1、BRITISH STANDARDBS EN 13940-1:2007Health informatics System of concepts to support continuity of care Part 1: Basic conceptsThe European Standard EN 13940-1:2007 has the status of a British StandardICS 35.240.80g49g50g3g38g50g51g60g44g49g42g3g58g44g55g43g50g56g55g3g37g54g44g3g51g40g53g48g44g54g54g44
2、g50g49g3g40g59g38g40g51g55g3g36g54g3g51g40g53g48g44g55g55g40g39g3g37g60g3g38g50g51g60g53g44g42g43g55g3g47g36g58Licensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIBS EN 13940-1:2007This British Standard was published under the authority of the Standards Policy
3、and Strategy Committee on 31 July 2007 BSI 2007ISBN 978 0 580 55267 0National forewordThis British Standard was published by BSI. It is the UK implementation of EN 13940-1:2007. It supersedes DD ENV 13940:2001 which is withdrawn.The UK participation in its preparation was entrusted to Technical Comm
4、ittee IST/35, Health informatics.A list of organizations represented on this committee can be obtained on request to its secretary.This publication does not purport to include all the necessary provisions of a contract. Users are responsible for its correct application.Compliance with a British Stan
5、dard cannot confer immunity from legal obligations.Amendments issued since publicationAmd. No. Date CommentsLicensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIEUROPEAN STANDARDNORME EUROPENNEEUROPISCHE NORMEN 13940-1June 2007ICS 35.240.80 Supersedes ENV 13940:
6、2001 English VersionHealth informatics - System of concepts to support continuity ofcare - Part 1: Basic conceptsInformatique de sant - Systme de concepts en appui dela continuit des soins - Partie 1: Concepts de baseMedizinische Informatik - Begriffssystem zur Untersttzungder Kontinuitt der Versorg
7、ung - Teil 1: GrundbegriffeThis European Standard was approved by CEN on 10 May 2007.CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this EuropeanStandard the status of a national standard without any alteration. Up-to-date lists an
8、d bibliographical references concerning such nationalstandards may be obtained on application to the CEN Management Centre or to any CEN member.This European Standard exists in three official versions (English, French, German). A version in any other language made by translationunder the responsibil
9、ity of a CEN member into its own language and notified to the CEN Management Centre has the same status as theofficial versions.CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland,France, Germany, Greece, Hungary, Iceland, Ir
10、eland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal,Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland and United Kingdom.EUROPEAN COMMITTEE FOR STANDARDIZATIONCOMIT EUROPEN DE NORMALISATIONEUROPISCHES KOMITEE FR NORMUNGManagement Centre: rue de Stassart, 3
11、6 B-1050 Brussels 2007 CEN All rights of exploitation in any form and by any means reservedworldwide for CEN national Members.Ref. No. EN 13940-1:2007: ELicensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIEN 13940-1:2007 (E) 2 Contents Page Foreword 5 0 Introdu
12、ction. 6 0.1 General 6 0.2 Target groups 6 0.3 Notes . 6 0.3.1 General 6 0.3.2 Subject of care . 6 0.3.3 Description and display of concepts. 7 0.3.4 Concept modelling vs. information modelling 7 0.3.5 Frequent use of the term care instead of health care . 8 1 Scope . 9 1.1 Main purpose. 9 1.2 Topic
13、s outside the scope. 10 2 Normative references . 10 3 Terms and definitions . 12 4 Symbols and abbreviations. 14 5 Domain description and organisational principles 14 6 Actors in Continuity of Care 15 6.1 Health care actor. 16 6.1.1 Health Care Device 17 6.1.2 Health care party 18 6.1.2.1 Subject of
14、 care 20 6.1.2.2 Health care provider 22 6.1.2.2.1 Health care organisation. 23 6.1.2.2.2 Health care professional. 25 6.1.2.2.2.1 Health care professional entitlement 27 6.1.2.2.2.2 Health care professional appointment 28 6.1.2.3 Health care third party. 29 6.1.2.3.1 Other carer 31 6.1.2.3.2 Health
15、 care supporting organisation . 32 6.1.2.3.2.1 Health care funder 33 7 Health issues and their management. 34 7.1 Health issue. 35 7.2 Health issue thread . 37 8 Time-related concepts in Continuity of Care 39 8.1 Period of care 40 8.2 Contact 41 8.2.1 Record contact. 43 8.2.2 Encounter. 44 8.3 Conta
16、ct element 45 8.4 Episode of care . 47 8.5 Cumulative episode of care. 49 8.6 Sub-episode of care 50 8.6.1 Health approach. 51 9 Concepts related to activity, use of clinical knowledge and decision support in Continuity of Care52 9.1 Clinical guideline 53 9.2 Protocol . 54 9.3 Programme of care . 55
17、 9.4 Care plan. 57 9.5 Health objective. 59 9.6 Health care goal 60 9.7 Health care activity 61 9.7.1 Health care provider activity. 62 9.7.2 Health self care activity 63 9.7.3 Health care contributing activity . 64 Licensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy,
18、(c) BSIEN 13940-1:2007 (E) 3 9.7.4 Health care automated activity. 65 9.8 Health care activities bundle .66 10 Concepts related to responsibility in Continuity of Care 67 10.1 Demand for care 68 10.2 Health mandate . 69 10.2.1 Demand mandate 71 10.2.2 Care mandate 73 10.2.3 Mandate to export persona
19、l data . 75 10.2.4 Continuity facilitator mandate. 77 10.3 Health mandate notification . 79 11 Health data management in Continuity of Care 80 11.1 Electronic health record. 81 11.1.1 Local health record. 82 11.1.1.1 Professional health record 83 11.1.2 Sharable data repository 84 11.2 Record compon
20、ent 86 11.3 Specific clinical information request 87 11.4 EHR extract . 88 11.4.1 Tailored clinical information . 89 11.4.2 Sharable data.90 11.5 Non ratified clinical data. 91 11.6 Clinical data for import. 92 12 Conformance 93 12.1 Full conformance . 93 12.2 Partial conformance.93 Annex A (informa
21、tive) On the issue of the subject of care being a group of persons . 94 Annex B (informative) Overview and explanatory comments 95 Bibliography . 108 Alphabetical Index 111 Licensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIEN 13940-1:2007 (E) 4 Tables Page Ta
22、ble B.1 Kinds of organisations for health care provision. 97 Table B.2 Hierarchical relationships between concepts related to knowledge, activities and decision support. 103 Table B.3 Levels of support provided by telematic tools for various levels of co-ordination. 106 Figures Page Figure 1: Compre
23、hensive UML diagram of actors in continuity of care 15 Figure 2: Comprehensive UML diagram of health issues and their management 34 Figure 3: Comprehensive UML diagram of time-related concepts in continuity of care 39 Figure 4: Comprehensive UML diagram of concepts related to activity, use of clinic
24、al knowledge, and decision support in continuity of care 52 Figure 5: Comprehensive UML diagram of concepts related to responsibility in continuity of care 67 Figure 6: Comprehensive UML diagram of health data management in continuity of care 80 Licensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+0
25、0:00 2007, Uncontrolled Copy, (c) BSIEN 13940-1:2007 (E) 5 Foreword This document (EN 13940-1:2007) has been prepared by Technical Committee 251 “Health informatics“, the secretariat of which is held by NEN. This European Standard shall be given the status of a national standard, either by publicati
26、on of an identical text or by endorsement, at the latest by December 2007, and conflicting national standards shall be withdrawn at the latest by December 2007. This document supersedes ENV 13940:2001. This two-part standard under the general heading Health informatics System of concepts to support
27、continuity of care consists of the following parts: Part 1: Basic concepts Part 2: Core process and work flow in health care According to the CEN/CENELEC Internal Regulations, the national standards organizations of the following countries are bound to implement this European Standard: Austria, Belg
28、ium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland and United Kingdom. Licensed Copy: Wang Bi
29、n, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIEN 13940-1:2007 (E) 6 0 Introduction 0.1 General Continuity of care is increasingly invoked nowadays as one of the most important issues in health care. What is in perspective is both an improvement of the quality of care, and a re
30、duction of costs. Continuity of care is now seen as prerequisite to improve at the same time efficacy, effectiveness and efficiency of health care. Thus there is a need for clinicians, private and public health care providers, health managers, and funding organisations to base their decisions, in te
31、rms of re-organisation of services, on a good understanding of the concepts involved. This European Standard defines the classes of concepts and their descriptive terms, regarding all processes of care, especially considering patient-centred continuity of care, shared care and seamless care. Continu
32、ity of care depends on the effective transfer and linkage of data and information about both the clinical situation and the health care provided to a subject of care, between different parties involved in the process, within the framework of ethical, professional and legal rules. The description and
33、 formalisation of continuity of care in information systems implies that the related concepts and descriptive terms be defined, so establishing a common conceptual framework across national, cultural and professional barriers. 0.2 Target groups The system of concepts and the terms defined in this Eu
34、ropean Standard are designed to support the management of health care related information over time and the delivery of care by different health care actors who are working together. This includes primary care professionals and teams, health care funding organisations, managers, patients, secondary
35、and tertiary health care providers, and community care teams. This harmonised system of concepts will be used to facilitate clinical and administrative decision making, and to enhance relationships between health care professionals and their patients. Among other applications, the content of this Eu
36、ropean Standard will prove of utmost importance for the development of well designed clinical networks, either at regional possibly cross-border , or at local level, either including hospital settings or not; it will help the correct management of personal health data, and of Electronic Health Recor
37、ds in that context. It provides a clear conceptual framework to establish the terms of reference of health information systems, to be used for tenders. 0.3 Notes 0.3.1 General These notes apply to this European Standard in general. 0.3.2 Subject of care In this European Standard, subject of care ref
38、ers to an individual. It is assumed that in those cases where a health care activity addresses a group of more than one individual (e.g. a family, a community), and where a single health record is used to capture the health care activities provided to the group, each individual within the group will
39、 be referenced explicitly within that health record. This issue is further discussed in Annex A “On the issue of the subject of care being a group of persons“, page 94. Licensed Copy: Wang Bin, na, Mon Oct 15 07:35:00 GMT+00:00 2007, Uncontrolled Copy, (c) BSIEN 13940-1:2007 (E) 7 0.3.3 Description
40、and display of concepts This European Standard aims to identify and describe concepts important to continuity of care, and to establish a system of concepts that is to be used when setting up information systems, especially when dealing with health record communication. The primary focus of the stan
41、dard is terminology and ontology. Descriptions framed in tables having the same pattern of rubrics are systematically provided for all the concepts presented in Clauses 6 to 11. Whenever not felt relevant to a given concept, some of these rubrics may intentionally be left blank. In the headings of t
42、hese tables, the names of those concepts that are purely abstract constructs and therefore are not instantiable but through their specialization, are shown in italic characters. Examples are provided wherever felt relevant and necessary. However, in general, examples for superordinate concepts are t
43、o be sought at the level of the corresponding subordinate concepts. In order to help the readers understand more easily the relationships between these concepts, diagrams have been introduced based on UML conventions. Thus, for each one of the concepts described in Clauses 6 to 11, a subset of the g
44、eneral and comprehensive diagram is provided as an illustrative part of the monograph, showing only its direct relationships with other concepts belonging to the current system of concepts. Diagrams providing partial views of the system of concepts are also proposed at the beginning of each one of C
45、lauses 6 to 11. These diagrams are focused on the topic addressed in the corresponding clause. For instance: actors, or health data management. For a better clarity, they only show the relationships between the concepts defined in that clause and, except for Clause 6, all relationships between those
46、 concepts and concepts defined in other clauses of this European Standard. For Clause 6 the relationship with a number of concepts that are not defined in this standard is shown. For clarity of reading, concepts defined in the clause the diagram is a part of are shown in white. Concepts defined in o
47、ther clauses of the standard are shown in grey while concepts not defined in this standard is light grey, whithout frames. The purpose of using UML diagrams in this European Standard is to highlight the relationships between concepts. Their attributes, which actually do not belong to the field of co
48、ncept modelling, are not addressed in this European Standard. This means that additional attributes may be felt useful or necessary in the course of implementation, without conformance with the current European Standard being at stake. Besides, there are related features and other related entities w
49、hich may be considered as concepts in their own right. They are usually of a generic nature, and do not belong to the system of concepts which is the focus of this European Standard. As a consequence, they are not described any further. An example of this is: a subject of care may have an undefined number of addresses, and an address may be associated with an undefined number of subjects of care. The resolution of this many to many relationship is not within the scope of this European Standard. In order to differentiate them both from normal attributes an
