Does the RIM Really Protect HL7 from the Proliferation of ‘Local Segments’?

From the HL7 Terminfo forum we read the following (posted by Rik Smithies) about the extension to the RIM created by the Connecting for Health initiative in the UK:

Statement Relationships are a UK/CFH invention I believe, that hasn’t gained wide acceptance elsewhere, perhaps because there hasn’ been a strong push, perhaps because our requirements are different, and perhaps because there are other ways to achieve the same thing.

Background :
A Statement Relationship is an Act that works as an Act Relationship. It’s an Act plus a pair of Act Relationships to Act References, that all stands in for a single Act Relationship.

Since it is an Act in its own right and uses ActRefs, it’s doesn’t have to be ‘in-line’ in the XML, and so can be sent separately ie. in a different message. They can have authors that are different from the Acts they relate together and can be updated or removed like any Act.

They have been used for :

1. ‘after the fact’ assertions of links/relationships
a) to allow not having to resend the acts that are being linked
b) to allow breaking the link between two acts (remove the linking act, remove the relationship)
c) to allow a different author from either act to assert the link

2. Allowing coded vocabs of relationship types, rather than using the small group of ActRelationshipTypes

I don’t fully understand how other solutions to 1a) and 1b) work, but I have heard that it is covered by controlActs, possibly in conjunction with updateMode.

A driver for 1a) was to avoid sending the Acts that are being referenced, firstly for message size reasons (though in fact Statement Relationships are physically large). Secondly and more importantly to avoid sending other people’s Acts, so as not to appear to be authoring them, and to avoid re-stating them out of context, without their associated statements, participations etc. I’m prepared to believe there are more elegant solutions to those problems.

1a and 1b are particularly helpful for larger structures that are prone to needing re-organisation, eg problem lists. You may want to move Acts from one list to another, without changing (or ideally restating) any of the Acts themselves. This is common in UK General Practice.

I have heard it stated that 1c) isn’t a requirement that many people need, so perhaps the use case just hasn’t been recognised yet.

2) is the case the Ed mentions. If there is no act relationship type of ‘probable cause’ then you can make a SNOMED code of that and use a statement relationship. My worry is that this is a very CFH specific mechanism. But maybe this is a case that an only be covered with such a construct, and if so it needs exploring further.

I am not troubled by the extension of the RIM. Indeed, as will be already clear, I believe that the RIM is urgently in need of a number of major extensions (for example in order to eliminate its current identification of a disease with its own observation). But I am still puzzled by the idea of a ‘Statement Relationship’ as ‘an Act that works as an Act Relationship’.