Published

Health Care Delivery

vr.wm-act-014 · wm-act-014-health-care-delivery

Give an agent the system-side context needed to understand, populate, inspect and operate health care delivery: which provider organizations offer which services, through which authorized roles and at which physical, mobile, home or virtual locations; what capacity and readiness exist; how demand queues, allocations, referrals and transfers move people toward care; and how those records are stewarded, verified, measured and disclosed. Encounter lifecycle is delegated to the contained model WM-ACT-018; clinical, personal, workforce-qualification, organizational and estates facts stay with their owning models.

World Models Activities and processes ACT.HCR

Bundle → Layer → Finding → Questions Classifiers What it is Why it exists Distinguishing features What robots and AI may and may not do Moral aspects Owners Links to other meta-models Identity and identifiers Direct properties Recognition Capabilities and actions Hazards and failure modes Standards and interfaces Context of use Sources

Bundle → Layer → Finding → Questions Filled

6 bundles · 16 layers · 28 findings · 98 questions

Delivery network Who offers which health services, through which authorized roles, and at which physical, mobile, home or virtual delivery locations.

Provider-service topology

The offered service, its classification and modality, and its bindings to an accountable provider organization and to delivery locations.

Service offering identity and classification

The identity, classification, specialty and modality of a care service that a provider organization offers, held distinct from the organization that provides it and the place where it is delivered.

Which identifier authoritatively distinguishes this service offering from every other offering of the same provider? identity
How is the offering classified by category, service type and specialty, and against which governed code systems? classification
Which delivery modalities does the offering support, and is each modality independently deliverable? definition
What is the offering's active status and effective period, and what supersedes it when it is withdrawn or replaced? lifecycle

Provider and delivery-location binding

The binding of an offering to the accountable provider organization and delivery unit and to one or more delivery locations, including virtual, mobile and home delivery points, held as references.

Which provider organization and internal delivery unit is accountable for the offering at each location? composition
At which physical, mobile, home or virtual locations is the offering delivered, and how is a virtual delivery point represented? spatial
How are many-to-many bindings between offerings, locations and delivery units represented without duplicating the location or organization record? relationship

Authorized delivery roles

The time-bounded authorizations under which practitioner roles deliver named services at named locations, and whether those authorizations actually cover operating periods.

Delivery role authorization

A time-bounded authorization for a practitioner role to deliver named services at named locations for a provider organization, referencing the person and their qualifications without restating them.

Under whose authority is a practitioner role authorized to deliver this service at this location? authority
What is the authorization period of the role, and how are lapses, suspensions and renewals represented here without restating licensure? temporal
Which services and locations does the role cover, and how is the role kept distinct from the person holding it? relationship

Role coverage and vacancy state

A derived, time-bounded assertion of whether authorized roles cover an offering's operating periods, including uncovered periods, temporary cover and on-call arrangement references, expressed as delivery supply rather than as staff rostering.

Is the offering covered by at least the minimum authorized roles for each operating period, and what state applies when it is not? state
What distinguishes an unfilled establishment post from a temporarily uncovered operating period, and which of the two is recorded here? definition
What evidence and observation time support a coverage assertion, and how confident is it? evidence

Availability and operational capacity What the delivery network publishes as available, what it can actually deliver, and whether the inputs required to deliver are in place.

Published availability

The operating hours, exceptions and access channels that the delivery network publishes, distinguished from bookable operational supply.

Published availability and access channel

The published operating hours, time zone, planned and unplanned exceptions, access channels, referral method and appointment-required flags of an offering at a location, distinguished from the bookable supply held by the scheduling system.

What are the published operating hours and time zone of the offering at each delivery location? temporal
How are planned closures, holiday exceptions and unplanned suspensions of published availability represented? exception
How does published availability differ from bookable supply, and which system of record owns each? definition
Through which channels can the offering be reached, is a referral or appointment required, and by which method are referrals accepted? access

Operational capacity

Quantified deliverable capacity and its point-in-time occupancy, with the definitional basis made explicit.

Capacity statement

A quantified statement of deliverable capacity for an offering at a location over a period, with capacity type, unit and an explicit basis distinguishing physical stock, staffed and immediately available capacity, and surge or overflow capacity.

What capacity type, unit and quantity are asserted, and over which period or at which instant? measurement
Does the quantity count physical stock, staffed and immediately available capacity, or surge and overflow capacity, and which definition profile applies? definition
Which system asserted the capacity, when was it observed, and when was it received here? provenance
To which authority and on what cadence must this capacity be reported, and under which instrument? requirement

Capacity occupancy snapshot

A point-in-time count of occupied and available capacity against a named capacity statement, with an explicit snapshot rule separating single-instant snapshots from period aggregations.

At which instant is occupancy measured, and is the value a single-instant snapshot or an aggregation over a reporting period? temporal
Which capacity statement is the denominator for an occupancy figure, and are surge and overflow units included in it? measurement
When must small-number occupancy values be suppressed or aggregated before they are disclosed? privacy

Service readiness

Whether the tracer inputs required to deliver an offering are present, and which external records those inputs depend on.

Readiness tracer items and input dependencies

The readiness of an offering expressed as tracer items across amenities, equipment, standard precautions, diagnostic capacity and commodities, together with references to the externally owned workforce, equipment, estates and commodity records those items depend on.

Which tracer items must be present for this offering to count as ready, and to which readiness domain does each belong? requirement
By what method, on which date and by which assessor was readiness observed? evidence
Which external inventory, workforce or estates records does a readiness item reference rather than restate? relationship
How is a composite readiness index derived from domain scores, and what does a missing domain do to it? measurement

Demand, access and allocation The conditions under which people may reach an offering, the demand waiting for it, and the supply-side commitment of capacity against that demand.

Access conditions

Service-level eligibility, reach and accommodation attributes that determine who can obtain the offering and how.

Service eligibility and entry condition

The conditions under which a person may receive an offering, expressed as coded service-level conditions and references to governing policy, never as an individual eligibility determination.

Which eligibility conditions and qualifying comments apply to the offering, and against which policy are they defined? constraint
Which authority sets each eligibility rule, and in which jurisdiction or profile does it apply? authority
Where is an individual person's eligibility determination recorded, given that this model holds only the service-level rule? decision

Access accommodation and reach

The reach of an offering over a population or area and the accommodations it provides, including languages, communication support, physical accessibility and remote or home delivery.

Which population or geographic area does the offering serve, and is service refused outside it? spatial
Which languages and communication supports are available, and are they available for every modality? access
Which physical-access and reasonable-adjustment attributes are asserted, and against which standard are they coded? requirement

Queue and waiting state

Registered demand awaiting delivery, the rules that turn it into waiting time, and how it leaves the queue.

Demand registration entry

A registered unit of demand awaiting delivery of a named offering, carrying listing time, priority or urgency class and requested service, and referencing the subject without inlining personal or clinical content.

Which identifier distinguishes a queue entry, and how are duplicate registrations for the same demand detected? identity
Which priority or clinical urgency class is assigned, under which scheme, and who may change it? classification
How is the subject of the demand referenced without inlining any clinical or demographic content? privacy
Which offering, delivery unit or unnamed service pool is the demand registered against? relationship

Waiting clock rule binding

The definition set that turns queue entries into waiting times: clock start event, pause or exclusion conditions, stop events and censoring. These rules are supplied by an adopting jurisdiction profile; no universal rule is asserted, and the national rule suites needed to fix them were not retrievable in this pass.

Which event starts the waiting clock for this offering, and does a re-referral start a new clock or continue the existing one? definition
Under what conditions does the clock pause or exclude days, and how are those periods evidenced? temporal
How are completed waits distinguished from ongoing waits that are still censored when a waiting time is published? measurement
Which jurisdiction profile supplies the clock rules in force, and what happens to entries created under a superseded profile? validation

Queue exit and removal

How a queue entry leaves the queue - fulfilled, offered and declined, deferred, transferred, removed or expired - with reasons, permitted transitions and the effect on waiting measurement.

Which terminal and non-terminal states may a queue entry take, and which transitions between them are permitted? state
What reason vocabulary explains a removal that is not a fulfilment, and who may record it? event
How are offers, refusals and non-attendance recorded so that they do not silently reset the waiting measure? exception

Capacity allocation

Supply-side commitment of capacity units against demand, and the exceptions that release them.

Capacity commitment and allocation exception

The commitment of a capacity unit, authorized role and location to a queue entry or referral, and the exceptions that release the commitment, held as delivery supply and referencing rather than reproducing patient-facing booking records.

Which capacity unit, authorized role and location are committed, and against which queue entry or referral? process
How does a supply-side capacity commitment differ from the patient-facing appointment record, and which model owns each? composition
Which events release a committed capacity unit, and is the released capacity returned to the same period? exception

Care-flow coordination Directed movement of demand and delivery responsibility between services, units and organizations, and the reference link to the encounters that result.

Referral routing

Directed requests that another service take on delivery, and what happens to them.

Referral request and routing

A directed request that a named or unnamed target service take on delivery, carrying source, target, urgency, routing method and a reference to the coded clinical reason held elsewhere.

Which identifier follows a referral across the sending and receiving organizations? identity
Is the referral directed to a named offering, a delivery unit, a location or an unnamed pool, and how is that expressed? relationship
How is urgency expressed on a referral, and under which coded scheme? classification
How is the clinical reason for a referral referenced without copying clinical content into this model? privacy

Referral disposition and closure

The dispositions a referral can reach - acknowledged, accepted, redirected, rejected, withdrawn, expired, completed - with reasons, response-time expectations and chain preservation across redirections.

Which dispositions may a referral reach, and which actor is entitled to set each one? state
When a referral is redirected, is it the same referral or a new one, and how is the chain preserved? lifecycle
What time targets apply between referral sent, acknowledged and accepted, and how is a breach recorded? temporal

Transfer and handoff

Movement of delivery responsibility between services, units, locations or organizations, with milestones and the point at which responsibility passes.

Transfer of delivery responsibility

The record of delivery responsibility passing from a sending to a receiving service, unit or organization, with timestamped milestones, an explicit responsibility-transfer point and a continuity exception when the transfer fails.

Which sending and receiving offering, delivery unit and location are party to the transfer? composition
At which milestone does delivery responsibility pass from the sending to the receiving service? ownership
Which milestones are timestamped, and what is recorded when a milestone is missing? event
What is recorded when a transfer fails or continuity of delivery is broken? exception

Encounter flow linkage

The reference boundary between delivery-system records and the encounters owned by the contained model.

Encounter reference and delivery attribution

The link from delivery-system records to encounters owned by WM-ACT-018, carrying only the external encounter reference plus delivery-side attribution keys such as the offering, delivery unit, location, fulfilled queue entry and consumed capacity commitment.

Which encounter identifier and issuing system are carried here, and how is the reference resolved? interoperability
Which delivery-side keys are attached to an encounter reference? composition
Which encounter fields must never be copied into this model, and what is the fallback when the contained model is unavailable? constraint
Can one encounter satisfy more than one queue entry or referral, and how is that represented? relationship

Quality, measurement and disruption The quality commitments a delivery unit asserts, the computable measures used to describe delivery performance, and declarations that delivery is degraded.

Delivery quality commitments

The quality-management standards, accreditations and service-level commitments a delivery unit asserts, held as references with the evidence of record held elsewhere.

Quality commitment reference

The quality-management systems, standards and service-level commitments a delivery unit asserts over a named scope of offerings and sites, referencing certificates and policies issued and held by other parties.

Which quality management system or standard does the delivery unit assert, and over which scope of offerings and sites? authority
Which quality dimensions does a stated commitment address? quality
What evidence supports a certification or accreditation claim, and where is the certificate of record held? evidence

Operational measurement

Computable definitions of delivery measures and the result statements produced from them.

Delivery measure specification

The computable definition of a delivery measure: initial population, denominator, numerator and exclusion criteria, stratifiers, supplemental data, scoring method, unit and improvement notation, with inputs owned by other models named as references.

What are the initial population, denominator, numerator and exclusion criteria of the measure? measurement
Which stratifiers and supplemental data are required, and which are prohibited because they would re-identify small groups? privacy
Which measure inputs are owned by other models, and how are they resolved without recomputing their state? composition
Is an increase or a decrease in the measure an improvement, and what scoring method and unit apply? definition

Measure result and comparability

A computed result for a named measure version over a stated period and population, carrying computation provenance, input digests and explicit comparability caveats.

Which measure version, input artifacts and computation run produced this result? provenance
What reporting period and time zone does the result cover, and when was it computed and published? temporal
Which definitional or coverage differences prevent this result from being compared with another jurisdiction or period? quality

Delivery disruption

Declarations that delivery is degraded, diverted, suspended or over capacity.

Delivery disruption declaration

A declaration that delivery of named offerings at named locations is degraded, diverted, suspended or over capacity, with affected scope, timing, restoration expectation and escalation reference, stopping short of investigation and cause attribution.

What kind of disruption is declared, and against which severity scale? classification
Which offerings, locations and populations are affected, and are alternatives named? state
When did the disruption start, when was it declared, and what restoration time is expected? temporal
To whom is the declaration escalated, and where is any resulting investigation record held? authority

Governance, provenance and disclosure Who owns each record class, how records are verified, identified and timestamped, and under what constraints they are disclosed and retired.

Stewardship, verification and provenance

Ownership and asserted authority per record class, attestation and verification of directory records, and the identity and time rules applied to every record.

Record stewardship and asserted authority

Which actor owns each record class in this model, on what basis they assert authority to publish or amend it, in which jurisdiction or profile, and what happens to stewardship on merger, closure or service transfer.

Which steward owns each record class in this model? ownership
On what basis does a steward assert authority to publish or amend a record class? authority
What happens to stewardship when a provider organization merges, closes or transfers a service? lifecycle

Directory verification and attestation

Attestation by a responsible party that a directory record is accurate, and verification of attested fields against primary sources, with verification status, method, date and re-verification due date.

Who attested to the accuracy of a directory record, and at what instant? evidence
Against which primary source and by what method was an attested field verified? validation
How stale may a verified field become before it must be re-verified or marked unreliable? temporal

Identifier and time provenance

The identity assignment rules, the separation of event, observation and ingestion time, supersession linkage and the boundary between provenance held here and the externally owned audit trail.

Which identifier is authoritative for a record when several systems issue one? identity
Which of event time, observation time and ingestion time does a given field carry, and are all three required? temporal
How is a superseded record version linked to its replacement and to the agent that made the change? provenance
What provenance must this model hold, and what belongs to the external audit trail? security

Directory discovery, projections and endpoints

Consumers query where care is offered, hours, specialties and how to connect electronically. Public projections omit capacity, staffing, encounters and sensitive practitioner contacts. Endpoints describe connectivity; they do not grant this model ownership of the target FHIR server, XCA actor or audit log. Federated directories must preserve time-stamped updates and deprecation status rather than hard-delete.

Which projection (public directory, professional referral search, internal network, capacity heatmap) is being served, and which finding classes are included or omitted? access
What electronic endpoints are published for this organization or affiliation, with connection type, managing organization for support, and applicable network context? interoperability
For federated ingest, what is the source directory, last-update watermark, conflict-resolution policy, and deprecation status of each entry? provenance

Disclosure and retention

Named projections with their permitted field sets and purposes, and retention and disposition instructions whose execution is delegated.

Projection and disclosure constraint

Named projections of this model - public directory, operational, and person-linked - with the fields each may contain, the purposes and recipient classes for which each is released, and the aggregation or suppression required before publication. Evaluation and enforcement of any release decision are owned by the access-authorization model.

Which fields may appear in each named projection, and which are excluded by construction? access
For which purpose and recipient class is each projection released? privacy
What aggregation or suppression must be applied before a capacity, queue or flow projection is published? requirement
Which model evaluates and enforces a release decision, given that this model only declares the constraint? authority

Retention and disposition instruction

The retention class assigned to each record class of this model, legal-hold marking, the tombstone that must survive deletion so that references from other models do not dangle, and the evidence of executed disposition. Periods and execution are owned externally.

Which retention class applies to each record class in this model, and which policy sets its period? retention
How is a legal hold recorded, and what does it suspend? constraint
What must survive deletion as a tombstone so that references from other models do not dangle? requirement
What evidence proves that a disposition was executed, and which model holds that evidence? evidence

Classifiers Filled

Family: World Models
Category: Activities and processes
Entry kind: aggregate
Navigation path: NAV.ACT.HCR
Domain: ACT.HCR
Industry: Cross-industry
Tags: healthcaredeliveryact.hcr
Also called: K12

What it is Filled

This model is the delivery-system aggregate: the standing capability to deliver named health services and the administrative records that show how that capability is published, quantified, allocated, coordinated, measured and governed. It holds offerings, bindings, availability, capacity, readiness, access conditions, queues, capacity commitments, referrals, transfers, delivery measures, disruption declarations and the stewardship, provenance, projection and retention metadata for its own records. It holds encounters only as external references plus delivery-side attribution keys. It is independent of storage format and access interface: JSON, YAML, Markdown, Git, MCP and MongoDB are projections of these semantics, not the semantics themselves.

In scope

Service offerings: identity, classification, specialty and delivery modality (inpatient, outpatient, day, mobile, home, virtual), and the provider organization accountable for delivery.
Bindings between an offering, its delivery locations and the authorized practitioner roles that staff it, carried as references to externally owned organization, place and person records.
Published availability: operating hours and time zone, planned and unplanned exceptions, access channels, referral method and appointment-required flags.
Operational capacity statements distinguishing physical stock, staffed and immediately available capacity, and surge or overflow capacity, plus point-in-time occupancy snapshots.
Service readiness: tracer items across amenities, equipment, standard precautions, diagnostic capacity and commodities, and references to the external dependencies that constrain deliverability.
Service-level access conditions: eligibility conditions, referral requirement, reach or catchment, languages, communication support and accessibility attributes.
Demand and queue state: queue-entry registration, priority or urgency class, jurisdiction-bound waiting-clock rule bindings, and queue exits with reasons.
Supply-side capacity commitment and the exceptions that release committed capacity.
Referral routing, acceptance, redirection, rejection, expiry and closure, and inter-service transfer of delivery responsibility with milestones.
Delivery measure specifications and result statements covering availability, readiness, utilization, waiting and continuity, with denominators, stratifiers and comparability caveats.
Service disruption, diversion, capacity-breach and access-failure declarations with scope and restoration expectations.
Stewardship and asserted authority per record class, attestation and verification of directory records, identity and time provenance, named disclosure projections, and retention and disposition instructions for this model's own records.

Out of scope

Encounter identity, status lifecycle, participants, actual timing, subject status and admission or discharge disposition, which belong to the contained model WM-ACT-018.
Clinical content: diagnoses, observations, procedures, medications, care plans and personal longitudinal health episodes.
Person identity, demographics, patient-recorded preferences and the consent decisions themselves.
Practitioner qualification, licensure, registration and employment lifecycle, including establishment posts, contracts and rostering systems of record.
Organization incorporation, ownership, accreditation award and legal-entity lifecycle.
Facility construction, estates, asset and device lifecycle, and geospatial definition of sites.
Patient-facing appointment booking records and scheduling workflow.
Billing, coverage, claims and insurance adjudication.
Evaluation and enforcement of access-control, consent or disclosure decisions at runtime.
System audit trails, access logs and audit-event capture.
Incident investigation, root-cause analysis and clinical outcome attribution arising from a declared disruption.
Execution of deletion and disposition, and the setting of retention periods themselves.
Inventory and stock levels of medicines, consumables and equipment.

Why it exists Filled

Distinguishing features Filled

Covers the standing capability to deliver health services, not individual encounters or clinical content.
Publishes offerings, availability, capacity and access conditions that patients and referrers act on.
Contains health care encounters as child records but does not own diagnoses, orders or treatment.
Separate from practitioner licensure and facility construction, which it references.

What robots and AI may and may not do Filled

Must not

Give diagnosis or treatment advice under the guise of service navigation.
Allocate or withhold scarce capacity on criteria not set by the governing authority.
Publish availability that has not been confirmed by the provider.
Disclose identifiable patient data in queue or capacity reports.
Steer patients to services for commercial reasons.

Only with a human decision

Changing triage, prioritization or eligibility rules for access.
Suspending or withdrawing a service that patients depend on.
Committing capacity under contracts with commissioners or insurers.

May

Publish service offerings, opening hours and access conditions from the authoritative directory.
Report available capacity and queue status to authorized referrers.
Help a person find a service that matches stated needs and eligibility.
Flag inconsistencies between published offerings and practitioner role bindings.

Moral aspects Filled

Access rules and capacity allocation decide who gets care first; they must be fair and explainable.
Wrong availability information can delay urgent care.
Aggregate service data can still reveal sensitive information about small patient groups.
People with disabilities or language needs must find accurate access information.

Who is affected

Patients and carers seeking services
Clinicians and staff delivering services
Commissioners, insurers and health authorities

Owners Filled

Steward

The adopting Dimension must nominate a named steward for each record class (directory, availability, capacity, readiness, queue, commitment, referral, transfer, measure, disruption, governance) and record the authority basis under which that steward publishes or amends it.

Roles

Delivery network steward: Owns service offering entries, delivery bindings and role authorizations for a provider organization; Ensures referenced organization, place and person records resolve and are not copied locally; Initiates attestation and responds to failed verification
Capacity and readiness reporter: Records capacity statements, occupancy snapshots and readiness assessments with an explicit basis and definition profile; Meets the reporting cadence set by the obligating instrument and records late or corrected returns as new versions; Declares source system, observation time and ingestion time for every submitted value
Access and queue coordinator: Registers demand, maintains priority class and executes permitted queue transitions; Applies the bound waiting-clock profile and records the clock effect of every offer, refusal and deferral explicitly; Commits and releases capacity against queue entries and referrals
Referral and transfer coordinator: Routes referrals, records dispositions and preserves the chain across redirections; Records transfer milestones and the responsibility-transfer point, including failed transfers; Links encounter references to fulfilled queue entries and consumed commitments without importing encounter state
Measure and disclosure steward: Maintains versioned measure specifications and authorises result publication; Applies suppression thresholds and records comparability caveats and break-in-series markers; Maintains projection definitions and their permitted field sets, purposes and recipient classes
Model maintainer: Maintains version bindings to FHIR releases, the national directory guide, ISO 7101 and the jurisdiction profile; Runs the boundary check that rejects target-owned concepts before publication; Registers relation-ledger edges and records unresolved boundaries as gaps rather than as settled structure

Links to other meta-models Filled

child

WM-ACT-018 Health Care Encounter - Encounter identity, status lifecycle, participants, actual timing, subject status and admission or discharge disposition are delegated entirely to the contained model. This model carries only the encounter reference plus delivery-side attribution keys (offering, delivery unit, location, fulfilled queue entry, consumed capacity commitment) and never reproduces encounter lifecycle, event semantics or clinical context.

aligned

HL7 FHIR R5 delivery directory resource set (Organization, Location, HealthcareService, PractitionerRole) - Alignment for interoperable projection of offerings, bindings, locations and role authorizations. Alignment is at the element and boundary level only; these resources are Trial Use, so no conformance is claimed and no FHIR resource lifecycle is adopted.
HL7 National Directory of Healthcare Providers & Services Implementation Guide (STU1 1.0.0) - Alignment for attestation, primary-source verification, re-verification cadence and validation vocabulary on directory records. The guide is built on FHIR R4 and US Core, so a projection must pin its version explicitly rather than assume R5 equivalence.
HL7 FHIR R5 ServiceRequest - Binding for the referral and transfer-of-care request payload: status, intent, priority, performer type and location preference. Clinical reason and order content remain in the owning clinical model and are referenced by identifier only.
HL7 FHIR R5 Measure and MeasureReport - Binding for measure population criteria, stratifiers, scoring and improvement notation, and for the separation between a measure definition and a computed result. Measure logic libraries remain externally owned.
IETF RFC 3339 timestamp profile - Normative profile for every time value in this model: seconds are mandatory, an explicit numeric offset or 'Z' is required, and '-00:00' denotes an unknown local offset.
ISO 7101:2023 healthcare quality management system - Requirement-level alignment for the quality dimensions asserted in delivery commitments. Management-system conformity, internal audit and improvement processes remain owned by the organization's management system; this model references commitments and certification evidence only.

references

HL7 FHIR R5 scheduling resources (Schedule, Slot, Appointment) - Bookable supply and patient-facing booking records are referenced, never mirrored. This model carries only the supply-side capacity commitment and its release, together with the external booking reference and its issuing system.
Practitioner identity, qualification and licensure model (external owner; candidate ledger entry) - Persons, qualifications, registrations and licensure state are referenced from role authorizations. This model does not hold qualification lifecycle, primary-source licence verification of record, employment or rostering.
Organization identity and legal-entity lifecycle model (external owner; candidate ledger entry) - Provider organizations and their hierarchies are referenced as accountable delivery parties. Incorporation, ownership, affiliation and accreditation award lifecycle are not modelled here.
Place and site model (external owner; candidate ledger entry) - Delivery locations are referenced in instance or class mode. Site geometry, estates records, building lifecycle and geocoding remain externally owned and are never copied into bindings.
Personal health and clinical state model (external owner; candidate ledger entry) - Subjects of demand, referral reasons and clinical content are referenced by identifier. Diagnoses, observations, procedures, medications and personal health episodes are never inlined in queue, referral or transfer records.
Records retention and disposition policy model (external owner; adopting-Dimension policy) - Retention periods and the execution of disposition are owned by the referenced policy. This model issues retention-class assignments, hold markings and tombstone requirements only, and holds a reference to the evidence of executed disposition.
Access control, consent and disclosure authorization model (external owner; candidate ledger entry) - Projection definitions, purposes and recipient classes are declared here; the runtime access decision, its evaluation and its enforcement belong to the referenced model, and this reference confers no evaluation or enforcement semantics.
Audit trail model (external owner; candidate ledger entry) - Access events, audit capture and audit retention are owned by the referenced model. This model holds record provenance (recording agent, occurrence and recording times, supersession) only; referencing an audit record grants no audit-trail semantics.

extends

General service offering model (external owner; candidate ledger entry) - Specializes a generic service offering with health-delivery-specific bindings: clinical specialty, care modality, readiness tracers, referral method and eligibility conditions. Generic offering identity, authority, versioning and conflict handling remain in the target and are not restated here.

neighbor

WM-ACT-018 Health Care Encounter (contained child model) - FHIR separates the planned event from the actual event and gives the actual encounter its own status set, participants, actualPeriod and discharge disposition. Those semantics are owned by the child model. This model carries an encounter reference plus delivery-side attribution keys (offering, delivery unit, location, fulfilled queue entry, consumed capacity commitment) and never restates encounter status, timing or disposition.
Organization identity and legal-entity lifecycle model - FHIR states that Organization represents the conceptual grouping while Location records where a service occurs, and that the organization property on a record may not be the place of delivery. This model records an organization's participation in delivery, not its incorporation, ownership, accreditation award or partOf hierarchy of record.
Place and site model - FHIR states that Location describes the physical structures managed or operated by an organization, and supports a 'kind' mode for a class of locations used in planning. This model binds offerings to delivery locations and may use class-level location references, but does not own site geometry, estates records or building lifecycle.
Practitioner identity, qualification and licensure model - FHIR places personal qualifications on Practitioner and organizational participation on PractitionerRole, and omits address from PractitionerRole to prevent duplication of the location record. This model holds the role authorization period and its service and location bindings only; licensure state and its verification of record stay with the qualification model and the primary-source registry.
Scheduling and appointment model - FHIR distinguishes directory availability from bookable supply: HealthcareService works with Schedule to define actual availability, Slot represents available time within a Schedule, and Appointment reserves time and is administrative while the encounter carries clinical implications. This model owns supply-side capacity commitment and releases; it references booking records rather than reproducing them.
Clinical order and referral-content model - FHIR ServiceRequest carries the clinical need and may support a referral or transfer of care, while Task tracks execution of administrative work. This model holds the routing shell - source, target service, urgency, disposition - and references the coded clinical reason without copying clinical content.
Audit trail model - FHIR distinguishes Provenance as a record-keeping assertion about why a resource exists from AuditEvent, created as events occur to track and audit system activity. This model asserts record provenance for its own artifacts; capture, retention and interpretation of the audit trail are owned elsewhere, and referencing an audit record grants this model no audit-trail semantics.
Organizational quality management system - ISO 7101:2023 specifies requirements for a management system for quality in healthcare organizations and does not define delivery data elements. This model references applicable commitments and certification evidence held by the organization's management system rather than modelling management-system conformity itself.
Population health survey and person-reported unmet need - Eurostat unmet-need indicators derive from EU-SILC, a household survey of persons aged 16 and over reporting their own assessment, with named methodological limits. This model holds service-side access-barrier attributes and may reference survey results as external evidence; it does not own person-reported need.
Retention, disposition and access-authorization policy models - This model declares retention classes, tombstone requirements and projection constraints for its own records; the period-setting policy, the runtime access decision and the execution of disposition are owned by the adopting Dimension's policy models, and a reference to an evaluator or enforcement engine does not transfer those semantics here.

contains

WM-ACT-018

What else AI and robots need to interact with it Filled

Sources Filled

HealthcareService - FHIR v5.0.0 - HL7 International
PractitionerRole - FHIR v5.0.0 - HL7 International
Location - FHIR v5.0.0 - HL7 International
Organization - FHIR v5.0.0 - HL7 International
Encounter - FHIR v5.0.0 - HL7 International
Appointment - FHIR v5.0.0 - HL7 International
ServiceRequest - FHIR v5.0.0 - HL7 International
Measure - FHIR v5.0.0 - HL7 International
Provenance - FHIR v5.0.0 - HL7 International
National Directory of Healthcare Providers & Services (NDH) Implementation Guide - HL7 International, Patient Administration Work Group
Service Availability and Readiness Assessment (SARA) - World Health Organization
Quality health services: a planning guide - World Health Organization
Service organizations and integration - World Health Organization, Integrated Health Services
ISO 7101:2023 Healthcare organization management - Management systems for quality in healthcare organizations - Requirements - International Organization for Standardization
Healthcare resource statistics - beds (Statistics Explained) - European Commission, Eurostat
Unmet health care needs statistics (Statistics Explained) - European Commission, Eurostat
Hospital Respiratory Data (HRD) Reporting, National Healthcare Safety Network - Centers for Disease Control and Prevention (NCEZID/DHQP)
RFC 3339: Date and Time on the Internet: Timestamps - Internet Engineering Task Force (IETF)
HL7 FHIR R5 Encounter - scope, status, class, admission versus Appointment - HL7 International
HL7 FHIR R5 Organization - HL7 International
HL7 FHIR R5 PractitionerRole - HL7 International
HL7 FHIR R5 Location - HL7 International
HL7 FHIR R5 HealthcareService - scope and SOA exclusion - HL7 International
HL7 FHIR R5 ServiceRequest - patient-specific request for a service - HL7 International
HL7 FHIR R5 Schedule - HL7 International
HL7 FHIR R5 Slot - element definitions - HL7 International
IHE Mobile Care Services Discovery (mCSD) v4.0.0 Volume 1 - IHE International
UNSD Classification of Health Care Providers (ICHA-HP), SHA 2011 - OECD/WHO/Eurostat via UNSD
Classifying health workers (ISCO-08 mapping) - World Health Organization
WHO Master Facility List Resource Package - World Health Organization
ISO 13940 System of concepts to support continuity of care (DIS ed.2 landing) - ISO/TC 215
NHS Data Model and Dictionary - REFERRAL TO TREATMENT PERIOD STATUS - NHS England
NHS England Waiting List Minimum Data Set (WLMDS) - NHS England
NHS England Digital - Organisation Data Service ORD API (catalogue entry) - NHS England Digital

Open questions

Waiting-clock rule suites: the base recorded NHS England RTT and AIHW METeOR as unretrievable (403) and left waiting-clock-rule as a profile binding, while Grok retrieved NHS England RTT status and the WLMDS live. Re-verify those pages and fold them in as a named England jurisdiction profile bound to the base waiting-clock-rule finding, never as a universal state machine.
Licence-to-operate versus accreditation award: adjudicate with the organization model whether a service-level authorization-to-operate precondition (CLIA, pharmacy authority, radiation licence) belongs to this aggregate as a deliverability constraint, or whether all such facts are referenced from the organization and place models as the base boundary note currently asserts.
Schedule, Slot and Appointment ownership: the base assigns bookable supply to the scheduling neighbour while Grok holds Schedule and Slot locally. Adjudicate where slot-level bookable capacity sits relative to the base capacity-commitment-and-release finding before either model publishes.
EpisodeOfCare and longitudinal administrative grouping: neither provider models it locally and both flag it as unresolved between WM-ACT-018, the personal-health model and this aggregate.
Patient transport and ambulance dispatch: the base neither includes nor explicitly excludes it and Grok splits EMS service offering (in) from vehicle tracking (out). Adjudicate against a transport or emergency-response model, together with ambulance offload-delay measures.
Provider affiliation and delivery-network topology: HIE, IDN and network membership with role codes and effective periods appears only in Grok and only inside a provider-registry wrapper this plan rejects. Determine whether delivery-network membership is a delivery fact belonging here or an organization-model relationship.
ISO 7101:2023 normative clause text and OECD comparative access and waiting-time indicator definitions were unretrievable for both providers; both quality-commitment and comparability claims stay reference-only until the normative text is reviewed.
Social-care delivery scope: ISO/DIS 13940 edition 2 adds social care and SHA ICHA-HP HP.2 is residential long-term care, leaving it unresolved whether social-care delivery is in this aggregate or an adopting-profile extension.
Jurisdiction-specific waiting-time rule suites were not retrievable; the clock-rule finding is a profile binding, not a validated rule set.
ISO 7101:2023 normative clauses were not reviewed, so no management-system requirement is mapped to a data element.
OECD comparative access and waiting-time indicator definitions are absent from the evidence base.
SNOMED CT and other terminology bindings for service type, specialty, priority and removal reason are named as required but no specific value sets are asserted, since no terminology source was verified in this pass.
Cost, tariff, contract volume and commissioned-activity concepts are omitted; whether commissioned volume belongs to delivery capacity or to a contracting model is unresolved.
Emergency and disaster surge governance beyond a disruption declaration - mutual aid, regional escalation tiers, mass-casualty triage capacity - is not modelled.
Home-based and community delivery are supported as modalities but the visit-territory, travel-time and caseload constructs specific to domiciliary delivery are not elaborated.
Pharmacy, laboratory, imaging and diagnostic services are treated as ordinary offerings; whether diagnostic turnaround belongs here or in a separate diagnostics model is unresolved.
Patient transport and ambulance dispatch are neither included nor explicitly excluded and need adjudication against a transport or emergency-response model.
Blood, organ and tissue inventory as specialised capacity.
Ambulance offload-delay metrics and EMS vehicle tracking.
Pharmacy dispensing queues distinct from outpatient waiting lists.
Teaching-supervision matrices beyond a supervision_required flag.
Network-adequacy travel-time calculation (insurance regulation).
Price and costing on internal directories (FHIR mentions costing; no tariff model here).
Virtual-ward and hospital-at-home operational telemetry.
Correctional, military, veterans and indigenous health-system facility classes as first-class types.
ISO/DIS 13940 social-care organisations; social-care delivery is a likely omission unless an adopting profile extends ICHA-HP.
Prior-authorisation case records (constraint flag only).
Evidence gap: ISO 7101:2023 normative clause text (facilities management, workforce, virtual care) - catalogue and table of contents only.
Evidence gap: ISO 13940:2015 full concept definitions (healthcare actor, mandate, activity, encounter) - OBP blocked.
Evidence gap: US NPPES NPI, CMS Provider of Services, Joint Commission privileging and EMTALA statute text - not live-fetched; treated as region profiles, not canon.

Machine files

Card as JSON Specification AGENTS.md Source Card backlog vercy.card/1

Provenance

world-models research · reviewable-draft

Built from: models/wm-act-014-health-care-delivery/spec.yaml, ver-cy/world-models/card-supplements/wm-act-014-health-care-delivery.json