Package | hl7.ehrs.ehrsfmr21 |
Type | Requirements |
Id | Id |
FHIR Version | R5 |
Source | http://hl7.org/ehrs/https://build.fhir.org/ig/mvdzel/ehrsfm-fhir-r5/Requirements-EHRSFMR2.1-RI.1.1.3.1.html |
Url | http://hl7.org/ehrs/Requirements/EHRSFMR2.1-RI.1.1.3.1 |
Version | 2.1.0 |
Status | active |
Date | 2024-11-26T16:30:50+00:00 |
Name | RI_1_1_3_1_Evidence_of_Record_Entry_Translate_Event |
Title | RI.1.1.3.1 Evidence of Record Entry Translate Event (Function) |
Experimental | False |
Realm | uv |
Authority | hl7 |
Description | Maintain Evidence of Record Entry Translate Event |
Purpose | Evidence of Record Entry Translate Event includes key metadata, ensures health record integrity (and trust) and enables record audit. |
No resources found
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Note: links and images are rebased to the (stated) source
Maintain Evidence of Record Entry Translate Event
Evidence of Record Entry Translate Event includes key metadata, ensures health record integrity (and trust) and enables record audit.
RI.1.1.3.1#01 | SHALL |
The system SHALL audit each occurrence when Record Entry content is translated. |
RI.1.1.3.1#02 | SHALL |
The system SHALL capture identity of the organization where Record Entry content is translated. |
RI.1.1.3.1#03 | SHALL |
The system SHALL capture identity of the patient who is subject of translated Record Entry content. |
RI.1.1.3.1#04 | conditional SHALL |
IF a user initiated a Record Entry content translation, THEN the system SHALL capture identity of the user initiating Record Entry content translation. |
RI.1.1.3.1#05 | SHALL |
The system SHALL capture identity of the system application which translated Record Entry content. |
RI.1.1.3.1#06 | SHALL |
The system SHALL capture the type of Record Event trigger (i.e., translation). |
RI.1.1.3.1#07 | SHALL |
The system SHALL capture the date and time Record Entry content is translated. |
RI.1.1.3.1#08 | SHOULD |
The system SHOULD capture identity of the location (i.e., network address) where Record Entry content is translated. |
RI.1.1.3.1#09 | conditional MAY |
IF a user initiated a Record Entry translation, THEN the system MAY capture the rationale for translating Record Entry content. |
RI.1.1.3.1#10 | SHALL |
The system SHALL capture a sequence identifier for translated Record Entry content. |
RI.1.1.3.1#11 | SHALL |
The system SHALL capture the identifier and version of Translation Tools used for each translated Record Entry. |
RI.1.1.3.1#12 | SHALL |
The system SHALL capture a reference (e.g., link, pointer) to pre-translation data for each Record Entry translation. |
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"id" : "EHRSFMR2.1-RI.1.1.3.1",
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"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>Maintain Evidence of Record Entry Translate Event</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>Evidence of Record Entry Translate Event includes key metadata, ensures health record integrity (and trust) and enables record audit.</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.1.1.3.1#01</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 audit each occurrence when Record Entry content is translated.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#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 capture identity of the organization where Record Entry content is translated.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#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 identity of the patient who is subject of translated Record Entry content.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#04</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>SHALL</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF a user initiated a Record Entry content translation, THEN the system SHALL capture identity of the user initiating Record Entry content translation.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#05</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 identity of the system application which translated Record Entry content.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#06</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 the type of Record Event trigger (i.e., translation).</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#07</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 the date and time Record Entry content is translated.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#08</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 capture identity of the location (i.e., network address) where Record Entry content is translated.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#09</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n <i>conditional</i>\n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>IF a user initiated a Record Entry translation, THEN the system MAY capture the rationale for translating Record Entry content.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#10</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 a sequence identifier for translated Record Entry content.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>RI.1.1.3.1#11</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 the identifier and version of Translation Tools used for each translated 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.1.1.3.1#12</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 a reference (e.g., link, pointer) to pre-translation data for each Record Entry translation.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n </table>\n</div>"
},
"url" : "http://hl7.org/ehrs/Requirements/EHRSFMR2.1-RI.1.1.3.1",
"version" : "2.1.0",
"name" : "RI_1_1_3_1_Evidence_of_Record_Entry_Translate_Event",
"title" : "RI.1.1.3.1 Evidence of Record Entry Translate Event (Function)",
"status" : "active",
"date" : "2024-11-26T16:30:50+00:00",
"publisher" : "EHR WG",
"contact" : [
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"telecom" : [
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"system" : "url",
"value" : "http://www.hl7.org/Special/committees/ehr"
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}
],
"description" : "Maintain Evidence of Record Entry Translate Event",
"jurisdiction" : [
{
"coding" : [
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"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001",
"display" : "World"
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],
"purpose" : "Evidence of Record Entry Translate Event includes key metadata, ensures health record integrity (and trust) and enables record audit.",
"statement" : [
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"extension" : [
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"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-01",
"label" : "RI.1.1.3.1#01",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL audit each occurrence when Record Entry content is translated.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-02",
"label" : "RI.1.1.3.1#02",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture identity of the organization where Record Entry content is translated.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-03",
"label" : "RI.1.1.3.1#03",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture identity of the patient who is subject of translated Record Entry content."
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-RI.1.1.3.1-04",
"label" : "RI.1.1.3.1#04",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "IF a user initiated a Record Entry content translation, THEN the system SHALL capture identity of the user initiating Record Entry content translation.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-05",
"label" : "RI.1.1.3.1#05",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture identity of the system application which translated Record Entry content.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
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"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-06",
"label" : "RI.1.1.3.1#06",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture the type of Record Event trigger (i.e., translation)."
},
{
"extension" : [
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"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-07",
"label" : "RI.1.1.3.1#07",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture the date and time Record Entry content is translated.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-08",
"label" : "RI.1.1.3.1#08",
"conformance" : [
"SHOULD"
],
"conditionality" : false,
"requirement" : "The system SHOULD capture identity of the location (i.e., network address) where Record Entry content is translated.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-09",
"label" : "RI.1.1.3.1#09",
"conformance" : [
"MAY"
],
"conditionality" : true,
"requirement" : "IF a user initiated a Record Entry translation, THEN the system MAY capture the rationale for translating Record Entry content.",
"derivedFrom" : "EHR-LM_R1 14.2.2"
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"valueBoolean" : false
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"key" : "EHRSFMR2.1-RI.1.1.3.1-10",
"label" : "RI.1.1.3.1#10",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture a sequence identifier for translated Record Entry content."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
}
],
"key" : "EHRSFMR2.1-RI.1.1.3.1-11",
"label" : "RI.1.1.3.1#11",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture the identifier and version of Translation Tools used for each translated Record Entry."
},
{
"extension" : [
{
"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-RI.1.1.3.1-12",
"label" : "RI.1.1.3.1#12",
"conformance" : [
"SHALL"
],
"conditionality" : false,
"requirement" : "The system SHALL capture a reference (e.g., link, pointer) to pre-translation data for each Record Entry translation."
}
]
}
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