Hierarchy of Concept in Document Type Axis

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    Loren Stevenson
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    Based on recent discussions in the adoption of the Document Ontology Axis Values, there appears to be a lack of consensus about how Document Types should be organized. I’m afraid that though many of the concepts populating the Document Type axis were proposed by the VA, we have learned in the past couple of years that our initial ideas could stand some refinement. Here is a proposal for organizing the Document Type axis:

    1. Administrative Note

      1. Advance Directive

        1. Do Not Resuscitate

          1. Rescinded Do Not Resuscitate
        2. Living Will
        3. Rescinded Advance Directive
      2. Against Medical Advice Note
      3. Agreement
      4. Certificate
      5. Consent
      6. Contract
      7. Legal
      8. Letter
    2. (Clinical) Note

      1. Adverse Event Note
      2. Alert
      3. Diagram
      4. Flowsheet
      5. Report

    “Clinical note” is represented above with parentheses because “Note” is the actual text that would appear appended to the Service term in the Component field.

    My primary goal in proposing this two-pronged hierarchy is to be able to encapsulate many of the Document Types into either of two main Document Types: the Clincal Note or the Administrative Note. Which is not, of course, to say that there is no overlap between categories, but only that most documentation can more-or-less be aligned one way or the other. One requirement for this reorganization has been that each of the existing Document Types be recapitulated, though I would additionally propose that one or more of the terms could be removed from either the current or this proposed list. Indeed, should a number of Document Types be removed, the hierarchy of terms might be reformulated substantially.

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