1
HL7 Arden Syntax Action Slot Write Statement Notification Message
Version 2.0
Description of Proposed XML Elements and Attributes
Presented at HL7 Spring Working Group Meeting
May 25-26, 2000
Audrius Polikaitis, Ph.D.
Alex Hirsbrunner
Motorola Healthcare Communications Solutions
Introduction
This document describes a reliable notification message protocol first introduced to the Clinical Decision Support and Arden Syntax Technical Committee at the HL7 Winter Meeting in January 2000. The original proposal has been updated to reflect the modifications discussed both at the winter meeting and subsequent to the meeting with committee members. The intent of the proposal is to develop a new message for the write statement of the Arden Syntax action slot. The scope of this proposed message is broad; it includes not only the information provided by the clinical content originating system, but also information about the subsequent notification activities provided by the notification system. This proposal is presented in XML format, required for Arden Syntax with the future acceptance of HL7 V3.0.
Discussion
When a CDSS or other ancillary system detects an abnormal or problematic condition healthcare providers must be notified in a timely manner so that appropriate corrective action can be taken. Delivery of clinical alerts to the appropriate providers is the role of the notification system. The CDSS or other content generating system must therefore, communicate to the notification system the content to be delivered and any additional directives regarding the resulting notifications. This information sent from the CDSS to the notification system includes the clinical content, patient or cohort, date and time of content generation, urgency, relevant context information, conclusions, clinical recommendations, initial notification recipient(s), etc. As the notification system initiates and manages the notification process additional information is captured and included in this message protocol. The description below, the DTD (document type definition) included in Appendix A, and the example XML document included in Appendix B identify the elements necessary to develop reliable notification messaging.
Description
1. <communique>
Description
The <communique> element is the root element. Every <communique> element must contain at least a single <content> element. The <communique> element may also contain <content.distributions>, <notifier.submission>, <notifier.acknowledgment> and <delivery> elements. The <communique> element grows in size, as recipients are resolved, the coverage of specified recipients is established, notifications are delivered and acknowledged, and notifications are escalated, forwarded, and closed.
Contents
One or more <content>, followed by zero or one <content.distributions>, followed by zero or one <notifier.submission>, followed by zero or one <notifier.acknowledgment>, followed by zero or one <delivery>
Attributes
None
1.1. <content>
Description
The <content> element contains all alert content information, including a unique identifier, content type, originator, date and time of origination, patient data, conclusion, relevant context information, clinical recommendations, and relevant explanations. This information is to be supplied by the originating system. The <content.type>, <content originator>, <person.cohort>, and <urgency> elements are optional.
Contents
One <content.id>, followed by zero or one <content.originator>, followed by one or more <date.time>, followed by zero or more <patient>, followed by zero or one <urgency>, followed by one or more <body>
Attributes
type (optional)
- indicates the content type, e.g. DSS output, ADT message.
1.1.1. <content.id>
Description
The <content.id> element contains a unique identifier assigned to the generated content.
Contents
Parsed character data
Attributes
None
1.1.2. <content.originator>
Description
The <content.originator> element contains information regarding the content originating system and the rule or condition in the system that originated the alert. The <address> and <source> elements are optional.
Contents
One <system>, followed by zero or one <address>, followed by zero or one <source>
Attributes
None
1.1.2.1. <system>
Description
The <system> element contains the system name.
Contents
Parsed character data
Attributes
None
1.1.2.2. <address>
Description
The <address> element contains the system address.
Contents
Parsed character data
Attributes
carrier (optional)
- indicates the carrier of the system or device address, e.g. SkyTel, Nextel, HTTP, PSTN.
1.1.2.3. <source>
Description
The <source> element contains information about the rule, condition, or individual that generated the alert.
Contents
Parsed character data
Attributes
type (optional)
- indicates the content originator type, e.g. medical logic module (MLM), manually generated
validation (optional)
- indicates the validation status of the MLM, e.g. production, research, testing, expired.
1.1.3. <date.time>
Description
The <date.time> element contains the content generation date and time.
Contents
Parsed character data
Attributes
type (optional)
- indicates the time type, e.g. now, eventtime, triggertime.
1.1.4. <patient>
Description
The <patient> element contains information that specifies the person/cohort/population whom the clinical content or alert is concerning. The <birth.date>, <gender>, <name>, and <race> elements are optional.
Contents
One <patient.id>, followed by zero or one <birth.date>, followed by zero or one <gender>, followed by zero or one <name>, followed by zero or one <race>
Attributes
type (optional)
- indicates the patient type, e.g. person, cohort, census, population.
1.1.4.1. <patient.id>
Description
The <patient.id> element contains a unique identifier assigned to the patient.
Contents
Parsed character data
Attributes
type (optional)
- indicates the patient identifier type, e.g. medical record number (MRN)
1.1.4.2. <birth.date>
Description
The <birth.date> element contains the patient’s birth date.
Contents
Parsed character data
Attributes
None
1.1.4.3. <gender>
Description
The <gender> element contains the patient’s gender.
Contents
Parsed character data
Attributes
None
1.1.4.4. <name>
Description
The <name> element contains the patient’s name. The <family>, <given>, and <middle> elements are optional.
Contents
Zero or one <family>, followed by zero or one <given>, followed by zero or one <middle>
Attributes
None
1.1.4.4.1. <family>
Description
The <family> element contains the patient’s given name.
Contents
Parsed character data
Attributes
None
1.1.4.4.2. <given>
Description
The <given> element contains the patient’s given name.
Contents
Parsed character data
Attributes
None
1.1.4.4.3. <middle>
Description
The <middle> element contains the patient’s given name.
Contents
Parsed character data
Attributes
None
1.1.4.5. <race>
Description
The <race> element contains the patient’s race.
Contents
Parsed character data
Attributes
None
1.1.5. <urgency>
Description
The <urgency> element contains the assigned urgency. The associated upper and lower limit attributes indicate the range of urgency levels that can then be utilized to assess the relative urgency.
Contents
Parsed character data
Attributes
upper.limit (required)
- indicates the highest allowable urgency value
lower.limit (required)
- indicates the lowest allowable urgency value
1.1.6. <body>
Description
The <body> element contains the main textual portion of the content. The <subject>, <context>, <recommendation>, and <explanation> elements are optional.
Contents
Zero or one <subject>, followed by zero or more <context>, followed by one <conclusion>, followed by zero or more <recommendation>, followed by zero or more <explanation>
Attributes
None
1.1.6.1. <subject>
Description
The <subject> element contains the subject of the content.
Contents
Parsed character data
Attributes
None
1.1.6.2. <context>
Description
The <context> element contains contextual information regarding the content or the associated patient, including previous lab results, existing allergies, etc.
Contents
Parsed character data
Attributes
None
1.1.6.3. <conclusion>
Description
The <conclusion> element contains the main statement of the content
Contents
Parsed character data
Attributes
None
1.1.6.4. <recommendation>
Description
The <recommendation> element contains a clinical recommendation and any associated selectable choices. The <choices> element is optional.
Contents
One <instruction>, followed by zero or one <choices>
Attributes
None
1.1.6.4.1. <instruction>
Description
The <instruction> element contains textual information about a recommended clinical action. The element may contain an instruction to select one of the subsequent clinical options.
Contents
Parsed character data
Attributes
None
1.1.6.4.2. <choices>
Description
The <choices> element contains clinical options appropriate for the above instruction.
Contents
One or more <choice>
Attributes
type (optional)
- indicates how the clinical options are to be selected, e.g. k of n
1.1.6.4.2.1. <choice>
Description
The <choice> element contains a clinical action option.
Contents
Parsed character data
Attributes
id (required)
- a unique identifier assigned to the clinical action option
1.1.6.5. <explanation>
Description
The <explanation> element contains information further explaining the content, instructions, or clinical action choices.
Contents
Parsed character data
Attributes
position (optional)
- indicates the position of the explanation, e.g. support, refute.
1.2. <distribution.list>
Description
The <distribution.list> element contains the initial distribution information.
Contents
One or more <distribution>
Attributes
None
1.2.1. <distribution>
Description
The <distribution> element contains information regarding a specific distribution including the unique distribution identifier, the initial distribution recipient, distribution security preferences and distribution workflow. The information in this element is likely supplied by the content originating system. The <security> and <workflow> elements are optional.
Contents
One <distribution.id>, followed by one <recipient>, followed by zero or one <security>, followed by zero or one <workflow>
Attributes
None
1.2.1.1. <distribution.id>
Description
The <distribution.id> element contains a unique distribution identifier.
Contents
Parsed character data
Attributes
None
1.2.1.2. <recipient>
Description
The <recipient> element contains the recipient of the notification. The type attribute may indicate that subsequent recipient processing may be required, e.g. resolve a group into individual providers or resolve a role to a provider.
Contents
Parsed character data
Attributes
type (required)
- indicates the target type, e.g. provider, group, role
1.2.1.3. <security>
Description
The <security> element contains information about the security measures to be employed in delivering content to the distribution recipient. The <encryption.required> and <authentication.required> elements are optional.
Contents
Zero or one <encryption.required>, followed by zero or one <authentication.required>
Attributes
None
1.2.1.3.1. <encryption.required>
Description
The <encryption.required> element indicates that notifications originating from this distribution are to be encrypted.
Contents
Parsed character data
Attributes
None
1.2.1.3.2. <authentication.required>
Description
The <authentication.required> element indicates that recipient authentication is required for notifications originating from this distribution.
Contents
Parsed character data
Attributes
None
1.2.1.4. <workflow>
Description
The <workflow> element contains information about notification workflow to be employed in delivering content to the distribution recipient, including various acknowledgment timers associated with the distribution. The <closure.required>, <forwarding.enabled>, <coverage.required>, and <timers> elements are optional.
Contents
Zero or one <closure.required>, followed by zero or one <forwarding.enabled>, followed by zero or one <coverage.required>, followed by zero or one <timers>
Attributes
None
1.2.1.4.1. <closure.required>
Description
The <closure.required> element indicates that closure is required for notifications originating from this distribution, closure responsibility can be passed to another recipient via escalation or forwarding.
Contents
Parsed character data
Attributes
None
1.2.1.4.2. <forwarding.enabled>
Description
The <forwarding.enabled> element indicates that notifications originating from this distribution can be forwarded to other recipients.
Contents
Parsed character data
Attributes
None
1.2.1.4.3. <coverage.required>
Description
The <coverage.required> element indicates that coverage must be guaranteed for notifications originating from this distribution. If coverage is required a notification is sent to the distribution recipient only after it has been ascertained that the recipient is available.
Contents
Parsed character data
Attributes
None
1.2.1.4.4. <timers>
Description
The <timers> element contains timeout values utilized in the notification workflow process (submission to network ack timeout, delivery to device ack timeout, display by device ack timeout, closure timeout, etc.).
Contents
One or more <timeout>
Attributes
None
1.2.1.4.4.1. <timeout>
Description
The <timeout> element contains a time utilized as a timeout for various workflow process elements.
Contents
Parsed character data
Attributes
type (optional)
- indicates the timeout type, e.g. submission ack, delivery ack, display ack, closure ack
1.3. <notifier.submission>
Description
The <notifier.submission> element contains information regarding submission of the content and distribution list to the notifier, including the date and time of submission to the notifier.
Contents
One <notifier>, followed by one <date.time>
Attributes
None
1.3.1. <notifier>
Description
The <notifier> element contains information regarding the notification system, including notification system name and address. The <address> element is optional.
Contents
One <system>, followed by zero or one <address>
Attributes
None
1.3.1.1. <system>
As presented in 1.1.2.1
1.3.1.2. <address>
As presented in 1.1.2.2
1.3.2. <date.time>
As presented in 1.1.3
1.4. <notifier.acknowledgment>
Description
The <notifier.acknowledgment> element contains information regarding notifier receipt acknowledgment of the content and distribution list, including the date and time of acknowledgment. The information in this element is to be supplied by the notification system
Contents
One <notifier>, followed by one <date.time>
Attributes
None
1.4.1. <notifier>
As presented in 1.3.1
1.4.2. <date.time>
As presented in 1.1.3
1.5. <delivery>
Description
The <delivery> element contains information regarding processing of the notification recipients, and actual delivery of the notifications. The <recipient.processing>, and <notification> elements are optional.
Contents
Zero or more (<recipient.processing> or <notification>)
Attributes
None
1.5.1. <recipient.processing>
Description
The <recipient.processing> element contains information about notification recipient processing, e.g. resolve a group recipient into individual provider recipients, resolve a role recipient to a provider recipient, establish coverage for a given provider recipient. The date and time of the recipient processing and the id of the originating distribution are explicitly indicated. The information in this element is to be supplied by the notification system. The <originating.reference.id> and <distribution.id> elements are optional.
Contents
One <reference.id>, followed by zero or one <originating.reference.id>, followed by zero or one <distribution.id>, followed by one <date.time>, followed by one <input>, followed by one <outcome>
Attributes
type (optional)
- indicates the recipient processing type, e.g. coverage, role, group.
1.5.1.1. <reference.id>
Description
The <reference.id> element contains a unique identifier assigned to a recipient processing (coverage, role resolution, group resolution) or notification element.
Contents
Parsed character data
Attributes
None
1.5.1.2. <originating.reference.id>
Description
The <originating.reference.id> element contains the unique identifier of the recipient processing or notification element that preceded this element. This pointer provides the ability to trace back the origins of a notification.
Contents
Parsed character data
Attributes
None
1.5.1.3. <distribution.id>
As presented in 1.2.1.1
1.5.1.4. <date.time>
As presented in 1.1.3
1.5.1.5. <input>
Description
The <input> element contains the notification recipient that was processed.
Contents
One <recipient>
Attributes
None
1.5.1.5.1. <recipient>
As presented in 1.2.1.2
1.5.1.6. <outcome>
Description
The <outcome> element contains the result of the notification recipient processing.
Contents
One or more <recipient>
Attributes
None
1.5.1.6.1. <recipient>
As presented in 1.2.1.2
1.5.2. <notification>