Data Set CEN/TC 251 prEN 17269ID: 2.16.840.1.113883.3.1937.777.13.1.2Version Label: 2018-08-29T11:43:19Concepts: 191 (Groups: 77 - Items: 114) |
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Name | ID[‑] | Datatype[‑] | Property[‑] | Example[‑] | Codes[‑] | Description[‑] | Source[‑] | Rationale[‑] | Operationalizations[‑] | Comment[‑] | Terminology[‑] | Value Set[‑] | Type[‑] | Parent concept[‑] | Inherit from[‑] |
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Patient Attributes | hl7ips-dataelement-2.1 | Collection
of data used for identification and assurance of identity within a patient
summary. Every PS conformant to IPS must contain ’Patient’s Name’ from this IPS collection. Insurance information is necessary in some countries |
CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | An IPS Attribute Collection will provide various data used individually or collectively to identify, or to assure the identity of a person and/or patient to an attending clinician at the point of care. |
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Group | ||||||||
Patient's Name | hl7ips-dataelement-3 | Collection of data | The name of a person is a familiar, cross-sector idea, independent of a particular use case. It is explained in the Primitive Values clause. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | It requires family and given name components. |
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Item | Patient Attributes | ||||||
Patient’s address and telecom | hl7ips-dataelement-155 | This Label Concept positions the nested attributes. However, it is useful to note that the patient’s address is administrative but can also be used in the clinical process to assist with the verification of the patient’s identification. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Patient Attributes | ||||||||
Address | hl7ips-dataelement-162 | Collection of data |
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Item | Patient’s address and telecom | |||||||||
Telecoms | hl7ips-dataelement-100 | Count |
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Item | Patient’s address and telecom | |||||||||
Administrative Gender | hl7ips-dataelement-4 | Code | Some countries require ‘gender’ as part of their identification of the patient. Administrative gender SHALL be specified from a value set including, ‘Male’, ‘Female’, ‘Unknown’, ‘Neutral’ | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Patient Attributes | |||||||
Date of Birth | hl7ips-dataelement-5 | Date/time |
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Item | Patient Attributes | ||||||||
Patient’s preferred language | hl7ips-dataelement-135 | Code |
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Item | Patient Attributes | |||||||||
Healthcare related Identifiers | hl7ips-dataelement-202 |
A list of patient identifiers.
Notes: Arguably a national health number would be of more use locally than for cross-border purposes. It is also possible, even probable, that a person will have several numbers, each one related to one or more healthcare providers. In an international context, a national healthcare identifier may be useful. However not all countries have such a registration scheme in place.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Patient Attributes | ||||||||
Patient Identifier | hl7ips-dataelement-6 | Identifier | Note, Patient Number is often used as a synonym, albeit that the identifier is not necessarily numeric; some jurisdictions use the Social Security Number as a healthcare identifier. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Healthcare related Identifiers | |||||||
Insurance Information | hl7ips-dataelement-203 | Insurance information is not always required in a patient summary. However, in some jurisdictions, the insurance number is also used as the patient identifier. It is necessary not just for identification but also forms access to funding for care. In those countries that require such information, it must be present. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Patient Attributes | ||||||||
Insurance identifier | hl7ips-dataelement-7 | Identifier |
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Item | Insurance Information | |||||||||
Patient’s Address Book | hl7ips-dataelement-154 | People and organizations address details relevant for the planned and unplanned care. Considered to be generic to the English language and not specific to this standard. Notes: A list relating to people or organisations details who might need to be contacted for this care event; it is not to do with previous care events involving this patient. These entities can be considered as providers (person or organisation) who are wholly or partially responsible for the safety and well-being of the subject of care. |
CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | This IPS Attribute Collection provides an Address Book resource detailing the address details of the patient, and people and organisations relevant to the patient with respect to the IPS. |
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Group | ||||||||
Preferred Healthcare providers | hl7ips-dataelement-163 | If known, this information shall be provided. Note it is not necessarily the case that Preferred Healthcare Provider is the same party as the source of the patient summary; the latter is given by the Provenance meta data. ‘Preferred’ indicates the most relevant entity to be contacted for use in this patient summary. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Patient’s Address Book | ||||||||
Healthcare Provider (person) (HP, HCP) | hl7ips-dataelement-165 |
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Group | Preferred Healthcare providers | ||||||||||
Name | hl7ips-dataelement-121 | Collection of data | It requires family and given name components. |
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Item | Healthcare Provider (person) | ||||||||
Telecoms | hl7ips-dataelement-169 | Collection of data |
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Item | Healthcare Provider (person) | |||||||||
Healthcare Provider (organisation) | hl7ips-dataelement-166 |
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Group | Preferred Healthcare providers | ||||||||||
Organisation’s Name | hl7ips-dataelement-172 | String |
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Item | Healthcare Provider (organisation) | |||||||||
Telecoms | hl7ips-dataelement-174 | Collection of data |
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Item | Healthcare Provider (organisation) | hl7ips-dataelement-169 | ||||||||
Other's Contacts’ Details | hl7ips-dataelement-164 | The urgency of the scenario suggests that the contact details will be minimised to the most likely means of getting in touch. The role distinguishes between individuals (and organisations) by means of their function with respect to the patient’s care to enable the relevant person to be contacted by the healthcare provider at the point of care. The role can be both functional (e.g. doctor) and a specialisation (e.g. specialist). | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Patient’s Address Book | ||||||||
Contact | hl7ips-dataelement-167 |
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Group | Other's Contacts’ Details | ||||||||||
Role | hl7ips-dataelement-175 | Code |
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Item | Contact | |||||||||
Name | hl7ips-dataelement-157 | Collection of data | It requires family and given name components. |
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Item | Contact | hl7ips-dataelement-121 | |||||||
Address | hl7ips-dataelement-120 | Collection of data | Address |
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Item | Contact | ||||||||
Telecoms | hl7ips-dataelement-122 | Collection of data |
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Item | Contact | hl7ips-dataelement-169 | ||||||||
Advance Directives (AD Section, Living will, Personal directive) | hl7ips-dataelement-8 |
Provision for healthcare decisions in the event that, in the future, a person is unable to make those decisions.
A conformant IPS document may not include this section. Healthcare directives concerning life or after life wishes of the patient
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | Deemed to be of value in unplanned care if a life-threatening event or fatality occurs and the patient or a legitimate decision maker has stipulated what should happen with respect to the patient who is too ill or hurt to express their wishes. |
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Group | ||||||||
Advance Directives (AD List) | hl7ips-dataelement-24 |
A list comprising one or more advance directives
Note: Although not in this version of the standard, future versions of the Advanced Directives IPS Section might also include definitions and descriptions regarding ‘CONSENT practices’ as directives and mandates from particular jurisdictions
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Advance Directives | ||||||||
Advance Directive | hl7ips-dataelement-179 |
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Group | Advance Directives | ||||||||||
Person authorising Directive | hl7ips-dataelement-22 | The source of each directive if known; the decision maker is usually the patient and/or a delegated person such as a Legal Guardian. If the authority is not the patient, then it will be someone to contact for further information and clarification of the patient’s wishes. The postal address elements are not included reflecting the urgency for the contact; however, full details should be consistent and available from the Patient’s Address Book. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Advance Directive | ||||||||
Name | hl7ips-dataelement-118 | Collection of data | It requires family and given name components. |
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Item | Person authorising Directive | hl7ips-dataelement-121 | |||||||
Telecoms | hl7ips-dataelement-178 | Count |
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Item | Person authorising Directive | hl7ips-dataelement-100 | ||||||||
Directive category | hl7ips-dataelement-180 | Code | There are Directives related to decisions prior and after death. For example, directives prior to death might relate to Blood transfusions, and Non-Resuscitation and post death directives might relate to organ donation. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Advance Directive | |||||||
Description | hl7ips-dataelement-26 | Text |
Textual description of the directive.
Derived models may choose to use distinct elements for each narrative directive or to collect them into a single section level narrative block.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Advance Directive | |||||||
Reference to Legal Document | hl7ips-dataelement-27 | Collection of data | The Directives may take the form of a reference to a legal document (e.g. Living Will) or an external textual description. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Advance Directive | |||||||
Allergies and Intolerances | hl7ips-dataelement-9 |
Relevant patient’s allergies and/or intolerance conditions.
NOTE 1 to entry: At a minimum, it should list currently active and any relevant historical allergies and adverse reactions. NOTE 2 to entry: ‘Alerts’ was used to describe this Section in the eHN guidance -lines, but ‘Alerts’ are far more general and are not regarded here as a synonym. Every PS conformant to IPS must contain this IPS section. Allergies and Intolerances affecting the Patient.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | To inform the treatment and care provisioning of an attending clinician to identify problem or to avoid adverse events arising from action taken. At a minimum, it should list currently active and any relevant historical allergies and adverse reactions. |
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Group | ||||||||
Allergies/Intolerances Content Status | hl7ips-dataelement-182 | Code | As this IPS Section is mandatory for conformance, information about “known absence of allergies” or no information about allergies is required to be stated. Known Content will be accompanied by the conditional list of Allergies and intolerances. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergies and Intolerances | |||||||
Allergy or Intolerance list | hl7ips-dataelement-28 | If allergies present then they shall be listed else give explicit reasons for why none are recorded. An ordered list comprising the name, code, a description of the Allergy/intolerance and Agent details for each Allergy/intolerance. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Allergies and Intolerances | ||||||||
Allergy/Intolerance | hl7ips-dataelement-184 |
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Group | Allergy or Intolerance list | ||||||||||
Description | hl7ips-dataelement-183 | Text |
Textual description of the allergy or intolerance.
Derived models may choose to use distinct elements for each narrative statement or to collect them into a single section level narrative block.
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Item | Allergy/Intolerance | |||||||
Clinical Status | hl7ips-dataelement-186 | Code |
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Provides the current status of the allergy or intolerance, for example, whether it is active, in remission, resolved, and so on.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | ||||||
Onset date | hl7ips-dataelement-187 | Date/time |
It shall be provided with the highest known precision, at least year
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | |||||||
End Date | hl7ips-dataelement-188 | Date/time |
If Clinical Status is non-active then an exception can be raised to indicate inconsistency.
It shall be provided with the highest known precision, at least year.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | |||||||
Criticality | hl7ips-dataelement-189 | Code |
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This attribute represents the gravity of the potential risk for future life-threatening adverse reactions when exposed to a substance known to cause an adverse reaction in that individual. When the ‘worst case’ result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.
Notes: In some contexts, the severity is used as a synonym of the criticality.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | ||||||
Certainty | hl7ips-dataelement-190 | Code |
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Assertion about certainty associated with the propensity, or potential risk, of a reaction to the identified substance | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | ||||||
Type of propensity | hl7ips-dataelement-191 | Code |
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Type of allergy or intolerance. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | ||||||
Diagnosis | hl7ips-dataelement-185 | Code |
A code indicating the type of reaction and the agent; an alternative option for describing an allergy to the agent. Described with Textual information if coded data are unavailable.
Example: lactose intolerance
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Allergy/Intolerance | |||||||
Reaction | hl7ips-dataelement-192 | A Label Concept recognising that other data concerning the reaction may be made available in later versions of this standard. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Allergy/Intolerance | ||||||||
Manifestation of the reaction | hl7ips-dataelement-193 | Code |
Description of the clinical manifestation of the allergic reaction. Example: anaphylactic shock, angioedema (the clinical manifestation also gives information about the severity of the observed reaction).
Textual information if coded/quantified data are not available. This is typically a more complex structure than simple text.
Example: “intestinal discomfort” is the manifestation of the reaction.
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Reaction | |||||||
Severity | hl7ips-dataelement-194 | Code | Coded element that described the subjective assessment of the severity of the condition as evaluated by the clinician, in the case of an allergy it is used as attribute of a manifestation of a reaction. For example, a person may have a severe rash as reaction, that it is not however critical. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Reaction | |||||||
Agent | hl7ips-dataelement-173 |
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Group | Allergy/Intolerance | ||||||||||
Agent code | hl7ips-dataelement-196 | Code | A specific allergen or other agent/substance to which the patient has an adverse reaction propensity. This will be taken from a list of agents and the associated code from a value set. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Agent | |||||||
Category | hl7ips-dataelement-195 | Code |
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Allergy substance category | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Agent | ||||||
Functional Status | hl7ips-dataelement-10 |
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Group | |||||||||||
Disabilities List | hl7ips-dataelement-156 |
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Group | Functional Status | ||||||||||
Disability | hl7ips-dataelement-29 |
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Group | Disabilities List | ||||||||||
Description | hl7ips-dataelement-197 | Text |
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Item | Disability | |||||||||
Disability Code | hl7ips-dataelement-198 | Code |
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Item | Disability | |||||||||
Onset date | hl7ips-dataelement-199 | Date/time |
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Item | Disability | |||||||||
Functional Assessments List | hl7ips-dataelement-30 |
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Group | Functional Status | ||||||||||
Functional Assessment | hl7ips-dataelement-201 |
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Group | Functional Assessments List | ||||||||||
Description | hl7ips-dataelement-137 | Text |
Textual description of the functional assessment.
Derived models may choose to use distinct elements for each narrative statement or to collect them into a single section level narrative block
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Item | Functional Assessment | |||||||
Date of assessment | hl7ips-dataelement-204 | Date/time |
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Item | Functional Assessment | ||||||||
Type | hl7ips-dataelement-205 | Code |
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Item | Functional Assessment | |||||||||
Result | hl7ips-dataelement-206 | Collection of data |
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Item | Functional Assessment | |||||||||
Functional Assessment | hl7ips-dataelement-21 |
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Group | Functional Assessment | hl7ips-dataelement-201 | |||||||||
History of Past Illness | hl7ips-dataelement-11 |
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Group | |||||||||||
Past illness content status | hl7ips-dataelement-208 | Code |
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Item | History of Past Illness | |||||||||
Past health conditions and problems list | hl7ips-dataelement-31 |
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Group | History of Past Illness | ||||||||||
Health condition / Problem | hl7ips-dataelement-209 |
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Group | Past health conditions and problems list | ||||||||||
Problem Type | hl7ips-dataelement-210 | Code |
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Item | Health condition / Problem | |||||||||
Description | hl7ips-dataelement-35 | Text |
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Item | Health condition / Problem | |||||||||
Diagnosis | hl7ips-dataelement-36 | Code |
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Item | Health condition / Problem | |||||||||
Severity | hl7ips-dataelement-136 | Code | Coded element that described the subjective assessment of the severity of the condition as evaluated by the clinician, in the case of an allergy it is used as attribute of a manifestation of a reaction. For example, a person may have a severe rash as reaction, that it is not however critical. | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Item | Health condition / Problem | hl7ips-dataelement-194 | ||||||
Onset Date | hl7ips-dataelement-32 | Date/time |
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Date of the first observation of adverse reactions | SPECIFIC GUIDELINES FOR ELECTRONIC EXCHANGE OF HEALTH DATA UNDER THE CROSS-BORDER DIRECTIVE 2011/24/EU RELEASE 2 PATIENT SUMMARY FOR UNSCHEDULED CARE |
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Item | Health condition / Problem | ||||||
Resolution | hl7ips-dataelement-33 | Code |
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Item | Health condition / Problem | |||||||||
Date resolved | hl7ips-dataelement-34 | Date/time |
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Item | Health condition / Problem | ||||||||
Specialist Contact | hl7ips-dataelement-124 | Collection of data |
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Item | Health condition / Problem | |||||||||
History of Pregnancy | hl7ips-dataelement-12 |
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Group | |||||||||||
Status of pregnancy | hl7ips-dataelement-37 |
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Group | History of Pregnancy | ||||||||||
Pregnancy Description | hl7ips-dataelement-225 | Text |
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Item | Status of pregnancy | |||||||||
Structured Description | hl7ips-dataelement-168 |
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Group | Status of pregnancy | ||||||||||
Date of Observation | hl7ips-dataelement-211 | Date/time |
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Item | Structured Description | ||||||||
Pregnancy State | hl7ips-dataelement-212 | Code |
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Item | Structured Description | |||||||||
Expected delivery date | hl7ips-dataelement-213 | Date/time |
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Item | Structured Description | ||||||||
Specialist Contact | hl7ips-dataelement-200 | Collection of data |
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Item | Status of pregnancy | hl7ips-dataelement-124 | ||||||||
Previous Pregnancies | hl7ips-dataelement-38 |
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Group | History of Pregnancy | ||||||||||
Previous Pregnancies Description | hl7ips-dataelement-39 | Text |
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Item | Previous Pregnancies | |||||||||
Previous Pregnancies List | hl7ips-dataelement-1 |
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Group | Previous Pregnancies | ||||||||||
Previous Pregnancy | hl7ips-dataelement-40 |
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Group | Previous Pregnancies List | ||||||||||
Outcome date | hl7ips-dataelement-41 | Date/time |
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Item | Previous Pregnancy | ||||||||
Outcome | hl7ips-dataelement-42 | Text |
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Item | Previous Pregnancy | |||||||||
Summary Metric | hl7ips-dataelement-214 | Collection of data |
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Item | Previous Pregnancies | |||||||||
Specialist Contact | hl7ips-dataelement-125 | Collection of data |
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Item | Previous Pregnancies | hl7ips-dataelement-124 | ||||||||
History of Procedures | hl7ips-dataelement-13 |
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Group | |||||||||||
Procedures Content Status | hl7ips-dataelement-44 | Code |
History of procedures informing whether there is no information about procedures or no known procedure
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Item | History of Procedures | ||||||||
Procedure list | hl7ips-dataelement-43 | A list of procedures performed on the subject of care |
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Group | History of Procedures | |||||||||
Procedure | hl7ips-dataelement-47 | Each member of the list describes the type of procedure and identifies the actual procedure performed and when it happened. |
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Group | Procedure list | |||||||||
Procedure code | hl7ips-dataelement-49 | Code |
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Item | Procedure | |||||||||
Procedure description | hl7ips-dataelement-51 | Text |
Textual description of the procedure.
Derived models may choose to use distinct elements for each narrative statement or to collect them into a single section level narrative block.
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Item | Procedure | ||||||||
Body site | hl7ips-dataelement-216 |
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Item | Procedure | ||||||||||
Procedure date | hl7ips-dataelement-48 | Collection of data | Period or Date Time |
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Item | Procedure | ||||||||
Immunizations | hl7ips-dataelement-14 |
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Group | |||||||||||
Immunizations Content Status | hl7ips-dataelement-46 | Code |
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Item | Immunizations | |||||||||
Immunizations list | hl7ips-dataelement-50 |
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Group | Immunizations | ||||||||||
Immunization | hl7ips-dataelement-45 |
A container for information related to information of the vaccine and its administration. |
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Group | Immunizations list | |||||||||
Vaccine for type of disease | hl7ips-dataelement-52 | Code |
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Item | Immunization | |||||||||
Target disease list | hl7ips-dataelement-181 |
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Group | Immunization | ||||||||||
Target disease | hl7ips-dataelement-207 | Code |
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Item | Target disease list | |||||||||
Date of Immunization | hl7ips-dataelement-53 | Date/time |
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Item | Immunization | ||||||||
Product Administered | hl7ips-dataelement-54 |
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Group | Immunization | ||||||||||
Brand name | hl7ips-dataelement-55 | String |
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Item | Product Administered | |||||||||
Product Administration Process | hl7ips-dataelement-215 |
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Group | Immunization | ||||||||||
Performer | hl7ips-dataelement-56 | Collection of data |
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Item | Product Administration Process | |||||||||
Route of administration | hl7ips-dataelement-217 | Code |
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Item | Product Administration Process | |||||||||
Medical Devices | hl7ips-dataelement-15 |
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Group | |||||||||||
Device content Status | hl7ips-dataelement-218 | Code |
Records whether there is no information about devices or no known devices |
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Item | Medical Devices | ||||||||
Device List | hl7ips-dataelement-219 |
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Group | Medical Devices | ||||||||||
Device | hl7ips-dataelement-57 |
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Group | Device List | ||||||||||
Device Type | hl7ips-dataelement-58 | Code | Category of the device |
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Item | Device | ||||||||
Device Identifier | hl7ips-dataelement-60 | Identifier |
Note, this was not part of the eHN dataset; the device identifier (e.g. UDI) has been added in the HL7 IPS as optional data.
Unique and normalized identifier of the device
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Item | Device | ||||||||
Use start date | hl7ips-dataelement-59 | Date/time | Date when the device was implantable to the patient or the external device was first in use. This field may contain only the year if the day and month are not available (ex: 01/01/2017). |
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Item | Device | ||||||||
Use end date | hl7ips-dataelement-150 | Date/time |
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Item | Device | ||||||||
Medication Summary | hl7ips-dataelement-16 |
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Group | |||||||||||
Medication Summary content status | hl7ips-dataelement-220 | Code |
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Item | Medication Summary | |||||||||
List of medication | hl7ips-dataelement-61 |
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Group | Medication Summary | ||||||||||
Medication | hl7ips-dataelement-104 |
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Group | List of medication | ||||||||||
Reason | hl7ips-dataelement-226 | Collection of data |
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Item | Medication | |||||||||
Medicinal Product | hl7ips-dataelement-2 |
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Group | Medication | ||||||||||
Product Code (Medicinal product Identifier ) | hl7ips-dataelement-105 | Code | A code identifying the medicine. |
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Item | Medicinal Product | ||||||||
Product Common Name (and Strength) | hl7ips-dataelement-171 | String |
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Item | Medicinal Product | |||||||||
Pharmaceutical dose form | hl7ips-dataelement-227 | Code |
Physical manifestation of a Medicinal Product that contains the active ingredient(s) and/or inactive ingredient(s)
that are intended to be delivered to the patient
NOTE 1 Dose form, dosage form and pharmaceutical dose form are synonymous.
NOTE 2 “Pharmaceutical dose form” can refer to the administered dose form or the manufactured dose form.
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EN-ISO IDMP 11615 |
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Item | Medicinal Product | |||||||
Brand Name | hl7ips-dataelement-117 | String |
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Item | Medicinal Product | |||||||||
Active ingredient List | hl7ips-dataelement-170 | CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Medicinal Product | |||||||||
Active Ingredient | hl7ips-dataelement-129 |
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Group | Active ingredient List | ||||||||||
Substance code | hl7ips-dataelement-132 | Code |
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Item | Active Ingredient | |||||||||
Strength | hl7ips-dataelement-133 | Quantity |
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Item | Active Ingredient | |||||||||
Administration Instruction | hl7ips-dataelement-222 |
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Group | Medication | ||||||||||
Instruction | hl7ips-dataelement-228 | Text |
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Item | Administration Instruction | |||||||||
Period of Medication Use | hl7ips-dataelement-103 | Duration | This information may be expressed using start and end date times OR indicating the duration. The first is used to indicate a specified interval (e.g. from March 15th, 2017); the latter for indicating a 'floating' period (e.g. 2 weeks). In case of unbounded period (continuous therapy) the end element will be valued with an exceptional value. |
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Item | Administration Instruction | ||||||||
Route of administration | hl7ips-dataelement-102 | Code |
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Item | Administration Instruction | hl7ips-dataelement-217 | ||||||||
Dose Instruction | hl7ips-dataelement-119 |
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Group | Administration Instruction | ||||||||||
Number of units per intake | hl7ips-dataelement-223 | Quantity | Range or Quantity |
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Item | Dose Instruction | ||||||||
Frequency of intake | hl7ips-dataelement-224 | Collection of data |
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Item | Dose Instruction | |||||||||
Plan Of Care | hl7ips-dataelement-17 |
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Group | |||||||||||
Plan Description | hl7ips-dataelement-110 | Text |
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Item | Plan Of Care | |||||||||
Plan Description list | hl7ips-dataelement-134 |
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Group | Plan Of Care | ||||||||||
Plan | hl7ips-dataelement-114 |
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Group | Plan Description list | ||||||||||
Plan Type | hl7ips-dataelement-108 | Code |
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Item | Plan | |||||||||
Plan Date | hl7ips-dataelement-107 | Date/time |
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Item | Plan | ||||||||
Recommendations list (Core Care Plan) | hl7ips-dataelement-109 |
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Group | Plan Description list | ||||||||||
Recommendation for treatment | hl7ips-dataelement-113 | Identifier |
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Item | Recommendations list | |||||||||
Given Recommendations date | hl7ips-dataelement-111 | Date/time |
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Item | Recommendations list | |||||||||
Applicable dates | hl7ips-dataelement-112 | Collection of data |
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Item | Recommendations list | |||||||||
Extended Plan (trade name) | hl7ips-dataelement-116 | Collection of data |
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Item | Plan Description list | |||||||||
Problems | hl7ips-dataelement-18 |
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Group | |||||||||||
Problem content status | hl7ips-dataelement-115 | Code | The
patient has had no previous problems, or the problem information is unknown |
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Item | Problems | ||||||||
Problem list | hl7ips-dataelement-139 |
The problem list comprises members that are current, either because they are active, unresolved or of concern and being monitored. |
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Group | Problems | |||||||||
Problem | hl7ips-dataelement-140 |
One or more problems are listed; each comprising the same structure describing the nature of the problem and its date of onset. |
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Group | Problem list | |||||||||
Problem type | hl7ips-dataelement-101 | Code |
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Item | Problem | |||||||||
Description | hl7ips-dataelement-130 | Text |
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Item | Problem | |||||||||
Diagnosis | hl7ips-dataelement-131 | Code |
Label used to describe a problem; usually coded. |
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Item | Problem | ||||||||
Severity | hl7ips-dataelement-128 | Code |
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Item | Problem | |||||||||
Onset date | hl7ips-dataelement-127 | Date/time |
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Item | Problem | ||||||||
Specialist Contact | hl7ips-dataelement-25 | Collection of data |
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Item | Problem | hl7ips-dataelement-124 | ||||||||
Results | hl7ips-dataelement-19 |
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Group | |||||||||||
Observation Results Content Status | hl7ips-dataelement-141 | Code |
Statement about presence/absence of content. |
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Item | Results | ||||||||
Observations results list | hl7ips-dataelement-126 | A conditional list of all observation results pertaining to the subject of care’s health condition |
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Group | Results | |||||||||
Observation Result | hl7ips-dataelement-106 |
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Group | Observations results list | ||||||||||
Date of observation | hl7ips-dataelement-143 | Duration | Date Time or Period |
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Item | Observation Result | ||||||||
Observation Type | hl7ips-dataelement-144 | Code |
The list contains members representing the types of results. Note: the eHN give only two examples (non-exhaustive) and these may be represented in a value set with these two types included:
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Item | Observation Result | ||||||||
Result Description | hl7ips-dataelement-142 | Text |
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Item | Observation Result | |||||||||
Value | hl7ips-dataelement-145 | Collection of data |
The measurement value and details about how the tests were done to get the result values. |
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Item | Observation Result | ||||||||
Observation Result | hl7ips-dataelement-23 |
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Group | Observation Result | hl7ips-dataelement-106 | |||||||||
Performer | hl7ips-dataelement-146 | Collection of data |
Identifies the originator/author and provides provenance information about the source of the results data that may have not originated with the source of the whole IPS document. |
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Item | Observation Result | ||||||||
Observer | hl7ips-dataelement-177 | Collection of data |
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Item | Observation Result | |||||||||
Social History | hl7ips-dataelement-20 |
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Group | |||||||||||
Life Style Factor list | hl7ips-dataelement-147 |
An open-ended list of composite objects that describes the past and current habits of the patient with respect to a particular life style observation. If this IPS Section is present then the list shall be non-empty. Composite object describing the name of the lifestyle factor and descriptive text or structured codes providing more details, with ranges and amounts when applicable; Textual information if coded/quantified data are not available. |
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Group | Social History | |||||||||
Life Style Factor | hl7ips-dataelement-148 |
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Group | Life Style Factor list | ||||||||||
Description | hl7ips-dataelement-149 | Text |
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Item | Life Style Factor | |||||||||
Life Style Factor | hl7ips-dataelement-176 |
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Group | Life Style Factor | hl7ips-dataelement-148 | |||||||||
Reference date range | hl7ips-dataelement-151 | Duration |
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Item | Life Style Factor | |||||||||
ATTIC | hl7ips-dataelement-221 |
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Group | |||||||||||
GRP | hl7ips-dataelement-138 |
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Group | ATTIC | ||||||||||
IPS Document | hl7ips-dataelement-152 |
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Group | ATTIC | ||||||||||
Patient Attributes | hl7ips-dataelement-153 | Collection
of data used for identification and assurance of identity within a patient
summary. Every PS conformant to IPS must contain ’Patient’s Name’ from this IPS collection. Insurance information is necessary in some countries |
CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care | An IPS Attribute Collection will provide various data used individually or collectively to identify, or to assure the identity of a person and/or patient to an attending clinician at the point of care. |
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Group | IPS Document | |||||||
Address Options | hl7ips-dataelement-158 |
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Group | ATTIC | ||||||||||
Telecoms Group | hl7ips-dataelement-159 |
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Group | Address Options | ||||||||||
Advance Directives (AD List) | hl7ips-dataelement-160 |
A list comprising one or more advance directives
Note: Although not in this version of the standard, future versions of the Advanced Directives IPS Section might also include definitions and descriptions regarding ‘CONSENT practices’ as directives and mandates from particular jurisdictions
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CEN/TC 251 prEN 17269:2018 Health informatics — The Patient Summary for Unscheduled Cross-border Care |
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Group | Address Options | hl7ips-dataelement-24 | |||||||
Specialist Contact | hl7ips-dataelement-161 | Collection of data |
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Item | Advance Directives | hl7ips-dataelement-25 | ||||||||
Substance classifcation (ATC) | hl7ips-dataelement-123 |
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Group | ATTIC |