Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.
Description:The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.
Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
To perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use.
To perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge without provision of patient care.
To perform one or more operations on information for conducting scientific investigations with patient care in accordance with clinical trial protocols to obtain health care knowledge.
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
To perform one or more actions on information in order to organize the provision and case management of an individual’s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
To perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use.
Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available
Example:Lab results, diagnostic imaging, etc.
To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance.
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
To perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment.
To perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies.
To perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users.
To perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.
To perform one or more operations on information, including genealogical pedigrees, historical records, surveys, family health data, health records, and genetic information, for conducting scientific investigations to obtain health care knowledge.
Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
To perform one or more operations on information in preparation for conducting scientific investigation to obtain health care knowledge, such as research on animals or review of patient health records, to determine the feasibility of a clinical trial study; assist with protocol design; or in preparation for institutional review board or ethics committee approval process.
Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.
Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge related to evidence based medicine during the course of providing healthcare treatment.
Description:Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties.
Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.
Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.
Examples are client deceased & adopted client has been given a new policy identifier.
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.
Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.
Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
A person becomes eligible for insurance or a program because of crime related health condition or injury.
Example: A person is a claimant under the U.S. Crime Victims Compensation program.
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
A person becomes eligible for a program based on financial criteria.
Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
A person becomes eligible for a program because of a qualifying health condition or injury.
Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
A person becomes eligible for a program based on more than one criterion.
Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.
Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
A person becomes eligible for a program based on statutory criteria.
Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
A person becomes eligible for insurance or a program because of a work related health condition or injury.
Example: A person is a claimant under the U.S. Black Lung Program.
Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
Description:The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.
To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.
Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.
Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
To perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent.
Usage Note: Maps to v2 CON-16 Subject Competence Indicator (ID) 01791 Definition: Identifies whether the subject was deemed competent to provide consent. Refer to table HL7 Table 0136 - Yes/No Indicator and CON-23 Non-Subject Consenter Reason User-defined Table 0502 - Non-Subject Consenter Reason code NC "Subject is not competent to consent".
To perform one or more operations on information to which the patient declined to consent for providing health care.
Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.
To perform one or more operations on information to which the patient has not consented for public safety reasons.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.
To perform one or more operations on information to which the patient has not consented for third party safety.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.
Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.
Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
To perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.
Usage Note: The concept of care management is narrower than the list of activities related to more general organizational objectives such as provider profiling, education of healthcare and non-healthcare professionals; insurance underwriting, premium rating, reinsurance; organizational legal, medical review, auditing, compliance and fraud and abuse detection; business planning, development, and restructuring; fund-raising; and customer service.
Map: Maps to ISO 14265 Classification Term "Health service management and quality assurance" described as "To inform persons or processes responsible for determining the availability, quality, safety, equity and cost-effectiveness of health care services."
There is a semantic gap in concepts. This classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
To perform one or more operation operations on information used to manage a patient directory.
Examples:
facility
enterprise
payer
health information exchange patient directory
To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.
Usage Note: Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking.
Map: Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care."
However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
To perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies.
Label management includes classification of target data by constructing and binding of a label set per applicable policies, security policy information file semantics, and classification guides. Label management also includes process and procedures for subsequent revision of a label for, e.g., reclassification, downgrading classification, and declassification.
Label revisions may be triggered by, e.g., expiry of classification period; changes in applicable policy, e.g., revocation of a consent directive; or changes in the governing policy domain in which the data is relocated or a copy of the data is sent. If a label is revised, an audit log should be kept and the provenance of the label changes should be tracked.
To perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users. For example, master index identifier, media type, and location.
To perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment.
Usage Note: Data marked with a HTEST security label enables an access control system to permit interfacing systems or end users provisioned with a clearance, which includes a HTEST purpose of use attribute, to test, verify, or validate that a system or application will operate in production as intended based on design specifications.
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.
To perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.
To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.
To perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data iincludes basic and applied research such as biomedical, population origin or ancestry, translational research, and disease, discipline, specialty specific healthcare research and clinical trial research.
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified biomedical basic or applied research. For example, research on rare plants to determine whether biologic properties may be useful for pharmaceutical development. May be used in combination with clinical trial and other healthcare research purposes of use.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge without provision of patient care. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, a clinical trial conducted on laboratory specimens collected from a specified patient population.
To perform one or more operations on information for conducting scientific investigations with patient care in accordance with clinical trial protocols to obtain health care knowledge. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, an "off-label" drug used for cancer therapy administer to a specified patient population.
To perform one or more operations on information in preparation for conducting scientific investigation to obtain health care knowledge, such as research on animals or review of patient health records, to determine the feasibility of a clinical trial study; assist with protocol design; or in preparation for institutional review board or ethics committee approval process. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research.
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified conditions, diagnosis, or disease healthcare research. For example, conducting cancer research by testing reaction of tumor cells to certain biologics. May be used in combination with clinical trial and other healthcare research purposes of use.
To perform one or more operations on information, including genealogical pedigrees, historical records, surveys, family health data, health records, and genetic information, for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to population origins and/or ancestry healthcare research. For example, gathering genetic specimens from a specific population in order to determine the ancestry and population origins of that group. May be used in combination with clinical trial and other healthcare research purposes of use.
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge related to evidence based medicine during the course of providing healthcare treatment. Sometimes referred to as "bench to bedside", which is the iterative feedback loop between healthcare research and clinical trials with input from information collected in the course of routine provision of healthcare. For example, by extending a patient encounter to conduct a survey related to a research topic such as attitudes about use of a wellness device that a patient agreed to use. May be used in combination with clinical trial and other healthcare research purposes of use.
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
To perform one or more actions on information in order to organize the provision and case management of an individual’s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.
Usage Note: Use when describing these functions: 1. Monitoring a person’s goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care.
The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment.
For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare.
Map: Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."
To perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use. Includes override of organizational provisioning policies and may include override of subject of care consent directive restricting access.
Map: Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care."
The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.
To perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use.
Map:Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care."
The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.
There is a semantic gap in concepts. This classification term is described as activities “to inform persons� rather than the rationale for performing actions/operations on information related to the activity.
Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".
(used when capturing 'refusal to fill' annotations)
Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available
Example:Lab results, diagnostic imaging, etc.
Definition:Fulfiller not able to provide appropriate care associated with fulfilling the order.
Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.
Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
Definition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
Definition:SSpecifies the reason that a test was performed or observation collected in a clinical research study.
Note:This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.
Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
Description:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.
Description:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.
Description:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.
Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.
Description:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.
Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.
Description:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.
Description:The decision on which the recorded information was based was changed before the decision had an effect.
Example:Aborted prescription before patient left office, released prescription before suspend took effect.
Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
Description: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.
Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.
In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
Reason for Clinical Service being performed.
This domain excludes reasons specified by diagnosed conditions.
Examples of values from this domain include duplicate therapy and fraudulent prescription.
Returns the enum constant of this type with the specified name.
The string must match exactly an identifier used to declare an
enum constant in this type. (Extraneous whitespace characters are
not permitted.)
Parameters:
name - the name of the enum constant to be returned.