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
