Alignment with other standards

• The concepts in ISO 30182 would be a useful consideration in revision of the concept model
• The modelling of roles needs further refinement and consideration of the link between a role and a mandate
• ISO 12381:2019 health informatics — Explicit time-related expressions for healthcare-specific problems includes definitions for useful time related concepts.

Issues with concepts

• demand for care always has the right for the recipient of the demand for care to deny the initial demand for care, request or referral. There are some initiators of healthcare mandates that cannot be denied, for example obligatory healthcare required by law such as when a subject of care is either a risk to others or to themselves. There probably should be a higher healthcare initiating concept with demand for care as a subtype where there is an option of denying care and another new subtype where there is an obligation to provide healthcare.
• The term healthcare is often used where the term care may be more appropriate and permissive.
• There is no definition of care or links to the sub-types healthcare and social care. As things stand, many concepts that are applicable to social care are implicitly excluded from social care through their name, such as healthcare commitment.
• episode of care is modelled as including management by one and only one healthcare provider. A period isn't managed (its the activity within the period). In addition, the limit on identification by one and only one healthcare professional is unduly restrictive.
• May be beneficial to add non-regulated healthcare personnel with a definition that is healthcare personnel that does not have a healthcare professional entitlement. Note: This may be best modelled with a restrictive association to healthcare professional entitlement.

Issues with terms

• Consider renaming health concern to make it clearer in the term that this is a type of extract (record concept) rather than simply a concern

Definition issues

• The association between observed condition is to one or more healthcare actors however a the definition of this concept and its sub-types are to one and only one healthcare actor. Suggested remedy: change the definition to permit one or more healthcare actor (and on the subtype professionally assessed condition)
• Does the model need a period associated with a service such as opening hours
• Does the model need a period associated with an intended absence from a facility where healthcare is provided by the subject of care.
  The English NHS uses the concept of leave

LEAVE occurs when a patient who is using a bed in a hospital WARD or care home, spends a period of time outside the hospital WARD or care home. For some types of LEAVE, the patient is intended to return after a specified period.

• Is a demand for care a type of healthcare activity element
• subject of care proxy - In the UK, an organisation may be a subject of care proxy where appointed by a court however the definition is

healthcare third party having person role with the right to take decisions on behalf of the subject of care

Suggest removing “person” from person role.

Association issues

None documented

Suggested additional notes

• It would be helpful to explain the impact of dissent and to provide examples

Suggested amended or additional examples

• In demand for care the two requests in the examples are more properly referrals
• It would be helpful to provide examples of dissent

Suggested additional synonyms

• In England the clinical process interest is primarily known as a patient pathway. See NHS data Dictionary
• It would be helpful to explain the impact of dissent and to provide examples