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Revise, Clarify and Fix the Goal, Outcome, and Intent Relationship Types and Moods

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NOTE: Harmonization proposal on public display here for the purpose of commenting and collaborative editing. All your edits are tracked and nothing gets lost. FEEL FREE to improve the proposal and to add any question you want to raise in the discussion. Thanks!

Recommendation for HL7 RIM Change RECOMMENDATION ID:
Submitted by: Gunther Schadow Revision (# and date): 1
Date submitted: 20060314 Committee status: open
Submitted by: Gunther Schadow  
NAME: Revise, Clarify and Fix the Goal, Outcome, and Intent Relationship Types and Moods  

Stewards Position

REQUIRED - This table should contain one row for each Steward Committee affected by the recommendation.

TC RECOMMENDATION APPROVAL STATUS AFFECTED ENTITIES OF INTEREST TO TC
(responsibility level: S=Steward; I=Interested)
O&O Unknown I
MnM Requested I

Issue

There is broad misunderstandings about Goals, Risk, Expectation, Prognosis, Intents in both the ActMood code as well as in the ActRelationship type code.

Original State

ActMood

ActMoodPredicate Any of the above service moods (e.g., event, intent, or goal) can be turned into a predicate used as a criterion to express conditionals (or queries.) However, currently we allow only criteria on service events.
*(EVN.CRT) *EVN.CRT event criterion A criterion or condition over service events that must apply for an associated service to be considered.
*(GOL) *GOL Goal Expectation to make a specific observation with a desired value at a predefined future time
*(OPT) *OPT option An option is an alternative set of property-value bindings. Options specify alternative sets of values, typically used in definitions or orders to describe alternatives. An option can only be used as a group, that is, all assigned values must be used together.

Historical note: in HL7 v2.x option existed in the special case for alternative medication routes (RXR segment).

ActRelationship Type

*ActRelationshipOutcome *OUTC has outcome An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-conditional".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute (AND, OR, XOR) can be used. An outcome link is often inverted to describe an outcome assessment.
* ActRelationshipObjective The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood.
**(OBJC) **OBJC has continuing objective A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.
**(OBJF) **OBJF has final objective A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood.
*(GOAL) *GOAL *has goal A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.
*(RISK) *RISK *has risk A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.

Recommendation(s)

Definition: "A role played by an Entity which is a structural component of the scoper Entity. Example: my arm is a part of my body, my car's tire is a part of my car, a syringe is part if a medicine kit. Discussion: taking away a part leaves the whole in a defective state. This is contrasted to member, where taking away a member reduces the whole, but it leaves behind other members which can take the place of the missing one."

Rationale

The present definition of PART is the definition of PartitiveRole and probably moved down in a reorganization of the part itive role hierarchy. It is only used presently in a specific meaning, as opposed to the other partitive roles. Therefore, it should be redefined rather than moved up in the hierarchy.

Workaround Considered

Moving PART up, see under rationale.

The new definition is a constraint of the old one, and is therefore not backwards compatible. Therefore (as an alternative which does not have such repercussions) it should be considered that a new concept code be created, as a subconcept of PART, which contains the constrained definition. Rene spronk 16:49, 14 Mar 2006 (CST)

Recommended Action Items

  • Implement the proposed solution

Resolution