1 HL7 RIM Barry Smith

2 HL7 RIM (Health Level 7 Reference Information Model) a set of standards for exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice

3 … based on Speech Act Theory the medical record is not a collection of facts, but "a faithful record of what clinicians have heard, seen, thought, and done" [based on] what is known as "speech-acts" in linguistics and philosophy.

4 The Ontology of HL7 RIM “Act as statements or speech-acts are the only representation of real world facts or processes in the HL7 RIM. The truth about the real world is constructed through a combination (and arbitration) of such attributed statements only, and there is no class in the RIM whose objects represent "objective states of affairs" or "real processes" independent from attributed statements. “As such, there is no distinction between an activity and its documentation. Every Act includes both to varying degrees.”

Health informatics: – HL7 version 3 Reference information model (RIM) – Release 4 … is being circulated as a draft in preparation for a Draft International Standard (DIS) ballot to be conducted by ISO TC Healthcare Informatics. 5

6 HL7 International Affiliates HL7 Argentina HL7 Australia HL7 Brazil HL7 Canada HL7 China HL7 Croatia HL7 Czech Republic HL7 Denmark HL7 Finland HL7 Germany HL7 Greece HL7 India HL7 Japan HL7 Korea HL7 Lithuania HL7 Mexico HL7 New Zealand HL7 Southern Africa HL7 Switzerland HL7 Taiwan HL7 The Netherlands HL7 UK Ltd.

7 HL7 Merchandizing

HL7 RIM Ontology 8

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EntityClass =def. Classifies the Entity class and all of its subclasses. The terminology is hierarchical. At the top is this HL7-defined domain of high-level categories (such as represented by the Entity subclasses). Each of these terms must be harmonized and is specializable. The value sets beneath are drawn from multiple, frequently external, domains that reflect much more fine-grained typing. 11

entity =def. Corresponds to the Entity class 12

HL7 RIM Ontology 13

How to evaluate an ontology such as this? One part of the answer? Does its basic framework conform to common sense? For example, does it recognize basic distinctions beween things and events things and attributes things and words universals and particulars 14

can it be represented as an extension of BFO? 15

Sequence Ontology 16

17 “We have completely aligned the ontology with the Open Biomedical Ontologies (OBO) Foundry-recommended upper level Basic Formal Ontology. Furthermore, we have aligned our chemical classification with the classification of chemical-involving processes in the Gene Ontology (GO), and as a result of this effort, the majority of chemical-involving …”

Ontology for General Medical Science 18

19 One indispensable foundation for a successful standard: a correct and uniform interpretation of the basic terms defining the standard. Act Participation Entity Role ActRelationship RoleLink

Backbone Class Description (from 0.2: “RIM as an abstract model”) Definition (from 9.3: “Code System”) Act represents the actions that are executed and must be documented as health care is managed and provided a record of something that is being done, has been done, can be done, or is intended or requested to be done. Entity represents the physical things and beings that are of interest to, and take part in health care a physical thing, group of physical things or an organization capable of participating in Acts while in a role. Role establishes the roles that entities play as they participate in health care acts a competency of the Entity that plays the Role as identified, defined, guaranteed, or acknowledged by the Entity that scopes the Role. 20

21 Demonstrably, the HL7 community does not understand these basic terms

Entity =def. A physical thing, group of physical things or an organization capable of participating in Acts while in a role. Living Subject =def. Anything that essentially has the property of life, independent of current state (a dead human corpse is still essentially a living subject). Organization =def. A social or legal structure formed by human beings. Group =def. A grouping of resources (personnel, material, or places) to be used for scheduling purposes. May be a pool of like-type resources, a team, or combination of personnel, material and places. Place =def. A physical place or site with its containing structure. May be natural or man-made. The geographic position of a place may or may not be constant. Health Chart Entity =def. A health chart included to serve as a document receiving entity in the management of medical records. 22