1. Health Level 7- Templates SIG By Peter Elkin, Mayo Clinic Martin Kernberg, UCSF Angelo Rossi-Mori, Italy

2. HL7 - Templates 1. Constraints on Content and Structure 2. System to allow / constrain the appropriate use of Templates in HL7 Messages

3. Constraints on Content and Structure  Templates interact at both the CDA2 and CDA3 Levels  Case #1 – CDA3  CDA1 v CDA2 CDA3 CDA3  Template (The Meta-Terminology Model (Huff))  Content of Template (Slots)  This contains Clinical Content

4. Constraints on Content and Structure  Templates interact at both the CDA2 and CDA3 Levels  Case #2 – CDA2  CDA1 v CDA2  Template  Content of Template (Slots)  This contains the Document Headings or Structure (e.g. History of Present Illness, Physical Exam, Impression, etc.).

5. System of Templates  Facilitate Information Retrieval  Registration of Templates (LOINC codes)  Each Template v ID, Name, Sequence of Purpose Codes (Definition), Cardinality LOINC Ontology for CDA-2 LOINC Ontology for CDA-2 v Slot Registration (If you need a WBC count it is found in the CBC Template).  Rule Base Needed to Facilitate Translation between Templates

6. HL7 Templates  Constraint System for HL7 Messages v Unambiguous Concept Representation v Format for attaching values to concepts v Communication of Document Structure

7. Unambiguous Concept Representation  Necessary for Compositional Terminologies which are not fully specified  Necessary for environments where multiple terminologies are used and ideal behavior can not be guaranteed.

8. Unambiguous Concept Representation  Template (Vital Signs) v Slots (Named in LOINC) Allowable Codes Allowable Codes  Terminology (e.g. SNOMED)  Code (e.g. Systolic Blood Pressure) Values (Association of “137” with the code above) Values (Association of “137” with the code above) v Slots can be hierarchically arranged. Blood Pressure can Subsume Blood Pressure can Subsume  Systolic Blood Pressure  Diastolic Blood Pressure

9. Format for attaching values to concepts  Many concepts are composite concepts with a defined structure v Blood Pressure (BP) Systolic BP Systolic BP Diastolic BP Diastolic BP v Orthostatic Blood Pressures Lying BP Lying BP Sitting BP Sitting BP Standing BP Standing BP

10. Communication of Document Structure  Physical Examination Template v HEENT v Heart v Lung v Abdomen v Neurological v Musculoskeletal v Extremities v Etc.

11. HL7 Templates SIG  RIM derivation of clinical documents and templates  Templates as constraints on messages: theoretical and use case issues  Development and proposal of graphic notational system for representation of clinical document templates (SR XML)  Initial comparison of information model and empiric foundations of clinical document ontology and clinical templates  Template conformance, specializations, and extensions to HL7  Coordinating compositional terminologies with data  Integration efforts and harmonization with international organizations, specialty societies, and government agencies

12. Types of Templates 1. Template types as constraints on messages: theoretical and use case issues (template ontology) a. Constraint templates (constraints on name-value pairs) b. Style templates (combinatorial combinations of name- value pairs) c. Pattern template (data structure of repeated similar data elements) d. Document template (structured input document) e. Profile or profile template (definition of the relationship between templates and profiles) f. Metatemplate (aggregation of templates) g. Extension template (constraints on extensibility)

13. Constraint Templates 1. O perate on code combinations permitted in a code phrase (a V3.0 CD data type that allows addition of data types), known as encapsulation. a. The definition of the boundary between information model and terminology model, in combination with a template registration process probably by HL7 (possibly the Vocabulary TC), or other designated organization, may be required. b. Registration of particular templates implies the need for registration of their components (metadata registries).

14. Style Templates  1. A llow the distribution of semantic details between name and value in name-value pairs (known as variable vs. value style), and the style to represent details, either by a pre-coordinated code or by a set of post-coordinated codes (known as the molecular vs. atomic issue). v a. The style templates can also be described as statement-level clinical templates. This activity requires terminological models harmonized with the RIM, and a formalism for representation of atomic elements to define the most granular level. v b. The definition of the boundary between the information model and terminology model is fundamental task. v c. There is a need operationally to preserve concepts under transformations, translation, and transmission.

15. Pattern Template  1. A class of items (battery, panel, check list, data set) with some common features (e.g. procedure, sample, dates).  a. Generic patterns (such as the information model underlying Chem7, Chem20, and Left’s; or message element types, such as US vs. international addresses) can also be termed a base class. Name-value pairs that can be combinatorial combined can be considered a name- data structure, with (1) recursive layers and (2) constraints or rules on associated values. These pattern templates can be used by external bodies (e.g. professional societies, regulatory agencies, and international organizations) to decentralise the production of a large collection of particular templates.  b. If required, in addition to the current procedures for interoperable communication about master table definitions, certain kinds of particular templates can be named and registered according to appropriate rules. Possible application of level 3 of the CDA may be required.

16. Document Template  1. The document template which governs the internal structure of a document, i.e., how a document may be constructed from particular data elements. These data elements are termed containers (sections, subsections, tables, lists), which hold, in turn, the data values. The document template can be considered as a particular example of CDA level 2. The boundary between standard tags of Level 2 of the CDA, at the upper level, and terminology at the lower level, is the domain of document templates. Given the identification of the document type, the appropriate constraints must be defined by the document template.

17. Profile Template  1. A profile (or profile template) is a dataset of selected items that describes an existing entity, and is thus related to templates (a data structure), which can be an input form for anticipated data, following defined constraints.

18. Meta-Template  1. The metatemplate can be considered an ordered aggregation of multiple other templates, such as an EHR template for the Electronic Health Record. This could be a representation of a CDA1 Construct.

19. Extension Template  1. The extension template or “official” profile template, which idiosyncratically constrains or modifies (extensions represented as local R-MIMS). The external implementation by agencies, institutions, or organizations must be authorized by HL7 according to procedures to be defined (franchising). Recommendations and rules will be promulgated for development, documentation, registration and maintenance of these external products strictly according to the RIM, the HDF, and any further standards promulgated by HL7.

20. Conclusion:  Join the HL7 Templates SIG v Where the Action is… v Where the Rubber Meets the Road… v Looking for hard working creative individuals to dedicate themselves to making interoperability a reality v Discussion: ………  Thank You for Your Kind Attention!