Foreword	5
	Preface	7
	Trademarks and Disclaimer	9
	Copy-Editor	9
	Contributors	9
	Reviewers	10
	HL7 Conformance Working Group	10
	Robert Snelick Acknowledgments	10
	Frank Oemig Acknowledgments	11
	Dedication	12
	Contents	13
	About the Authors	24
	Acronyms	26
	List of Figures	32
	List of Tables	40
	Healthcare Information Technology	46
	1 Introduction	47
	1.1 The Case for Common Understanding	49
	1.1.1 The Need for Consistency	50
	1.2 Information Cycle	51
	1.3 Motivation for Cooperation	52
	1.4 Definition of Key Terms and Concepts	53
	1.4.1 Conformance	53
	1.4.2 Interoperability	54
	1.5 Interoperability Levels	56
	1.6 Standards Development Life-Cycle	57
	1.7 ISO/OSI Stack	59
	1.8 Reference Model for Open Distributed Processing (RM-ODP)	61
	1.9 Concept Relationships	63
	1.10 Approaches to Standards Development	64
	1.11 Testing	66
	1.12 Scope and Purpose	67
	1.13 Commonly Used Terms and Definitions	69
	1.14 Intended Audience	71
	1.15 Keywords for Use	72
	1.16 Summary	72
	References	73
	2 Architecture	75
	2.1 Interface	75
	2.1.1 Types of Interfaces	76
	2.1.1.1 Functional (Local + Remote)	76
	2.1.1.2 Message-Based Data Exchange	77
	2.1.1.3 Document Exchange	78
	2.1.2 Communication Paradigms	79
	2.1.3 Protocol Layer	80
	2.1.4 Levels for Interoperability	80
	2.2 Interfacing	81
	2.2.1 Impact on Interfaces	82
	2.3 Serving Interfaces with Data	83
	2.3.1 General “Capability” of a System	83
	2.3.2 Relevance for Interfaces	85
	2.4 Dynamic Behavior	86
	2.4.1 Message Pairs	86
	2.4.2 Timing	87
	2.4.3 Message Identification	87
	2.4.4 Routing to Multiple Destinations	89
	2.4.5 Responsibility of a System	90
	2.4.6 Event Handling	91
	2.4.7 Delayed Message Handling (Sender)	92
	2.4.8 Handling of Outdated Data (Receiver)	93
	2.5 Intermediate Message Handling	94
	2.6 Message Population	95
	2.7 Information Transmission	96
	2.8 Delete Indication	97
	2.8.1 Legal Requirements for Data Persistence	100
	2.8.2 Receiver Responsibility	100
	2.8.3 Data Granularity	101
	2.8.4 Impact of Order of Messages	101
	2.8.5 Sender Responsibility: Impact to System Design	102
	2.9 Null Flavors	103
	2.10 Snapshot Mode Versus Update Mode	105
	2.11 Considerations in Application Development	108
	2.11.1 Introducing Functional Requirements	108
	2.11.2 Conformance Discussion	113
	2.12 Summary	116
	References	117
	3 Healthcare Standards Landscape	118
	3.1 Introduction	118
	3.2 Standards Developing Organizations	119
	3.2.1 UNECE	119
	3.2.2 ASC (US)	120
	3.2.3 ASTM (US)	121
	3.2.4 HL7	121
	3.2.4.1 Affiliates	122
	3.2.5 DICOM	122
	3.2.6 KBV, ZI and QMS (Germany)	123
	3.2.7 KV-Telematik (Germany)	123
	3.2.8 NCPDP (USA)	124
	3.2.9 OASIS	125
	3.3 Profile Development Organizations	126
	3.3.1 IHE	126
	3.3.2 ELGA (Austria)	129
	3.3.3 eHealth Suisse (Switzerland)	130
	3.3.4 HITSP (US)	131
	3.3.5 S&I Framework (US)	132
	3.3.6 Standards Collaborative (Canada)	133
	3.3.7 Interop’Santé (France)	134
	3.3.8 ASIP Santé (France)	135
	3.3.9 Phast (France)	135
	3.3.10 eSanté (Luxembourg)	136
	3.3.11 Interoperability Forum (Germany)	136
	3.3.12 NHS (UK)	138
	3.3.13 SMART Health IT on FHIR® (US)	139
	3.3.13.1 Profiles	139
	3.4 Overview of Widely Used Standards	140
	3.4.1 HL7	140
	3.4.1.1 Version 2.x and 3.0	140
	3.4.1.2 CDA	141
	3.4.1.3 CCOW	142
	3.4.1.4 FHIR	142
	3.4.1.5 More HL7 Family Members	142
	3.4.2 Other Standards	143
	3.5 Summary	144
	References	144
	4 Healthcare Data Exchange Standards	147
	4.1 Introduction	148
	4.2 HL7 Version 2.X	148
	4.2.1 Versions	149
	4.2.2 Information Model	151
	4.2.3 Message Structure	151
	4.2.4 Optionality	153
	4.2.5 Encoding	154
	4.2.6 Delimiters	156
	4.2.7 Delete Requests	156
	4.2.8 Null-Flavors	157
	4.2.9 Data Types	157
	4.2.10 Events	159
	4.2.11 Dynamic Behavior	161
	4.2.12 Transmission Protocols	163
	4.2.13 Tables and Table Values	163
	4.2.14 Conformance Methodology	165
	4.3 FHIR (HL7)	165
	4.3.1 Introduction and Overview	165
	4.3.2 Element Hierarchy	168
	4.3.3 References	170
	4.3.4 Bundling	171
	4.3.5 Retrieval and Queries	171
	4.3.6 Extensibility	172
	4.3.7 Use of Vocabulary	172
	4.3.8 Data Types	173
	4.3.9 Representation/Encoding	175
	4.3.10 Maturity Model	175
	4.3.11 Versions	176
	4.3.12 Profiling by “Slicing”	177
	4.3.13 Conformance	177
	4.3.13.1 Conformance Resource	178
	4.3.13.2 DataElement Resource	179
	4.3.13.3 Structure Definition Resource	179
	4.3.13.4 Operation Definition Resource	179
	4.3.13.5 Search Parameter Resource	181
	4.3.14 Conformance Methodology	181
	4.4 UN/EDIFACT	182
	4.4.1 Introduction and Overview	182
	4.4.2 Message Structure	182
	4.4.3 Delimiter	183
	4.4.4 Data Types Format Notation	185
	4.4.5 Tables	186
	4.4.6 Conformance Methodology	187
	4.5 ebXML	187
	4.5.1 ebRIM	187
	4.5.2 Data Types	188
	4.5.3 Classes and Attributes	189
	4.5.4 Methods	189
	4.5.5 Conformance Methodology	190
	4.6 CTS2 (HL7)	190
	4.6.1 Information Model	191
	4.6.2 Conformance Methodology	192
	4.7 ClaML (ISO)	192
	4.7.1 Information Model	192
	4.7.2 Conformance Methodology	193
	4.8 Technical Compatibility Matrix	194
	4.9 Summary	194
	References	197
	Conformance (and Tools)	199
	5 Conformance Constructs	200
	5.1 Overview	200
	5.1.1 Conformance Constructs Overview	201
	5.1.2 Related Conformance Concepts	204
	5.1.3 Example Specifications	205
	5.1.4 Summary	206
	5.2 Data Structures and Data Types	207
	5.2.1 Binding to Elements	207
	5.2.2 Atomic Versus Complex Information	208
	5.2.3 Representation/Formats	209
	5.2.4 Precision in Representation	210
	5.2.5 Precision in Meaning	211
	5.2.6 Collections of Data Types	211
	5.2.7 Promotion/Demotion (in HL7 V3)	212
	5.3 Usage (Optionality)	213
	5.3.1 Example Application Discussion	214
	5.3.2 Support for an Element	216
	5.3.3 Implementation Support Versus Presence in Instances	217
	5.3.4 Conditional Usage	218
	5.3.5 Case Study: HL7 v2.x Conditional Usage	219
	5.3.6 “Required” Versus “Mandatory”	220
	5.3.7 Binding of Elements	222
	5.3.8 Interface Design Choices	222
	5.3.9 Sender and Receiver Perspectives	223
	5.4 Cardinality	223
	5.4.1 Limitations	224
	5.4.2 Delimiters	225
	5.4.3 Alternate Terms for Cardinality	225
	5.4.4 Notation for Cardinality	225
	5.4.5 Use of Cardinality	225
	5.4.6 Relationship of Optionality and Cardinality	226
	5.5 Length	227
	5.5.1 Sender/Receiver Role	228
	5.5.2 Truncation	228
	5.5.3 Padding	229
	5.5.4 Conformance Length	230
	5.6 Content	230
	5.6.1 Vocabulary	231
	5.6.1.1 Vocabulary Mechanics	233
	5.6.1.2 Value Set Definition and Value Set Expansion	237
	5.6.1.3 Value Sets Using Multiple Code Systems	237
	5.6.1.4 Coded Elements with Text Exceptions	240
	5.6.1.5 Explicit Binding Strength Specification	241
	5.6.1.6 Types of Bindings Used in Standards	242
	5.6.2 Null Flavors (Values)	242
	5.6.3 Fixed Value (Constant)	243
	5.6.4 Default Values	244
	5.6.5 Placeholder Values	245
	5.7 Conformance Statements	245
	5.8 Data Semantics	246
	5.8.1 Models	246
	5.9 Encoding	246
	5.9.1 Display-Oriented Encoding Concepts	247
	5.9.1.1 Escaping	247
	5.9.1.2 Text Formatting	250
	5.9.1.3 Character Sets	251
	5.9.1.4 HL7 v2.x XML Encoding	254
	5.9.2 Presence/Absence of an Element	254
	5.9.2.1 Summary of Presence/Absence Capabilities	257
	5.9.3 Parsing	257
	5.9.3.1 Message Substructures	258
	5.9.3.2 HL7 v2.x: Implicit Segment Structures	258
	5.9.3.3 HL7 v2.x: Explicit Message Structures/BNF	260
	5.9.3.4 HL7 v3 Message Structures	260
	5.10 Summary	261
	References	261
	6 Principles of Specifying Conformance	263
	6.1 Introduction	263
	6.2 Overloaded Terms	265
	6.2.1 Declaring Requirements and Conformance	265
	6.2.2 Requirement Documents	266
	6.3 Conformance Keywords	266
	6.3.1 Impact of Keywords on Requirements	268
	6.3.2 Nested Requirements	269
	6.3.3 Normative and Informative Statements	270
	6.4 Conformance Clause	270
	6.4.1 Conformance Claim	271
	6.5 Specifying Conformance Requirements	272
	6.5.1 Implicit Definitions with Conformance Constructs	272
	6.5.2 Explicit Definition with Normative Statements	276
	6.5.3 Principles for Writing Conformance Requirements	276
	6.6 Scope of Conformance Specifications	279
	6.7 Summary	281
	References	281
	7 Principles of Effective Profiling	283
	7.1 Introduction	283
	7.2 Profiling: Definition of Terms	284
	7.2.1 Profile Components	289
	7.2.2 Annotations	289
	7.3 Refinement of a Standard	290
	7.3.1 Profiling Methodology Summary	291
	7.3.2 Constraints	291
	7.3.2.1 Usage (Optionality) Constraint	293
	7.3.2.2 Cardinality Constraint	293
	7.3.2.3 Data Type Constraint	293
	7.3.2.4 Content (Value Set) Constraint	294
	7.3.2.5 Length Constraint	295
	7.3.2.6 Conformance Statement (Predicate Constraint)	296
	7.3.2.7 Co-constraints	296
	7.3.3 Allowable Constraints	297
	7.3.4 Extensions	297
	7.3.5 Conformance Approaches: Constraints Versus Extensions	298
	7.4 Profile Hierarchy	298
	7.4.1 Profile Hierarchy in Use	300
	7.4.2 Profile Hierarchies for Standard Specifications	301
	7.4.3 Non-compliant Profiles	303
	7.5 Profiling Case Study: HL7 v2	304
	7.5.1 HL7 v2.x Profiles: Background and Motivation	304
	7.5.2 HL7 v2 Conformance Profile Defined	306
	7.5.3 Message Profile Components Defined	307
	7.6 Vocabulary Profiling	309
	7.6.1 Vocabulary Binding and Profiling	310
	7.6.2 Use of Extensibility and Stability	313
	7.6.3 Profiling at the Code Level	315
	7.6.4 Summary	323
	7.7 Vocabulary Management	323
	7.7.1 Managing Code Systems	324
	7.7.2 Value Set Definition and Expansion	325
	7.7.3 Managing Dynamic Value Sets	326
	7.8 Uses of Conformance Profiles	328
	7.9 Profile Design and Management	329
	7.9.1 Profile Identification Management	332
	7.9.2 Publishing the Specification	332
	7.10 Pairing Sender and Receiver Profiles for Use	333
	7.10.1 One-to-One Profile Pairing	334
	7.10.2 One-to-Many Profile Pairing	334
	7.10.3 Many-to-One Profile Pairing	336
	7.10.4 Design Considerations: Profiling Pairing	339
	7.11 Case Studies	339
	7.11.1 Localization Using Profile Components	339
	7.11.2 IHE Integration Profile	341
	7.11.3 Laboratory Orders, Results, and Public Health	341
	7.11.4 HL7 v2.x Message Profiles (in Germany)	344
	7.12 Documenting Interfaces	346
	7.12.1 Profile and Implementation Relationships	347
	7.12.2 Documentation Quality	350
	7.13 Summary	350
	References	352
	8 Profile Relationships	354
	8.1 Introduction	354
	8.2 Specialization of Profiles	358
	8.2.1 Usage (Optionality) Compliance Rules	359
	8.2.1.1 Conditional Usage	361
	8.2.1.2 Withdrawn Usage	362
	8.2.2 Cardinality Compliance Rules	363
	8.2.3 Length Compliance Rules	364
	8.2.3.1 Maximum Length	364
	8.2.3.2 Minimum Length	365
	8.2.3.3 Conformance Length	365
	8.2.4 Vocabulary Compliance Rules	366
	8.2.4.1 Constraining Vocabulary	366
	8.3 Versioning of Profiles	367
	8.3.1 Example	369
	8.4 Creating New Profiles	371
	8.5 Compatibility of (Sender and Receiver) Profiles	371
	8.5.1 Usage	372
	8.5.2 Cardinality	374
	8.5.3 Length	374
	8.5.4 Vocabulary	375
	8.6 Summary	376
	References	377
	9 Conformance Profiling Tools	378
	9.1 Introduction	378
	9.2 Messaging Workbench	379
	9.3 IGAMT	382
	9.4 MDHT	384
	9.5 ART-DECOR	385
	9.6 Lantana Template Repository: Trifolia	391
	9.7 Forge	397
	9.8 Summary	399
	References	399
	Testing (and Tools)	401
	10 Testing Models	402
	10.1 Introduction	402
	10.2 Testing Objectives	403
	10.3 Definition of Terms	404
	10.4 Test Organization Hierarchy	405
	10.5 Test Evaluation Types	409
	10.6 Testing Models	411
	10.6.1 Data Instance Testing Model	412
	10.6.2 Isolated System Testing Model	413
	10.6.3 Peer-to-Peer System Testing Model	415
	10.7 Additional Testing Considerations	416
	10.8 Summary	417
	References	418
	11 Principles of Conformance Testing	419
	11.1 Overview	419
	11.2 Conformance and Interoperability Testing	420
	11.2.1 Conformance Testing	420
	11.2.2 Interoperability Testing	420
	11.2.3 Conformance and Interoperability Testing Relationship	421
	11.2.4 Periodic Testing	423
	11.2.5 Conformance Testing in Operational Environments	423
	11.3 Standards Development Life-Cycle	424
	11.4 Test Methodology Framework	426
	11.4.1 System-Under-Test (SUT)	428
	11.4.2 Anatomy of a Test Suite	428
	11.4.3 Anatomy of a Test Plan	428
	11.4.4 Anatomy of a Test Case	429
	11.4.5 Anatomy of a Test Step	429
	11.4.6 Test Data	430
	11.4.7 Test Script	430
	11.4.8 Inspection Documents	431
	11.4.9 Test Artifact	431
	11.4.10 Test Assertion	432
	11.4.11 Test Tool	432
	11.4.12 Configuration Information	432
	11.4.13 Test Report	433
	11.5 Testing in Practice	433
	11.5.1 Testing Sending Applications	433
	11.5.1.1 Context-Free Testing Versus Context-Based Testing	435
	11.5.2 Case Study: Laboratory Results	437
	11.5.2.1 Test Procedure Workflow	443
	11.5.3 Testing Receiving Applications	443
	11.5.3.1 Inspection Testing Approach	444
	11.5.3.2 Use of Acknowledgements Approach	445
	11.5.3.3 Query and Response Approach	445
	11.5.3.4 Extended Workflow Approach	446
	11.5.3.5 Artificial System Capability Approach	448
	11.5.3.6 Combining Approaches	449
	11.5.4 Case Study: Incorporation of Laboratory Results	449
	11.5.4.1 Juror Document Interpretation and Use	452
	11.6 Context-Based Test Data Categorizations	454
	11.6.1 Data Content Conformity Assessment Examples	460
	11.6.2 Testing Cardinality and Other Conformance Constructs	462
	11.7 Strategies and Best Practices for Test Case Development	462
	11.8 Capability, Site, and Interoperability Testing	466
	11.9 Negative Testing	468
	11.9.1 Message and Document Incorporation	469
	11.9.2 Boundary Testing	471
	11.9.3 False Positive and False Negative Test Results	471
	11.10 Other Types of Testing	472
	11.10.1 Smoke Testing	473
	11.10.2 Communication Testing	473
	11.10.3 Application Functional Testing	474
	11.10.4 Data Quality Testing	475
	11.10.5 Usability Testing	476
	11.10.6 Load Testing	477
	11.11 Summary	477
	References	479
	12 Conformity Assessment	481
	12.1 Overview	481
	12.2 Processing Aspects (for Receiving Applications)	484
	12.3 Usage/Optionality	484
	12.3.1 Sender Usage Conformity Assessments	485
	12.3.2 Receiver Usage Conformity Assessment	487
	12.4 Cardinality	493
	12.4.1 Sender Cardinality Conformity Assessment	494
	12.4.2 Receiver Cardinality Conformance Assessment	500
	12.5 Vocabulary Conformance and Assessment	511
	12.5.1 Vocabulary Conformance	511
	12.5.2 Vocabulary Conformity Assessment	513
	12.5.2.1 Conformity Assessment for Senders	513
	12.5.2.2 Conformity Assessment for Receivers	515
	12.6 Summary	516
	References	516
	13 Testing Architectures	517
	13.1 Introduction	517
	13.2 Testing Infrastructure	518
	13.2.1 Key Objectives of a Testing Infrastructure	521
	13.2.2 Resource Repository	521
	13.2.3 Test Harness	522
	13.2.4 Services	523
	13.2.4.1 Generation Services	523
	13.2.4.2 Validation Services	525
	13.2.4.3 Test Agents	525
	13.2.4.4 Registry/Repository Services	528
	13.2.4.5 Test Data Services	528
	13.2.4.6 Report Services	529
	13.2.4.7 Consistent Time Service	529
	13.2.4.8 Proxy Service	529
	13.2.4.9 Communication Infrastructure	529
	13.2.4.10 Terminology Service	530
	13.2.4.11 Aggregated Services	531
	13.2.4.12 Other Services	531
	13.2.5 Infrastructure Components	532
	13.2.6 Testing Infrastructure—A Broader Context	532
	13.2.6.1 Test Management Systems	532
	13.2.6.2 Tool Access and Delivery	533
	13.2.6.3 External Tools and Services	534
	13.2.6.4 Development Components	535
	13.2.7 Testing Infrastructure Observations	535
	13.3 A Test Scenario	535
	13.4 Testing Frameworks	539
	13.4.1 Data Instance Test Framework	539
	13.4.2 Isolated System Test Framework	541
	13.4.3 Peer-to-Peer Testing Framework	542
	13.5 Instantiation of Test Tools	544
	13.5.1 Data Instance Testing Test Tool	544
	13.5.2 Isolated System Testing Test Tool	545
	13.5.3 Interoperability Test Bed	549
	13.5.3.1 Operational Functions	549
	13.5.3.1.1ƒSimulating a Vendor System	552
	13.5.3.2 Test Flow	552
	13.5.3.2.1ƒScheduling and Configuration	553
	13.5.3.2.2ƒTest Execution Status Evaluation and Progress Display	553
	13.5.3.2.3ƒOrchestration of Events	554
	13.5.3.2.4ƒAnalysis and Results Reporting	557
	13.5.3.2.5ƒDiscussion	557
	13.5.3.3 Need for the ITB	558
	13.5.3.4 Multiple Domain Test Scenarios and Testing	558
	13.6 Summary	559
	References	559
	14 Testing Tools	561
	14.1 Introduction	561
	14.2 NIST HL7 v2.x Test Tools	562
	14.2.1 NIST Immunization Test Suite	563
	14.2.1.1 General Tool Capabilities	563
	14.2.1.2 Testing Sending Applications in the Tool	565
	14.2.1.3 Testing Receiving Applications in the Tool	568
	14.2.2 Testing Functional Requirements with the Tool	570
	14.2.3 NIST HL7 v2.x Testing Web Services API	572
	14.3 Message Workbench (MWB)	572
	14.3.1 Message Instance Validation	572
	14.3.2 Message Validation via a Proxy-Server	573
	14.3.3 MWB Validation Server	573
	14.4 CDC Message Quality Framework	575
	14.5 AHML-Australian Healthcare Messaging Laboratory	576
	14.5.1 Message Testing Process	577
	14.5.2 Reporting	579
	14.6 CDA Test Tools	579
	14.6.1 ART-DECOR	579
	14.6.2 Lantana Trifolia	580
	14.6.3 NIST CDA Testing	581
	14.6.4 eHealth Suisse	583
	14.6.5 IHE Gazelle Object Checker	584
	14.7 IHE Conformance and Interoperability Test Tools	584
	14.8 e-Prescribing (e-Rx) Tools	586
	14.8.1 NIST e-Prescribing Test Tool	587
	14.9 DVTk—DICOM Validation Toolkit	588
	14.9.1 History	588
	14.9.2 Functionality	588
	14.10 Related Tools	590
	14.10.1 HAPI	590
	14.10.2 MDHT	591
	14.10.3 IPF (by Open eHealth Foundation)	592
	14.10.4 eHealth Connector (by eHealth Suisse)	592
	14.11 Table of Tools and Access Points	593
	14.12 Summary	593
	References	593
	15 Testing and Certification Programs	595
	15.1 Introduction	595
	15.2 Certification Perspectives	596
	15.3 IHE Testing Programs	598
	15.3.1 IHE Technical Framework Overview	598
	15.3.2 IHE Testing Process	598
	15.3.2.1 Pre-connect-a-Thon	600
	15.3.2.2 Virtual Connect-a-Thon	600
	15.3.2.3 Connect-a-Thon	601
	15.3.3 IHE Product Registry	602
	15.3.4 Gazelle	603
	15.4 EHR Certification and Meaningful Use Programs	604
	15.4.1 Patient Safety and Federal EHR Technology Programs	604
	15.4.2 The Federal HIT Certification Program	605
	15.4.3 The Role of NIST	610
	15.4.4 Reaction in the Market to the Federal EHR Programs	613
	15.4.5 The Interoperability Factor	618
	15.4.6 Summary and Conclusions	619
	15.5 Other Programs	620
	15.5.1 Surescripts	620
	15.5.2 Certification in Australia	620
	15.5.3 Certification in Germany	621
	15.6 Scope of Certification Testing	622
	15.7 Summary	624
	References	624
	Appendix A: Additional Healthcare Data Exchange Standards	626
	A.1 HL7 Version 3	626
	A.1.1 Reference Information Model (RIM)	627
	A.1.2 Structural Attributes	631
	Outline placeholder	1
	A.1.2.1 Mood Code	631
	A.1.2.2 Class Code	632
	A.1.3 Null-Flavors	633
	A.1.4 Required and Mandatory Values	633
	A.1.5 State Transitions	635
	A.1.6 Application Roles	635
	A.1.7 Data Types	637
	A.1.8 ITS	637
	A.1.9 Recursive Relationships	638
	A.2 CDA	638
	Outline placeholder	1
	A.2.1 Levels	642
	A.2.2 Releases	644
	A.2.3 Templates	645
	A.2.4 Implementation Guides	646
	A.2.5 SDA—Structured Document Architecture	646
	A.3 ASTM	647
	Outline placeholder	1
	A.3.1 Message Structure and Segments	647
	A.3.2 Chapters	647
	A.3.3 Conformance Methodology	648
	A.4 DICOM	649
	Outline placeholder	1
	A.4.1 Introduction and Overview	649
	A.4.2 Information Model	649
	A.4.3 Information Object	650
	A.4.4 Data Element	652
	A.4.5 Value Representation	653
	A.4.6 Conformance Methodology	654
	A.4.7 Proprietary Extensions	654
	A.5 XDT (Germany)	655
	Outline placeholder	1
	A.5.1 Introduction and Overview	655
	A.5.2 Information Model	656
	A.5.3 Data Exchange	656
	A.5.4 Encoding and Parsing	657
	A.5.5 Explanation of Segment Structure	658
	A.5.6 Overall Structure (Message Structure)	659
	A.5.7 “Datenpaket” (Data Package/Message)	660
	A.5.8 “Satz” (Segment)	660
	A.5.8.1 “Feldarten” (Optionality)	663
	A.5.9 “Bedingung” (Condition/Rules)	663
	Outline placeholder	1
	A.5.10 Feldtabelle (Data Element Table)	664
	A.5.11 Feldtypen (Data Types)	664
	A.5.12 Vocabulary	665
	A.5.13 Character Sets	666
	A.5.14 Example	667
	A.5.15 Conformance Methodology	668
	A.6 Hprim Santé (France)	668
	Outline placeholder	1
	A.6.1 Introduction and Overview	669
	A.6.2 Segments	669
	A.6.2.1 Properties	670
	A.6.3 Message Types	671
	A.6.4 Message Structure	671
	A.6.4.1 Comparison to HL7 V2.X	674
	A.6.5 Data Types	675
	A.6.6 Vocabulary	675
	A.6.7 Encoding	676
	A.6.8 Conformance Methodology	676
	A.7 PN13 (France)	676
	Outline placeholder	1
	A.7.1 Introduction and Overview	677
	A.7.2 Message Types	677
	A.7.3 Data Elements	677
	A.7.4 Data Type	678
	A.7.5 Optionality and Cardinality	680
	A.7.6 Representation	680
	A.7.7 Conformance Methodology	680
	A.8 Summary	680
	References	682
	Appendix B: Trademark Information	683
	Index	685