D-MIM Walkthrough Care Provision Domain

Patient Care

Patient Care Normative Ballot Content

Description

1.2 Domain Message Information Model

1.2.2 Description

1.2.2.1 Overall Organization of the Care Provision DMIM

This domain-level document describes in detail the focal act of the domain, the Care Provision Act, which establishes the context for the entire domain.

In addition to the Care Provision Act itself, this section includes a walk-through of the associations on the Care Provision Act. These associations include participations (to Providers and Targets of Care), components (e.g., to Clinical Statements), and pertinent information (to any additional information required for care, such as listed in the choicebox of the CMET Clinical Statement).

Most of the variability in the Care Provision DMIM will be expressed through patterns of detailed clinical information called Care Structures and through Detailed Clinical Models. In the 2011 meetings, Patient Care decided to differentiate between clinical structures and infrastructural structures. Infrastructural structures can be exhanged as messages of their own. The clinical structures are not messages, but internal message components or detailed specifications for semantic interoperability. The walk-throughs of these patterns are included in the different Topic sections. These patterns are expressed in each Topic section as RMIM's and HMD's. For now, the patterns are called CMET's, despite the limitation of their use to the Care Provision Domain. When these structures pass normative ballot in the Care Provision Domain, they will be submitted as shared CMET's for use by multiple domains. The CMET's described in the different Topics include many structures such as: explanation of the use of Clinical Statement proper instead of the former Care Statement; Concern Tracking; Worklist; Care Plan; among others. These CMET's are utilized in the message specification topics such as the Care Transfer and Care Record Topics in order to simplify the illustrations.

However, in this section, the focus will be on the meaning of the Care Provision Act and on the associations surrounding the Care Provision Act.

1.2.2.2 Care Provision Act in Patient Care

An understanding of this act is central to the concept of patient care by professionals. Normally, a patient is completely responsible for his or her own care. However, when people are ill, it is difficult for them to be completely responsible themselves. Part of the process of healthcare is that patients request that healthcare providers help them with their care. This request to help is central to the contract between patients and their healthcare providers. It is also common in healthcare for one professional to request the help of another professional in the context of this contract with the patient. This Care Provision Act represents a statement about the scope of responsibility that is shared between the patient, sometimes family members, and one or more healthcare providers. The discussion that follows is intended to further elucidate the concept of shared responsibility and extends the patient-related concepts of care to Care Provision in general.

Care Provision Act: The meaning of the Care Provision Act begins with an examination of the meaning of "Care" and the meaning of "Provision" in the context of this domain.

Stipulated Dictionary Definitions: Care (5): CHARGE, SUPERVISION, MANAGEMENT: responsibility for or attention to safety and well-being (under a doctor's...), (the ... of all the churches) CUSTODY: temporary charge

Provision (2a): the act or process of providing (the ... of a play area for the children)

Provide (3): to supply what is needed for sustenance or support (the Lord will...), (we'll have to ... for him) Merriam- Webster's Third New International Dictionary Unabridged, copyright 1961-2002.

Guidance: In the HL7 Reference Information Model (RIM), the term "Act" always represents the record of the "process of doing." "Care Provision" represents a constraint on the definition of "Act" that takes the form, "The Act of Care Provision" where "Care Provision" is the noun form of the infinitive "to provide care." Therefore, the "Act of Care Provision" is the recording of a process that defines the responsibility for supplying support. It is a statement of SUPERVISION, MANAGEMENT, and CUSTODY.

In healthcare, many workers are assigned to the care of facilities and devices as well as living subjects. This Act of Care Provision is to be used when the explicit accountability for the care of a living or non-living subject is a component of the intended semantic. In other words the subject of care is defined in the subject participation, which constrains the semantic of care provision, e.g. subject is in a patient role; subject is in the role of a manufactured device.

In healthcare, the condition of the medical device, home of the patient, or other non-living subjects may need to be managed as well as the conditions of the patients' bodies themselves. Accordingly, "Care Provision" is often combined with the HL7 concepts of "Concern Tracking" and "Care Plan," structures that are found in the different Topic areas of the Care Provision Domain.

Examples: equipment care, patient care, facility care, responsibility for population monitoring, responsibility for an environmental site.

Other Examples of the Scope of Care Provision include:

• preferred primary care provision: the primary care physician being the primary performer participation, author being the patient
• referral from general practitioner to specialist: (a Care Provision in request mood, where the author participant is the GP, and the primary performer participation is the specialist)
• case management: case manager is the performer to a patient or group of patient subject participants coverage assignment: assigning nurses to patients each shift
• environmental site care: the environmental site is the subject participant and a company is the performer participant
• population monitoring: a population is the subject participant and the government agency is the performer participant

1.2.2.3 Care Provision DMIM Walk-through

CareProvision Focal Class

The Care Provision act is used to describe all aspects of care provision like the patient details and the name of care professionals. This central act has relationships to itself and several other acts. Most of these relationships connect directly to acts of the Clinical Statement eg (observation, activities, encounters). It also has Participations which define roles of entities, e.g. the role of patient or provider of care. The details of the Care Provision Domain are described hereafter, beginning with the attributes.

CareProvision Attributes classCode: The vocabulary domain specified for Act.classCode includes PCPR (Patient Care Provision) as a specialization of the Act class.

moodCode: Like all Acts in the RIM, the Care Provision Act may be expressed in many moods.These moods distinguish the different aspects of the business lifecycle of a Care Provision Act. These moods, which are central concepts for the DMIM, are defined as follows:

Code	Definition
RQO (request)	A "Care Transfer Request" is a question to another care provider regarding their ability to accept the responsibility of Care Provision for the subject. Typically the request is made by a care provider, recorded within one computer system, and then transmitted to a second system for analysis and response by the receiving care provider. However, support is also provided to allow the patient to self-refer themselves. A referring Responsible party such as a State or Court may also author a Care Transfer Request. In a Care Transfer Request, the receiving provider is listed as the performer. The scope of responsibility including CareProvision.code, reasons for care provision, and component care plans that set the specific expectations for care apply to the scope of responsibility for the receiver of the request.
PRMS (promise)	A "Care Provision Promise" is the statement of commitment to accept the responsibility of Care Provision as specified in the promise. It is assumed the receipt of a request message triggers a promise across a messaging interface from the requesting party. Due to the patient safety implications of care responsibility, there is no support for the type of "Implicit Promise" found in the Lab Domain. An acceptance of responsibility must be communicated as an explicit Promise. In this case, the performer is the sender of the promise. Likewise, the scope of responsibility including CareProvision.code, reasons for care provision, and component care plans that set the specific expectations for care apply to the scope of responsibility for the sender of the promise.
EVN (event)	An Event according to the RIM is a service that actually happens, may be an ongoing service or a documentation of a past service. For Care Provision, a Care Provision Event is a record, which summarizes the events that happened during care including who is responsible for the care provided. An author of the "Care Provision Event" records and summarizes the events The performer is responsible for carrying out the care events. The author and performer can be the same person. Care Provision Event messages may be sent during the course of care to describe the progress of care or may be sent at the termination of care to describe all the activities that occurred during the provision of care. In this case, the performer is the sending provider.
DEF (definition)	Definition mood code can be used to express a guideline or protocol.
INT (intent)	Intent can be used to express the intended activities in a care plan. In particular the appropriate selection of observations and activities from a guideline that are included in the care plan for one particular patient. So the intended Acts are individualized from the guideline.
PRP (proposal)	Proposal is used to suggest an idea to someone else, but not with the status of a request. It is further used as placeholder for the use in Care Plan R-MIM. For instance, it can be used by a consultant to recommend a course of action. Care Provision Acts in different moods are linked by the fact that promises are created to fulfill requests, and events are created to fulfill promises and/or requests.