresent,nullvaluesarenotallowed.Thisisa responsibilityofthesenderApplicationRole. Theattributenamemayhaveastar*nexttoit.Thisindicatesthatthisattributeis requiredtobepresentinmessages.Ifdataisnotavailableanullvaluemaybesent. Themultiplicityorcardinalityoftheattributeisdenotedwithinsquarebrackets[]to indicatehowmanytimesthisattributemayberepeated.[0..1]indicateszeroorone; [1..1]indicatesexactlyone.*indicatesnoupperlimit,so[0..*]indicateszeroto many. TheattributesDataTypeisspecifiedaftertheattributename,separatedbyacolon:. ThespecifiedDataTypemustbeeitherthesameasoravalidconstraintontheRIMData Typeforthatattribute. Ifthedatatypeisacode,thenthecodingstrengthmaybedenotedbyaddingeitherCNE (codednoexceptions)orCWE(codedwithexceptions)afterthedatatypedesignator. Thevaluesetorvocabularydomaintobeusedwiththisattributeisspecifiedaftereither an<=or=;<=indicatesthatthevaluemaybetakenfromavocabularydomainor thecodespecifiedoranyofitsdescendantsinahierarchy.Theequalssignindicatesthat thevalueshouldbeasspecified.Thedomainspecificationmustbeeitheradomain namedefinedinthevocabularytables,orasinglecodevaluefromtheappropriate domain.
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Astringinquotes(e.g.string)indicatesadefaultvalueforthisattribute. Finally,abriefdescriptionofattributesmaybeincluded,enclosedwithinparentheses (..).

Iftheattributeinformationextendsbeyondoneline,thensecondandsubsequentlinesare indented. EntryPoint EveryRMIMhasanentrypoint,whichpointstothefocalclass.Thisalsostatesitsname, identifierandanydescriptivenotestheauthorhasprovided. CMET CommonMessageElementTypes(CMET)isareusablemodules,whichcanbeusedin multiplemessages,ratherlikeaprogramsubroutine.UsingCMETscanspeedupthe processofdevelopingmessagesandincreaseconsistencybetweendifferentspecifications. EachCMEThastwoparts.TheCMETreferenceisaspecialclass,whichcanbeaddedtoan RMIM.WhenaCMETisreferenced,orusedinanotherdiagram,itisshownwithaspecial notation,aboxwithdashededges.ItcontainsthenameoftheCMET,itsartifactid,itsclass codeanditslevelofattribution.Itiscolourcodedinamannerconsistentwithitsrootclass. EachCMEThasauniqueartifactidentifier(beginningwithCOCT_),whichistheprimarylink betweeneachCMETreferenceanditscontent. TheCMETcontentitselfisdefinedasasmallRMIM,whichisstoredinaCMETlibrary.Thisis includedautomaticallyinmessageswhentheyareconstructed. EachCMEThasasingleentrypoint,whichisthepointatwhichitisattachedtoany containingmessage,whichreferencesit.CMETsdonothaveexitpoints,whichmeansthey havetobeattheterminalorleafpointinthehierarchicalstructureofamessage. BecauseCMETsaredesignedforcommonusebyanyHL7committeetheyarekeptina separatecommoncomponentslibrary. ChoiceBox HL7RMIMsshowchoicesoroptionsbyusingachoicebox.Eachoftheoptionsisshownin aboxwithadashedlineborder,fromwhichasinglechoiceismade. Associationsmaybemadetoaspecificclasswithinthechoicebox,ortoanyoftheclasses, irrespectiveofwhichisselected.

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 Fig83HL7V3DiagramNotation Tooling RMIMsarebuiltusingaspecialtoolsetdevelopedbyHL7.Theoriginaltools,basedon MicrosoftAccessandVisioareintheprocessofbeingreplacedbyanewgenerationoftools, whichuseaslightlymodifiednotation. ThebasisofthesetoolsisasetofinterrelatedXMLschema,knownasModelInterchange Format(MIF).MIFdefinestheprimaryartifactsthatcanbedevelopedorexchangedasa resultofHL7V3standardsdevelopmentandimplementation. Templates InHL7,templatesareusedtoconstrainandverifyconformancetoprofiledHL7Version3 RefinedMessageInformationModels(RMIMs).Atemplateisanexpressionofasetof
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constraintsontheRIM,whichisusedtoapplyadditionalconstraintstoaportionofan instanceofdataexpressedintermsofsomeotherStaticModel.Templatesareusedto furtherdefineandrefinetheseexistingmodelswithinanarrowerandmorefocusedscope. EachtemplateisidentifiedwithatemplateID,agloballyuniqueidentifier. HL7DevelopmentFramework HL7sstandarddevelopmentmethodologyisdocumentedintheHL7Development Framework(HDF)1.TheHDFiswrittenforHL7memberswhoaredevelopingstandards withinHL7committees.Howevermuchofwhatitsaysisofuniversalrelevance.TheHDF adoptsaprojectorientedapproach,basedonaProductLifeCycleforProductDevelopment. TheHDFidentifiesthefollowingmajorstages: ProjectInitiation TheProjectInitiationProcess(PIP)includesinitiation,planning,andapprovalsubstages, includingthedevelopmentofadetailedProjectScopeStatement(PSS)andplan.The projectplanidentifiesthebusinesscaseandobjectives,participantsincludingsponsor committee,projectleader,contributorsandearlyimplementersandatimeschedule. DomainAnalysis DomainAnalysisProcess(DAP)includesanalysisandrequirementsdocumentation,including thedevelopmentofaDomainAnalysisModel(DAM),whichincludes: Businesscontextincludingdocumentationusingstoryboardsandidentificationof relevantactorsandinteractions Usecaseanalysisdocumentingusecasesandactors Processmodel,documentedusingactivitydiagrams Informationmodel,documentedusingclassesandattributes Businessrulesincludingtriggerevents Glossary

SpecificationDesign SpecificationDesignProcess(SDP)isthecoreoftheprocess.Itinvolvesmappingthe requirementsassetoutintheDomainAnalysisModeltotheHL7RIM,datatypesand vocabularytospecifythemessagestructures,valuesetsanddynamicprocesses. Profiles Aprofileisasetofinformationusedtodocumentsystemrequirementsorcapabilitiesfrom aninformationexchangeperspectiveandisexpressedintermsofconstraints,extensions,or otheralterationstoareferencedstandardoranotherprofile.ProfilesofHL7Version3are derivedfromaVersion3specification,asballotedeitherbyHL7orbyoneofitsaffiliates. Thecategoriesanduseofprofilesincludeannotation,constraint,localizationimplementable andconformanceprofiles. AnnotationProfile Annotationprofilesdocumentthestandardexactlybutwithmoreinformationtofurther explainthebasedocumenttoeducateprospectiveusersand/orimplementers. ConstraintProfile

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Constraintprofilesmaycontainunchangedandconstrainedelements,reducingthe optionalityandcardinalityofthebasespecification(i.e.,theHL7V3standard)inorderto makethespecificationmoreexact. LocalizationProfile Localizationprofilesmeetthesameobjectivesasaconstraintprofile,withtheadditionof someadditionalelements(extensions).HL7Version3allowslocalizationofsomepartsof thestandardbutnotothers.Inparticular,HL7doesnotallowanyone,apartfromHL7itself throughaformalprocess,tochangeormodifytheRIMoranyoftheDataTypes. Localizationcanmakefulluseoftheconstraintmechanismsandmakecertainchangesto RMIMs,DataTypes,MessageTypes,CMETsandVocabularies. ImplementableProfile Implementableprofilesarethemostconstrainedconstraintprofilesandeliminateall optionalityinthebasespecification(theHL7V3standard)inordertomakethespecification exactandapproach"plugandplay"interoperability.Optionalityforaprofileiseliminated whentheconformanceindicatorforeveryattributeandassociationiseitherRequiredor NotPermittedandeveryvocabularydomainisboundtoavalueset. ConformanceStatement Conformancestatementssetoutacomputersystem'sconformanceclaimtoasetof interactions.Aconformanceprofileindicatesthesetofinteractionsthatacomputersystem (orapplicationrole)supports.Itimpliesacommitmenttofulfilalloftheresponsibilitiesof theinteractionsspecifiedandtoimplementfaithfullytheartifactsthatconstitutethe interactionsandanyfurtherconstraintsorextensions. ImplementationTechnologySpecification(ITS) TheXMLimplementationtechnologyspecificationdescribeshowindividualinstancesof messagetypesshallberenderedinXMLforserialtransmissionoverthenetworkandthe structureofschemasusedtovalidateeachinstance.NotethattheHL7generatedXML schemasarenotabletotestalloftheconstraintsdefinedinaHL7messagedefinition. Thegenerationoftheschemasandmessagerepresentationisdoneautomatically.Those notdirectlyinvolvedinthatprocessdonotneedtounderstandthetechnicaldetails.Thekey pointsasfollows: OneXMLelementisdefinedtocorrespondtoeachrowintheHMDgrid,withtheexception ofstructuralattributeswhichareexpressedasXMLattributes. EachDataTypehasadefinedXMLrepresentation.TherestrictionbasefeatureinanXML schemaisusedextensivelytodefinehowdatatypesareimplemented. TheschemafilesforCMETsaresuppliedseparatelyandthenusedbyeachmessageschema asrequired. TheXMLschemasdefinedsupportV3DataTypes,andDataTyperefinement,throughthe useoftheW3CSchemarestrictionelement.Additionalstandardschemasectionssupport RIMclassesandtheHL7definedvocabularydefinitions.Theseschemasectionscanbe selectivelycombinedwithaspecificmessageschemathroughtheincludefunctioninthe XMLschemastandard. HL7messagesallsharethesameXMLnamespace. Messageversioninformationisconveyedasattributeswithinthemessageratherthanby changestothenamespaceidentifier.
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Fig84HL7DevelopmentFramework Documentation HL7V3documentationisvoluminous.ThefullsetofHL7V3standardsispublishedannually andcanbedownloadedformtheHL7website(www.hl7.org). FoundationDocuments Foundationdocumentsarethebasisofthestandard.ThefollowingFoundationdocuments in2008contain359,000words(about30hoursreadingat200wordsperminute.In additionthereare30ormoredomainspecificstandardscovering:

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Fig85HL7Version3Documentation
1

HL7 Development Framework. Version 1.3, 2009

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