Health Level 7- Templates SIGHealth Level 7- Templates SIG

ByByPeter Elkin, Mayo ClinicPeter Elkin, Mayo ClinicMartin Kernberg, UCSFMartin Kernberg, UCSFAngelo Rossi-Mori,Angelo Rossi-Mori, Italy Italy

HL7 - TemplatesHL7 - Templates

1.1. Constraints on Content and StructureConstraints on Content and Structure

2.2. System to allow / constrain the System to allow / constrain the

appropriate use of Templates in HL7 appropriate use of Templates in HL7

MessagesMessages

Constraints on Content and StructureConstraints on Content and Structure

Templates interact at both the CDA2 Templates interact at both the CDA2 and CDA3 Levelsand CDA3 Levels

Case #1 – CDA3Case #1 – CDA3CDA1CDA1

CDA2CDA2CDA3CDA3

Template (The Meta-Terminology Model Template (The Meta-Terminology Model (Huff))(Huff))

Content of Template (Slots)Content of Template (Slots) This contains Clinical ContentThis contains Clinical Content

Constraints on Content and StructureConstraints on Content and Structure

Templates interact at both the CDA2 Templates interact at both the CDA2 and CDA3 Levelsand CDA3 Levels

Case #2 – CDA2Case #2 – CDA2CDA1CDA1

CDA2CDA2 TemplateTemplate

Content of Template (Slots)Content of Template (Slots) This contains the Document Headings or This contains the Document Headings or

Structure (e.g. History of Present Illness, Structure (e.g. History of Present Illness, Physical Exam, Impression, etc.).Physical Exam, Impression, etc.).

System of TemplatesSystem of Templates Facilitate Information RetrievalFacilitate Information Retrieval Registration of Templates (LOINC codes)Registration of Templates (LOINC codes) Each TemplateEach Template

ID, Name, Sequence of Purpose Codes ID, Name, Sequence of Purpose Codes (Definition), Cardinality(Definition), CardinalityLOINC Ontology for CDA-2LOINC Ontology for CDA-2

Slot Registration (If you need a WBC count it is Slot Registration (If you need a WBC count it is found in the CBC Template).found in the CBC Template).

Rule Base Needed to Facilitate Translation Rule Base Needed to Facilitate Translation between Templatesbetween Templates

HL7 TemplatesHL7 Templates

Constraint System for HL7 MessagesConstraint System for HL7 Messages

Unambiguous Concept RepresentationUnambiguous Concept Representation

Format for attaching values to conceptsFormat for attaching values to concepts

Communication of Document StructureCommunication of Document Structure

Unambiguous Concept RepresentationUnambiguous Concept Representation

Necessary for Compositional Necessary for Compositional

Terminologies which are not fully Terminologies which are not fully

specifiedspecified

Necessary for environments where Necessary for environments where

multiple terminologies are used and multiple terminologies are used and

ideal behavior can not be guaranteed.ideal behavior can not be guaranteed.

Unambiguous Concept RepresentationUnambiguous Concept Representation Template (Vital Signs)Template (Vital Signs)

Slots (Named in LOINC)Slots (Named in LOINC)Allowable CodesAllowable Codes

Terminology (e.g. SNOMED)Terminology (e.g. SNOMED)

Code (e.g. Systolic Blood Pressure)Code (e.g. Systolic Blood Pressure)

Values (Association of “137” with the code above)Values (Association of “137” with the code above) Slots can be hierarchically arranged.Slots can be hierarchically arranged.

Blood Pressure can Subsume Blood Pressure can Subsume Systolic Blood Pressure Systolic Blood Pressure Diastolic Blood PressureDiastolic Blood Pressure

Format for attaching values to conceptsFormat for attaching values to concepts

Many concepts are composite Many concepts are composite concepts with a defined structureconcepts with a defined structure Blood Pressure (BP)Blood Pressure (BP)

Systolic BPSystolic BPDiastolic BPDiastolic BP

Orthostatic Blood PressuresOrthostatic Blood PressuresLying BPLying BPSitting BPSitting BPStanding BPStanding BP

Communication of Document StructureCommunication of Document Structure

Physical Examination TemplatePhysical Examination Template HEENTHEENT HeartHeart LungLung AbdomenAbdomen NeurologicalNeurological MusculoskeletalMusculoskeletal ExtremitiesExtremities Etc.Etc.

HL7 Templates SIGHL7 Templates SIG RIM derivation of clinical documents and templatesRIM derivation of clinical documents and templates Templates as constraints on messages: theoretical and use Templates as constraints on messages: theoretical and use

case issuescase issues Development and proposal of graphic notational system for Development and proposal of graphic notational system for

representation of clinical document templates (SR XML)representation of clinical document templates (SR XML) Initial comparison of information model and empiric foundations Initial comparison of information model and empiric foundations

of clinical document ontology and clinical templatesof clinical document ontology and clinical templates Template conformance, specializations, and extensions to HL7Template conformance, specializations, and extensions to HL7 Coordinating compositional terminologies with dataCoordinating compositional terminologies with data Integration efforts and harmonization with international Integration efforts and harmonization with international

organizations, specialty societies, and government agenciesorganizations, specialty societies, and government agencies

Types of TemplatesTypes of Templates1.1. Template types Template types as constraints on messages: as constraints on messages:

theoretical and use case issues (template ontology)theoretical and use case issues (template ontology)a.a. Constraint templates (constraints on name-value pairs)Constraint templates (constraints on name-value pairs)b.b. Style templates (combinatorial combinations of name-value Style templates (combinatorial combinations of name-value

pairs)pairs)c.c. Pattern template (data structure of repeated similar data Pattern template (data structure of repeated similar data

elements)elements)d.d. Document template (structured input document)Document template (structured input document)e.e. Profile or profile template (definition of the relationship Profile or profile template (definition of the relationship

between templates and profiles)between templates and profiles)f.f. Metatemplate (aggregation of templates)Metatemplate (aggregation of templates)g.g. Extension template (constraints on extensibility)Extension template (constraints on extensibility)

Constraint TemplatesConstraint Templates1.1.  O  Operate on code combinations permitted in a perate on code combinations permitted in a

code phrase (a V3.0 CD data type that allows code phrase (a V3.0 CD data type that allows addition of data types), known as eaddition of data types), known as encapsulationncapsulation. . a.a.                The definition of the boundary between The definition of the boundary between

information model and terminology model, in information model and terminology model, in combination with a template registration process combination with a template registration process probably by HL7 (possibly the Vocabulary TC), or other probably by HL7 (possibly the Vocabulary TC), or other designated organization, may be required. designated organization, may be required.

b.b.              Registration of particular templates implies the Registration of particular templates implies the need for registration of their components (need for registration of their components (metadata metadata registriesregistries).).

Style TemplatesStyle Templates

1.1.        A        Allow the distribution of semantic details between llow the distribution of semantic details between name and value in name-value pairs (known as name and value in name-value pairs (known as variable variable vs. valuevs. value style), and the style to represent details, either style), and the style to represent details, either by a pre-coordinated code or by a set of post-coordinated by a pre-coordinated code or by a set of post-coordinated codes (known as the codes (known as the molecular vs. atomicmolecular vs. atomic issue). issue). a.a.                The The style templatesstyle templates can also be described as can also be described as statement-level clinical statement-level clinical

templatestemplates. This activity requires terminological models harmonized with the . This activity requires terminological models harmonized with the RIM, and a formalism for representation of atomic elements to define the most RIM, and a formalism for representation of atomic elements to define the most granular level. granular level.

b.b.              The definition of the boundary between the information model and The definition of the boundary between the information model and terminology model is fundamental task. terminology model is fundamental task.

c.c.                There is a need operationally to preserve concepts under There is a need operationally to preserve concepts under transformations, translation, and transmission. transformations, translation, and transmission.

Pattern TemplatePattern Template 1.1.                A class of items (battery, panel, check list, data A class of items (battery, panel, check list, data

set) with some common features (e.g. procedure, set) with some common features (e.g. procedure, sample, dates). sample, dates).

a.a.                Generic patternsGeneric patterns (such as the information model underlying Chem7, (such as the information model underlying Chem7, Chem20, and Left’s; or message element types, such as US vs. international Chem20, and Left’s; or message element types, such as US vs. international addresses) can also be termed a base class. addresses) can also be termed a base class. Name-value pairsName-value pairs that can be that can be combinatorial combined can be considered a combinatorial combined can be considered a name-data structurename-data structure, with (1) , with (1) recursive layers and (2) constraints or rules on associated values. These recursive layers and (2) constraints or rules on associated values. These pattern templatespattern templates can be used by external bodies (e.g. professional societies, can be used by external bodies (e.g. professional societies, regulatory agencies, and international organizations) to decentralise the regulatory agencies, and international organizations) to decentralise the production of a large collection of production of a large collection of particular templatesparticular templates. .

b.b.              If required, in addition to the current procedures for interoperable If required, in addition to the current procedures for interoperable communication about master table definitions, certain kinds of communication about master table definitions, certain kinds of particular particular templatestemplates can be named and registered according to appropriate rules. can be named and registered according to appropriate rules. Possible application of Possible application of level 3 of the CDAlevel 3 of the CDA may be required. may be required.

Document TemplateDocument Template 1.1.                The The document templatedocument template which governs the which governs the

internal structure of a document, i.e., how a document internal structure of a document, i.e., how a document may be constructed from particular may be constructed from particular data elementsdata elements. These . These data elementsdata elements are termed are termed containerscontainers (sections, (sections, subsections, tables, lists), which hold, in turn, the subsections, tables, lists), which hold, in turn, the data data valuesvalues. The . The document templatedocument template can be considered as a can be considered as a particular example of particular example of CDA level 2CDA level 2. . The boundary The boundary between between standard tagsstandard tags of of Level 2 of the CDALevel 2 of the CDA, at the , at the upper level, and terminology at the lower level, is the upper level, and terminology at the lower level, is the domain of domain of document templatesdocument templates. Given the identification of . Given the identification of the document type, the appropriate constraints must be the document type, the appropriate constraints must be defined by the defined by the document templatedocument template. .

Profile TemplateProfile Template

1.1.                A A profile (or profile (or profile templateprofile template)) is a dataset of selected items that is a dataset of selected items that describes an existing entity, and is describes an existing entity, and is thus related to templates (a data thus related to templates (a data structure), which can be an input structure), which can be an input form for anticipated data, following form for anticipated data, following defined constraints. defined constraints.

Meta-TemplateMeta-Template

1.1.                The The metatemplatemetatemplate can be can be considered an ordered aggregation considered an ordered aggregation of multiple other templates, such as of multiple other templates, such as an an EHR templateEHR template for the Electronic for the Electronic Health Record. This could be a Health Record. This could be a representation of a CDA1 Construct.representation of a CDA1 Construct.

Extension TemplateExtension Template 1.1.                The The extension templateextension template or or “official” profile “official” profile

templatetemplate, , which idiosyncratically constrains or which idiosyncratically constrains or modifies (modifies (extensions represented asextensions represented as local R-MIMSlocal R-MIMS). ). The external implementation by agencies, The external implementation by agencies, institutions, or organizations must be authorized by institutions, or organizations must be authorized by HL7 according to procedures to be defined HL7 according to procedures to be defined ((franchisingfranchising). Recommendations and rules will be ). Recommendations and rules will be promulgated for development, documentation, promulgated for development, documentation, registration and maintenance of these external registration and maintenance of these external products strictly according to the RIM, the HDF, and products strictly according to the RIM, the HDF, and any further standards promulgated by HL7. any further standards promulgated by HL7.

Conclusion:Conclusion:

Join the HL7 Templates SIG Join the HL7 Templates SIG Where the Action is…Where the Action is… Where the Rubber Meets the Road…Where the Rubber Meets the Road… Looking for hard working creative Looking for hard working creative

individuals to dedicate themselves to individuals to dedicate themselves to making interoperability a realitymaking interoperability a reality

Discussion: ………Discussion: ………Thank You for Your Kind Attention!Thank You for Your Kind Attention!