Appendix 9 HL7v2 Virtual Medical Record (Normative)

A9.1 Introduction

The HL7v2 Virtual Medical Record (VMR) is a way to implement a structured information atomically in a series of HL7 OBX segments following a template methodology. 

It is based upon the HL7 Publication "HL7 Version 2 Implementation Guide: Implementing the Virtual Medical Record for Clinical Decision Support (vMR-CDS), Release 1 " (you may need an account with HL7 International to download). Refer to that document for a deeper understanding and discussion of the methodology. This appendix will simply provide a prescription for its implementation in a simple way.

The HL7v2 Virtual Medical Record is also defined by the LOINC as "Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS" (74028-2). The panel definition can be viewed at the following URL: https://s.details.loinc.org/LOINC/74028-2.html?sections=Comprehensive

A9.2 Implementing the HL7v2 Virtual Medical Record with OBX segments

A9.2.1 Specifying the HL7v2 VMR is in use.

When using the HL7v2 VMR a header OBX must be present which indicates that a report template is in use. In the header, OBX-3 field must have the value "74028-2^Report template ID^LN", and the template that is in use OBX-5 must, and also specify an OBX-4 sub-ID which must be a dotted decimal value (for simplicity "1" has been specified as the root sub ID). This header OBX must have a OBX-2 Datatype field value of "RP" (See 3.20 RP - Reference Pointer). OBX-5 must be valued as "HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream".

Subsequently all other OBX segments present that form part of the HL7.VMR must have dotted sub id based on this OBX-4 sub-ID this header OBX.

Therefore as an example, the first OBX is static and must be as follows:

OBX|1|RP|74028-2^Report template ID^LN|1|HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream||||||F

A9.2.2 Implementing each element of the HL7v2 VMR

The HL7v2 VMR OBX implementation table below defines the elements of the VMR and provides values that must be used in various OBX fields as indicated by the column headings. 

Each VMR element must be implemented as an OBX, the values of which will be discussed following the table.

When the row in the table has a VMR Datatype column of ENTRY, SECTION, STRUCTURAL, COLLECTION then the prescribed values in the table must be used. 

Technically, OBX for VMR Data SECTION, STRUCTURAL and COLLECTION are optional as the structure is implied by the dotted decimal structured OBX-4 Observation sub-ID. However, including these OBX segments can be useful to viewers of the atomic data but non-essential for computed interpretation of the actual content.

A9.2.2.1 HL7v2 VMR OBX implementation table

Refer to the legend table that follows after this table which explains the colours used. The colours are redundant and are indicative of certain values in the VMR Datatype column.

A9.T.1 HL7v2 VMR OBX implementation table

Legend:

A9.2.2.2 OBX-2 DataType (ID)

Each OBX must have it's OBX-2 value as specified exactly as per the HL7v2 VMR OBX implementation table.

A9.2.2.3 OBX-3 Observation Identifier (CE)

A9.2.3.4 OBX-4 Observation sub-ID (ST)

In the table A9.T.1 OBX-4 subIDs are dotted decimals that start with "1" which is the root OBX-4 subID for all elements of the HL7v2 Virtual Medical Record. The root value "1" has been specified in the above table to aid in simplicity. Theoretically other subID root values could be used instead of "1", but this value must be practical in most cases.

Observations which are not specified by the HL7v2 VMR must not have a OBX-4 subID sharing the same root.

Rows marked VMR DATATYPE column as STRUCTURAL (red rows) must not be written to OBX segments and are present in the table are purely virtual and are to assist with understanding the hierarchy. They must be allocated a dotted subID however, on which all child elements must be prefixed with this subID. 

A9.2.3.4.1 Example of use of Past Illness VMR elements

OBX|6|CE|70949-3^^LN|1.2|11348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT||||||F
OBX|7|CE|11349-8^Past Illness^LN|1.2.1.1.1|50711007^Viral hepatitis C^SCT||||||F
OBX|8|CE|408731000^Temporal Context^SCT|1.2.1.1.2|410584005^Current - specified^SCT||||||F
OBX|9|DR|11368-8^Illness Dates^LN|1.2.1.1.3|20090107||||||F
OBX|10|CE|11349-8^Past Illness^LN|1.2.1.2.1|6142004^Influenza^SCT||||||F
OBX|11|CE|408731000^Temporal Context^SCT|1.2.1.2.2|410587003^Past - specified^SCT||||||F
OBX|12|DR|11368-8^Illness Dates^LN|1.2.1.2.3|20170131^20170318||||||F

A9.2.3.5 OBX-5 Observation value (*)

OBX-5 value domains in table A9.T.1 are suggested and values only, sending systems must use the values that they have available in their systems. If common standard terminologies are available, then those can be supplied as alternative code components of the CE/CWE/CNE if a standard terminology isn't used aren't the primary coding system. Where no codes is available then only the text component must be populated.

A9.3 Value Domain Tables

Table HL7 v3 FamilyMember Value set

Level	Code	Display	Definition
1	(_PersonalRelationshipRoleType) Abstract
2	FAMMEMB	family member	A relationship between two people characterizing their "familial" relationship
3	CHILD	child	The player of the role is a child of the scoping entity.
4	CHLDADOPT	adopted child	The player of the role is a child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
5	DAUADOPT	adopted daughter	The player of the role is a female child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
5	SONADOPT	adopted son	The player of the role is a male child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
4	CHLDFOST	foster child	The player of the role is a child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
5	DAUFOST	foster daughter	The player of the role is a female child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
5	SONFOST	foster son	The player of the role is a male child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
4	DAUC	daughter	Description: The player of the role is a female child (of any type) of scoping entity (parent)
5	DAUADOPT
5	DAUFOST
5	DAU	natural daughter	The player of the role is a female offspring of the scoping entity (parent).
5	STPDAU	stepdaughter	The player of the role is a daughter of the scoping person's spouse by a previous union.
4	NCHILD	natural child	The player of the role is an offspring of the scoping entity as determined by birth.
5	DAU
5	SON	natural son	The player of the role is a male offspring of the scoping entity (parent).
4	SONC	son	Description: The player of the role is a male child (of any type) of scoping entity (parent)
5	SONADOPT
5	SONFOST
5	SON
5	STPSON	stepson	The player of the role is a son of the scoping person's spouse by a previous union.
4	STPCHLD	step child	The player of the role is a child of the scoping person's spouse by a previous union.
5	STPDAU
5	STPSON
3	EXT	extended family member	Description: A family member not having an immediate genetic or legal relationship e.g. Aunt, cousin, great grandparent, grandchild, grandparent, niece, nephew or uncle.
4	AUNT	aunt	The player of the role is a sister of the scoping person's mother or father.
5	MAUNT	maternal aunt	Description:The player of the role is a biological sister of the scoping person's biological mother.
5	PAUNT	paternal aunt	Description:The player of the role is a biological sister of the scoping person's biological father.
4	COUSN	cousin	The player of the role is a relative of the scoping person descended from a common ancestor, such as a grandparent, by two or more steps in a diverging line.
5	MCOUSN	maternal cousin	Description:The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's mother's side, such as a grandparent, by two or more steps in a diverging line.
5	PCOUSN	paternal cousin	Description:The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's father's side, such as a grandparent, by two or more steps in a diverging line.
4	GGRPRN	great grandparent	The player of the role is a parent of the scoping person's grandparent.
5	GGRFTH	great grandfather	The player of the role is the father of the scoping person's grandparent.
6	MGGRFTH	maternal great-grandfather	Description:The player of the role is the biological father of the scoping person's biological mother's parent.
6	PGGRFTH	paternal great-grandfather	Description:The player of the role is the biological father of the scoping person's biological father's parent.
5	GGRMTH	great grandmother	The player of the role is the mother of the scoping person's grandparent.
6	MGGRMTH	maternal great-grandmother	Description:The player of the role is the biological mother of the scoping person's biological mother's parent.
6	PGGRMTH	paternal great-grandmother	Description:The player of the role is the biological mother of the scoping person's biological father's parent.
5	MGGRPRN	maternal great-grandparent	Description:The player of the role is a biological parent of the scoping person's biological mother's parent.
6	MGGRFTH
6	MGGRMTH
5	PGGRPRN	paternal great-grandparent	Description:The player of the role is a biological parent of the scoping person's biological father's parent.
6	PGGRFTH
6	PGGRMTH
4	GRNDCHILD	grandchild	The player of the role is a child of the scoping person's son or daughter.
5	GRNDDAU	granddaughter	The player of the role is a daughter of the scoping person's son or daughter.
5	GRNDSON	grandson	The player of the role is a son of the scoping person's son or daughter.
4	GRPRN	grandparent	The player of the role is a parent of the scoping person's mother or father.
5	GRFTH	grandfather	The player of the role is the father of the scoping person's mother or father.
6	MGRFTH	maternal grandfather	Description:The player of the role is the biological father of the scoping person's biological mother.
6	PGRFTH	paternal grandfather	Description:The player of the role is the biological father of the scoping person's biological father.
5	GRMTH	grandmother	The player of the role is the mother of the scoping person's mother or father.
6	MGRMTH	maternal grandmother	Description:The player of the role is the biological mother of the scoping person's biological mother.
6	PGRMTH	paternal grandmother	Description:The player of the role is the biological mother of the scoping person's biological father.
5	MGRPRN	maternal grandparent	Description:The player of the role is the biological parent of the scoping person's biological mother.
6	MGRFTH
6	MGRMTH
5	PGRPRN	paternal grandparent	Description:The player of the role is the biological parent of the scoping person's biological father.
6	PGRFTH
6	PGRMTH
4	INLAW	inlaw	A relationship between an individual and a member of their spousal partner's immediate family.
5	CHLDINLAW	child-in-law	The player of the role is the spouse of scoping person's child.
6	DAUINLAW	daughter in-law	The player of the role is the wife of scoping person's son.
6	SONINLAW	son in-law	The player of the role is the husband of scoping person's daughter.
5	PRNINLAW	parent in-law	The player of the role is the parent of scoping person's husband or wife.
6	FTHINLAW	father-in-law	The player of the role is the father of the scoping person's husband or wife.
6	MTHINLAW	mother-in-law	The player of the role is the mother of the scoping person's husband or wife.
5	SIBINLAW	sibling in-law	The player of the role is: (1) a sibling of the scoping person's spouse, or (2) the spouse of the scoping person's sibling, or (3) the spouse of a sibling of the scoping person's spouse.
6	BROINLAW	brother-in-law	The player of the role is: (1) a brother of the scoping person's spouse, or (2) the husband of the scoping person's sister, or (3) the husband of a sister of the scoping person's spouse.
6	SISINLAW	sister-in-law	The player of the role is: (1) a sister of the scoping person's spouse, or (2) the wife of the scoping person's brother, or (3) the wife of a brother of the scoping person's spouse.
4	NIENEPH	niece/nephew	The player of the role is a child of scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
5	NEPHEW	nephew	The player of the role is a son of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
5	NIECE	niece	The player of the role is a daughter of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
4	UNCLE	uncle	The player of the role is a brother of the scoping person's mother or father.
5	MUNCLE	maternal uncle	Description:The player of the role is a biological brother of the scoping person's biological mother.
5	PUNCLE	paternal uncle	Description:The player of the role is a biological brother of the scoping person's biological father.
3	PRN	parent	The player of the role is one who begets, gives birth to, or nurtures and raises the scoping entity (child).
4	ADOPTP	adoptive parent	The player of the role (parent) has taken the scoper (child) into their family through legal means and raises them as his or her own child.
5	ADOPTF	adoptive father	The player of the role (father) is a male who has taken the scoper (child) into their family through legal means and raises them as his own child.
5	ADOPTM	adoptive mother	The player of the role (father) is a female who has taken the scoper (child) into their family through legal means and raises them as her own child.
4	FTH	father	The player of the role is a male who begets or raises or nurtures the scoping entity (child).
5	ADOPTF
5	FTHFOST	foster father	The player of the role (parent) who is a male state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	NFTH	natural father	The player of the role is a male who begets the scoping entity (child).
6	NFTHF	natural father of fetus	Indicates the biologic male parent of a fetus.
5	STPFTH	stepfather	The player of the role is the husband of scoping person's mother and not the scoping person's natural father.
4	MTH	mother	The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child).
5	ADOPTM
5	GESTM	gestational mother	The player is a female whose womb carries the fetus of the scoper. Generally used when the gestational mother and natural mother are not the same.
5	MTHFOST	foster mother	The player of the role (parent) who is a female state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	NMTH	natural mother	The player of the role is a female who conceives or gives birth to the scoping entity (child).
6	NMTHF	natural mother of fetus	The player is the biologic female parent of the scoping fetus.
5	STPMTH	stepmother	The player of the role is the wife of scoping person's father and not the scoping person's natural mother.
4	NPRN	natural parent
5	NFTH
5	NMTH
4	PRNFOST	foster parent	The player of the role (parent) who is a state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	FTHFOST
5	MTHFOST
4	STPPRN	step parent	The player of the role is the spouse of the scoping person's parent and not the scoping person's natural parent.
5	STPFTH
5	STPMTH
3	SIB	sibling	The player of the role shares one or both parents in common with the scoping entity.
4	BRO	brother	The player of the role is a male sharing one or both parents in common with the scoping entity.
5	HBRO	half-brother	The player of the role is a male related to the scoping entity by sharing only one biological parent.
5	NBRO	natural brother	The player of the role is a male having the same biological parents as the scoping entity.
6	TWINBRO	twin brother	The scoper was carried in the same womb as the male player and shares common biological parents.
7	FTWINBRO	fraternal twin brother	The scoper was carried in the same womb as the male player and shares common biological parents but is the product of a distinct egg/sperm pair.
7	ITWINBRO	identical twin brother	The male scoper is an offspring of the same egg-sperm pair as the male player.
5	STPBRO	stepbrother	The player of the role is a son of the scoping person's stepparent.
4	HSIB	half-sibling	The player of the role is related to the scoping entity by sharing only one biological parent.
5	HBRO
5	HSIS	half-sister	The player of the role is a female related to the scoping entity by sharing only one biological parent.
4	NSIB	natural sibling	The player of the role has both biological parents in common with the scoping entity.
5	NBRO
5	NSIS	natural sister	The player of the role is a female having the same biological parents as the scoping entity.
6	TWINSIS	twin sister	The scoper was carried in the same womb as the female player and shares common biological parents.
7	FTWINSIS	fraternal twin sister	The scoper was carried in the same womb as the female player and shares common biological parents but is the product of a distinct egg/sperm pair.
7	ITWINSIS	identical twin sister	The female scoper is an offspring of the same egg-sperm pair as the female player.
5	TWIN	twin	The scoper and player were carried in the same womb and shared common biological parents.
6	TWINBRO
6	TWINSIS
6	FTWIN	fraternal twin	The scoper and player were carried in the same womb and share common biological parents but are the product of distinct egg/sperm pairs.
7	FTWINBRO
7	FTWINSIS
6	ITWIN	identical twin	The scoper and player are offspring of the same egg-sperm pair.
7	ITWINBRO
7	ITWINSIS
4	SIS	sister	The player of the role is a female sharing one or both parents in common with the scoping entity.
5	HSIS
5	NSIS
5	STPSIS	stepsister	The player of the role is a daughter of the scoping person's stepparent.
4	STPSIB	step sibling	The player of the role is a child of the scoping person's stepparent.
5	STPBRO
5	STPSIS
3	SIGOTHR	significant other	A person who is important to one's well being; especially a spouse or one in a similar relationship. (The player is the one who is important)
4	DOMPART	domestic partner	The player of the role cohabits with the scoping person but is not the scoping person's spouse.
4	FMRSPS	former spouse	Player of the role was previously joined to the scoping person in marriage and this marriage is now dissolved and inactive. Usage Note: This is significant to indicate as some jurisdictions have different legal requirements for former spouse to access the patient's record, from a general friend.
4	SPS	spouse	The player of the role is a marriage partner of the scoping person.
5	HUSB	husband	The player of the role is a man joined to a woman (scoping person) in marriage.
5	WIFE	wife	The player of the role is a woman joined to a man (scoping person) in marriage.