CSCR-085-PHER-Clinical Statement Boundaries

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Submitted by: Austin Kreisler	Revision date: 11/24/2008
Submitted date: 11/24/2008	Change request ID: CSCR-085

Issue

There has been some discussion in the past regarding how to draw a boundary around what is and is not inside clinical statement. Nothing practical has resulted from those discussions. This is a proposal to at least show in the Clinical Statement model where the boundary exists, and how things outside the boundary should interact with clinical statement based models.

Recommendation

This proposal defines the “interface” between those elements of a model that claim conformance with clinical statement and those elements of a model that do not claim conformance with clinical statement. The following rules should apply:

1. Components of a model claiming clinical statement conformance should be contained within a Focal Boundary labeled “Clinical Statement Conformant”.
2. ActRelationships may cross the boundary under the following circumstances:
   • ActRelationships associating an Act outside clinical statement with an Act inside clinical statement may be traversed in either direction if the clinical statement Act is contained in the ActChoice in the clinical statement pattern.
   • ActRelationships associating an Act outside clinical statement with the ActReference in clinical statement may be only be traversed from outside clinical statement to the ActReference in clinical statement.
   • The following attributes shall be included on the ActRelationship crossing the boundary:
     • contextControlCode: CS CNE [0..1] required, default AN
     • contextConductionInd: BL [1..1] mandatory, default “true”
   • All other attributes of ActRelationship are optional and outside the scope of clinical statement.
3. Participations may cross the boundary under the following circumstances:
   • Participations associating a Role outside clinical statement with an Act inside clinical statement may be traversed in either direction if the clinical statement Act is contained in the ActChoice in the clinical statement pattern.
   • Participations associating a Role outside clinical statement with the ActReference in clinical statement may be only be traversed from outside clinical statement to the ActReference in clinical statement.
   • The following attributes shall be included on the Participation crossing the boundary:
     • contextControlCode: CS CNE [0..1] requires, default AN
   • All other attributes of Participation are optional and outside the scope of clinical statement.

Rationale

There has been endless debate over what is and is not inside clinical statement. This gives some clear rules for using the clinical statement in other models.

Discussion

This proposal does not try to further characterize what is considered outside clinical statement, instead it simply provides a mechanism for a model that does not claim overall clinical statement conformance to connect to and use parts of the clinical statement pattern. This is accomplished by using ActRelationships and Participations as interfaces between the clinical statement pattern and models that are not part of clinical statement.

The following diagram illustrates the rules given above.

Recommended Action Items

Implement recomendation.

Resolution

15-Jan-09 Motion to accept: Austin, Rik

• Drop 3 bullet 2 as inappropriate with use of participation to ActReference
• Rules were choosen as documented to be as reasonably close to current convention/approaches within the Clinical Statement pattern.
• Will discuss the appropriate/inappropriate connections with constructs outside the pattern in another venue (e.g., methodology). Only focusing on how to document what is in or out, not whether it should be in instead of out.

Against: 0; Abstain: 4; In Favor: 18

12-Feb-09 This is not a fundamental CS model change, rather documentation on the model that utilizes the CS.