1. EHR System Function and Information Model (EHR-S FIM) Release 2
EHR System Function and Information Model (EHR-S FIM) Release HL7 Project ID# Executive Summary for EHR-S FIM Prototype on Results Management
, EHR WG Modeling Facilitator
, DoD-MHS Proponent
May 29, 2012 – Original Working-Draft
Jul 5, 2012 – Most Recent Working-Draft
Work in Progress
Call for Participation
This work is being done by the HL7 EHR Interoperability Work-group,
meeting every Tuesday at 2 PM ET, dial-in: , Passcode: #
 The most current artifacts are at:
11/16/2018

2. RED: Recommended deletion, Blue: Recommended Insertion
CP.5 Manage Results
Statement: Manage Present, annotate, and route current and historical test results to appropriate providers for review. Provide the ability to filter and compare results.
Description: Results of tests are presented in an easily accessible manner to the appropriate providers. For example, flow sheets, graphs, or other tools allow care providers to view or uncover trends in test data over time. In addition to making results viewable, it is often necessary to send results to appropriate providers using electronic messaging systems, pagers, or other mechanisms. In addition, the system may have the ability to redirect or copy specific test results to a specified individual, according to scope of practice, organizational policy and/or jurisdictional law. Documentation of notification is accommodated. Results may also be routed to patients electronically or by letter. Note: “Results” are understood as applying to any type of test, whether biological or psychological.
Manage results may enable the provider to communicate with the patient (see function DC (Provider-Patient Communication)).
There may also be a need to notify public health agencies based on the result. See function DC (Support for Epidemiological Investigations of Clinical Health Within a Population).
Example: (notional scenario based on conformance criteria) Current test results are linked to the original order (if one exists), may be grouped with historical test results and are routed to the requesting provider for review; and, the provider may contact the patient. Patient test results may reported-to or coordinated- with appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools, registries, public health).
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RED: Recommended deletion, Blue: Recommended Insertion

3. CP.5.1 Manage Results of Diagnostic Tests
Statement: Enable the receipt and display of results for diagnostics tests.
Description: Diagnostic test results are received and should be stored and displayed while linked to the original order in the system.
Example: (notional scenario based on conformance criteria) Current test results are linked to the original order (if one exists), may be grouped with historical test results and are routed to the requesting provider for review; and, the provider may contact the patient. Patient test results may reported-to or coordinated- with appropriate sources, appropriate clinicians and organizations (e.g., PHRs, schools, registries, public health).
RECOMMENDATION: Merge Manage Results and Manage Results of Diagnostic Tests or make Manage Results types correspond with Manage Orders types.
11/16/2018
RED: Recommended deletion, Blue: Recommended Insertion

4. CP.5 Manage Results EHR-S Components Dependent-on Clinician-Activities
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
ISSUE: Things that happen between order and results generally involve clinical documentation, follow-on orders, …
Recommendation: Merge results and Results of Diagnostic Tests
11/16/2018
RED: Recommend deletion, Blue: Recommended Insertion

5. CP.4 Manage Results Conceptual Information Model (CIM)
ISSUE: data associated with Clinical Decision Support (CDS)
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6. CP.5. Manage Results Conformance Criteria (CC) Applicable to this CDM
SHALL CCs have bolded borders.
RECOMMENDATION: Delete “Results of Diagnostic Test” class
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7. CP.5 Manage Results Conformance Criteria
CP.5#01 The system SHALL provide the ability to manage test results in according to scope of practice, organizational policy and/or jurisdictional law.
CP.5#02 The system SHALL provide the ability to render numerical and non-numerical current and historical test results.
CP.5#03 The system SHALL provide the ability to render results for an identified patient or group of patients.
CP.5#04 The system SHALL provide the ability to render results by factors that supports results management including type of test, critical indicator and abnormal indicator.
CP.5#05 The system SHALL provide the ability to tag and render normal and abnormal indictors for results based on data provided from the original data source.
CP.5#06 The system SHOULD provide the ability to render numerical results in flow sheets, graphical form or other views that allow comparison of results, and display values graphed over time.
CP.5#07 The system SHALL provide the ability to render results by date/time range including ordered date/time, specimen collection date/time and results received date/time.
CP.5#08 The system SHOULD provide the ability to tag new results received and render to the relevant providers (ordering, copy to) that new results have been received but not reviewed.
CP.5#09 The system SHOULD provide the ability to capture an indicator that a result has been rendered and acknowledged by a user.
CP.5#10 The system SHOULD provide the ability to transmit results to other care providers.
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8. CP.5 Manage Results Conformance Criteria
CP.5#11 The system MAY provide the ability to transmit results to patients by methods such as phone, fax, electronically or letter.
CP.5#12 The system MAY provide the ability to transmit results to an automated callback system.
CP.5#13 The system MAY provide the ability to capture and transmit a request for action to another provider(s).
CP.5#14 The system MAY provide the ability to receive a request for action regarding a result from another provider and capture an acknowledgement of receipt.
CP.5#15 The system MAY provide the ability to render results in clinically logical sections (e.g., Pathology, Chemistry).
CP.5#16 The system SHALL link results to the electronic order if the system contains the electronic order.
CP.5#17 The system SHOULD provide the ability to annotate a result.
CP.5#18 The system SHOULD provide the ability to link and render the results report to other data (e.g., images) with which it is associated.
CP.5#19 The system SHALL provide the ability to import and receive preliminary and final result reports from ancillary systems according to scope of practice, organizational policy and/or jurisdictional law.
CP.5#20 The system SHALL provide the ability to import or receive preliminary and final results as discrete data from ancillary systems according to scope of practice, organizational policy and/or jurisdictional law.
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9. CP.5 Manage Results Conformance Criteria
CP.5#21 The system SHALL provide the ability to capture, maintain and render preliminary (e.g., "wet read") and final result reports according to scope of practice, organizational policy and/or jurisdictional law.
CP.5#22 The system SHALL provide the ability to tag and render a notification to the appropriate health care team member(s) (using role-based alerts) of clinically-significant results or result changes.
CP.5#23 The system SHOULD provide the ability to link results to a specific medical condition, medication or therapeutic class of medication.
CP.5#24 The system MAY provide the ability to link with Radiology Information Systems (RIS) or Picture Archiving & Communication Systems (PACS) to enable the presentation of images.
CP.5#25 The system SHALL provide the ability to link one or more images to a result report.
CP.5#26 IF the system provides the ability to annotate a result, THEN the system SHALL render the annotation with subsequent views of that result.
CP.5#27 The system SHOULD provide the ability to capture an annotation from the patient on a result and render the annotation with subsequent views of that result.
CP.5#28 The system SHALL provide the ability to tag and render a notification that results are received for a patient no longer actively at the facility.
CP.5#29 The system MAY provide the ability to manage results of specific genetic tests, genetic markers, or findings according to scope of practice, organizational policy and/or jurisdictional law and subject to patient's preferences and consent.
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10. DRAFT WORKING DOCUMENT
CP.5.1 Manage Results of Diagnostic Tests Conformance Criteria (CC) Applicable to this CDM
CP.5.1#01 The system SHOULD provide the ability to capture, maintain and render diagnostic results, including preliminary as well as final results.
CP.5.1#02 The system SHOULD provide the ability to capture, maintain and render microorganism information/descriptions from laboratory results as free-text.
CP.5.1#03 The system SHOULD provide the ability to capture, maintain and render microbiology laboratory results (with sensitivity testing) using standard coding methodology according to scope of practice, organizational policy and/or jurisdictional law.
CP.5.1#04 The system SHOULD provide the ability to capture, maintain and render laboratory results that identify new and emerging laboratory procedures (e.g., processes that examine emerging organisms, new processes that examine existing organisms).
CP.5.1#05 The system SHALL provide the ability to capture, maintain and render discrete diagnostic results received through an electronic interface.
CP.5.1#06 The system SHALL provide the ability to render indicators of normal and abnormal diagnostic results based on information provided from the original source (e.g., from a laboratory or radiology department).
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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11. EHR-S FIM 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
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NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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12. Event Conformance Criteria (CC) Applicable to this CDM
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RED: Recommended deletion, Blue: Recommended Insertion

13. DRAFT WORKING DOCUMENT
Dependencies
R1.1 / R2.0
DC / CPS.5 - Support for Result Interpretation
S / CPS Health Record Output
S / CPS Clinical Decision Support System Guidelines Updates
IN.1.6 / TI Secure Data Exchange
IN.1.7 / TI Secure Data Routing
IN.2.4 / RI Extraction of Health Record Information
IN / ??? - Manage Unstructured Health Record Information
IN / ??? - Manage Structured Health Record Information
IN.6 / TI.6 - Business Rules Management
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14. DRAFT WORKING DOCUMENT
Dependencies
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15. BACKUP Project Overview Slides
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16. EHR System Function and Information Model EHR-S FIM Vision
The EHR-S FIM vision is that analysts, engineers or testers can efficiently compose and refine the architecture-and-workflow agnostic EHR-S FIM into interoperability-specifications, which meet their system acquisition, implementation or test needs.
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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17. EHR-S FM Release 2.0 Contents
Overarching (O) – 2 major subsections
Care Provision (CP) - 9 major subsections
Care Provision Support (CPS) – 9 major subsections
Population Health Support (POP) – 10 major subsections
Administrative Support (AS) – 9 major subsections
Record Infrastructure (RI) – 3 major subsections
Trust Infrastructure (TI) – 9 major subsections
EHR-S FM R2 ballot package can be downloaded at:
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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18. PART 1: Executive Summary
For EHR-S FIM Release 2.1, this prototype has the purpose to
Add conceptual information and data models for each EHR-S function
make the EHR-S FM easier to use for analysts and engineers
verify and validate EHR-S FM Release 2.0
Demonstrate Service Aware Interoperability Framework (SAIF) use
Support specific profiles (e.g., DAMs, DIMs, DCMs).
The DoD-VA Joint Immunization Capability (JIC), Pharm-Lab-Rad, and than ISO Continuity-of-Care System-of Concepts-and-Glossary harmonization are proposed as a set of demonstration prototypes of increasing complexity.
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NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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19. DRAFT WORKING DOCUMENT
EHR-FIM Model Legend
NOTE: EHR-S FIM is NOT intended to imply a specific architecture or workflow!
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