Business Context > Business Data

Mental Health & Addictions Conceptual Data Model

This model is linked to Ontario’s Electronic Health Record (EHR) Conceptual Information Model 2.0 (CIM 2.0). See: https://ehealthontario.on.ca/files/public/support/Architecture/Ontario_EHR_CIM_2.0.pdf

To support the use of structured data through the adoption of data content and health terminology standards in the solution, this CDM also includes high-level entity relationships and attributes discovered in versions of the FHIR R4.0.1 interoperability standard. The model does not repeat the structure of the messages laid out in FHIR. Links to FHIR specs are included for entity definitions and field code values. In any difference of meaning between cited FHIR elements and this model, FHIR is the authoritative voice. This model relies on the following specifications:

  • FHIR R4.0.1 - The current official version of FHIR as of the time this implementation guide was published

Conceptual Data Model ERDs and Metadata

Entity Relationship Diagrams (ERDs) follow. These include:

  1. a conceptual high-level ERD for solution data structures for the Release 1 solution, including metadata for each entity,
  2. an ERD for the Client & Provider subject area (including metadata for each entity) which is not called out as a FHIR Profile but is included because all other entities in the model are dependent on it,
  3. three other subject area ERDs, one for each of the three Release 1 Mental Health & Addiction profile subject areas, and metadata is included for each attribute

BD-Diagram1

Mental Health & Addictions

BD-Diagram2

Entity Name Description FHIR Resource Name
Health Care Encounter (Appointment) An event occurring at a given time and place, where one or more services or products are provided to assess, maintain or improve the health of the health care client.

Types of encounter include: inpatient, outpatient, emergency, ambulatory, telehealth, community care, long-term care etc.

Could be unplanned (e.g. ER visit) or planned (e.g. doctor’s appointment). A self-care encounter is self-provided, e.g. glucometer reading, treatment of a wound, non-prescription medication.

An encounter may be a step in a larger care process. The status of the care process may be noted by the provider as part of the encounter.

Also includes phone calls and email correspondences between health care clients and health care providers.

Encounter information should be categorized to support functionality to consolidate diverse, high-volume encounter information gathered over an extended period.

May have an encounter-level outcome (as distinct from an Episode of Care Outcome) with information details such as:

  • appointment was kept
  • discharge
  • admission
  • transfer
  • death
  • left without being seen (LWBS)
  • left without treatment (LWOT)
  • elopement (i.e. leaving without notifying the facility or wandering)
  • left against medical advice (AMA)
  • health care client triaged to another clinic
  • recommendation for future care (e.g. book a follow-up)
  • may include time provider was notified of encounter and time he or she arrived.


Encounters can also be for individual health care clients or for groups of health care clients. If it is a group encounter then the EHR should document the fact that it is a group and group characteristics such as name of group, size of group, health care professionals conducting the group should be included.

In this context (i.e. appointment), Encounter represents a booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s). It is realized in this specification as an Appointment.
Appointment
Health Condition A mode or state of being, the state of being fit: the physical status of the body as a whole or of one of its parts usually used to indicate abnormality.

May include a descriptive narrative. Over time a health condition can change in nature or acuity, or split or merge. It includes all diseases and disorders, specifically to denote any illness, injury, disease, or complications from existing health conditions or treatment. A health condition may be contagious, having implications on health care client management. A health condition may be genetically based.

A health condition can also be positive, e.g. pregnancy, wellness. It can be physical, mental or emotional.

For Mental Health & Additions, Health Condition represents a condition the patient suffered in the past.
Condition
Health Care Provider Describes a health care provider involved in the delivery of healthcare services. Encompasses both professional and non-professional members. Has professions, areas of practice for which the provider is qualified. May have information on clinician credentialing and privileging as defined by the applicable professional and governing organizations. This includes remote participation (e.g., via tele-health activities such as tele-consultation, home health monitoring.) Includes any information about licensing status and license suspension. May be an author, authenticator or scribe/transcriber of clinical documentation. Has a Unique Provider Identifier, a key assigned by eHealth to uniquely identify each Provider. May have a health system universal ID. May have a license number or national provider identifier (U.S.). May have multiple unique identifiers. N/A
Health Care Encounter An event occurring at a given time and place, where one or more services or products are provided to assess, maintain or improve the health of the health care client.

Types of encounter include: inpatient, outpatient, emergency, ambulatory, telehealth, community care, long-term care etc.

Could be unplanned (e.g. ER visit) or planned (e.g. doctor’s appointment). A self-care encounter is self-provided, e.g. glucometer reading, treatment of a wound, non-prescription medication.

An encounter may be a step in a larger care process. The status of the care process may be noted by the provider as part of the encounter.

Also includes phone calls and email correspondences between health care clients and health care providers.

Encounter information should be categorized to support functionality to consolidate diverse, high-volume encounter information gathered over an extended period.

May have an encounter-level outcome (as distinct from an Episode of Care Outcome) with information details such as:

  • appointment was kept
  • discharge
  • admission
  • transfer
  • death
  • left without being seen (LWBS)
  • left without treatment (LWOT)
  • elopement (i.e. leaving without notifying the facility or wandering)
  • left against medical advice (AMA)
  • health care client triaged to another clinic
  • recommendation for future care (e.g. book a follow-up)
  • may include time provider was notified of encounter and time he or she arrived.

Encounters can also be for individual health care clients or for groups of health care clients. If it is a group encounter then the EHR should document the fact that it is a group and group characteristics such as name of group, size of group, health care professionals conducting the group should be included.

In this context, the Encounter represents the Health Care Encounter information as captured during the encounter between the Health Care Provider and Health Care Client (e.g. fulfilling the appointment).
Encounter
Provider Episode of Care A series of Health Care Encounters to address one Health Condition by the same Provider Person.

An episode of care starts with the first contact with the provider for the health issue and it ends after the last encounter with the provider for the Health Condition. A hospital stay is represented by a Provider Episode of Care for the Most Responsible Physician. An episode of care for a home care referral may include different provider persons.

An association between a patient and an organization / healthcare provider(s) during which time encounters may occur. The managing organization assumes a level of responsibility for the patient during this time.
Episode of Care
Client Supporter Legal entity (i.e. either an individual or an organization) holding rights and responsibilities for a health care client with respect to health care. A health care client managing his or her own care acts as the health client. Where care of a health care client is legally managed by another person, that person is the health client. Includes power of attorney and substitute decision maker. Includes personal representative, advocate, healthcare proxy, legal representative, financially responsible entity. It includes information about contact method e.g. geographic or virtual address, telephone number. Patient.Contact(Contact element within Patient Resource)
Health Care Service Action performed with the intention of directly or indirectly improving the health of the person or populations for whom it is provided.
Each service may include a range of actions and interactions over time.
Classification of types of health care service:
Primary care:
  • treatment of chronic illness
  • family planning
  • vaccination

Secondary care:
  • specialist care such as psychiatric and therapeutic care
  • acute care
  • hospital emergency care
  • obstetrics
  • intensive care
  • medical imaging

Tertiary care:
  • cancer management
  • surgery
  • treatment for severe burns
  • advanced neonatology
  • palliative care

Examples:
  • provision of a Health Product e.g. a blood transfusion service includes a blood product
  • a Community Care Service such as home care, homemaking, respite services or home palliative care

May include expected turnaround time for service delivery, e.g., the time from when a lab receives a specimen to when test results are available.
Healthcare Service
Health Care Provider Product Location An address or other identifiable locale at which health products have been provided to an individual health care client in a Health Care Encounter, often by a particular provider playing a particular role.

It may also be:

  • temporary (e.g. flu shot clinic in a mall)
  • mobile (e.g., ambulance, mobile lab)
  • in the field (e.g., car, accident site)
  • the health care client’s home
  • virtual (e.g. a tele-health activity such as tele-consultation or home health monitoring)

Locations and contact information may refer to the location of the provider within a health care facility's premises e.g. a hospital unit.

Products and services can be provided by non-licensed providers e.g. caregivers.

In this context, the Health Care Provider Product Location provides details and position information for a physical place where services are provided and resources and participants may be stored, found, contained, or accommodated.
Location
Observation Information derived from performance of a health related activity.

An observation may be clinical i.e. made during an Encounter, or it may be made during a laboratory test. These are distinct types of observations.

Observations often involve measurement or other elaborate methods of investigation, but may also be simply assertive statements, findings, symptoms, conclusions, etc. e.g. triage disposition or acuity or severity of a condition.

An Observation may be a self-observation made by a health care client, e.g. blood pressure, photograph, pulse. These may be annotated by an authorized health care provider.

May be broken down into several types:

  • vital signs (e.g., blood pressure, temperature, heart rate and respiratory rate)
  • other clinical measures (e.g. peak expiratory flow rate, size of lesions, oxygen saturation, height, weight, length, bone density, bone age, cardiac rhythm)
  • additional values (e.g., Body Mass Index based on height and weight)
  • mood, behavioural and daily functioning


An alternate classification based on the nature of an observation:

  • Coded Observation (blood type, mole shape, family support etc.)
  • Measured Observation (height, blood pressure, weight etc.)
  • Clinical Document (includes Diagnostic Image (e.g. x-ray; x-ray report etc.), Laboratory Data and any other relevant Clinical Document (e.g. discharge summary, consult note etc.)


May include annotations. May be preliminary or final. May be from any care setting e.g. hospital, lab, EMS. May be measurement from an ancillary system or external device. Information may be from telemetry i.e. a real-time or near-real-time feed. May be provided by non-medical devices (e.g., digital camera or sound recorder). May be a recorded audio narrative e.g. from EMS.

May include the following attributes, if applicable:

  • measurement timestamp, recording timestamp
  • observation class e.g., lab result, diagnostic imaging study, assessment result. Clinically logical classifications may include Pathology, Chemistry, Cytology, etc.
  • standardized test name
  • standardized unit of measure
  • contextual information (e.g. methods used for the vital signs measurements, position of health care client, etc.)
  • normal and abnormal results, e.g. errors, interruptions, exceptions, reactions, complications.
  • pain scale


For example, Diagnostic Image (an observation in the form of a spatial representation of a physical subject suitable for visual presentation (from HL7 v3)); e.g. photograph, scan, or other type of images (e.g. radiographs, pictures, video/audio, waveforms). May include other forms of results (e.g., wave files of EKG tracings or psychological assessment results).

Other information about Observation:
  • date/time of collection
  • laboratory panel name
  • pre-defined testing conditions
  • specimen identifier
  • reference range limits
  • laboratory identifier
  • clinical significance


In this context, this entity documents various types of observations related to mental health.
Observation (Mental Health)
Observation Information derived from performance of a health related activity.

An observation may be clinical i.e. made during an Encounter, or it may be made during a laboratory test. These are distinct types of observations.

Observations often involve measurement or other elaborate methods of investigation, but may also be simply assertive statements, findings, symptoms, conclusions, etc. e.g. triage disposition or acuity or severity of a condition.

An Observation may be a self-observation made by a health care client, e.g. blood pressure, photograph, pulse. These may be annotated by an authorized health care provider.

May be broken down into several types:

  • vital signs (e.g., blood pressure, temperature, heart rate and respiratory rate)
  • other clinical measures (e.g. peak expiratory flow rate, size of lesions, oxygen saturation, height, weight, length, bone density, bone age, cardiac rhythm)
  • additional values (e.g., Body Mass Index based on height and weight)
  • mood, behavioural and daily functioning


An alternate classification based on the nature of an observation:

  • Coded Observation (blood type, mole shape, family support etc.)
  • Measured Observation (height, blood pressure, weight etc.)
  • Clinical Document (includes Diagnostic Image (e.g. x-ray; x-ray report etc.), Laboratory Data and any other relevant Clinical Document (e.g. discharge summary, consult note etc.)


May include annotations. May be preliminary or final. May be from any care setting e.g. hospital, lab, EMS. May be measurement from an ancillary system or external device. Information may be from telemetry i.e. a real-time or near-real-time feed. May be provided by non-medical devices (e.g., digital camera or sound recorder). May be a recorded audio narrative e.g. from EMS.

May include the following attributes, if applicable:

  • measurement timestamp, recording timestamp
  • observation class e.g., lab result, diagnostic imaging study, assessment result. Clinically logical classifications may include Pathology, Chemistry, Cytology, etc.
  • standardized test name
  • standardized unit of measure
  • contextual information (e.g. methods used for the vital signs measurements, position of health care client, etc.)
  • normal and abnormal results, e.g. errors, interruptions, exceptions, reactions, complications.
  • pain scale


For example, Diagnostic Image (an observation in the form of a spatial representation of a physical subject suitable for visual presentation (from HL7 v3)); e.g. photograph, scan, or other type of images (e.g. radiographs, pictures, video/audio, waveforms). May include other forms of results (e.g., wave files of EKG tracings or psychological assessment results).

Other information about Observation:

  • date/time of collection
  • laboratory panel name
  • pre-defined testing conditions
  • specimen identifier
  • reference range limits
  • laboratory identifier
  • clinical significance


Documents various types of observations related to social determinants of health.
Observations (SDOH):

Sexual Orientation;

citizenship status;

Employment Status;

Legal Status;

Level of Education;

Number of People Income Supports;

Personal Income Source;

Residence Type;

Total Household income;
Provider Organization An organization that provides health care or other health-related services or products.

Includes e.g. insurers and transcription services.

May have information on service classification e.g. Regional Cancer Centre.

[For Single Sign on application, a Provider Organization may be a Sponsoring Organization, a Health Care organization that has users that require access to at least one Federated Service. 2015-6-15]

In this context, Provider Organization documents a grouping of people or organizations formed for health care. Includes institutions, departments, community groups, healthcare practice groups, etc.
Organization
Health Care Client An individual participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. (U.S. National Library of Medicine - Medical Subject Headings)

A natural person (i.e. a human being) who:

  • is eligible to receive health care services in Ontario,
    or
  • has received or is receiving health care services in the province of Ontario (i.e. a health care client).


This entity covers personal identifying information but not health information.

It includes information about:

  • identity within the health system e.g. a Health Number; each care setting may have a separate unique ID. E.g. a research study may uniquely identify a health care client as a test subject.
  • administrative gender, e.g. Male, Female, undisclosed
  • adoption: whether or not the health care client was adopted
  • birth and death dates
  • official versus preferred name
  • whether or not the health care client would prefer to receive correspondence


The health care client's identity may be unknown e.g. for a protected person or if the identity of the health care client is unknown. A health care client may be a VIP whose identity must be omitted from reporting. A health care client may be identified by an alias. Health care client-identifying information could include a photograph. May be related genetically or by physical co-location (e.g. residential, occupational, travel, etc.) to another person not necessarily a health care client.

Depending on care setting, a health care client may be referred to as:

  • Patient (currently receiving care)
  • Participant (in a clinical study)
  • Resident (of a long term care facility)
  • Subject (in a public health case)
  • Client (in home care/community care cases/ settings)


In this context, Health Care Client represents the demographics and other administrative information about an individual receiving care or other health-related services.
Patient
Provider Person Describes a health care provider involved in the delivery of healthcare services. Encompasses both professional and non-professional members.

Has professions, areas of practice for which the provider is qualified. May have information on clinician credentialing and privileging as defined by the applicable professional and governing organizations. This includes remote participation (e.g., via tele-health activities such as tele-consultation, home health monitoring.) Includes any information about licensing status and license suspension. May be an author, authenticator or scribe/transcriber of clinical documentation.

Has a Unique Provider Identifier, a key assigned by eHealth to uniquely identify each Provider. May have a health system universal ID. May have a license number or national provider identifier (U.S.). May have multiple unique identifiers.

In this context, the provider person is a part of the health care client’s care team who is directly or indirectly involved in the provisioning of healthcare for the health care client.
Practitioner
Requisition
(Referral)
A request for a Health Product, fulfilled by providers.

A requisition may come with instructions, which may come from the provider, a pharmacist, or a manufacturer.

May have:

  • a life cycle to manage the creation, renewal, modification and discontinuation or cancellation of a requisition.
  • oral verification (i.e a 'read-back') of the complete requisition by the person receiving the telephone or verbal requisition.
  • an association with an order set, a frequently used and institutionally-approved preferred group of requisitions facilitating retrieval and ordering. They allow a care provider to choose common orders for a particular circumstance or disease state according to standards or other criteria such as provider preference.


May include:

  • a status (e.g. captured, verified, filled, or dispensed to health care client; for inpatient: captured, verified, filled, or medication administered).
  • indication of urgency (e.g. ASAP or STAT).
  • recurrence


Documents details about a request for a service or transfer of a patient to the care of another provider or provider organization.
Service Request

Encounter Subject Area

BD-Diagram3

Health Care Encounter (Appointment)
Health Care Encounter
Observation (Mental Health): N/A
Requisition (Service Request)
Health Care Client
Provider Person: N/A
Provider Episode of Care

Observation (SDOH):

Client & Provider Subject Area

BD-Diagram4

Client Supporter(Contact element)
Health Care Client
Health Care Provider Product Location
Provider Person: N/A
Provider Organization

Health Product or Service


BD-Diagram5

Health Care Service

Health Care Profile


BD-Diagram6

Health Condition