Schema Reference¶
Complete reference for the healthcare semantic schema — 12 domains, ~50 tables across 6 source systems, aligned to HL7 FHIR, ICD-10, CPT/HCPCS, SNOMED CT, LOINC, NDC, RxNorm, and HIPAA standards.
Source File: enterprise-knowledge/healthcare-schema.yaml
Domain 1: Patient & Demographics¶
System: EHR | FHIR Resource: Patient
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Patient_Master |
Central patient master record — most connected entity in the ontology | high | MRN, Name, DOB, Gender, Race, Ethnicity, Language, Address, Phone, Insurance_ID, PCP_ID, Consent_Status, Status (Active/Inactive/Deceased/Merged) |
Emergency_Contact |
Patient emergency contact persons | low | Contact_ID, Patient_ID, Name, Relationship, Phone, Priority |
Patient_Identifier |
MRN cross-references across systems for EMPI resolution | medium | Identifier_ID, Patient_ID, MRN, Source_System (EHR/Billing/Lab/Imaging/Pharmacy), Identifier_Type (MRN/SSN/Insurance/Enterprise), Status (Active/Merged/Retired) |
Key Relationships:
Patient_Masteris referenced by ALL 8 applications (most foundational entity)Patient_Master--syncs_to-->Population_Roster(via ehr-population-health-sync)Patient_Master--constrained_by--> hipaa-privacy-policyPatient_Identifier--triggers--> Patient Identity Resolution workflow (EMPI matching)Patient_Master--triggers--> Patient 360 Assembly workflow
Domain 2: Clinical Records¶
System: EHR | FHIR Resource: Condition | Coding: ICD-10-CM / SNOMED CT
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Diagnosis |
Clinical diagnosis record with standardized coding | high | Diagnosis_ID, Patient_ID, Encounter_ID, ICD10_Code, SNOMED_Code, Description, Type (Admitting/Principal/Secondary), Status (Active/Resolved/Chronic), Onset_Date, Diagnosed_By |
Problem_List |
Longitudinal chronic condition tracking | medium | Problem_ID, Patient_ID, Diagnosis_ID, ICD10_Code, SNOMED_Code, Description, Status (Active/Inactive/Resolved), Onset_Date, Last_Reviewed |
Allergy |
Patient allergy and adverse reaction record | high | Allergy_ID, Patient_ID, Allergen, SNOMED_Code, Reaction, Severity (Mild/Moderate/Severe/Life_Threatening), Status (Active/Inactive/Entered_in_Error), Verified_By |
Key Relationships:
Diagnosis--syncs_to-->Claim(via ehr-rcm-billing-sync)Diagnosis--triggers--> Clinical Decision Support workflow (new diagnosis detection)Diagnosis--constrained_by--> clinical-documentation-policyProblem_List--depends_on-->DiagnosisAllergy--triggers--> Medication Safety Alerting workflow (interaction check)
Domain 3: Medications & Pharmacy¶
System: EHR + Pharmacy | FHIR Resource: MedicationRequest / MedicationAdministration | Coding: NDC / RxNorm
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Medication_Order |
Physician medication prescription / CPOE order | high | Order_ID, Patient_ID, Encounter_ID, Drug_Name, NDC, RxNorm_CUI, Dose, Route, Frequency, Start_Date, End_Date, Prescriber_ID, Indication, Status (Active/Completed/Discontinued/Cancelled) |
Medication_Administration |
Bedside MAR record of drug administration | high | Admin_ID, Order_ID, Patient_ID, Drug_Name, Dose_Given, Route, Time, Nurse_ID, Site, Status (Given/Held/Refused/Not_Given) |
Drug_Interaction |
Drug-drug and drug-allergy interaction knowledge base | medium | Interaction_ID, Drug_A_RxNorm, Drug_B_RxNorm, Severity (Minor/Moderate/Major/Contraindicated), Effect, Evidence_Level, Source |
Pharmacy_Inventory |
Pharmacy stock and formulary management | medium | Inventory_ID, NDC, Drug_Name, Lot, Qty, Expiry, Location, Formulary_Status (Formulary/Non_Formulary/Restricted), Cost, Controlled_Flag, DEA_Schedule |
Key Relationships:
Medication_Order--triggers--> Medication Safety Alerting workflow (interaction/allergy check)Medication_Order--constrained_by--> clinical-safety-policy, controlled-substance-policyMedication_Administration--depends_on-->Medication_OrderMedication_Administration--validates-->Medication_Order(five-rights verification)Pharmacy_Inventory--triggers--> Supply Replenishment workflow (below par level)
Domain 4: Lab & Diagnostics¶
System: LIS + Imaging/PACS | FHIR Resource: Observation / DiagnosticReport | Coding: LOINC
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Lab_Order |
Physician order for laboratory test | medium | Order_ID, Patient_ID, Encounter_ID, LOINC_Code, Test_Name, Ordering_Provider, Priority (Routine/Urgent/STAT), Specimen_Type, Status (Ordered/Collected/In_Process/Resulted/Cancelled) |
Lab_Result |
Laboratory test result with standardized coding | high | Result_ID, Order_ID, Patient_ID, LOINC_Code, Test_Name, Value, Unit, Reference_Range, Critical_Flag, Status (Preliminary/Final/Corrected/Cancelled), Resulted_Date |
Imaging_Order |
Physician order for diagnostic imaging | medium | Order_ID, Patient_ID, Encounter_ID, Modality (XRAY/CT/MRI/US/PET/Fluoroscopy), Body_Part, Ordering_Provider, Priority (Routine/Urgent/STAT), Clinical_Indication, Status (Ordered/Scheduled/Completed/Cancelled) |
Imaging_Result |
Radiology report and findings | high | Result_ID, Order_ID, Patient_ID, Modality (XRAY/CT/MRI/US/PET), Findings_Text, Impression, Critical_Flag, Radiologist_ID, Report_Date, Status (Preliminary/Final/Addended) |
Key Relationships:
Lab_Result--triggers--> Critical Result Management workflow (Critical_Flag = true)Lab_Result--validates-->Diagnosis(clinical confirmation)Lab_Result--depends_on-->Lab_OrderImaging_Result--triggers--> Critical Result Management workflow (Critical_Flag = true)Imaging_Result--depends_on-->Imaging_Order
Domain 5: Clinical Orders & Guidelines¶
System: EHR CPOE | FHIR Resource: ServiceRequest
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Clinical_Order |
Unified clinical order across order types | medium | Order_ID, Patient_ID, Encounter_ID, Order_Type (Lab/Imaging/Procedure/Consult/Diet/Therapy), Priority (Routine/Urgent/STAT), Ordering_Provider, Indication, Status (Ordered/In_Progress/Completed/Cancelled) |
Clinical_Guideline |
Evidence-based clinical protocol knowledge base | low | Guideline_ID, Condition, Source (UpToDate/NCCN/ADA/ACC/AHA/IDSA), Recommendation, Evidence_Level (A/B/C/D), Last_Reviewed |
Early_Warning_Score |
Patient deterioration risk scoring (MEWS/NEWS) | medium | Score_ID, Patient_ID, Encounter_ID, Score_Type (MEWS/NEWS/NEWS2), Vital_Signs_Used, Score, Alert_Level (Low/Medium/High/Critical), Timestamp |
Key Relationships:
Clinical_Order--triggers--> Order Fulfillment workflow (routing to Lab/Imaging/Pharmacy)Clinical_Order--constrained_by--> clinical-documentation-policyClinical_Guideline--validates-->Clinical_Order(order appropriateness)Early_Warning_Score--triggers--> Rapid Response workflow (High/Critical alert)Early_Warning_Score--depends_on-->Encounter(inpatient context)
Domain 6: Encounters & Visits¶
System: EHR + HIS | FHIR Resource: Encounter
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Encounter |
Patient visit or admission episode — second most connected entity | high | Encounter_ID, Patient_ID, Type (Inpatient/Outpatient/ED/Observation/Telehealth), Admission_Date, Discharge_Date, LOS_Days, Facility, Unit, Attending_ID, Disposition (Home/SNF/Rehab/AMA/Expired), DRG, Status (Pre_Admit/Active/Discharged/Cancelled) |
Admission |
Inpatient admission detail record | high | Admission_ID, Encounter_ID, Patient_ID, Admit_Date, Admit_Source (ED/Direct/Transfer/Newborn), Admit_Type (Emergency/Urgent/Elective), Attending_ID, Service_Line, Expected_LOS |
Transfer |
Unit-to-unit patient movement within a visit | medium | Transfer_ID, Encounter_ID, Patient_ID, From_Unit, To_Unit, Transfer_Time, Reason, Ordering_Provider |
Discharge |
Discharge planning and execution record | high | Discharge_ID, Encounter_ID, Patient_ID, Discharge_Date, Disposition (Home/Home_Health/SNF/Rehab/LTAC/AMA/Expired), Discharge_Instructions, Follow_Up_Appointments, Medication_Reconciliation_Status (Pending/Complete) |
Key Relationships:
Encounter--syncs_to-->Claim(via ehr-rcm-billing-sync)Encounter--triggers--> Length of Stay Prediction workflow (on admission)Encounter--constrained_by--> patient-flow-policyAdmission--depends_on-->EncounterDischarge--triggers--> Readmission Risk Prediction workflow
Domain 7: Revenue & Billing¶
System: Revenue Cycle | FHIR Resource: Claim / ExplanationOfBenefit | Coding: CPT / HCPCS / DRG
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Claim |
Insurance claim for services rendered | high | Claim_ID, Patient_ID, Encounter_ID, Payer_ID, Type (Professional/Institutional), Diagnosis_Codes, Procedure_Codes_CPT, Total_Charge, Allowed_Amount, Status (Submitted/Accepted/Denied/Paid/Appealed) |
Charge |
Individual charge line item within an encounter | medium | Charge_ID, Encounter_ID, CPT_Code, HCPCS_Code, Description, Qty, Unit_Price, Total_Amount, Department, Service_Date |
Denial |
Claim denial tracking and rework | high | Denial_ID, Claim_ID, Denial_Code, Reason, Amount, Rework_Status (Open/In_Review/Appealed/Overturned/Written_Off), Appeal_Deadline |
Payer_Contract |
Insurance payer fee schedules and terms | high | Contract_ID, Payer_ID, Payer_Name, Fee_Schedule_Type, Reimbursement_Terms, Prior_Auth_Rules, Timely_Filing_Limit_Days, Effective_Date, Expiry_Date |
Prior_Authorization |
Pre-service authorization from payer | medium | Auth_ID, Patient_ID, Payer_ID, Service_Requested, CPT_Code, Status (Requested/Approved/Denied/Expired), Approved_Units, Valid_From, Valid_To |
Patient_Financial |
Patient financial responsibility tracking | medium | Record_ID, Patient_ID, Encounter_ID, Copay, Deductible, Coinsurance, Out_of_Pocket_Max, Financial_Assistance_Status (None/Applied/Approved/Charity_Care), Collection_Status |
Key Relationships:
Claim--triggers--> Denial Prevention workflow (pre-submission validation)Claim--depends_on-->Encounter,Diagnosis,ChargeClaim--constrained_by--> revenue-cycle-policy (timely filing, clean claim rules)Denial--triggers--> Denial Management workflow (rework prioritization)Payer_Contract--constrained_by--> revenue-cycle-policy
Domain 8: Hospital Operations¶
System: HIS | FHIR Resource: Location / Schedule
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Bed_Census |
Real-time bed status and patient assignment | high | Census_ID, Unit, Bed_ID, Patient_ID, Status (Occupied/Clean/Dirty/Blocked/Reserved), Expected_Discharge, Isolation_Flag, Acuity_Level |
OR_Schedule |
Operating room scheduling and utilization | high | Case_ID, Encounter_ID, Surgeon_ID, Procedure, Room, Scheduled_Start, Estimated_Duration, Actual_Duration, Status (Scheduled/In_Progress/Completed/Cancelled/Delayed), Anesthesia_Type |
ED_Arrival |
Emergency department arrival and triage record | high | Arrival_ID, Patient_ID, Arrival_Time, Acuity_ESI (1/2/3/4/5), Chief_Complaint, Triage_Nurse_ID, Disposition (Admit/Discharge/Transfer/LWBS/AMA), Boarding_Time, Door_to_Provider_Min |
Staffing |
Unit staffing levels and labor tracking | medium | Staffing_ID, Unit, Shift (Day/Evening/Night), Staff_Type (RN/LPN/CNA/RT/PharmD), Hours, FTE_Count, Patient_Ratio, Agency_Flag, Overtime_Hours |
Patient_Acuity |
Nursing acuity scoring for staffing decisions | medium | Acuity_ID, Patient_ID, Encounter_ID, Unit, Acuity_Score, Classification (Low/Medium/High/ICU), Assessment_Date |
Key Relationships:
Bed_Census--triggers--> Capacity Management workflow (occupancy threshold breach)Bed_Census--constrained_by--> patient-flow-policyOR_Schedule--triggers--> Surgical Block Optimization workflowED_Arrival--triggers--> ED Throughput Management workflowStaffing--depends_on-->Patient_Acuity(ratio-based staffing model)
Domain 9: Supply & Materials¶
System: HIS + Pharmacy
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Supply_Inventory |
Medical/surgical supply stock levels | medium | Item_ID, Description, Location, Qty, Par_Level, Lot, Expiry, Vendor, GPO_Contract_Flag, Unit_Cost, Category (Med_Surg/Implant/PPE/Sterile/General) |
Supply_Usage |
Supply consumption per case or encounter | medium | Usage_ID, Item_ID, Case_ID, Encounter_ID, Qty_Used, Waste_Qty, Department, Charge_Flag |
Purchase_Order |
Supply procurement order | medium | PO_ID, Vendor, Items, Qty, Price, GPO_Price, Delivery_Date, Status (Draft/Approved/Shipped/Received/Closed) |
Controlled_Substance_Log |
DEA-regulated substance chain-of-custody | high | Log_ID, Drug_Name, NDC, Dispense_Event, Patient_ID, Nurse_ID, Qty_Dispensed, Qty_Wasted, Waste_Witness, Timestamp, Discrepancy_Flag |
Key Relationships:
Supply_Inventory--triggers--> Supply Replenishment workflow (below par level)Supply_Inventory--constrained_by--> supply-management-policyControlled_Substance_Log--constrained_by--> controlled-substance-policyControlled_Substance_Log--triggers--> Diversion Detection workflow (discrepancy detection)Supply_Usage--depends_on-->Encounter(consumption attribution)
Domain 10: Quality & Safety¶
System: EHR + Internal | Standards: CMS / TJC
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Quality_Measure |
CMS/TJC quality metric definition and performance | high | Measure_ID, CMS_ID, Name, Numerator_Criteria, Denominator_Criteria, Exclusion_Criteria, Performance_Rate, Benchmark, Period, Status (Active/Retired) |
Adverse_Event |
Patient safety event and incident report | high | Event_ID, Event_Type (Medication_Error/Fall/Procedural_Complication/HAI/Missed_Diagnosis/Near_Miss), Patient_ID, Encounter_ID, Severity (Near_Miss/Minor/Moderate/Major/Sentinel), Date, Contributing_Factors, Outcome, RCA_Status |
Infection_Indicator |
Healthcare-associated infection surveillance | high | Indicator_ID, Patient_ID, Encounter_ID, Infection_Type (CLABSI/CAUTI/SSI/CDiff/VAP/MRSA), Culture_Result, Device_Days, Detection_Date, Confirmed_Flag, NHSN_Reported |
Safety_Assessment |
Standardized patient risk screening scores | medium | Assessment_ID, Patient_ID, Encounter_ID, Assessment_Type (Fall_Risk_Morse/Pressure_Injury_Braden/VTE_Risk/Delirium_CAM/Suicide_Risk_Columbia), Score, Risk_Level, Timestamp, Assessed_By |
Antibiotic_Order |
Antibiotic stewardship tracking | medium | Order_ID, Patient_ID, Encounter_ID, Drug_Name, NDC, Indication, Culture_Pending_Flag, Duration_Days, De_Escalation_Flag, Stewardship_Review_Status (Pending/Reviewed/Approved/Modified) |
Key Relationships:
Quality_Measure--triggers--> Quality Reporting workflow (period close)Quality_Measure--constrained_by--> quality-reporting-policyAdverse_Event--triggers--> Patient Safety Response workflow (severity >= Moderate)Infection_Indicator--triggers--> Infection Control Response workflowSafety_Assessment--depends_on-->Encounter(assessment context)
Domain 11: Population Health¶
System: External + EHR | Standards: HEDIS / HCC
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
Population_Roster |
Attributed patient panel for value-based care | medium | Roster_ID, MRN, Patient_ID, Payer, Attributed_PCP, HCC_Risk_Score, Chronic_Conditions, Last_Visit, Panel_Status (Active/Inactive/Disenrolled) |
Risk_Stratification |
Patient risk tier assignment for care management | medium | Stratification_ID, Patient_ID, Risk_Tier (Low/Rising/High/Complex), Risk_Score, Key_Drivers, Model_Version, Calculation_Date |
SDoH_Assessment |
Social determinants of health screening | medium | Assessment_ID, Patient_ID, Housing_Status, Food_Security, Transportation, Employment, ADI_Score, Screening_Date, Referral_Status |
Care_Gap |
Open quality/preventive care gap for outreach | medium | Gap_ID, Patient_ID, Measure_HEDIS, Gap_Type (Screening/Lab/Immunization/Annual_Visit/Follow_Up), Due_Date, Status (Open/Closed/Excluded), Closure_Date, Outreach_Attempts |
Key Relationships:
Population_Roster--syncs_to-->Patient_Master(via ehr-population-health-sync)Risk_Stratification--triggers--> Care Management Outreach workflow (High/Complex tier)Risk_Stratification--depends_on-->Diagnosis,Encounter,Medication_OrderSDoH_Assessment--triggers--> Community Resource Referral workflowCare_Gap--constrained_by--> quality-reporting-policy (HEDIS measure specs)
Domain 12: Regulatory & Compliance¶
System: Internal + External | Standards: HIPAA / CMS / TJC
| Table | Semantic | Risk | Key Fields |
|---|---|---|---|
PHI_Access_Log |
Protected health information access audit trail | high | Log_ID, User_ID, Patient_ID, System, Action (View/Modify/Print/Export), Timestamp, Access_Justification, Anomaly_Score, IP_Address |
Regulatory_Return |
Required regulatory submission tracking | high | Return_ID, Return_Type (CMS_MIPS/IQR/Promoting_Interop/VBP/State_Report), Period, Status (Drafting/Under_Review/Submitted/Accepted/Rejected), Submission_Deadline, Submitted_Date |
Accreditation_Standard |
Hospital accreditation compliance tracking | medium | Standard_ID, Body (TJC/DNV/CMS_CoP/State), Category, Requirement, Compliance_Status (Compliant/Partial/Non_Compliant), Last_Review, Next_Review, Evidence_Location |
Patient_Consent |
Patient consent and advance directive management | medium | Consent_ID, Patient_ID, Consent_Type (Treatment/Research/Data_Sharing/Advance_Directive/HIE_Opt_In), Status (Active/Revoked/Expired), Granted_Date, Expiry, Witness |
Regulatory_Publication |
External regulatory update tracking (NLP-extracted) | medium | Publication_ID, Source (CMS/State/TJC/OIG/FDA), Title, Publication_Date, Effective_Date, Impact_Areas, Summary, Extraction_Confidence |
Key Relationships:
PHI_Access_Log--triggers--> Privacy Breach Detection workflow (Anomaly_Score threshold)PHI_Access_Log--constrained_by--> hipaa-privacy-policyRegulatory_Return--depends_on-->Quality_Measure(measure data feeds submissions)Accreditation_Standard--constrained_by--> accreditation-readiness-policyRegulatory_Publication--triggers--> Regulatory Change Impact workflow (new effective dates)