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LIM - NHS Connecting for Health

VIEWS: 10 PAGES: 3094

									National Healthcare - Logical Information Model
Revision History

LIM Model    Version     Author             Date
             LIM



             0.0         Cheong Yu Chye     1/25/2010
                         Cheong Yu Chye     7/7/2010


Archetypes   Version     Author             Date
             P1-P11. Participation




             0.0         Cheong Yu Chye     1/25/2010
                                            7/7/2010




             P12-P13. Patient




             0.0         Cheong Yu Chye     1/25/2010
                                            1/29/2010
                                            2/10/2010
                                            7/7/2010



             P14. Patient HC Organisation




             0.0         Cheong Yu Chye     2/5/2010
                                            7/7/2010
CL1. Medication


0.0        Cheong Yu Chye   7/7/2010




CL2. Medication Item

0.0        Cheong Yu Chye   7/7/2010




E1. Patient Event Context




0.0        Cheong Yu Chye   2/5/2010
                            2/26/2010
                            7/7/2010



E2. Document Context



0.0        Cheong Yu Chye   2/5/2010
                            2/26/2010
                            7/7/2010



E3. Problem Diagnosis



0.0        Cheong Yu Chye   2/5/2010
                            2/26/2010
                            7/7/2010



E4. Medication Order


0.0        Cheong Yu Chye   6/1/2010
                            6/2/2010
                            7/7/2010
E5. Medication Dispense


0.0         Cheong Yu Chye      6/1/2010
                                6/2/2010
                                7/7/2010



E6. Medication Administration


0.0         Cheong Yu Chye      6/1/2010
                                6/2/2010
                                7/7/2010



E7. Investigation Order


0.0         Cheong Yu Chye      7/7/2010




E8. Investigation Activity




0.0         Cheong Yu Chye      2/25/2010
                                2/26/2010
                                7/7/2010



E9. Laboratory Test


0.0         Cheong Yu Chye      7/7/2010




E10. Procedure Activity



0.0         Cheong Yu Chye      3/1/2010
                                3/25/2010
                                7/7/2010
E11. Adverse Reaction




0.0          Cheong Yu Chye   3/1/2010
                              3/25/2010
                              7/7/2010



E12. Alert


0.0          Cheong Yu Chye   3/1/2010
                              3/25/2010
                              7/7/2010



E13. Observation


0.0          Cheong Yu Chye   3/1/2010
                              3/25/2010
                              7/7/2010



E14. Clinical Synopsis


0.0          Cheong Yu Chye   7/7/2010




S1. Problem Diagnosis List




0.0          Cheong Yu Chye   3/1/2010
                              3/25/2010
                              7/7/2010
S2. Medication List




0.0         Cheong Yu Chye      3/1/2010
                                3/25/2010
                                7/7/2010



C1. Investigation Composition




0.0         Cheong Yu Chye      3/1/2010
                                3/25/2010
                                7/7/2010



C2. Patient Event Composition




0.0         Cheong Yu Chye      3/1/2010
                                3/25/2010
                                7/7/2010



C3. Medication Composition


0.0         Cheong Yu Chye      7/7/2010




C4. Summary Care View




0.0         Cheong Yu Chye      3/1/2010
                                7/7/2010
M1. Investigation Message




0.0         Cheong Yu Chye   3/1/2010
                             3/25/2010
                             7/7/2010



M2. Patient Event Message



0.0         Cheong Yu Chye   3/1/2010
                             3/25/2010
                             7/7/2010



M3. Medication Message




0.0         Cheong Yu Chye   3/1/2010
                             3/25/2010
                             7/7/2010



R1. Data Types

0.0         Cheong Yu Chye   2/17/2010
                             2/26/2010
                             7/7/2010



T1. Design Patterns

0.0         Cheong Yu Chye   2/17/2010
                             2/26/2010



T2. Term Lists

0.0         Cheong Yu Chye   2/17/2010
                             2/26/2010
cal Information Model

      Description
      The Logical Information Model (LIM) is a shared, implementation-
      independent representation of the healthcare information that is
      exchanged across Singapore, and that which is required as part of the
      National Electronic Health Record (NEHR).
      Initial Draft
      Major revision that aligns the LIM to an underlying LRM (Logical
      Reference Model)

      Description
      This worksheet includes those archetypes used to model individual
      people, healthcare providers and organisations that operate within
      the healthcare domain (participants) and the roles that they may play
      within these domains. The participation model is defined in this way,
      so that healthcare participants can be represented consistently across
      all the other archetypes.
      Initial Draft
      Second Draft
      Internal Review
      Stakeholder Review
      Stakeholder Sign-off (--> v0.1)

      This worksheet describes the 'Patient' archetype, and includes those
      data elements that pertain to patients. The Patient data group is a
      specialisation of the PERSON PARTICIPATION data group, and
      therefore inherits all of its data elements. In addition to the PERSON
      PARTICIPATION data elements, the Patient data group also includes
      'Patient Indicators', 'Next of Kin Details' and 'Financial Information'.

      Initial Draft
      Internal Review
      NHIS Review
      Second Draft
      Stakeholder Review
      Stakeholder Sign-off (--> v0.1)

      This worksheet describes the 'Patient Healthcare Organisation'
      archetype, and includes data elements that pertain to the
      organisation at which the patient receives healthcare. This data group
      is modelled as a specialisation of the Organisation Participation data
      group.
      Initial Draft
      Second Draft
      Internal Review
      Stakeholder Review
      Stakeholder Sign-off (--> v0.1)
This worksheet describes the 'Medication' Cluster and consists of
Information on the Medication entity on which a particular
medication item is based.
Initial Draft
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Medication Item' Cluster and consists of
information pertaining to a single medication item.
Initial Draft
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Patient Event Context' Administration
ENTRY archetype, and includes data elements that pertain to the
event during which the patient receives healthcare. This data group
includes information, such as the start and end dates of the event, the
participants and the event location.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Document Control' Administration
ENTRY archetype, and includes data elements that describe the
identity, type, status, dates and authorship of documents, such as
discharge summaries.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Problem Diagnosis' Evaluation ENTRY
archetype, and includes data elements that pertain to the name, type,
status and dates of each problem or diagnosis associated with the
patient.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Medication Order' ENTRY archetype and
includes data elements that pertain to the medication order.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)
This worksheet describes the 'Medication Dispense' ENTRY archetype
and includes data elements that pertain to an a medication item that
is dispensed.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Medication Administration' ENTRY
archetype and includes data elements that pertain to an a medication
item that is administered.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Investigation Order' ENTRY archetype
and includes data elements that pertain to the ordering of an
investigation.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Investigation Result' archetype and
includes data elements that pertain to the name, type, status, dates
and structured results (where relevant) of investigations which have
been (or are expected to be) performed on the patient.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Laboratory Test' Observation ENTRY
archetype and includes data elements that pertain to a particular
laboratory test.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Procedure Activity' ENTRY archetype
and includes data elements that pertain to the name, type, dates and
report of procedures which have been (or are expected to be)
performed on the patient.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)
This worksheet describes the 'Adverse Reaction' ENTRY archetype and
includes data elements that pertain to individual adverse reactions
(also known as allergies, sensitivities or intolerances) that the patient
has experienced, or is at risk of experiencing. These data elements
include the adverse reaction category, relevant dates, the causative
agent, participants and episode details.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Alert' ENTRY archetype and includes
data elements that pertain to individual alerts that may be relevant to
the patient.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Observation' ENTRY archetype and
includes data elements that pertain to an individual observation that
was performed.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Clinical Synopsis' Evaluation ENTRY
archetype and includes data elements that pertain to a particular
clinical synopsis.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Problem Diagnosis List' SECTION
archetype. It captures information about a list of diagnostic labels or
problem statements assigned by the clinician to describe the
diagnoses and medical/health problems associated with the patient
during the healthcare episode. It allows the list to be represented as
eitEHR a single free text summary, or individual problem/diagnosis
entries (or both).
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)
This worksheet describes the 'Medication List' SECTION archetype. It
captures information about a list of medications that is relevant to the
patient, such as medication orders, medications dispensed, current
medications and reconciled medications. It allows the list to be
represented as eitEHR a single free text summary, or individual
medication entries (or both).
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Investigation Results; Composition
archetype and includes data elements that pertain to a single
laboratory or radiology report, such as document control information,
the report contents (as a single encapsulated data), and individual
investigation results (where relevant).
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Patient Event' Composition archetype
and includes data elements that capture clinically relevant
information about a particular patient event (e.g. Discharge
Summary). The data elements describe information captured before,
during and after the patient event, such as adverse reactions, alerts,
clinical synopsis, problem diagnosis lists, medication lists, procedures,
follow-up services and triage information.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Medication' Composition archetype and
includes ENTRYs related to the ordering, dispensing and administering
of medications.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the 'Summary Care View' Composition
archetype and includes data elements that pertain to the NEHR
Summary Care View. This health record includes information about
the patient's reconciled problems/diagnoses, problem/diagnosis
history, laboratory and radiology investigation results, medication
history and current/reconciled medications list.

Initial Draft
Second Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes an 'Investigation Message' Message
archetype and includes data elements pertaining to the message
control, the patient, the healthcare event, the healthcare
organisation, and the relevant investigation results that are exchanged
in a message.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes a 'Patient Event Message' Message
archetype and includes data elements pertaining to message control,
and the patient event content being exchanged in the message.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes a 'Medication Message' Message archetype
and includes data elements pertaining to the message control, the
patient, the healthcare event, the healthcare organisation, and the
relevant medication details that are exchanged in a message.

Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the data types that are in use throughout
the LIM.
Initial Draft
Internal Review
Second Draft
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the design patterns that are in use within
the LIM.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)

This worksheet describes the value domains and associated
classification schemes, which are referenced within the LIM.
Initial Draft
Internal Review
Stakeholder Review
Stakeholder Sign-off (--> v0.1)
Guide for Use
1.   The columns in each of the main worksheets can be read as follows:

     LIM ID Ref          This is a unique identifier for the LIM data item. The ID references
                         are indented to show the nesting of the respective data item
                         within the corresponding 'parent' data group.
     LIM Data Item       This is the name of the data element. where the data element has
     Name                been inEHRited from a specialised datagroup, the original name
                         appears in brackets under the new data element name.
                         "Synonyms", which denote alternative name(s), are also shown
                         for some data elements.

                         Names that are preceded with two asterisks(**) indicate elements
                         that can be derived from other elements for the purposes of
                         querying.

                      Names that have the label [National] under them indicate
                      elements that are used in the national mapping of that clinical
                      concept. The national mapping provides a common semantic
                      representation of each clinical concept that is consistent across all
                      source systems.
     LIM Data Type    The type of the data element or group (refer to 'Data Types'
                      worksheet for data element types). Components of shared data
                      groups (e.g. "Address") are prefixed with a dash (e.g. "- Street
                      Name").
     LIM Cardinality  The number of values that can populate the given data item,
                      within the parent data group. Examples:
                      - [0..1]: At most one instance of this data item may exist, for each
                      instance of the parent data group.
                      - [1]: Exactly one instance of this data item must exist, for each
                      instance of the parent data group.
                      - [1..Many]: One or more instances of the data item may exist, for
                      each instance of the parent data group.
                      - [0..Many]: Zero to many instances of the data item may exist, for
     LIM Definition   A description of the data element or group.
     LIM Value Domain A value domain constrains the permissible values for a data
                      element. Value domains are reusable and, as such, the same value
                      domain can be used by different data elements. The 'Term Lists'
                      worksheet contains a list of all the value domains that are
                      referenced in the various LIM worksheets.
     LIM Format       A constraint on the format of the data element, where applicable.
     Constraint       A common format constraint is "YYYYMMDD[HHMMSS]" which
                      applies to the DateTime data type. The components appearing in
                      square brackets are optional. In other words, this particular
                      format constraint can be interpreted as year (YYYY), month (MM)
                      and day (DD) being mandatory components, while hour (HH),
                      month (MM) and second (SS) being optional components of the
                      date.
     Other LIM        Other constraint(s) that apply to the data item. e.g. default values
     Constraints      or other conditions.
Example (for      A sample value of the data element as it would be exchanged
Exchange)         between IT systems. Typically the corresponding sample value is
                  shown for both the Example (for Exchange) and Example (for
                  Display) columns.
Example (for      A sample value of the data element as it may appear on a
Display)          standard user interface. Typically the same sample value is shown
                  for both the Example (for Exchange) and Example (for Display)
                  columns.
Finance-related   This column only appears in the "P12-P13. Patient" worksheet,
                  and indicates if the data element is finance-related.
LIM Comments      Additional comments pertaining to the data element.
LIM Change Log    Comments related to changes made to the data element.
NEHR List Columns Data elements required by NEHR Phase 1 that correspond to the
                  LIM data element.
NHIS List Columns Data elements required by NHIS that correspond to the LIM data
                  element.
NDDS Template     These are columns that specify the inclusion or exclusion of LIM
Columns           data elements within a particular NDDS. In general, for each
                  NDDS, there are the following columns (xxx = message/document
                  type, yyy = insitution/cluster):
                  - xxx NDDS: contains the cardinalities of the parent and child
                  components (where applicable). The cardinalities may differ from
                  the LIM cardinalities.
                  - xxx NDDS Cardinality: This is always the same as the parent
                  cardinality in the "xxx NDDS" column and is present to facilitate
                  the creation of NDDS spreadsheets.
                  - xxx IDDS (yyy): The data elements in the IDDS for the yyy
                  institution/cluster that correspond (or map to) to the LIM data
                  element.
Summary
                                                                                            Reviewers
S/N       Worksheets                              Type                           NEHR          EA       CTS


P1-P11    Participation                           Data Group                               (NHIS)    
P12-P13   Patient                                 Data Group                               (NHIS)    
P14       Patient HC Organisation                 Data Group                                          
CL1       Medication                              CLUSTER                                              
CL2       Medication Item                         CLUSTER                                              
E1        Patient Event Context                   ENTRY                                                
E2        Document Context                        ENTRY                                        
E3        Problem Diagnosis                       ENTRY                                                
E4        Medication Order                        ENTRY                                                
E5        Medication Dispense                     ENTRY                                                
E6        Medication Administration               ENTRY                                                
E7        Investigation Order                     ENTRY                                                
E8        Investigation Activity                  ENTRY                                                
E9        Laboratory Test                         ENTRY                                                
E10       Procedure Activity                      ENTRY                                                
E11       Adverse Reaction                        ENTRY                                                
E12       Alert                                   ENTRY                                                
E13       Observation                             ENTRY                                                
E14       Clinical Synopsis                       ENTRY                                                
S1        Problem Diagnosis List                  SECTION                                              
S2        Medication List                         SECTION                                              
C1        Investigation Composition               Composition                                          
C2        Patient Event Composition               Composition                                          
C3        Medication Composition                  Composition                                          
C4        Summary Care View                       Composition                                          
M1        Investigation Message                   Message                                             
M2        Patient Event Message                   Message                                             
M3        Medication Message                      Message                                             
R1        Data Types                              Reference Model                                     
T1        Design Patterns                         Terminology Patterns                                 
T2        Term Lists                              Terminology                                          

          Legend
          x = Worksheet has elements that are referenced in the template/list
          tick = (For templates) Worksheet (i.e. archetype) is constrained by the template
          tick = (For NEHR/NHIS lists) Worksheet (i.e. archetype) has elements included in the list
          tick = (For Reviewers) Worksheet to be reviewed by respective reviewer
                                                NEHR Lists
Summary Care Patient   Laboratory   Radiology    Diagnosis   Reconciled   Medication
View         Event     Results      Results      Problem     Diagnosis    History
                                                 History     Problem
     x            x          x           x              x            x          x
                 x          x           x              x            x          x
                                                                          


                                                                          
                                                                           
                 
                                                                              
                                                                              




     
                  

                                                                 
                                                                               
                                       
                 

     



     x            x          x            x            x            x           x
     x            x          x            x            x            x           x
     x            x          x            x            x            x           x
              NHIS List                       NDDS Templates                           Discharge Summary Templates
Current &                 ADT       Lab         Radiology Meds    Meds       ACIDS     ACIDS
Reconciled                                                Order   Dispense   Phase 1   Phase 2
Medications
       x         x                                                          x         x
       x                                                                            
                                                                                    
                                                                    
                                                                    
                                                                                    
                                                                                         
                                                                                         
                                                                                        
                                                                                         

                                                   
                                                   
                                                   

                                                                   
                                
                                                                    
                                                   
                                                                                         
                                                                                       
                                                   
                                                                                         
                                                                    

                                                   
                                
                                                                    
      x          x                                                          x         x
      x                                                                          x         x
      x          x                                                          x         x
Discharge Summary Templates
            ACIDS Goal CHIDS
            State      (Community )
                       Phase 1
                  x            x
                              
                              


                             
                             
                             
               
               




               
               
               
                             

                             
               

                             




               x              x
               x              x
               x              x
Glossary
Term             Description
Archetype        A reusable model for describing a particular clinical concept.
Cardinality      The number of elements in a set or group. Examples:
                 [0..1]: At most one instance of this data element/group may exist, for each instance
                 of the parent data group.
                 [1]: One and only one instance of the data element/group may exist, for each
                 instance of the parent data group.
                 [1..Many]: One or more instances of the data element/group may exist, for each
                 instance of the parent data group.
                 [0..Many]: Zero to many instances of the data element/group may exist, for each
                 instance of the parent data group.
Composition      A group of archetypes assembled for a particular purpose, e.g. a discharge
                 summary is an assembly of various archetypes such as problem diagnosis list,
                 medication list and so on.
Design Pattern   A reusable model for describing a particular clinical concept (e.g. procedures,
                 medications and problem diagnoses), in which different source systems may use a
                 different split between information model and terminology model.

ENTRY            A single 'clinical statement', which may be a single, short narrative phrase, or may
                 contain a significant amount of data, e.g. a microbiology result, a psychiatric
                 examination, a complex prescription.
IDDS             Individual Data Definition Specification. An IDDS is a message definition of the
                 source systems, and is comprised of message structure, the data elements within
                 the message, data types of the elements, values and terms that are used to
                 represent the codified clinical concepts.
NDDS             National Data Definition Specification. The NDDS is a domain-specific information
                 template for a specific domain and use case, such as exchanging laboratory results,
                 medication dispense, etc. NDDS is derived from LIM with use case specific
                 variations & restrictions on values and terminology bindings, and other use case
                 specific validation rules. Depending on the clinical capability, different NDDS can be
                 derived from the same LIM with different clinical conformance level. Messages
                 from individual source system will be transformed to NDDS structurally conformed
                 to LIM via structural mapping and mapping of code sets from locally defined code
                 set to national reference sets.
NEHR             National Electronic Health Record. The NEHR is a national system that will
                 revolutionise the timely and accurate communication of clinical information, so
                 that patients will have confidence that clinicians have critical clinical information
                 available to deliver high quality care. The NEHR will help transform the way
                 clinicians make decisions, deliver care and interact with other members of the
                 health system.
NHIS             National Healthcare Identification Service. The NHIS system consists of a registry of
                 patients, clinicians and facilities.
Participation    An act in which a healthcare participant participates in a given role.
SECTION          A SECTION is an organising container that gives a reader a clue as to the expected
                 content. The primary purpose of a SECTION is to organise information to suit the
                 purpose for its collection and facilitate navigation. SECTIONs are also meant to be
                 safely reused for secondary purposes, e.g. clinical coding or inclusion in a
                 summarised form in an electronic health record. A SECTION is context-specific to
                 the document in which it resides.
Template         A means of constraining the LIM for a given use case or purpose. A NDDS is an
                 example of a template used for a specific national purpose.
Value Domain     A value domain constrains the permissible values for a data element. Value
                 domains are reusable components and, as such, the same value domain can be
                 used by different data elements.
Issues Tracker
S/N Issue
  22 Rationalisation of
     Organisations,
     Departments &
     Facilities
  21 Valid 'Information
     Provider'

  20 Requirements for
     Investigation Results

  19 Understanding
     Context of Radiology
     Data Elements

  18 Concomitant
     Causative Agent
     Indicator
  17 Medication Dispenser
     Order Number



  16 Ordered vs Executed
     Priority




  15 Use of abnormal as
     well as normal
     indicator/flags




   1 Relationship between
     Status, Type and
     Design Patterns




   2 Problem Diagnosis
     ENTRY
 3 Medications List


 4 Use of ‘SECTION’




 6 LIM Update to NHIS




 7 Consolidate ‘Patient’
   and ‘Participation’
   worksheets




 8 Relationship of
   Accident Code to
   Causative Agent

 9 Capturing the context
   of entries
10 Removal of ‘Lists’
11 Decomposition of
   composite LIM
   elements to individual
   components

14 ‘Past Medical History’
   SECTION in C2.Patient
   Event Report

 5 InEHRitance of
   Clinical Context



12 Including Check Digits
   and Check Digit
   Schemes into
   Identifier Data Type




13 Review of
   Participation Model
Description
The LIM is structured to implicitly link the department (e.g. DG4.1.3.5 Admitting Department in the
Patient Event Information Data Group) to the facility ((i.e. DG1.3.3. Organisation Identifier in the Patient
HCO Data Group) by specifying that both the Data Groups are included in an ADT message, for example.

Need to decide if Software is to be a valid ‘Information Provider’. P.S. ENTRY.Information Provider has
been moved down to Participations, and the datatype changed to ‘Participations’, to align with NHS’s
LRA in including software as a type of ‘Participation’.
NEHR requirements to date for lab and rad reports state only the MINIMUM of what is required -- still
need to study EMRs

Need to verify with IHIS what RIS (Aurora?) they are using and whehter info from Z segments (e.g. ZBX-4)
is actually being consumed. NEHR (Florence) needs to incorporate same business rules that govern how
this data is used/displayed by their consuming systems (e.g. EMR). Sessions needed with NEHR Team to
get IHIS to show us the flow of data.
Within E6.1.2 (Causative Agent DG): We may need to add an additional indicator to denote causative
agent(s) that are concomitant

E11.1.2.3 (Medicaton Dispenser Order Number) -- Chee Leong suspects that even if the same med order
is dispensed multiple times, a differnent dispense ID is issued. Change the name to "Medication Dispense
Identifier" -- need to seek clarification from IHIS whether a new Dispense Identifier is indeed issued for
the same med order. If the same dispense ID is used, How do we differentiate between a corrected med
dispense or a new med dispense?
E11.1.2.1.3 (Priority) - This LIM field is probably meant to represent the ‘Ordered Priority’. TEHRe is a
need to find out from IHIS whether this priority is the ordered priority or the executed priority, and then
discuss with CTS (Chee Leong) whether tEHRe is a need to keep these two distinct from each other – or
whether one is more important than the other.



Need to assess whether our Investigation model can cater for different types of investigations (e.g.
histopathology/cytology)




I think we need to review how we’re handling the combination of Status, Type and Design Patterns. In
many cases, tEHRe is a strong overlap between Status (e.g. ("P", "Provisional"), ("A", "Active"), ("I",
"Inactive"), ("C", "Canceled")), Type (ie “Primary”, “Secondary”, “Past History”, “Family History”), Finding
Context (e.g. “Suspected”), Temporal Context (e.g. “Past”) and Subject-Relationship Context (e.g. “Family
history of”). I don’t think we have this sorted yet … but need to address this fairly urgently.


I’m concerned that we should be accessing the ‘Problem Diagnosis ENTRY’ directly from the Discharge
Summary, ratEHR than going through the ‘Problem Diagnosis List’ (which was originally created for
consistency with the Medication list). This ‘Problem Diagnosis List’ will still be useful for the SUMMARY
CARE VIEW – however, eitEHR way I suspect that we should be adding the “Problem Diagnosis Type”
information directly attached to each Problem/Diagnosis ENTRY (next to the “Problem Diagnosis
Status”). This seems to be the more common way of modeling this (not sure if that makes it right ;-)).

<Linda> I have decided that we need to go through the list, so that we can have a ‘Problems Diagnoses
Summary’ for each type of Problem Diagnosis List (ie. A ‘Primary Diagnosis summary’, a ‘Secondary
Diagnoses summary’, a ‘past diagnoses summary’ etc). However, in order to make the ‘ENTRY’
independently queriable, I have added a ‘Problem/Diagnosis Type’ to the PD ENTRY. This may appear to
be redundant, but unless we use Context, tEHRe seems to be no other solution.
Based on the above, we need to consider if tEHRe are any implications to the Medications List.
<Linda> Should ‘Medication Set Type’ be added to the ‘Medication Set’ (even though this may repeat the
List Type?
I’m conscious that we may be using the ‘SECTION’ inappropriately. I think it is important to understand
that “SECTIONs provide both a logical structure for the author to arrange Entries, and a navigational
structure for readers of the record, whether they be human or machine. . . . SECTION structures are not
essential in a Composition – they can always be removed or ignored (typically in machine processing
such as querying) without losing the meaning of the Entries in the Composition. While SECTIONs are
often used to group Entries according to status, e.g. “family history”, “problems”, “observations”, it is
the Entries themselves that indicate the definitive category of information contained tEHRein.” We
tEHRefore need to make sure that we have not erroneously used SECTIONs to capture clinical content
(e.g. Problem Diagnosis Type)

<Linda> This could be resolved by adding ‘Medicaiton Set Type’ to the Medication Set (although this may
appear redundant.
Update Anthony (NHIS):
·     In our current HL7 source messages, we are seeing a ‘Line 3’ component as part of the Patient’s
address. We have tEHRefore added this ‘Line 3’ component into the Address data group (ID# 2) found in
the ‘DG1. Participation’ worksheet of the LIM, to be able to model this in the LIM accordingly.
·     If you recall, we had earlier included in a LIM element called ‘EHR Opt-out Exceptions’ indicator
(ID# 1.4.7) in the ‘DG2. Patient’ worksheet to model this indicator in NHIS. Could you please advise us if
the cardinality of this element (as captured in NHIS) is ‘0..1’, or ‘0..Many’.
·     We are assuming that Next of Kin ‘Job Title’ is not required. NOK Occupation is provided (as per
Anthony’s requirement), and ‘NOK Job Title’ in the HL7 messages seems to be populated with
Occupation codes by SH (and is not provided by NHG).
Remove all components from data type column - put a link to participation page, then just add an ‘other
Constraint’ to specify all individual cardinalities that differ from the default (i.e. anything extra that is
mandatory).
. I agree that what we should be doing is including ALL or NONE of the core PERSON PARTICIPATION
attributes in the Patient data group. The advantage of including ALL is that tEHRe are fewer pages that
require templates (ie no need to add new template columns to the ‘Participation’ page for Patient and
NOK). The disadvantage is that it becomes redundant (for maintenance), and its harder to tell what is
added for Patient. Perhaps the best solution would be (and I apologise for suggesting this);
o Remove the ‘Patient’ tab all togetEHR, and instead, on the ‘Participation tab’ add all additional
‘Biodata’ data elements to the ‘PERSON PARTICIPATION’ (note this will then also cover the ‘Next of Kin’
attributes when occupation and Birth DateTime are all tEHRe (note, I’m assuming that Occupation and
Job Title are the same, but if they’re not, then we’d need to add job title as well. We would then have a
‘Patient Participation’ specialization on this same page, which includes the ‘Indicators’ and ‘Finanical
Information’ (although I’d probably tend to put ‘resident status’ in Person, because it may be relevant to
doctors as well.
Accident Code (ACC-2) [0..1]
We need to consider the relationship (if any) to the 'Causative Agent' data element in the Problem
Diagnosis archetype - our goal is to ensure that the same logical piece of information is only recorded in
one place in the LIM (where possible).
We need to log an issue to look into how we will capture the context of entries so that we can use
elements of the context such as 'ENTRY date' in our LIM@@
Each Problem Diagnosis List should have a ‘List Type’ (in this case it will be repeat of the
‘Problem/Diagnosis Category’ – e.g. “Admission Diagnosis”, “Discharge Diagnosis”). What I am starting
to suspect, however, is that we could probably remove the ‘Problem Diagnosis List’ and just include a
‘Problem Diagnosis Summary’ (as per the other data groups) on the ‘C2. Patient Event Report Page’ (as
per the other ones). I think this is another example of where the list was added as a grouping mechanism
on the NEHR ‘view’, but is not actually required in the message exchange. The same may apply for the
Medication List. Happy for you to leave it as is for the moment (but please define the List Type in the
same way as Problem/Diagnosis Category was mapped) …. But we will need to discuss this bigger change
for the next major release of the LIM.
Break up composite LIM elements to individual line items (e.g. address).




The KTPH discharge summary requires a SECTION called ‘Past Medical History’. We need to discuss with
Chee Leong the feasibility of introducing this new SECTION under C2.Patient Event Report that allows a
combination of problem/diagnoses, events and procedures to be recorded.

I suspect that tEHRe are some places in the model where the clinical context is inEHRited, and tEHRefore
does not need to be included separately. The main example I am thinking of EHRe is E11.1.3.2.1.1.2
(Investigation Test Details’ Procedure Context Group) and E11.1.3.2.1.2 (Investigation Test Details’
Source Attributes). I believe that all of these should be inEHRited from the main Investigation
Description (in 1.2).
Patient Identifier List (PID-3) [1]
- code identifying the check digit scheme employed (PID-3.3) [1]
[Recommendation: Add new Designation.check digit method LIM element]
<Linda: I would prefer not to add check digits and check digit schemes into this datatype, as neitEHR
openEHR, ISO21090 or HL7v3 includes check digits in identifiers. I suggest that we put this on the Issues
List with a question "Do we really need to support this requirement?" It looks like SH uses them, but not
NHG.
<Yu Chye> We have already included ‘Check Digit’ and ‘Check Digit Method’ into the Identifier data type.
As discussed, we will need to get ‘Patient’ and ‘Next of Kin’ aligning more closely with the participation
model (and extend the participation model to suit).
Author           Action                      Status
Cheong Yu Chye                               6/7: Open



Cheong Yu Chye                               5/7: Open


Cheong Yu Chye                               11/6: Open


Cheong Yu Chye   To include this with        11/6: Open
                 discussions between IHIS,
                 NEHR and STDS

Cheong Yu Chye                               11/6: Open


Cheong Yu Chye   To check with IHIS          11/6: Open




Cheong Yu Chye   To check with IHIS          8/6: Open (questions
                                             to IHIS have been
                                             added to IDDS
                                             columns within the
                                             LIM)


Cheong Yu Chye   To discuss with Chee Leong. 2/6: Open




Cheong Yu Chye   To discuss with Chee Leong. 12/3: Open




Cheong Yu Chye   For discussion.             12/3: Open
                                             17/3: Revised.
Cheong Yu Chye   12/3: Open


Cheong Yu Chye   12/3: Open




Cheong Yu Chye   12/3: Open
                 17/3: Revised




Cheong Yu Chye   19/3: Open




Cheong Yu Chye   6/5: Open



Cheong Yu Chye   9/4: Open

Cheong Yu Chye   6/5: Open
Cheong Yu Chye                                12/3: Open




Cheong Yu Chye                                4/5: Open



Cheong Yu Chye   Fixed                        12/3: Open
                                              17/3: Closed



Cheong Yu Chye                                7/4: Open
                                              29/4: Closed




Cheong Yu Chye   The ‘Participation’ model    12/3: Open
                 has been revised to better   17/3: Closed
                 support both ‘Patient’ and
                 ‘Next of Kin’.
                 The ‘Patient’ and ‘Next of
                 Kin’ data groups have been
                 aligned with the revised
                 ‘Participation’ model.
PARTICIPANT & PARTICIPATION
             LIM ID Ref       LIM Data Item Name     LIM Data Type

P1                            PARTICIPANT            Class


P2                            PERSON                 Class


P3                            HEALTHCARE PROVIDER    Class


P4                            ORGANISATION           Class


P5                            PARTICIPATION          Class

P6                            PERSON PARTICIPATION   PARTICIPATION


P7                            HEALTHCARE PROVIDER    PERSON PARTICIPATION
                              PARTICIPATION


P8                            ORGANISATION           PARTICIPATION
                              PARTICIPATION

P9                            PERSON NAME            Class

P10                           ADDRESS                Class

P11                           HEALTHCARE FACILITY    Class
                              LOCATION
LIM Cardinality   LIM Definition                                                 LIM Value Domain

<Undefined>       A person or organisation that participates in the healthcare
                  domain.

<Undefined>       A person who participates in the healthcare domain.


<Undefined>       A person who provides healthcare.


<Undefined>       An organisation that participates in the healthcare domain.


<Undefined>       The act of a participant performing a role.

<Undefined>       A participation in which the participant is a person.


<Undefined>       A participation in which the participant is a person and a
                  healthcare provider.


<Undefined>       A participation in which the participant is a organisation


<Undefined>       The name of the person.

<Undefined>       The address of the participant.

<Undefined>       Information describing a particular location within a
                  healthcare facility.
LIM Format Constraint   Other LIM Constraints




                        PARTICIPATION.Participant.Participant_Type = "Person"


                        PARTICIPATION.Participant.Participant_Type = "Healthcare
                        Provider"


                        PARTICIPATION.Participant.Participant_Type = "Organisation"
LIM Example (for Exchange)   LIM Example (for Display)
LIM Comments   LIM Change Log
PATIENT PARTICIPANT
                      LIM ID Ref


P12




P13
LIM Data Item Name      LIM Data Type          LIM Cardinality


PATIENT PARTICIPATION   PERSON PARTICIPATION   <Undefined>




PATIENT                 PERSON                 <Undefined>
LIM Definition                                     LIM Value Domain


A participation, whose participant is a patient.




A participant who is a patient.
LIM Format Constraint   Other LIM Constraints


                        1. PARTICIPATION.Participation Type = "Patient"
                        2. PARTICIPATION.Healthcare Role = "Subject"
                        3. PARTICIPATION.Participant->Relationship to Patient = "Self"
                        where PARTICIPATION.Participant in PARTICIPANT.UID
LIM Example (for Exchange) LIM Example (for Display)   Finance-related LIM Comments
                                           SUMMARY CARE VIEW - NEHR LIST

LIM Change Log   NEHR Phase 1   Term
                 Core

                 Yes




                 Yes




                                UNMAPPED
UMMARY CARE VIEW - NEHR LIST                         PATIENT DEMOGRAPHICS DRILL-DOWN VIEW
                                                                  - NEHR LIST
                  Definition & Comments   Term                             Definition & Comments




                  UNMAPPED                UNMAPPED                         UNMAPPED
                               NHIS LIST

NHIS Phase 1 Core NHIS Data Item Name


Yes




Yes




UNMAPPED NHIS
FIELDS
                 src [1] (Source & Source ID)

                 Source: NHIS product terminology & used in technical
                 trial. Needs to be informed by both sending application
                 and sending facility. To be clarified during the current
                 Initiate consultancy.

                 Source ID: NHIS product generated ID for 'Source' field
                 mentioned above.
                 createdate [1] (Creation Date)

                 The date the patient record was created in the source.
                 Applies to extract only, not ongoing interfaces. A valuable
                 piece of information for NHIS.
                 updatedate [1] (Last Update Date)

                 The date that any field within the patient demographic
                 record was last updated. Applies to extract only, not
                 ongoing interfaces. Another valuable piece of
                 information for NHIS.
ADT NDDS                  ADT NDDS
                          Cardinality

                          <Undefined>




LIM.PATIENT <Undefined>   <Undefined>
               ADT - NDDS TEMPLATE

SCM


Patient Info




Patient Info
KIV FOR MOHH
             ADT - NDDS TEMPLATE

ADT IDDS (SHS)


PID [1]
MRG [0..1]
PV1 [0..1]
NK1 [0..Many]
PID [1]
MRG [0..1]
PV1 [0..1]

UNMAPPED FIELDS FOR IHIS CLARIFICATION/ATTENTION

Driver's License Number - Patient (PID-20) [0..1]

[12042010 MOHH} Please clarify if the purpose of this HL7 component is to capture (a) 'Patient
Document Type' (or 'Type of Identification') and (b) the 'Subvention Document Type' (or 'Type of
Identification for Subvention'). Can some sample values be provided to us so that we can decide
on the mappings to appropriate LIM elements?]




NOTES FOR MOHH USE ONLY




- Set ID - Next of Kin (NK1 - 1)
[Recommendation: Ignore since this is just a system-generated ID]
<Linda: Agreed>
PID-3 id's realm/issuer should be set to the Patient's HCO
- Driver's License Number - Patient (PID-20) [0..1]
[Recommendation: Add new LIM element for this]
<Linda: Looking at the original specification, this actually stores the 'Patient Document Type' (or
'Type of Identification') and the 'Subvention Document Type' (or 'Type of Identification for
Subvention'). I can't find any values for the second part in the data - not sure if it's used. Yes, we
should add one (or two?) data elements for this - but perhaps need to clarify its values a bit
further. From what I can see it's valid values are "X", "P" and "B".

[7/4 YC: To discuss further with WH]
[12/4 YC: Will seek clarification from IHIS]




Patient Identifier List (PID-3) [1]
- code identifying the check digit scheme employed (PID-3.3) [1]
[Recommendation: Add new Designation.check digit method LIM element]
<Linda: I would prefer not to add check digits and check digit schemes into this datatype, as
neither openEHR, ISO21090 or HL7v3 includes check digits in identifiers. I suggest that we put
this on the Issues List with a question "Do we really need to support this requirement?" It looks
like SH uses them, but not NHG.
Patient Address (PID-11) [0..Many]
- state or province (PID-11.4) [0..1]
- other geographic designation (PID-11.8) [0..1]
- county/parish code (PID-11.9) [0..1]
- census tract (PID-11.10) [0..1]
[Recommendation: Add new components to 'Identifier' data type to cater for the above]
<Linda: Looking back at the IDDS, the stucture constraint seems to be defined incorrectly. For
example, even though the 'census tract' component is used, it is not populated with this. The
'Local Database Column' shows that the data used is: Street^Building Name^Block/House
Number^Unit Number^Level^City^District^Geographical Area^Postal Code^Country
Code~Other Address^Street^Building Name^Block/House Number^
Unit Number^Level^City^District^Geographical Area^Postal Code^Country Code
I would tend to populate this as follows:
  - LIM.StreetName = Street
  - LIM.Block/House =Block/House number
  - LIM.Level = Level
  - LIM.Unit = Unit Number
  - LIM.Line 1 = Building Name
  - LIM.Line 2 = ['Unit ' + Unit Number + ' '] + ['Level ' + Level] Block/House Number + ' ' Street
  - LIM.Line 3 = City [+ ', ' District'] [ + ', ' + Other Geographical Area]
  - LIM.City = City
  - LIM.Postal Code = Postal Code
  - LIM.Country = Country Code
  - LIM.Address Type = "Primary" (for 1st address), "Other" (for 2nd address)
The only three that we're missing in the LIM (I think) are "Building Name", "District", "Other
Patient Address (NK1-4) [0..Many]
- state or province (NK1-4.4) [0..1]
- other geographic designation (NK1-4.8) [0..1]
- county/parish code (NK1-4.9) [0..1]
- census tract (NK1-4.10) [0..1]
[Recommendation: Add new components to 'Identifier' data type to cater for the above]
<Linda: Note, this it the Next of Kin address, but could be resolved as above. Note 'Census tract'
and State-or-province are NOT required.>




Patient Account Number (PID-18) [0..1]
- code identifying the check digit scheme employed [0..1]
[Recommendation: Add new Designation.check digit method LIM element]
<Linda: Once again I'm hesitant to add the check-digits to the identifier datatype. I would like to
confirm this requirement before doing so. Perhaps we need a general rule when mapping to HL7
v2 that we allow these components to be optional, but that we don't create check digits in other
formats - unless this is a requirement?>

Prior Patient Identifier List (MRG-1) [1]
- check digit scheme (MRG-1.3)
[Recommendation: Add new LIM.Identifier.Check Digit Method field]
<Linda: As above … we need to check this requirement.>
Insurance Company Address (IN1-5) [0..1]
- Building Name
[Recommendation: Add new element LIM.Address.other designation]
- District
[Recommendation: Add new element LIM.Address.State or Province]
- Geographical Area
[Recommendation: Add new element LIM.Address.other geographic designation]
<Linda: I don't have the original spec at hand - however I would be tempted to instead add
'Building Name', 'District' and 'Other Geographical Area (as above).
KIV FOR MOHH
Patient Identifier List (PID-3) [1]
- code identifying the check digit scheme employed (PID-3.3) [1]
[Recommendation: Add new Designation.check digit method LIM element]
<Linda: I would prefer not to add check digits and check digit schemes into this datatype, as
neither openEHR, ISO21090 or HL7v3 includes check digits in identifiers. I suggest that we put
this on the Issues List with a question "Do we really need to support this requirement?" It looks
like SH uses them, but not NHG.
ADT IDDS (NHG)


PID [1]
MRG [0..1]
PD1 [0..1]
PV1 [0..1]
PID [1]
MRG [0..1]
PD1 [0..1]

UNMAPPED FIELDS FOR IHIS CLARIFICATION/ATTENTION




NOTES FOR MOHH USE ONLY
Patient Address (PID-11) [0..Many]
- state or province (PID-11.4) [0..1]
- other geographic designation (PID-11.8) [0..1]
- county/parish code (PID-11.9) [0..1]
- census tract (PID-11.10) [0..1]
[Recommendation: Add new components to 'Identifier' data type to cater for the above]
<Linda. Do not add components to the 'Identifier' data type. Instead add to P13.2: Address, the fields
that we don't have in the LIM that are used in this specification. This IDDS populates the address field
with the following components:
SAP TABLE/FIELD:
   NADR-BUILD
   NADR-FLOOR
   NADR-ROOM
   NADR-STRAS
   NADR-PSTLZ
   NADR-LAND
   NADR-STRAZ
If we can work out what each of these means, then we can work out what we have and what we
don't have. I would guess (but this needs to be confirmed) that:
   NADR-BUILD --> LIM.Block/House (N.B.: Should we rename this to 'Block/House Number'?)
   NADR-FLOOR --> LIM.Level
    NADR-ROOM --> LIM.Unit
   NADR-STRAS --> LIM.Street Name
   NADR-PSTLZ --> LIM.Postal Code
   NADR-LAND --> LIM.Country
   NADR-STRAZ --> ??? Unless this is the Street Number, and NADR-BUILD is the Building Name??
(Note: It's hard to tell as we don't have any sample data for this field)
- Patient ID (PID-2) [0..1]
[Recommendation: Ignore since this is always the same value as PID-3]
<Linda: In the NUH data PID-2 and PID-3 values are always different. If you look at the Local Database
field column of the IDDS, you'll see that PID-2 is populated with the 'External Patient ID' and PID-3 is
populated with the 'Internal Patient ID'. They both should therefore be mapped to the same field, but
the PID-3 id's realm/issuer should be set to the Patient's HCO, whereas I don't think we can find out
the Realm/Issuer of the PID-2's Patient ID, so this should just be left blank.
- Mother's Maiden Name (PID-6) [0..1]
[Recommendation: Add new LIM element 'Mother's Maiden Name']
<Linda: Agreed. I would consider adding this to PERSON PARTICIPATION's Additional Demographics,
as it may, at some stage be relevant for Healthcare Providers as well.>
- Cause of Patient's Death - local field (PID-31) [0..1]
[Recommendation: Add new LIM element]
<Linda: We need to make sure that there is only one way to model 'Cause of Death' in the LIM. At the
moment, you can either put the cause of death in PID-31 OR put the cause of death in P1-4 (or P1-1 if
coded) while setting P13.20 (Cause of Death Indicator). In the LIM, we need a single way of
representing this. I would probably tend to map this to the Problem/ Diganosis archetype (with Cause
Prior Patient ID (MRG-4) [0..1]
- id
[29/3: WH to check with IHIS how this is different from MRG-1]
<Linda: MRG-1 seems to record the prior 'internal' patient id (ie. from the same hospital), whereas
MRG-4 seems to record the prior 'external' patient id (presumably from another facility). I think
these can be mapped to the same 'Prior Patient Id' data element, but the MRG-1 ids should get the
'realm' assigned based on the Patient HCO, while MRG-4 doesn't (I assume we can't find a realm or
issuer for these)>




Patient Address (NK1-4) [0..1]
- state or province (NK1-4.4) [0..1]
[Recommendation: Add new component to 'Identifier' data type to cater for the above]
<Linda: I think that the structure constraint here is actually quite misleading, and instead we
should be looking at the meaning of the database elements that are put into these fields. In this
case SAP populated these with:
SAP TABLE/FIELD:
NADR-BUILD
NADR-FLOOR
NADR-ROOM
NADR-STRAS
NADR-PSTLZ
NADR-LAND
We need to understand what each of these fields really mean ... but my first guess would be:
<Block/House>^<Level>^<Unit>^<StreetName>^<Postal Code>^<Country>
in which case we've got all the required bits in the LIM ... we just need to map it properly (and fix
up the IDDS structure constraint).>
KIV FOR MOHH
                                        LABORATORY - ND

LAB NDDS                  Lab NDDS
                          Cardinality

                          <Undefined>




LIM.PATIENT <Undefined>   <Undefined>




UNMAPPED
                 LABORATORY - NDDS TEMPLATE

LAB IDDS (KKH)    LAB IDDS (SGH)


PID [1]           PID [1]




PID [1]           PID [1]




UNMAPPED          UNMAPPED
LATE

       LAB IDDS (CGH)   LAB IDDS (NHG)


       PID [1]          PID [1]




       PID [1]          PID [1]




       UNMAPPED         UNMAPPED
RAD NDDS                  Radiology NDDS
                          Cardinality

                          <Undefined>




LIM.PATIENT <Undefined>   <Undefined>




UNMAPPED
                                  RADIOLOGY (RAD) - NDDS TEMPLATE

RAD IDDS (KKH)   RAD IDDS (SGH)


PID [1]          PID [1]




PID [1]          PID [1]




UNMAPPED         UNMAPPED
RADIOLOGY (RAD) - NDDS TEMPLATE

                  RAD IDDS (CGH)


                  PID [1]
                  PV1 [0..1]



                  PID [1]
                  PV1 [0..1]


                  UNMAPPED
RAD IDDS (NHG)   RAD IDDS (NHGP)


PID [0..Many]    PID [0..Many]
PV1 [0..Many]



PID [0..Many]    PID [0..Many]
PV1 [0..Many]


UNMAPPED
                                           MEDS ORDER (MO) - NDDS TEMPLATE

MO NDDS                   Med Order NDDS
                          Cardinality

                          <Undefined>




LIM.PATIENT <Undefined>   <Undefined>




UNMAPPED
             MEDS ORDER (MO) - NDDS TEMPLATE

MO IDDS (NHG)


PID [0..1]




PID [0..1]




UNMAPPED
                                                             ME

MO IDDS (KKH)   MD NDDS                   Med Dispense
                                          NDDS Cardinality

PID [1]                                   <Undefined>




PID [1]         LIM.PATIENT <Undefined>   <Undefined>




UNMAPPED        UNMAPPED
                MEDS DISPENSE (MD) - NDDS TEMPLATE

MD IDDS (NHG)


PID [1]




PID [1]




UNMAPPED
MD IDDS (CGH)


PID [1]




PID [1]




UNMAPPED
ACIDS Phase 1 NDDS




UNMAPPED
                           DISCHARGE SUMMARY TEMPLATES

ACIDS Phase 1 IDDS (NHG)
                   DISCHARGE SUMMARY TEMPLATES

ACIDS Phase 1 IDDS (SHS)                         ACIDS Phase 1 IDDS (KTPH)




                                                 UNMAPPED
ACIDS Phase 2 NDDS   ACIDS Goal State NDDS   CHIDS
                                             (Community ) Phase
                                             1 NDDS




UNMAPPED             UNMAPPED                UNMAPPED
PATIENT HEALTHCARE ORGANISATION PARTICIPATION

              LIM ID Ref   LIM Data Item Name     LIM Data Type       LIM Cardinality


P14                        PATIENT HEALTHCARE     ORGANISATION
                           ORGANISATION           PARTICIPATION


      P14.1                LOCATABLE              Class               0

      P14.2                Participation Type     Coded Text          1

      P14.3                Healthcare Role        Codeable Text       0..1

      P14.4                Participation Period   DateTime Interval   0..1

      P14.5                Participation Mode     Codeable Text       0

      P14.6                Participant            PERSON              1
LIM Definition                                              LIM Value Domain        LIM Format
                                                                                    Constraint

The healthcare establishment (e.g. hospital) at which the
healthcare event occurred.


Root class of all information model classes that can be
archetyped.
The type of participation played by the patient's           Participation_Type_VD
healthcare organisation.
The role that the healthcare organisation plays in the     Healthcare_Role_VD
patient's healthcare (if applicable).
The time interval during which the patient was in the care
of the healthcare organisation.
The mode in which the participation took place.            Participation_Mode_VD

Details about the patient's healthcare organisation.
Other LIM Constraints                      LIM Example (for Exchange)       LIM Example (for Display)


DG1.3.1: Participation Type = "Patient
Healthcare Establishment"
DG1.3.2: Healthcare Role = "Healthcare
Provider Organisation"


Fixed: "Patient Healthcare Organisation"   ("xxx", "Patient Healthcare      "Patient Healthcare
                                           Organisation")                   Organisation"
Default: "Healthcare Provider"             ("xxx", "Healthcare Provider")   "Healthcare Provider"

                                           ("20100105", "20100108", "")     "5 Jan 2010 - 8 Jan 2010"

                                           ("xx", "Phone")                  "Phone"
                                           ("xx", "Email")                  "Email"
                                           ("xx", "Direct")                 "Direct"
                                                       SUMMARY CARE VIEW - NEHR LIST


LIM Comments   LIM Change Log   NEHR Phase 1 Term
                                Core

                                Yes




                                            UNMAPPED
ARY CARE VIEW - NEHR LIST                 EVENT DRILL-DOWN LIST (LIST VIEW) - NEHR LIST        EVENT SUMMARY VIEW - NEHR LIST


                   Definition & Comments Term                     Definition & Comments Term




                   UNMAPPED             UNMAPPED                  UNMAPPED                UNMAPPED
EVENT SUMMARY VIEW - NEHR LIST        PROBLEM/DIAGNOSIS HISTORY (DRILL-DOWN VIEW) -     RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIS
                                                       NEHR LIST                                         NEHR LIST

               Definition & Comments Term                   Definition & Comments     Term




               UNMAPPED             UNMAPPED                UNMAPPED
PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST) -      RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST
           NEHR LIST                                         VIEW) - NEHR LIST

                  Definition & Comments      Term                         Definition & Comments




                                             LIM.Participation Type [1]   1

                                             LIM.Healthcare Role [0..1]   0..1
                                             - Code
                                             - Term
                                             LIM.Participation Period     0..1
                                             [0..1]




                                             UNMAPPED                     UNMAPPED
 MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR          CURR MEDS LIST (DRILL-DOWN LIST VIEW)
                      LIST

Term                     Definition & Comments      Term




Role [0..1]              N/A                        N/A

N/A                      N/A                        N/A




UNMAPPED                 UNMAPPED
CURR MEDS LIST (DRILL-DOWN LIST VIEW)            RECON MEDS LIST (DRILL-DOWN LIST VIEW)


                  Definition & Comments   Term                      Definition & Comments
                                         ADT - NDDS TEMPLATE


ADT NDDS                          ADT NDDS         ADT IDDS (SHS)
                                  Cardinality

                                                   MSH [1]



N/A                               N/A              N/A

LIM.Participation Type [1]        1                N/A
- Code
- Term
LIM.Healthcare Role [0..1]        0..1             N/A
- Code
- Term
LIM.Participation Period [0..1]   0..1             N/A

N/A                               N/A              N/A

LIM.Participant [1]               1                N/A


UNMAPPED                                           UNMAPPED
                                                                 LABORATORY - NDDS TEM


ADT IDDS (NHG)   LAB NDDS                          Lab NDDS
                                                   Cardinality

MSH [1]



N/A              N/A                               N/A

N/A              LIM.Participation Type [1]        1
                 - Code
N/A              - Term
                 LIM.Healthcare Role [0..1]        0..1
                 - Code
N/A              - Term
                 LIM.Participation Period [0..1]   0..1

N/A              N/A                               N/A

N/A              LIM.Participant [1]               1


UNMAPPED         UNMAPPED
                 LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)               LAB IDDS (SGH)   LAB IDDS (CGH)


PV1 [0..1]                   PV1 [0..1]       N/A



N/A                          N/A              N/A

N/A                          N/A              N/A

N/A                          N/A              N/A

N/A                          N/A              N/A

N/A                          N/A              N/A

N/A                          N/A              N/A


UNMAPPED                     UNMAPPED         UNMAPPED
LAB IDDS (NHG)   RAD NDDS                          Radiology NDDS
                                                   Cardinality

N/A



N/A              N/A                               N/A

N/A              LIM.Participation Type [1]        1
                 - Code
N/A              - Term
                 LIM.Healthcare Role [0..1]        0..1
                 - Code
N/A              - Term
                 LIM.Participation Period [0..1]   0..1

N/A              N/A                               N/A

N/A              LIM.Participant [1]               1


UNMAPPED         UNMAPPED
                                  RADIOLOGY (RAD) - NDDS TEMPLATE


RAD IDDS (KKH)   RAD IDDS (SGH)             RAD IDDS (CGH)


PV1 [0..1]       PV1 [0..1]                 PV1 [0..1]



N/A              N/A                        N/A

N/A              N/A                        N/A

N/A              N/A                        N/A

N/A              N/A                        N/A

N/A              N/A                        N/A

N/A              N/A                        N/A


UNMAPPED         UNMAPPED                   UNMAPPED
EMPLATE


          RAD IDDS (NHG)   RAD IDDS (NHGP)


          MSH [1]          MSH [1]
          PV1 [0..1]
          ZOR [0..Many]

          N/A              N/A

          N/A              N/A

          N/A              N/A

          N/A              N/A

          N/A              N/A

          N/A              N/A


          UNMAPPED
                                  MEDS ORDER (MO) - NDDS TEMPLATE


MO NDDS                           Med Order     MO IDDS (NHG)
                                  NDDS
                                  Cardinality
                                                MSH [1]



N/A                               N/A           N/A

LIM.Participation Type [1]        1             N/A
- Code
- Term
LIM.Healthcare Role [0..1]        0..1          N/A
- Code
- Term
LIM.Participation Period [0..1]   0..1          N/A

N/A                               N/A           N/A

LIM.Participant [1]               1


UNMAPPED                                        UNMAPPED
MPLATE                                                     MEDS DISPENSE (MD) - NDDS TEMPLATE


         MO IDDS (KKH)   MD NDDS                           Med Dispense
                                                           NDDS
                                                           Cardinality
         PV1 [1]



         N/A             N/A                               N/A

         N/A             LIM.Participation Type [1]        1
                         - Code
         N/A             - Term
                         LIM.Healthcare Role [0..1]        0..1
                         - Code
         N/A             - Term
                         LIM.Participation Period [0..1]   0..1

         N/A             N/A                               N/A

                         LIM.Participant [1]               1


         UNMAPPED        UNMAPPED
MEDS DISPENSE (MD) - NDDS TEMPLATE


              MD IDDS (NHG)          MD IDDS (CGH)


              ORC [1..Many]          PV1 [0..1]



              N/A                    N/A

              N/A                    N/A

              N/A                    N/A

              N/A                    N/A

              N/A                    N/A




              UNMAPPED               UNMAPPED
ACIDS Phase 1 NDDS


LIM.Patient Healthcare Organisation



N/A

LIM.Participation Type [1]
- Code
- Term
LIM.Healthcare Role [0..1]
- Code
- Term
LIM.Participation Period [0..1]

N/A

LIM.Participant [1]


UNMAPPED
                               DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (NHG)


Healthcare Establishment [1]



N/A

N/A

N/A

N/A

N/A
                               DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (SHS)


Healthcare Establishment [1]



N/A

N/A

N/A

N/A

N/A
DISCHARGE SUMMARY TEMPLATES


             ACIDS Phase 1 IDDS (KTPH)   ACIDS Phase 2 NDDS




             N/A                         N/A

             N/A                         LIM.Participation Type [1]
                                         - Code
             N/A                         - Term
                                         LIM.Healthcare Role [0..1]
                                         - Code
             N/A                         - Term
                                         LIM.Participation Period [0..1]

             N/A                         N/A

                                         LIM.Participant [1]


                                         UNMAPPED
ACIDS Goal State NDDS             CHIDS
                                  (Community ) Phase 1
                                  NDDS




N/A

LIM.Participation Type [1]
- Code
- Term
LIM.Healthcare Role [0..1]
- Code
- Term
LIM.Participation Period [0..1]

N/A                               N/A

LIM.Participant [1]


UNMAPPED                          UNMAPPED
MEDICATION CLUSTER
                     LIM ID Ref


CL1



      CL1.1

      CL1.2

      CL1.3
      CL1.4

      CL1.5

      CL1.6
LIM Data Item Name             LIM Data Type   LIM Cardinality


MEDICATION                     CLUSTER



LOCATABLE                      Class           0

DATA ITEM                      Class           0

CLUSTER                        Class           1
CARE ENTRY OBJECT              Class           1

MATERIAL ENTITY                Class           1

Medication Product Component   Data Group      0..Many
LIM Definition                                                     LIM Value Domain


Information on the Medication entity on which a particular
medication item is based.


Root class of all information model classes that can be
archetyped.
The abstract parent of CLUSTER and ELEMENT representation
classes.
A class representing a grouping of data items.
A class defining the protocol and guidelines for the medication
item.
A class defining attributes of the materials that the medication
item consists of.
A distinct type of medicinal preparation contained within the
medication product, identified by a unique set of ingredients,
strengths, container type or other identifying information.
LIM Format   Other LIM Constraints   LIM Example (for Exchange)
Constraint
LIM Example (for Display)   LIM Comments   LIM Change Log




                                                            Medicat

                                                            Curr & R
                                                 SUMMARY CARE VIEW - NEHR LIST

NEHR Phase Term
1 Core

Yes




           UNMAPPED
           Medication History.Event Summary Available

           Curr & Recon Meds.Event Summary Available
UMMARY CARE VIEW - NEHR LIST                                                           MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR L

          Definition & Comments                                       Term




          UNMAPPED                                                      UNMAPPED
          [STD20100513] We will look into the incorporation of a        Medication History.Event Summary Available
          'Event Summary Document Identifier' LIM element (or
          [STD20100513] We will look into the incorporation of a
          'Event Summary Document Identifier' LIM element (or
          something similar to this) for events, procedures, medication
(DRILL-DOWN LIST VIEW) - NEHR LIST                      MEDICAL ALERT VIEW - NEHR LIST

           Definition & Comments                 Term




           UNMAPPED
           [STD20100513] We will look into the
           incorporation of a 'Event Summary
DICAL ALERT VIEW - NEHR LIST                   CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST

            Definition & Comments   Term




                                    UNMAPPED
MEDS LIST (DRILL-DOWN LIST) - NEHR LIST                           CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST

             Definition & Comments        Term




             UNMAPPED                     UNMAPPED
                                          Curr & Recon Meds.Event Summary Available
LL-DOWN LIST VIEW) - NEHR LIST                                               RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST

           Definition & Comments                        Term




           UNMAPPED                                     UNMAPPED
           [STD20100513] We will look into the          Curr & Recon Meds.Event Summary Available
           incorporation of a 'Event Summary Document
DRILL-DOWN LIST VIEW) - NEHR LIST

           Definition & Comments                        MO NDDS                                      Med Order
                                                                                                     NDDS
                                                                                                     Cardinality




                                                        N/A                                          N/A

                                                        N/A                                          N/A

                                                        LIM.CLUSTER [1]                              1
                                                        LIM.CARE ENTRY OBJECT [1]                    1

                                                        LIM.MATERIAL ENTITY [1]                      1

                                                        LIM.Medication Product Component [0..Many]   0..Many




           UNMAPPED
           [STD20100513] We will look into the
           incorporation of a 'Event Summary Document
                                          MEDS ORDER (MO) - NDDS TEMPLATE

SCM                                                   MO IDDS (NHG)


Ordered Meds                                          ORC [1..Many]
                                                      RXO [0..Many]
                                                      ZCO [0..Many]

N/A                                                   N/A

N/A                                                   N/A

N/A                                                   N/A
Ordered Meds                                          RXO [0..Many]
                                                      ZCO [0..Many]
N/A                                                   ORC [1..Many]

Ordered Meds                                          RXO [0..Many]




UNMAPPED                                              UNMAPPED
Order Priority [0..1] (Indicates the urgency of the   Order Control (ORC-1) [1]
order)                                                [Recommendation: Add new LIM element]
POM (Patient's own medicine) [1] (To indicate         Filler Order Number (ORC-3) [0]
whether this medication is prescribed by the          [Recommendation: Add new LIM element]
clinician or whether the patient personally           <L.B.: E2.1.1.1 Medication Unit) (RXO-17) [0..1]
                                                      Requested Give per (Time Order Number>
                                                      [Recommendation: Add new LIM element for this; this element is only
                                                      populated if RXO-16 (Needs Human Review) is 'Yes']
                                                      Ordering Provider's DEA Number (For ordering of controlled substance
                                                      (eg: Narcotics) (RXO14) [0..Many]
                                                      [Recommendation: Add new LIM element "Ordering Provider's DEA
                                                      Number"]
                                                      <L.B. - E2.1.6.2 (Ordered By).Participant Identifier.Designation, where
                                                      Identifier_Type = "DEA Number", Issue = ??, Realm = ??>
                                                      [1/4 YC: No, this is a number pertaining to a medication item, not a
                                                      healthcare individual; recommend creating a new LIM element
                                                      "Medication Item DEA Number"]
Needs Human Review (RXO-16) [0..1]
[Recommendation: Add new LIM element; set to 'Yes' if there is a risk
that the patient is likely to experience an Adverse Drug Reaction]
<L.B.: E2.1.6.9 Intervention Recommended Reason. Note, I've added
'Review_Required_Reason_VD'> I assume this is the correct
interpretation of this field.
[1/4 YC: RXO-16 should be mapped to LIM.Intervention Recommended
Indicator and not LIM.Intervention Recommended Reason.
Recommend we delete the LIM.Intervention Recommended Reason
element]


Observation Value (OBX-5)
- weight (OBX-5.1)
- height (OBX-5.2)
[Recommendation: Add new composite LIM element called "Body
Measurement" with Height (Quantity.Value), Weight (Quantity.Value)
as component elements.]
<L.B.: This needs to use an 'Observation' Entry archetype (as used in
the Discharge Summary). I have therefore removed the Observation
Archetype details from Patient Event, and added a reference to a new
E7. Observation worksheet. The Medication message now also refers
to the E7 Observation worksheet. These fields now map to E7.1.4.1,
where E7.1.1.1 = "Height" and "Width".
Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: E7.1.4.2 - Observation's Value Type>




Units (relating to observations) (OBX-6) [0..1]
[Recommendation: This should be associated with new suggested
"Body Measurement" LIM field (see above)]
<L.B. E7.1.4.1 (Observation Value).Units>
Update Date (ZXO-4) [0..1]
[Recommendation: Create new LIM element "Last Updated DateTime"
under Medication Change Details DG]
<L.B.: E2.1.2.2 Medication Item Update Date>



NHG: Provider's Administration Instructions (RXO-7) [0..1]
[Recommendation: Include (?) Adverse Reaction fields here,
specifically: E5.1.1.3 "Adverse Reaction Category", and E5.1.1.4
"Adverse Reaction Remarks"]
<L.B.: Are we sure that this field is used? If it is, then we will need to
add a single Codeable Text data element ... may need more
information on this one.>
[1/4 YC: Unfortunately no POC data; IHIS mentioned that this in use at
NHGP, and will soon be used at TTSH and NUH. Example in IDDS is
"ADR_Reason_Code" and "ADR_Reason_Description". Please see
recommendation above]
Frequency (ZXO-1) [1]
[Recommendation: create new LIM element "Frequency Description"
since ZXO-1 includes both frequency, frequency qualifier and PRN
reason info]
<L.B. I've changed E2.1.5.1 (Frequency) to Codeable Text, which allows
this to be entered as a description. If, however, we need both a coded
term, and an additional frequency description text, then we may need
to add a new data element. But at this stage I don't think so.>
Duration Code (ZXO-2)
- Duration Code (ZXO-2.1) [1]
- Duration Text (ZXO-2.2) [1]
[Recommendation: change data type of "Duration" to Coded Text?]
<L.B. E2.1.6.6 is now a Codeable Text. I'm hesitant to use CodedText in
case sometimes there is no code?>

Request Dispense Unit (RXO-12) [0..1]
- Dispense Unit of Measurement (RXO-12.2) [0..1]
[Recommendatin: Ignore since this is just RXO-12.1 (unit code) spelt
out]
<L.B.: E2.1.4 (Dispensed Quantity).Units. Note that the 'Request
Dispense Value' gets mapped to the same data element (but just the
'Value' component, rather than the 'Units' component.>
[1/4 YC: Our recommendation to ignore this element is based on our
observation that this element is the spelt out equivalent of RXO-12.1,
which is already mapped to E2.1.6.4 (Ordered Quantity). E.g. when
E2.1.6.4 (Ordered Quantity) = "BTL", RXO-12.2 will be "Bottle". So this
element (RXO-12.2) appears to be redundant. Recommend we ignore
it]
Requested Give Strength (RXO-18) [0..1]
(Note: this is a free text field that includes both the value and units of a
Quantity)
[Recommendation: Ignore this field as it is always the same value as
ZXO-8 which is mapped to LIM.Dose Quantity)]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only be
used when the medication product is single ingredient>
Order Status (ORC-5) [1]
[Recommendation: this field was mapped to "LIM.Medication Set
Status" in the previous version of the LIM but somehow this
LIM.Medication Set Status has been removed, so this is now an
unmapped field. SCM's "Order Status" was also mapped to this
LIM.Medication Set Status.]
MO IDDS (KKH)


OBX [0..Many]
RXO [0..Many]
OBR [0..Many]

N/A

N/A

N/A
OBX [0..Many]
RXO [0..Many]
N/A

RXO [0..Many]




UNMAPPED
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
Placer Order Number (OBR-2) [0..1]
[Recommendation: Ignore since ORC-2 (Placer Order Number)
already tracks this and is mapped above]
Filler Order Number (ORC-3) [1]
Filler Order Number+ (OBR-3) [0..1]
[Recommendation: Add new LIM element]
Universal Service ID (OBR-4) [1]
- id (OBR-4.1) [1] (ancillary name item catalog; probably a product
code, e.g. "8602")
- name of coding system (OBR-4.3) [1] (has fixed value of
"KKHPHXIN")
[Recommendation: to revisit after other IDDS have been
incorporated into LIM]
<L.B.: It looks like this may map to E2.1.3.1 Medication Name … but
it's a little unclear>
[1/4 YC: We have discovered that the id component is equal to the
medication name, and the name of coding system is always a fixed
value]
Placer Field 1 (OBR-18) [0..1]
[Recommendation: Ignore since the value is always the same as
OBR-3, which is currently mapped to Ingredient Strength]
<L.B.: Why is 'Filler Order Number' mapped to 'Ingredient
Strength'??? This does not seem right.> Filler Order Number should
map to 'Medication Dispense Number'. Please read about 'Placers'
and 'Fillers' in the HL7v2 spec.>
[1/4 YC: Sorry, must have made a typo in my note above. Please
see note above on OBR-3 (Filler Order Number+), for which we are
recommending the creation of a new LIM element. Recommend
that we map this 'Placer Field 1' element to this new LIM element]
Quantity/Timing (OBR-27) [0..Many] (relating to the services to
performed during Observations)
[YC: Need further clarification from IHIS on how this is different
from Date & Time of Transaction (ORC-9)]
<L.B.: It looks like it may be Medication Start DateTime and
Medication Stop DateTime ??>
[YC 31/3: IHIS has clarified that OBR-27 and ORC-9 are identical;
have indicated ORC-9 as '1st Choice' and OBR-27 as '2nd Choice'
under E2.1.6.3 (Ordered DateTime)]




Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
Agreed. No mapping. This would be a fixed value in the NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.2
(Observation Value Type) to be consistent with what is done for
NHG case)]

Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
Agreed. No Maping. As above, this would be a fixed value in the
NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.4
(Observation Status)]
Observation Identifier (OBX-3)
- Pharmacy Instructions (OBX-3.1) [0..1]
[Recommendation: create new "Frequency Description" field that
covers both frequency, frequency qualifier and PRN reason in a
single value]
<L.B.: No - This maps to E2.1.4.5 Dose Instructions.>
                                                            MEDS DISPENSE (

MD NDDS                                      Med Dispense
                                             NDDS
                                             Cardinality




N/A                                          N/A

N/A                                          N/A

LIM.CLUSTER [1]                              1
LIM.CARE ENTRY OBJECT [1]                    1

LIM.MATERIAL ENTITY [1]                      1

LIM.Medication Product Component [0..Many]   0..Many
                                            MEDS DISPENSE (MD) - NDDS TEMPLATE

SCM


Dispensed Meds



N/A

N/A

N/A


N/A

Dispensed Meds




UNMAPPED
Filler Order Number [1] (The ancillary reference code)
[Recommendation: Add new LIM element]
Drug Strength [0..1]
[Recommendation: Add new LIM element
"Medication Item Strength" for these IDDS
MEDS DISPENSE (MD) - NDDS TEMPLATE

        MD IDDS (NHG)


        ORC [1..Many]
        RXD [1..Many]
        ZXO [0..Many]
        ZCO [0..Many]
        N/A

        N/A

        N/A


        N/A

        RXD [1..Many]




        UNMAPPED
        Filler Order Number (ORC-3) [0…1]
        - entity identifier (ORC-3.1) [0…1]
        Order Control (ORC-1) [1]
        [Recommendation: Add new LIM element]
        <L.B.: E2.1.2.1 Medication Item Status>
        Entered By (ORC-10) [0…Many]
        - id number (ORC-10.1) [0…1]
        (This refers to pharmacy staff)
        Enterer's Location (ORC-13) [0…1]
        - point of care (ORC-13) [0…1]
        [Recommendation: Add new LIM element "Enterer's Location"]
        <L.B.: E2.1.2.10 Medication Item Entry Location>
Date/Time of Transaction (ORC-9) [0…1] (Refers to new/cancelled/ modified
order date/time
[Recommendation: Add new LIM element "Last Updated DateTime" under
Medication Change Details DG]
<L.B.: E2.1.2.2 Medication Item Update Date>




Dispense to Location (RXD-13) [0…1]
- point of care (RXD-13.1) [1] (refers to location of pharmacy)
[Recommendation: Add new LIM element "Dispensed To" under "Medication
Set Information" DG]
<L.B.: E2.1.7.6: Dispensed To Location>




Prescription Number (RXD-7) [1]
[Recommendation: Add new LIM element "Prescription ID" under "Medication
Set Information" DG]
<L.B.: E2.1.1.1 Medication Item Order Number>
[YC 31/3: Filler Order Number.entity identifer (ORC-3.1) is already mapped to
this field as per instruction above; prescription Number is for medication set.
Recommend that a new LIM element "Medication Set Number".]

Pharmacist Intervention For Item (ZXO-6) [0…1]
- intervention flag (ZXO-6.1) [1]
[Recommendation: Add new LIM element "Pharmacist Intervention" under
"Medication Item Administer Details" DG]
<L.B.: E2.1.7.7 Intervention Required Indicator>
Medication Type (ZCO-4) [0…1] (eg outpatient, inpatient medication)
[Recommendation: Add new LIM element "Medication Set Type" under
"Medication Set Information" DG]
<L.B. E2.1.2.6 Medication Item Type. Note, I've added
'Medication_Item_Type_VD'


1. Actual Dosage Form (RXD-6) [0…1]
- identifier (RXD-6.1) [1]
2. Dosage (ZXO-8) [0…1]
[Recommendation: create new "Dosage Description" LIM element]
<L.B. - I have changed E2.1.4.5 Dose Instructions to Codeable Text, and now this
should be mapped to E2.1.4.5>




Update Date (ZXO-4) [0…1]
[YC: Need further clarification from IHIS - is it different from Order Effective
Date/Time (ORC-15)]
<L.B.: I assume this maps to E2.1.2.2 Medication Item Update Date.>

[YC 31/3: IHIS has clarified that this field is NOT always the same as ORC-15.
Recommend that we create a new LIM.Additional Med Dispense Information
element with Information Type = "Update Date", and Information Value = ZXO-
4]




Actual Strength (RXD-16) [0…1]
Actual Strength Unit (RXD-17) [0…1]
[Recommendation: Add new LIM element "Medication Item Strength" for
these IDDS elements]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only be used
when the medication product is single ingredient>
                                                                          DISCHARGE SUMMARY TEMPLATES

MD IDDS (CGH)                                        ACIDS Phase 2 NDDS


ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
RXE [1..Many]
N/A                                                  N/A

N/A                                                  N/A

N/A                                                  LIM.CLUSTER [1]


OBX [0..Many]

OBX [0..Many]




UNMAPPED                                             UNMAPPED
Filler Order Number (ORC-3) [1]
- entity identifier (ORC-3.1) [1]
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
<L.B.: E2.1.2.1 Medication Item Status>
1. Quantity/Timing (ORC-7) [1]
- end date/time (ORC-7.5) [0…1]
2. Quantity/Timing (RXE-1) [1]
Entered By (ORC-10) [1…Many]
- id number (ORC-10.1) [1]
- family name (ORC-10.2) [1]
[Recommendation: Add new LIM element "Entered By"]
<E2.1.2.9 Medication Item Entered By>
2. Give Code (RXE-2) [1]
- identifier (RXE-2.1) [1]
- description (RXE-2.2) [1]
- ancillary coding standard (RXE-2.3) [1]
[Recommendation: Ignore since this is always the same as similar
fields under Requested Give Code]
<L.B. This still needs to be mapped, even if it maps to the same
thing. Should map to E2.1.3.1 Medicaiton Name (and its
component bits), including id, term, coding system, mappings>



Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.2 (Observation
Result Value Type) to be consistent with other institutions]




Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.4 (Observation
Result Status; is this ok?]



Observation Value (OBX-5) [1] when value of OBX-3 = "Pharmacy
Instructions"
(currently one single text string contains:
- Medication Item Set Connecting Term
- Dose Instructions
- Frequency Qualifier)
[Recommendation: create new LIM text element "Pharmacy
Instructions" under Medication Item, i.e. a new E2.1.4.1 element]
<L.B. E2.1.4.5 Dosage Instructions.>
<L.B. If there is any consistency in the pattern in which Medication
Connecting Term is provided, it would be great to be able to 'Parse'
this out, into the appropriate Data Element. Not sure if this is
possible - depends on how reliable the text pattern is.>

[8/4 YC: Unfortunately, there is no consistency in the structure of
the text string which would allow us to parse the relevant data.
However, we have now mapped this field to 'Additional Order
Instructions']
Observation Value (OBX-5) [1] when value of OBX-3 = "Strength"
[Recommendation: Add new LIM element "Medication Item
Strength" for these IDDS elements]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only
be used when the medication product is single ingredient>


Observation Value (OBX-5) (trade product name) when value of OBX-
3 [0..1] = "Brand Name"
[Recommendation: This brand name may be different from
medication name; suggest we create a new LIM element to track
this information]
CHARGE SUMMARY TEMPLATES

          ACIDS Goal State NDDS




          N/A

          N/A
          LIM.CLUSTER [1]




          LIM.Medication Product Component [0..Many]




          UNMAPPED
MEDICATION ITEM CLUSTER
       LIM ID Ref   LIM Data Item Name


CL2                 MEDICATION ITEM




      CL2.1         MEDICATION

      CL2.2         MATERIAL ITEM


      CL2.3         Medication Dosage

      CL2.4         Medication Frequency

      CL2.5         Medication Dispensing Information

      CL2.6         Medication Administration Information

      CL2.7         Medication Item General Information

      CL2.8         ADR Override Information

      CL2.9         Controlled Substance Ordering Information

      CL2.10        Medication Item Update Details
LIM Data Type   LIM Cardinality   LIM Definition


CLUSTER                           Information pertaining to a single medication item.




Class           1                 The Medication entity on which this medication item is based.

Class           1                 A single item used to describe a material for an order, action
                                  (such as dispensing), or other purpose.

CLUSTER         0..1              A description of the dosage in which the medication should be
                                  or has been taken.
CLUSTER         0..1              A description of the frequency that the medication should be
                                  taken.
CLUSTER         0..1              A description of how the medication should be or has been
                                  administered.
CLUSTER         0..1              A description of how the medication should be or has been
                                  administered.
CLUSTER         0..1              Information about the Medication Set associated with the
                                  Medication Order Item.
CLUSTER         0..1              Information relating to the overriding of ADR (Adverse Drug
                                  Reaction) warnings.
CLUSTER         0..1              Information related to the ordering of controlled substances.

CLUSTER         0..1              Change-related details associated with the Medication Item.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)
                                                         SUMMARY CARE VIEW - NEHR LIST

LIM Comments   LIM Change Log   NEHR Phase Term
                                1 Core

                                Yes




                                Yes


                                Yes

                                Yes

                                Yes

                                Yes

                                Yes




                                Yes


                                           UNMAPPED
                                           Medication History.Event
                                           Summary Available
Curr & Recon Meds.Event
Summary Available
SUMMARY CARE VIEW - NEHR LIST                               MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST

             Definition & Comments           Term




             UNMAPPED                          UNMAPPED
             [STD20100513] We will look into Medication History.Event Summary Available
             the incorporation of a 'Event
             Summary Document Identifier'
             LIM element (or something
             similar to this) for events,
             procedures, medication items,
             investigations, problem/diagnosis
             which will capture the Set
             Identifier and Version Number.
             The NEHR 'Event Summary
             Available' can then be derived
             from the presence of this 'Event
             Summary Document Identifier'.
[STD20100513] We will look into
the incorporation of a 'Event
Summary Document Identifier'
LIM element (or something
similar to this) for events,
procedures, medication items,
investigations, problem/diagnosis
which will capture the Set
Identifier and Version Number.
The NEHR 'Event Summary
Available' can then be derived
from the presence of this 'Event
Summary Document Identifier'.
HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST                              MEDICAL ALERT VIEW - NEHR LIST

                   Definition & Comments                         Term




                   UNMAPPED
                   [STD20100513] We will look into the
                   incorporation of a 'Event Summary
                   Document Identifier' LIM element (or
                   something similar to this) for events,
                   procedures, medication items,
                   investigations, problem/diagnosis which
                   will capture the Set Identifier and Version
                   Number. The NEHR 'Event Summary
                   Available' can then be derived from the
                   presence of this 'Event Summary
                   Document Identifier'.
MEDICAL ALERT VIEW - NEHR LIST                    CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST

               Definition & Comments   Term




                                       UNMAPPED
RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST                           CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST

                   Definition & Comments        Term




                   UNMAPPED                     UNMAPPED
                                                Curr & Recon Meds.Event Summary Available
LIST (DRILL-DOWN LIST VIEW) - NEHR LIST                                                RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST

                    Definition & Comments                        Term




                    UNMAPPED                                       UNMAPPED
                    [STD20100513] We will look into the            Curr & Recon Meds.Event Summary Available
                    incorporation of a 'Event Summary Document
                    Identifier' LIM element (or something similar
                    to this) for events, procedures, medication
                    items, investigations, problem/diagnosis which
                    will capture the Set Identifier and Version
                    Number. The NEHR 'Event Summary Available'
                    can then be derived from the presence of this
                    'Event Summary Document Identifier'.
DS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST

                    Definition & Comments                            MO NDDS




                                                                     LIM.MEDICATION [1]

                                                                     LIM.MATERIAL ITEM [1]


                                                                     LIM.Medication Dosage [1]

                                                                     LIM.Medication Frequency [1]

                                                                     LIM.Medication Dispensing Information [0..1]

                                                                     LIM.Medication Administration [0..1]

                                                                     LIM.Medication Item General Information [1]

                                                                     LIM.ADR Override Information [0..1]

                                                                     LIM.Controlled Substance Ordering Information [0..1]

                                                                     LIM.Medication Item Update Details [0..1]


                    UNMAPPED
                    [STD20100513] We will look into the
                    incorporation of a 'Event Summary Document
                    Identifier' LIM element (or something similar
                    to this) for events, procedures, medication
                    items, investigations, problem/diagnosis which
                    will capture the Set Identifier and Version
                    Number. The NEHR 'Event Summary Available'
                    can then be derived from the presence of this
                    'Event Summary Document Identifier'.
                                                        MEDS ORDER (MO) - NDDS TEMPLATE

Med Order     SCM
NDDS
Cardinality
              Ordered Meds




1             Ordered Meds

1             Ordered Meds


1             Ordered Meds

1             Ordered Meds

0..1          Ordered Meds

0..1          Ordered Meds

1             N/A

0..1          N/A

0..1          N/A

0..1          N/A


              UNMAPPED
              Order Priority [0..1] (Indicates the urgency of the
              order)
              [Recommendation: Add new Text LIM element
              under 'Medication Item Order Details' DG]
              <L.B. - E2.1.6.7 Order Priority. Note, I've added
              'Medication_ Order_Priority_VD>
POM (Patient's own medicine) [1] (To indicate
whether this medication is prescribed by the
clinician or whether the patient personally
requested the medication)
[Recommendation: Add new Boolean LIM
element under 'Medication Item Order Details'
DG]
<L.B. - E2.1.2.6 Patients Own medicine>
MEDS ORDER (MO) - NDDS TEMPLATE

        MO IDDS (NHG)


        ORC [1..Many]
        RXO [0..Many]
        RXR [0..Many]
        ZXO [0..Many]
        ZCO [0..Many]

        ORC [1..Many]
        RXO [0..Many]
        RXO [0..Many]


        RXO [0..Many]
        ZXO [0..Many]
        ZXO [0..Many]

        RXO [0..Many]

        RXR [0..Many]
        ZXO [0..Many]
        ZXO [0..Many]

        RXO [0..Many]

        RXO [0..Many]

        ORC [1..Many]
        ZXO [0..Many]

        UNMAPPED
        Order Control (ORC-1) [1]
        [Recommendation: Add new LIM element]
        <L.B.: E2.1.2.1 Medication Item Status>
Filler Order Number (ORC-3) [0]
[Recommendation: Add new LIM element]
<L.B.: E2.1.1.1 Medication Order Number>
[YC 30/3: Placer Order Number (ORC-2) is already mapped to E2.1.1.1
which is usually differnet from Placer Order Number. Is this an issue?]




Requested Give per (Time Unit) (RXO-17) [0..1]
[Recommendation: Add new LIM element for this; this element is only
populated if RXO-16 (Needs Human Review) is 'Yes']
<L.B. - Doesn' this map to E2.1.4.2 Dose Quantity?>
[1/4 YC: No, this does not map to Dose Quantity as there is a rate
involved, e.g. "xxx ml per hour"; recommend to map to 2.1.4.4 Dose
Quantity Rate]


Ordering Provider's DEA Number (For ordering of controlled substance
(eg: Narcotics) (RXO14) [0..Many]
[Recommendation: Add new LIM element "Ordering Provider's DEA
Number"]
<L.B. - E2.1.6.2 (Ordered By).Participant Identifier.Designation, where
Identifier_Type = "DEA Number", Issue = ??, Realm = ??>
[1/4 YC: No, this is a number pertaining to a medication item, not a
healthcare individual; recommend creating a new LIM element
"Medication Item DEA Number"]



Needs Human Review (RXO-16) [0..1]
[Recommendation: Add new LIM element; set to 'Yes' if there is a risk
that the patient is likely to experience an Adverse Drug Reaction]
<L.B.: E2.1.6.9 Intervention Recommended Reason. Note, I've added
'Review_Required_Reason_VD'> I assume this is the correct
interpretation of this field.
[1/4 YC: RXO-16 should be mapped to LIM.Intervention Recommended
Indicator and not LIM.Intervention Recommended Reason.
Recommend we delete the LIM.Intervention Recommended Reason
element]
Observation Value (OBX-5)
- weight (OBX-5.1)
- height (OBX-5.2)
[Recommendation: Add new composite LIM element called "Body
Measurement" with Height (Quantity.Value), Weight (Quantity.Value)
as component elements.]
<L.B.: This needs to use an 'Observation' Entry archetype (as used in
the Discharge Summary). I have therefore removed the Observation
Archetype details from Patient Event, and added a reference to a new
E7. Observation worksheet. The Medication message now also refers
to the E7 Observation worksheet. These fields now map to E7.1.4.1,
where E7.1.1.1 = "Height" and "Width".
Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: E7.1.4.2 - Observation's Value Type>




Units (relating to observations) (OBX-6) [0..1]
[Recommendation: This should be associated with new suggested
"Body Measurement" LIM field (see above)]
<L.B. E7.1.4.1 (Observation Value).Units>




Update Date (ZXO-4) [0..1]
[Recommendation: Create new LIM element "Last Updated DateTime"
under Medication Change Details DG]
<L.B.: E2.1.2.2 Medication Item Update Date>



NHG: Provider's Administration Instructions (RXO-7) [0..1]
[Recommendation: Include (?) Adverse Reaction fields here,
specifically: E5.1.1.3 "Adverse Reaction Category", and E5.1.1.4
"Adverse Reaction Remarks"]
<L.B.: Are we sure that this field is used? If it is, then we will need to
add a single Codeable Text data element ... may need more
information on this one.>
[1/4 YC: Unfortunately no POC data; IHIS mentioned that this in use at
NHGP, and will soon be used at TTSH and NUH. Example in IDDS is
"ADR_Reason_Code" and "ADR_Reason_Description". Please see
recommendation above]
Frequency (ZXO-1) [1]
[Recommendation: create new LIM element "Frequency Description"
since ZXO-1 includes both frequency, frequency qualifier and PRN
reason info]
<L.B. I've changed E2.1.5.1 (Frequency) to Codeable Text, which allows
this to be entered as a description. If, however, we need both a coded
term, and an additional frequency description text, then we may need
to add a new data element. But at this stage I don't think so.>
Duration Code (ZXO-2)
- Duration Code (ZXO-2.1) [1]
- Duration Text (ZXO-2.2) [1]
[Recommendation: change data type of "Duration" to Coded Text?]
<L.B. E2.1.6.6 is now a Codeable Text. I'm hesitant to use CodedText in
case sometimes there is no code?>

Request Dispense Unit (RXO-12) [0..1]
- Dispense Unit of Measurement (RXO-12.2) [0..1]
[Recommendatin: Ignore since this is just RXO-12.1 (unit code) spelt
out]
<L.B.: E2.1.4 (Dispensed Quantity).Units. Note that the 'Request
Dispense Value' gets mapped to the same data element (but just the
'Value' component, rather than the 'Units' component.>
[1/4 YC: Our recommendation to ignore this element is based on our
observation that this element is the spelt out equivalent of RXO-12.1,
which is already mapped to E2.1.6.4 (Ordered Quantity). E.g. when
E2.1.6.4 (Ordered Quantity) = "BTL", RXO-12.2 will be "Bottle". So this
element (RXO-12.2) appears to be redundant. Recommend we ignore
it]
Requested Give Strength (RXO-18) [0..1]
(Note: this is a free text field that includes both the value and units of a
Quantity)
[Recommendation: Ignore this field as it is always the same value as
ZXO-8 which is mapped to LIM.Dose Quantity)]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only be
used when the medication product is single ingredient>
Order Status (ORC-5) [1]
[Recommendation: this field was mapped to "LIM.Medication Set
Status" in the previous version of the LIM but somehow this
LIM.Medication Set Status has been removed, so this is now an
unmapped field. SCM's "Order Status" was also mapped to this
LIM.Medication Set Status.]
MO IDDS (KKH)


ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
RXR [0..Many]
OBR [0..Many]
NTE [0..1]
OBX [0..Many]
RXO [0..Many]
OBX [0..Many]


RXO [0..Many]
OBX [0..Many]
ORC [1..Many]

N/A

RXR [0..Many]
OBR [0..Many]
ORC [1..Many]
N/A

N/A

N/A

NTE [0..1]


UNMAPPED
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
<L.B.: E2.1.2.1 Medication Item Status>
Placer Order Number (OBR-2) [0..1]
[Recommendation: Ignore since ORC-2 (Placer Order Number)
already tracks this and is mapped above]
<L.B.: E2.1.1.2 Medication Dispense Number>




Filler Order Number (ORC-3) [1]
Filler Order Number+ (OBR-3) [0..1]
[Recommendation: Add new LIM element]
<L.B.: Medication Order Number E2.1.1.1>
[YC 30/3: Placer Order Number (ORC-2) is already mapped to
E2.1.1.1. Placer Order Number (ORC-2) may be differnet from Filler
Order Number (ORC-3). Recommend we create a new LIM
element]
Universal Service ID (OBR-4) [1]
- id (OBR-4.1) [1] (ancillary name item catalog; probably a product
code, e.g. "8602")
- name of coding system (OBR-4.3) [1] (has fixed value of
"KKHPHXIN")
[Recommendation: to revisit after other IDDS have been
incorporated into LIM]
<L.B.: It looks like this may map to E2.1.3.1 Medication Name … but
it's a little unclear>
[1/4 YC: We have discovered that the id component is equal to the
medication name, and the name of coding system is always a fixed
value] Field 1 (OBR-18) [0..1]
Placer
[Recommendation: Ignore since the value is always the same as
OBR-3, which is currently mapped to Ingredient Strength]
<L.B.: Why is 'Filler Order Number' mapped to 'Ingredient
Strength'??? This does not seem right.> Filler Order Number should
map to 'Medication Dispense Number'. Please read about 'Placers'
and 'Fillers' in the HL7v2 spec.>
[1/4 YC: Sorry, must have made a typo in my note above. Please
see note above on OBR-3 (Filler Order Number+), for which we are
recommending the creation of a new LIM element. Recommend
that we map this 'Placer Field 1' element to this new LIM element]
Quantity/Timing (OBR-27) [0..Many] (relating to the services to
performed during Observations)
[YC: Need further clarification from IHIS on how this is different
from Date & Time of Transaction (ORC-9)]
<L.B.: It looks like it may be Medication Start DateTime and
Medication Stop DateTime ??>
[YC 31/3: IHIS has clarified that OBR-27 and ORC-9 are identical;
have indicated ORC-9 as '1st Choice' and OBR-27 as '2nd Choice'
under E2.1.6.3 (Ordered DateTime)]




Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
Agreed. No mapping. This would be a fixed value in the NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.2
(Observation Value Type) to be consistent with what is done for
NHG case)]

Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
Agreed. No Maping. As above, this would be a fixed value in the
NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.4
(Observation Status)]




Observation Identifier (OBX-3)
- Pharmacy Instructions (OBX-3.1) [0..1]
[Recommendation: create new "Frequency Description" field that
covers both frequency, frequency qualifier and PRN reason in a
single value]
<L.B.: No - This maps to E2.1.4.5 Dose Instructions.>
                                                                      MEDS DISPENSE (MD)

MD NDDS                                                Med Dispense
                                                       NDDS
                                                       Cardinality




LIM.MEDICATION [1]                                     1

LIM.MATERIAL ITEM [1]                                  1


LIM.Medication Dosage [1]                              1

LIM.Medication Frequency [1]                           1

LIM.Medication Dispensing Information [0..1]           0..1

LIM.Medication Administration Information [0..1]       0..1

LIM.Medication Item General Information [0..1]         0..1

LIM.ADR Override Information [0..1]                    0..1

LIM.Controlled Substance Ordering Information [0..1]   0..1

LIM.Medication Item Update Details [0..1]              0..1
                                           MEDS DISPENSE (MD) - NDDS TEMPLATE

SCM


Dispensed Meds




Dispensed Meds

Dispensed Meds


Dispensed Meds

Dispensed Meds

Dispensed Meds

Dispensed Meds

N/A

N/A

N/A

N/A


UNMAPPED
Filler Order Number [1] (The ancillary reference
code)
[Recommendation: Add new LIM element]
<L.B.: E2.1.1.1 Medication Order Number>
Drug Strength [0..1]
[Recommendation: Add new LIM element
"Medication Item Strength" for these IDDS
elements]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this
field can only be used when the medication product
is single ingredient>
MEDS DISPENSE (MD) - NDDS TEMPLATE

         MD IDDS (NHG)


         ORC [1..Many]
         RXD [1..Many]
         ZXO [0..Many]
         ZCO [0..Many]


         ORC [1..Many]
         RXD [1..Many]
         N/A


         RXD [1..Many]
         ZXO [0..Many]
         ZXO [0..Many]

         N/A

         N/A

         ZXO [0..Many]

         N/A

         N/A

         N/A


         UNMAPPED
         Filler Order Number (ORC-3) [0…1]
         - entity identifier (ORC-3.1) [0…1]
         [Recommendation: Add new LIM element]
         <L.B.: E2.1.1.1 Medication Order Number>
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
<L.B.: E2.1.2.1 Medication Item Status>




Entered By (ORC-10) [0…Many]
- id number (ORC-10.1) [0…1]
(This refers to pharmacy staff)
[Recommendation: Add new LIM participation "Entered By"]
<E2.1.2.9 Medication Item Entered By>




Enterer's Location (ORC-13) [0…1]
- point of care (ORC-13) [0…1]
[Recommendation: Add new LIM element "Enterer's Location"]
<L.B.: E2.1.2.10 Medication Item Entry Location>




Date/Time of Transaction (ORC-9) [0…1] (Refers to new/cancelled/ modified
order date/time
[Recommendation: Add new LIM element "Last Updated DateTime" under
Medication Change Details DG]
<L.B.: E2.1.2.2 Medication Item Update Date>
Dispense to Location (RXD-13) [0…1]
- point of care (RXD-13.1) [1] (refers to location of pharmacy)
[Recommendation: Add new LIM element "Dispensed To" under "Medication
Set Information" DG]
<L.B.: E2.1.7.6: Dispensed To Location>




Prescription Number (RXD-7) [1]
[Recommendation: Add new LIM element "Prescription ID" under "Medication
Set Information" DG]
<L.B.: E2.1.1.1 Medication Item Order Number>
[YC 31/3: Filler Order Number.entity identifer (ORC-3.1) is already mapped to
this field as per instruction above; prescription Number is for medication set.
Recommend that a new LIM element "Medication Set Number".]

Pharmacist Intervention For Item (ZXO-6) [0…1]
- intervention flag (ZXO-6.1) [1]
[Recommendation: Add new LIM element "Pharmacist Intervention" under
"Medication Item Administer Details" DG]
<L.B.: E2.1.7.7 Intervention Required Indicator>




Medication Type (ZCO-4) [0…1] (eg outpatient, inpatient medication)
[Recommendation: Add new LIM element "Medication Set Type" under
"Medication Set Information" DG]
<L.B. E2.1.2.6 Medication Item Type. Note, I've added
'Medication_Item_Type_VD'


1. Actual Dosage Form (RXD-6) [0…1]
- identifier (RXD-6.1) [1]
2. Dosage (ZXO-8) [0…1]
[Recommendation: create new "Dosage Description" LIM element]
<L.B. - I have changed E2.1.4.5 Dose Instructions to Codeable Text, and now
this should be mapped to E2.1.4.5>
Update Date (ZXO-4) [0…1]
[YC: Need further clarification from IHIS - is it different from Order Effective
Date/Time (ORC-15)]
<L.B.: I assume this maps to E2.1.2.2 Medication Item Update Date.>

[YC 31/3: IHIS has clarified that this field is NOT always the same as ORC-15.
Recommend that we create a new LIM.Additional Med Dispense Information
element with Information Type = "Update Date", and Information Value = ZXO-
4]




Actual Strength (RXD-16) [0…1]
Actual Strength Unit (RXD-17) [0…1]
[Recommendation: Add new LIM element "Medication Item Strength" for
these IDDS elements]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only be used
when the medication product is single ingredient>
                                                                                   DISCHARGE SUMMARY TEMPLATES

MD IDDS (CGH)                                                      ACIDS Phase 2
                                                                   NDDS

ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
RXE [1..Many]


ORC [1..Many]
OBX [0..Many]
N/A


OBX [0..Many]
RXO [0..Many]
ORC [1..Many]

N/A

OBX [0..Many]

N/A

N/A

N/A

OBX [0..Many]


UNMAPPED                                                           UNMAPPED
Filler Order Number (ORC-3) [1]
- entity identifier (ORC-3.1) [1]
- namespace ID (ORC-3.2) [1]
[Recommendation: Add new LIM element]
<L.B.: E2.1.1.1 Medication Order Number. Note, entity identifier
maps to 'Designation' and Namespace ID maps to 'Realm' - and
possibly 'Issuer', depending on how namespaces are allocated.>
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
<L.B.: E2.1.2.1 Medication Item Status>




1. Quantity/Timing (ORC-7) [1]
- end date/time (ORC-7.5) [0…1]
2. Quantity/Timing (RXE-1) [1]
- end date/time (RXE-1.5) [0…1]
[Recommendation: Add new LIM element called "Collect Stop
DateTime" - this field refers to the datetime that the dispensed
medication will run out.]
<L.B.: E2.1.7.5 (Dispensed Quantity Time Interval).End DateTIme>
Entered By (ORC-10) [1…Many]
- id number (ORC-10.1) [1]
- family name (ORC-10.2) [1]
[Recommendation: Add new LIM element "Entered By"]
<E2.1.2.9 Medication Item Entered By>




2. Give Code (RXE-2) [1]
- identifier (RXE-2.1) [1]
- description (RXE-2.2) [1]
- ancillary coding standard (RXE-2.3) [1]
[Recommendation: Ignore since this is always the same as similar
fields under Requested Give Code]
<L.B. This still needs to be mapped, even if it maps to the same
thing. Should map to E2.1.3.1 Medicaiton Name (and its
component bits), including id, term, coding system, mappings>
Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.2 (Observation
Result Value Type) to be consistent with other institutions]




Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.4 (Observation
Result Status; is this ok?]



Observation Value (OBX-5) [1] when value of OBX-3 = "Pharmacy
Instructions"
(currently one single text string contains:
- Medication Item Set Connecting Term
- Dose Instructions
- Frequency Qualifier)
[Recommendation: create new LIM text element "Pharmacy
Instructions" under Medication Item, i.e. a new E2.1.4.1 element]
<L.B. E2.1.4.5 Dosage Instructions.>
<L.B. If there is any consistency in the pattern in which Medication
Connecting Term is provided, it would be great to be able to 'Parse'
this out, into the appropriate Data Element. Not sure if this is
possible - depends on how reliable the text pattern is.>

[8/4 YC: Unfortunately, there is no consistency in the structure of
the text string which would allow us to parse the relevant data.
However, we have now mapped this field to 'Additional Order
Instructions']

Observation Value (OBX-5) [1] when value of OBX-3 = "Strength"
[Recommendation: Add new LIM element "Medication Item
Strength" for these IDDS elements]
<L.B.: E2.1.3.3.2> Ingredient Strength. Note that this field can only
be used when the medication product is single ingredient>


Observation Value (OBX-5) (trade product name) when value of
OBX-3 [0..1] = "Brand Name"
[Recommendation: This brand name may be different from
medication name; suggest we create a new LIM element to track
this information]
       DISCHARGE SUMMARY TEMPLATES

ACIDS Goal State NDDS




LIM.MEDICATION [1]

LIM.MATERIAL ITEM [1]


LIM.Medication Dosage [0..1]

LIM.Medication Frequency [0..1]

LIM.Medication Administration [0..1]

LIM.Medication Administration [0..1]

LIM.Medication Set Details [1]

N/A

N/A

LIM.Medication Item Update Details [0..1]


UNMAPPED
PATIENT EVENT CONTEXT ENTRY
             LIM ID Ref       LIM Data Item Name

E1                            PATIENT EVENT CONTEXT


     E1.1                     LOCATABLE




     E1.2                     CONTENT ITEM

     E1.3                     ENTRY



     E1.4                     ADMINISTRATION ENTRY




     E1.5                     Participation



     E1.6                     Patient Event General Information

     E1.7                     Patient Admission Information

     E1.8                     Patient Discharge Information

     E1.9                     Patient Event Location Information

     E1.10                    Patient Event Dates

     E1.11                    Patient Event Financial Information
LIM Data Type          LIM Cardinality   LIM Definition

ADMINISTRATION ENTRY   <Undefined>       General information about the patient event.


Class                  1                 Root class of all information model classes that can be
                                         archetyped, including COMPOSITION, ENTRY, SECTION,
                                         CLUSTER and ELEMENT.

Class                  0                 An abstract class of all concrete content types, including
                                         ENTRY and SECTION.
Class                  1                 A class that defines the semantics of the core clinical and
                                         administrative information in the EHR.

Class                  0                 The abstract parent of all clinical ENTRY subtypes. A
                                         CARE_ENTRY defines protocol
                                         and guideline attributes for all clinical ENTRY subtypes.

PARTICIPATION          0..Many           Any participant (person, healthcare provider or
                                         organisation) that was involved in the patient's healthcare
                                         event.
CLUSTER                1                 Details that help to identify the patient event.

CLUSTER                0..1              Information pertaining to the admission of the patient.

CLUSTER                0..1              General information about the discharge of the patient.

CLUSTER                0..1              Information pertaining to the location of the patient.

CLUSTER                0..1              Dates associated with the sending and receiving of the
                                         message.
CLUSTER                0..1              Financial information related to the patient event.
LIM Value Domain                       LIM Format   Other LIM Constraints
                                       Constraint




Participant Identifier.Designation =                Default Value(s):
Doctor_MCR_VD                                       Participant Identifier.Type = "MCRN"
                                                    Participant Identifier.Realm =
                                                    "Singapore"
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments                  Finance-
                                                                                       related




                                                         Healthcare Provider
                                                         Individual.Participant
                                                         Identifier is equivalent to
                                                         the MOH Data Dictionary




                                                                                       Yes
                                   SUMMARY CARE VIEW - NEHR LIST
LIM Change Log   NEHR Phase Term                     Definition &
                 1 Core                              Comments
                 Yes




                 Yes



                 Yes



                 Yes




                           UNMAPPED                  UNMAPPED
 EVENT DRILL-DOWN LIST (LIST VIEW) - NEHR LIST          EVENT SUMMARY VIEW - NEHR LIST
Term                      Definition &           Term                    Definition &
                          Comments                                       Comments




UNMAPPED                  UNMAPPED
PROBLEM/DIAGNOSIS HISTORY (DRILL-DOWN VIEW) - RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST
                 NEHR LIST                                 VIEW) - NEHR LIST
Term                     Definition &         Term                    Definition &
                         Comments                                     Comments




UNMAPPED                 UNMAPPED             UNMAPPED                 UNMAPPED
  MEDICATION HISTORY (DRILL-DOWN LIST VIEW) -     PROCEDURES (DRILL-DOWN VIEW) - NEHR LIST
                  NEHR LIST
Term                      Definition &          Term                     Definition &
                          Comments                                       Comments




                                                                         LIM.Problem Diagnosis
                                                                         Type [0..1]
                                                                         - Code
                                                                         - Term




UNMAPPED                  UNMAPPED
           LAB REPORT - NEHR LIST                   RADIOLOGY REPORT - NEHR LIST
Term                     Definition &   Term                         Definition &
                         Comments                                    Comments




0..1                     N/A            Major Diagnostic Category    Diagnosis Type (DG1-6)
                                        (DG1-7) [0..1]               [0..1]

                                        Examples:                    Examples:




UNMAPPED                 UNMAPPED       UNMAPPED                     UNMAPPED
  INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST                                                  ADT -
Term                       Definition &          ADT NDDS                         ADT NDDS
                           Comments                                               Cardinality



                                                 LIM.LOCATABLE [1]                1




                                                 N/A                              N/A

                                                 LIM.ENTRY [1]                    1



                                                 N/A                              N/A




                                                 LIM.Participation [0..Many]      0..Many



                                                 LIM.Patient Event General        1
                                                 Information [1]
                                                 LIM.Patient Admission            0..1
                                                 Information [0..1]
                                                 LIM.Patient Discharge            0..1
                                                 Information [0..1]
                                                 LIM.Patient Event Location       0..1
                                                 Information [0..1]
                                                 LIM.Patient Event Dates [0..1]   0..1

                                                 LIM.Patient Event Financial      0..1
                                                 Information [0..1]
               ADT - NDDS TEMPLATE
SCM                            ADT IDDS (SHS)                         ADT IDDS (NHG)

Patient Info                   PV1 [0..1]                             PV1 [0..1]
                               PV2 [0..1]                             PV2 [0..1]
                               MRG [0..1]
N/A                            N/A                                    N/A




N/A                            N/A                                    N/A

N/A                            N/A                                    N/A



N/A                            N/A                                    N/A




Patient Info                   PV1 [1]                                PV1 [1]



Patient Info                   PV1 [1]                                PV1 [1]
                               MRG [0..1]
N/A                            PV1 [0..1]                             PV1 [0..1]

Patient Info                   PV1 [0..1]                             PV1 [0..1]

Patient Info                   PV1 [0..1]                             PV1 [0..1]

Patient Info                   PV1 [0..1]                             PV1 [0..1]
                               PV2 [0..1]                             PV2 [0..1]
Patient Info                   PV1 [0..1]                             PV1 [0..1]
                               PV2 [0..1]

UNMAPPED FIELDS FOR IHIS       UNMAPPED FIELDS FOR IHIS               UNMAPPED FIELDS FOR IHIS
CLARIFICATION/ATTENTION        CLARIFICATION/ATTENTION                CLARIFICATION/ATTENTION
                               Accomodation Code (PV2-2) [0..1]       Associated Movement (PV1-75) (local
                                                                      field) [0..1]
                               [MOHH 13042010] Can IHIS provide
                               some sample descriptions of the        [MOHH 13042010] We are unable to
                               values found in the stated value       determine the right mapping for this
                               domain for this element, so that we    element. Can IHIS please provide
                               can understand how it relates to the   some additional sample values and
                               other LIM elements.                    describe how this is used so that we
                                                                      understand how PV1-75 relates to the
                                                                      other LIM elements.
                                        Admit Reason (PV2-3) [0..1]

                                        [MOHH 13042010] We are unable to
                                        determine the right mapping for this
                                        element. Can IHIS please provide
                                        some sample values so that we
                                        understand how this 'Admit Reason'
                                        relates to the other LIM elements.
                                        Expected Admit Date/Time (PV2-8)
                                        [0..1]

                                        [MOHH 13042010] We are proposing
                                        the creation of a new LIM element
                                        called 'Appointment DateTime' in the
                                        'Patient Event Dates' Data Group.
                                        Please comment if the following LIM
                                        definition is correct: "The date (and
                                        optionally time) of the patient's
                                        appointment."
Referral Source [0..1] (The source of   Referral Source Code (PV2-13) [0..1]
referral of the patient visit)          - referral source code
                                        - referral sub code
[MOHH 13042010]
The mapping of this SCM element to [MOHH 13042010]
the LIM is pending IHIS clarification as 1. Please comment if 'referral source
shown on the right.                      code' is the referring clinician's
                                         organisation, and 'referral sub code'
                                         is the clinic within the referring
                                         clinician's organisation.
                                         2. Is the usage in ISH consistent with
                                         this understanding as the names of
                                         the fields (i.e. "REFERTYPE" and
                                         "REFERTYPE2") seem to imply that
                                         the two fields are some form of
                                         referral types.

                                        Financial Class.Choice Class (PV1-
                                        20(2))

                                        [MOHH 26042010] Please provide
                                        sample values for PV1-20 (2nd
                                        instance) as we need to determine
                                        how to map it to the LIM.

NOTES FOR MOHH USE ONLY                 NOTES FOR MOHH USE ONLY                   NOTES FOR MOHH USE ONLY
Accomodation Code (PV2-2) [0..1]       Expected Admit Date/Time (PV2-8)
[Recommendation: Add new LIM           [0..1]
element under 'Financial Information'  [Recommendation: Add new LIM
DG']                                   element under 'Patient Event Dates'
                                       DG]
[29/3: WH to check with IHIS on        <Linda: No. Looking at both the
difference with PV1-20]                database fields used, and also the
<Linda: This seems to be called        sample data, in all cases this seems to
'Treatment Category' in ISH, and I     map to Admit Date/Time. I do NOT
suspect this better reflects that      think that a new data element is
meaning of the values.>                required EHRe.>
Admit Reason (PV2-3) [0..1]            Expected Discharge Date/Time (PV2-9)
[Recommendation: Add new element [0..1]
under 'Patient Event Type Details' DG] [Recommendation: Add new LIM
<Linda: This seems to record 'Service element under 'Patient Event Dates'
Provider Attendance Type' - We'll      DG]
need to see some sample values to      <Linda: Looking at both the database
understand how this relates to the     fields, and the sample data, it seems
other LIM elements.>                   that this field is populated from
                                       exactly the same database field as the
                                       Discharge Date/Time. I would
                                       tEHRefore map this to the existing
                                       'Discharge DateTime' data element.
                                       Do not create a new one at this
Expected Admit Date/Time (PV2-8)       stage.> Source Code (PV2-13) [0..1]
                                       Referral
[0..1]                                 [Recommendation: Add new LIM
[Recommendation: Add new element element 'Referral Source' under
under 'Patient Event Dates' DG]        'Patient Event Type Details' DG]
<Linda: This records the               <Linda: As per comment for SHS,
'Appointment Date/Time'. We really please map this to 'Referred By'.
should get a definition of this, to    Question - Are PV1:69/70 >
understand how to define the LIM
data element.>
Referral Source [0..1] (The source of    Referral Source Code (PV2-13) [0..1]         Accident Code (ACC-2) [0..1]
referral of the patient visit)           [Recommendation: Add new LIM                 [Recommendation: Add new LIM
[Recommendation: Add new LIM             element 'Referral Source' under              element LIM.Accident Code.Code
element 'Referral Source' under          'Patient Event Type Details' DG]             under 'Patient Event Type Details' DG
'Patient Event Type Details' DG - note   <Linda: We need to understand the            in 'Patient EI' worksheet]
that this field is different from        meaning of this better - based on the        <Linda: At the moment this is mapped
SCM.Patient Event Type]                  SCM example, I assume that this is the       to C2. Patient Event Report (last data
<Linda: Please see comment to the        organisation of the referring clinician      element). Note, PV1:69/70 seem to
right.>                                  (optionally with the clinic within that      map to the same database fields as
                                         organisation)?However ISH calls it the       ACC-2 (indicating the same data is put
                                         'referral type' - is this a different        into these, and tEHRefore they should
                                         meaning? If this is the organisation         have the same LIM mapping). We also
                                         and clinic of the referring clinician,       need to consider the relationship (if
                                         then we may want to include                  any) to the 'Causative Agent' data
                                         'organisation' and 'suborganisation'         element in the Problem Diagnosis
                                         into the HPI participation, and map          archetype - our goal is to ensure that
                                         this all to the 'Referred By' details.       the same logical piece of information
                                         (eitEHR as a HPO participation in cases      is only recorded in one place in the
                                         where the referring clinician is not         LIM (where possible). I would NOT add
                                         individually named, or as the                this data element to 'DG4. Patient EI',
                                         organisation associated with the             as it is not specifically about the
                                         referring HPI).                              patient healthcare event, it is about
                                                                                      something that happened prior to the
                                                                                      patient healthcare event.>



                                         Signature on File Date (PV2-28) [0..1]
                                         [Recommendation: Add new LIM
                                         element called 'Patient Movement
                                         DateTime' under 'Patient Event
                                         Dates' SG]
                                         <Linda: Agree! Well done!>

                                         Patient Class (PV1-2) [1]                    Patient Class (PV1-2) [1]
                                         [Recommendation: Add new LIM                 [Recommendation: Add new LIM
                                         element under 'Patient Information'          element under 'Patient Information'
                                         DG]                                          DG]
                                         <Linda: Yes. I think we should add a         <Linda: As per comment to left.>
                                         'Patient Class' data element under
                                         'Patient Event Type', as it is specific to
                                         this paticular Patient Event>
Prior Patient Location (PV1-6) [0..1]         Prior Patient Location (PV1-6) [0..1]
[Recommendation: Define new data              [Recommendation: Define new data
type 'Patient Event Location', then           type 'Patient Event Location', then
this element (PV1-6) will be a new            this element (PV1-6) will be a new
LIM element with this new type, but           LIM element with this new type, but
only point of care and room will be           only point of care and room will be
populated]                                    populated]
<Linda: Yes, please add a data group          <Linda: As per comment to left.>
(not data type) called 'Patient
Location' to DG1. Participation (e.g.
'DG1.7 Patient Location', Data
Group), which is then referred to by
'Patient Event Location' (above) and
then add 'Patient Event Prior
Location' data group below it (both
with data type of 'Patient Location
DG'. Cardinality of [0..2] to cater for
Prior Temporary Location, below.>

Re-admission Indicator (PV1-13) [0..1]
[Recommendation: Add new LIM
element under 'Patient Event Details']
<Linda: Yes, under 'Patient Event Type
Details'
Note: NHG has a PV1:4 (Admission
Type) value of 'Readmission" that
would need to be mapped to this LIM
indicator to ensure tEHRe is only one
way to query for this information.>

[13/4 YC: I have created a new LIM
element called 'Consultation Indicator'
as OAS is using it for this purpose. Will
clarify with IHIS if the use in ISH is also
as a consultation indicator.]
Admit Source (PV1-14) [0..1]              Admit Source (PV1-14) [0..1]
[Recommendation: This appears to be       - admission reason 1 (PV1-14.1) [0..1]
another classification of PV2-13          (e.g. "A&E", "SOC", "Ward")
(Referral Source Code); suggest we        - admission reason 2 (PV1-14.2) [0..1]
add a new LIM element to cater for        (e.g. "foreigner living in SG")
Admit Source]                             [Recommendation: This appears to be
<Linda: Given the valid values, I would   different from PV2-13 (Referral Source
prefer to call this 'Referral Type' and   Code); suggest we add a new LIM
put it in 'Patient Event Type Details'>   element to cater for Admit Source]
                                          <Linda: I would add 'Admission Source
                                          Type' for PV1-14.1. I am not clear as to
                                          what all the values for PV1-14.2 mean -
                                          e.g. what is the difference between
                                          'Foreigner Came For Treatment' and
                                          the other values? ('Foreigner Living in
                                          SG' and 'Tourist')? I would tend to add
                                          a new data element for PV1-14.2
                                          called 'Patient Foreigner Type' ...
                                          although this probably should be
                                          added against 'DG2.Patient', and I
                                          note that tEHRe is some overlap with
                                          'Residency Status'>

                                          [13/4 YC: LIM elements added - PV1-
                                          14.2 has been added to DG2 as
                                          'Foreigner Status' as it applies to
                                          foreigners as opposed to 'Resident
                                          Status']
Patient Type (PV1-18) [0..1]              Delete Account Indicator (PV1-34)
[Recommendation: Add new LIM              [0..1]
element under 'Financial Information'     [Recommendation: Add new LIM
DG as this field is capturing finance-    element under 'Patient Event Details'
related data]                             DG]
<Linda: Yes, please add 'Visit            <Linda: I would add this under
Payment Class' and 'Visit Choice          'Financial Information'>
Class' under 'Financial Information'.>

[13/4 YC: Will add one new LIM
element called "Visit Payment Class"
for this IDDS element. Not sure why a
second LIM element callde "Visit
Choice Class" needs to be added"]
Charge Price Indicator (PV1-21) [0..1]      Delete Account Date (PV1-35) [0..1]
[Recommendation: Add new finance-           [Recommendation: Add new LIM
related LIM element under 'Financial        element under 'Patient Event Details'
Information' DG; 29/3: WH to check          DG]
with IHIS if this is a peak/non-peak        <Linda: Once again, under 'Financial
indicator]                                  Information' add 'Account Deletion
<Linda: Agree. Please add 'Visit            DateTime>
Downtime Indicator under 'Financial
Information'.>
Bad Debt Agency Code (PV1-31) [0..1]
[Recommendation: Add new finance-
related LIM element under 'Financial
Information' DG]
<Linda: It looks like it should be called
'Billing Program Type'>

Account Status (PV1-41) [0..1]              Account Status (PV1-41) [0..1]
[Recommendation: Add new finance-           [Recommendation: Add new finance-
related LIM element under 'Financial        related LIM element under 'Financial
Information' DG]                            Information' DG]
<Linda: Yes, please add 'Account            <Linda: Agree. Perhaps call it eitEHR
Status' or 'Bill Status'>                   'Account Status' or 'Billing Indicator'>
                                                                         LABORATORY - NDDS TEMPLATE
LAB NDDS                         Lab NDDS Cardinality   LAB IDDS (KKH)

                                                        PV1 [0..1]


LIM.LOCATABLE [1]                1                      N/A




N/A                              N/A                    N/A




N/A                              N/A                    N/A




LIM.Participation [0..Many]      0..Many                N/A



LIM.Patient Event General        1                      PV1 [0..1]
Information [1]
N/A                              N/A                    N/A

N/A                              N/A                    N/A

LIM.Patient Event Location       0..1                   PV1 [0..1]
Information [0..1]
LIM.Patient Event Dates [0..1]   0..1                   PV1 [0..1]

N/A                              N/A                    N/A
UNMAPPED   UNMAPPED
ABORATORY - NDDS TEMPLATE
          LAB IDDS (SGH)                      LAB IDDS (CGH)   LAB IDDS (NHG)

          PV1 [0..1]                          PV1 [0..1]       PV1 [0..1]


          N/A                                 N/A              N/A




          N/A                                 N/A              N/A




          N/A                                 N/A              N/A




          LIM.other Participant               N/A              N/A
          - Participation Type = "Attending
          Doctor"
          - Person Name.Complete Name =
          PV1 [0..1]                          PV1 [0..1]       PV1 [0..1]

          N/A                                 N/A              N/A

          N/A                                 N/A              N/A

          PV1 [0..1]                          PV1 [0..1]       PV1 [0..1]

          N/A                                 PV1 [0..1]       PV1 [0..1]

          N/A                                 N/A              N/A
UNMAPPED   UNMAPPED   UNMAPPED
                                                                               RADIOLOGY (RAD) - N
RAD NDDS                         Radiology NDDS Cardinality   RAD IDDS (KKH)

                                                              PV1 [0..1]


LIM.LOCATABLE [1]                1                            N/A




N/A                              N/A                          N/A




N/A                              N/A                          N/A




LIM.Participation [0..Many]      0..Many                      N/A



LIM.Patient Event General        1                            PV1 [0..1]
Information [1]
N/A                              N/A                          N/A

N/A                              N/A                          N/A

LIM.Patient Event Location       0..1                         PV1 [0..1]
Information [0..1]
LIM.Patient Event Dates [0..1]   0..1                         PV1 [0..1]

LIM.Patient Event Financial      0..1                         PV1 [0..1]
Information [0..1]
UNMAPPED   UNMAPPED
           Patient Type (PV1-18) [0..1] (example:
           "Research" or "N/A")
           [Recommendation: Add new LIM
           element]
  RADIOLOGY (RAD) - NDDS TEMPLATE
RAD IDDS (SGH)                  RAD IDDS (CGH)   RAD IDDS (NHG)

PV1 [0..1]                      PV1 [0..1]       PV1 [0..1]
                                ORC [1..Many]    ZOR [0..Many]

N/A                             N/A              N/A




N/A                             N/A              N/A




N/A                             N/A              N/A




N/A                             N/A              LIM.other Participant
                                                 - Participation Type = "Attending
                                                 Doctor"
PV1 [0..1]                      PV1 [0..1]       - Participant Identifier.Designation =
                                                 PV1 [0..1]

N/A                             N/A              N/A

N/A                             N/A              N/A

PV1 [0..1]                      PV1 [0..1]       PV1 [0..1]
                                ORC [1..Many]
PV1 [0..1]                      PV1 [0..1]       PV1 [0..1]

N/A                             N/A              PV1 [0..1]
                                                 ZOR [0..Many]
UNMAPPED                             UNMAPPED                             UNMAPPED
Patient Type (PV1-18) [0..1] (care   Patient Type (PV1-18) [0..1] (care
level, default = "N/A")              level, default = "N/A")
[Recommendation: Add new LIM         [Recommendation: Add new LIM
element]                             element]
                                                                      MEDS ORDER (MO) - NDDS TEMPLATE
RAD IDDS (NHGP)   MO NDDS                          Med Order NDDS Cardinality

PV1 [0..Many]


N/A               LIM.LOCATABLE [1]                1




N/A               N/A                              N/A




N/A               N/A                              N/A




N/A               LIM.Participation [0..Many]      0..Many



N/A               LIM.Patient Event General        1
                  Information[1]
N/A               N/A                              N/A

N/A               N/A                              N/A

PV1 [0..Many]     LIM.Patient Event Location       0..1
                  Information [0..1]
PV1 [0..Many]     LIM.Patient Event Dates [0..1]   0..1

N/A               LIM.Patient Event Financial      0..1
                  Information [0..1]
UNMAPPED   UNMAPPED
DS ORDER (MO) - NDDS TEMPLATE                                                    ME
           MO IDDS (NHG)        MO IDDS (KKH)   MD NDDS

           PV1 [0..1]           PV1 [1]


           N/A                  N/A             LIM.LOCATABLE [1]




           N/A                  N/A             N/A




           N/A                  N/A             N/A




           N/A                  N/A             LIM.Participation [0..Many]



           PV1 [0..1]           PV1 [1]         LIM.Patient Event General
                                                Information [1]
           N/A                  N/A             N/A

           N/A                  N/A             N/A

           PV1 [0..1]           PV1 [1]         LIM.Patient Event Location
                                                Information [0..1]
           PV1 [0..1]           PV1 [1]         LIM.Patient Event Dates [0..1]

           PV1 [0..1]           N/A             LIM.Patient Event Financial
                                                Information [0..1]
UNMAPPED   UNMAPPED                                 UNMAPPED
           Patient Type (PV1-18) [1] (This is for
           care level)
           [Recommendation: Ignore since this
           field has a fixed value of "N/A"]
                  MEDS DISPENSE (MD) - NDDS TEMPLATE
Med Dispense NDDS Cardinality    MD IDDS (NHG)                            MD IDDS (CGH)

                                 PV1 [1]                                  PV1 [0..1]


1                                N/A                                      N/A




N/A                              N/A                                      N/A




N/A                              N/A                                      N/A




0..Many                          LIM.other Participant                    N/A
                                 - Participant Identifier.Designation =
                                   Attending Doctor [1].id number
1                                (PV1-7.1) [1]
                                 PV1 [1]                                  PV1 [0..1]

N/A                              N/A                                      N/A

N/A                              N/A                                      N/A

0..1                             PV1 [1]                                  PV1 [0..1]

0..1                             PV1 [1]                                  N/A

0..1                             PV1 [1]                                  N/A
UNMAPPED   UNMAPPED
           Patient Type (PV1-18) [1] (This is for
           care level)
           [Recommendation: Ignore since this
           field has a fixed value of "N/A"]
ACIDS Phase 1 NDDS                          ACIDS Phase 1 IDDS (NHG)




LIM.LOCATABLE [1]




N/A                                         N/A




N/A                                         N/A




N/A                                         N/A



LIM.Patient Event general Information [1]   Patient Event Information

N/A                                         N/A

LIM.Patient Discharge Information [1]       Discharge Summary Event Information

LIM.Patient Event Location Information      Discharge Summary Event Information
[0..1]
LIM.Patient Event Dates [1]                 Patient Event Information

N/A                                         N/A


UNMAPPED
                                            DISCHARGE SUMMARY TEMPLATES
ACIDS Phase 1 IDDS (SHS)              ACIDS Phase 1 IDDS (KTPH)




N/A                                   N/A




N/A                                   N/A




N/A                                   N/A



Patient Event Information

N/A

Discharge Summary Event Information

Discharge Summary Event Information

Patient Event Information

N/A
MPLATES
          ACIDS Phase 2 NDDS   ACIDS Goal State NDDS




                               LIM.LOCATABLE [1]




          N/A                  N/A




          N/A                  N/A




          N/A                  LIM.Participation [0..Many]



                               LIM.Patient Event General Information [1]

                               LIM.Patient Admission Information [0..1]



                               LIM.Patient Event Location Information
                               [0..1]
                               LIM.Patient Event Dates [0..1]

                               LIM.Patient Event Financial Information
                               [0..1]

          UNMAPPED             UNMAPPED
CHIDS
(Community ) Phase 1 NDDS




N/A




N/A




UNMAPPED
DOCUMENT CONTROL ENTRY

            LIM ID Ref   LIM Data Item Name


E2                       DOCUMENT CONTROL


     E2.1                LOCATABLE




     E2.2                CONTENT ITEM

     E2.3                ENTRY



     E2.4                ADMINISTRATION ENTRY




     E2.5                Participation


     E2.6                Document Control
                         Information
     E2.7                Document Reference
                         Information
LIM Data Type          LIM Cardinality   LIM Definition


ADMINISTRATION ENTRY   <Undefined>       Information about a document that is used to
                                         manage, identify or locate the document.

Class                  1                 Root class of all information model classes that can be
                                         archetyped, including COMPOSITION, ENTRY,
                                         SECTION, CLUSTER and ELEMENT.

Class                  0                 An abstract class of all concrete content types,
                                         including ENTRY and SECTION.
Class                  1                 A class that defines the semantics of the core clinical
                                         and administrative information in the EHR.

Class                  0                 The abstract parent of all clinical ENTRY subtypes. A
                                         CARE_ENTRY defines protocol and guideline attributes
                                         for all clinical ENTRY subtypes.

PARTICIPATION          0..Many           Any participant (person, healthcare provider or
                                         organisation) that was involved in the patient's
                                         healthcare event.
CLUSTER                1                 Information about the given document, not captured
                                         elsewhere.
DOCUMENT REFERENCE     1                 Information about the given document, not captured
                                         elsewhere.
LIM Value Domain                       LIM Format Constraint   Other LIM Constraints




Participant Identifier.Designation =                           Default Value(s):
Doctor_MCR_VD                                                  Participant Identifier.Type =
                                                               "MCRN"
                                                               Participant Identifier.Realm
LIM Example (for Exchange) LIM Example (for Display)   LIM Comments




                                                       Healthcare Provider
                                                       Individual.Participant
                                                       Identifier is equivalent to
                                                       the MOH Data Dictionary
                                     SUMMARY CARE VIEW - NEHR LIST


LIM Change Log   NEHR Phase 1 Term                        Definition &
                 Core                                     Comments

                 Yes
  EVENT DRILL-DOWN LIST (LIST VIEW) -     EVENT SUMMARY VIEW - NEHR LIST
              NEHR LIST

Term               Definition &         Term             Definition &
                   Comments                              Comments
 RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST) - NEHR   RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
                       LIST

Term                       Definition & Comments         Term
M/DIAGNOSIS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST          CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST


                  Definition & Comments               Term                             Definition & Comments
       CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST          RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST


Term                           Definition & Comments       Term
MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST          MEDICAL ALERTS VIEW - NEHR LIST


                  Definition & Comments        Term                  Definition & Comments
       DOCUMENT LIST VIEW - NEHR LIST          LAB REPORT - NEHR LIST


Term      Definition & Comments         Term
LAB REPORT - NEHR LIST              RADIOLOGY REPORT - NEHR LIST


              Definition &   Term        Definition & Comments
              Comments




                                         LIM.Participation [0..Many]
ACIDS Phase 1 NDDS




LIM.LOCATABLE [1]




N/A
ACIDS Phase 1 IDDS (NHG)


Document Control




N/A
                           DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (SHS)


Document Control




N/A
DISCHARGE SUMMARY TEMPLATES


    ACIDS Phase 1 IDDS (KTPH)




    LIM.Participation [0..Many]
ACIDS Phase 1 - NEHR Mapping   ACIDS Phase 2 NDDS




0..Many                        LIM.Participation
                               - Participant
                               Identifier.Designation =
                                 Attending Doctor [1].id
ACIDS Goal State NDDS   CHIDS
                        (Community ) Phase 1
                        NDDS




LIM.LOCATABLE [1]




N/A
N/A
PROBLEM DIAGNOSIS ENTRY

                LIM ID Ref   LIM Data Item Name


E3                           PROBLEM DIAGNOSIS ENTRY

     E3.1                    LOCATABLE


     E3.2                    CONTENT ITEM

     E3.3                    ENTRY


     E3.4                    CARE ENTRY

     E3.5                    EVALUATION ENTRY




     E3.6                    Participation


     E3.7                    Problem Diagnosis Dates

     E3.8                    Problem Diagnosis Additional
                             Information
LIM Data Type      LIM Cardinality


EVALUATION ENTRY   <Undefined>

Class              1


Class              0

Class              1


Class              1

Class              0




PARTICIPATION      0..Many


CLUSTER            0..1

CLUSTER            0..1
LIM Definition                                                         LIM Value Domain


Information pertaining to a single problem or diagnosis ENTRY.

Root class of all information model classes that can be archetyped,
including COMPOSITION, ENTRY, SECTION, CLUSTER and ELEMENT.

An abstract class of all concrete content types, including ENTRY and
SECTION.
A class that defines the semantics of the core clinical and
administrative information in the EHR.

The abstract parent of all clinical ENTRY subtypes.

ENTRY type for evaluation statements. Used for all kinds of
statements which evaluate other information, such as interpretations
of observations, diagnoses, differential diagnoses, hypotheses, risk
assessments, goals and plans.
A generic domain concept that defines an association between an
act and an entity (person or organisation) in a healthcare role.

Dates related to this problem diagnosis.

Additional details about the problem diagnosis being described.
LIM Format Other LIM Constraints   LIM Example (for Exchange)   LIM Example (for Display)
Constraint
                                                    SUMMARY CARE VIEW - NEHR LIST


LIM Comments   LIM Change Log   NEHR Phase 1 Term
                                Core

                                Yes
SUMMARY CARE VIEW - NEHR LIST            EVENT DRILL-DOWN LIST (LIST VIEW) - NEHR LIST    PROBLEM/DIAGNOSIS HISTORY (DRILL-DOWN VIE
                                                                                                           NEHR LIST

              Definition & Comments   Term                     Definition & Comments     Term
LEM/DIAGNOSIS HISTORY (DRILL-DOWN VIEW) -   RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST) -    RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN
             NEHR LIST                                       NEHR LIST                                       VIEW) - NEHR LIST

                  Definition & Comments     Term                    Definition & Comments      Term
N PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST          MEDICAL ALERT VIEW - NEHR LIST
         VIEW) - NEHR LIST

                  Definition & Comments     Term                  Definition & Comments
                                                                ADT - NDDS TEMPLATE


ADT NDDS                                     ADT NDDS Cardinality SCM


                                                                 Patient Info

LIM.LOCATABLE [1]                            1                   N/A


N/A                                          N/A                 N/A

LIM.ENTRY [1]                                1                   N/A


LIM.CARE ENTRY [1]                           1                   N/A

N/A                                          N/A                 N/A




LIM.Participation [0..Many]                  0..Many             N/A


LIM.Problem Diagnosis Dates [0..1]           0..1                Patient Info

LIM.Problem Diagnosis Additional Information 0..1                N/A
[0..1]
DS TEMPLATE


              ADT IDDS (SHS)   ADT IDDS (NHG)   ACIDS Phase 1 NDDS


              DG1 [0..Many]    DG1 [0..Many]

              N/A              N/A              LIM.LOCATABLE [1]


              N/A              N/A              N/A

              N/A              N/A              LIM.ENTRY [1]


              N/A              N/A              LIM.CARE ENTRY [1]

              N/A              N/A              N/A




              N/A              DG1 [0..Many]    N/A


              DG1 [0..Many]    DG1 [0..Many]    N/A

              N/A              DG1 [0..Many]    N/A
                                                                  DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (NHG)   ACIDS Phase 1 IDDS (SHS)   ACIDS Phase IDDS (KTPH)   ACIDS Phase 2 NDDS




N/A                        N/A                        N/A


N/A                        N/A                        N/A

N/A                        N/A                        N/A


N/A                        N/A                        N/A

N/A                        N/A                        N/A




N/A                        N/A                        N/A


N/A                        N/A                        N/A

N/A                        N/A                        N/A
Y TEMPLATES


              ACIDS Goal State NDDS                                 CHIDS
                                                                    (Community )
                                                                    Phase 1 NDDS


              LIM.LOCATABLE [1]


              N/A

              N/A


              LIM.CARE ENTRY [1]

              N/A




              N/A


              LIM.Problem Diagnosis Dates [0..1]

              LIM.Problem Diagnosis Additional Information [0..1]
MEDICATION ORDER ENTRY
            LIM ID Ref   LIM Data Item Name


E4                       MEDICATION ORDER


     E4.1                LOCATABLE




     E4.2                CONTENT ITEM

     E4.3                ENTRY



     E4.4                CARE ENTRY

     E4.5                INSTRUCTION ENTRY




     E4.6                ORDER ENTRY
     E4.7                MATERIAL ORDER
     E4.8                Participation


     E4.9                Medication Item
                         (Material Item)
LIM Data Type   LIM Cardinality


ENTRY           <Undefined>


Class           1




Class           0

Class           1



Class           1

Class           0




Class           1
Class           0
PARTICIPATION   0..Many


CLUSTER         1
LIM Definition                                                      LIM Value Domain


Information pertaining to a single medication item that is
ordered.

Root class of all information model classes that can be
archetyped, including COMPOSITION, ENTRY, SECTION,
CLUSTER and ELEMENT.

An abstract class of all concrete content types, including ENTRY
and SECTION.
A class that defines the semantics of the core clinical and
administrative information in the EHR.

The abstract parent of all clinical ENTRY subtypes.

Used for any actionable statement such as medication and
therapeutic orders, monitoring, recall and review. Enough details
must be provided for the specification
to be directly executed by an actor, either human or machine.

Defines an order entry within an instruction.
Defines a material order within an Instruction.
A generic domain concept that defines an association between
an act and an entity (person or organisation) in a healthcare
role.
Details that fully describe the medication item that is being
ordered. This may include the active ingredients, dosage form,
strength, brand name, dosage, frequency and administration
instructions.
LIM Format   Other LIM Constraints   LIM Example (for Exchange)
Constraint
LIM Example (for Display)   LIM Comments   LIM Change Log
                                                SUMMARY CARE VIEW - NEHR LIST
NEHR Phase Term
1 Core

Yes




Yes




           UNMAPPED
           Medication History.Event Summary Available

           Curr & Recon Meds.Event Summary Available
SUMMARY CARE VIEW - NEHR LIST                                                      MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST
           Definition & Comments                                    Term




           UNMAPPED                                                 UNMAPPED
           [STD20100513] We will look into the incorporation of a   Medication History.Event Summary Available
           'Event Summary Document Identifier' LIM element (or
           [STD20100513] We will look into the incorporation of a
           'Event Summary Document Identifier' LIM element (or
HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST                      MEDICAL ALERT VIEW - NEHR LIST
                   Definition & Comments                 Term




                   UNMAPPED
                   [STD20100513] We will look into the
                   incorporation of a 'Event Summary
MEDICAL ALERT VIEW - NEHR LIST                CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST
               Definition & Comments   Term                     Definition & Comments




                                       UNMAPPED                 UNMAPPED
                        CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
Term                                                   Definition & Comments




UNMAPPED                                               UNMAPPED
Curr & Recon Meds.Event Summary Available              [STD20100513] We will look into the
                                                       incorporation of a 'Event Summary Document
                     RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
Term                                             Definition & Comments




UNMAPPED                                         UNMAPPED
Curr & Recon Meds.Event Summary Available        [STD20100513] We will look into the
                                                 incorporation of a 'Event Summary Document
                                            MEDS ORDER (MO) - NDDS
MO NDDS                       Med Order
                              NDDS
                              Cardinality



LIM.LOCATABLE [1]             1




N/A                           N/A

LIM.ENTRY [1]                 1



LIM.CARE ENTRY [1]            1

N/A                           N/A




LIM.ORDER ENTRY [1]           1
N/A                           N/A
LIM.Participation [0..Many]   0..Many


LIM.Medication Item [1]       1
                                          MEDS ORDER (MO) - NDDS TEMPLATE
SCM


Ordered Meds


N/A




N/A

N/A



Ordered Meds

N/A




Ordered Meds
N/A
Ordered Meds


Ordered Meds




NOTES FOR MOHH USE ONLY
Order Priority [0..1] (Indicates the urgency of the
order)
POM (Patient's own medicine) [1] (To indicate
whether this medication is prescribed by the
MEDS ORDER (MO) - NDDS TEMPLATE
        MO IDDS (NHG)


        ORC [1..Many]
        RXO [0..Many]
        RXR [0..Many]
        N/A




        N/A

        N/A




        N/A




        ORC [1..Many]
        N/A
        ORC [1..Many]


        RXO [0..Many]




        NOTES FOR MOHH USE ONLY
        Order Control (ORC-1) [1]
        [Recommendation: Add new LIM element]
        Filler Order Number (ORC-3) [0]
        [Recommendation: Add new LIM element]
        Requested Give per (Time Unit) (RXO-17) [0..1]
        [Recommendation: Add new LIM element for this; this element is only
        populated if RXO-16 (Needs Human Review) is 'Yes']
        <L.B. - Doesn' this map to E4.1.4.2 Dose Quantity?>
        [1/4 YC: No, this does not map to Dose Quantity as tEHRe is a rate
        involved, e.g. "xxx ml per hour"; recommend to map to 2.1.4.4 Dose
        Quantity Rate]
Ordering Provider's DEA Number (For ordering of controlled substance
(eg: Narcotics) (RXO14) [0..Many]
[Recommendation: Add new LIM element "Ordering Provider's DEA
Number"]
<L.B. - E4.1.6.2 (Ordered By).Participant Identifier.Designation, where
Identifier_Type = "DEA Number", Issue = ??, Realm = ??>
[1/4 YC: No, this is a number pertaining to a medication item, not a
healthcare individual; recommend creating a new LIM element
"Medication Item DEA Number"]



Needs Human Review (RXO-16) [0..1]
[Recommendation: Add new LIM element; set to 'Yes' if tEHRe is a risk
that the patient is likely to experience an Adverse Drug Reaction]
<L.B.: E4.1.6.9 Intervention Recommended Reason. Note, I've added
'Review_Required_Reason_VD'> I assume this is the correct
interpretation of this field.
[1/4 YC: RXO-16 should be mapped to LIM.Intervention Recommended
Indicator and not LIM.Intervention Recommended Reason. Recommend
we delete the LIM.Intervention Recommended Reason element]



Observation Value (OBX-5)
- weight (OBX-5.1)
- height (OBX-5.2)
[Recommendation: Add new composite LIM element called "Body
Measurement" with Height (Quantity.Value), Weight (Quantity.Value) as
component elements.]
<L.B.: This needs to use an 'Observation' ENTRY archetype (as used in
the Discharge Summary). I have tEHRefore removed the Observation
Archetype details from Patient Event, and added a reference to a new
E7. Observation worksheet. The Medication message now also refers to
the E7 Observation worksheet. These fields now map to E7.1.4.1, where
E7.1.1.1 = "Height" and "Width".
Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: E7.1.4.2 - Observation's Value Type>
Units (relating to observations) (OBX-6) [0..1]
[Recommendation: This should be associated with new suggested
"Body Measurement" LIM field (see above)]
<L.B. E7.1.4.1 (Observation Value).Units>




Update Date (ZXO-4) [0..1]
[Recommendation: Create new LIM element "Last Updated DateTime"
under Medication Change Details DG]
<L.B.: E4.1.2.2 Medication Item Update Date>



NHG: Provider's Administration Instructions (RXO-7) [0..1]
[Recommendation: Include (?) Adverse Reaction fields EHRe,
specifically: E5.1.1.3 "Adverse Reaction Category", and E5.1.1.4
"Adverse Reaction Remarks"]
<L.B.: Are we sure that this field is used? If it is, then we will need to add
a single Codeable Text data element ... may need more information on
this one.>
[1/4 YC: Unfortunately no POC data; IHIS mentioned that this in use at
NHGP, and will soon be used at TTSH and NUH. Example in IDDS is
"ADR_Reason_Code" and "ADR_Reason_Description". Please see
recommendation above]
Frequency (ZXO-1) [1]
[Recommendation: create new LIM element "Frequency Description"
since ZXO-1 includes both frequency, frequency qualifier and PRN
reason info]
<L.B. I've changed E4.1.5.1 (Frequency) to Codeable Text, which allows
this to be entered as a description. If, however, we need both a coded
term, and an additional frequency description text, then we may need
to add a new data element. But at this stage I don't think so.>
Duration Code (ZXO-2)
- Duration Code (ZXO-2.1) [1]
- Duration Text (ZXO-2.2) [1]
[Recommendation: change data type of "Duration" to Coded Text?]
<L.B. E4.1.6.6 is now a Codeable Text. I'm hesitant to use CodedText in
case sometimes tEHRe is no code?>
Request Dispense Unit (RXO-12) [0..1]
- Dispense Unit of Measurement (RXO-12.2) [0..1]
[Recommendatin: Ignore since this is just RXO-12.1 (unit code) spelt out]
<L.B.: E4.1.4 (Dispensed Quantity).Units. Note that the 'Request
Dispense Value' gets mapped to the same data element (but just the
'Value' component, ratEHR than the 'Units' component.>
[1/4 YC: Our recommendation to ignore this element is based on our
observation that this element is the spelt out equivalent of RXO-12.1,
which is already mapped to E4.1.6.4 (Ordered Quantity). E.g. when
E4.1.6.4 (Ordered Quantity) = "BTL", RXO-12.2 will be "Bottle". So this
element (RXO-12.2) appears to be redundant. Recommend we ignore it]


Requested Give Strength (RXO-18) [0..1]
(Note: this is a free text field that includes both the value and units of a
Quantity)
[Recommendation: Ignore this field as it is always the same value as ZXO-
8 which is mapped to LIM.Dose Quantity)]
<L.B.: E4.1.3.3.2> Ingredient Strength. Note that this field can only be
used when the medication product is single ingredient>
Order Status (ORC-5) [1]
[Recommendation: this field was mapped to "LIM.Medication Set
Status" in the previous version of the LIM but somehow this
LIM.Medication Set Status has been removed, so this is now an
unmapped field. SCM's "Order Status" was also mapped to this
LIM.Medication Set Status.]
MO IDDS (KKH)


ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
N/A




N/A

N/A




N/A




ORC [1..Many]
OBX [0..Many]
N/A
ORC [1..Many]


RXO [0..Many]
OBR [0..Many]
OBX [0..Many]


NOTES FOR MOHH USE ONLY
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
Placer Order Number (OBR-2) [0..1]
[Recommendation: Ignore since ORC-2 (Placer Order Number)
Filler Order Number (ORC-3) [1]
Filler Order Number+ (OBR-3) [0..1]
[Recommendation: Add new LIM element]
<L.B.: Medication Order Number E4.1.1.1>
[YC 30/3: Placer Order Number (ORC-2) is already mapped to
E4.1.1.1. Placer Order Number (ORC-2) may be differnet from Filler
Order Number (ORC-3). Recommend we create a new LIM element]
Universal Service ID (OBR-4) [1]
- id (OBR-4.1) [1] (ancillary name item catalog; probably a product
code, e.g. "8602")
- name of coding system (OBR-4.3) [1] (has fixed value of
"KKHPHXIN")
[Recommendation: to revisit after other IDDS have been
incorporated into LIM]
<L.B.: It looks like this may map to E4.1.3.1 Medication Name … but
it's a little unclear>
[1/4 YC: We have discovered that the id component is equal to the
medication name, and the name of coding system is always a fixed
value] Field 1 (OBR-18) [0..1]
Placer
[Recommendation: Ignore since the value is always the same as
OBR-3, which is currently mapped to Ingredient Strength]
<L.B.: Why is 'Filler Order Number' mapped to 'Ingredient
Strength'??? This does not seem right.> Filler Order Number should
map to 'Medication Dispense Number'. Please read about 'Placers'
and 'Fillers' in the HL7v2 spec.>
[1/4 YC: Sorry, must have made a typo in my note above. Please
see note above on OBR-3 (Filler Order Number+), for which we are
recommending the creation of a new LIM element. Recommend
that we map this 'Placer Field 1' element to this new LIM element]
Quantity/Timing (OBR-27) [0..Many] (relating to the services to
performed during Observations)
[YC: Need furtEHR clarification from IHIS on how this is different
from Date & Time of Transaction (ORC-9)]
<L.B.: It looks like it may be Medication Start DateTime and
Medication Stop DateTime ??>
[YC 31/3: IHIS has clarified that OBR-27 and ORC-9 are identical;
have indicated ORC-9 as '1st Choice' and OBR-27 as '2nd Choice'
under E4.1.6.3 (Ordered DateTime)]




Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
Agreed. No mapping. This would be a fixed value in the NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.2
(Observation Value Type) to be consistent with what is done for
NHG case)]
Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
Agreed. No Maping. As above, this would be a fixed value in the
NXDS.
[YC 31/3: I assume that this should instead be mapped to E7.1.4.4
(Observation Status)]




Observation Identifier (OBX-3)
- Pharmacy Instructions (OBX-3.1) [0..1]
[Recommendation: create new "Frequency Description" field that
covers both frequency, frequency qualifier and PRN reason in a
single value]
<L.B.: No - This maps to E4.1.4.5 Dose Instructions.>
                                             MEDS DISPENSE (MD
MD NDDS                       Med Dispense
                              NDDS
                              Cardinality



LIM.LOCATABLE [1]             1




N/A                           N/A

LIM.ENTRY [1]                 1



LIM.CARE ENTRY [1]            1

N/A                           N/A




LIM.ORDER ENTRY [1]           1
N/A                           N/A
LIM.Participation [0..Many]   0..Many


LIM.Medication Item [1]       1
                                          MEDS DISPENSE (MD) - NDDS TEMPLATE
SCM


Dispensed Meds


N/A




N/A

N/A



Dispensed Meds

N/A




Dispensed Meds
N/A
Dispensed Meds


Dispensed Meds




NOTES FOR MOHH USE ONLY
Filler Order Number [1] (The ancillary reference
code)
Drug Strength [0..1]
[Recommendation: Add new LIM element
MEDS DISPENSE (MD) - NDDS TEMPLATE
          MD IDDS (NHG)


          ORC [1..Many]
          RXD [1..Many]
          ZXO [0..Many]
          N/A




          N/A

          N/A




          N/A




          ORC [1..Many]
          N/A
          ORC [1..Many]


          ORC [1..Many]
          RXD [1..Many]
          ZXO [0..Many]
          ZCO [0..Many]

          NOTES FOR MOHH USE ONLY
          Filler Order Number (ORC-3) [0…1]
          - entity identifier (ORC-3.1) [0…1]
          Order Control (ORC-1) [1]
          [Recommendation: Add new LIM element]
          Entered By (ORC-10) [0…Many]
          - id number (ORC-10.1) [0…1]
          (This refers to pharmacy staff)
          [Recommendation: Add new LIM participation "Entered By"]
          <E4.1.2.9 Medication Item Entered By>
Enterer's Location (ORC-13) [0…1]
- point of care (ORC-13) [0…1]
[Recommendation: Add new LIM element "Enterer's Location"]
<L.B.: E4.1.2.10 Medication Item ENTRY Location>




Date/Time of Transaction (ORC-9) [0…1] (Refers to new/cancelled/ modified
order date/time
[Recommendation: Add new LIM element "Last Updated DateTime" under
Medication Change Details DG]
<L.B.: E4.1.2.2 Medication Item Update Date>




Dispense to Location (RXD-13) [0…1]
- point of care (RXD-13.1) [1] (refers to location of pharmacy)
[Recommendation: Add new LIM element "Dispensed To" under "Medication Set
Information" DG]
<L.B.: E4.1.7.6: Dispensed To Location>




Prescription Number (RXD-7) [1]
[Recommendation: Add new LIM element "Prescription ID" under "Medication
Set Information" DG]
<L.B.: E4.1.1.1 Medication Item Order Number>
[YC 31/3: Filler Order Number.entity identifer (ORC-3.1) is already mapped to
this field as per instruction above; prescription Number is for medication set.
Recommend that a new LIM element "Medication Set Number".]
Pharmacist Intervention For Item (ZXO-6) [0…1]
- intervention flag (ZXO-6.1) [1]
[Recommendation: Add new LIM element "Pharmacist Intervention" under
"Medication Item Administer Details" DG]
<L.B.: E4.1.7.7 Intervention Required Indicator>




Medication Type (ZCO-4) [0…1] (eg outpatient, inpatient medication)
[Recommendation: Add new LIM element "Medication Set Type" under
"Medication Set Information" DG]
<L.B. E4.1.2.6 Medication Item Type. Note, I've added
'Medication_Item_Type_VD'


1. Actual Dosage Form (RXD-6) [0…1]
- identifier (RXD-6.1) [1]
2. Dosage (ZXO-8) [0…1]
[Recommendation: create new "Dosage Description" LIM element]
<L.B. - I have changed E4.1.4.5 Dose Instructions to Codeable Text, and now this
should be mapped to E4.1.4.5>




Update Date (ZXO-4) [0…1]
[YC: Need furtEHR clarification from IHIS - is it different from Order Effective
Date/Time (ORC-15)]
<L.B.: I assume this maps to E4.1.2.2 Medication Item Update Date.>

[YC 31/3: IHIS has clarified that this field is NOT always the same as ORC-15.
Recommend that we create a new LIM.Additional Med Dispense Information
element with Information Type = "Update Date", and Information Value = ZXO-4]
Actual Strength (RXD-16) [0…1]
Actual Strength Unit (RXD-17) [0…1]
[Recommendation: Add new LIM element "Medication Item Strength" for these
IDDS elements]
<L.B.: E4.1.3.3.2> Ingredient Strength. Note that this field can only be used when
the medication product is single ingredient>
                                                                                   DISCHARGE SUMMARY TEMPLATES
MD IDDS (CGH)                                                      ACIDS Phase 2
                                                                   NDDS

ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
N/A




N/A

N/A




N/A




ORC [1..Many]
OBX [0..Many]
N/A
N/A


ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
RXE [1..Many]

NOTES FOR MOHH USE ONLY
Filler Order Number (ORC-3) [1]
- entity identifier (ORC-3.1) [1]
Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
1. Quantity/Timing (ORC-7) [1]
- end date/time (ORC-7.5) [0…1]
2. Quantity/Timing (RXE-1) [1]
- end date/time (RXE-1.5) [0…1]
[Recommendation: Add new LIM element called "Collect Stop
DateTime" - this field refers to the datetime that the dispensed
medication will run out.]
<L.B.: E4.1.7.5 (Dispensed Quantity Time Interval).End DateTIme>
Entered By (ORC-10) [1…Many]
- id number (ORC-10.1) [1]
- family name (ORC-10.2) [1]
[Recommendation: Add new LIM element "Entered By"]
<E4.1.2.9 Medication Item Entered By>




2. Give Code (RXE-2) [1]
- identifier (RXE-2.1) [1]
- description (RXE-2.2) [1]
- ancillary coding standard (RXE-2.3) [1]
[Recommendation: Ignore since this is always the same as similar
fields under Requested Give Code]
<L.B. This still needs to be mapped, even if it maps to the same
thing. Should map to E4.1.3.1 Medicaiton Name (and its component
bits), including id, term, coding system, mappings>



Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX" (Text Data
(Display))]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.2 (Observation Result
Value Type) to be consistent with other institutions]




Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F" for Final]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E7.1.4.4 (Observation
Result Status; is this ok?]
Observation Value (OBX-5) [1] when value of OBX-3 = "Pharmacy
Instructions"
(currently one single text string contains:
- Medication Item Set Connecting Term
- Dose Instructions
- Frequency Qualifier)
[Recommendation: create new LIM text element "Pharmacy
Instructions" under Medication Item, i.e. a new E4.1.4.1 element]
<L.B. E4.1.4.5 Dosage Instructions.>
<L.B. If tEHRe is any consistency in the pattern in which Medication
Connecting Term is provided, it would be great to be able to 'Parse'
this out, into the appropriate Data Element. Not sure if this is
possible - depends on how reliable the text pattern is.>

[8/4 YC: Unfortunately, tEHRe is no consistency in the structure of
the text string which would allow us to parse the relevant data.
However, we have now mapped this field to 'Additional Order
Instructions']

Observation Value (OBX-5) [1] when value of OBX-3 = "Strength"
[Recommendation: Add new LIM element "Medication Item
Strength" for these IDDS elements]
<L.B.: E4.1.3.3.2> Ingredient Strength. Note that this field can only
be used when the medication product is single ingredient>


Observation Value (OBX-5) (trade product name) when value of
OBX-3 [0..1] = "Brand Name"
[Recommendation: This brand name may be different from
medication name; suggest we create a new LIM element to track
this information]
       DISCHARGE SUMMARY TEMPLATES
ACIDS Goal State NDDS




LIM.LOCATABLE [1]




N/A

LIM.ENTRY [1]



LIM.CARE ENTRY [1]

N/A




LIM.ORDER ENTRY [1]
N/A
LIM.Participation [0..Many]


LIM.Medication [1]




UNMAPPED
MEDICATION DISPENSE ENTRY
            LIM ID Ref      LIM Data Item Name       LIM Data Type


E5                          MEDICATION DISPENSE      ENTRY




     E5.1                   LOCATABLE                Class




     E5.2                   CONTENT ITEM             Class

     E5.3                   ENTRY                    Class



     E5.4                   CARE ENTRY               Class

     E5.5                   ACTIVITY ENTRY           Class

     E5.6                   MATERIAL ACTIVITY        Class
     E5.7                   MEDICATION ACTIVITY      Class
     E5.8                   Participation            PARTICIPATION


     E5.9                   Medication Dispense      CLUSTER
                            Additional Information
LIM Cardinality   LIM Definition


<Undefined>       Information pertaining to a single medication item that is
                  dispensed.



1                 Root class of all information model classes that can be
                  archetyped, including COMPOSITION, ENTRY, SECTION,
                  CLUSTER and ELEMENT.

0                 An abstract class of all concrete content types, including ENTRY
                  and SECTION.
1                 A class that defines the semantics of the core clinical and
                  administrative information in the EHR.


1                 The abstract parent of all clinical ENTRY subtypes.

1                 Defines a single activity within an Instruction, such as a
                  medication administration.
0                 Defines a material activity within an Instruction.
0                 Defines a medication activity within an Instruction.
0..Many           A generic domain concept that defines an association between
                  an act and an entity (person or organisation) in a healthcare
                  role.
0..1              Additional information about the Medication Dispense action.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)
LIM Comments   LIM Change Log   NEHR Phase
                                1 Core

                                Yes
                                     SUMMARY CARE VIEW - NEHR LIST
Term                                            Definition & Comments




Medication History.Event Summary Available      [STD20100513] We will look into the incorporation of a
                                                'Event Summary Document Identifier' LIM element (or
                                                something similar to this) for events, procedures, medication
                                                items, investigations, problem/diagnosis which will capture
                                                the Set Identifier and Version Number. The NEHR 'Event
                                                Summary Available' can then be derived from the presence
                                                of this 'Event Summary Document Identifier'.




Curr & Recon Meds.Event Summary Available       [STD20100513] We will look into the incorporation of a
                                                'Event Summary Document Identifier' LIM element (or
                                                something similar to this) for events, procedures, medication
                                                items, investigations, problem/diagnosis which will capture
                                                the Set Identifier and Version Number. The NEHR 'Event
                                                Summary Available' can then be derived from the presence
                                                of this 'Event Summary Document Identifier'.
               MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST
Term                                          Definition & Comments




Medication History.Event Summary Available    [STD20100513] We will look into the
                                              incorporation of a 'Event Summary
                                              Document Identifier' LIM element (or
                                              something similar to this) for events,
                                              procedures, medication items,
                                              investigations, problem/diagnosis which
                                              will capture the Set Identifier and Version
                                              Number. The NEHR 'Event Summary
                                              Available' can then be derived from the
                                              presence of this 'Event Summary
                                              Document Identifier'.
       MEDICAL ALERT VIEW - NEHR LIST                CURR & RECON MEDS LIST (DRILL-DOWN LIST) -
Term                  Definition & Comments   Term
CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST                           CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
                  Definition & Comments                Term




                                                       Curr & Recon Meds.Event Summary Available
LIST (DRILL-DOWN LIST VIEW) - NEHR LIST                                                RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
                    Definition & Comments                        Term




                    [STD20100513] We will look into the            Curr & Recon Meds.Event Summary Available
                    incorporation of a 'Event Summary Document
                    Identifier' LIM element (or something similar
                    to this) for events, procedures, medication
                    items, investigations, problem/diagnosis which
                    will capture the Set Identifier and Version
                    Number. The NEHR 'Event Summary Available'
                    can then be derived from the presence of this
                    'Event Summary Document Identifier'.
DS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST                                                                                           MED
                    Definition & Comments                            MD NDDS                                          Med Dispense
                                                                                                                      NDDS
                                                                                                                      Cardinality




                                                                     LIM.LOCATABLE [1]                                1




                                                                     N/A                                              N/A

                                                                     LIM.ENTRY [1]                                    1



                                                                     LIM.CARE ENTRY [1]                               1

                                                                     LIM.ACTIVITY ENTRY [1]                           1

                                                                     N/A                                              N/A
                                                                     N/A                                              N/A
                                                                     LIM.Participation [0..Many]                      0..Many


                                                                     LIM.Medication Dispense Additional Information   0..1
                                                                     [0..1]

                    [STD20100513] We will look into the
                    incorporation of a 'Event Summary Document
                    Identifier' LIM element (or something similar
                    to this) for events, procedures, medication
                    items, investigations, problem/diagnosis which
                    will capture the Set Identifier and Version
                    Number. The NEHR 'Event Summary Available'
                    can then be derived from the presence of this
                    'Event Summary Document Identifier'.
                  MEDS DISPENSE (MD) - NDDS TEMPLATE
SCM                                      MD IDDS (NHG)


Dispensed Meds                           ORC [1..Many]
                                         RXD [1..Many]
                                         ZXO [0..Many]
                                         ZCO [0..Many]

N/A                                      N/A




N/A                                      N/A

N/A                                      N/A



Dispensed Meds

Dispensed Meds                           ORC [1..Many]
                                         RXD [1..Many]
N/A                                      N/A
N/A                                      N/A
N/A                                      RXD [1..Many]


N/A                                      ZXO [0..Many]
                                         RXD [1..Many]

Filler Order Number [1] (The ancillary   Filler Order Number (ORC-3) [0…1]
reference code)                          - entity identifier (ORC-3.1) [0…1]
[Recommendation: Add new LIM             [Recommendation: Add new LIM element]
element]                                 <L.B.: E6.1.1.1 Medication Order Number>
<L.B.: E6.1.1.1 Medication Order
Number>




Drug Strength [0..1]                    Order Control (ORC-1) [1]
[Recommendation: Add new LIM            [Recommendation: Add new LIM element]
element "Medication Item Strength" <L.B.: E6.1.2.1 Medication Item Status>
for these IDDS elements]
<L.B.: E6.1.3.3.2> Ingredient
Strength. Note that this field can only
be used when the medication
product is single ingredient>
Entered By (ORC-10) [0…Many]
- id number (ORC-10.1) [0…1]
(This refers to pharmacy staff)
[Recommendation: Add new LIM participation
"Entered By"]
<E6.1.2.9 Medication Item Entered By>




Enterer's Location (ORC-13) [0…1]
- point of care (ORC-13) [0…1]
[Recommendation: Add new LIM element "Enterer's
Location"]
<L.B.: E6.1.2.10 Medication Item ENTRY Location>

Date/Time of Transaction (ORC-9) [0…1] (Refers to
new/cancelled/ modified order date/time
[Recommendation: Add new LIM element "Last
Updated DateTime" under Medication Change Details
DG]
<L.B.: E6.1.2.2 Medication Item Update Date>




Dispense to Location (RXD-13) [0…1]
- point of care (RXD-13.1) [1] (refers to location of
pharmacy)
[Recommendation: Add new LIM element "Dispensed
To" under "Medication Set Information" DG]
<L.B.: E6.1.7.6: Dispensed To Location>

Prescription Number (RXD-7) [1]
[Recommendation: Add new LIM element
"Prescription ID" under "Medication Set Information"
DG]
<L.B.: E6.1.1.1 Medication Item Order Number>
[YC 31/3: Filler Order Number.entity identifer (ORC-
3.1) is already mapped to this field as per instruction
above; prescription Number is for medication set.
Recommend that a new LIM element "Medication Set
Number".]
Pharmacist Intervention For Item (ZXO-6) [0…1]
- intervention flag (ZXO-6.1) [1]
[Recommendation: Add new LIM element "Pharmacist
Intervention" under "Medication Item Administer
Details" DG]
<L.B.: E6.1.7.7 Intervention Required Indicator>




Medication Type (ZCO-4) [0…1] (eg outpatient,
inpatient medication)
[Recommendation: Add new LIM element
"Medication Set Type" under "Medication Set
Information" DG]
<L.B. E6.1.2.6 Medication Item Type. Note, I've added
'Medication_Item_Type_VD'

1. Actual Dosage Form (RXD-6) [0…1]
- identifier (RXD-6.1) [1]
2. Dosage (ZXO-8) [0…1]
[Recommendation: create new "Dosage Description"
LIM element]
<L.B. - I have changed E6.1.4.5 Dose Instructions to
Codeable Text, and now this should be mapped to
E6.1.4.5>
Update Date (ZXO-4) [0…1]
[YC: Need furtEHR clarification from IHIS - is it
different from Order Effective Date/Time (ORC-15)]
<L.B.: I assume this maps to E6.1.2.2 Medication Item
Update Date.>

[YC 31/3: IHIS has clarified that this field is NOT always
the same as ORC-15. Recommend that we create a
new LIM.Additional Med Dispense Information
element with Information Type = "Update Date", and
Information Value = ZXO-4]


Actual Strength (RXD-16) [0…1]
Actual Strength Unit (RXD-17) [0…1]
[Recommendation: Add new LIM element
"Medication Item Strength" for these IDDS elements]
<L.B.: E6.1.3.3.2> Ingredient Strength. Note that this
field can only be used when the medication product is
single ingredient>
                                                                             DISCHARGE SUMMARY TEMPLATES
MD IDDS (CGH)                                           ACIDS Phase 2 NDDS


PV1 [0..Many]
ORC [1..Many]
OBX [0..Many]
RXO [0..Many]
RXE [1..Many]
N/A




N/A

N/A




ORC [1..Many]
PV1 [0..Many]
N/A
N/A
N/A


N/A


Filler Order Number (ORC-3) [1]
- entity identifier (ORC-3.1) [1]
- namespace ID (ORC-3.2) [1]
[Recommendation: Add new LIM element]
<L.B.: E6.1.1.1 Medication Order Number. Note, entity
identifier maps to 'Designation' and Namespace ID
maps to 'Realm' - and possibly 'Issuer', depending on
how namespaces are allocated.>



Order Control (ORC-1) [1]
[Recommendation: Add new LIM element]
<L.B.: E6.1.2.1 Medication Item Status>
1. Quantity/Timing (ORC-7) [1]
- end date/time (ORC-7.5) [0…1]
2. Quantity/Timing (RXE-1) [1]
- end date/time (RXE-1.5) [0…1]
[Recommendation: Add new LIM element called
"Collect Stop DateTime" - this field refers to the
datetime that the dispensed medication will run out.]
<L.B.: E6.1.7.5 (Dispensed Quantity Time Interval).End
DateTIme>
Entered By (ORC-10) [1…Many]
- id number (ORC-10.1) [1]
- family name (ORC-10.2) [1]
[Recommendation: Add new LIM element "Entered
By"]
<E6.1.2.9 Medication Item Entered By>
2. Give Code (RXE-2) [1]
- identifier (RXE-2.1) [1]
- description (RXE-2.2) [1]
- ancillary coding standard (RXE-2.3) [1]
[Recommendation: Ignore since this is always the
same as similar fields under Requested Give Code]
<L.B. This still needs to be mapped, even if it maps to
the same thing. Should map to E6.1.3.1 Medicaiton
Name (and its component bits), including id, term,
coding system, mappings>
Value Type (OBX-2) [1]
[Recommendation: Ignore as this is always set to "TX"
(Text Data (Display))]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E5.1.4.2
(Observation Result Value Type) to be consistent with
other institutions]
Observation Result Status (OBX-11) [1]
[Recommendation: Ignore as this is always set to "F"
for Final]
<L.B.: Agreed>
[YC 31/3: Have mapped this instead to E5.1.4.4
(Observation Result Status; is this ok?]
Observation Value (OBX-5) [1] when value of OBX-3 =
"Pharmacy Instructions"
(currently one single text string contains:
- Medication Item Set Connecting Term
- Dose Instructions
- Frequency Qualifier)
[Recommendation: create new LIM text element
"Pharmacy Instructions" under Medication Item, i.e. a
new E6.1.4.1 element]
<L.B. E6.1.4.5 Dosage Instructions.>
<L.B. If tEHRe is any consistency in the pattern in
which Medication Connecting Term is provided, it
would be great to be able to 'Parse' this out, into the
appropriate Data Element. Not sure if this is possible -
depends on how reliable the text pattern is.>

[8/4 YC: Unfortunately, tEHRe is no consistency in the
structure of the text string which would allow us to
parse the relevant data. However, we have now
mapped this field to 'Additional Order Instructions']

Observation Value (OBX-5) [1] when value of OBX-3 =
"Strength"
[Recommendation: Add new LIM element
"Medication Item Strength" for these IDDS elements]
<L.B.: E6.1.3.3.2> Ingredient Strength. Note that this
field can only be used when the medication product is
single ingredient>

Observation Value (OBX-5) (trade product name)
when value of OBX-3 [0..1] = "Brand Name"
[Recommendation: This brand name may be
different from medication name; suggest we create a
new LIM element to track this information]
DISCHARGE SUMMARY TEMPLATES
     ACIDS Goal State NDDS




     LIM.LOCATABLE [1]




     N/A

     LIM.ENTRY [1]



     LIM.CARE ENTRY [1]

     LIM.ACTIVITY ENTRY [1]

     N/A
     N/A
     LIM.Participation [0..Many]


     LIM.Medication Dispense Additional Information
     [0..1]
MEDICATION ADMINISTRATION ENTRY
            LIM ID Ref        LIM Data Item Name

E6                            MEDICATION ADMINISTRATION

     E6.1                     LOCATABLE




     E6.2                     CONTENT ITEM

     E6.3                     ENTRY



     E6.4                     CARE ENTRY

     E6.5                     ACTIVITY ENTRY

     E6.6                     MATERIAL ACTIVITY
     E6.7                     MEDICATION ACTIVITY
     E6.8                     Participation
LIM Data Type   LIM Cardinality

ENTRY           <Undefined>

Class           1




Class           0

Class           1



Class           1

Class           1

Class           0
Class           0
PARTICIPATION   0..Many
LIM Definition                                                     LIM Value Domain

Information pertaining to a single medication that is
administered.
Root class of all information model classes that can be
archetyped, including COMPOSITION, ENTRY, SECTION,
CLUSTER and ELEMENT.

An abstract class of all concrete content types, including ENTRY
and SECTION.
A class that defines the semantics of the core clinical and
administrative information in the EHR.

The abstract parent of all clinical ENTRY subtypes.

Defines a single activity within an Instruction, such as a
medication administration.
Defines a material activity within an Instruction.
Defines a medication activity within an Instruction.
A generic domain concept that defines an association between
an act and an entity (person or organisation) in a healthcare
role.
LIM Format   Other LIM Constraints   LIM Example (for Exchange)
Constraint
LIM Example (for Display)   LIM Comments   LIM Change Log
                  SUMMARY CARE VIEW - NEHR LIST
NEHR Phase Term
1 Core
SUMMARY CARE VIEW - NEHR LIST             MEDICATION HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST
           Definition & Comments   Term
HISTORY (DRILL-DOWN LIST VIEW) - NEHR LIST          MEDICAL ALERT VIEW - NEHR LIST
                   Definition & Comments     Term
MEDICAL ALERT VIEW - NEHR LIST                CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST
               Definition & Comments   Term                     Definition & Comments
       CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
Term                                  Definition & Comments
       RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST
Term                               Definition & Comments
                           DISCHARGE SUMMARY TEMPLATES
ACIDS Phase 2 NDDS   ACIDS Goal State NDDS



                     LIM.LOCATABLE [1]




                     N/A

                     LIM.ENTRY [1]



                     LIM.CARE ENTRY [1]

                     LIM.ACTIVITY ENTRY [1]

                     N/A
                     N/A
                     LIM.Participation [0..Many]
INVESTIGATION ORDER ENTRY

                 LIM ID Ref   LIM Data Item Name


E7                            INVESTIGATION ORDER




     E7.1                     LOCATABLE




     E7.2                     CONTENT ITEM


     E7.3                     ENTRY




     E7.4                     CARE ENTRY


     E7.5                     INSTRUCTION ENTRY




     E7.6                     ORDER ENTRY

     E7.7                     Participation
LIM Data Type   LIM Cardinality   LIM Definition


ENTRY           <Undefined>       Each relevant investigations performed on the
                                  patient during the healthcare event, as individual
                                  result entries.

Class           1                 Root class of all information model classes that
                                  can be archetyped, including COMPOSITION,
                                  ENTRY, SECTION, CLUSTER and ELEMENT.

Class           0                 An abstract class of all concrete content types,
                                  including ENTRY and SECTION.
Class           1                 A class that defines the semantics of the core
                                  clinical and administrative information in the EHR.



Class           1                 The abstract parent of all clinical ENTRY subtypes.


Class           0                 Used for any actionable statement such as
                                  medication and therapeutic orders,
                                  monitoring, recall and review. Enough details must
                                  be provided for the specification
                                  to be directly executed by an actor, either human
                                  or machine.
Class           1                 Defines an order entry within an instruction.

PARTICIPATION   0..Many           A generic domain concept that defines an
                                  association between an act and an entity (person
                                  or organisation) in a healthcare role.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)
LIM Comments   LIM Change Log   NEHR Phase
                                1 Core
       SUMMARY CARE VIEW - NEHR LIST


Term                     Definition & Comments
UNMAPPED                                UNMAPPED
Investigation.Event Summary Available   [STD20100513] We will look into the
                                        incorporation of a 'Event Summary
                                        Document Identifier' LIM element (or
                                        something similar to this) for events,
                                        procedures, medication items,
                                        investigations, problem/diagnosis which will
                                        capture the Set Identifier and Version
                                        Number. The NEHR 'Event Summary
                                        Available' can then be derived from the
                                        presence of this 'Event Summary Document
                                        Identifier'.
       INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST


Term                           Definition & Comments
UNMAPPED                                UNMAPPED
Investigation.Ordering Institution




Investigation.Event Summary Available   [STD20100513] We will look into the
                                        incorporation of a 'Event Summary Document
                                        Identifier' LIM element (or something similar
                                        to this) for events, procedures, medication
                                        items, investigations, problem/diagnosis
                                        which will capture the Set Identifier and
                                        Version Number. The NEHR 'Event Summary
                                        Available' can then be derived from the
                                        presence of this 'Event Summary Document
                                        Identifier'.
       LAB REPORT - NEHR LIST


Term            Definition & Comments
UNMAPPED                             UNMAPPED
Investigation.Ordering Institution
       RADIOLOGY REPORT - NEHR LIST


Term
UNMAPPED
Investigation.Ordering Institution
RADIOLOGY REPORT - NEHR LIST


   Definition & Comments
UNMAPPED
LAB NDDS             Lab NDDS
                     Cardinality




LIM.LOCATABLE [1]    1




N/A                  N/A


LIM.ENTRY [1]        1




LIM.CARE ENTRY [1]   1


N/A                  N/A
SCM




N/A




N/A


N/A




Laboratory


N/A
UNMAPPED
                                                                                                  LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)




N/A




N/A


N/A




OBR [1..Many]


N/A




FIELDS FOR IHIS ATTENTION/CLARIFICATION
Observation Value (OBX-5) [1] when Observation Identifier [1].catalog id (OBX-3.1) [1] = "HISTOPATHOLOGY
KKH"
Observation Value (OBX-5) [1] when Observation Identifier [1].catalog id (OBX-3.1) [1] = "CYTOLOGY KKH"




UNMAPPED




Quantity/Timing (OBR-27) [1]
- quantity (OBR-27.1) [1]
[Recommendation: Ignore since this is always a fixed value of "1"]

- duration (OBR-27.3) [1]
[Recommendation: Ignore since this is always a fixed value of "0"]




Action By (ORC-19) [0..1]
- ID Number (ORC-19.1) [1]
- Full Name (ORC-19.2) [1]

[MOHH20100527] IHIS to confirm what role this person has, e.g. clinical (performs the test), administrative
(change the order control code), etc.

Order Control (ORC-1) [1]
Order Control Code Reason (ORC-16) [0..1]
- identifier (ORC-16.1) [1]
- text (ORC-16.2) [1]



Entering Device (ORC-18) [0..1]
- identifier (ORC-18.1) [1]
- text (ORC-18.2) [1]
LABORATORY - NDDS TEMPLATE


         LAB IDDS (SGH)




         N/A




         N/A


         N/A




         OBR [1..Many]


         N/A




         FIELDS FOR IHIS ATTENTION/CLARIFICATION
         Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-3.1) [1] =
         "HISTOPATHOLOGY SGH"
Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-3.1) [1] =
"CYTOLOGY NEW SGH"




UNMAPPED
LAB IDDS (CGH)




ORC [1..Many]




N/A


N/A




OBR [1..Many]


N/A




FIELDS FOR IHIS ATTENTION/CLARIFICATION
Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-
3.1) [1] = "HISTOPATHOLOGY CGH"
Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-
3.1) [1] = "CYTOLOGY NEW CGH"




UNMAPPED




Diagnostic Serv Sect ID (OBR-24) [0..1]
- discipline short text (OBR-24.1)
- discipline number (OBR-24.2)
- chapter number (OBR-24.3)
- printing index number (OBR-24.4)

[28/4 YC: Linda, it appears that we can't map even OBR-24.1 to LIM.Investigation
SubType as OBR-24.1 has values that map to LIM.Investigation Type as well (e.g.
"LAB"). I'm unsure whether we need to create dedicated LIM elements to map
the 4 components above to.
Enterer's Location (ORC-13) [0..1]
- Location code (ORC-13.1) [1]
- Room (ORC-13.2) [1]
- Location description (ORC-13.5) [1]
LAB IDDS (NHG)




N/A




N/A


N/A




OBR [1..Many]


N/A
UNMAPPED




Diagnostic Serv Sect ID (OBR-24) [1]
- Lab Type (OBR-24.1)
- Discipline (OBR-24.2)
- Chapter (OBR-24.3)
- Print Index (OBR-24.4)

[28/4 YC: Linda, although we don't have the complete value domain for OBR-
24.1 in the IDDS, I suspect that the possible values are a mix of both
LIM.Investigation Type and LIM.Investigation SubType. I'm unsure whether we
need to create dedicated LIM elements to map the 4 components above to.
RAD NDDS             Radiology NDDS
                     Cardinality




LIM.LOCATABLE [1]    1




N/A                  N/A


LIM.ENTRY [1]        1




LIM.CARE ENTRY [1]   1


N/A                  N/A
SCM




N/A




N/A


N/A




Radiology


N/A
UNMAPPED
                 RADIO


RAD IDDS (KKH)




ORC [0..Many]




N/A


OBR [1..Many]
ORC [0..Many]
NTE [0..Many]


OBR [1..Many]
OBX [0..Many]
N/A
NOTES FOR MOHH USE ONLY
Specimen Source (OBR-15) [0..1]

This field wil be ignored as it is hardcoded.
                 RADIOLOGY (RAD) - NDDS TEMPLATE


RAD IDDS (SGH)




N/A




N/A


N/A




OBR [1..Many]
OBX [0..Many]
N/A
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]
IOLOGY (RAD) - NDDS TEMPLATE


                  RAD IDDS (CGH)




                  ORC [1..Many]




                  N/A


                  N/A




                  OBR [1..Many]
                  OBX [0..Many]
                  N/A
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]
RAD IDDS (NHG)




ORC [0..Many]
ZOR [0..Many]


N/A


OBR [1..Many]




OBR [1..Many]


N/A




FIELDS FOR IHIS ATTENTION/CLARIFICATION
Exam Procedure Component ID (ZEX-4) [0..1]

AH: "technical";
NUH: "profession";
TTSH: "profession", "NOCHG", "technical", "Global"

[MOHH 28042010] Please give the definition of this element (e.g. how it is used) so that we can determine how best to map
it to the LIM.
Exam Indications (ZEX-6) [0..1]
(free text)
TTSH: "5 pt chg appt frm 2/6", "2 s2a", "25 w12d/b128 op ward req"

[MOHH 28042010] IHIS has previously clarified that this is field consists of free-text remarks used by staff and is not relevant
for external use. Nevertheless, as the LIM is meant to capture all the information currently being exchanged in HL7
messages, we need to understand the definition (e.g. purpose) of this element so that we can map it to the LIM accordingly.
Please give the definition (e.g. purpose) of this element.
Order CLUSTER (ZOR-4) [0..1]

"1" [TTSH]

[MOHH 28042010] IHIS has earlier shared that this is the CLUSTER hospital interface code which is "1". This is not the
organisation of the Requesting Clinician. As the LIM is meant to capture all the information currently being exchanged in HL7
messages, we need to understand the definition (e.g. purpose) of this element so that we can map it to the LIM accordingly.
Please give the definition (e.g. purpose) of this element.
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation Result General Information" DG.]




Filler Field 1 (OBR-20) [0..3]

[Recommendation: Add new LIM.Procedure Modifier [0..3] element under "Investigation Result General Information" DG.
IHIS has only clarified that this is a procedure repeated subsequent to the original procedure.]




Results Rpt/Status Chng - Date/Time (OBR-22) [0..1]

[Recommendation: Add new LIM.Request Status Update DateTime element under "Request Information" DG, as this
element stores the date/time of the order status change]



Entered By (ORC-10) [0..1]

[Recommendation: Add new LIM.Entered By element under "Request Information" DG - this may differ from existing
LIM.Performing Clinician element.]
Order Control Code Reason (ORC-16) [0..1]

[Recommendation: Ignore since IHIS has clarified that this is a RIS-specific application event code]



Transcriptionist (OBR-35) [0..1]
- Transcriptionist Code (OBR-35.1) [0..1] (identifier)
- Last Name (OBR-35.2) [0..1] (complete name)

[Recommendation: Add new LIM.Transcriptionist under "Request Information" DG]
Technician (OBR-34) [0..1]
- Interface Code (OBR-34.1) [0..1] (identifier.designation)
- Last Name (OBR-34.2) [0..1] (complete name)

[Recommendation: Change LIM element 'Performing Clinician' to 'Performed By' with cardinality [0..Many]]

Assistant Result Interpreter (OBR-33) [0..1]
- ID Value (OBR-33.1) [0..1]
= LIM.Participant Identifier.Designation
- Last Name (OBR-33.2) [0..1]
= LIM.Person Name
- Suffix (OBR-33.5) [0..1]
= LIM.Person Name.Tiltle?
- Prefix (OBR-33.6) [0..1]
= LIM.Person Name.Tiltle?
[Recommendation: Change LIM element 'Performing Clinician' to 'Performed By' with cardinality [0..Many]]
Order Internal ID (ZOR-2) [0..1]
(stores the RIS Internal Order ID)

This field is different from placer order and filler order number -> unmapped.

[Recommendation: Change cardinality of LIM.Request Identifier to 0..2 to cater for existing (external) ID (i.e. placer order
number) and this internal ID]
Ordering Physician Office (ZOR-6) [0..1]

This field is used as Ordering Room id, e.g. 'T12754Z', 'TP6375J' -> unmapped

[MOHH 14042010] This is apparently the office ID of the office where the order was entered, based on IHIS clarification.
Recommend adding a new LIM.Request Entered Location [0..1] element under "Request Information" DG.
Patient Mobility For Order (ZOR-11) [0..1]

(free text)
e.g. NUH & TTSH: "WHEELCHAIR", "TROLLEY", "PORTABLE", "WALK", "WHEELCHAIRWITHNURSE"

[Recommendation: Add new LIM.Patient Mobility for Order element]
Result Report Appendix Number (ZBX-2) [0..1]

E.g. "0", "1" -> unmapped

[Recommendation: Add new LIM.Result Report Appendix Number element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix Status (ZBX-3) [0..1]

E.g. "APRV", "TRANS", "RAPRV"

[Recommendation: Add new LIM.Result Report Appendix Status element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix Normal Flag (ZBX-4) [0..1]

E.g. "Y", "N"

[Recommendation: Add new LIM.Result Report Appendix Normal Flag element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix
Dictated Timestamp (ZBX-5) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Transcribed Timestamp (ZBX-6) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Resident Timestamp (ZBX-7) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Approved Timestamp (ZBX-8) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Report Appendix Dictating
Physician (ZBX-9) [0..1]
- Radiologist Code (ZBX-9.1) [1]
- Last Name (ZBX-9.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Appendix
Transcriptionist (ZBX-10) [0..1]
- Transcriptionist Code (ZBX-10.1) [1]
- Last Name (ZBX-10.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Resident Physician (ZBX-11) [0..1]
- Physician ID (ZBX-11.1) [1]
- Last Name (ZBX-11.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Staff Physician (ZBX-12) [0..1]
- Physician ID (ZBX-12.1) [1]
- Last Name (ZBX-12.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Approving Physician (ZBX-13) [0..1]
- Dictating Doctor (13.1) [1]
- Last Name (13.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Exam Cancelled Timestamp (ZEX-10) [0..1]

[Recommendation: Add new LIM.Cancellation DateTime element] under "Investigation Result Dates" DG]
Exam Arrived Timestamp (ZEX-11) [0..1]

[Recommendation: Add new LIM.Arrival DateTime element] under "Investigation Result Dates" DG.]
Exam Resident Timestamp (ZEX-13) [0..1]

[Recommendation: Add new LIM.Resident DateTime element] under "Investigation Result Dates" DG. This is the datetime a
draft of the report was completed by a resident clinician.]
Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request Information" DG as the value domain differs from
OBR-25 (Result Status)]
Enterer's Location (ORC-13) [0..1]

Examples:
NUH: "NW88", "NADDI", "NCKSUR";
TTSH: "TW09A", "TCSOCK", "b1a" - radiology

[Recommendation: IHIS has clarified that this is not the same as PV1-3 (Assigned Patient Location) -- PV1-3 refers to an
inpatient location. As such, we recommend adding a new element LIM.Requester Location under "Request Information" DG.]
RAD IDDS (NHGP)




N/A




N/A


N/A




OBR [0..Many]


N/A
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]




Entering Organisation (ORC-17) [1]

[Refers to Ordering OU] [need to add as new LIM element]

[Recommendation: Add new LIM.Entered By element under "Request
Information" DG - this may differ from existing LIM.Performing Clinician
element.]
Technician (OBR-34) [0..1]
- (OBR-34.1) [0..1]
= LIM.Participant Identifier.Designation
- (OBR-34.2) [0..1]
= LIM.Person Name
[Recommendation: Change LIM element 'Performing Clinician' to
'Performed By' with cardinality [0..Many]]
Principal Result Interpreter (OBR-32) [0..1]
- ID number (OBR-32.1)
- Family Name & Last Name Prefix (OBR-32.2)

[Recommendation: Add a new HPI LIM.other Participant [0..Many] element to
capture this]
Dictation Date/Time (ZBX-5) [0..1]

[Recommendation: Add new LIM.Dictation DateTime element] under
"Investigation Result Dates" DG.]

Transcribed Date/Time (ZBX-6) [0..1]
Transcribed Date/Time (ZEX-12) [0..1]

[Recommendation: IHIS has clarified that the 2 elements above are
identical. We should add new LIM.Transcription DateTime element] under
"Investigation Result Dates" DG.]
Exam Status (ZEX-8) [0..1]
- Code (ZEX-8.1) [0..1]
- Description (ZEX-8.2) [0..1]

(same meaning as OBX-11 but use different set of codes)

[14/4 YC: Linda, if a ZEX-8 has a different value domain from OBX-11, can we
still map it to LIM.Result Status, but indicate somehow that some form of
mapping will need to be done from the ZEX-8 value domain to the OBX-11
value domain?]
                        DISCHARGE SUMMARY TEMPLATES


ACIDS Goal State NDDS




LIM.LOCATABLE [1]




N/A


LIM.ENTRY [1]




LIM.CARE ENTRY [1]


N/A
UNMAPPED
INVESTIGATION ACTIVITY ENTRY

                   LIM ID Ref   LIM Data Item Name


E8                              INVESTIGATION ACTIVITY




     E8.1                       LOCATABLE




     E8.2                       CONTENT ITEM

     E8.3                       ENTRY




     E8.4                       CARE ENTRY

     E8.5                       ACTIVITY ENTRY


     E8.6                       PROCEDURE ACTIVITY

     E8.7                       OBSERVATION ENTRY


     E8.8                       PROPERTY OBSERVATION

     E8.9                       Participation


     E8.10                      Structured Test Results
                                (Laboratory Test)
     E8.11                      Investigation Interpretation

     E8.12                      Investigation Dates

     E8.13                      Investigation Additional
                                Information
LIM Data Type       LIM Cardinality   LIM Definition


ENTRY               <Undefined>       Each relevant investigations performed on the
                                      patient during the healthcare event.




Class               1                 Root class of all information model classes that can
                                      be archetyped, including COMPOSITION, ENTRY,
                                      SECTION, CLUSTER and ELEMENT.

Class               0                 An abstract class of all concrete content types,
                                      including ENTRY and SECTION.
Class               1                 A class that defines the semantics of the core
                                      clinical and administrative information in the EHR.



Class               1                 The abstract parent of all clinical ENTRY subtypes.

Class               1                 Defines a single activity within an Instruction, such
                                      as a medication administration.

Class               1                 Defines a procedure activity within an Instruction.

Class               0..Many           Information and Results about the individual test
                                      observations that were made.

Class               1                 An observation that assigns values to specific
                                      properties.
PARTICIPATION       0..Many           A generic domain concept that defines an
                                      association between an act and an entity (person or
                                      organisation) in a healthcare role.
OBSERVATION ENTRY   0..Many           The test results of each individual test of a
                                      laboratory panel.
CLINICAL SYNOPSIS   0..Many           Clinical interpretation of the observation results.

CLUSTER             1                 Additional dates associated with the investigation.

CLUSTER             1                 Additional information about the Investigation
                                      Order.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
                                   SUMMARY CARE VIEW - NEHR LIST


LIM Change Log   NEHR Phase Term
                 1 Core

                 Yes




                 Yes




                 Yes

                 Yes
UNMAPPED
Investigation.Event Summary Available
SUMMARY CARE VIEW - NEHR LIST                    INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST


                  Definition & Comments   Term
UNMAPPED                                     UNMAPPED
[STD20100513] We will look into the          Investigation.Ordering Institution
incorporation of a 'Event Summary
Document Identifier' LIM element (or
something similar to this) for events,
procedures, medication items,
investigations, problem/diagnosis which will
capture the Set Identifier and Version
Number. The NEHR 'Event Summary
Available' can then be derived from the
presence of this 'Event Summary Document
Identifier'.
                                             Investigation.Event Summary Available
TIGATIONS (DRILL-DOWN LIST) - NEHR LIST           LAB REPORT - NEHR LIST


                   Definition & Comments   Term
UNMAPPED                                        UNMAPPED
                                                Investigation.Ordering Institution




[STD20100513] We will look into the
incorporation of a 'Event Summary Document
Identifier' LIM element (or something similar
to this) for events, procedures, medication
items, investigations, problem/diagnosis
which will capture the Set Identifier and
Version Number. The NEHR 'Event Summary
Available' can then be derived from the
presence of this 'Event Summary Document
Identifier'.
LAB REPORT - NEHR LIST                  RADIOLOGY REPORT - NEHR LIST


         Definition & Comments   Term
UNMAPPED   UNMAPPED
           Investigation.Ordering Institution
RADIOLOGY REPORT - NEHR LIST


   Definition & Comments
UNMAPPED
LAB NDDS                                      Lab NDDS
                                              Cardinality




LIM.OBSERVATION ENTRY [1]                     1




LIM.Investigation Dates [1]                   1

LIM.Investigation Additional Information[1]   1
SCM


Lab




Lab




Lab

Lab
UNMAPPED
                            LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)


PV1 [0..1]
OBR [1..Many]
ORC [1..Many]
{OBX [0..Many]} [0..Many]
{NTE [0..Many]} [0..Many]




OBX [0..Many]




OBX [0..Many]

OBX [0..Many]
FIELDS FOR IHIS ATTENTION/CLARIFICATION
Observation Value (OBX-5) [1] when Observation Identifier [1].catalog id (OBX-3.1) [1] = "HISTOPATHOLOGY
KKH"




Observation Value (OBX-5) [1] when Observation Identifier [1].catalog id (OBX-3.1) [1] = "CYTOLOGY KKH"




UNMAPPED




Quantity/Timing (OBR-27) [1]
- quantity (OBR-27.1) [1]
[Recommendation: Ignore since this is always a fixed value of "1"]

- duration (OBR-27.3) [1]
[Recommendation: Ignore since this is always a fixed value of "0"]




Action By (ORC-19) [0..1]
- ID Number (ORC-19.1) [1]
- Full Name (ORC-19.2) [1]

[MOHH20100527] IHIS to confirm what role this person has, e.g. clinical (performs the test), administrative
(change the order control code), etc.
Order Control (ORC-1) [1]




Order Control Code Reason (ORC-16) [0..1]
- identifier (ORC-16.1) [1]
- text (ORC-16.2) [1]



Entering Device (ORC-18) [0..1]
- identifier (ORC-18.1) [1]
- text (ORC-18.2) [1]
LABORATORY - NDDS TEMPLATE


         LAB IDDS (SGH)


         OBR [1..Many]
         ORC [1..Many]
         {OBX [0..Many]} [0..Many]
         {NTE [0..Many]} [0..Many]




         N/A




         N/A

         N/A
FIELDS FOR IHIS ATTENTION/CLARIFICATION
Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-3.1) [1] =
"HISTOPATHOLOGY SGH"




Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-3.1) [1] =
"CYTOLOGY NEW SGH"




UNMAPPED
LAB IDDS (CGH)


OBR [1..Many]
ORC [1..Many]
{OBX [0..Many]} [0..Many]
{NTE [0..Many]} [0..Many]
ORC [1..Many]




ORC [1..Many]
OBR [1..Many]




ORC [1..Many]
OBR [1..Many]
ORC [1..Many]
OBR [1..Many]
FIELDS FOR IHIS ATTENTION/CLARIFICATION
Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-
3.1) [1] = "HISTOPATHOLOGY CGH"




Observation Value (OBX-5) [0..1] when Observation Identifier [1].identifier (OBX-
3.1) [1] = "CYTOLOGY NEW CGH"




UNMAPPED




Diagnostic Serv Sect ID (OBR-24) [0..1]
- discipline short text (OBR-24.1)
- discipline number (OBR-24.2)
- chapter number (OBR-24.3)
- printing index number (OBR-24.4)

[28/4 YC: Linda, it appears that we can't map even OBR-24.1 to LIM.Investigation
SubType as OBR-24.1 has values that map to LIM.Investigation Type as well (e.g.
"LAB"). I'm unsure whether we need to create dedicated LIM elements to map
the 4 components above to.
Enterer's Location (ORC-13) [0..1]
- Location code (ORC-13.1) [1]
- Room (ORC-13.2) [1]
- Location description (ORC-13.5) [1]
LAB IDDS (NHG)


OBR [1..Many]
ORC [1..Many]
{OBX [0..Many]} [0..Many]
{NTE [0..Many]} [0..Many]




OBR [1..Many]




OBR [1..Many]

OBR [1..Many]
UNMAPPED




Diagnostic Serv Sect ID (OBR-24) [1]
- Lab Type (OBR-24.1)
- Discipline (OBR-24.2)
- Chapter (OBR-24.3)
- Print Index (OBR-24.4)

[28/4 YC: Linda, although we don't have the complete value domain for OBR-
24.1 in the IDDS, I suspect that the possible values are a mix of both
LIM.Investigation Type and LIM.Investigation SubType. I'm unsure whether we
need to create dedicated LIM elements to map the 4 components above to.
RAD NDDS                                       Radiology NDDS
                                               Cardinality




LIM.OBSERVATION ENTRY [1]                      1




LIM.Investigation Dates[1]                     1

LIM.Investigation Additional Information [1]   1
SCM


Radiology




Radiology




Radiology

Radiology
UNMAPPED
                            RADIO


RAD IDDS (KKH)


ORC [0..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]
NTE [0..Many]




ORC [0..Many]
OBR [1..Many]
NTE [0..Many]




ORC [0..Many]
OBR [1..Many]
ORC [0..Many]
OBR [1..Many]
NTE [0..Many]
NOTES FOR MOHH USE ONLY
Specimen Source (OBR-15) [0..1]

This field wil be ignored as it is hardcoded.
                            RADIOLOGY (RAD) - NDDS TEMPLATE


RAD IDDS (SGH)


ORC [1..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]




ORC [1..Many]
OBR [1..Many]




ORC [1..Many]
OBR [1..Many]
ORC [1..Many]
OBR [1..Many]
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]
IOLOGY (RAD) - NDDS TEMPLATE


                  RAD IDDS (CGH)


                  ORC [1..Many]
                  OBR [1..Many]
                  {OBX [0..Many]} [0..Many]




                  ORC [1..Many]
                  OBR [1..Many]




                  ORC [1..Many]
                  OBR [1..Many]
                  ORC [1..Many]
                  OBR [1..Many]
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]
RAD IDDS (NHG)


ORC [0..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]
ZEX [0..Many]
ZOR [0..Many]
ZBX [0..Many]




ORC [0..Many]
OBR [1..Many]




ORC [0..Many]
OBR [1..Many]
ORC [0..Many]
OBR [1..Many]
FIELDS FOR IHIS ATTENTION/CLARIFICATION
Exam Procedure Component ID (ZEX-4) [0..1]

AH: "technical";
NUH: "profession";
TTSH: "profession", "NOCHG", "technical", "Global"

[MOHH 28042010] Please give the definition of this element (e.g. how it is used) so that we can determine how best to map
it to the LIM.
Exam Indications (ZEX-6) [0..1]
(free text)
TTSH: "5 pt chg appt frm 2/6", "2 s2a", "25 w12d/b128 op ward req"

[MOHH 28042010] IHIS has previously clarified that this is field consists of free-text remarks used by staff and is not relevant
for external use. Nevertheless, as the LIM is meant to capture all the information currently being exchanged in HL7
messages, we need to understand the definition (e.g. purpose) of this element so that we can map it to the LIM accordingly.
Please give the definition (e.g. purpose) of this element.
Order CLUSTER (ZOR-4) [0..1]

"1" [TTSH]

[MOHH 28042010] IHIS has earlier shared that this is the CLUSTER hospital interface code which is "1". This is not the
organisation of the Requesting Clinician. As the LIM is meant to capture all the information currently being exchanged in HL7
messages, we need to understand the definition (e.g. purpose) of this element so that we can map it to the LIM accordingly.
Please give the definition (e.g. purpose) of this element.
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation Result General Information" DG.]




Filler Field 1 (OBR-20) [0..3]

[Recommendation: Add new LIM.Procedure Modifier [0..3] element under "Investigation Result General Information" DG.
IHIS has only clarified that this is a procedure repeated subsequent to the original procedure.]




Results Rpt/Status Chng - Date/Time (OBR-22) [0..1]

[Recommendation: Add new LIM.Request Status Update DateTime element under "Request Information" DG, as this
element stores the date/time of the order status change]
Entered By (ORC-10) [0..1]

[Recommendation: Add new LIM.Entered By element under "Request Information" DG - this may differ from existing
LIM.Performing Clinician element.]



Order Control Code Reason (ORC-16) [0..1]

[Recommendation: Ignore since IHIS has clarified that this is a RIS-specific application event code]



Transcriptionist (OBR-35) [0..1]
- Transcriptionist Code (OBR-35.1) [0..1] (identifier)
- Last Name (OBR-35.2) [0..1] (complete name)

[Recommendation: Add new LIM.Transcriptionist under "Request Information" DG]
Technician (OBR-34) [0..1]
- Interface Code (OBR-34.1) [0..1] (identifier.designation)
- Last Name (OBR-34.2) [0..1] (complete name)

[Recommendation: Change LIM element 'Performing Clinician' to 'Performed By' with cardinality [0..Many]]

Assistant Result Interpreter (OBR-33) [0..1]
- ID Value (OBR-33.1) [0..1]
= LIM.Participant Identifier.Designation
- Last Name (OBR-33.2) [0..1]
= LIM.Person Name
- Suffix (OBR-33.5) [0..1]
= LIM.Person Name.Tiltle?
- Prefix (OBR-33.6) [0..1]
= LIM.Person Name.Tiltle?
[Recommendation: Change LIM element 'Performing Clinician' to 'Performed By' with cardinality [0..Many]]
Order Internal ID (ZOR-2) [0..1]
(stores the RIS Internal Order ID)

This field is different from placer order and filler order number -> unmapped.

[Recommendation: Change cardinality of LIM.Request Identifier to 0..2 to cater for existing (external) ID (i.e. placer order
number) and this internal ID]
Ordering Physician Office (ZOR-6) [0..1]

This field is used as Ordering Room id, e.g. 'T12754Z', 'TP6375J' -> unmapped

[MOHH 14042010] This is apparently the office ID of the office where the order was entered, based on IHIS clarification.
Recommend adding a new LIM.Request Entered Location [0..1] element under "Request Information" DG.
Patient Mobility For Order (ZOR-11) [0..1]

(free text)
e.g. NUH & TTSH: "WHEELCHAIR", "TROLLEY", "PORTABLE", "WALK", "WHEELCHAIRWITHNURSE"

[Recommendation: Add new LIM.Patient Mobility for Order element]
Result Report Appendix Number (ZBX-2) [0..1]

E.g. "0", "1" -> unmapped

[Recommendation: Add new LIM.Result Report Appendix Number element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix Status (ZBX-3) [0..1]

E.g. "APRV", "TRANS", "RAPRV"

[Recommendation: Add new LIM.Result Report Appendix Status element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix Normal Flag (ZBX-4) [0..1]

E.g. "Y", "N"

[Recommendation: Add new LIM.Result Report Appendix Normal Flag element under a new "Investigation Result Appendix
Information" DG]
Result Report Appendix
Dictated Timestamp (ZBX-5) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Transcribed Timestamp (ZBX-6) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Resident Timestamp (ZBX-7) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Approved Timestamp (ZBX-8) [0..1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Report Appendix Dictating
Physician (ZBX-9) [0..1]
- Radiologist Code (ZBX-9.1) [1]
- Last Name (ZBX-9.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Appendix
Transcriptionist (ZBX-10) [0..1]
- Transcriptionist Code (ZBX-10.1) [1]
- Last Name (ZBX-10.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Resident Physician (ZBX-11) [0..1]
- Physician ID (ZBX-11.1) [1]
- Last Name (ZBX-11.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Staff Physician (ZBX-12) [0..1]
- Physician ID (ZBX-12.1) [1]
- Last Name (ZBX-12.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Result Report Appendix
Approving Physician (ZBX-13) [0..1]
- Dictating Doctor (13.1) [1]
- Last Name (13.2) [1]

[Recommendation: Add new LIM element under a new "Investigation Result Appendix Information" DG]
Exam Cancelled Timestamp (ZEX-10) [0..1]

[Recommendation: Add new LIM.Cancellation DateTime element] under "Investigation Result Dates" DG]
Exam Arrived Timestamp (ZEX-11) [0..1]

[Recommendation: Add new LIM.Arrival DateTime element] under "Investigation Result Dates" DG.]
Exam Resident Timestamp (ZEX-13) [0..1]

[Recommendation: Add new LIM.Resident DateTime element] under "Investigation Result Dates" DG. This is the datetime a
draft of the report was completed by a resident clinician.]
Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request Information" DG as the value domain differs from
OBR-25 (Result Status)]
Enterer's Location (ORC-13) [0..1]

Examples:
NUH: "NW88", "NADDI", "NCKSUR";
TTSH: "TW09A", "TCSOCK", "b1a" - radiology

[Recommendation: IHIS has clarified that this is not the same as PV1-3 (Assigned Patient Location) -- PV1-3 refers to an
inpatient location. As such, we recommend adding a new element LIM.Requester Location under "Request Information" DG.]
RAD IDDS (NHGP)


ORC [0..Many]
OBR [0..Many]
{OBX [0..Many]} [0..Many]
ZBX [0..1]
ZEX [0..1]
ZOR [0..1]




ORC [0..Many]
OBR [0..Many]




ORC [0..Many]
OBR [0..Many]
ORC [0..Many]
OBR [0..Many]
UNMAPPED
Order Control (ORC-1) [1]

[Recommendation: Add new LIM.Result Type element under "Investigation
Result General Information" DG.]




Order Status (ORC-5) [0..1]

[Recommendation: Add new LIM.Request Status element under "Request
Information" DG as the value domain differs from OBR-25 (Result Status)]




Entering Organisation (ORC-17) [1]

[Refers to Ordering OU] [need to add as new LIM element]

[Recommendation: Add new LIM.Entered By element under "Request
Information" DG - this may differ from existing LIM.Performing Clinician
element.]
Technician (OBR-34) [0..1]
- (OBR-34.1) [0..1]
= LIM.Participant Identifier.Designation
- (OBR-34.2) [0..1]
= LIM.Person Name
[Recommendation: Change LIM element 'Performing Clinician' to
'Performed By' with cardinality [0..Many]]
Principal Result Interpreter (OBR-32) [0..1]
- ID number (OBR-32.1)
- Family Name & Last Name Prefix (OBR-32.2)

[Recommendation: Add a new HPI LIM.other Participant [0..Many] element to
capture this]
Dictation Date/Time (ZBX-5) [0..1]

[Recommendation: Add new LIM.Dictation DateTime element] under
"Investigation Result Dates" DG.]

Transcribed Date/Time (ZBX-6) [0..1]
Transcribed Date/Time (ZEX-12) [0..1]

[Recommendation: IHIS has clarified that the 2 elements above are
identical. We should add new LIM.Transcription DateTime element] under
"Investigation Result Dates" DG.]
Exam Status (ZEX-8) [0..1]
- Code (ZEX-8.1) [0..1]
- Description (ZEX-8.2) [0..1]

(same meaning as OBX-11 but use different set of codes)

[14/4 YC: Linda, if a ZEX-8 has a different value domain from OBX-11, can we
still map it to LIM.Result Status, but indicate somehow that some form of
mapping will need to be done from the ZEX-8 value domain to the OBX-11
value domain?]
                        DISCHARGE SUMMARY TEMPLATES


ACIDS Goal State NDDS




LIM.OBSERVATION ENTRY [1]




LIM.Investigation Dates [1]

LIM.Investigation Additional Information [1]
UNMAPPED
LABORATORY TEST ENTRY

            LIM ID Ref   LIM Data Item Name


E9                       LABORATORY TEST

     E9.1                LOCATABLE


     E9.2                CONTENT ITEM


     E9.3                ENTRY



     E9.4                CARE ENTRY

     E9.5                OBSERVATION ENTRY




     E9.6                PROPERTY OBSERVATION

     E9.7                Participation
LIM Data Type       LIM Cardinality   LIM Definition


OBSERVATION ENTRY   <Undefined>       Result findings about an individual laboratory test
                                      observation.
Class               0                 Root class of all information model classes that can be
                                      archetyped, including COMPOSITION, ENTRY, SECTION,
                                      CLUSTER and ELEMENT.
Class               0                 An abstract class of all concrete content types, including ENTRY
                                      and SECTION.
Class               1                 A class that defines the semantics of the core clinical and
                                      administrative information in the EHR.


Class               1                 The abstract parent of all clinical ENTRY subtypes.

Class               0                 ENTRY type for evaluation statements. Used for all kinds of
                                      statements which evaluate other information, such as
                                      interpretations of obvservations, diagnoses, differential
                                      diagnoses, hypotheses, risk assessments, goals and plans.

Class               1                 An observation that assigns values to specific properties.

PARTICIPATION       0..Many           A generic domain concept that defines an association between
                                      an act and an entity (person or organisation) in a healthcare
                                      role.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
                                   SUMMARY CARE VIEW - NEHR LIST


LIM Change Log   NEHR Phase Term
                 1 Core

                 Yes
RY CARE VIEW - NEHR LIST                   INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST


            Definition & Comments   Term
ONS (DRILL-DOWN LIST) - NEHR LIST           LAB REPORT - NEHR LIST


             Definition & Comments   Term
LAB REPORT - NEHR LIST                  RADIOLOGY REPORT - NEHR LIST


         Definition & Comments   Term
RADIOLOGY REPORT - NEHR LIST


   Definition & Comments
LAB NDDS   Lab NDDS
           Cardinality




N/A        N/A
SCM


Lab




N/A
                 LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)


PV1 [0..1]
OBR [1..Many]
ORC [1..Many]
LABORATORY - NDDS TEMPLATE


         LAB IDDS (SGH)


         OBR [1..Many]
         ORC [1..Many]
         {OBX [0..Many]} [0..Many]
LAB IDDS (CGH)


OBR [1..Many]
ORC [1..Many]
{OBX [0..Many]} [0..Many]
LAB IDDS (NHG)


OBR [1..Many]
ORC [1..Many]
{OBX [0..Many]} [0..Many]
RAD NDDS   Radiology NDDS
           Cardinality
SCM


Radiology
                            RA


RAD IDDS (KKH)


ORC [0..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]
                            RADIOLOGY (RAD) - NDDS TEMPLATE


RAD IDDS (SGH)


ORC [1..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]
RAD) - NDDS TEMPLATE


           RAD IDDS (CGH)


           ORC [1..Many]
           OBR [1..Many]
           {OBX [0..Many]} [0..Many]
RAD IDDS (NHG)


ORC [0..Many]
OBR [1..Many]
{OBX [0..Many]} [0..Many]
RAD IDDS (NHGP)


ORC [0..Many]
OBR [0..Many]
{OBX [0..Many]} [0..Many]
                        DISCHARGE SUMMARY TEMPLATES


ACIDS Goal State NDDS
PROCEDURE ACTIVITY ENTRY
                   LIM ID Ref   LIM Data Item Name

E10                             PROCEDURE ACTIVITY
      E10.1                     LOCATABLE


      E10.2                     CONTENT ITEM

      E10.3                     ENTRY



      E10.4                     CARE ENTRY


      E10.5                     ACTIVITY ENTRY

      E10.6                     Participation


      E10.7                     Procedure Report
LIM Data Type        LIM Cardinality

ENTRY                <Undefined>
Class                1


Class                0

Class                1



Class                1


Class                1

PARTICIPATION        0..Many


DOCUMENT REFERENCE   0..1
LIM Definition                                                     LIM Value Domain

Details about an individual procedure.
Root class of all information model classes that can be
archetyped, including COMPOSITION, ENTRY, SECTION, CLUSTER
and ELEMENT.
An abstract class of all concrete content types, including ENTRY
and SECTION.
A class that defines the semantics of the core clinical and
administrative information in the EHR.

The abstract parent of all clinical ENTRY subtypes.


Defines a single activity within an Instruction, such as a
medication administration.
A generic domain concept that defines an association between an
act and an entity (person or organisation) in a healthcare role.

The procedure report that was written as a result of the
procedure being performed.
LIM Format Constraint   Other LIM Constraints   LIM Example (for Exchange)
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR Phase
                                                            1 Core
                                                            Yes




                                                            Yes
                                     SUMMARY CARE VIEW - NEHR LIST
Term                                                 Definition & Comments




UNMAPPED                                             UNMAPPED
Procedures.Procedure Report Date                     [STD20100513] We will assess the feasibility of
                                                     creating a new "Procedure Report Date" LIM element
                                                     under the "Procedure Report" Data Group (DG) above
                                                     to map this NEHR field to. Note: CTS has clarified that
                                                     conceptually, this should be the date/time report is
                                                     completed/finalized and may be part of document
                                                     control information.
Procedures.Institution                               Procedure report should have it's own institution field.

                                                     [STD20100513] We will assess the feasibility of
                                                     creating a new "Procedure Institution" LIM element
                                                     under the "Procedure Report" DG above to map this
                                                     NEHR field to.


Procedures.Event Summary Available                   [STD20100513] We will look into the incorporation of a
                                                     'Event Summary Document Identifier' LIM element (or
                                                     something similar to this) for events, procedures,
                                                     medication items, investigations, problem/diagnosis
                                                     which will capture the Set Identifier and Version
                                                     Number. The NEHR 'Event Summary Available' can then
                                                     be derived from the presence of this 'Event Summary
                                                     Document Identifier'.
                         PROCEDURES (DRILL-DOWN VIEW) - NEHR LIST
Term                                                 Definition & Comments




UNMAPPED                                             UNMAPPED
Procedures.Procedure Report Date                     [STD20100513] We will assess the
                                                     feasibility of creating a new "Procedure
                                                     Report Date" LIM element under the
                                                     "Procedure Report" Data Group (DG)
                                                     above to map this NEHR field to.


Procedures.Institution                               Procedure report should have it's own
                                                     institution field.

                                                     [STD20100513] We will assess the
                                                     feasibility of creating a new "Procedure
                                                     Institution" LIM element under the
                                                     "Procedure Report" DG above to map
                                                     this NEHR field to.
Procedures.Event Summary Available                   [STD20100513] We will look into the
                                                     incorporation of a 'Event Summary
                                                     Document Identifier' LIM element (or
                                                     something similar to this) for events,
                                                     procedures, medication items,
                                                     investigations, problem/diagnosis which
                                                     will capture the Set Identifier and Version
                                                     Number. The NEHR 'Event Summary
                                                     Available' can then be derived from the
                                                     presence of this 'Event Summary
                                                     Document Identifier'.
                           DISCHARGE SUMMARY TEMPLATES
ACIDS Phase NDDS   ACIDS Phase IDDS (KTPH)




N/A                N/A
RY TEMPLATES
               ACIDS Goal State NDDS




               N/A


               LIM.Procedure Report [0..1]
ADVERSE REACTION ENTRY
                  LIM ID Ref   LIM Data Item Name


E11                            Adverse Reaction


      E11.1                    LOCATABLE


      E11.2                    CONTENT ITEM


      E11.3                    ENTRY



      E11.4                    CARE ENTRY


      E11.5                    EVALUATION ENTRY




      E11.6                    Participation


      E11.7                    Causative Agent




      E11.8                    Adverse Reaction General
                               Information
LIM Data Type   LIM Cardinality


ENTRY           <Undefined>


Class           1


Class           0


Class           1



Class           1


Class           0




PARTICIPATION   0..Many


Cluster         1..Many




Cluster         0..1
LIM Definition                                                    LIM Value Domain   LIM Format
                                                                                     Constraint

An individual adverse reaction (e.g. allergy, sensitivity or
intolerance) that the patient has experienced, or is at risk of
experiencing.
Root class of all information model classes that can be
archetyped, including COMPOSITION, ENTRY, SECTION,
CLUSTER and ELEMENT.
An abstract class of all concrete content types, including
ENTRY and SECTION.
A class that defines the semantics of the core clinical and
administrative information in the EHR.

The abstract parent of all clinical ENTRY subtypes.


ENTRY type for evaluation statements. Used for all kinds of
statements which evaluate other information, such as
interpretations of obvservations, diagnoses, differential
diagnoses, hypotheses, risk assessments, goals and plans.

A generic domain concept that defines an association
between an act and an entity (person or organisation) in a
healthcare role.
Information about the causative agent(s) of the adverse
reaction. When multiple casuative agents are concomitant
and are suspected or confirmed to cause the reaction, then
each of these casuative agents are recorded in the ENTRY.


Details about the adverse reaction that the patient has
experienced to this causative agent, or is at risk of
experiencing.
Other LIM Constraints   LIM Example (for Exchange)
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR
                                                            Phase 1
                                                            Core




                                                            Yes




                                                            Yes
       SUMMARY CARE VIEW - NEHR LIST                ALLERGY/ADR (DRILL-DOWN LIST) - NEHR LIST
Term                 Definition & Comments   Term
(DRILL-DOWN LIST) - NEHR LIST
                   Definition & Comments   CMIS




                                           t_CMIS_ADR_Drug




                                           t_CMIS_ADR
                                                                             ADT - NDDS TEMPLATE
ADT NDDS                                        ADT NDDS      SCM
                                                Cardinality

                                                              Patient Info




LIM.Causative Agent [1..Many]                   1..Many       Patient Info




LIM.Adverse Reaction General Information [0..1] 0..1          N/A
ADT - NDDS TEMPLATE
              ADT IDDS (SHS)            ADT IDDS (NHG)


              N/A                       AL1 [0..Many] where AL1-2 (Allergy Type) <> "MA"




              N/A                       AL1 [0..Many] where AL1-2 (Allergy Type) <> "MA"




              N/A                       AL1 [0..Many] where AL1-2 (Allergy Type) <> "MA"


              NOTES FOR MOHH USE ONLY   NOTES FOR MOHH USE ONLY
                                        Set ID - AL1 (AL1-1) [1] {4}
                                        [Recommendation: Ignore this field as it is HL7 v2.3.1-
                                        specific]
                                        <Agree - I don't believe that tEHRe is any value in
                                        capturing this Set ID order.>
                      MEDS ORDER (MO) - NDDS TEMPLATE
MO NDDS                                          Med Order NDDS Cardinality




                                                 LIM.Problem Diagnosis Type
                                                 [0..1]
                                                 - Code
                                                 LIM.Problem Diagnosis Notes
                                                 [0..1]




LIM.Causative Agent [1..Many]                    1..Many




LIM.Adverse Reaction General Information[0..1]   0..1
                    MEDS DISPENSE (MD) - NDDS TEMPLATE
MD NDDS                                          Med Dispense NDDS Cardinality




N/A                                              Major Diagnostic Category (DG1-
                                                 7) [0..1]
N/A                                              N/A




LIM.Causative Agent [1..Many]                    1..Many




LIM.Adverse Reaction General Information[0..1]   0..1
            DISCHARGE SUMMARY TEMPLATES
ACIDS Goal State NDDS




LIM.Causative Agent [1]




LIM.Adverse Reaction General Information [0..1]


UNMAPPED
Alert - ENTRY
                LIM ID Ref   LIM Data Item Name

E12.1                        Alert

        E12.1                LOCATABLE


        E12.2                CONTENT ITEM

        E12.3                ENTRY



        E12.4                CARE ENTRY


        E12.5                EVALUATION ENTRY




        E12.6                Participation


        E12.7                Alert Active Interval
LIM Data Type       LIM Cardinality   LIM Definition

ENTRY               <Undefined>       An individual alert that may be relevant to the patient.

Class               1                 Root class of all information model classes that can be
                                      archetyped, including COMPOSITION, ENTRY, SECTION,
                                      CLUSTER and ELEMENT.
Class               0                 An abstract class of all concrete content types, including
                                      ENTRY and SECTION.
Class               1                 A class that defines the semantics of the core clinical and
                                      administrative information in the EHR.


Class               1                 The abstract parent of all clinical ENTRY subtypes.


Class               0                 ENTRY type for evaluation statements. Used for all kinds of
                                      statements which evaluate other information, such as
                                      interpretations of obvservations, diagnoses, differential
                                      diagnoses, hypotheses, risk assessments, goals and plans.

PARTICIPATION       0..Many           A generic domain concept that defines an association
                                      between an act and an entity (person or organisation) in a
                                      healthcare role.
DateTime Interval   0..Many           One or more time intervals during which the alert is/was
                                      active - each including the date (and optionally time) when
                                      the alert started and ended.
LIM Value Domain   LIM Format Constraint   Other LIM Constraints




                   YYYYMMDD[HHMMSS]
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments




"20090915"                   "15 Sep 2009"
"20081227213000"             "27 Dec 2008, 21:30:00"
                             MEDICAL ALERTS (DRILL-DOWN LIST) - NEHR LIST
LIM Change Log   Term                              Definition & Comments




                 1. Medical Alerts.Alert Start
                 DateTime (KIV)
                                                                   ADT - NDDS TEMPLATE
NEHR Phase 1   ADT NDDS                              ADT NDDS      SCM
Core                                                 Cardinality
                                                                   N/A




               LIM.Alert Active Interval [0..Many]   0..Many       N/A
T - NDDS TEMPLATE
                    ADT IDDS (SHS)   ADT IDDS (NHG)

                    N/A              AL1 [0..Many] where Allergy Type (AL1-
                                     2) = "MA"




                    N/A              N/A
                  DISCHARGE SUMMARY TEMPLATES
ACIDS Goal State NDDS




LIM.Alert Active Interval [0..Many]
Observation - ENTRY (Finding or Property)

                       LIM ID Ref           LIM Data Item Name



E13.1                                       Observation
        E13.1                               LOCATABLE


        E13.2                               CONTENT ITEM

        E13.3                               ENTRY



        E13.4                               CARE ENTRY


        E13.5                               OBSERVATION ENTRY




        E13.6                               PROPERTY OBSERVATION
        E13.7                               Participation
LIM Data Type   LIM Cardinality   LIM Definition



ENTRY           <Undefined>       An individual observation that was performed.
Class           1                 Root class of all information model classes that can be
                                  archetyped, including COMPOSITION, ENTRY, SECTION,
                                  CLUSTER and ELEMENT.
Class           0                 An abstract class of all concrete content types, including ENTRY
                                  and SECTION.
Class           1                 A class that defines the semantics of the core clinical and
                                  administrative information in the EHR.

Class           1                 The abstract parent of all clinical ENTRY subtypes.


Class           1                 ENTRY type for evaluation statements. Used for all kinds of
                                  statements which evaluate other information, such as
                                  interpretations
                                  of obvservations, diagnoses, differential diagnoses,
                                  hypotheses, risk
                                  assessments, goals and plans.
Class           1                 An observation that assigns values to specific properties.
PARTICIPATION   0..Many           Other participants (person, healthcare provider or
                                  organisation) that were involved in the observation.
LIM Value Domain   LIM Format Constraint   Other LIM Constraints
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
                                                                        MEDS ORDER (MO) - NDDS TEM


LIM Change Log   NEHR Phase 1 MO NDDS                     Med Order
                 Core                                     NDDS
                                                          Cardinality




                            LIM.Participation [0..Many]   0..Many
     MEDS ORDER (MO) - NDDS TEMPLATE


MO IDDS (NHG)                          MO IDDS (KKH)



OBX [0..Many]                          N/A
                               MEDS DISPENSE (MD) - NDDS TEMPLATE


MD NDDS                       Med Dispense MD IDDS (NHG)
                              NDDS
                              Cardinality

                                          N/A




LIM.Participation [0..Many]   0..Many
MD) - NDDS TEMPLATE                                                    DISCHARGE SUMMARY TEMPLATES


                 MD IDDS (CGH)   ACIDS Phase 1 NDDS   ACIDS Phase 2 NDDS



                 N/A




                                 N/A                  N/A
DISCHARGE SUMMARY TEMPLATES


            ACIDS Goal State NDDS         CHIDS
                                          (Community ) Phase 1
                                          NDDS




            LIM.Participation [0..Many]   N/A
CLINICAL SYNOPSIS ENTRY

              LIM ID Ref   LIM Data Item Name             LIM Data Type


E14                        CLINICAL SYNOPSIS              EVALUATION ENTRY

      E14.1                LOCATABLE                      Class



      E14.2                CONTENT ITEM                   Class


      E14.3                ENTRY                          Class



      E14.4                CARE ENTRY                     Class


      E14.5                EVALUATION ENTRY               Class




      E14.6                Participation                  PARTICIPATION


      E14.7                Clinical Synopsis Additional   CLUSTER
                           Information
LIM Cardinality   LIM Definition


<Undefined>       Information pertaining to a single clinical synopsis ENTRY.

1                 Root class of all information model classes that can be archetyped,
                  including COMPOSITION, ENTRY, SECTION, CLUSTER and
                  ELEMENT.
0                 An abstract class of all concrete content types, including ENTRY
                  and SECTION.
1                 A class that defines the semantics of the core clinical and
                  administrative information in the EHR.

1                 The abstract parent of all clinical ENTRY subtypes.


0                 ENTRY type for evaluation statements. Used for all kinds of
                  statements which evaluate other information, such as
                  interpretations of obvservations, diagnoses, differential diagnoses,
                  hypotheses, risk assessments, goals and plans.

0..Many           A generic domain concept that defines an association between an
                  act and an entity (person or organisation) in a healthcare role.

1                 Additional information about the clinical synopsis.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
                                     SUMMARY CARE VIEW - NEHR LIST


LIM Change Log   NEHR Phase 1 Term                 Definition & Comments
                 Core

                 Yes
       INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST          LAB REPORT - NEHR LIST


Term                         Definition & Comments    Term
LAB REPORT - NEHR LIST                    RADIOLOGY REPORT - NEHR LIST


           Definition & Comments   Term                 Definition & Comments
                               LABORATORY - NDDS TEMPLAT


LAB NDDS   Lab NDDS      SCM
           Cardinality
   LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)              LAB IDDS (SGH)                       LAB IDDS (CGH)




                            LIM.Problem Diagnosis Notes [0..1]   0..1
LAB IDDS (NHG)   RAD NDDS        Radiology NDDS
                                 Cardinality

Patient Info     DG1 [0..Many]




N/A              N/A
                                                            RADIOLOGY (RAD) - NDDS TEMPLATE


SCM                                  RAD IDDS (KKH)                             RAD IDDS (SGH)




LIM.Problem Diagnosis Notes [0..1]   Diagnosis/Problem Additional Remarks N/A
                                     [0..1] {LEN=255}

                                     The additional remarks is a generic text
                                     for all coded diagnoses at the episode
RAD IDDS (CGH)   RAD IDDS (NHG)   RAD IDDS (NHGP)
ACIDS Phase 1 NDDS
                           DISCH


ACIDS Phase 1 IDDS (NHG)
                           DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (SHS)
MARY TEMPLATES


           ACIDS Phase 1 IDDS (KTPH)   ACIDS Phase 2 NDDS
ACIDS Goal State NDDS   CHIDS
                        (Community )
                        Phase 1 NDDS
Problem Diagnosis List - SECTION

                   LIM ID Ref      LIM Data Item Name


S1                                 Problem Diagnosis List



     S1.1                          LOCATABLE

     S1.2                          CONTENT ITEM
     S1.3                          SECTION
     S1.4                          Problem Diagnosis ENTRY
LIM Data Type   LIM Cardinality


SECTION         <Undefined>



Class           1

Class           0
Class           0..1
ENTRY           0..Many
LIM Definition                                                                            LIM Value Domain


A list of diagnostic labels or problem statements assigned by the clinician (or Medical
Records Officer) to describe the diagnoses and medical/health problems pertaining to
the patient during the healthcare episode.
Root class of all information model classes that can be archetyped.

An abstract class of all concrete content types.
A grouping of entries related to single clinical session.
Information pertaining to a single problem or diagnosis ENTRY.
LIM Format   Other LIM Constraints   LIM Example (for Exchange)
Constraint
LIM Example (for Display)   LIM Comments   LIM Change Log
                         SUMMARY CARE VIEW - NEHR LIST           RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIS
                                                                                       LIST

NEHR Phase Term                         Definition & Comments   Term
1 Core

Yes




Yes




          UNMAPPED                         UNMAPPED             UNMAPPED
          Recon Problem/Diagnosis.Date and                      Recon Problem/Diagnosis.Date
          Time(List was Created)                                and Time(List was Created)
OBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST) - NEHR    RECON PROBLEM/DIAGNOSIS LIST (DRILL-DOWN LIST VIEW) -
              LIST                                                  NEHR LIST

                  Definition & Comments         Term                       Definition & Comments




                  UNMAPPED                      UNMAPPED                     UNMAPPED
                                                Recon Problem/Diagnosis.Date
                                                and Time(List was Created)
                                             ADT - NDDS TEMPLATE


ADT NDDS                      ADT NDDS       ADT IDDS (SHS)
                              Cardinality

                                             {DG1 [0..Many]} [0..Many]



LIM.LOCATABLE [1]                           1 N/A

N/A                           N/A            N/A

LIM.Problem Diagnosis ENTRY   0..Many        DG1 [0..Many]
[0..Many]
MPLATE


         ADT IDDS (NHG)              ACIDS Phase 1 NDDS


         {DG1 [0..Many]} [0..Many]



         N/A                         LIM.LOCATABLE [1]

         N/A                         N/A

         DG1 [0..Many]               LIM.Problem Diagnosis ENTRY [1..Many]




                                     UNMAPPED
                                                     DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (NHG)      ACIDS Phase 1 IDDS (SHS)


Diagnosis/Problem [1..Many]   Diagnosis/Problem [1..Many]



N/A                           N/A

N/A                           N/A

Diagnosis/Problem [1..Many]   Diagnosis/Problem [1..Many]
E SUMMARY TEMPLATES


                ACIDS Phase 1 IDDS (KTPH)   ACIDS Phase 2   ACIDS Goal State NDDS
                                            NDDS




                                                            LIM.LOCATABLE [1]

                                                            N/A

                                                            LIM.Problem Diagnosis ENTRY
                                                            [1..Many]


                                            UNMAPPED        UNMAPPED
CHIDS
(Community ) Phase 1 NDDS




UNMAPPED
Medication List - SECTION

                LIM ID Ref   LIM Data Item Name

S2.1                         Medication List




       S2.1                  LOCATABLE

       S2.2                  CONTENT ITEM

       S2.3                  SECTION
       S2.4                  Medication ENTRY
LIM Data Type   LIM Cardinality   LIM Definition

SECTION                           Medication lists that are captured during or relevant to
                                  the patient event - e.g. medication orders, medications
                                  dispensed, current medications, reconciled medications.

Class           1                 Root class of all information model classes that can be
                                  archetyped.
Class           0                 An abstract class of all concrete content types.

Class           0..1              A grouping of entries related to single clinical session.
ENTRY           0..Many           Information pertaining to a single medication ENTRY -
                                  e.g. Medication Order ENTRY or Medication Dispense
                                  ENTRY.
LIM Value Domain   LIM Format
                   Constraint
Other LIM Constraints                                                     LIM Example (for Exchange)

If List Type (S2.1.1.1) = "Ceased Medications", then the Medication Set
should use the following data elements:
- Medication (E6.1.4.2)
- Medication Set Status (E6.1.1.2) = "Ceased Medication"
- Changes Made (E6.1.4.8.1) = "Medication ceased"
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR Phase 1
                                                            Core
                                                            Yes




                                                            Yes
       SUMMARY CARE VIEW - NEHR LIST            CURR & RECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST


Term                         Definition &   Term
                             Comments




UNMAPPED                     UNMAPPED       UNMAPPED
Curr & Recon Meds.DateTime                  Curr & Recon Meds.DateTime (List
(List was created)                          was created)
ECON MEDS LIST (DRILL-DOWN LIST) - NEHR LIST       CURR MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST


                    Definition & Comments      Term                         Definition & Comments




                    UNMAPPED                   UNMAPPED                     UNMAPPED
                                               Curr & Recon Meds.DateTime
                                               (List was created)
   RECON MEDS LIST (DRILL-DOWN LIST VIEW) - NEHR LIST               MEDICAL ALERTS VIEW - NEHR LIST


Term                         Definition & Comments      Term




UNMAPPED                     UNMAPPED                   UNMAPPED
Curr & Recon Meds.DateTime                              Curr & Recon Meds.DateTime
(List was created)                                      (List was created)
MEDICAL ALERTS VIEW - NEHR LIST                                             MEDS ORDER (MO) - NDDS TEMPLATE


               Definition & Comments   MO NDDS                Med Order
                                                              NDDS
                                                              Cardinality




                                       LIM.LOCATABLE [1]      1

                                       N/A                    N/A


                                       LIM.Medication ENTRY   0..Many
                                       [0..Many]




               UNMAPPED
MEDS ORDER (MO) - NDDS TEMPLATE                                                      MEDS DISPENSE (MD


     MO IDDS (NHG)                MO IDDS (KKH)               MD NDDS

     {ORC [1..Many]} [0..Many]    {ORC [1..Many]} [0..Many]
     {RXO [0..Many]} [0..Many]    {OBX [0..Many]} [0..Many]
     {RXR [0..Many]} [0..Many]    {OBR [0..Many]} [0..Many]
     {ZXO [0..Many]} [0..Many]    {RXO [0..Many]} [0..Many]
     N/A [0..Many]} [0..Many]
     {ZCO                         N/A [0..Many]} [0..Many]
                                  {RXR                        LIM.LOCATABLE [1]

     N/A                          N/A                         N/A


     ORC [1..Many]                ORC [1..Many]               LIM.Medication ENTRY
     RXO [0..Many]                OBX [0..Many]               [0..Many]
     RXR [0..Many]                RXO [0..Many]
     ZXO [0..Many]                RXR [0..Many]
          MEDS DISPENSE (MD) - NDDS TEMPLATE


Med Dispense   MD IDDS (NHG)                   MD IDDS (CGH)
NDDS
Cardinality    {ORC [1..Many]} [0..Many]       {ORC [1..Many]} [0..Many]
               {RXD [1..Many]} [0..Many]       {OBX [0..Many]} [0..Many]
               {ZXO [0..Many]} [0..Many]       {RXO [0..Many]} [0..Many]
               {ZCO [0..Many]} [0..Many]       {RXE [1..Many]} [0..Many]
1              N/A                             N/A

N/A            N/A                             N/A


0..Many        ORC [1..Many]                   ORC [1..Many]
               RXD [1..Many]                   OBX [0..Many]
               ZXO [0..Many]                   RXO [0..Many]
               ZCO [0..Many]                   RXE [1..Many]
ACIDS Phase 1 NDDS

LIM.Medication List




LIM.LOCATABLE [1]

N/A


N/A
                                DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (NHG)

Medication Orders
(a.k.a Discharge Medications)




N/A


N/A
                           DISCHARGE SUMMARY TEMPLATES


ACIDS Phase 1 IDDS (SHS)

Medication Orders
(a.k.a Discharge Medications)




N/A


N/A
EMPLATES


           ACIDS Phase 1 IDDS (KTPH)   ACIDS Phase 2 NDDS
ACIDS Goal State NDDS




LIM.LOCATABLE [1]

N/A


LIM.Medication ENTRY [0..Many]
INVESTIGATION COMPOSITION

             LIM ID Ref     LIM Data Item Name

C1                          INVESTIGATION RESULTS
                            COMPOSITION




     C1.1                   LOCATABLE

     C1.2                   EXTRACT COMPOSITION

     C1.3                   Participation

     C1.4                   Patient Event Context
     C1.5                   Document Context




     C1.6                   Investigation Activity
LIM Data Type   LIM Cardinality   LIM Definition

Composition     <Undefined>       A composition that includes information about
                                  (laboratory or radiology) investigation activities.




Class           1                 Root class of all information model classes that
                                  can be archetyped.
Class           1                 An abstract class of all concrete content types.

PARTICIPATION   0..Many           Participants who play a role in the Composition.

ENTRY           1                 General information about the patient event
ENTRY           0..1              about which this event summary isthe report as a
                                  General information pertaining to related.
                                  whole, including the author of the report, and the
                                  datetime it was completed (if relevant).

ENTRY           1..Many           Details about the results of an individual
                                  requested investigation.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint




                                LIM.Document Type Name (DG6.1.3.1) =
                                "Radiology Results Report"

                                IF LIM.Result Status (E11.1.3.1.2.1) <>
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
                                   INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST


LIM Change Log   NEHR Phase 1   Term                       Definition & Comments
                 Core
                 Yes




                                UNMAPPED                   UNMAPPED
           LAB REPORT - NEHR LIST                RADIOLOGY REPORT - NEHR LIST


Term                       Definition &   Term                       Definition &
                           Comments                                  Comments




UNMAPPED                   UNMAPPED       UNMAPPED                   UNMAPPED
                                                                 LABORATORY - NDDS TEMPLATE


LAB NDDS                        Lab NDDS        LAB IDDS (KKH)
                                Cardinality
                                                PID [1]
                                                PV1 [0..1]
                                                OBR [1..Many]
                                                OBX [0..Many]
                                                ORC [1..Many]
                                                NTE [0..Many]



LIM.LOCATABLE [1]               1               N/A

LIM.EXTRACT COMPOSITION 1                       N/A
[1]
LIM.Participation [0..Many] 0..Many             N/A

LIM.Patient Event Context [1]                 1 PV1 [0..1]
N/A                             N/A             N/A




LIM.Investigation Result        1..Many         PV1 [0..1]
[1..Many]                                       OBR [1..Many]
                                                UNMAPPED
LABORATORY - NDDS TEMPLATE


 LAB IDDS (SGH)              LAB IDDS (CGH)

 PID [1]                     PID [1]
 PV1 [0..1]                  PV1 [0..1]
 OBR [1..Many]               OBR [1..Many]
 OBX [0..Many]               OBX [0..Many]
 ORC [1..Many]               ORC [1..Many]
 NTE [0..Many]               NTE [0..Many]
                             ORC [1..Many]


 N/A                         N/A

 N/A                         N/A

 N/A                         N/A

 PV1 [0..1]                  PV1 [0..1]
 N/A                         N/A




 OBR [1..Many]               OBR [1..Many]
 ORC [1..Many]               ORC [1..Many]
 UNMAPPED                    UNMAPPED
LAB IDDS (NHG)   RAD NDDS                        Radiology NDDS
                                                 Cardinality
PID [1]
PV1 [0..1]
OBR [1..Many]
ORC [1..Many]
OBX [0..Many]
NTE [0..Many]



N/A              LIM.LOCATABLE [1]               1

N/A              LIM.EXTRACT COMPOSITION 1
                 [1]
N/A              LIM.Participation [0..Many] 0..Many

PV1 [0..1]       LIM.Patient Event Context [1]                    1
N/A              N/A                             N/A




OBR [1..Many]    LIM.Investigation Result        1..Many
ORC [1..Many]    [1..Many]
UNMAPPED
                              RADIOLOGY (RAD) - NDDS TEMPLATE


RAD IDDS (KKH)   RAD IDDS (SGH)                 RAD IDDS (CGH)

PID [1]          PID [1]                        PID [1]
PV1 [0..1]       PV1 [0..1]                     PV1 [0..1]
ORC [0..Many]    ORC [1..Many]                  ORC [1..Many]
OBR [1..Many]    OBR [1..Many]                  OBR [1..Many]
OBX [0..Many]    OBX [0..Many]                  OBX [0..Many]
NTE [0..Many]



N/A              N/A                            N/A

N/A              N/A                            N/A

N/A              N/A                            N/A

PV1 [0..1]       PV1 [0..1]                     PV1 [0..1]
N/A              N/A                            ORC [1..Many]
                                                N/A




ORC [0..Many]    ORC [1..Many]                  ORC [1..Many]
OBR [1..Many]    OBR [1..Many]                  OBR [1..Many]
UNMAPPED         UNMAPPED                       UNMAPPED
TE


     RAD IDDS (NHG)   RAD IDDS (NHGP)

     MSH [1]          MSH [1]
     PID [0..Many]    PID [0..Many]
     PV1 [0..Many]    PV1 [0..Many]
     ORC [0..Many]    ORC [0..Many]
     OBR [1..Many]    OBR [0..Many]
     OBX [0..Many]    OBX [0..Many]
     ZEX [0..Many]    ZBX [0..1]
     ZOR [0..Many]    ZEX [0..1]
                      ZOR [0..1]
     N/A              N/A

     N/A              N/A

     N/A              N/A

     PV1 [0..1]       PV1 [0..Many]
     ZOR [0..Many]
     N/A              N/A




     ORC [0..Many]    ORC [0..Many]
     OBR [1..Many]    OBR [0..Many]
     UNMAPPED         UNMAPPED
PATIENT EVENT COMPOSITION
               LIM ID Ref   LIM Data Item Name


C2.1                        PATIENT EVENT
                            COMPOSITION
       C2.1                 LOCATABLE
       C2.2                 EXTRACT COMPOSITION
       C2.3                 Participation
       C2.4                 Patient Event Context


       C2.5                 Document Context


       C2.6                 Adverse Reactions


       C2.7                 Alerts




       C2.8                 Clinical Synopsis




       C2.9                 Problem/Diagnosis List




       C2.10                Medication List


       C2.11                Investigations


       C2.12                Procedures


       C2.13                Follow-up Services

       C2.14                Triage

       C2.15                Travel History
       C2.16                Medical Certificates

       C2.17                Observations
       C2.18                Accident Details

       C2.19                Attachment
                            (Document Context)
LIM Data Type   LIM
                Cardinality

Composition

Class           1
Class           1
PARTICIPATION   0..Many
ENTRY           0..1


ENTRY           0..1


SECTION         0..1


SECTION         0..1




ENTRY           0..Many




SECTION         0..Many




SECTION         0..Many


SECTION         1


SECTION         0..1


SECTION         0..1

ENTRY           0..Many

ENTRY           0..1
SECTION         0..1

SECTION         0..1
ENTRY           0..1

ENTRY           0..Many
LIM Definition


A composition describing a particular healthcare event.

Root class of all information model classes that can be archetyped.
An abstract class of all concrete content types.
Participants who play a role in the Composition.
General information about the patient event about which this event summary is
related.

General information pertaining to the report as a whole, including the author of the
report, and the datetime it was completed (if relevant).

An allergy, sensitivity or intolerance caused by a substance.


Information pertaining to a patient that may need special consideration by a
healthcare provider before making a decision in order to avert an unfavourable
healthcare event, or relate to the safety of subject or providers, or pertain to special
circumstances relevant to the delivery of care.

Summary information or comments about the clinical management of the patient,
and the prognosis of diagnoses/problems identified during the healthcare event. It
may also include health related information pertinant to the patient, a clinical
interpretation of relevant investigations performed on the patient, and suggestions
for post-discharge care.


A list of diagnostic labels or problem statements assigned by the clinician to describe
the diagnoses and medical/health problems pertaining to the patient during the
healthcare event.

Medication lists that are captured during or relevant to the patient event - e.g.
medication orders, medications dispensed, current medications, reconciled
medications.
The most important investigations performed on the patient during the healthcare
event, that are considered relevant to the patient's ongoing care.

Describes the most important procedures performed on the patient during the
healthcare event, that are considered relevant to the patient's ongoing care.

Services and follow-up care that have been recommended or arranged for the
patient.
Information on the prioritisation of the patient based on severity of their condition.

A history of the locations the patient has travelled to.
Information related to the medical certificates issued to the patient.

Observations of the patient that were performed during the healthcare event.
Details about an accident that the patient was involved in that resulted in this
patient event.
Documents that have been attached to the discharge summary because they are
relevant to the ongoing care of the patient.
LIM Value Domain   LIM Format   Other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)
                                                  SUMMARY CARE VIEW - NEHR LIST
LIM Comments   LIM Change Log   NEHR Phase Term
                                1 Core
UNMAPPED
SUMMARY CARE VIEW - NEHR LIST          PATIENT EVENT - NEHR LIST
        Definition & Comments   Term        Definition & Comments
UNMAPPED   UNMAPPED   UNMAPPED
                                                                           ADT - NDDS TEMPLATE
ADT NDDS                               ADT NDDS      ADT IDDS (SHS)
                                       Cardinality

                                                     PID [1]
                                                     MRG [0..1]
LIM.LOCATABLE [1]                      1             PV1 [0..1]
                                                     N/A
LIM.EXTRACT COMPOSITION [1]            1             N/A
LIM.Participation [0..Many]            0..Many       N/A
LIM.Patient Event Information [0..1]   0..1          PV1 [0..1]
                                                     PV2 [0..1]
                                                     MRG [0..Many]
N/A                                    N/A           N/A


LIM.Adverse Reactions [0..1]           0..1          N/A


Alerts [0..1]                          0..1          N/A




N/A                                    N/A           N/A




LIM.Problem/Diagnosis List [0..1]      0..1          {DG1 [0..Many]} [0..Many]




N/A                                    N/A           N/A


N/A                                    N/A           N/A


N/A                                    N/A           N/A


N/A                                    N/A           N/A

N/A                                    N/A           N/A

N/A                                    N/A           N/A
N/A                                    N/A           N/A

N/A                                    N/A           N/A
LIM.Accident Details [0..1]            0..1          N/A

N/A                                    N/A           N/A
UNMAPPED   UNMAPPED
ADT - NDDS TEMPLATE
          ADT IDDS (NHG)


          PID [1]
          MRG [0..1]
          PD1 [0..1]
          N/A
          N/A
          N/A
          PV1 [0..1]
          PV2 [0..1]
          ACC [0..1]
          N/A


          {AL1 [0..Many]} [0..1]


          {AL1 [0..Many]} [0..1]




          N/A




          {DG1 [0..Many]} [0..Many]




          N/A


          N/A


          N/A


          N/A

          N/A

          N/A
          N/A

          N/A
          ACC [0..1]

          N/A
UNMAPPED
ACIDS Phase 1 NDDS


Discharge Summary

LIM.LOCATABLE [1]
LIM.EXTRACT COMPOSITION [1]
LIM.Participation [0..Many]
LIM.Patient Event Information [1]


LIM.Report Document Control [0..1]


LIM.Adverse Reactions [0..1]


LIM.Alerts [0..1]




LIM.Clinical Synopsis [0..Many]




LIM.Problem/Diagnosis List [1..Many]




LIM.Medication List [0..Many]


LIM.Investigations [0..1]


LIM.Procedures [0..1]


N/A

N/A

N/A
LIM.Medical Certificates [0..1]

N/A
N/A

N/A
UNMAPPED
                                    DISCH
ACIDS Phase 1 IDDS (NHG)




Patient Event Information


Document Control


Allergy and Adverse Drug Reaction


Alert




Clinical Synopsis [0..Many]




Diagnosis/Problem [1..Many]




Medication Orders [0..1]


Investigations [0..1]


Procedures [0..1]


N/A

N/A

N/A
Medical Certificate [0..Many]

N/A
N/A

N/A
                                    DISCHARGE SUMMARY TEMPLATES
ACIDS Phase 1 IDDS (SHS)




Patient Event Information


Document Control


Allergy and Adverse Drug Reaction


Alert




Clinical Synopsis [0..Many]




Diagnosis/Problem [1..Many]




Medication Orders [0..1]


Investigations [0..1]


Procedures [0..1]


N/A

N/A

N/A
Medical Certificate [0..Many]

N/A
N/A

N/A
HARGE SUMMARY TEMPLATES
                ACIDS Phase 1 IDDS (KTPH)   ACIDS Phase 2 NDDS


                                            Discharge Summary
UNMAPPED
ACIDS Goal State NDDS                  CHIDS
                                       (Community ) Phase 1 NDDS

Discharge Summary                      Discharge Summary

LIM.LOCATABLE [1]
LIM.EXTRACT COMPOSITION [1]
LIM.Participation [0..Many]
LIM.Patient Event Information [1]


LIM.Report Document Control [0..1]


LIM.Adverse Reactions [0..1]


LIM.Alerts [0..1]




LIM.Clinical Synopsis [0..Many]




LIM.Problem/Diagnosis List [1..Many]




LIM.Medication List [0..Many]


LIM.Investigations [1]


LIM.Procedures [0..1]


LIM.Follow-up Services [0..1]

N/A

LIM.Travel History [0..1]



LIM.Observations [0..1]
N/A

LIM.Attachment [0..Many]
UNMAPPED   UNMAPPED
MEDICATION COMPOSITION
             LIM ID Ref   LIM Data Item Name    LIM Data Type


C3                        MEDICATION            COMPOSITION
                          COMPOSITION

     C3.1                 LOCATABLE             Class

     C3.2                 EXTRACT               Class
                          COMPOSITION
     C3.3                 Participation         PARTICIPATION

     C3.4                 Patient Event Context ENTRY

     C3.5                 Document Context      ENTRY


     C3.6                 Medication Order      ENTRY

     C3.7                 Medication Dispense   ENTRY

     C3.8                 Medication            ENTRY
                          Administration
     C3.9                 Observation           ENTRY


     C3.10                Adverse Reaction      ENTRY
LIM Cardinality LIM Definition                                                  LIM Value Domain   LIM Format
                                                                                                   Constraint

                A composition that includes medication order,
                dispensing or administration information.

1               Root class of all information model classes that can be
                archetyped.
1               An abstract class of all concrete content types.

0..Many         Participants who play a role in the Composition.

1               General information about the patient event associated
                with the medication message.
0..1            General information pertaining to the report as a whole,
                including the author of the report, and the datetime it was
                completed (if relevant).
0..Many         A medication order ENTRY.

0..Many         A medication dispense ENTRY.

0..Many         A medication administration ENTRY.

0..Many         An individual observation that was performed on the
                patient - specifically used to capture 'Weight' and 'Height'.

0..Many         An individual adverse reaction (e.g. allergy, sensitivity or
                intolerance) that the patient has experienced, or is at risk
                of experiencing.
Other LIM Constraints         LIM Example (for Exchange)   LIM Example (for Display)




Observation Type = 'Weight'
or 'Height'
                                                                    MEDS ORDER (MO) - NDDS TEMP
LIM Comments   LIM Change Log   MO NDDS




                                LIM.LOCATABLE [1]

                                LIM.EXTRACT COMPOSITION [1]

                                LIM.Participation [0..Many]

                                LIM.Patient Event Information [1]

                                LIM.Document Context [0..1]


                                LIM.Medication Order ENTRY [1]

                                N/A

                                N/A

                                LIM.Observation [0..Many]


                                LIM.Adverse Reaction [0..Many]
MEDS ORDER (MO) - NDDS TEMPLATE
Med Order     MO IDDS (NHG)       MO IDDS (KKH)
NDDS
Cardinality
              MSH [1]             MSH [1]
              PID [0..1]          PID [1]
              PV1 [0..1]          PV1 [1]
1             N/A                 N/A

1             N/A                 N/A

0..Many       PID [0..1]          PID [1]
              MSH [1]             PV1 [1]
1             PV1 [0..1]          PV1 [1]

0..1          N/A                 N/A


1             ORC [1..Many]       ORC [1..Many]
              RXO [0..Many]       OBX [0..Many]
N/A           N/A                 N/A

N/A           N/A                 N/A

0..Many       OBX [0..Many]       N/A


0..Many       N/A                 N/A
                                    MEDS DISPENSE (MD) - NDDS TEMPLATE
MD NDDS                             Med        MD IDDS (NHG)
                                    Dispense
                                    NDDS
                                               MSH [1]
                                               PID [1]
                                               PV1 [1]
LIM.LOCATABLE [1]                   1          N/A

LIM.EXTRACT COMPOSITION [1]         1          N/A

LIM.Participation [0..Many]         0..Many    PID [1]
                                               ORC [1..Many]
LIM.Patient Event Information [1]   1          PV1 [1]

LIM.Document Context [0..1]         0..1       N/A


LIM.Medication Order ENTRY [0..1]   0..1       ORC [1..Many]
                                               RXD [1..Many]
LIM.Medication Dispense ENTRY [1]   1          ORC [1..Many]
                                               RXD [1..Many]
N/A                                 N/A        N/A

LIM.Observation [0..Many]           0..Many    N/A


LIM.Adverse Reaction [0..Many]      0..Many    N/A
S TEMPLATE
             MD IDDS (CGH)


             MSH [1]
             PID [1]
             PV1 [0..1]
             N/A

             N/A

             PID [1]
             PV1 [0..1]
             PV1 [0..1]

             N/A


             ORC [1..Many]
             OBX [0..Many]
             PV1 [0..Many]
             ORC [1..Many]
             N/A

             N/A


             N/A
Summary Care View - Composition
      LIM ID Ref   LIM Data Item Name         LIM Data Type   LIM Cardinality


C4                 Summary Care View          Composition

     C4.1          LOCATABLE                  Class           1

     C4.2          EXTRACT COMPOSITION        Class           1

     C4.3          Participation              PARTICIPATION   0..Many

     C4.4          Patient Event Context      ENTRY           0..1

     C4.5          Laboratory Investigation   COMPOSITION     0..Many
                   Result
     C4.6          Radiology Investigation    COMPOSITION     0..Many
                   Result
     C4.7          Patient Event              COMPOSITION     0..Many

     C4.8          Problem Diagnosis History SECTION          0..1
                   (Problem Diagnosis List)



     C4.9          Reconciled Problem         SECTION         0..Many
                   Diagnosis List
                   (Problem Diagnosis List)



     C4.10         Medication History         SECTION         0..1
                   (Medication List)


     C4.11         Current Medications List   SECTION         0..Many
                   (Medication List)

     C4.12         Reconciled Medications     SECTION         0..Many
                   List
                   (Medication List)
     C4.13         Document                   ENTRY           0..Many
                   (Document Context)
LIM Definition                                                LIM Value Domain   LIM Format
                                                                                 Constraint

A summary of pertinant healthcare information relating
to a specific patient.
Root class of all information model classes that can be
archetyped.
An abstract class of all concrete content types.

Participants who play a role in the Composition.

General information about the patient event about which
this event summary is related.
A list of the laboratory result reports for this patient,
grouped by investigation ENTRY.
A list of the radiology result reports for this patient,
grouped by investigaiton ENTRY.
A list of the healthcare events that the given patient has
been involved in, linked to the relevant report.
A list of the diagnostic labels or problem statements that
have been associated with the given patient.



A list of the diagnostic labels or problem statements
associated with the given patient, that have been
reconciled by a clinician.



A history of the medications that have been prescribed
for, dispensed for or administered to the given patient.


A list of the medications that are believed to be currently
taken by the patient.

A list of the medications that are currently being taken by
the patient, that has been reconciled by a clinician.

A list of other documents, not included above, that are
relevant to the care of the patient – e.g. OT Notes.
Other LIM Constraints   LIM Example (for Exchange)   LIM Example (for Display)
LIM Comments   LIM Change Log                                             NEHR Phase
                                                                          1 Core




                                                                          Yes




               [YC30100531] Cardinality changed to 0..Many based on
               clarification from CTS that this is a SECTION containing
               potentially more than one list.




               [YC30100531] Cardinality changed to 0..Many based on
               clarification from CTS that this is a SECTION containing
               potentially more than one list.
               [YC30100531] Cardinality changed to 0..Many based on
               clarification from CTS that this is a SECTION containing
               potentially more than one list.
       SUMMARY CARE VIEW - NEHR LIST

Term                      Definition &
                          Comments
INVESTIGATION MESSAGE

            LIM ID Ref   LIM Data Item Name            LIM Data Type

M1                       INVESTIGATION MESSAGE         MESSAGE

     M1.1                LOCATABLE                     Class

     M1.2                Sending Information           Data Group

     M1.3                Receiving Information         Data Group

     M1.4                General Message Information   Data Group
     M1.5                Event Information             Data Group

     M1.6                Content                       EXTRACT
LIM Cardinality   LIM Definition                                              LIM Value Domain

<Undefined>       A message that is used to exchange clinical investigation
                  information between two systems.
1                 Root class of all information model classes that can be
                  archetyped.
1                 Information pertaining to the sending of the message.

1                 Information pertaining to the receipt of the message.

1                 General information about the message.
1                 Information about the event related to the message.

0..1              The content (or payload) of the message.
LIM Format Constraint   Other LIM Constraints   LIM Example (for Exchange)
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR Phase
                                                            1 Core
                                                            Yes
       INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST          LAB REPORT - NEHR LIST


Term                    Definition & Comments         Term
LAB REPORT - NEHR LIST              RADIOLOGY REPORT - NEHR LIST


     Definition & Comments   Term
RADIOLOGY REPORT - NEHR LIST


       Definition & Comments   LAB NDDS                              Lab NDDS
                                                                     Cardinality



                               LIM.LOCATABLE [1]                     1

                               LIM.Sending Information [1]           1

                               LIM.Receiving Information [1]         1

                               LIM.General Message Information [1]   1
                               LIM.Event Information [1]             1

                               LIM.Content [0..1]                    0..1

                               UNMAPPED
                           LABORATORY - NDDS TEMPLATE


LAB IDDS (KKH)   LAB IDDS (SGH)

MSH [1]          MSH [1]

N/A              N/A

N/A              N/A

MSH [1]          MSH [1]

MSH [1]          MSH [1]
MSH [1]          MSH [1]

N/A              N/A

UNMAPPED         UNMAPPED
MPLATE


         LAB IDDS (CGH)

         MSH [1]

         N/A

         N/A

         MSH [1]

         MSH [1]
         MSH [1]

         N/A

         UNMAPPED
LAB IDDS (NHG)   RAD NDDS

MSH [1]

N/A              LIM.LOCATABLE [1]

N/A              LIM.Sending Information [1]

MSH [1]          LIM.Receiving Information [1]

MSH [1]          LIM.General Message Information [1]
MSH [1]          LIM.Event Information [1]

N/A              LIM.Content [0..1]

UNMAPPED         UNMAPPED
                                                                        RADIOLOGY - NDDS TEMPL


Radiology NDDS   RAD IDDS (KKH)
Cardinality
                 MSH [1]

1                N/A

1                MSH [1]

1                MSH [1]

1                MSH [1]
1                MSH [1]

0..1             N/A

                 UNMAPPED
                 Sequence Number (MSH-13) [0..1]
                 [Recommendation: Ignore since this is a HL7-specific
                 field]
                                RADIOLOGY - NDDS TEMPLATE


RAD IDDS (SGH)                                    RAD IDDS (CGH)

MSH [1]                                           MSH [1]

N/A                                               N/A

MSH [1]                                           MSH [1]

MSH [1]                                           MSH [1]

MSH [1]                                           MSH [1]
MSH [1]                                           MSH [1]

N/A                                               N/A

UNMAPPED                                             UNMAPPED
Sequence Number (MSH-13) [0..1]
[Recommendation: Ignore since this is a HL7-specific
field]
RAD IDDS (NHG)

MSH [1]
ORC [0..Many]
N/A

MSH [1]

MSH [1]

MSH [1]
MSH [1]
ORC [0..Many]
N/A

UNMAPPED
RAD IDDS (NHGP)

MSH [1]

N/A

MSH [1]

MSH [1]

MSH [1]
MSH [1]

N/A
PATIENT EVENT MESSAGE
            LIM ID Ref   LIM Data Item Name            LIM Data Type


M2                       PATIENT EVENT MESSAGE         MESSAGE


     M2.1                LOCATABLE                     Class

     M2.2                Sending Information           Data Group

     M2.3                Receiving Information         Data Group

     M2.3                General Message Information   Data Group

     M2.4                Event Information             Data Group

     M2.5                Content                       EXTRACT
LIM Cardinality   LIM Definition                                     LIM Value Domain


<Undefined>       A message that is used to exchange healthcare
                  information between two systems.

1                 Root class of all information model classes that
                  can be archetyped.
1                 Information pertaining to the sending of the
                  message.
1                 Information pertaining to the receipt of the
                  message.
1                 General information about the message.

1                 Information about the event related to the
                  message.
0..1              The content (or payload) of the message.
LIM Format Constraint   Other LIM Constraints   LIM Example (for Exchange)
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR Phase
                                                            1 Core

                                                            Yes
       INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST          LAB REPORT - NEHR LIST

Term                    Definition & Comments         Term
LAB REPORT - NEHR LIST              RADIOLOGY REPORT - NEHR LIST

     Definition & Comments   Term
RADIOLOGY REPORT - NEHR LIST                                         ADT - NDD

       Definition & Comments   ADT NDDS




                               LIM.LOCATABLE [1]

                               LIM.Sending Information [1]

                               LIM.Receiving Information [1]

                               LIM.General Message Information [1]

                               LIM.Event Information [1]

                               LIM.Content [0..1]


                               UNMAPPED
                        ADT - NDDS TEMPLATE

ADT NDDS      ADT IDDS (SHS)
Cardinality

              MSH [1]
              EVN [1]

1             N/A

1             MSH [1]
              EVN [1]
1             MSH [1]

1             MSH [1]

1             MSH [1]
              EVN [1]
0..1          N/A


              UNMAPPED FIELDS REQUIRING IHIS
              CLARIFICATION/ATTENTION
              Operator ID (EVN-5) [0..Many]

              [MOHH 14042010] Is this the ID of the person entering
              the data or the person sending the message? If so, how
              can tEHRe be multiple such Operator IDs (i.e. cardinality
              of 0..Many)? We need this information to understand
              how to map it to the LIM.




              NOTES FOR MOHH USE ONLY
              Field Separator (MSH-1) [1]
              [Recommendation: Ignore as this element is HL7 v2.3.1-
              specific]
              Linda: Agree
              Encoding Characters (MSH-2) [1]
              [Recommendation: Ignore as this element is HL7 v2.3.1-
              specific]
              Linda: Agree
Processing ID (MSH-11) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: I would suggest that we should include this to
allow production versus test messages.




Version ID (MSH-12) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: We definitely should be including 'Message
Format' (ie 'HL7' and 'Message Format Version' (ie
'v2.3.1') data elements for this purpose.




Event Type Code (EVN-1) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: Is this always the same as the 'Trigger Event'? If so,
please map this to Trigger Event. Do not ignore.

[7/4: To check furtEHR with WH]
Recorded Date/Time (EVN-2) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: If this is always the Message Sent DateTime, then
it should be mapped to this as well.

[7/4: To check furtEHR with WH]
[14/4 YC: Have added this as second choice for
LIM.Message Sent DateTime, but will indicate that IHIS
clarification is needed]


Operator ID (EVN-5) [0..many]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: We shouldn't ignore this. I'd like to understand if
this is the 'Data Entered By' Person, because this is a
valid part of the reference model (as opposed to the
'Message Sent By' person).

[7/4: To check furtEHR with WH]
Event Occurred (EVN-6) [0..1]
[Recommendation: Ignore as this element is application-
specific]
Linda: I would suggest adding a 'Trigger Event Type'
data element under 'Trigger Event'
ADT IDDS (NHG)


MSH [1]
EVN [1]

N/A

MSH [1]
EVN [1]
MSH [1]

MSH [1]

MSH [1]
EVN [1]
N/A


UNMAPPED FIELDS REQUIRING IHIS
CLARIFICATION/ATTENTION
Operator ID (EVN-5) [0..Many]

[MOHH 14042010] Is this the ID of the person entering
the data or the person sending the message? If so, how
can tEHRe be multiple such Operator IDs (i.e. cardinality
of 0..Many)? We need this information to understand
how to map it to the LIM.




NOTES FOR MOHH USE ONLY
Field Separator (MSH-1) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: Agree
Encoding Characters (MSH-2) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: Agree
Processing ID (MSH-11) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: I would suggest that we should include this to
allow production versus test messages.




Version ID (MSH-12) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: We definitely should be including 'Message
Format' (ie 'HL7' and 'Message Format Version' (ie
'v2.3.1') data elements for this purpose.




Event Type Code (EVN-1) [0..1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: Is this always the same as the 'Trigger Event'? If
so, please map this to Trigger Event. Do not ignore.

[8/4: To check furtEHR with WH]
Recorded Date/Time (EVN-2) [1]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: If this is always the Message Sent DateTime, then
it should be mapped to this as well.

[8/4: To check furtEHR with WH]
[14/4 YC: Have added this as second choice for
LIM.Message Sent DateTime, but will indicate that IHIS
clarification is needed]


Operator ID (EVN-5) [0..many]
[Recommendation: Ignore as this element is HL7 v2.3.1-
specific]
Linda: As per comment to left.

[8/4: To check furtEHR with WH]
HCM Event Type (local field) (EVN-7) [0..1]
[Recommendation: Ignore as this element is application-
specific]
Linda: I would suggest adding a 'Trigger Event Type'
data element under 'Trigger Event'
MEDICATION MESSAGE
            LIM ID Ref   LIM Data Item Name            LIM Data Type


M3                       MEDICATION MESSAGE            MESSAGE


     M3.1                LOCATABLE                     Class

     M3.2                Sending Information           Data Group

     M3.3                Receiving Information         Data Group
     M3.3                General Message Information   Data Group

     M3.4                Event Information             Data Group

     M3.5                Content                       EXTRACT
LIM Cardinality   LIM Definition                                     LIM Value Domain


<Undefined>       A message that is used to exchange healthcare
                  information between two systems.

1                 Root class of all information model classes that
                  can be archetyped.
1                 Information pertaining to the sending of the
                  message.
1                 Information pertaining to the receipt of the
1                 message.
                  General information about the message.

1                 Information about the event related to the
                  message.
0..1              The content (or payload) of the message.
LIM Format Constraint   Other LIM Constraints   LIM Example (for Exchange)
LIM Example (for Display)   LIM Comments   LIM Change Log   NEHR Phase
                                                            1 Core

                                                            Yes
       INVESTIGATIONS (DRILL-DOWN LIST) - NEHR LIST          LAB REPORT - NEHR LIST


Term                    Definition & Comments         Term
LAB REPORT - NEHR LIST              RADIOLOGY REPORT - NEHR LIST


     Definition & Comments   Term
RADIOLOGY REPORT - NEHR LIST                                         MEDS ORDER (MO) - ND


       Definition & Comments   MO NDDS




                               LIM.LOCATABLE [1]

                               LIM.Sending Information [1]

                               LIM.Receiving Information [1]
                               LIM.General Message Information [1]

                               LIM.Event Information [1]

                               LIM.Content [0..1]


                               UNMAPPED
           MEDS ORDER (MO) - NDDS TEMPLATE


Med Order NDDS MO IDDS (NHG)
Cardinality

               MSH [1]


1              N/A

1              N/A

1              MSH [1]
1              MSH [1]

1              MSH [1]

0..1           N/A


               UNMAPPED
ATE                                                         MEDS DISPENSE (MD) - ND


      MO IDDS (KKH)   MD NDDS


      MSH [1]


      N/A             LIM.LOCATABLE [1]

      N/A             LIM.Sending Information [1]

      N/A             LIM.Receiving Information [1]
      MSH [1]         LIM.General Message Information [1]

      MSH [1]         LIM.Event Information [1]

      N/A             LIM.Content [0..1]


      UNMAPPED        UNMAPPED
       MEDS DISPENSE (MD) - NDDS TEMPLATE


Med Dispense     MD IDDS (NHG)              MD IDDS (CGH)
NDDS Cardinality

                  MSH [1]                   MSH [1]


1                 N/A                       N/A

1                 MSH [1]                   MSH [1]

1                 MSH [1]                   MSH [1]
1                 MSH [1]                   MSH [1]

1                 MSH [1]                   MSH [1]

0..1              N/A                       N/A


                  UNMAPPED                  UNMAPPED
Data Types
LIM ID Ref   LIM Data Type Component      LIM Type   LIM Cardinality
             Name
1            Boolean


2            Coded Text




3            Codeable Text


4            DateTime

5            DateTime Interval



6            Duration                     Quantity

7            Electronic Contact Details


8            Encapsulated Data


9            Identifier
10           Integer


11           Quantity



12           Quantity Range


13           Quantity Ratio


14           Real




15           Text


16           UID

17           URI
LIM Definition                                                        LIM Value Domain

A mathematical datatype associated with two-valued logic, e.g.
"true" or "false".
Coded text without exceptions; text with code mappings. Values
in this datatype must come from the bound value domain, with
no exceptions.

Coded text with exceptions; flexible datatype to support various
ways of holding text, both free text and coded text.
A single date and/or time.

The start datetime (optional) and end datetime (optional) of a
period of time, and the length of time (width, optional) between
the start and end of the time interval.

The period of time during which something continues

This data group contains data elements used to capture and
store the electronic communication details of entities.

Data that is primarily intended for human interpretation or for
furtEHR machine processing.


A mathematical datatype comprising exact integral values.


Used for recording the result of measurements and observations.



Two Quantity values that define the minimum and maximum
values, i.e. lower and upper bounds.

The relative magnitude of two Quantity (UCUM) values (usually
expressed as a quotient).
A computational approximation to the standard mathematical
concept of real numbers.




A character string.


A universally unique identifier.

A string of characters used to identify a resource on the Internet,
or a node within an EHR.
LIM Format Constraint   other LIM Constraints                     LIM Example (for LIM Example (for
                                                                  Exchange)        Display)




YYYYMMDD [HHMMSS]

                        Unbounded time intervals can be
                        defined by not including a start and/or
                        end datetime value.




                        Unbounded quantity ranges can be
                        defined by not including a minimum
                        and/or maximum quantity value.
LIM Comments                                          LIM Change Log




This is typically used for defining the valid range
of values for a particular measurement or
observation.
Design Patterns
                  LIM ID Ref   LIM Data Item Name


1                              Problem Diagnosis Pattern


2                              Procedure Pattern



3                              Evaluation Procedure Pattern



4                              Specimen



5                              Medication Product


6                              Investigation Pattern
LIM Data Type/Group           LIM Cardinality


Data Group


Data Group



Extension of Procedure
Pattern

Design Pattern



Design Pattern


Specialisation of Procedure
Pattern
LIM Definition


A design pattern used to describe a problem diagnosis. The national representation of a problem
diagnosis will include data items 1.1, 1.2 and 1.3.

A design pattern used to describe a procedure.



A design pattern used to describe an evaluation procedure.



A design pattern used to describe a specimen.



A design pattern used to describe a medication product.


A design pattern used to describe an investigation.
LIM Value Domain   LIM Format   other LIM Constraints
                   Constraint
LIM Example (for Exchange)   LIM Example (for Display)   LIM Comments
LIM Change Log
Term Lists


                                      National   National Map                Classification
        Value Domain Name                                         Required
                                      or Local     Available                    Scheme


Address_Type_VD                   National       Yes            Mandatory



Administration_Method_VD          National       No             Optional

Admission_Source_Type_VD          National       No             Optional

ADR_Override_Reason_VD            National       Yes            Mandatory

Adverse_Reaction_Category_VD      National       Yes            Mandatory

Adverse_Reaction_Description_VD   National       Yes            Mandatory

Adverse_Reaction_Presence_VD      National       Yes            Mandatory

Adverse_Reaction_Status_VD        National       Yes            Mandatory

Alert_Certainty_VD                National       Yes            Mandatory

Alert_Description_VD              National       Yes            Mandatory

Alert_Status_VD                   National       Yes            Optional

Alert_Type_VD                     National       Yes            Mandatory

Allergen_Route_VD                 National       Yes            Optional

Application_Event_Trigger_VD      Local          No             Optional

Application_VD                    National       N/A            Mandatory




Arrival_Mode_VD                   National       No             Optional

Associated_Finding_VD             National       Yes            Optional
                                                      Optional




Associated_Procedure_VD              National   Yes   Optional




Bed_VD                               Local      No    Optional




Bill_Status_VD                       Local      No    Optional

Billing_Program_Type_VD              Local      No    Mandatory

Brand_Substituted_VD                 National   Yes   Optional

Building_VD                          Local      No    Optional

Case_Classification_Category_VD      National   No    Optional

Case_Classification_Type_VD          Local      No    Optional

Causative_Agent_Category_VD (SIN)    National   Yes   Mandatory

Causative_Agent_VD                   National   Yes   Mandatory




Cause_of_Death_Diagnosis_Indicator_V National   Yes   Mandatory
D
Check_Digit_Method_VD                National   No    Mandatory
Choice_of_Ward_Class_VD          Local      No    Optional

CIP_Status_VD                    National   Yes   Mandatory

City_VD                          Local      No    Optional

Clinical_Course_VD               National   Yes   Optional

Confidentiality_Requirement_VD   National   Yes   Mandatory

Consultation_Indicator_VD        National         Optional

Contact_Type_VD                  National   No    Mandatory




Contact_Use_VD                   National   No    Mandatory




Container_Type_VD                National   Yes   Mandatory

Country_VD                       National   No    Mandatory




Coverage_Type_VD                 National   No    Optional
Data_Format_VD (SIN)                 National   No           Mandatory




DateTime_Description_VD              Local      No           Optional




Deactivation_Reason_VD               National   No           Mandatory

Death_Indicator_VD                   National   No           Mandatory




Department_VD                        Local      No           Optional

Diagnostic_Related_Group_VD          National   No           Mandatory

Dialect_Group_VD                     Local      No           Optional




Discharge_Outcome_VD                 National   Yes          Mandatory

Discharge_Status_VD                  National   No           Mandatory

Dispensed_Administration_Schedule_D Local       No           Optional
escription_VD
Dispensed_Indicator_VD              National                 Mandatory

Dispensed_To_Location_VD             Local      No           Optional

Document_Category_VD                 National   N/A (Must use Optional
                                                National)
Document_Confidentiality_Status_VD   National   N/A (Must use Mandatory
                                                National)
Document_Status_VD       National   Yes          Mandatory

Document_SubType_VD      National   N/A (Must use Mandatory
                                    National)
Document_Type_VD         National   N/A (Must use Mandatory
                                    National)
Doctor_MCR_VD            National   No            Mandatory




Dosage_Form_VD           National   Yes          Mandatory




Dose_Instructions_VD     National   No           Mandatory

Emergency_Indicator_VD   National   Yes          Optional
Employer_VD                        Local      No    Optional

ENTRY_Location_VD                  Loca       No    Optional

Episodicity_VD                     National   Yes   Optional

Facility_VD                        National   Yes   Mandatory




Financial_Class_VD                 National   No    Optional

Finding_Context_VD                 National   Yes   Optional

Floor_VD                           Local      No    Optional

Foreigner_Status_VD                National   No    Optional

Gender_VD                          National   Yes   Mandatory




Healthcare_Establishment_Type_VD   National   No    Mandatory

Healthcare_Facility_VD             National   Yes   Optional




Healthcare_Role_VD                 National   No    Mandatory

Hospital_Service_VD                Local      No    Mandatory

Identifier_Type_VD                 National   Yes   Mandatory
Ingredient_VD                      National   Yes   Optional




Intervention_Required_Reason_VD    Local      No    Optional

Investigation_Name_VD              National   Yes   Mandatory

Investigation_SubType_VD           National   Yes   Mandatory

Investigation_Type_VD              National   Yes   Mandatory

Laboratory_Participation_Type_VD   National   Yes   Mandatory

Laboratory_Test_VD                 National   No    Mandatory

Language_VD                        National   No    Mandatory




Laterality_VD                      National   Yes   Mandatory




List_Status_VD                     National   Yes   Mandatory

Location_Status_VD                 Local      No    Optional


Location_Type_VD                   Local      No    Mandatory

Marital_Status_VD                  National   No    Mandatory
Medical_Leave_Description_VD        Local      No              Optional

Medical_Leave_Type_VD               National   No              Optional

Medication_Changes_VD               National   Yes             Mandatory

Medication_Dose_Units_VD            National   Yes             Mandatory




Medication_Frequency_Qualifier_VD   National   No              Mandatory

Medication_Frequency_VD             National   No              Mandatory

Medication_Item_Compliance_VD       National   No              Mandatory

Medication_Item_Connecting_Term_V National     No              Mandatory
D
Medication_Item_Dispense_Type_VD National      Yes             Mandatory

Medication_Item_Order_Priority_VD   National   No              Optional

Medication_Item_Treatment_Status_V National    No              Mandatory
D
Medication_List_Status_VD          National    N/A (? - Same   Mandatory
                                               as other list
Medication_List_Type_VD             National   Yes             Mandatory

Medication_Name_VD                  National   Yes             Optional

Medication_Quantity_Units_VD        National   Yes             Mandatory




Medication_Reason_VD                National   No              Mandatory
Medication_Strength_Units_VD         National   Yes       Mandatory




Message_Type_VD                      National   Yes       Mandatory




Mode_of_Transport_VD                 Local      No        Optional

Movement_Plan_Registration_Indicator Local      No        Optional
_VD

Name_Suffix_VD                       Local      No        Optional




Name_Title_VD                        National   No        Optional




Name_Type_VD                         Local      No        Optional




Nationality_VD                       National   No        Mandatory




NOK_Role_VD                          National   No        Optional

Observation_Name_VD                  National   Yes (?)   Mandatory

Observation_Result_Value_Type_VD     National   Yes       Mandatory

Observation_Setting_VD               Local      No        Optional

Observation_Status_VD                National   Yes       Mandatory

Observation_Type_VD                  National   No        Optional

Occupation_VD                        Local      No        Mandatory
                                                          Mandatory




Opt_Out_Exception_VD              National   N/A (Must use Optional
                                             National)
Opt_Out_Indicator_VD              National   N/A (Must use Optional
                                             National)
Ordered_Duration_Description_VD   Local      No            Mandatory

Ordered_Indicator_VD              Local      National     Mandatory

Organ_Donor_Indicator_VD          National   Yes          Optional

Organisation_Role_VD              Local      No           Mandatory

Organisation_Type_VD              National   No           Mandatory

Organisation_VD                   National   Yes          Mandatory
other_Component_Identifying_Informa National   No    Optional
tion_VD
Participation_Type_VD               National   Yes   Mandatory

Patient_Class_VD                    National   No    Mandatory

Patient_Event_Location_VD           Local      No    Optional

Patient_Event_Status_VD             National   Yes   Mandatory

Patient_Event_Type_VD               National   Yes   Mandatory

Plan_Type_VD                        Local      No    Mandatory




Point_of_Care_VD                    Local      No    Optional
Priority_VD                       National   Yes   Optional




PRN_Reason_VD                     Local      No    Optional

Probability_of_Causation_VD       National   Yes   Mandatory

Problem_Diagnosis_Category_VD     National   Yes   Mandatory

Problem_Diagnosis_Frequency_VD    National   No    Mandatory

Problem_Diagnosis_Status_VD       National   Yes   Mandatory

Problem_Diagnosis_Type_VD         National   Yes   Mandatory




Problem_Diagnosis_Name_VD         National   Yes   Mandatory

Procedure_Context_VD              National   No    Optional




Procedure_Type_VD                 National   Yes   Mandatory

Processing_ID_VD                  National   Yes   Mandatory

Race_VD                           National   No    Mandatory




Radiology_Participation_Type_VD   National   Yes   Mandatory

Reaction_Site_VD                  National   No    Mandatory

Realm_VD                          National   No    Mandatory
Reason_For_Change_VD                 National         No    Mandatory

Reason_For_Investigation_VD          National         No    Mandatory

Referral_Type_VD                     National         No    Optional

Region_VD                            Local            No    Optional

Registration_Document_Type_VD        National         No    Optional

Relationship_VD                      National         No    Optional




Religion_VD                          National         No    Mandatory




Request_Status_Update_Reason_VD      Local            No    Mandatory

Requested_Action_VD                  National         Yes   Optional
                                     ** Try to make
Resident_Status_VD                   National         No    Mandatory




Result_Interpretation_Normal_Flag_VD National         Yes   Optional

Result_Interpretation_Status_VD      National         Yes   Optional

Result_Status_VD                     National         Yes   Mandatory

Room_VD                              Local            No    Optional


Route_of_Administration_VD           National         Yes   Mandatory

Service_Category_VD                  National         Yes   Mandatory
Service_Description_VD            Local      No    Mandatory

Severity_VD                       National   Yes   Mandatory


Site_of_Administration_VD         National   No    Optional

Site_VD                           National   No    Mandatory




Specialty_VD                      National   No    Mandatory

Specimen_VD                       National   Yes   Optional


Subject_Relationship_Context_VD   National   Yes   Optional

Subvention_Document_Type_VD       National   No    Optional

Synopsis_Type_VD                  National   Yes   Mandatory

Temporal_Context_VD               National   Yes   Optional




Temporal_Units_VD                 National   Yes   Optional

Test_Result_Status_VD             National   Yes   Mandatory

Test_Result_Value_Type_VD         National   Yes   Mandatory

Time_Units_UCUM_VD                National   Yes   Optional

Treatment_Category_VD             National   No    Mandatory
Triage_Category_VD                National   No    Optional    Singapore
                                                               Emergency
                                                               Patient Acuity
                                                               Category
                                                               Scale (PACS)

Trigger_Event_Type_VD             National   Yes   Mandatory
Trigger_Event_VD                  National   Yes   Mandatory
Units_UCUM_VD                     National   Yes   Optional
Units_VD                      National   Yes   Optional
VIP_Status_VD                 National   Yes   Mandatory
Visit_Downtime_Indicator_VD   Local      No    Optional

Visit_Payment_Class_VD        Local      No    Mandatory
VVIP_Status_VD                National   Yes   Mandatory
                                        Data Element / Component
Comments          Worksheet        Data Element    Data Element Name         Component Name
                                        ID
           DG2. Patient            DG2.1.4        Address                 Address Type

           DG3. Patient HCO        DG1.3.4        Organisation Address    Address Type

           DG7. Medication Item    DG7.1.4.4      Administration Method

           DG4. Patient EI         DG4.1.3.3      Admission Source Type

           E6. Medication Order    E6.1.4.7.2     ADR Override Reason

           E6. Adverse Reaction    E6.1.1.3       Adverse Reaction
                                                  Category
           E6. Adverse Reaction    E6.1.3.1       Reaction Description

           E6. Adverse Reaction    E6.1.1.2       Adverse Reaction
                                                  Presence
           E6. Adverse Reaction    E6.1.1.1       Adverse Reaction
                                                  Status
           E11. Alert              E11.1.4        Alert Certainty

           E11. Alert              E11.1.2        Alert Description

           E11. Alert              E11.1.3        Alert Status

           E11. Alert              E11.1.1        Alert Type

           E6. Adverse Reaction    E6.1.2.2       Allergen Route

           DG5. Message Control    DG5.1.2.4      Application Event
                                                  Trigger
           DG5. Message Control    DG5.1.5.2      Sending Application

           DG5. Message Control    DG5.1.6.2      Target Application

           DG6. Document Control   DG6.1.6.4      Creating Application

           DG4. Patient EI         DG4.1.3.4      Arrival Mode

           DG7. Medication Item    DG7.1.1.2.2    Associated Finding
E11. Investigation Result   E11.1.2.1.2.3   Associated Finding

E6. Procedure               E6.1.1.2.2      Associated Finding

DG7. Medication Item        DG7.1.1.2.1     Associated Procedure

E11. Investigation Result   E11.1.2.1.2.2   Associated Procedure

DG4. Patient EI             DG4.1.5.1       Patient Event Location

DG1. Participation          DG1.7.3         Bed


DG4. Patient EI             DG4.1.8.6       Bill Status

DG4. Patient EI             DG4.1.8.5       Billing Program Type

E11. Medication Dispense E11.1.4.7          Brand Substituted

DG1. Participation          DG1.7.7         Building

DG4. Patient EI             DG4.1.2.2       Case Classification
                                            Category
DG4. Patient EI             DG4.1.2.3       Case Classification
                                            Type
E6. Adverse Reaction        E6.1.2.3        Causative Agent
                                            Category
E1. Problem Diagnosis       E1.1.4.2        Causative Agent

E6. Adverse Reaction        E6.1.2.1        Causative Agent Name

E1. Problem Diagnosis       E1.1.4.3        Cause of Death
                                            Diagnosis Indicator
R1. Data Types              8.3             Identifier               Check Digit Method

DG2. Patient                DG2.1.3         Patient Identifier       Check Digit Method

DG3. Patient HCO            DG1.3.3         Organisation Identifier Check Digit Method

DG2. Patient                DG2.1.11.3      NOK identifier           Check Digit Method

DG2. Patient                DG2.1.12.1      Account Number           Check Digit Method

DG2. Patient                DG2.1.9.15      Prior Patient Identifier Check Digit Method

DG2. Patient                DG2.1.14.1      Insurance Plan           Check Digit Method
                                            identifier
DG2. Patient               DG2.1.13.3      Employer Number          Check Digit Method

DG2. Patient               DG2.1.14.6.3    Insured Person           Check Digit Method
                                           Identifier
DG2. Patient               DG2.1.15.3      Guarantor Identifier     Check Digit Method

DG4. Patient EI            DG4.1.8.9       Choice of Ward Class

DG2. Patient               DG2.1.10.1.3    CIP Status

C2. Patient Event Report   C2.1.15.2.1.3   City Visited

E1. Problem Diagnosis      E1.1.1.4        Clinical Course

DG2. Patient               DG2.1.10.5      Confidentiality
                                           Requirement
DG4. Patient EI            DG4.1.3.1       Consultation Indicator

DG1. Participation         DG1.3.5         Electronic Contact       Contact Type

R1. Data Types             6.2             Electronic Contact       Contact Type
                                           Details
DG1. Participation         DG1.3.5         Electronic Contact       Contact Use

DG2. Patient               DG2.1.5         Electronic Contact       Contact Use

R1. Data Types             6.3             Electronic Contact       Contact Use
                                           Details
DG7. Medication Item       DG7.1.1.5       Container Type

DG1. Participation         DG1.2.14        Country

DG1. Participation         DG1.4.3.3       Birth Country

DG2. Patient               DG2.1.9.3       Birth Country

DG3. Patient HCO           DG1.3.4         Organisation Address     Country

DG5. Message Control       DG5.1.5.3       Country of Origin

C2. Patient Event Report   C2.1.15.2.1.1   Country Visited

DG2. Patient               DG2.1.4         Address                  Country

DG2. Patient               DG2.1.14.12     Coverage Type
C1. Investigation Report   C1.1.5.2      Report Contents
                                         Format
C2. Patient Event Report   C2.1.13.2.3   Document Data Format

C2. Patient Event Report   C2.1.16.4.3   Medical Certificate
                                         Data Format
C3. Summary Care Record C3.1.11.2.3      Document Data Format

E6. Procedure              E6.1.5.3      Procedure Report Data
                                         Format
E1. Problem Diagnosis      E1.1.3.6      Resolution DateTime
                                         Description
E1. Problem Diagnosis      E1.1.3.4      Clinically Recognised
                                         DateTime Description
E1. Problem Diagnosis      E1.1.3.8      Last Occurrence
                                         DateTime Description
E1. Problem Diagnosis      E1.1.3.2      Onset DateTime
                                         Description

E6. Adverse Reaction       E6.1.1.5      Reason for
                                         Deactivation
DG1. Participation         DG1.4.3.4     Death Indicator

DG2. Patient               DG2.1.9.4     Death Indicator

DG4. Patient EI            DG4.1.3.5     Admitting Department

E1. Problem Diagnosis      E1.1.2.4      Diagnostic Related
                                         Group
DG1. Participation         DG1.4.3.9     Dialect Group

DG2. Patient               DG2.1.9.9     Dialect Group

DG4. Patient EI            DG4.1.4.3     Discharge Outcome

DG4. Patient EI            DG4.1.4.1     Discharge Status

E11. Medication Dispense E11.1.4.3       Dispensed
                                         Administration
E11. Medication Dispense E11.1.4.8       Dispensed Indicator

E11. Medication Dispense E11.1.4.4       Dispensed To Location

DG6. Document Control      DG6.1.2.2     Document Category

DG6. Document Control      DG6.1.4.2     Document
                                         Confidentiality Status
DG6. Document Control       DG6.1.4.1       Document Status
                                            Name
DG6. Document Control       DG6.1.3.3       Document SubType
                                            Name
DG6. Document Control       DG6.1.3.1       Document Type Name

DG4. Patient EI             DG4.1.7.1       Referred By             Participant
                                                                    identifier.Designation
DG4. Patient EI             DG4.1.7.2       Admitting Clinician     Participant
                                                                    identifier.Designation
DG4. Patient EI             DG4.1.7.3       Discharging Clinician   Participant
                                                                    identifier.Designation
C2. Patient Event Report    C2.1.7.4        Synopsis Author         Participant
                                                                    identifier.Designation
C2. Patient Event Report    C2.1.12.2.3.1   Service Provider        Participant
                                                                    identifier.Designation
C2. Patient Event Report    C2.1.14.3.1     Triage Performed By     Participant
                                                                    identifier.Designation
C2. Patient Event Report    C2.1.16.3.1     Issued By               Participant
                                                                    identifier.Designation
DG6. Document Control       DG6.1.6.1       Document Author         Participant
                                                                    identifier.Designation

DG6. Document Control       DG6.1.6.2       Document Authoriser     Participant
                                                                    identifier.Designation
E1. Problem Diagnosis       E1.1.5.1        Diagnosing Clincian     Participant
                                                                    identifier.Designation
E6. Medication Order        E6.1.2.3        Ordered By              Participant
                                                                    identifier.Designation
E11. Medication Admin       E11.1.2.7       Administered By

E11. Investigation Result   E11.1.1.3       Requesting Clinician    Participant
                                                                    identifier.Designation
E6. Procedure               E6.1.4.1        Performed By            Participant
                                                                    identifier.Designation
DG2. Patient                DG2.1.16.1      Care Team member        Participant
                                                                    identifier.Designation
DG7. Medication Item        DG7.1.1.5.3     Dosage Form

DG7. Medication Item        DG7.1.1.5.11.1 Formulation Input
                            .4             Dosage Form
DG7. Medication Item        DG7.1.2.6      Dose Instructions

DG4. Patient EI             DG4.1.2.7       Emergency Indicator
              DG2. Patient            DG2.1.13.7     Employer Name

              DG7. Medication Item    DG7.1.6.5      Medication Item
                                                     ENTRY Location
              E1. Problem Diagnosis   E1.1.1.3       Episodicity

              DG1. Participation      DG1.7.4        Facility

              DG4. Patient EI         DG4.1.5.1      Patient Event Location

              DG4. Patient EI         DG4.1.8.1      Financial Class

              E1. Problem Diagnosis   E1.1.1.2.1     Finding Context

              DG1. Participation      DG1.7.8        Floor

              DG2. Patient            DG2.1.9.16     Foreigner Status

              DG2. Patient            DG2.1.9.1      Gender

              DG1. Participation      DG1.4.3.1      Gender

              DG2. Patient            DG2.1.11.9.1   NOK Gender

              DG2. Patient            DG2.1.14.6.9.1 Insured Person Gender

              DG3. Patient HCO        DG1.6.2        Organisation Type

              DG5. Message Control    DG5.1.5.1      Sending Organisation

              DG5. Message Control    DG5.1.6.1      Target Organisation

              DG5. Message Control    DG5.1.5.2      Sending Application

              DG1. Participation      DG1.3.2        Healthcare Role

Hierarchy     DG4. Patient EI         DG4.1.2.6      Service or Specialty
needed.
Singapore     R1. Data Types          8.4            Identifier               Type
Blue and Pink
              DG2. Patient            DG2.1.3        Patient Identifier       Type

              DG2. Patient            DG2.1.11.3     NOK Identifier           Type

              DG2. Patient            DG2.1.9.15     Prior Patient Identifier Type
DG3. Patient HCO            DG1.3.3         Organisation Identifier Type

DG7. Medication Item     DG7.1.1.5.1.11     Formulation Input
                         .3.1               Ingredient
DG7. Medication Item     DG7.1.1.5.1.11     Formulation Input
                         .3.2               BOSS Ingredient
E11. Medication Dispense E11.1.4.6          Intervention Required
                                            Reason
E11. Investigation Result   E11.1.2.1.1     Investigation Name

E11. Investigation Result   E11.1.2.2.2     Investigation SubType

E11. Investigation Result   E11.1.2.2.1     Investigation Type

E11. Investigation Result   E11.1.3.1.4.1   Healthcare Provider
                                            Participant
E11. Investigation Result   E11.1.3.3.1.1   Test Name

DG1. Participation          DG1.4.3.8       Language

DG2. Patient                DG2.1.9.8       Language

DG2. Patient                DG2.1.11.9.3    NOK Language

DG5. Message Control        DG5.1.3.4       Language

E1. Problem Diagnosis       E1.1.1.5.2      Laterality

E11. Investigation Result   E11.1.2.1.4.2   Laterality

E6. Procedure               E6.1.1.4.2      Laterality


S1. Problem Diagnosis List S1.1.1.2         List Status

DG1. Participation          DG1.7.5         Location Status


DG1. Participation          DG1.7.6         Location Type

DG1. Participation          DG1.4.3.12      Marital Status


DG2. Patient                DG2.1.9.12      Marital Status
C2. Patient Event Report   C2.1.16.2.2   Medical Leave
                                         Description
C2. Patient Event Report   C2.1.16.2.1   Medical Leave Type

DG7. Medication Item       DG7.1.6.1     Changes Made

DG7. Medication Item       DG7.1.2.1     Dose Quantity           Units

DG7. Medication Item       DG7.1.2.3     Dose Quantity Range     Units

DG7. Medication Item       DG7.1.2.5     Daily Dose Range        Units

DG7. Medication Item       DG7.1.2.4     Dose Quantity Rate      Units

DG7. Medication item       DG7.1.3.2     Frequency Qualifier

DG7. Medication item       DG7.1.3.1     Frequency

DG7. Medication Item       DG7.1.5.3     Medication Item
                                         Compliance
E6. Medication Order       E6.1.3.3      Medication Item
                                         Connecting Term
DG7. Medication Item       DG7.1.5.4     Medication Item
                                         Dispense Type
E6. Medication Order       E6.1.2.6      Order Priority

DG7. Medication item       DG7.1.5.2     Medication Item
                                         Treatment Status
S2. Medication List        S2.1.1.2      List Status

S2. Medication List        S2.1.1.1      List Type

DG7. Medication Item       DG7.1.1.1     Medication Name

E6. Medication Order       E6.1.4.1      Requested Quantity      Units

DG7. Medication Item       DG7.1.1.5.4  Total Component          Units
                                        Quantity
DG7. Medication Item     DG7.1.1.5.6    Component Quantity       Container Size
                                        per Container
DG7. Medication Item     DG7.1.1.5.11.1 Formulation Input        Units
                         .5             Total Quantity
E11. Medication Dispense E11.1.4.1      Dispensed Quantity       Units

DG7. Medication Item       DG7.1.5.1     Reason for Medication
DG7. Medication Item       DG7.1.1.5.2.3   Ingredient Strength      Units

DG7. Medication Item                      Formulation input
                           DG7.1.1.5.1.11.3.3                       Units
                                          Ingredient Strength
DG5. Message Control       DG5.1.2.1      Message Type




C2. Patient Event Report   C2.1.14.1.1     Mode of Transport

DG4. Patient EI            DG4.1.5.3       Movement Plan
                                           Registration Indicator

DG1. Participation         DG1.1.5         Suffix

DG2. Patient                               Patient Name             Suffix

DG1. Participation         DG1.1.2         Title

DG2. Patient               DG2.1.7         Patient name             Title

DG1. Participation         DG1.1.6         Name Type

DG2. Patient               DG2.1.7         Name Type                Name Type

DG1. Participation         DG1.4.3.6       Nationality

DG2. Patient               DG2.1.9.6       Nationality

DG2. Patient               DG2.1.11.2      Healthcare Role

E11. Observation           E11.1.1.1       Observation Name

E11. Observation           E11.1.4.2       Observation Result
                                           Value Type
E11. Observation           E11.1.1.3       Observation Setting

E11. Observation           E11.1.4.4       Observation Status

E11. Observation           E11.1.1.2       Observation Type

DG1. Participation         DG1.4.3.11      Occupation

DG2. Patient               DG2.1.11.9.4    NOK Occupation
            DG2. Patient               DG2.1.9.11      Occupation

            DG2. Patient               DG2.1.10.4      EHR Opt-out Exception

            DG2. Patient               DG2.1.10.3      EHR Opt-out Indicator

            E6. Medication Order       E6.1.4.3        Ordered Duration
                                                       Description
            E6. Medication Order       E6.1.2.7        Ordered Indicator

            DG2. Patient               DG2.1.10.6      Organ Donor Indicator

            DG1. Participation         DG1.5.2.2       Organisation Role

            DG1. Participation         DG1.6.2         Organisation Type

Hierarchy   DG1. Participation         DG1.6.1         Organisation Name
needed.
            DG3. Patient HCO           DG1.6.1         Organisation Name

            DG3. Patient HCO           DG1.3.3         Organisation identifier Issuer

            DG4. Patient EI            DG4.1.4.2       Discharged To           Participant
                                                       Organisation            identifier.Designation
            DG4. Patient EI            DG4.1.4.2       Discharged To           Organisation Name
                                                       Organisation
            DG4. Patient EI            DG4.1.7.1       Referred By             Participant
                                                                               identifier.Designation
            DG6. Document Control      DG6.1.6.3       Creating Organisation   Participant
                                                                               identifier.Designation
            DG6. Document Control      DG6.1.6.3       Creating Organisation   Organisation Name

            C2. Patient Event Report   C2.1.12.2.3.1   Service Provider

            DG5. Message Control       DG5.1.5.1       Sending Organization    Participant
                                                                               identifier.Designation
            DG5. Message Control       DG5.1.5.1       Sending Organization    Organisation Name

            DG5. Message Control       DG5.1.5.4       Content Source          Participant
                                                       Organisation            identifier.Designation
            DG5. Message Control       DG5.1.5.4       Content Source          Organisation Name
                                                       Organisation
            DG5. Message Control       DG5.1.6.1       Target Organisation     Participant
                                                                               identifier.Designation
            DG5. Message Control       DG5.1.6.1       Target Organisation     Organisation Name
E11. Investigation Result   E11.1.3.1.4.2   Requested Performing
                                            Facility
E11. Investigation Result   E11.1.3.1.4.3   Reference Facility   Participant
                                                                 identifier.Designation
E11. Investigation Result   E11.1.3.1.4.3   Reference Facility   Organisation Name

E11. Investigation Result   E11.1.1.4       Requested                 Participant
                                            Investigation Facility    identifier.Designation
E11. Investigation Result   E11.1.1.4       Requested                 Organisation Name
                                            Investigation Facility
DG2. Patient                DG2.1.3         Patient Identifier        Issuer

DG2. Patient                DG2.1.10.1.1    Healthcare Facility       Participant
                                                                      identifier.Designation
DG2. Patient                DG2.1.10.1.1    Healthcare Facility       Organisation Name

DG2. Patient                DG2.1.11.3      NOK Identifier            Issuer

DG2. Patient                DG2.1.9.15      Prior Patient Identifier Issuer

DG2. Patient                DG2.1.16.1      Care Team member          Participant
                                                                      identifier.Designation
C2. Patient Event Report    C2.1.12.2.3.1   Service Provider          Participant
                                                                      identifier.Designation
R1. Data Types              8.5             Issuer

DG7. Medication Item        DG7.1.1.5.8     other Component
                                            Identifying Information
DG1. Participation          DG1.3.1         Participation Type

DG4. Patient EI             DG4.1.8.1       Financial Class

C2. Patient Event Report    C2.1.12.2.3.1   Service Provider          Point of Care

DG4. Patient EI             DG4.1.2.4       Patient Event Control
                                            Status
DG4. Patient EI             DG4.1.2.1       Patient Event Type

DG2. Patient                DG2.1.14.5      Plan Type




DG1. Participation          DG1.7.1         Point of Care
DG4. Patient EI             DG4.1.5.1       Patient Event Location


E11. Investigation Result   E11.1.2.1.3     Priority

E6. Procedure               E6.1.1.3        Priority

DG7. Medication Item        DG7.1.3.3       PRN Reason

E6. Adverse Reaction        E6.1.2.4        Probability of
                                            Causation
E1. Problem Diagnosis       E1.1.2.3        Problem Diagnosis
                                            Category
E1. Problem Diagnosis       E1.1.4.1        Frequency of
                                            Reoccurrence
E1. Problem Diagnosis       E1.1.2.1        Problem Diagnosis
                                            Status
E1. Problem Diagnosis       E1.1.2.2        Problem Diagnosis
                                            Type
S1. Problem Diagnosis List S1.1.1.1         List Type

E1. Problem Diagnosis       E1.1.1.1        Problem Diagnosis
                                            Name
E11. Investigation Result   E11.1.2.1.2.1   Procedure Context

E6. Procedure               E6.1.1.2.1      Procedure Context

E6. Procedure               E6.1.2.1        Procedure Type

DG5. Message Control        DG5.1.1.2       Processing ID

DG1. Participation          DG1.4.3.7       Race

DG2. Patient                DG2.1.9.7       Race

E11. Investigation Result   E11.1.3.1.4.1   Healthcare Provider
                                            Participant
E6. Adverse Reaction        E6.1.3.2        Reaction Site

R1. Data Types              8.4             Identifier               Realm

DG2. Patient                                Patient identifier       Realm

DG2. Patient                                NOK Identifier           Realm

DG2. Patient                                Prior Patient Identifier Realm
DG3. Patient HCO            DG1.3.3         Organisation Identifier Realm

DG7. Medication Item        DG7.1.6.2       Reason for Change

E11. Investigation Result   E11.1.1.5       Reason For
                                            Investigation
DG4. Patient EI             DG4.1.3.2       Referral Type

C2. Patient Event Report    C2.1.15.2.1.2   Region Visited

DG2. Patient                DG2.1.12.3      Registration Document
                                            Type
DG1. Participation          DG2.1.18.6.2    Relationship to Patient

DG2. Patient                DG2.1.14.6.8    Relationship to Patient

DG2. Patient                DG2.1.15.8      Guarantor Relationship
                                            to Patient
DG2. Patient                DG2.1.11.8      NOK Relationship to
                                            Patient
DG1. Participation          DG1.4.3.10      Religion

DG2. Patient                DG2.1.9.10      Religion

E11. Investigation Result   E11.1.1.1.5     Order Control Reason

E11. Investigation Result   E11.1.1.1.3     Requested Action

DG1. Participation          DG1.4.3.13      Resident Status

DG2. Patient                DG2.1.9.13      Resident Status

E11. Investigation Result   E11.1.3.2.3.2   Result Interpretation
                                            Normal Flag
E11. Investigation Result   E11.1.3.2.3.1   Result Interpretation
                                            Status
E11. Investigation Result   E11.1.3.1.2.1   Result Status

DG4. Patient EI             DG4.1.5.1       Patient Event Location

DG1. Participation          DG1.7.2         Room
DG7. Medication Item        DG7.1.4.1       Route of
                                            Administration
C2. Patient Event Report    C2.1.12.2.1.2   Service Category
            C2. Patient Event Report    C2.1.12.2.1.1   Service Description

            E1. Problem Diagnosis       E1.1.1.6        Severity
            E6. Adverse Reaction        E6.1.3.3        Reaction Severity
            E11. Alert                  E11.1.8         Alert Severity
            DG7. Medication Item        DG7.1.4.2       Site of Administration

            E1. Problem Diagnosis       E1.1.1.5.1      Finding Site
            E11. Investigation Result   E11.1.2.1.4.1   Procedure Site Direct

            E6. Procedure               E6.1.1.4.1      Procedure Site Direct

Hierarchy   DG1. Participation          DG1.5.1         Specialty
needed.
            E11. Investigation Result   E11.1.2.3.1.1   Specimen Type Name

            T1. Design Patterns         4.1             Specimen Name
            E1. Problem Diagnosis       E1.1.1.2.3      Subject Relationship
                                                        Context
            DG2. Patient                DG2.1.12.4      Subvention Document
                                                        Type
            C2. Patient Event Report    C2.1.7.2        Synopsis Type

            E1. Problem Diagnosis       E1.1.1.2.2      Temporal Context
            DG7. Medication Item        DG7.1.1.2.3     Temporal Context
            E11. Investigation Result   E11.1.2.1.2.4   Temporal Context

            E6. Procedure               E6.1.1.2.3      Temporal Context
            E1. Problem Diagnosis       E1.1.4.1        Frequency of             Denominator.Units
                                                        Reoccurrence
            E11. Investigation Result   E11.1.3.3.2.3   Test Result Status

            E11. Investigation Result   E11.1.3.3.2.2   Test Result Value Type

            R1. Data Types              5.2             Duration                 Units
            DG7. Medication Item        DG7.1.2.4       Dose Quantity rate       Denominator.Units
            DG4. Patient EI             DG4.1.8.2       Treatment Category
            C2. Patient Event Report    C2.1.14.1.2     Triage Category




            DG5. Message Control        DG5.1.2.3       Trigger Event Type
            DG5. Message Control        DG5.1.2.2       Trigger Event
            R1. Data Types              10.2            Quantity                 Units
            DG7. Medication Item        DG7.1.2.4       Dose Quantity Rate       Denominator.Units
R1. Data Types    10.2           Quantity              Units
DG2. Patient      DG2.1.10.1.2   VIP Status
DG4. Patient EI   DG4.1.8.4      Visit Downtime
                                 Indicator
DG4. Patient EI   DG4.1.8.3      Visit Payment Class
DG2. Patient      DG2.1.10.2     VVIP Status
          NDDS

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