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Development of a Provisional Domain Model for the Nursing Process for Use within the Health Level 7 Reference Information Model

Affiliations of the authors: Acquest Research & Development, Koudekerk aan den Rijn, The Netherlands (WTFG); University of Iowa, Iowa City, IA (WTFG); Vanderbilt University, Nashville, TN (JGO); ICN Geneva, Geneva, Switzerland (AC); University of Wisconsin, Milwaukee, WI (AC); Seoul National University, Seoul, Korea (H-AP); University of California, San Francisco, CA (CM); HL7 Modeling and Methodology Technical Committee, Ann Arbor, MI (CM); Oracle Corporation, Redwood Shores, CA (CM);Örebro University, Örebro, Sweden (ME); Federal University of São Paulo, São Paulo, Brazil (HFM); Johns Hopkins University, School of Nursing, Baltimore, MD (HFM); University of Iowa, College of Nursing, Iowa City, IA (HFM).

Correspondence and reprints: William T. F. Goossen, RN, PhD, Acquest Research & Development, Dorpsstraat 50, 2396 HC Koudekerk aan den Rijn, The Netherlands; e-mail: <acquest{at}acquest.nl>.

Received for publication: 01/27/02; accepted for publication: 01/22/04.

Objective: Since 1999, the Nursing Terminology Summits have promoted the development, evaluation, and use of reference terminology for nursing and its integration into comprehensive health care data standards. The use of such standards to represent nursing knowledge, terminology, processes, and information in electronic health records will enhance continuity of care, decision support, and the exchange of comparable patient information. As part of this activity, working groups at the 2001, 2002, and 2003 Summit Conferences examined how to represent nursing information in the Health Level 7 (HL7) Reference Information Model (RIM).

Design: The working groups represented the nursing process as a dynamic sequence of phases, each containing information specific to the activities of the phase. They used Universal Modeling Language (UML) to represent this domain knowledge in models. An Activity Diagram was used to create a dynamic model of the nursing process. After creating a structural model of the information used at each stage of the nursing process, the working groups mapped that information to the HL7 RIM. They used a hierarchical structure for the organization of nursing knowledge as the basis for a hierarchical model for "Findings about the patient." The modeling and mapping reported here were exploratory and preliminary, not exhaustive or definitive. The intent was to evaluate the feasibility of representing some types of nursing information consistently with HL7 standards.

Measurements: The working groups conducted a small-scale validation by testing examples of nursing terminology against the HL7 RIM class "Observation."

Results: It was feasible to map patient information from the proposed models to the RIM class "Observation." Examples illustrate the models and the mapping of nursing terminology to the HL7 RIM.

Conclusion: It is possible to model and map nursing information into the comprehensive health care information model, the HL7 RIM. These models must evolve and undergo further validation by clinicians. The integration of nursing information, terminology, and processes in information models is a first step toward rendering nursing information machine-readable in electronic patient records and messages. An eventual practical result, after much more development, would be to create computable, structured information for nursing documentation.