Guide to ISO-conformant Demographics Archetypes

Demographic Archetypes

Rigoleta Dutra Mediano Dias

Sergio Miranda Freire

Introduction

The demographic archetypes shown in this document were based on the two ISO Technical Specification: ISO2220 - Identification of the subject of care and ISO27527 - Provider Identification. Although the main concepts and attributes will be presented here, knowledge of those specifications is indispensable for a complete understanding of the archetypes.

Design

Main archetypes

The main demographic archetypes are:

-       person

-       organisation

-       healthcare consumer

-       individual healthcare provider

-       healthcare provider organisation

-       third-party payer

The composition of these archetypes is summarized in table 1.

Health consumer and individual provider are roles that a person may perform, whereas healthcare provider organization and third-party payer are roles that an organisation may perform.

Both ISO specifications deal with the identification of subjects of care (patients) and health care providers (individual or organisations). The components of the identification of the subject of care (ISO22220) are used in several archetypes that will fill archetypes slots in the person archetype. Patient in the archetypes is a party-relationship between a person in the role of healthcare consumer and a person in the role of an individual provider or an organization in the role of a healthcare provider organisation.

A healthcare consumer may also have a party relationship with a third-party payer called beneficiary

An individual provider may have a party relationship with an organization provider (a kind of employee/employer relationship) or with a third-party payer.

An organization may have a relationship with another organization (ownership). A healthcare provider organization may have a relationship with a third-party payer.

Table 1 - Main Archetypes

Archetypes RM Root Attributes

organisation 		ORGANISATION -        Identification - archetypes organisation_name
-        Details: provider_identifie
-        Contacts - archetypes address, electronic_communication
-        Party-relationship
o   ownership
person PERSON -        Identification - archetypes person_name
-        Details: archetypes person birth data, person death data, person_identifier, additional data
-        Contacts - archetypes address, electronic_communication
-        Party-relationship
o   Personal relationships
health_consumer ROLE -        Identification - archetypes person_name
-        Party-relationship
o    person - third-party payer) (details - archetype person_identifier)
o   person -provider (patient) (details - archetype person_identifier)
individual_provider ROLE -        Identification - archetypes person_name
-        capabilities: archetype individual_provider_credentials
-        Contacts - archetypes address, electronic_communication
-        Party-relationship
o    Individual provider - third-party payer) (details - archetype provider_identifier)
o   Individual provider - organisation provider (details - archetype provider_identifier)
third_party_payer ROLE -        Identification - archetypes organisation_name
-        Details: provider_identifier
healthcare_provider_organisation ROLE -        Identification - archetypes organisation_name
-        details: archetype provider_identifier
-        Party-relationship
o    provider - third-party payer) (details - archetype provider_identifier)

 

Auxiliary archetypes

Instead of creating huge archetypes for each main concept, a series of auxiliary archetypes (table 2) was designed as components of the main archetypes. This allows greater flexibility in the evolution of the archetype repository as new archetypes can be designed to accommodate local needs.

For instance, in ISO22220 there is a section relative to other details of the identification of the subject of care. The following archetypes were designed to account for those data:

-       Person birth data-iso

-       Person other birth data-br

-       Person death data-iso

-       Person other death data

-       Person additional data-iso

-       Person additional data-br

In these archetypes the suffix ISO means that the elements in the archetypes correspond to attributes in the technical specification referenced in the body of the archetype. Each iso-suffixed archetype however has an archetype slot in order to allow for archetypes that add attributes to the iso specification in order to meet local needs. For example, the archetype person other birth data-br contains elements that are present in birth certificates in Brazil, but are not in ISO22220. When designing a template, this archetype may fill a slot in person birth data ISO. The same reasoning applies to the pairs person death data-iso/person other death data and person additional data-iso/person additional data-br

The archetypes for ISO addresses were split into three archetypes:

-       Address-iso

-       Address iso-provider

-       High level address other data-br

Address ISO is composed of two clusters: one for Line address and the other is for the high level address. Line address is a composite of one or more standard address components that describe a low level of geographical / physical description of a location that, used in conjunction with the other high-level address components i.e. 'suburb / town / locality name', 'postal code', 'state / territory / province', and 'country', forms a complete geographical / physical address.. Address ISO-provider is a specialization of address ISO to account for additional attributes used in a provider address.

The same reasoning used above is followed here: both line address and high level address have slots that may be filled with archetypes designed to meet local needs. For instance, High level address other data-br contains attributes used in high level addresses in Brazil.

Naming

The archetypes are named according to the concept they represent followed by the prefix ISO when it includes attributes from the ISO specification referenced in the details section. Usually the ISO-suffixed archetypes have slots for other archetypes that may add attributes to the corresponding iso component in order to meet local needs.

Composition x inheritance

Usually composition was used rather that inheritance in the design of the demographic archetypes, except in three cases: address, electronic communications and person name. These archetypes were specialized for the corresponding provider address, electronic communications and name.

The treatment of Dates

Dates are represented with DV_DATE as it should be. When an ISO specification specifies a start and end date, the respective archetype uses a DV_INTERVAL<DV_DATE>.

However in several places ISO specifications use a date accuracy indicator to indicate whether the date is accurate or not and also which date component (year, month or day) is accurate, estimated or unknown, with all combinations allowed. The archetypes do not use a special element to indicate date accuracy because the reference model classes for dates allow date to be expressed as a missing day, missing month and day, or all three components missing, and the precision can be expressed as DV_DURATION.

In order to be fully compatible with ISO an accuracy indicator element could be added, but we preferred to wait for comments from the community whether this should be done.

Local codes x Constraint Binding

Local codes are used whenever the corresponding ISO specification provides a list of fixed codes to be used. When this list is not provided or is just an example, constraint definitions are used. For example, ISO22220 provides several examples of titles to be used with the name of a subject of care. Since this list can vary depending on the locality it is used, the archetype uses a constraint definition. However, no constraint binding was provided for any constraint definition.

The only place where ISO local codes were not used is for expressing a relationship between two persons. We think that list is very restrictive. The openEHR subject relationship group is more comprehensive for instance. In this case we use a constraint definition.

Acknowledgments

We are grateful to Thomas Beale, Heather Leslie, Ian McNicoll, Sebastian Garde and Pablo Pazos Gutierrez for the discussions that led to this version of the demographic archetypes.

References

ISO/TS 22220:2008(E) - Identification of Subject of Care - Technical Specification - International Organization for Standardization

ISO/DTS 27527:2007(E) - Provider Identification - Draft Technical Specification - International Organization for Standardization

Table 2 - Auxiliary archetypes that fills slots in the main archetypes

Archetypes RM Root Attributes
Address_iso ADDRESS ISO22220-27527: line address
-        Building/complex sub unit type
-        sub unit number
-         address site name
-         floor number
-         floor type
-         street number
-        lot number
-        street name
-        street type code
-        street suffix code
-        slot for other address line components

ISO22220-27527: high level address
-        postal code,
-        delivery point identifier
-        suburb/town/locality
-        state/province/territory
-        country
-        address type
o    start date
o    start date accuracy
o    end date
o    end date  accuracy
-        slot for other high level address components

Start and end date accurary indicator is in ISO22220, but was not included in the archetype. See text

address_iso-provider
Specializes:
address_iso 		ADDRESS ISO27527 - adds two attributes:
-        address security : a Boolean that indicates whether this address may be openly displayed.
-        provider identifiers: one or more provider identifiers who may access the address. Only if address security is true.
high_level_address_other_data_br CLUSTER High level address data specific to Brazil

electronic_communication_iso ADDRESS ISO22220-27527
-        Medium: possible values (telephone, mobile, pager, fax, e-mail, url, other)
-        preference code: possible values (business hours, daytime, weekend, at all times, evening/night hours)
-        details - the number, e-mail address, url, etc
-        usage: possible values (business, personal ou both)

electronic_communication_iso-provider
Specializes: electronic_communication_iso 		ADDRESS ISO27527 - adds two attributes:
-        address security : a Boolean that indicates whether this medium may be openly displayed.
-        provider identifiers: one or more provider identifiers who may access the medium. Only if address security is true.

person_identifier_iso CLUSTER ISO22220:
-        designation
-        Geographic area (local, regional, state, national)
-        issuer
-        type of identifier

Slot for other details of an identifier

identifier_other_details CLUSTER Other details of an identifier:
-        time validity
-        City of issuer
-        State of issuer
-        Country of issuer

provider_identifier_iso CLUSTER ISO27527:
-        designation
-        Geographic area (local, regional, state, national)
-        issuer
-        type of identifier
-        Duplicate resolution
o    Not a duplicate of
o    Duplicate of
o    Confirmed by organisation
o    Date confirmed
o    Retired

Slot for other details of an identifier

person_death_data_iso CLUSTER ISO22220:
-        date of death
-        source of notification (registry, health provider, relatives, other, Unknown)

Date of death accurary indicator is in ISO22220, but was not included in the archetype. See text.

archetype slot for /(person_death_data)([a-zA-Z0-9_]+)*\.v1/

person_other_death_data CLUSTER Adds data used in death certificates in Brazil: city, state, country and death certificate number

person_birth_data_iso CLUSTER ISO22220:
-        country
-        date of birth
-        birth plurality
-        birth order
-        date of birth follow up indicator

Date of birth accurary indicator is in ISO22220, but was not included in the archetype. See text.

Archetype slot for /(person_birth_data)[a-zA-Z0-9_]*\.v1/

person_birth_data_br
 CLUSTER Adds data used in birth certificates in Brazil: city of birth, state of birth, etc

person_additional_data_iso CLUSTER ISO 22220:
-        sex (male, female, intersex or indeterminate, not stated/inadequately described
-        mother´s family name
-        comments

person_additional_data_br CLUSTER -        Marital status
-        Ethnic background

Organisation_name_iso PARTY_IDENTITY ISO27527:
-        identifier number
-        type of  name (1-organization unit, section or division name;2-service location name; 3: business name; 4:locally used name; 5: abbreviated name; 6:enterprise name;8:other; 9:unknown),
-         name

person_name_iso PARTY_IDENTITY ISO2220:
-        given name group (given name and sequence number)
-        family name group (family name and sequence number)
-        title group (title and sequence number)
-        suffix group (suffix and sequence number)
-        usage name group
o    name usage - reporting, newborn name, business, name, maiden name, registered name, other name)
o    name usage start and end date
o    usage identifier
-        preferred name (boolean)
-        conditional use (unreliable information, known misspelling, name not to be used, name linkage forbidden by law, special privacy/security requirement, temporary name)
-        alternativee name representation group ( representation usage and alternative representation)

person_name_iso-individual_provider

Specializes

person_name_iso 		PARTY_IDENTITY ISO27527:
-        remove conditional usage
-        add restricted usage name group
o    type of restriction (unreliable information, name not for continued use, special privacy/security requirement)
o     restriction start date
o    restriction end date
o    available provider

biometric_identifier_iso CLUSTER ISO22220:
-        type of biometric: (finger print - rolled; finger print - flat; facial features; voice; Iris; retina; hand geometry; signature dynamics, keystroke dynamics, lip movement; thermal face image; thermal hand image; gait; blood type; DNA; Unknown)
-        biometric data template
-        biometric enrolment quality
-        biometric creating authority
-        location of biometric identifier
-        biometric schema
-        biometric version
-        biometric date of creation

Individual_provider_credentials_iso CLUSTER ISO27527:
-        field of practice
o    (field of practice,
o    start and end date
o    primary field of practice
-        registration details
o    Registration body
o     Status
o    Registration number
o     Start Date
o     End Date
o    Slot for other registration data
-        Qualifications
o    Qualification name
o    Qualification level
o    Issuing institution
o    Issuing institution country
o    Qualification year

Field of practice start date accuracy indicator is in ISO27527, but was not included in the archetype. See text.

registration_other_data CLUSTER State and Country of a provider registering body
       
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