spark_auto_mapper_fhir.value_sets.act_class_observation

Module Contents

Classes

ActClassObservation	v3.ActClassObservation
ActClassObservationValues	A record of something that is being done, has been done, can be done, or is

class spark_auto_mapper_fhir.value_sets.act_class_observation.ActClassObservation(value)

Bases: spark_auto_mapper_fhir.value_sets.generic_type.GenericTypeCode

v3.ActClassObservation From: http://terminology.hl7.org/ValueSet/v3-ActClassObservation in v3-codesystems.xml

Description:

An act that is intended to result in new information about a subject. The main difference between Observations and other Acts is that Observations have a value attribute. Thecode attribute of Observation and thevalue attribute of Observation must be considered in combination to determine the semantics of the observation. Discussion:

Structurally, many observations are name-value-pairs, where the

Observation.code (inherited from Act) is the name and the Observation.value is the value of the property. Such a construct is also known as a variable (a named feature that can assume a value) hence, the Observation class is always used to hold generic name-value-pairs or variables, even though the variable valuation may not be the result of an elaborate observation method. It may be a simple answer to a question or it may be an assertion or setting of a parameter. As with all Act statements, Observation statements describe what was done, and in the case of Observations, this includes a description of what was actually observed (results or answers); and those results or answers are part of the observation and not split off into other objects. The method of action is asserted by the Observation classCode or its subclasses at the least granular level, by the Observation.code attribute value at the medium level of granularity, and by the attribute value of observation.methodCode when a finer level of granularity is required. The method in whole or in part may also appear in the attribute value of Observation.value when using coded data types to express the value of the attribute. Relevant aspects of methodology may also be restated in value when the results themselves imply or state a methodology. An observation may consist of component observations each having their own Observation.code and Observation.value. In this case, the composite observation may not have an Observation.value for itself. For instance, a white blood cell count consists of the sub-observations for the counts of the various granulocytes, lymphocytes and other normal or abnormal blood cells (e.g., blasts). The overall white blood cell count Observation itself may therefore not have a value by itself (even though it could have one, e.g., the sum total of white blood cells). Thus, as long as an Act is essentially an Act of recognizing and noting information about a subject, it is an Observation, regardless of whether it has a simple value by itself or whether it has sub- observations. Even though observations are professional acts (see Act) and as such are intentional actions, this does not require that every possible outcome of an observation be pondered in advance of it being actually made. For instance, differential white blood cell counts (WBC) rarely show blasts, but if they do, this is part of the WBC observation even though blasts might not be predefined in the structure of a normal WBC. Clinical documents commonly have Subjective and Objective findings, both of which are kinds of Observations. In addition, clinical documents commonly contain Assessments, which are also kinds of Observations. Thus, the establishment of a diagnosis is an Observation. Examples:

Recording the results of a Family History Assessment Laboratory test and

associated result Physical exam test and associated result Device temperature Soil lead level

Parameters

value (spark_auto_mapper.type_definitions.defined_types.AutoMapperTextInputType) –

codeset :spark_auto_mapper_fhir.fhir_types.uri.FhirUri = http://terminology.hl7.org/CodeSystem/v3-ActClass

class spark_auto_mapper_fhir.value_sets.act_class_observation.ActClassObservationValues

A record of something that is being done, has been done, can be done, or is intended or requested to be done.

Examples:The kinds of acts that are common in

health care are (1) a clinical observation, (2) an assessment of health condition (such as problems and diagnoses), (3) healthcare goals, (4) treatment services (such as medication, surgery, physical and psychological therapy), (5) assisting, monitoring or attending, (6) training and education services to patients and their next of kin, (7) and notary services (such as advanced directives or living will), (8) editing and maintaining documents, and many others.

Discussion and Rationale: Acts are the pivot of the

RIM; all domain information and processes are represented primarily in Acts. Any profession or business, including healthcare, is primarily constituted of intentional and occasionally non-intentional actions, performed and recorded by responsible actors. An Act-instance is a record of such an action.

Acts connect to Entities in their Roles through

Participations and connect to other Acts through ActRelationships. Participations are the authors, performers and other responsible parties as well as subjects and beneficiaries (which includes tools and material used in the performance of the act, which are also subjects). The moodCode distinguishes between Acts that are meant as factual records, vs. records of intended or ordered services, and the other modalities in which act can appear.

One of the Participations that all acts have (at least

implicitly) is a primary author, who is responsible of the Act and who “owns” the act. Responsibility for the act means responsibility for what is being stated in the Act and as what it is stated. Ownership of the act is assumed in the sense of who may operationally modify the same act. Ownership and responsibility of the Act is not the same as ownership or responsibility of what the Act-object refers to in the real world. The same real world activity can be described by two people, each being the author of their Act, describing the same real world activity. Yet one can be a witness while the other can be a principal performer. The performer has responsibilities for the physical actions; the witness only has responsibility for making a true statement to the best of his or her ability. The two Act-instances may even disagree, but because each is properly attributed to its author, such disagreements can exist side by side and left to arbitration by a recipient of these Act- instances.

In this sense, an Act-instance represents a

“statement” according to Rector and Nowlan (1991) [Foundations for an electronic medical record. Methods Inf Med. 30.] Rector and Nowlan have emphasized the importance of understanding the medical record not as a collection of facts, but “a faithful record of what clinicians have heard, seen, thought, and done.” Rector and Nowlan go on saying that “the other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view.” Indeed the Act class is this attributable statement, and the rules of updating acts (discussed in the state-transition model, see Act.statusCode) versus generating new Act- instances are designed according to this principle of permanent attributable statements.

Rector and Nolan focus on the electronic medical

record as a collection of statements, while attributed statements, these are still mostly factual statements. However, the Act class goes beyond this limitation to attributed factual statements, representing what is known as “speech-acts” in linguistics and philosophy. The notion of speech-act includes that there is pragmatic meaning in language utterances, aside from just factual statements; and that these utterances interact with the real world to change the state of affairs, even directly cause physical activities to happen. For example, an order is a speech act that (provided it is issued adequately) will cause the ordered action to be physically performed. The speech act theory has culminated in the seminal work by Austin (1962) [How to do things with words. Oxford University Press].

An activity in the real world may progress from

defined, through planned and ordered to executed, which is represented as the mood of the Act. Even though one might think of a single activity as progressing from planned to executed, this progression is reflected by multiple Act-instances, each having one and only one mood that will not change along the Act-instance life cycle. This is because the attribution and content of speech acts along this progression of an activity may be different, and it is often critical that a permanent and faithful record be maintained of this progression. The specification of orders or promises or plans must not be overwritten by the specification of what was actually done, so as to allow comparing actions with their earlier specifications. Act-instances that describe this progression of the same real world activity are linked through the ActRelationships (of the relationship category “sequel”).

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 state 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. For example, a factual statement made about recent (but past) activities, authored (and signed) by the performer of such activities, is commonly known as a procedure report or original documentation (e.g., surgical procedure report, clinic note etc.). Conversely, a status update on an activity that is presently in progress, authored by the performer (or a close observer) is considered to capture that activity (and is later superceded by a full procedure report). However, both status update and procedure report are acts of the same kind, only distinguished by mood and state (see statusCode) and completeness of the information. From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Act

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

DOCCNTNT

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

DOCLIST

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

DOCLSTITM

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

DOCPARA

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

DOCTBL

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

LINKHTML

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

LOCALATTR

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

LOCALMRKP

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Ordered

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

REFR

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

TBLCOL

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

TBLCOLGP

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

TBLDATA

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

TBLHDR

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

TBLROW

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Tbody

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Tfoot

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Thead

From: http://terminology.hl7.org/CodeSystem/v3-ActClass in v3-codesystems.xml

Unordered