EHR System Function and Information Model (EHR-S FIM is based on EHR-S FM R2.0) CPS.1.7.2 Manage Patient Advance Directives aka DC.1.3.2 in EHR-S FM R1.1 Stephen.Hufnagel@tma.osd.mil , facilitator January 25, 2012, original February 24, 2012, last updated Call for Participation This work is being done by the HL7 EHR Interoperability Work-group, meeting every Tuesday at 4PM ET, dial-in: 1-770-657-9270, Passcode: 510269#  The most current artifacts are at: http://wiki.hl7.org/index.php?title=EHR_Interoperability_WG 11/9/2018 DRAFT WORKING DOCUMENT

CPS.1.7.2 Manage Patient Advance Directives Statement: The purpose of this function is to capture and maintain patient advance directives. Description: Patient advance directives and provider Do Not Resuscitate (DNR ) orders are captured, as well as the date and circumstances under which the directives were received, and the location of any paper or electronic advance directive documentation. Example: (Notional Scenario) During an encounter, a health care professional might manage a patient’s advanced directives, according to scope of practice, organizational policy and/or jurisdictional law. 11/9/2018 RED: delete, Blue: insert DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.1.7.2 Manage Patient Advance Directives Activities Mapped-to System-Components 11/9/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.1.7.2 Manage Patient Advance Directives Conceptual Information Model (CIM) Mapped to EHR-S Functions 11/9/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.1.7.2 Manage Patient Advance Directives Conceptual Data Model (CDM) 11/9/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT CPS.1.7.2 Manage Patient Advance Directives CDM Requirements-Traceability 11/9/2018 DRAFT WORKING DOCUMENT

CPS.1.7.2 Manage Patient Advance Directives “See Also” Dependencies 11/9/2018 DRAFT WORKING DOCUMENT

Action Verb Hierarches Manage (Data) Capture Maintain Render Exchange Determine Manage- Data- Visibility Auto-Populate Enter Import Receive Store Update Remove Extract Present Transmit Export Analyze Decide De-Identify Hide Mask Re-Identify Unhide Unmask Archive Backup Decrypt Encrypt Recover Restore Save Annotate Attest Edit Harmonize Integrate Link Tag Delete Purge 11/9/2018 DRAFT WORKING DOCUMENT

DRAFT WORKING DOCUMENT Archive Old slides 11/9/2018 DRAFT WORKING DOCUMENT

CPS.1.7.2 Manage Patient Advance Directives Requirements The system SHALL provide the ability to manage advance directive information including the type of directive, relevant dates (e.g., received, reviewed, rescinded, updated), circumstances under which the directives were received, and the location of any paper or electronic advance directive documentation. 1. The system SHALL render an indication that advance directive(s) have been captured. 2. The system SHALL provide the ability to render the type of advance directives captured for the patient (e.g., living will, durable power of attorney, preferred interventions for known conditions, or the existence of a "Do Not Resuscitate" order). 3. The system SHALL provide the ability to manage “Do Not Resuscitate” orders. 4. The system SHOULD conform to function CPS.2.4 (Support Externally Sourced Clinical Images) in order to capture scanned patient advance directive documents and/or “Do Not Resuscitate” orders. 5. The system SHALL provide the ability to manage the date and circumstances of the most recent review of the advanced directives. 6. The system SHALL provide the ability to manage the name and relationship of the principal completing the advance directive for the patient. The system SHALL provide the ability to manage the date and/or time an advance directives paper document was signed/completed. RED: delete, Blue: insert DRAFT WORKING DOCUMENT 11/9/2018

CPS.1.7.2 Manage Patient Advance Directives Dependencies CP.1.8 Capture and maintain patient and family preferences. (DC.1.3.1) CPS.1.6.1 Provide information on relationships by genealogy. (S.3.5.1) CPS.1.6.3 Provide information on relationships by living situation. Examples of living situations include college dormitory, military deployment, in same household. (S.3.5.3) CPS.1.6.4 Provide information on patient relationships that are represented other than by genealogy, insurance or living situation. (S.3.5.4) CPS.1.7.3 Create, maintain, and verify patient decisions (such as informed consent for treatment and authorization/consent for disclosure). (DC.1.3.3) OVERARCHING: Trust Infrastructure Record Infrastructure 11/9/2018 DRAFT WORKING DOCUMENT