ASTM E1715-01(2013)
(Practice)Standard Practice for An Object-Oriented Model for Registration, Admitting, Discharge, and Transfer (RADT) Functions in Computer-Based Patient Record Systems (Withdrawn 2017)
Standard Practice for An Object-Oriented Model for Registration, Admitting, Discharge, and Transfer (RADT) Functions in Computer-Based Patient Record Systems (Withdrawn 2017)
SIGNIFICANCE AND USE
5.1 RADT Object Model as a Basis for Communication—The RADT object model is the first model used to create a common library of consistent entities (objects) and their attributes in the terminology of object analytical models as applied to the healthcare domain. These object models can be used to construct and refine standards relating to healt care information and its management. Since the RADT object model underpins the design and implementation of specific systems, it provides the framework for establishing the systematics of managing observations made during health care. The observations recorded during health care not only become the basis for managing an individual's health care by practitioners but are also used for research and resource management. They define the common language for abstracting and codifying observations. The inconsistency and incompleteness of the data recorded in paper records is well known and has been noted by the Institute of Medicine's study (4). The ability to build the recommended EHR begins with RADT, as noted in Practice E1239. A more detailed specification of the RADT process and its specific functional domain shall begin with a formal model. Furthermore, following agreement on the initial model, that model shall evolve as knowledge accumulates and the initial view of the healthcare domain extends to other social and psychologic processes that link healthcare with other functional domains of society. The management of lifelong cases of care, such as those of birth defects in newborns, will involve interactions with social work and educational functional domains of experience. It has been recognized for some time (5) that a “healthcare team,” in the broader sense, is involved in dealing with these complex cases. The RADT model is the core to linking these functional domains together in a transparent way. For that reason, the object terminology is used to enable the most global view and vernacular that will facilitate communicatio...
SCOPE
1.1 This practice is intended to amplify Practice E1239 and to complement Practice E1384 by detailing the objects that make up the reservation, registration, admitting, discharge, and transfer (RADT) functional domain of the computer-based record of care (CPR). As identified in Practice E1239, this domain is seminal to all patient record and ancillary system functions, including messaging functions used in telecommunications. For example, it is applicable to clinical laboratory information management systems, pharmacy information management systems, and radiology, or other image management, information management systems. The object model terminology is used to be compatible with other national and international standards for healthcare data and information systems engineering or telecommunications standards applied to healthcare data or systems. This practice is intended for those familiar with modeling concepts, system design, and implementation. It is not intended for the general computer user or as an initial introduction to the concepts.
WITHDRAWN RATIONALE
Formerly under the jurisdiction of Committee E31 on Healthcare Informatics, this practice was withdrawn in March 2017. This standard is being withdrawn without replacement due to its limited use by industry.
General Information
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Standards Content (Sample)
NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
Contact ASTM International (www.astm.org) for the latest information
Designation: E1715 − 01 (Reapproved 2013) An American National Standard
Standard Practice for
An Object-Oriented Model for Registration, Admitting,
Discharge, and Transfer (RADT) Functions in Computer-
Based Patient Record Systems
This standard is issued under the fixed designation E1715; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (´) indicates an editorial change since the last revision or reapproval.
1. Scope E1633 SpecificationforCodedValuesUsedintheElectronic
Health Record
1.1 This practice is intended to amplify Practice E1239 and
E1639 Guide for Functional Requirements of Clinical Labo-
to complement Practice E1384 by detailing the objects that
ratory Information Management Systems (Withdrawn
make up the reservation, registration, admitting, discharge, and
2002)
transfer (RADT) functional domain of the computer-based
E1744 Practice for View of Emergency Medical Care in the
record of care (CPR). As identified in Practice E1239, this
Electronic Health Record
domain is seminal to all patient record and ancillary system
F1629 Guide for Establishing Operating Emergency Medi-
functions, including messaging functions used in telecommu-
cal Services and Management Information Systems, or
nications. For example, it is applicable to clinical laboratory
Both (Withdrawn 2015)
information management systems, pharmacy information man-
2.2 ANSI Standard:
agement systems, and radiology, or other image management,
ANSI X3.172 Dictionary of Information Systems
information management systems. The object model terminol-
2.3 IEEE Standard:
ogy is used to be compatible with other national and interna-
IEEE 1157.1 Trial Use Standard for Healthcare Information
tional standards for healthcare data and information systems
Interchange—Information Modelling (6 June 1994)
engineeringortelecommunicationsstandardsappliedtohealth-
2.4 Other Document:
care data or systems. This practice is intended for those
HL-7 v2.4 Data Communication Standard
familiar with modeling concepts, system design, and imple-
mentation.Itisnotintendedforthegeneralcomputeruseroras
3. Terminology
an initial introduction to the concepts.
3.1 Definitions—General terms are defined in accordance
2. Referenced Documents
with ANSI X3.172.
2.1 ASTM Standards:
3.2 Definitions of Terms Specific to This Standard:
E1238 Specification for Transferring Clinical Observations
3.2.1 functional domain, n—thatareaofactivitythatencom-
Between Independent Computer Systems (Withdrawn
passes a given function. (HL-7, v2.4)
2002)
3.2.2 healthcare domain, n—that functional domain encom-
E1239 Practice for Description of Reservation/Registration-
passing all aspects of the delivery of health care, both preven-
Admission, Discharge, Transfer (R-ADT) Systems for
tive and corrective, to patients, and the management of
Electronic Health Record (EHR) Systems
resources enabling that care to be delivered. (HL-7, v2.4)
E1384 Practice for Content and Structure of the Electronic
Health Record (EHR)
4. Background
4.1 Object Representation of RADT Processes—Practice
This practice is under the jurisdiction ofASTM Committee E31 on Healthcare
E1239 provides the experiential background of the functions in
Informatics and is the direct responsibility of Subcommittee E31.25 on Healthcare
RADT. These functions are common to all systems that deal
Data Management, Security, Confidentiality, and Privacy.
with patient data. The minimal essential data elements for
Current edition approved March 01, 2013. Published March 2013. Originally
approved in 1995. Last previous edition approved in 2008 as E1715 – 01(2008).
DOI: 10.1520/E1715-01R13.
2 4
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contact ASTM Customer Service at service@astm.org. For Annual Book of ASTM 4th Floor, New York, NY 10036, http://www.ansi.org.
Standards volume information, refer to the standard’s Document Summary page on Available from Institute of Electrical and Electronics Engineers, Inc. (IEEE),
the ASTM website. 445 Hoes Ln., P.O. Box 1331, Piscataway, NJ 08854-1331, http://www.ieee.org.
3 6
The last approved version of this historical standard is referenced on AvailablefromHealthLevelSeven,900VictorsWay,Suite122,AnnArbor,MI
www.astm.org. 48108.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
E1715 − 01 (2013)
RADT were identified and characterized partly in Practice yet been agreed on formally. The objects included here are
E1239. Table 1 of that guide identifies a logical data structure thosethatinvolvedatagenerallyassociatedwithadministrative
for the data elements, but it does not relate these elements to and demographic functions in patient care but that may also be
constituent “entities” or “objects” in the sense that they are linkedwithotherfunctionaldomainsinvolvedwithhealthcare.
now used in analysis. Entity-relationship modeling is one
4.2 Inclusion of Emergency Medical Systems Functions—
major technique used (1) to establish the conceptual“ things”
This practice also takes note of the recent work of the
and their relationships involved in this overall functional
emergency medical systems (EMS) standardsASTM Subcom-
domain. “Objects” (2, 3) is another term for these things, and
mittee F30.03.03 on Data Management Systems in defining the
the object concept involves very specific characteristics asso-
pre-hospital and associated emergency room data (Guide
ciated with a defined object such as encapsulation and inheri-
F1629) required for emergency medical service system man-
tance. Common ground exists between entity and object
agement.Thehospitalandemergencyroomdataareasubsetof
representations of models. However, the object terminology is
that identified in Practice E1384 and is consistent with the
still evolving into a clearly established dictionary associated
statement of Steen and Dick (4) that EMS data are part of the
with object modeling at the analysis (2), design (3), and
primary record of care. This concept has already been recog-
implementation (3) levels of information systems engineering.
nized in several state statutes that are part of the implementa-
4.1.1 At the analysis level, which is most relevant to
tion of an injury control plan by the Centers for Disease
implementation-independentstandardscreation,thestaticlevel
Control (see Practice E1744). This RADT object model prac-
is first in importance since it identifies the involved objects and
tice extends those data elements already defined in Practice
their static characteristics, such as definitions, relationships,
E1384 by associating them with common RADT objects, as
and inheritance. Subsequently, the service/messages commu-
defined here, that form the basis for a predictable system
nication properties constitute the second level of importance,
behavior for trauma data. The behavior of clinical data will be
because they specify the dynamics of system behavior.
defined subsequently in following standards.
However, messages are more difficult to define since system
4.3 Relationships to Other Systems—This practice also
behavior patterns are more complex. This secondary domain
identifiesthoseobjectsintheRADTfunctionaldomainthatare
also involves the telecommunications aspects that are the focus
required by clinical laboratory information management sys-
of other standards bodies. Because of the distributed and
tems (CLIMS) (Guide E1639), radiology information systems
networked architectures of the newest systems, telecommuni-
(RIS), and other ancillary systems. This model also forms the
cations may be of prime importance in qualifying the defini-
core for a basic ambulatory record system, and specialized
tionsofsystembehavioridentifiedinPracticeE1239.Forallof
variants, in support of clinical specialties in medicine and
thesereasons,itisofspecialimportancetoinitiallyestablishan
dentistry.The object models for these ancillary and specialized
object-oriented static model for the RADT functional domain
electronic health record (EHR) systems are defined in other
that can be the basis for definitions of healthcare data manage-
standards that constitute the “family of models” that extend the
ment and standards setting and serve as a foundation for
RADT function.
modeling telecommunications standards.
4.1.2 While this practice was being developed, a joint
5. Significance and Use
working group (JWG) on data modeling of the then American
5.1 RADT Object Model as a Basis for Communication—
National Standards Institute (ANSI) Healthcare Informatics
The RADT object model is the first model used to create a
Standards Planning Panel (HISPP), now Health Informatics
common library of consistent entities (objects) and their
StandardsBoard(HISB),beganworkonacommondatamodel
attributes in the terminology of object analytical models as
(CDM) for the healthcare information domain. A JWG data
applied to the healthcare domain. These object models can be
modeling convention document (IEEE 1157.1) guides the
used to construct and refine standards relating to healt care
conventions to be used, and this practice reflects those conven-
information and its management. Since the RADT object
tions as they are currently known. It is intended that this
model underpins the design and implementation of specific
practice contribute to establishing the RADTcore of the CDM.
systems, it provides the framework for establishing the sys-
The exact boundaries of the RADTfunctional domain have not
tematics of managing observations made during health care.
The observations recorded during health care not only become
the basis for managing an individual’s health care by practi-
The boldface numbers in parentheses refer to the list of references at the end of
the standard.
tioners but are also used for research and resource manage-
ment. They define the common language for abstracting and
TABLE 1 Data Element Datatypes
codifying observations. The inconsistency and incompleteness
Type Standard Tag/ of the data recorded in paper records is well known and has
Mnemonic
been noted by the Institute of Medicine’s study (4). The ability
Name Name
tobuildtherecommendedEHRbeginswithRADT,asnotedin
Number Num
Practice E1239. A more detailed specification of the RADT
Code Code
Datetime Dtm process and its specific functional domain shall begin with a
Signature Sig
formal model. Furthermore, following agreement on the initial
Text Text
model, that model shall evolve as knowledge accumulates and
Quantity Qty
theinitialviewofthehealthcaredomainextendstoothersocial
E1715 − 01 (2013)
and psychologic processes that link healthcare with other by a branching tree, is the “is a special case of” relationship,
functional domains of society. The management of lifelong which implies encapsulation of the special attributes that
cases of care, such as those of birth defects in newborns, will
differentiate the individual characteristics of a more general
involve interactions with social work and educational func-
object. The combination of these two relationships permits all
tional domains of experience. It has been recognized for some
of the complexities in the static interrelationships of the
time (5) that a “healthcare team,” in the broader sense, is
constituent objects comprising the RADT model to be repre-
involved in dealing with these complex cases. The RADT
sented. Instance connections are a weaker form of relationship
model is the core to linking these functional domains together
that have not been included in the basic framework for this
in a transparent way. For that reason, the object terminology is
model. Instance connections show references to master system
used to enable the most global view and vernacular that will
tables of context-insensitive entities. These same terms appear
facilitate communication among technical specialties that par-
in the tabular representation. The sequential application of
ticipate in managing some aspect of health care or that build
these relationships, visually from the top down in Figs. 1-4,
systems to manage the required information.
depict the inheritance properties since the objects later in the
sequence of the relationships inherit the attributes from those
5.2 Common Terminology as a Basis for Education—The
earlier in the sequence. These concepts are all explained by
use of models and their associated terminology implies that
education of the healthcare practitioners shall incorporate this Coad and Yourdon (2).
view to a significant extent. While a detailed specification of
systems requires extensive lexicons of carefully defined terms, 7. Tabular Representation
amoreunderstandableterminologyshallevolvefortheprocess
7.1 Tables 1 and 2 and Annex A1 provide the detailed
of educating practitioners during their formal education as well
attributes of the objects and should be compared with Table 1
as continuing to educate current practioners concerning how
of Practice E1239 and Annex A1 of Practice E1384, which
this new technology can be integrated with their existing
show the integrated logical structure of the computer-based
practices. This challenge has yet to be met, but the objects and
primary record of care. The latest revision of Practice E1384
modeling concepts presented here are intended to be named
associates each data element with an index that uniquely
with the most intuitive titles in order to promote clear under-
identifies its segment location in Annex A1 and provides a
standing during their use in instruction. Nevertheless, relating
definition and references its representation. Certain data ele-
these objects and their properties to everyday practice remains
ments with coded values have their value sets, which are also
a significant challenge, for both the implementors of systems
identified in that specification by its specific index contained in
and educators. The perspectives cataloged here can be used in
Practice E1384 and point to Specification E1633. The
thecreationofsystemdocumentationandcurricularepresented
definitions, mnemonics, and associated attributes of the objects
in a variety of media.
in the RADT object model are given in Table A1.1 of Annex
6. Graphic Representation
A1 of this practice. The object mnemonics that are used in the
construction of standardized short names for the data elements
6.1 The graphic representation in Figs. 1-4 of the relation-
indexed and characterized in Practice E1384 are given as
shipsamongtheobjectsdepictsthestaticinheritanceproperties
...
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