ISO/HL7 10781 - Electronic Health Record System Functional Model, Release 2.1
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: RI.1.3.3 Manage Record Entry Succession and Version Control (Function) - TTL Representation

Active as of 2024-11-26

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Requirements ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "EHRSFMR2.1-RI.1.3.3"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "http://hl7.org/ehrs/StructureDefinition/FMFunction"^^xsd:anyURI ;
fhir:link <http://hl7.org/ehrs/StructureDefinition/FMFunction>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <span id=\"description\"><b>Statement <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b> <div><p>Manage successive Record Entry versions over time.</p>\n</div></span>\n\n    \n    <span id=\"purpose\"><b>Description <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Informative Content\" class=\"informative-flag\">I</a>:</b> <div><p>The system must have a mechanism to handle versions and succession of Record Entries (such as a preliminary and final laboratory reports, amended or corrected documents). Versioning and succession management is based on Record Entry content, and/or status change over time.</p>\n<p>A version may be one of:1) A completed and attested Record Entry; 2) A Record Entry completed and attested which has been modified one or more times3) A Record Entry that has been viewed for clinical decision-making purposes by an individual other than the author4) A Record Entry that has been captured in an incomplete state per organization business rules and updated over time (i.e., a preliminary laboratory test). 5) A Record Entry that electively, according to the author, must be preserved in the current state at a given point in time (i.e., History and Physical). Certain types of Record Entries are typically handled in versions, for example:\nlaboratory results (preliminary and final)- Dictated reports- Work ups (over course of days)The prior version of Record Entries should be retained for the legally prescribed timeframe as defined by scope of practice, organizational policy, and jurisdictional law.</p>\n</div></span>\n    \n\n    \n\n    \n    <span id=\"requirements\"><b>Criteria <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b></span>\n    \n    <table id=\"statements\" class=\"grid dict\">\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>RI.1.3.3#01</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHOULD provide the ability to manage Record Entries that become new versions when their state changes (e.g., augmented, amended, corrected, etc.).</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>RI.1.3.3#02</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL provide the ability to update a Record Entry and save it as a new version.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>RI.1.3.3#03</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL capture, maintain and render the date, time and user for the original and each updated version of the Record Entry.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>RI.1.3.3#04</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHALL</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHALL manage the succession of Record Entries in chronological version order.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n    </table>\n</div>"
  ] ; # 
  fhir:url [ fhir:v "http://hl7.org/ehrs/Requirements/EHRSFMR2.1-RI.1.3.3"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "2.1.0"] ; # 
  fhir:name [ fhir:v "RI_1_3_3_Manage_Record_Entry_Succession_and_Version_Control"] ; # 
  fhir:title [ fhir:v "RI.1.3.3 Manage Record Entry Succession and Version Control (Function)"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2024-11-26T16:30:50+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "EHR WG"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/ehr" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Manage successive Record Entry versions over time."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]     ] )
  ] ) ; # 
  fhir:purpose [ fhir:v "The system must have a mechanism to handle versions and succession of Record Entries (such as a preliminary and final laboratory reports, amended or corrected documents). Versioning and succession management is based on Record Entry content, and/or status change over time.\n\nA version may be one of:1) A completed and attested Record Entry; 2) A Record Entry completed and attested which has been modified one or more times3) A Record Entry that has been viewed for clinical decision-making purposes by an individual other than the author4) A Record Entry that has been captured in an incomplete state per organization business rules and updated over time (i.e., a preliminary laboratory test). 5) A Record Entry that electively, according to the author, must be preserved in the current state at a given point in time (i.e., History and Physical). Certain types of Record Entries are typically handled in versions, for example:\n        laboratory results (preliminary and final)- Dictated reports- Work ups (over course of days)The prior version of Record Entries should be retained for the legally prescribed timeframe as defined by scope of practice, organizational policy, and jurisdictional law."] ; # 
  fhir:statement ( [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/ehrs/StructureDefinition/requirements-dependent"^^xsd:anyURI ] ;
fhir:value [ fhir:v "false"^^xsd:boolean ]     ] ) ;
fhir:key [ fhir:v "EHRSFMR2.1-RI.1.3.3-01" ] ;
fhir:label [ fhir:v "RI.1.3.3#01" ] ;
    ( fhir:conformance [ fhir:v "SHOULD" ] ) ;
fhir:conditionality [ fhir:v "false"^^xsd:boolean ] ;
fhir:requirement [ fhir:v "The system SHOULD provide the ability to manage Record Entries that become new versions when their state changes (e.g., augmented, amended, corrected, etc.)." ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/ehrs/StructureDefinition/requirements-dependent"^^xsd:anyURI ] ;
fhir:value [ fhir:v "false"^^xsd:boolean ]     ] ) ;
fhir:key [ fhir:v "EHRSFMR2.1-RI.1.3.3-02" ] ;
fhir:label [ fhir:v "RI.1.3.3#02" ] ;
    ( fhir:conformance [ fhir:v "SHALL" ] ) ;
fhir:conditionality [ fhir:v "false"^^xsd:boolean ] ;
fhir:requirement [ fhir:v "The system SHALL provide the ability to update a Record Entry and save it as a new version." ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/ehrs/StructureDefinition/requirements-dependent"^^xsd:anyURI ] ;
fhir:value [ fhir:v "false"^^xsd:boolean ]     ] ) ;
fhir:key [ fhir:v "EHRSFMR2.1-RI.1.3.3-03" ] ;
fhir:label [ fhir:v "RI.1.3.3#03" ] ;
    ( fhir:conformance [ fhir:v "SHALL" ] ) ;
fhir:conditionality [ fhir:v "false"^^xsd:boolean ] ;
fhir:requirement [ fhir:v "The system SHALL capture, maintain and render the date, time and user for the original and each updated version of the Record Entry." ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/ehrs/StructureDefinition/requirements-dependent"^^xsd:anyURI ] ;
fhir:value [ fhir:v "false"^^xsd:boolean ]     ] ) ;
fhir:key [ fhir:v "EHRSFMR2.1-RI.1.3.3-04" ] ;
fhir:label [ fhir:v "RI.1.3.3#04" ] ;
    ( fhir:conformance [ fhir:v "SHALL" ] ) ;
fhir:conditionality [ fhir:v "false"^^xsd:boolean ] ;
fhir:requirement [ fhir:v "The system SHALL manage the succession of Record Entries in chronological version order." ]
  ] ) . #