VMR Act Classes

 Act Attributes (classCode = "ACT")

Act.classCode:CS (?OUT)

The VMR will provide entry points for Acts and Subclasses so may not be required

Act.moodCode:CS (?OUT)

For decision support we are mostly interested in Events, but will probably want to be able to access orders. The moodCode is not thought easily understandable by domain experts. If not included, an alternative mechanism will be required to access eg. orders by providing a specific entry point for events and orders. Observations of interest for CDS are in Event mood, but to determine if an observation has been ordered the VMR will need to provide access to eg Orders:Sequence(Observation). If this is done moodCode can be abstracted away.

Act.id:SET<II> (IN)

Ideally retained so can identify the evidence used for a decision that has been made

Act.code:CD (IN)

Retained, essential for VMR

Act.actionNegationInd:BL (OUT)

Possibly removed as also difficult for domain experts. In general is an instruction not to do something, or an Observation did not occur. Most of Decision support is related to Events that did occur. Would mean that all Acts in VMR have an implied value of false for this attribute.

Act.negationInd:BL (IN)

Essential to be able to say eg "No Family History of Hypertension" or "No Abdominal Pain": Means that GELLO code will need to check "and (not negationInd)" when doing select queries to find specific values

Act.derivationExpr:ST (OUT in non Template context)

In general we are after the value and not how it was derived. May be useful in context of a template however as could then contain the GELLO expression for deriving a calculated value

Act.title:ED (OUT)

Cannot reason on this, although could be useful to produce a string response to show to a clinician.

Act.text:ED (OUT)

Not useful for decision making

Act.statusCode (?OUT)

In CDS not as interested in the status of an observation, eg New or cancelled. In general cancelled Acts would not be in the VMR. Look for use cases that require it.

Act.recordStatusCode (OUT)

Not applicable to Events

Act.effectiveTime:GTS (IN)

Required, is clinically relevant Time.

Act.activityTime (OUT)

More administrative than clinically relevant

Act.availabilityTime (OUT)

Describes when act available to System. VMR is a snapshot so not relevant

Act.priorityCode (OUT)

In general not something a VMR can reason on.

Act.confidentialityCode (OUT)

VMR is either given data or is not so can't reason on this

Act.repeatNumber:IVL<INT> (OUT)

Generally not something would reason on

Act.interruptableInd:BL (OUT)

VMR is point in time snapshot

Act.levelInd (OUT)

Appears deprecated

Act.independentInd (OUT)

out of VMR scope

Act.uncertaintyCode (?OUT)

Could be used with fuzzy logic

Act.reasonCode:SET<CE> (OUT)

Not relevant to CDS

Act.languageCode:CE (OUT)

Decision support generally dependant on codes and values, rather than text

  Observation Attributes (classCode = "OBS")

inherits Act Attributes

Observation.value:ANY (IN)

Essential attribute

Observation.valueNegationInd:BL (?IN)

Generally only used if terminology unable to negate a value (eg ICD code) but probably required in some domains?

Observation.interpretationCode:SET<CE> (?IN)

Is V2 equivalent of abnormal Flags. Questionable value in CDS ?Opinions

Observation.methodCode: SET<CE> (?OUT)

May not be important for CDS?

Observation.targetSiteCode:SET<CD> (?OUT)

Generally not needed, ?use case for including it in CDS

  Procedure Attributes (classCode = "PROC")

Procedure.methodCode: SET<CD> (IN)

Needed for substanceadministration and relevant to procedures

Procedure.approachSiteCode:SET<CE> (IN)

Required for determining the way some surgical procedures were done

Procedure.targetSiteCode:SET<CD> (IN)

Defines Target of the procedure

 SubstanceAdministration Attributes (classCode = "SBADM")

SubstanceAdministration.routeCode:CE (IN)

Required for CDS

SubstanceAdministration.doseQuantity:IVL<PQ> (IN)

Required

SubstanceAdministration.rateQuantity: IVL<PQ> (IN)

Required for continuous infusions etc

SubstanceAdministration.doseCheckQuantity:SET<TRO> (?IN)

Regulatory requirement in some domains

SubstanceAdministration.maxDoseQuantity:SET<RTO> (?IN)

Useful for checking prescribed dose

SubstanceAdministration.administrationUnitCode:CE (IN)

Unit of administration