BackgroundThe TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture.MethodsThree approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms.ResultsThe archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it.ConclusionsModeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented.
The upper Pennsylvanian Jackfork Formation is exposed at the 900 m (2750 ft) wide by 60 m (200 ft) high wall of Big Rock Quarry, in North Little Rock, Arkansas. At this location, the formation provides a strike section view of a sand-rich submarine fan, comprising laterally imbricated and crosscutting channels. Geological heterogeneity within the nested submarine fan channel complex was described qualitatively to note architectural characteristics not usually observed in outcrops due to limited scale of exposure. Field reconaissance and photographic studies revealed a variety of channel fill types in the overall exposure, with amalgamated massive sandstone fill as the dominant lithology.
Architectural drawings of the quarry, made from enlarged photographic prints, were digitized and analyzed using a Shell software package with the intent of translating outcrop-based observations into useful parameters for subsurface reservoir models. The analysis revealed that 1) the facies distribution calculated during the statistical analysis compares favorably to the facies distribution in a core taken 15 m (50 ft) behind the face of the outcrop; 2) no discrete, recognizable beds are continuous across the 900 m (2750 ft) strike-oriented exposure; 3) maximum well spacing (along strike) for a dual production well scenario is approximately 1.6 km (1 mi); and 3) maximum well spacing for an injection-production (water-flood) well plan is approximately 300 m (1000 ft).
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