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Reason to build data structure
it is able to bind all of the components of a concept into a manageable and understandable object; facilitate the capture of data in the sense of completeness; guide data entry and provide a template for the presentation of results
Compound data elements
a structure that includes other data elements; the attributes are similar to those for simple data elements; the advantage of a compound element is that linked components with tags can be included as an encapsulated set, but can be addresses as a whole unit or by components; ie blood pressure; can be built into higher level structures such as templates (HL7), archetypes (openEHR), Common Message Element Type (CMET)(HL7) and clinical statements (HL7) and other structures, must frequently use XML syntax
Complex data elements
the attributes are similar to data elements but may include description logic and mathematical calculations, or actions; may support trigger-driven data transport profiles such as data required when a patient is transferred from hospital to nursing home; may support Disease Management Profiles
Common Message Element Types (CMET)
were originally meant to be administrative objects defined by groups within HL7; were simple and obvious constructs such as person name, address, telephone numbers email addresses etc; as the power of these was appreciated, the group defining them expanded both the scope and dimension of CMETs; it may contain other of the same and are resuable without redefining the data object
defines a higher level data structure and may extend to such things as a well-baby exam, a school physical an employment physical, a diabetic screen, etc. are defined using XML syntac
HL7 Template examples
can be coupled to a clinical guideline and bundle the dat acollected from the guideline to the clinical note; static models describe the information structure of message documents that are defined according to the Clinical Document Architecture (CDA); can also bundle data collection definitions based on the presence of specific data element values
HL7 Template specific examples
Document Templates (of which CDA is one example)
Atomic Concept Definition Templates
Aggregate Measures Templates (compound data elements)
Computed Measures Templates (complex data elements
Assembly or Sub-assembly templates (structures within structures)
HL7 Template Contraints
is both structural and content; structural further restrict model elements such as cardinality, new class clones derived from balloted class clones, their attributes, relationships and HL7 data-types; nonstructural constraints include valid value set expressions and conditional constraints affecting more than one model element
Object Constraint Language (OCL)
how non-structural constraints are to be expresses; can specify most of the desirable constraints. has few tools available to help correctly author constraints in a static model
may be incorporated in CDAs and permit a generic CDA to be used for specific applications or data exchanges based on specific triggers, can be included into the CDA to provide flexibility in the visit-specific, event-specific, test-specific or any other tailoring of the encounter data, but retain interoperability within a single structure;
Permits a generic CDA to be tailored in a defined, constrained way to meet many data structure requirements; this approach is analogous to a paper form with mandatory and optional sections and described level of detain for each section; can define requirements in such a way that conformance can be determined
Atomic Concept Template
a template applied to part of a static mode that specifies the structure and permits coding to completely define a particular clinical concept; any constraints on coded elements or value ranges are specified; optional relevant components that may add nuances in particular circumstances can be included; are designed to be reusable in many different contexts; CEN defines Archetypes as these formally approved by recognized clinical bodies; example is Blood pressure, composed of two numerical measures with optional additional information about patient positioning, cuff size, etc
Computed Measures Template
is applied to an observation that has multiple components; describes the computational algorithm that creates the data element; is in effect a complex data element; examples are Apgar score and Glasgow Coma score
How are templates created -1
ideally we would have a tool that would prompt for data elements and relationships and automatically create templates and other required parts of it would be prompted for
How are templates created - 2
a static model derived from a ballotted static model using the HL7 Design tools
defined by ISO/CEN 13606 standard; denotes a model defining some domain concept, expressed using constraints on instance structures of an underling reference model; they guarantee interoperability at knowledge level in addition to data structure level; provide a well-defined basis for efficient querying of complex data; are similar to HL7 templates
Detailed Clinical Models (DCM)
are descriptions of items of clinical information that include the clinical knowledge about the concept, the data specification, a model and where possible, technical implementation specifications; are now being harmonized across ISO and HL7
they are balloted and a repository is being set up to include normative ones; Apgar Score, Barthel Index, Blood Pressure, Body Height, Body Temperature, Body Weight, Glasgow Coma Score, Pulse Rate and Respiration
provide another level of consistency, reusability and data sharing; the ability to incorporate data and knowledge into work-flow objects; structure objects play an important role in meaningful use; if the content is good, a mapping tool can bring harmony and receive benefit from both groups
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