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Composite Order Conceptual Spec

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Composite Order

Executive Summary

  • This document contains the necessary definitions, descriptions, graphics, and artifacts relevant to the implementation of an electronic request for healthcare services between an ordering provider and fulfilling service providers.

Business Model Conceptual Artifacts

Business Context

  • The composite order domain comprises the models, messages, and other artifacts that are needed to support messaging related to sending multiple requests for healthcare services in one exchange.

Business Function

For this specification, the business function at its most basic is about ordering (requesting a healthcare service) and the fulfillment of that request by filling entities.

Basic business process use case bubble diagram

The following bubble diagram describes the ordering business process.


Conceptual Roles


Storyboards and Event Flows

Universal Storyboard - Create Composite Order

Eve Everywoman, a 27-year-old female, presents at Good Health Hospital Outpatient Clinic
and is seen by Dr. Patricia Primary. Eve reports a history of Anemia and recent,
excessive tiredness.  Dr. Primary enters a request to check the iron levels in Eve’s
blood into her care system.  Dr. Primary’s care system then sends the test requests to 
the lab system at the Good Health Hospital’s Laboratory service.  Eve receives a paper 
order requisition that serves as a reminder,  provides instructions for where to find 
the collection center, and also details preparation instructions for the patient to 
follow (no food or drink from midnight until collection time on the day of collection).

Later that week Eve presents herself at the Lab Collection Center.  The lab looks up and 
finds the order for her testing in the lab system.  The appropriate blood samples are 
extracted, their containers labeled, and the sample information added to the information
in the lab system. 

The lab performs the analysis on the specimen(s), adds the results to the lab system, and
sends the results to Dr. Primary’s care system reported as final.  Dr. Primary reviews the
results, formulates a treatment, if needed, and notifies Eve Everywoman of the results and

Use Cases

  • What is the use case?
  • Dr Hippocrates has created order sets, by condition, for conditions which he treats. His order system communicates....
  • Nutrition - some orders are communicated to both the nutrition department and pharmacy (TPN).
  • Patient on insulin

Composite Order Business Process

For Laboratory Diagnostics (specimen testing), the following illustrates high-level business functions:

  1. Diagnostic (or Public Health) Specimen-based Laboratory work requested for a subject (patient, animal, environmental location, etc)
  2. Specimen collected from subject
  3. Specimen accessioned by lab (i.e., enters lab testing process)
  4. Specimen processed into testable samples
  5. Samples tested by lab
  6. Results from lab testing obtained, interpreted, and approved/authorized
  7. Results returned to requester
  8. Requester determines next steps and course of action

Business Process Assumptions

While the above list shows the performed steps in a basic lab ordering/fulfillment process, each of these steps may be performed by different actors/roles in any one specific process; for example, a Clinician, Laboratory Technician (e.g., phlebotomist), Investigation Team Member, the Subject (patient), or a person responsible for a Subject may collect the specimen. In addition, the steps may be performed at different locations; specimens may be collected at the point of care, at the subject's location (e.g., at a patient's home, "in the field", etc), in the testing lab, or at a specimen collection organization. The steps may also be performed in different order or not performed at all under given, specific conditions - a specimen may not require any processing prior to being tested or a specimen is assigned an accession number prior to being collected if it is being collected in the lab. Finally, the involvement of an electronic system to capture the information and facilitate the business process is not assumed in the above steps and may not be present depending upon the conditions under which each step is performed.

Event Flows

Below is the event flow for Create Laboratory Order which defines the necessary activities, decisions, and information exchange points. The Laboratory Order Repository needed for the 3rd storyboard above is handled via an alternate flow and is not represeted in the diagram below.


Next is the event flow for Revise Laboratory Order. Note that any revision is a 'request to modify'. Depending on the situation, the performing laboratory may reject the revision.

ISSUE: Is modifying the composite order allowed?

Information Model Conceptual Artifacts

Conceptual Information Model

   Provide links to the Analysis Information Model for the domain

The following classes were derived from the storyboards and use cases.

Conceptual Laboratory Information Objects.png

Conceptual Data Types Model


Conceptual State Model

There are a couple of different types of state models. The first is representing the status of the whole business process. The states are represented as statuses which correlate to Key activities on the event flow. The second are a set of state models, one for each Key information object, defining the appropriate statuses for each object.

For the business process state machine:


We can derive the following request object states and transitions from the above storyboards:


As you can see, the request object has a status for when the fulfiller asserts the request is fulfilled, but the request has not yet evaluated that assertion (called fulfillment resolution). There are also the two other, expected, request statuses: active and complete. In the simplest request use cases, the request only takes one of these states. We can derive the following fulfillment object states and transitions from the storyboard:


Again the status, this time for fulfillment, is restricted in this simplest use case to null and resulted.

Lastly for this simple use case, we can derive the following result object states and transitions from the storyboard:


In this use case, only the completed state is important for interoperability.

Concept Domains

  • ActStatus
  • LaboratoryOrderableTestCode
  • LaboratoryQualitativeResultCode
  • DocumentTypeCode

Solution Specification

Scenario #1 - Create Lab Order


Business Scenario

The event flow for a simple lab order is shown below

File:Create Laboratory Order Activity Diagram.png

Contract Roles and Agents

The commissioning and responsible parties involved in this process include:

Specification Reference Commissioning System Role Responsible System Role Operation
Order Requestor (Placer in v2) Order Request Manager createRequest
Order Request Manager Fulfillment Manager createRequest
add add add

Computational Viewpoint

The following sequence diagram depicts the interactions that support the above event flow


Service Dependencies

   Describe any dependencies of the process being specified

The parties supporting this process are the Order Request Manager and Fulfillment Manager, depicted below

OrderManagementConceptual.png FulfillmentManagementConceptual.png

Implemented Patterns

   Indicate the any patterns that apply to this process specification

Contractual Semantics and Issues

Conformance Statements

   define the conformance criteria for this specification

Computational Services

Order Request Manager

Fulfillment Manager