5.1 This wipe sampling and indirect analysis test method is used for the general testing of surfaces for asbestos. It is used to assist in the evaluation of surfaces in buildings, such as ceiling tiles, shelving, electrical components, duct work, and so forth. This test method provides an index of the concentration of asbestos structures per unit area sampled as derived from a quantitative measure of the number of asbestos structures detected during analysis.5.1.1 This test method does not describe procedures or techniques required for the evaluation of the safety or habitability of buildings with asbestos-containing materials, or compliance with federal, state, or local regulations or statutes. It is the user's responsibility to make these determinations.5.1.2 At present, a single direct relationship between asbestos sampled from a surface and potential human exposure does not exist. Accordingly, the user should consider these data in relationship to other available information (for example, air sampling data) in their evaluation.5.2 One or more large asbestos-containing particles dispersed during sample preparation may result in large asbestos surface loading results in the TEM analyses of that sample. It is, therefore, recommended that multiple replicate independent samples be secured in the same area, and that a minimum of three such samples be analyzed by the entire procedure.1.1 This test method covers a procedure to identify asbestos in samples wiped from surfaces and to provide an estimate of the concentration of asbestos reported as the number of asbestos structures per unit area of sampled surface. The procedure outlined in this test method employs an indirect sample preparation technique. It is intended to disperse aggregated asbestos into fundamental fibrils, fiber bundles, clusters, or matrices. However, as with all indirect sample preparation techniques, the asbestos observed for quantification may not represent the physical form of the asbestos as sampled. More specifically, the procedure described neither creates nor destroys asbestos, but it may alter the physical form of the mineral fiber aggregates.1.2 This test method describes the equipment and procedures necessary for wipe sampling of surfaces for levels of asbestos structures. The sample is collected onto a particle-free wipe material (wipe) from the surface of a sampling area that may contain asbestos.1.2.1 The collection efficiency of this wipe sampling technique is unknown and will vary among substrates. Properties influencing collection efficiency include surface texture, adhesiveness, and other factors.1.2.2 This test method is generally applicable for an estimate of the surface loading of asbestos structures starting from approximately 1000 asbestos structures per square centimetre.1.3 Asbestos identification by transmission electron microscopy (TEM) is based on morphology, electron diffraction (ED), and energy dispersive X-ray analysis (EDXA).1.4 This test method allows determination of the type(s) of asbestos fibers present.1.4.1 This test method cannot always discriminate between individual fibers of the asbestos and nonasbestos analogues of the same amphibole mineral.1.4.2 There is no lower limit to the dimensions of asbestos fibers that can be detected. However, in practice, the lower limit to the dimensions of asbestos fibers, that can be detected, is variable and dependent on individual microscopists. Therefore, a minimum length of 0.5 μm has been defined as the shortest fiber to be incorporated in the reported results.1.5 The values stated in SI units are to be regarded as standard.1.6 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.1.7 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 Each Facility Rating Scale in this classification (see Figs. 1-24) provides a means to estimate the level of serviceability of a building or facility for one topic of serviceability, and to compare that level against the level of any other building or facility.4.2 This classification can be used for comparing how well different buildings or facilities meet a particular requirement for serviceability. It is applicable despite differences such as location, structure, mechanical systems, age, and building shape.4.3 This classification can be used to estimate the amount of variance of serviceability from target or from requirement, for a single office facility, or within a group of office facilities.4.4 This classification can be used to estimate the following:4.4.1 Serviceability of an existing facility for uses other than its present use.4.4.2 Serviceability (potential) of a facility that has been planned but not yet built.4.4.3 Serviceability (potential) of a facility for which a remodeling has been planned.4.5 Use of this classification does not result in building evaluation or diagnosis. Building evaluation or diagnosis generally requires a special expertise in building engineering or technology, and the use of instruments, tools, or measurements.4.6 This classification applies only to facilities that are building constructions, or parts thereof. (While this classification may be useful in rating the serviceability of facilities that are not building constructions, such facilities are outside the scope of this classification.)1.1 This classification covers matched sets of scales (see Figs. 1-24) for classifying an aspect of the serviceability of an office facility, that is, the capability of an office facility to meet certain possible requirements for structure and building envelope.1.2 Within that aspect of serviceability, each matched set of scales (see Figs. 1-24) is for classifying one topic of serviceability. Each topic is typically broken down into two more demand functions and supply features. Each paragraph in an Occupant Requirement Scale summarizes one level of serviceability on that function, which occupants might require. The matching entry in the Facility Rating Scale is a translation of the requirement into a description of certain features of a facility which, taken in combination, indicate that the facility is likely to meet that level of required serviceability.1.3 The entries in the Facility Rating Scale (see Figs. 1-24) are indicative and not comprehensive. They are for quick scanning, to estimate approximately, quickly, and economically, how well an office facility is likely to meet the needs of one or another type of occupant group, over time. The entries are not for measuring, knowing, or evaluating how an office facility is performing.1.4 This classification can be used to estimate the level of serviceability of an existing facility. It can also be used to estimate the serviceability of a facility that has been planned but not yet built, such as one for which single-line drawings and outline specifications have been prepared.1.5 This classification indicates what would cause a facility to be rated at a certain level of serviceability, but does not state how to conduct a serviceability rating nor how to assign a serviceability score. That information is found in Practice E1679. The scales in Figs. 1-24 are complimentary to and compatible with Practice E1679. Each requires the other.1.6 The scales are intended to identify the levels of various requirements unique to a particular user, and the serviceability (capability) of a building to meet those requirements. The scales thus supplement rather than include code requirements. It remains the responsibility of designers, builders, and building managers to meet applicable code requirements relative to their respective roles in facility design, construction, and ongoing management.1.7 The values stated in inch-pound units are to be regarded as standard. The values given in parentheses are mathematical conversions to SI units that are provided for information only and are not considered standard.

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5.1 This microvacuum sampling and indirect analysis method is used for the general testing of non-airborne dust samples for asbestos. It is used to assist in the evaluation of dust that may be found on surfaces in buildings such as ceiling tiles, shelving, electrical components, duct work, carpet, etc. This test method provides an index of the surface loading of asbestos structures in the dust per unit area analyzed as derived from a quantitative TEM analysis.5.1.1 This test method does not describe procedures or techniques required to evaluate the safety or habitability of buildings with asbestos-containing materials, or compliance with federal, state, or local regulations or statutes. It is the user’s responsibility to make these determinations.5.1.2 At present, no relationship has been established between asbestos-containing dust as measured by this test method and potential human exposure to airborne asbestos. Accordingly, the users should consider other available information in their interpretation of the data obtained from this test method.5.2 This definition of dust accepts all particles small enough to pass through a 1-mm (No. 18) screen. Thus, a single, large asbestos containing particle(s) (from the large end of the particle size distribution) dispersed during sample preparation may result in anomalously large asbestos surface loading results in the TEM analyses of that sample. It is, therefore, recommended that multiple independent samples are secured from the same area, and that a minimum of three samples be analyzed by the entire procedure.1.1 This test method covers a procedure to (a) identify asbestos in dust and (b) provide an estimate of the surface loading of asbestos in the sampled dust reported as the number of asbestos structures per unit area of sampled surface.1.1.1 If an estimate of the asbestos mass is to be determined, the user is referred to Test Method D5756.1.2 This test method describes the equipment and procedures necessary for sampling, by a microvacuum technique, non-airborne dust for levels of asbestos structures. The non-airborne sample is collected inside a standard filter membrane cassette from the sampling of a surface area for dust which may contain asbestos.1.2.1 This procedure uses a microvacuuming sampling technique. The collection efficiency of this technique is unknown and will vary among substrates. Properties influencing collection efficiency include surface texture, adhesiveness, electrostatic properties and other factors.1.3 Asbestos identified by transmission electron microscopy (TEM) is based on morphology, selected area electron diffraction (SAED), and energy dispersive X-ray analysis (EDXA). Some information about structure size is also determined.1.4 This test method is generally applicable for an estimate of the surface loading of asbestos structures starting from approximately 1000 asbestos structures per square centimetre.1.4.1 The procedure outlined in this test method employs an indirect sample preparation technique. It is intended to disperse aggregated asbestos into fundamental fibrils, fiber bundles, clusters, or matrices that can be more accurately quantified by transmission electron microscopy. However, as with all indirect sample preparation techniques, the asbestos observed for quantification may not represent the physical form of the asbestos as sampled. More specifically, the procedure described neither creates nor destroys asbestos, but it may alter the physical form of the mineral fibers.1.5 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only.1.6 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

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5.1 In addition to its cost management and project management functions, the ECES can also be used to support a number of other program and project functions. These functions include:5.1.1 Bid solicitation, collection, and evaluation;5.1.2 Communicating project data between installations, complexes, agencies, and industry;5.1.3 Providing a project checklist;5.1.4 Cost and schedule estimating;5.1.5 Historical cost/schedule data collection;5.1.6 Historical project data collection (for example, technology deployments, project conditions);5.1.7 Validating and calibrating cost estimates and software tools; and5.1.8 Establishing and disseminating best practices and lessons learned.5.2 Several government agencies are already incorporating this structure into existing and future cost estimating models, databases, and other similar software tools and systems.1.1 The Environmental Cost Element Structure (ECES) covered by Classification E2150 (and Adjunct E2150) provides a consistent and comprehensive structure across all phases of environmental remediation projects and is a tool to improve the cost management of those projects. This guide is intended to facilitate the application of the ECES to any environmental remediation project, without regard to project size.1.2 Classification E2150 establishes the broad, top-level framework for environmental remediation projects by providing a hierarchical list of project elements to two levels of detail. Its associated Adjunct E2150 supports the top-level structure by providing more detailed elements and definitions of the ECES to three additional levels of detail. Although it is assumed that the user is familiar with Classification E2150, much of the content of the classification is repeated in this guide to relieve the user of the burden of back-and-forth referencing during use. It is assumed, however, that all users of this guide will have at hand both Classification E2150 and the Adjunct E2150 during project planning.1.3 The values stated in SI units are to be regarded as standard. No other units of measurement are included in this standard.1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 To achieve success in ship construction, it is necessary for the ship owner and the ship builder to agree on the level of quality in the final product. Classification rules, regulatory requirements, and ship specifications all help to define an acceptable level of construction quality; however, this guidance alone is not sufficient. It is up to the shipbuilder, therefore, to describe the level of workmanship sufficiently that will be reflected in the delivered ship, and for the ship owner to communicate their expectations effectively for the final product.4.2 It is the intent of this document to contribute to these objectives in the following ways:4.2.1 To describe a reasonable acceptable level of workmanship for commercial vessels built in the United States.4.2.2 To provide a baseline from which individual shipyards can begin to develop their own product and process standards in accordance with generally accepted practice in the commercial marine industry.4.2.3 To provide a foundation for negotiations between the shipbuilder and the ship owner in reaching a common expectation of construction quality.4.3 The acceptance criteria herein are based on currently practiced levels of quality generally achieved by leading international commercial shipbuilders. These criteria are not intended to be a hard standard with which all U.S. shipyards must comply. Rather, they are intended to provide guidance and recommendations in the key areas that play a major role in customer satisfaction and cost-effective ship construction.1.1 This practice consists of three annexes: hull structure, outfitting, and coating. The subject of these annexes was selected for several reasons. Other commercial shipbuilding nations already have in place widely recognized standards of expectations in these areas. These constitute the most significant areas where workmanship is a critical factor in customer satisfaction. The cost associated with the labor involved in these three areas is a significant factor in construction man-hours and overall schedules.1.2 The standard criteria provided in this practice are intended to apply to conventional, commercial ship construction. In many cases, specialized, nonconventional vessels using nonstandard materials or built-to-serve sole requirements may require unique acceptance criteria that are beyond those provided in this practice.1.3 The values stated in SI units are to be regarded as standard. No other units of measurement are included in this standard.1.4 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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3.1 Intended Use—Compliance with this guide will allow the sharing of electronic data between contracting parties that is normally done by hard copy. This can only be used when both parties use a database-derived software package to manage their contracts. Specifically, it will:3.1.1 Eliminate the duplication of manual entry of data into each party’s contract administration software package and3.1.2 Allow for wide access of the data to all authorized parties.1.1 This guide provides the database structure of electronic data interchange (EDI) information between ship owner and a shipyard for contract administration. Ship owners (hereinafter referred to as owners) and shipyards may each have unique software programs to manage their respective portions of a ship repair period. There is information that must be exchanged between the parties during the contract period. This guide has been developed to establish common field lengths, names, and types such that the exchanged information can be used directly by the respective software programs without scanning, typing, or redundant keying of information.1.2 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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5.1 Membrane switches or printed electronic devices are tested for function and aesthetically inspected by the manufacturer before release to the end user. The user can unknowingly damage the device beyond repair prior to, or during, the application (laminating) process.5.2 Awareness and proper techniques are essential to the end user and this guide should be noted on all drawings, quality control documentation, and assembly instructions. Proper training and practice must be provided to work area supervisors and their staff.5.3 Concerning materials choice, consistency, and design in use, it is important to know what to look for and how to design for durability and to test for or prevent potential failures, or both.5.4 Component failure due to handling damage is one of the most common causes of customer complaints. It is the end user’s responsibility to ensure that the product is not damaged during installation5.5 In the event of component failures a comparison of pre- and post-assembly test performance may help determine the cause of failure. Even if an acceptable change is noted, it may be the result of the unit being over stressed and the application process should be reviewed and changed if necessary. It is important to determine if the change or failure is one that should have withstood the application process, or whether the application process is causing undue stress. Bend, Crease, and Mandrel Testing in accordance with Test Methods F2749, F2750, and F3147 may be necessary to determine the root cause and location of failure.1.1 This guide covers proper handling and application of a flexible circuit membrane switch, or printed electronic assembly to its final support structure to avoid mechanical or electrical failure.1.2 Damage of internal tactile devices or surface mount device (SMD) components can occur with excessive flexing or bending during lamination, repositioning, from uneven support surface, air entrapment, or pressing keys when unsupported.1.3 Design considerations and material selection can impact the membrane switch or the printed electronic device’s ability to endure the mechanical stress that can occur in handling, application and use. These should be considered as early as possible in the design phase.1.4 Recent advancements in printed electronic polymer materials have shown increased reliability from flexing and creasing, replacing copper flex circuits in many cases.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 This classification identifies and hierarchically arranges the work elements, activities, and tasks required for environmental projects. This classification increases the level of communication and allows for more effective exchange of cost and performance data between environmental projects.4.2 This classification defines environmental work elements as major components of environmental projects. It is the common thread linking activities and participants in an environmental project from initial planning through operations and maintenance, D&D, and SLTM.4.3 The users of ECES include program and project managers, cost estimators, and cost analysts in both the public and private sector.4.4 This classification uses an increased level of standardization, uniformity, and consistency that provides a common basis for comparing, analyzing, and calibrating cost data. This classification can also be used as a checklist of project activities to be completed.4.5 Use this classification when:4.5.1 Developing a company-specific Code of Accounts (COAs) for capturing and reporting cost early in the project development for more effective project controls and management. COA is a logical breakdown of a project into controllable elements for the purpose of cost collection, control, and reporting. COA is organized at lower detailed levels that summarize to higher levels and is company or site, or both, and project-specific.4.5.2 Developing a work breakdown structure (WBS) early in the project development for proper management of the project. The WBS provides a framework for managing the cost, schedule, and performance objectives of a project. This framework allows the project to be separated into logical components and makes the relationship of the components clear. The WBS defines the project in terms of hierarchically related action and product-oriented elements. Each element provides logical summary points for assessing technical accomplishments and for measuring cost and schedule performance.4.5.3 Supporting programs and project functions. Use ECES for bid solicitation, collection, and evaluation; communicating project data between installations or agencies and industry; cost and schedule estimating; historical cost and schedule data collection; historical project data collection for technology deployments and project conditions; validating and calibrating cost estimates and software tools; and establishing and disseminating best practices and lessons learned.4.6 The hierarchical nature of the classification allows for collecting data using more detailed lower level elements or for summarizing data at higher levels.4.7 ECES, as described in this classification, is being included in the Remedial Action Cost Estimating Requirement (RACER)6 system and the Environmental Cost Analysis System (ECAS).7 RACER is used for estimating cost and ECAS is used to collect, maintain, and analyze the cost of completed projects. Federal agencies performing environmental work intend to incorporate the ECES.1.1 This standard establishes a classification of the comprehensive hierarchical list of elements for life-cycle environmental work. The classification is based on the Interagency Environmental Cost Element Structure (ECES).2 Elements, as defined here, are major components common to environmental projects.3 The elements represent the life-cycle activities for environmental projects regardless of the project design specification, construction method, technology type, or materials used. The classification serves as a consistent reference for cost estimating, analysis, and monitoring during the various phases of the project life cycle. Using ECES ensures consistency, over time and from project to project, in the cost management and performance measurement of environmental projects. It also enhances reporting at all phases of a project, from assessment and studies through design, construction, operations and maintenance (O&M), and surveillance and long-term monitoring (SLTM).1.2 This classification applies to all environmental work, including environmental restoration, waste management, decontamination and decommissioning (D&D), surveillance and long-term monitoring, and technology development.1.3 The use of this classification increases the level of standardization, uniformity, and consistency of collected environmental project costs. Such uniformity and standardization allows for ease of understanding project costs, provides a common “cost language” for sharing and comparing cost information, and allows for easier analysis and calibration of cost data. This standard classification can be used as a checklist of activities to be completed in environmental projects.1.4 Guide E2637 is intended to facilitate the application of the ECES to any environmental remediation project, without regard to project size.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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This specification covers the design testing of mechanical and electrical characteristics of structure-mounted insulating work platforms for electrical workers in conjunction with personal protective equipment while working on energized circuits. This shall include, but not limited to, insulating gloves with protectors or insulating and insulated hotsticks, or both and a fall protection device that does not compromise the electrical insulating protection of the platform. The platforms shall be subjected to electrical test to determine the leakage current and the ability of the specimen to withstand certain alternating-current potential without flashover between electrodes. Mechanical test shall also be conducted to allow deflection measurement under controlled loading and to determine the ability of the platform to withstand this loading without visible damages such as cracks, delamination, permanent deformation, or discoloration.1.1 This specification covers the design testing of mechanical and electrical characteristics of structure-mounted insulating work platforms used by electrical workers.1.2 Platforms covered by this specification are singleworker platforms not exceeding 9 ft (2.75 m) in length. Platforms designed to support more than one worker at a time are beyond the scope of this specification.1.3 Non-insulating platforms are not within the scope of this specification.1.4 The use and maintenance of this equipment are beyond the scope of this specification.1.5 The values stated in inch-pound units are to be regarded as standard. The values given in parentheses are mathematical conversions to SI units that are provided for information only and are not considered standard.1.6 The following safety hazards caveat pertains only to the test method portion, Section 9 of this specification: This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.1.7 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 This Guide has Four Parts:4.1.1 The first part (Section 5) identifies items of information carried in the traditional paper record organized by the source oriented structures common to paper records. The purpose of this section is to remind users of the spectrum of information that shall be accommodated by the logical structure of a EHR and to present a point of reference for the more abstract description of the patient record that follows.4.1.2 The second part (Section 6) presents a number of operational principles, including such matters as privacy and security that should guide the implementation and operation of EHRs.4.1.3 The third part (Section 7) describes a logical data organization and content (common data model) of an EHR. It is not a blueprint for constructing or implementing a EHR system. The model presents an organization according to the major informational structures and content of the EHR. The focus is on the structure required to store all clinically relevant patient information: those that describe the patient's state; the actions directed at the patient variables; and the actions initiated to diagnose, educate, or treat the patient. These are regarded as repository functions of the EHR. This standard does not describe all of the data structures required by applications that might use information contained in the EHR. In particular, the data structures used to control and guide the process of care such as utilization review or quality assurance, and the goals or thresholds (for example, mean length of stay) that might be used to judge the patient's care are not included.4.1.3.1 There are many different ways to implement physical structures that could map into the model presented. It is emphasized that this standard should neither impede technical progress nor define the precise manner in which the EHR system is implemented.4.1.3.2 The focus of this guide is on the kinds of information that should be included and upon a global description of the organization of that data within the EHR. This guide does not deal in detail with issues related to charges and billing for patient care, only the documentation required to support usual charging and administrative issues.4.1.3.3 This standard deals with the health information as it would be stored in the EHR, not as it would be sent as a message to or from the EHR. Pains have been taken to be sure that the information content from existing healthcare informatics messages that lie within the scope of the EHR can be mapped into the EHR structure. Where mappings are one-to-one, the EHR data elements have been cross referenced with the message fields. However, the EHR is not just a collection of messages. It makes stronger assumptions about the context in which it exists, so there is not perfect correspondence between the structure and content of messages on the one hand and the EHR on the other.4.1.3.4 This guide applies across a range of scales. Though the ultimate goal is a EHR that spans the entire nation and the lifetime of an individual, the reality is that EHRs are mostly of much smaller scope (for example, within institutions, communities, or states) and these can be implemented much sooner. This standard is intended to apply equally to all scopes of time and place. Within the scope of a EHR, all master tables and code systems (for example, service catalog, patient registry, patient identifier) will be held in common. It denotes extensions of text content for document format standards and references standard XML designation for document section tags.4.1.4 The fourth part (Sections 8, 9, 10) describes some alternative views (subsets of information presented in various orderings) of the content and proposes the minimum data elements contained in the EHR. What has been described as the “Longitudinal Health Record” (a very short précis of the patient's entire history) falls into this category. A set of “views” will serve as the user interface to the EHR for various customers. When all of the data is available in a EHR, providing different views of that data to satisfy various user needs and perspectives will be facilitated. Further, the kinds of views that are “required” and their dependencies (differing by institution, by specialty, by health/medical problem, by practitioner) will evolve over time. Section 10 is a repository of data elements to be used as an electronic health record data dictionary (Annex A1) (18).4.2 General—Healthcare Documentation:4.2.1 A patient's health record plays five unique roles: (1) It represents that patient's health history, that is, a record of the patient's health states and the health services provided, over time. (2) It provides a method for clinical communication and care planning among the individual healthcare practitioners serving the patient. (3) It serves as the legal document describing the healthcare services provided. (4) It is a source of data for clinical, health services, and outcomes research. (5) It serves as a major resource for healthcare practitioner education.4.2.2 Keeping complete and accurate records is an essential part of patient care management. Increasing specialization in healthcare and population mobility have increased the fragmentation of the traditional health record. The EHR offers a unified, coordinated, complete repository of patient health information. It includes such things as treatments, prescriptions, test results, diagnostic impressions, and significant genetic, environmental, and clinical healthcare data.4.2.3 The person's health record consists of the original documentation of their health information and of the associated health and clinical services provided at the various care sites including the results of tests and outcomes of treatments. Each care site will require basic data that may be common to all care sites, data specific to that particular type of care site, and data unique to the individual care site.4.2.4 The EHR serves all of the functions of the traditional record but has many advantages.4.2.4.1 It solves the logistic problems of easy access to the paper health/medical record. Information can be concurrently accessed from multiple locations.4.2.4.2 It will provide efficient communication of information to support coordination of services between care practitioners (See Specification E2369).4.2.4.3 It calls for data content to be stored so that it links to automatic reminders and alerts to avoid errors of omission and commission.4.2.4.4 By providing cross-patient retrievals it will provide the statistics needed by clinical, outcomes, health services and policy researchers as well as administrators and managers, to define better policies and practices to improve the healthcare process and make it efficient.4.2.5 The longitudinal healthcare record, which is the brief synopsis of the significant facts derived from the primary documentation, can be constructed from views of the elements described here.4.3 The Role of Standards in Healthcare Documentation:4.3.1 Healthcare informatics standards are essential for an efficient and affordable EHR. Even within a single institution, much of the information that should be stored in the EHR will come from other electronic sources. Message standards are needed to ensure that this data can be transmitted from a source system and received and stored with a EHR without requiring human intervention. The need for information from other healthcare facilities (the hospital would like nursing home records when the patient is admitted and vice versa when the patient is discharged) is even greater. Finally, standard terminology, codes, and formats are the sine qua non for aggregating many EHRs for research and policy purposes.4.3.2 The model for an EHR described here provides a general guideline that describes the data and data organization for an EHR and recommends minimal content requirements. It promotes common approaches to documentation. The model should be flexible enough to permit the storage of any kind of patient information deemed important by an individual provider, ensure that a minimum set of patient data is maintained, as well as information required by diagnostic and therapeutic services of the future.1.1 This practice covers all types of healthcare services, including those given in ambulatory care, hospitals, nursing homes, skilled nursing facilities, home healthcare, and specialty care environments. They apply both to short term contacts (for example, emergency rooms and emergency medical service units) and long term contacts (primary care physicians with long term patients). The vocabulary aims to encompass the continuum of care through all delivery models. This practice defines the persistent data needed to support Electronic Health Record system functionality.1.2 This practice has four purposes:1.2.1 Identify the content and logical data structure and organization of an Electronic Health Record (EHR) consistent with currently acknowledged patient record content. The record carries all health related information about a person over time. It may include history and physical, laboratory tests, diagnostic reports, orders and treatments documentation, patient identifying information, legal permissions, and so on. The content is presented and described as data elements or as clinical documents. This standard is consistent with eXtensible Markup Language (XML). See Document Type Definition (DTD) 2.1 and W3CXML Schema 1.01.2.2 Explain the relationship of data coming from diverse sources (for example, clinical laboratory information management systems, order entry systems, pharmacy information management systems, dictation systems), and other data in the Electronic Health Record as the primary repository for information from various sources.1.2.3 Provide a common vocabulary for those developing, purchasing, and implementing EHR systems.1.2.4 Provide sufficient content from which data extracts can be compiled to create unique setting “views.”1.2.5 Map the content to selected relevant biomedical and health informatics standards.

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