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Act in DEF Mood

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Introduction

Various challenges with using DEV (or EVN.CRT) mood have been identified. These are detailed here: http://wiki.hl7.org/images/d/d1/EMeasureMNMPresentation_17July2009.pdf

Defining the Issue

(From M&M discussions Q2 in Atlanta, and others)

DEF and CRT mood are not usable as Mood Codes because the usual rules around the meaning of participations and Act attributes inevitably lead to conflict. For example, as things presently stand:

  • How do I DEF a test that can only be ordered by an RN? I cannot since I cannot use other mood codes, and the author is the one who authored the definition.
  • How do I create a CRT for a class in "INT" mood? I cannot unless I add a new mood INT.CRT.
  • How do I specify a DEF for an ACT that should be created in "suspended" status? I cannot since status belongs to the DEF, unless I create a second status attribute, as GS suggests below.
  • If there is a need for both EVN.CRT and CRT, is there not also a need for everyOtherMoodCode.CRT?
  • How do I include the requirement that the author of an Act not be the subject? I cannot unless we create another "flavor" of the author Participation.

Initial Analysis

The presence the need for "paired" attributes - two flavors of author participation, paired mood codes like EVN.CRT, two flavors of statusCode - are prima facia evidence that there are two different states present that are been collapsed into one. I submit that the distinction is between Acts that are "normal" and will represent real world artifacts (INT, EVN, GOL) and acts that are an "abstract definition" of that reality like "DEF", "CRT", "EVN.CRT". From eMeasures, it has become clear that criteria must exist in all moods and involve all reasonable participations. There seem to be similar requirements for DEF Acts. That being the case, this is not manageable so long as DEF and CRT are mood codes and so long as Act attributes and associations must be relegated to either document characteristic or not.

Recommendations

[1] Document characteristic attributes: Current thinking is to assume that in EVN.CRT mood, no properties are documentation characteristic. Gunther suggests that we may need to split Act.statusCode into an Act.actStatusCode and an Act.recordStatusCode.

[2] Vocabulary binding: Current thinking is to include a local code, which in the local code system reflects a value set.