Concept Domains

Acknowledgement Condition codes describe the conditions under which accept or application level acknowledgements are required to be returned in response to the message send operation.

A site specific code indicating the specific problem being reported by this Ack Detail.

Refelects rejections because elements of the communication are not supported in the current context.

Reflects errors in the syntax or structure of the communication.

A code identifying the specific message to be provided.

A textual value may be specified as the print name, or for non-coded messages, as the original text.Discussion:

'Required attribute xxx is missing', 'System will be unavailable March 19 from 0100 to 0300'Examples:

Identifies the the kind of information specified in the acknowledgement message. Options are: Error, Warning or Information.

Acknowledgement code as described in HL7 message processing rules.

Description: Types of acts that can be scheduled.

Examples:

• Follow-up appointment
• New referral appointment
• Consultation appointment
• Specimen Collection appointment
• Procedure appointment

A code specifying the major type of Act that this Act-instance represents.

Constraints: The classCode domain is a tightly controlled vocabulary, not an external or user-defined vocabulary.

Every Act-instance must have a classCode. If the act class is not further specified, the most general Act.classCode (ACT) is used.

The Act.classCode must be a generalization of the specific Act concept (e.g., as expressed in Act.code), in other words, the Act concepts conveyed in an Act must be specializations of the Act.classCode. Especially, Act.code is not a "modifier" that can alter the meaning of a class code. (See Act.code for contrast.)

**Description:**The interaction of entities whereupon a subject entity is brought into proximity to a physical, chemical or biological agent. This includes intended exposure (e.g. administering a drug product) as well as accidental or environmental exposure. (Note: This class deals only with proximity and not the effectiveness of the exposure, i.e. not all exposed will suffer actual harm or benefit.)

**Examples:**Exposure to radiation, drug administration, inhalation of peanut aerosol or viral particles.

**Description:**An observation of genomic phenomena.

**Description:**A mandate, regulation, obligation, requirement, rule, or expectation unilaterally imposed by one party on:

• The activity of another party
• The behavior of another party
• The manner in which an act is executed

An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject.

Examples: : Procedures may involve the disruption of some body surface (e.g. an incision in a surgical procedure), but they also include conservative procedures such as reduction of a luxated join, chiropractic treatment, massage, balneotherapy, acupuncture, shiatsu, etc. Outside of clinical medicine, procedures may be such things as alteration of environments (e.g. straightening rivers, draining swamps, building dams) or the repair or change of machinery etc.

The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.

The spatial relationship of a subject whether human, other animal, or plant, to a frame of reference such as gravity or a collection device.

A code specifying qualitatively the spatial relation between imaged object and imaging film or detector.

Contains codes for defining the observed, physical position of a subject, such as during an observation, assessment, collection of a specimen, etc. ECG waveforms and vital signs, such as blood pressure, are two examples where a general, observed position typically needs to be noted.

The table that provides the detailed or rich codes for the Act classes.

Open Issue: The hierarchy has issues and several of the existing domains may be moved under this new one; this must be examined and a proposal to clean up the hierarncy in the near future is needed

Open Issue: The description of this domain seems odd and may be a leftover from long ago and needs improvement.

Description: Types of representation groupings of financial transactions that are tracked and reported together with a single balance.

Examples:

• Patient billing accounts
• Cost center
• Cash

Description: Types of responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

Examples:

• adjudicated with adjustments
• adjudicated as refused
• adjudicated as submitted

Explanatory codes that provide information derived by an Adjudicator during the course of adjudicating an Invoice. Codes from this domain are purely information and do not materially affect the adjudicated Invoice. That is, codes do not impact or explain financial adjustments to an Invoice.

A companion domain (ActAdjudicationReason) includes information reasons which have a financial impact on an Invoice (claim).

Example adjudication information code is 54540 - Patient has reached Plan Maximum for current year.

Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to describe the process of adjudicating an Invoice.

Description: Actions to be carried out by the recipient of the Adjudication Result information.

**Description:**The type and scope of responsibility taken-on by the performer of the Act for a specific subject of care.

**Description:**Concepts identifying different types of referral requests. These concepts identify the general type of care or category of services requested. They are not used to represent the indication or diagnosis which triggered the need for the referral. E.g. Anger management service, Intensive Care service, Orthodontics service.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by a credentialing agency, i.e. government or non-government agency. Failure in executing this Act may result in loss of credential to the person or organization who participates as performer of the Act. Excludes employment agreements.

**Example:**Hospital license; physician license; clinic accreditation.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing individuals.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing programs within organizations.

Concepts representing types of patient encounter such as ambulatory encounter, inpatient encounter or emergency encounter.

**Definition:**A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

**Definition:**A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility.)

**Definition:**A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site and at a supermarket.

**Definition:**Healthcare encounter that takes place in the residence of the patient or a designee

**Definition:**A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service.

**Definition:**An encounter where the patient is admitted to a health care facility for a predetermined length of time, usually less than 24 hours.

**Definition:**A patient encounter where the patient and the practitioner(s) are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.

**** MISSING DEFINITIONS ****

Concepts representing types of patient encounter such as ambulatory encounter, inpatient encounter or emergency encounter. Note that this code is a synonym of ActEncounterType, and follows the original naming conventions for v3 Concept Domains, and is as published in the CDA R2 base; the naming conventions were corrected in later revisions of V3, but is kept here for backwards compatibility for the CDA R2 base.

Description: Codes for general process steps.

Examples:

• lab process steps
• diagnostic imaging process steps
• etc. (Missing third example)

Codes for general laboratory process steps.

The act of storing information to long term storage.

The act of verifying an observations. The subject act related to the observation verification (act relationship SUBJ) must be an observation (OBS)

The accession act related to a specimen or group of specimens.

The act of printing a specimen label. The printing of a label for a specimen container is a significant act in the workflow for collecting specimens.

The act of adding a specimen to a transportation manifest. For example a laboratory will pack together in a carton all the specimens to be shipped to a reference lab. An electronic manifest showing all the specimens in the shippment is communicated to the reference lab.

Transportation of a specimen.

**Definition:**Used to identify if a lab result is reported as preliminary, final, or corrected. Provides a consistent way to distinguish the business or reporting status of the lab result.

Denotes the specific service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider. Professional services are generally cognitive in nature and exclude surgical procedures. E.g. Provided training, Provided drug therapy review, Gave smoking-cessation counseling, etc.

Definition: The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research.

**Description:**The type of data consent directive.

**Description:**The type of financial participation consent directive.

Examples: The Advanced Beneficiary Notice that Medicare patients consent or dissent to prior to receiving health services in the U.S. \ Current values include consent to financial responsibility (1) if the service is not deemed medically necessary; (2) will self pay for a service; or (3) requests that payer be billed.

Description: The type of health information to which the subject of the information or the subject's delegate consents or dissents.

Examples:

• allergy information
• medication information
• professional services information

Description:

Represents types of consent that patient must sign prior to receipt of service, which is required for billing purposes.

Examples:

• Advanced beneficiary medically necessity notice.
• Advanced beneficiary agreement to pay notice.
• Advanced beneficiary requests payer billed.

An agreement of obligation between two or more parties that is subject to contractual law and enforcement.

Examples: approvals granted by a regulatory agency; contracts measured in financial terms; insurance coverage contracts.

A type of Act representing a contract whose value is measured in monetary terms.

Examples:

• insurance policy
• providercontract
• billing arrangement

Definition: Set of codes indicating the type of insurance policy or program that pays for the cost of benefits provided to covered parties.

Indication of eligibility coverage for healthcare service(s) and/or product(s).

Criteria that are applicable to the authorized coverage.

Maximum amount paid or maximum number of services/products covered; or maximum amount or number covered during a specified time period under the policy or program.

Codes representing the types of covered parties that may receive covered benefits under a policy or program.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Codes representing the level of coverage provided under the policy or program in terms of the types of entities that may play covered parties based on their personal relationships or employment status.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Types of insurance coverage legal documentation to cover healthcare costs.

Examples:

• Automobile
• Extended healthcare
• Worker's compensation

Definition: Set of codes indicating the type of insurance policy. Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of potential financial loss. Insurance is defined as the equitable transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care. A policy holder is an individual or an organization enters into a contract with an underwriter which stipulates that, in exchange for payment of a sum of money (a premium), one or more covered parties (insureds) is guaranteed compensation for losses resulting from certain perils under specified conditions. The underwriter analyzes the risk of loss, makes a decision as to whether the risk is insurable, and prices the premium accordingly. A policy provides benefits that indemnify or cover the cost of a loss incurred by a covered party, and may include coverage for services required to remediate a loss. An insurance policy contains pertinent facts about the policy holder, the insurance coverage, the covered parties, and the insurer. A policy may include exemptions and provisions specifying the extent to which the indemnification clause cannot be enforced for intentional tortious conduct of a covered party, e.g., whether the covered parties are jointly or severably insured.

Discussion: In contrast to programs, an insurance policy has one or more policy holders, who own the policy. The policy holder may be the covered party, a relative of the covered party, a partnership, or a corporation, e.g., an employer. A subscriber of a self-insured health insurance policy is a policy holder. A subscriber of an employer sponsored health insurance policy is holds a certificate of coverage, but is not a policy holder; the policy holder is the employer. See CoveredRoleType.

Definition: Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement).

Definition: A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.

Discussion: Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

A type of Act representing any transaction between two accounts whose value is measured in monetary terms.

Examples:

• patient account transaction
• encounter accounttransaction
• cost center transaction

Description: Types of provision(s) made for reimbursing for the deliver of healthcare services and/or goods provided by a Provider for one or more occurrence or over a specified period.

Examples:

• Contract
• Rostering
• Capitation

Description: Types of operations that may be performed on objects. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.

Examples:

• Create
• Update
• Delete

Open Issue: This is too restrictive to deal with what CBCC wants.

Description: Types of operations that may accomplish access of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.

Examples:

• Query
• Search
• Transport
• Send
• Receive

Description: Types of operations that may accomplish collection or related management of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.

Examples:

• Create
• Store
• Archive

Description: Types of operations that may accomplish disclosure of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.

Examples:

• Disclose
• Forward
• Publish

Description: Types of operations that may accomplish usage of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.

Examples:

• Activate
• Release
• Execute Read
• Display
• Update
• Append
• Amend

Description: Issue management types that dealing with detected issue observations.

Rationale: Allows for consistent specification and interpretation of issue management.

Includes coded types of actions that can be taken by a supervising entity in response to inappropriate action (or inaction) on the part of a supervised entity.

Description: List of broad catagorizations of clinical event records.

Examples:

• Allergies
• Drugs
• Referrals

**Description:**Lists of high-level categorizations for clinical coded observations that do not require numeric values with a specific unit of measure.

Examples:

• Symptoms
• History
• Observations

Description: of high-level categorization for clinical non-laboratory and non-diagnostic image measured observations with numeric values and specific units of measure.

Examples:

• Vital Signs
• Physiological Measurements
• Procedure Results

Description: Describes types of criteria used when making observations, conducting procedures, and substance administrations.

Examples:

• medications
• immunizations

Description: of procedure used for evaluating a precondition, goal, or trigger.

Examples:

• some radiology procedures
• respiratory therapy
• physical therapy

Description: Type of substance administration used for evaluating a precondition, goal, or trigger.

Examples:

• other substance administrations
• respiratory therapy
• immunizations

Description: of observation used for evaluating a precondition, goal, or trigger.

Examples:

• age-based criteria
• diagnostic-based criteria
• simple observation-based criteria (vital signs)

Description: Type of observation used in lab for evaluating reference ranges.

Examples:

• age-based criteria
• sex-based criteria
• condition-based criteria

Concepts that identify the type or nature of exposure interaction. Examples include "household", "care giver", "intimate partner", "common space", "common substance", etc. to further describe the nature of interaction.

Codes dealing with the management of Detected Issue observations for the financial acts domain.

Definition: Set of codes indicating the type of incident or accident.

Definition: A code specifying the particular kind of Patient Safety Incident that the Incident class instance represents.

Examples:"Medication incident", "slips, trips and falls incident".The actual value set for the domain will be determined by each (realm) implementation, whose Patient Safety terminology will be specific, although probably linked to the WHO Patient Safety Taxonomy that is currently under development

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Conveyance of the type of information transfer protocol.

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Codes representing a service or product that is being invoiced (billed). The code can represent such concepts as "office visit", "drug X", "wheelchair" and other billable items such as taxes, service charges and discounts.

**** MISSING DEFINITIONS ****

An identifying data string for healthcare procedures.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes are procedure identifying codes. HCPCS is Health Care Finance AdministrationaTMs (HFCA) coding scheme to group procedures performed for payment to providers. contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) are procedure identifying codes. ICD-10-PCS describes the classification of inpatient procedures for statistical purposes.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**International Classification of Diseases, 9th Revision, Procedure Coding System (ICD-9-PCS) are procedure identifying codes. ICD-9-PCS describes the classification of inpatient procedures for statistical purposes.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Types of tax associated with billable services or products.

Examples:

• Provincial or State sales tax
• Harmonized sales tax
• Federal sales tax

**Description:**External value set for accommodation types used in the U.S. Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Types of summary information that can be reported by queries dealing with Statement of Financial Activity (SOFA). The summary information is generally used to help resolve balance discrepancies between providers and payors.

Examples:

• number and total value of payable items;
• number and value of same period nullify items;
• number and value of prior nullify;
• number of non-payable nullify items;
• number of pending items;
• number of rejected items;
• number of adjudicated to zero items;
• reimbursement items (e.g., pay patient)
• Adjudicated non-payee payable prior-period electronic amount
• Adjudicated nullified prior-period electronic amount
• Adjudicated refused prior-period electronic amount

Description: Types of grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

Description: Types of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for its immediate children invoice elements.

Examples:

• CPINV - Clinical product invoice
• CSINV- Clinical service invoice
• RXDINV - Drug invoice
• RXCINV - Compound invoice
• CSPINV - Combined service and clinical product invoice

Description: Types of responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

Examples:

• Re-bill for the professional fee
• Good faith override
• Wasted Drug

Provides codes associated with ActClass value of LIST (working list)

**Description:**Describes the high level classification of professional services for grouping.

**Examples:**Education, Counseling, Surgery, etc.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Codes used to identify different types of 'duration-based' working lists. Examples include "Continuous/Chronic", "Short-Term" and "As-Needed".

**Definition:**A collection of concepts that identifies different types of 'duration-based' mediation working lists.

Examples:"Continuous/Chronic" "Short-Term" and "As Needed"

Description: Identifies types of monitoring programs such as tracking specified medication prescribing e.g. narcotic(s), identifying investigational studies or identifying programs regarding reimbursement or prescribing privileges.

**Description:**Concepts representing indications (reasons for clinical action) other than diagnosis and symptoms.

The type of order that was fulfilled by the clinical service

**Description:**Types of policies that further specify the ActClassPolicy value set.

**Description:**Types of privacy policies that further specify the ActClassPolicy value set e.g. override policy, minor's rights to mask sensitive information policy, opt-in, opt-out policy.

**Description:**Specifies the type of consent directive indicated by an ActClassPolicy e.g., a 3rd party authorization to disclose or consent for a substitute decision maker (SDM) or a notice of privacy policy. Sibling to ActPrivacyPolicyType and Child of ActPolicyType.

Description: Types of jurisdictional mandates relating to privacy.

A sensitivity policy is adopted by an enterprise or group of enterprises (a "policy domain") through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations.

Description: Types of Sensitivity policies that may apply to a sensitive attribute on an Entity.

Description: Types of sensitivity policies that apply to Acts.

Description: Types of sensitivity policies that apply to Roles.

Types of security policies that further specify the ActClassPolicy value set.

Conveys the mandated workflow action that an information custodian, receiver, or user must perform.

Usage Note: Per ISO 22600-2, ObligationPolicy instances "are event-triggered and define actions to be performed by manager agent". Per HL7 Composite Security and Privacy Domain Analysis Model: This value set refers to the action required to receive the permission specified in the privacy rule. Per OASIS XACML, an obligation is an operation specified in a policy or policy that is performed in conjunction with the enforcement of an access control decision.

Conveys prohibited actions which an information custodian, receiver, or user is not permitted to perform unless otherwise authorized or permitted under specified circumstances.

Usage Notes: ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

A mandate, obligation, requirement, rule, or expectation conveyed as security metadata between senders and receivers required to establish the reliability, authenticity, and trustworthiness of their transactions.

Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability).

Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. [Based on ISO IEC 10181-1 and NIST SP 800-63-2]

For example, identity proofing level of assurance and Trust Framework.

Concepts representing a type of preference that can be specified.

Examples:

• Food
• Drug
• Vegetarian
• Sweets

Description: An identifying code for healthcare interventions/procedures.

Examples:

• immunization
• appendectomy
• physiotherapy

Definition: An identifying code for billable services, as opposed to codes for similar services used to identify them for functional purposes.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Definition: An identifying code for billable medical services, as opposed to codes for similar services to identify them for clinical purposes.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Definition: An identifying code for billable services that are not medical procedures, such as social services or governmental program services.

Example: Building a wheelchair ramp, help with groceries, giving someone a ride, etc.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Chemical reactions in the widest sense of the word.

Examples: Transcription (creating mRNA from a DNA gene), translation (creating a protein from mRNA), cleavage (hydrolysis of a peptide), substitution (replacing an element or residue with another, such as in glycosylation, phosphorylation), addition (adding a residue to a double bond), receptor binding.

**Description:**An identifying code for oral health interventions/procedures.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Concept domain which includes those ActProcedureCodes which are appropriate for ordering.

Examples:

• physical therapies
• excisions
• surgery

DESCRIPTION

Identifies the nature (or type) of transformation that a (medicinal) product may undergo, prior to its administration to a patient.

Examples:

• Dilution
• Dissolution
• Suspension

Description: Denotes the specific professional service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider.

Examples:

• adjustment of hearing aid
• excision of skin lesion
• stitching skin lacerations

Description: Used to further classify the type of specimen collection procedure being documented.

Examples:

• Venipuncture
• Swab
• Biopsy

Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

The introduction of ??? with the intent of stimulating an immune response, aimed at preventing subsequent infections by more viable agents.

Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information. Note that this code is a synonym of ActSubstanceAdministrationCode, and follows the original naming conventions for v3 Concept Domains, and is as published in the CDA R2 base; the naming conventions were corrected in later revisions of V3, but is kept here for backwards compatibility for the CDA R2 base.

Acts of producing a substance by processing input material in any way thus deriving the product substance from the inputs

Examples: Fermentation, filtration, separation, extraction, or any complex procedure involving multiple such steps.

UsageNotes: This domain may involve molecular interactions as components, but substance derivation - even if implementing a single defined reaction on the molecular level - implies not only that reaction but the methods and devices by which to induce that reaction.

Description: In addition to the class code, further defines the type of substance extraction.

Examples:

• excision
• surgical
• passive

Description: Defines the type of blood donation.

Examples:

• autologous
• directed
• volunteer

Concepts that are used to convey modifications to the food or serving utensils that should be given in a diet order. These can be derived from patient allergies, intolerances, or preferences. They can also be specific to the order and not have any relationship to the allergies, intolerances, or preferences.

Examples:

• Vegetarian
• Liquids separate from solids
• Small Portions
• disposable utensils (for psych or isolation rooms)

A set of concepts that identifies any texture modifications that should be made to a diet order.

Examples:

• Pudding Thick
• Pureed
• Easy to Chew

Description: An approval granted to a product by a regulatory agency or other government body.

Examples:

• Approval to sell
• Approval to initiate clinical trial
• Approval to market (i.e., advertise)

Description: A type of application made in order to obtain a product approval from a regulatory agency or other government body.

Examples:

• Application for new approval
• Application for renewal of approval
• Application for variation of approval

Description: A type of approval process by which a product approval is obtained from a regulatory agency or other government body.

Examples:

• Centralized process approval
• Mutual recognition process approval
• National process approval

Types of state an act may exist in.

Description: A type of act that indicates the action taken by a practitioner or other responsible party in response to the reaction/event that is reported in the ICSR.

Examples:

• failing device replaced
• medication stopped
• medication dose adjusted

Description: A code further classifying the type of record organizer. Used with the ActClassRecordOrganizer ActClass concept domain.

Examples:

• CDA R2
• Electrolytes Battery
• Specimen Cluster

A context representing a grouped commitment of information to the EHR. It is considered the unit of modification of the record, the unit of transmission in record extracts, and the unit of attestation by authorizing clinicians.

Examples: document; authentication unit; transmission unit.

Identifies the heading under which a document is to appear in a pre-defined, pro forma table of contents for a collection of documents within a regulatory category.

Examples:

• m1-1-forms (eCTD module 1, forms)
• m1-1-1-fda-form-1571 (eCTD. Module 1, specific FDA form)
• m3-2-s-drug-substance (eCTD module 3, section 2, drug substance by substance)

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Codes for additional metadata to be assigned to document or context of use instances to organize a group of documents within the same table of contents heading. These external code systems specify the category or type of keyword (e.g. Species) and the applicable values.

Examples:

• Species code system
• Species code
• Sponsor's manufacturing site code system

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies the regulatory processes and/or submission contents specified in law or practice for a particular realm used to organize submitted materials.

Examples:

• Application Type: NDA
• Submission Type: Efficacy Supplement
• Submission Unit Type: Amendment

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

The kind of document. Possible values: discharge summary, progress note, Oncology note, etc.

**Description:**Identifies the type of document that was attached to support the processing of claims, adjudication decision determination or extensions to coverage.

**Description:**Contrains the type of attachment (document, XRAY, bit map image, etc.) included to support a healthcare claim. Vocabulary bound to this domain should be a specification for the type of document (i.e. WCB First Report of Acccident - Form 8).

**Description:**Identifies the type of document that is used to support a request which requires special authorization. Example values in this concept domain could be: coverage extensions, step therapy, medical report, lab result, etc.

Description: A type of document that has information related to the investigation of an adverse event or product problem report.

Examples:

• Autopsy report
• toxicology report
• clinical journal article

Code identifying the type of identification document (e.g. passport, drivers license)

**Implementation Note:**The proposal called for a domain, but a code was also provided. When codes are available for the value set the code IDENTDOC (identity document) will be used as the headcode for the specializable value set.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Definition:**Indicates the set of information types which may be manipulated or referenced, such as for recommending access restrictions.

Description: Information type for which a provider is requesting routing of health information. This could include messaging of results or documents especially in the context of a specific service delivery location.

Examples:

• Diagnostic Image Interpretations
• Lab Test Results
• Electrocardiogram Reports

Indicates the types of documents that can be associated with a medication or group of medications.

Examples include: Patient monographs, Provider monographs, Drug protocols, etc.

Description:

A type of documentation that is used to convey information about a product or an aspect of its life as a product - ranging from production to disposition.

Examples:

• Bill of lading
• product label
• Report of Product Disposal

A type of document used to represent a health quality measure (aka eMeasure).

Identifies the document type from a regulator-defined set of codes similar to the ICH-defined File Tags used on clinical study documents in an eCTD.

Examples:

• Pre-clinical study report
• Study report
• Sample CRF

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

**Description:**Constrains vocabulary to that which describes the type of documents that can be attached to a financial transaction such as a Special Authorization Request.

Example values under this concept domain could be: drug, device, service, etc.

Description: Further defines the type of grouping of orders or events. This concept domain is intended to be used with the GROUPER Act class code.

Examples:

• requisition
• pre-coordinated order set
• custom order set

Description: A type of concept that is used within adverse event and product problem reporting to organize data - often clinical in nature - provided for an investigative subject or other party within the scope of the investigation.

Examples:

• Medical history
• previous drug reactions
• immunization history

Description: Container of clinical statements. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "container tree".

Examples: category; document section; document body.

A type of document section (specialization of ActClass "DOCSECT").

A type of document section within a health quality measure (aka eMeasure), used to cluster the various parts of the eMeasure into a more human navigable format.

This is the domain of registry types. Examples include Master Patient Registry, Staff Registry, Employee Registry, Tumor Registry.

Identifies different classes of regulatory policy that can be applied within a Regulated Product Submission.

Usage Note: This Domain is used to administratively group its subdomains specifically for usage in the RPS model, and is not intended to participate in any binidngs.

Identifies a temporary or final legal status assigned to a submission by a particular regulatory realm based on the laws and practices of the realm.

Examples:

• Active (as authorized by section abc)
• Approved (under section xyz)
• Withdrawn (under section pqr)

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies the legal or administrative category assigned to a regulated product that determines or influences the way in which its submission is reviewed.

Examples:

• New active ingredients
• New ethical combination drug
• New administrative route

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies the time period in which a submission of a given type is to be reviewed as established by law or practice in the particular regulatory realm.

Examples:

• 30 days, reduced time
• 60 days, regular time
• 90 days, extended time

Usage Note: This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

**Description:**Concepts representing the categorization of health services available at a particular delivery location site.

Examples:

• anesthetic service
• colonoscopy service
• orthopedic service

Concepts identifying the general type of care or category of services being documented.

Examples:

• Colonoscopy
• appendectomy
• laboratory test

**Definition:**Identifies the types of substitution that may be permitted when ordering a medication, as well as those which have actually occurred during the act of dispensing.

Description: Further defines the type of supply for order or distribution.

Examples:

• central supply
• materials management
• nurse station supply

**Definition:**Identifies types of dispensing events.

Description: Financial Acquisition Terms: categorizations of acquisition terms for a product.

Types of method a product can be obtained for use by the subject of the supply act (e.g. patient). Product examples are consumable or durable goods.

Examples:

• Loan
• Rent
• Sale

Description: A type of activity that takes place during the life of a product as it moves from the point of production to the point of consumption, use, or disposition (most notably in the case of contaminated products). It will be possible for concepts at different levels of granularity to be included.

Examples:

• Manufacture
• paint
• wholesale
• dispose

Concepts representing diets that can be taken via the mouth.

Examples:

• General
• Pureed
• Easy to Chew

Description: A task or action that a user may perform in a clinical information system

Examples:

• medication order entry
• laboratory test results review
• problem list entry

Characterizes how a transportation act was or will be carried out.

Examples: Via private transport, via public transit, via courier.

Definition: Characterizes how a patient was or will be transported to the site of a patient encounter.

Examples: Via ambulance, via public transit, on foot.

Description: Different types that are used to organize and classify product related investigations.

Examples:

• Original source investigation
• Secondary party investigation
• Report to regulatory authority

DEA schedule for a drug.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

The trigger event referenced by the Control Act instance. Values are drawn from the available trigger events used in the release of HL7 identified by the versionCode.

Description: Trigger events associated with laboratory results.

Examples:

• Lab result activate
• Lab result complete
• Lab result abort

Description: Trigger events associated with specimen process steps.

Examples:

• Specimen process step activate
• Specimen process step complete
• Specimen process step abort

Used to represent the patient's status with respect to their immunization guideline as of an evaluation date.

Description: The activity of businesses operating in the manufacture and distribution of products.

Examples:

• manufacture
• repack
• import

Description: The broad activity of businesses operating in the distribution of products, the general act of making a product available to the public.

Examples:

• Marketing, (this is required as a singleton value set, as there may be no other use case for this than to distinguish one Act of handling products from other Acts, such as manufacturing.)

Identifies the kinds of observations that can be performed

**Definition:**Identifies what type of issue detected during occurrence of an act (e.g. unrecognized identifiers, drug-drug contraindications, drug-allergy alerts).

Examples:

• High dosage alert
• Conditional element missing
• Timing detected issue

Identifies types of detected issues for Act class "ALRT" for the financial acts domain.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Identifies types of issues detected regarding the performance of a clinical action on a patient.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Any type of issue that identifies a potential adverse situation that would or might occur with the described substance administration.

Examples:

• adverse effect
• drug interaction
• drug-food interaction

Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Identifies the type of verification investigation being undertaken with respect to the subject of the verification activity.

Examples:

1. Verification of eligibility for coverage under a policy or program - aka enrolled/covered by a policy or program
2. Verification of record - e.g., person has record in an immunization registry
3. Verification of enumeration - e.g. NPI
4. Verification of Board Certification - provider specific
5. Verification of Certification - e.g. JAHCO, NCQA, URAC
6. Verification of Conformance - e.g. entity use with HIPAA, conformant to the CCHIT EHR system criteria
7. Verification of Provider Credentials
8. Verification of no adverse findings - e.g. on National Provider Data Bank, Health Integrity Protection Data Base (HIPDB)

**Description:**Provides a categorization for annotations recorded directly against the patient

An Act which characterizes a Privilege can have additional observations to provide a finer definition of the requested or conferred privilege. This domain describes the categories under which this additional information is classified.

This domain includes observations used to characterize a privilege, under which this additional information is classified.

*Examples:*A privilege to prescribe drugs has a RESTRICTION that excludes prescribing narcotics; a surgical procedure privilege has a PRE-CONDITION that it requires prior Board approval.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**An access control object used to manage permissions and capabilities of users within information systems. (See HL7 RBAC specification fo examples of thes objects.)

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Definition: Indicates the class of actions taken with regard to a substance administration related adverse event. This characterization offers a judgment of the practitioner"s response to the patient"s problem.

Examples: Example values include dose withdrawn, dose reduced, dose not changed.

NOTE: The concept domain is currently supported by a value set created by the International Conference on Harmonization

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Categorization of types of observation that captures a person's age as a numeric quantity.

Used in a patient care message to report and query simple clinical (non-lab) observations.

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Identifies the type for a clinical observation whose value is expressed as a code.

Examples:

• Home support level
• Tumor staging
• abdominal pain characteristic

Description: Represents the components of a coded clinical observation.

Examples:

• ability to articulate
• ability to chop food
• ability to crouch

**Description:**To be used to code and identify the Microbiology laboratory orderable and resultable observation question.

Examples:

• Urine; Culture
• Deep Wound; Aerobic Culture
• Microscopic Examination; Gram Stain

**Description:**To be used to code and identify the Microbiology laboratory observation code that relates to the microorganism identification.

Examples:

• Bacteria identified
• Bacteria identified in tissue
• Fungus identified

Identifies characteristics (physical, visual, clinical) that may be observed for a particular device or device type.

Examples:

• Height
• Sterility
• External diameter

Identifies the types of diagnostic image.

Examples: Echocardiogram, electocardiogram, X-ray.

Identifies the type of diagnostic image report.

Examples:

• Echocardiogram Report
• Ultrasound Report
• Nuclear Medicine Imaging Report

Description: An observation that categorizes an existing observation of a disease, symptom or condition.

Usage Note: The act being categorized should be an observation of a disease, symptom or condition; the categorizing act should be an observation of the category of that disease, symptom or condition, and the relationship between the two acts should be a "has generalization" relationship.

Examples:

• [Observation of] "thrombocytopenia" is categorized as an observation of "Haematologic system" category
• [Observation of] "duodenal ulcer" is categorized as an observation of "Gastro-intestinal system" category
• [Observation of] "eczema" is categorized as an observation of "Dermatologic system" category

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Identifies types of observations about the parameters required for acquisition and processing of ECG data.

Examples:

• item byte order
• sample rate
• displayed sweep rate

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Description: Identifies types of observations that describe or categorize an observation in terms of the frequency of the observed event occurring.

Examples:

• Very common
• Uncommon
• Rare

FDA label data

OpenIssue: This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Describes the supporting information for financial transactions such as a Special Authorization Request.

Example values under this concept domain could be: height, weight, duration of disease, site of fistula, etc.

This concept domain is intended to be used as part of a code/value pair within a generic structure that would convey ANY sort of information or proof of criteria that is needed to support a special authorization request.

Description: Identifies the kinds of genetic observations that can be performed.