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Table 1 Archetypes for the TISS standard

From: Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

Archetypes

Information contained in the archetype

openEHR-EHR-EVALUATION.

patient_evaluation.v1

ELEMENTs: clinical indication, type of disease, duration of disease, accident indication, main diagnosis, secondary diagnoses, cause of death, death certificate number.

CLUSTER (obstetrics): gestation, abortion, pregnancy-related problems, puerperium complications, neonatal assistance, neonatal complication, low birthweight, cesarean section, normal delivery, maternal death, number of living births (living term births, premature living births, still births, early neonatal deaths, late neonatal deaths).

CLUSTER (planned services)

 

ELEMENTs: type of procedure, procedure, quantity requested, quantity authorized

CLUSTER (orthoses and prostheses): vendor, unit cost.

openEHR-EHR-EVALUATION.

odontologic_evaluation.v1

ELEMENTs: periodontal disease, alterations in soft tissues.

CLUSTER (initial status): tooth, status

openEHR-EHR-ACTION.claim_services.v1

ELEMENTs: type of procedure, procedure, quantity authorized, quantity performed, access, technique, vendor, unit cost, total cost, percent of reduction/addition, deduction, tooth, face.

openEHR-CLUSTER.admission.v1

ELEMENTs: type of admission, probable date of admission, hospital service, admission regime, requested number of days, authorized number of days, type of accommodation, date of admission, discharge date.

openEHR-CLUSTER.total_costs.v1

ELEMENTs: total costs, total rent, total drugs, total materials, total hospital stay, total gases, total other rates, total procedures, total medicinal gases, Total deduction.

openEHR-EHR- ADMIN_ENTRY.professional_claim.v1

ELEMENTs: original submission, submission ID, submission date, validity, billing date, type of claim, type of encounter, date of encounter, discharge reason, further action, status, comments

SLOT for CLUSTER total_costs.

openEHR-EHR- ADMIN_ENTRY.institutional_claim.v1

ELEMENTs: original submission, submission ID, submission date, billing date, type of claim, type of encounter, date of encounter, type of claim, discharge reason, further action, status, comments.

SLOT for CLUSTERs admission and total_costs

openEHR-EHR- ADMIN_ENTRY.

authorization.v1

ELEMENTs: original submission, submission ID, submission date, validity, authorization date, authorization number, type of encounter, date of encounter, status, comments.

SLOT for CLUSTER admission

openEHR-EHR-ADMIN_ENTRY.authorization_request.v1

ELEMENTs: submission ID, submission date, status, type of encounter, date of encounter, comments.

SLOT for CLUSTER admission

openEHR-EHR-COMPOSITION.tiss_claim.v1

Archetype slots that include each of the archetypes above.

  1. These archetypes are based on the openEHR RM.