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Section 1e: Version 3 (V3)
Section 2: Clinical and Administrative Domains
Section 4: Rules and References

HL7 Version 3 Standard: Order Set Publication, Release 1

DESCRIPTION

Order sets can organize and structure complex health care plans into useful units of work for clinicians. An order within an order set can request any clinical activity including referrals (requests for encounters), acts, supplies, procedures and observations among others. Within the model presented herein, structured observations (observation events) and goal setting can also be supported as elements within the order set. The sharing of care protocols and regimes authored as phased order sets has a much broader audience for work on error reduction, standardization of care and quality improvement. Order sets in this context can be envisioned as action elements within a care plan, allowing a clinician to organize and request a step in a larger protocol. Definition of the structure and function of orders and order sets for integration into the the electronic medical record of a vendor compliant with the order set standard is a central issue in development of interoperable functionality necessary to shared guidelines. The application program interface to this medical record is assumed to be compliant with the HL7 clinical statements model consistent throughout HL7 guideline model developments.

This document proposes a multi-layered standard that supports the publication and maintenance of order set libraries, the sharing of order sets between collaborating institutions and entities, the structuring of order sets to support effective presentation and clinical use, and the importing and interoperation of order sets within advanced clinical guideline and care planning software. The proposal assumes that organizations employing this standard may deploy the depth of specification appropriate to their enterprise needs and the availability of vendor decision support software.

ALTERNATIVE NAMES

HL7 Version 3 Standard: Order Set Publication, Release 1 may also go by the following names or acronyms:

"V3 Order Set Publication, R1",Order Sets

TARGETS

  • Health Care IT Vendors
  • EHR, PHR Vendors
  • Clinical Decision Support Systems Vendors
  • Knowledge publishers
  • Emergency Services Providers
  • Healthcare Institutions (hospitals, long term care, home care, mental health)

BENEFITS

  • Enables knowledge publishers to produce order set content in a standard fashion.
  • Enables standard order set content produced by knowledge publishers to be imported into CPOE systems.
  • Enables provider organizations to share locally developed order sets with each other

IMPLEMENTATIONS/CASE STUDIES

  • Wolters Kluwer Health
  • University of Utah

RELATED DOCUMENTS

HL7 Version 3 Standard: Order Set Publication, Release 1

TOPICS

  • Care Provision
  • Decision Support
  • Patient Care

BALLOT TYPE

  • DSTU

STATUS DATE

2013-10-31

RESPONSIBLE WORK GROUP

Clinical Decision Support

STAKEHOLDERS

  • Clinical Decision Support Systems Vendors
  • EHR, PHR Vendors
  • Emergency Services Providers
  • Health Care IT Vendors
  • Healthcare Institutions

FAMILY

  • V3

CURRENT STATE

  • Stable

REALM

  • Universal