3/18/19990© 1999, Health Level Seven, Inc. Introduction: Vocabulary domains Marital Status...

3/18/1999 1© 1999, Health Level Seven, Inc.

Introduction: Vocabulary domains

• Marital Status– single (never married)– married– divorced– separated

• “Vocabulary” to distinguish from “Subject Domains” in the RIM

• Why Vocabulary Domains?– Increase interoperability– Sharing of data (clinical care, outcomes, research)– Sharing of decision logic


Vocabulary domain

• “The set of all concepts that can be taken as valid values in an instance of a coded field or attribute.”

• Concept - “A unit of thought constituted through abstraction on the basis of characteristics common to a set of objects.” ISO 1087

• Each concept in the domain can be represented using a specific vocabulary/terminology


Each coded attribute has a domain specification

Class: Patient

Description: A person who may receive, is receiving, or has received healthcare services.

Associationsis_a_role_of (1,1) :: Personis_source_for (0,n) :: Specimen_sample

Attributesbirth_order_numberbirth_dttm (from Person)gender_cd <Gender, Ext:CWE>


Vocabulary Domain Specification

• One and only one for each coded RIM attribute

• General form:– <domain name, list of domain qualifiers>– <Gender, Ext:CWE>

• Currently two types of domain qualifiers– Extensibility (Extensibility)

• CNE - Coded No Exceptions

• CWE - Coded With Exceptions

– Realm (RealmOfUse)• Universal

• USA?

• Europe?

• Others


Specialization of Domains• Used in specifying message

– MIM, MET, CMET, HMD, Clinical Templates(?)

• Example:– MyGender = (“Gender:USA:HL7” - “Other:USA:HL7-001”)

• General Form– “value set name” <set operator> “value set name”

• Value set name– “Domain name:Realm:Terminology”

• Allowed set operators– “+” Union ()– “-” Difference (sometimes represented as “\”) – “*” Intersection ()


Validating Specifications and Constraints

• Validation can be time and resource intensive

• May want to do selective validiation– During testing and debugging– During conformance testing– During the creation of each message– During the decoding of each message– Only on some fields– Only when errors occur– Or all of the above


General process of maintaining domains

• Follow pattern of RIM harmonization

• Vocabulary TC appoints facilitators

• Message development TCs have stewardship– Ultimate authority for domain contents– Follow RIM harmonization rules

• Vocabulary Facilitators– Insure that good vocabulary practices are followed– Actual maintenance of domain specification database– Submit new concepts to vocabulary providers

• All vocabulary/terminology providers can provide mappings to HL7 domains


Domain specification table maintenance (plan)

• Available on HL7 web site– All members can read tables

• Edit Permissions table– who can edit which domains– vocabulary co-chairs maintain permissions table

• Assigned persons make edits (proposed status)

• Entries reviewed by Vocab Review Committee

• Reports presented to RIM harmonization process

• Approved changes reflected by status chanages

• HL7 standard versions synch’ed with edit versions


Local Vocabulary Use

• Can only be used with qualifier Strength:CWE

• The complete domain is a union of standard domain plus local concepts (as a union of the two)

• Rules– Local concept can not replace standard concept– Local code system names must start with “99” – Local codes should be submitted to HL7 for inclusion in

standard domain and forwarded to terminology developers

The Domain Specification Database


The domain specification database

• This is only the first version. There will be future enhancements to domain specifications and to the table design

• Requirements: (UML model not shown)– Unique, non-sense identifier– Unique textual name– Description/definition– Edit note– Version tracking– Can be specific to a realm of use– Each “leaf” set is from a single vocabulary– Domains can be recursively defined– Set notation will be used to describe relationships


Domain Specification Database Tables

• Value Set Definition Table

• Version Tracking Table

• Edit Permissions Table (not shown)

• Value Set Relationship Table

• Source Vocabulary Representation Table

• Observation Identifier to Value Set Linking Table


Value Set Definition Table

HL7 Value Set IDDomainName

Realm

CodeSystem

Value Set Description Expression CurrentStatus

Vin Vout

1 Gender Root HL7 The gender of a person. "Gender:Root:HL7" A 110001 MyGender Root HL7 The gender of a person.

Does not allow Unknownor Other.

("Gender:Root:HL7" - "O:HL7-0001")

A 1

60001 ClinicalDiagnosis USA SNM3 A clinical diagnosis orsyndrome.

ChildrenOf("D*") A 3

60002 ClinicalDiagnosis USA MED Diagnosis or syndromethat best explains thepatient's symptoms.

SubTypes("1278") A 3

70001 BillingDiagnosis USA IC9 The billing diagnosis forthird partyreimbursement purposes.

Any("ICD-9CM") A 2

5 Race Root HL7 The race of a person. "Race:Root:HL7" A 150005 Race USA HL7 The race of a person. "Race:USA:HL7" A 250006 Race UK RC A person's race. ChildrenOf("Race") P 120001 AmericanIndian

OrAlaskaNativeUSA HL7 American Indian or

Alaska Native Race"AmericanIndianOrAlaskaNative:USA:HL7"

A 1

20002 Asian USA HL7 Asian Race "Asian:USA:HL7" A 120003 BlackOrAfrican

AmericanUSA HL7 Black or African

American Race"BlackOrAfricanAmerican:USA:HL7"

A 1

20004 NativeHawaiianOrPacificIslander

USA HL7 Native Hawaiian orPacific Islande Racer

"NativeHawaiianOrPacificIslande:USA:HL7"

A 1

20005 WhiteRace USA HL7 White Race "WhiteRace:USA:HL7" A 130001 AmericanIndian USA HL7 American Indian Race "AmericanIndian:USA:HL7" A 130002 AlaskaNative USA HL7 Alaska Native Race "Alaska Native:USA:HL7" A 1


Value Set Definition Table (content 1)

• A single row is a value set– Each row gets a unique HL7 Value Set Id– The primary key consists of Domain Name, Realm, Code System

• The union of all value sets with the same Domain Name is a domain

HL7Value SetID

DomainName

Realm CodeSystem

Value Set Description Expression

1 Gender Root HL7 The gender of a person. "Gender:Root:HL7"10001 MyGender Root HL7 The gender of a person.


("Gender:Root:HL7"- "O:HL7-0001")


ChildrenOf("D*")


SubTypes("1278")


Any("ICD-9CM")



• Two kinds of mutually exclusive domains– Domains maintained by HL7– Domains maintained by external terminology providers

• An HL7 maintained domain can not have value sets defined by reference to an external terminology

HL7Value SetID

DomainName

Realm CodeSystem






ChildrenOf("D*")


SubTypes("1278")


Any("ICD-9CM")



• Expression contains the information that can be used to resolve the value set to its individual elements

• The expression would be sent to a terminology service

• The semantics of the expression are specific to the terminology service

HL7Value SetID

DomainName

Realm CodeSystem






ChildrenOf("D*")


SubTypes("1278")


Any("ICD-9CM")


Value Set Definition Table - Version Tracking

• A value set gets a Vin number when it first becomes a part of the table

• A value set gets a Vout number when it becomes inactive

• A value set with a blank Vout is currently active

HL7 ValueSet ID

DomainName

Realm CodeSystem

CurrentStatus

Vin Vout

1 Gender Root HL7 A 110001 MyGender Root HL7 A 160001 ClinicalDiagnosis USA SNM3 A 360002 ClinicalDiagnosis USA MED A 370001 BillingDiagnosis USA IC9 A 2


Version Tracking TableVersion Date/Time of Edit Who For Whom Comment1 199904142200 1234

(Dan)4359(PAFM)

Created entries for all composite racevocabulary domains

2 199904161000 1234(Dan)

922(Vocab TC)

After testing and review, changed thestatus of the race domain to active.

3 199905181200 8765(Jim)

2566(HL7)

Release of Version 2.3.1 of the standard.

• A new version get created each time there is a new editting session

• The version number becomes part of each domain specification table as edit are made

• A permissions table (not shown) controls who can edit which value sets


Value Set Relationship TableHL7

ValueSet Id

Value Set Name Operator Generality HL7Concept

Id

HL7 Value Set/Concept Name

50005 Race:USA:HL7 Include Abstract 20001 AmericanIndianOrAlaskaNative50005 Race:USA:HL7 Include Specializable 20002 Asian50005 Race:USA:HL7 Include Abstract 20003 BlackOrAfricanAmerican50005 Race:USA:HL7 Include Abstract 20004 NativeHawaiianOrPacificIslander50005 Race:USA:HL7 Include Specializable 20005 WhiteRace20001 AmericanIndianOrAlaskaNative

:USA:HL7Include Specializable 30001 AmericanIndian

20001 AmericanIndianOrAlaskaNative:USA:HL7

Include Specializable 30002 AlaskaNative

• Value Set Name and Concept Name are only shown for purposes of illustration

• Operator can be Include or Exclude

• Generality says whether to include the node itself in the value set


Source Vocabulary Representation Table

• Based on example from Wayne Tracy

• HL7 Concept ID asserts HL7’s view of synonyms

• HL7 Concept ID could be replaced by universal concept identifier (UMLS CUI?)

• Supports multiple languages

HL7 ValueSet Id

HL7Concept

ID

CodeSys

SourceDomainName

TableID

CodeSysVin

Code Lang Description

1 40001 CR Sex 0220 6 1 E Male1 40002 CR Sex 0220 6 2 E Female1 40003 CR Sex 0220 6 3 E Other (Hermaphrodite)1 40004 CR Sex 0220 6 4 E Transsexual1 40005 CR Sex 0220 6 9 E Not Stated/Unknown1 40001 HL7 Gender 0001 2.3.1 M E Male1 40002 HL7 Gender 0001 2.3.1 F E Female1 40003 HL7 Gender 0001 2.3.1 O E Other1 40005 HL7 Gender 0001 2.3.1 U E Unknown


Observation Id to Value Set Linking Table

Code Sys ObservationIdentifier

Value SetId

Value SetName

LN 11882-8(Fetal Gender)

1 Gender

• Used to connect value sets to observation identifiers when used in name-value pairs like an OBX segment

• LOINC gives only examples, and is not prescriptive

• Allows for strong constraints when OBX like structures are used in messages


Using the Domain Specification Database

• Look in Value Set Definition Table– Use domain name, realm, and code system– Find and remember the Expression

• Pass the Expression to a terminology server (TQS)

• Knowledge of how to resolve HL7 Value Sets to individual elements is available in the Value Set Relationship Table and the Source Vocabulary Representation Table

• Knowledge of how to resolve external Value Sets is the responsibility of the terminology provider

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