Wound-v3.1(2017EN): verschil tussen versies
Geen bewerkingssamenvatting |
Geen bewerkingssamenvatting |
||
Regel 3: | Regel 3: | ||
Version: '''3.1''' <br> | Version: '''3.1''' <br> | ||
HCIM Status:Final<br> | HCIM Status:Final<br> | ||
Release: '''2017''' <br> | |||
Release status: Prepublished<br> | Release status: Prepublished<br> | ||
Release date: 04-09-2017 | |||
----- | ----- | ||
<div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release_2017(EN)]] [[HCIM_Release_2017(EN) |Back to HCIM list ]]</div> | <div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release_2017(EN)]] [[HCIM_Release_2017(EN) |Back to HCIM list ]]</div> | ||
Regel 121: | Regel 121: | ||
==Information Model== | ==Information Model== | ||
<BR> | <BR> | ||
<imagemap> Bestand:Wound-v3.1Model(EN).png | center | |||
rect 765 635 885 685 [[#WoundEdgeCodelist]] | |||
rect 25 309 217 359 [[#WoundAnatomicalLocationCodelist]] | |||
rect 250 210 386 280 [[#12329]] | |||
rect 194 35 386 85 [[#WoundTypeCodelist]] | |||
rect 587 118 723 188 [[#10125]] | |||
rect 260 529 388 599 [[#10129]] | |||
rect 585 529 713 599 [[#10130]] | |||
rect 425 118 561 188 [[#10131]] | |||
rect 925 391 1074 461 [[#10132]] | |||
rect 428 529 556 599 [[#10133]] | |||
rect 149 635 305 685 [[#WoundTissueWCSCodelist]] | |||
rect 577 635 727 685 [[#WoundMoistureCodelist]] | |||
rect 250 118 386 188 [[#10120]] | |||
rect 250 300 386 370 [[#10117]] | |||
rect 582 295 682 375 [[#10119]] | |||
rect 244 410 386 480 [[MedicalDevice-v3.1(2017EN)]] | |||
rect 752 529 900 599 [[#10321]] | |||
rect 333 635 523 685 [[#WoundTissueOncoUlcerCodelist]] | |||
rect 749 118 898 188 [[#10720]] | |||
rect 924 118 1073 188 [[#10721]] | |||
rect 925 209 1074 279 [[#10722]] | |||
rect 925 300 1074 370 [[#10723]] | |||
rect 80 410 216 480 [[#11574]] | |||
rect 63 531 217 581 [[#WoundDrainTypeCodelist]] | |||
rect 25 220 217 270 [[#WoundLateralityCodelist]] | |||
desc none | |||
</imagemap> | |||
<BR> | <BR> | ||
{| border= "1" width="1500px" style = "font-size: 9.5pt; border: solid 1px silver; border-collapse:collapse;" cellpadding = "3px" cellspacing ="0px" | {| border= "1" width="1500px" style = "font-size: 9.5pt; border: solid 1px silver; border-collapse:collapse;" cellpadding = "3px" cellspacing ="0px" | ||
Regel 127: | Regel 154: | ||
|style="width:30px;"|Type||style="width:100px;"|Id||colspan="6 " style="width:140px;"|Concept||Card.||style="width: 600px;"|Definition||style="width:200px;"|DefinitionCode||style="width:200px;"|Reference | |style="width:30px;"|Type||style="width:100px;"|Id||colspan="6 " style="width:140px;"|Concept||Card.||style="width: 600px;"|Definition||style="width:200px;"|DefinitionCode||style="width:200px;"|Reference | ||
|-style="vertical-align:top; background-color: #E3E3E3; " | |-style="vertical-align:top; background-color: #E3E3E3; " | ||
|style = "text-align:center" |[[Bestand: block.png| 20px]] | |style = "text-align:center" |[[Bestand: block.png| 20px | link=]] | ||
||NL-CM:19.2.1 | ||NL-CM:19.2.1 | ||
|colspan ="6" style ="padding-left: 0px"|<span Title="NL: Wond">[[Bestand: arrowdown.png | 10px]]Wound</span> | |colspan ="6" style ="padding-left: 0px"|<span Id=10119 Title="NL: Wond">[[Bestand: arrowdown.png | 10px | link=]]Wound</span> | ||
| | | | ||
|Root concept of the Wound information model. This root concept contains all data elements of the Wound information model. | |Root concept of the Wound information model. This root concept contains all data elements of the Wound information model. | ||
Regel 135: | Regel 162: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.5 | ||NL-CM:19.2.5 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondSoort">[[Bestand: arrowright.png | 10px]]WoundType</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10120 Title="NL: WondSoort">[[Bestand: arrowright.png | 10px | link=]]WoundType</span> | ||
|1 | |1 | ||
|Description of the type of wound. | |Description of the type of wound. | ||
Regel 145: | Regel 172: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundTypeCodelist|WoundTypeCodelist]] | |[[Bestand: List2.png | link=#WoundTypeCodelist]]||[[#WoundTypeCodelist|WoundTypeCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.4 | ||NL-CM:19.2.4 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondWeefsel">[[Bestand: arrowright.png | 10px]]WoundTissue</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10129 Title="NL: WondWeefsel">[[Bestand: arrowright.png | 10px | link=]]WoundTissue</span> | ||
|0..1 | |0..1 | ||
|Description of the tissue of the wound. For this, the WCS model can be used. A different classification is used for oncological ulcers. | |Description of the tissue of the wound. For this, the WCS model can be used. A different classification is used for oncological ulcers. | ||
Regel 158: | Regel 185: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundTissueOncoUlcerCodelist|WoundTissueOncoUlcerCodelist]] | |[[Bestand: List2.png | link=#WoundTissueOncoUlcerCodelist]]||[[#WoundTissueOncoUlcerCodelist|WoundTissueOncoUlcerCodelist]] | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundTissueWCSCodelist|WoundTissueWCSCodelist]] | |[[Bestand: List2.png | link=#WoundTissueWCSCodelist]]||[[#WoundTissueWCSCodelist|WoundTissueWCSCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: BL.png| 16px]] | |style = "text-align:center" |[[Bestand: BL.png| 16px | link=]] | ||
||NL-CM:19.2.7 | ||NL-CM:19.2.7 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondInfectie">[[Bestand: arrowright.png | 10px]]WoundInfection</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10133 Title="NL: WondInfectie">[[Bestand: arrowright.png | 10px | link=]]WoundInfection</span> | ||
|0..1 | |0..1 | ||
|Indication stating whether the wound is infected. | |Indication stating whether the wound is infected. | ||
Regel 176: | Regel 203: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.6 | ||NL-CM:19.2.6 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondVochtigheid">[[Bestand: arrowright.png | 10px]]WoundMoisture</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10130 Title="NL: WondVochtigheid">[[Bestand: arrowright.png | 10px | link=]]WoundMoisture</span> | ||
|0..1 | |0..1 | ||
|Description of the moisture in the wound. | |Description of the moisture in the wound. | ||
Regel 190: | Regel 217: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundMoistureCodelist|WoundMoistureCodelist]] | |[[Bestand: List2.png | link=#WoundMoistureCodelist]]||[[#WoundMoistureCodelist|WoundMoistureCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.11 | ||NL-CM:19.2.11 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondRand">[[Bestand: arrowright.png | 10px]]WoundEdge</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10321 Title="NL: WondRand">[[Bestand: arrowright.png | 10px | link=]]WoundEdge</span> | ||
|0..1 | |0..1 | ||
|Description of the condition of the outer edges of the wound. | |Description of the condition of the outer edges of the wound. | ||
Regel 207: | Regel 234: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundEdgeCodelist|WoundEdgeCodelist]] | |[[Bestand: List2.png | link=#WoundEdgeCodelist]]||[[#WoundEdgeCodelist|WoundEdgeCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: PQ.png| 16px]] | |style = "text-align:center" |[[Bestand: PQ.png| 16px | link=]] | ||
||NL-CM:19.2.12 | ||NL-CM:19.2.12 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Wondlengte">[[Bestand: arrowright.png | 10px]]WoundLength</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10720 Title="NL: Wondlengte">[[Bestand: arrowright.png | 10px | link=]]WoundLength</span> | ||
|0..1 | |0..1 | ||
|The length of the wound. | |The length of the wound. | ||
Regel 223: | Regel 250: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: PQ.png| 16px]] | |style = "text-align:center" |[[Bestand: PQ.png| 16px | link=]] | ||
||NL-CM:19.2.13 | ||NL-CM:19.2.13 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Wondbreedte">[[Bestand: arrowright.png | 10px]]WoundWidth</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10721 Title="NL: Wondbreedte">[[Bestand: arrowright.png | 10px | link=]]WoundWidth</span> | ||
|0..1 | |0..1 | ||
|The width of the wound. | |The width of the wound. | ||
Regel 236: | Regel 263: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: PQ.png| 16px]] | |style = "text-align:center" |[[Bestand: PQ.png| 16px | link=]] | ||
||NL-CM:19.2.14 | ||NL-CM:19.2.14 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Wonddiepte">[[Bestand: arrowright.png | 10px]]WoundDepth</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10722 Title="NL: Wonddiepte">[[Bestand: arrowright.png | 10px | link=]]WoundDepth</span> | ||
|0..1 | |0..1 | ||
|The depth of the wound. | |The depth of the wound. | ||
Regel 249: | Regel 276: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.8 | ||NL-CM:19.2.8 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: AnatomischeLocatie">[[Bestand: arrowright.png | 10px]]AnatomicalLocation</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10117 Title="NL: AnatomischeLocatie">[[Bestand: arrowright.png | 10px | link=]]AnatomicalLocation</span> | ||
|0..1 | |0..1 | ||
|The location of the wound on the body. | |The location of the wound on the body. | ||
Regel 263: | Regel 290: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundAnatomicalLocationCodelist|WoundAnatomicalLocationCodelist]] | |[[Bestand: List2.png | link=#WoundAnatomicalLocationCodelist]]||[[#WoundAnatomicalLocationCodelist|WoundAnatomicalLocationCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:19.2.18 | ||NL-CM:19.2.18 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Lateraliteit">[[Bestand: arrowright.png | 10px]]Laterality</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=12329 Title="NL: Lateraliteit">[[Bestand: arrowright.png | 10px | link=]]Laterality</span> | ||
|0..1 | |0..1 | ||
|Laterality adds information about body side to the anatomic location, <i>e.g.</i> left | |Laterality adds information about body side to the anatomic location, <i>e.g.</i> left | ||
Regel 280: | Regel 307: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundLateralityCodelist|WoundLateralityCodelist]] | |[[Bestand: List2.png | link=#WoundLateralityCodelist]]||[[#WoundLateralityCodelist|WoundLateralityCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: TS.png| 16px]] | |style = "text-align:center" |[[Bestand: TS.png| 16px | link=]] | ||
||NL-CM:19.2.2 | ||NL-CM:19.2.2 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondOntstaansdatum">[[Bestand: arrowright.png | 10px]]WoundDateOfOnset</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10131 Title="NL: WondOntstaansdatum">[[Bestand: arrowright.png | 10px | link=]]WoundDateOfOnset</span> | ||
|0..1 | |0..1 | ||
|The date on which the wound appeared. | |The date on which the wound appeared. | ||
Regel 292: | Regel 319: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: TS.png| 16px]] | |style = "text-align:center" |[[Bestand: TS.png| 16px | link=]] | ||
||NL-CM:19.2.3 | ||NL-CM:19.2.3 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: DatumLaatsteVerbandwissel">[[Bestand: arrowright.png | 10px]]DateOfLastDressingChange</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10132 Title="NL: DatumLaatsteVerbandwissel">[[Bestand: arrowright.png | 10px | link=]]DateOfLastDressingChange</span> | ||
|0..1 | |0..1 | ||
|Date on which the dressing was last changed. | |Date on which the dressing was last changed. | ||
Regel 301: | Regel 328: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: Verwijzing.png| 20px]] | |style = "text-align:center" |[[Bestand: Verwijzing.png| 20px | link=]] | ||
||NL-CM:19.2.17 | ||NL-CM:19.2.17 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Drain::MedischHulpmiddel">[[Bestand: arrowright.png | 10px]]Drain::MedicalDevice</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10879 Title="NL: Drain::MedischHulpmiddel">[[Bestand: arrowright.png | 10px | link=]]Drain::MedicalDevice</span> | ||
|0..1 | |0..1 | ||
|A drain is a medical aid placed to drain blood and exudate from the wound area. | |A drain is a medical aid placed to drain blood and exudate from the wound area. | ||
Regel 315: | Regel 342: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: block.png]]||[[MedicalDevice-v3.1(2017EN) |MedicalDevice]] | |[[Bestand: block.png | link=MedicalDevice-v3.1(2017EN)]]||[[MedicalDevice-v3.1(2017EN) |MedicalDevice]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: CD.png| 16px]] | |style = "text-align:center" |[[Bestand: CD.png| 16px | link=]] | ||
||NL-CM:10.1.3 | ||NL-CM:10.1.3 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: none;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: none;" | | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: none;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: none;" | | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="3" style ="padding-left: 0px"|<span Title="NL: ProductType">[[Bestand: arrowright.png | 10px]]ProductType</span> | |colspan ="3" style ="padding-left: 0px"|<span Id=11574 Title="NL: ProductType">[[Bestand: arrowright.png | 10px | link=]]ProductType</span> | ||
| | | | ||
|Type of drain applied to the wound. | |Type of drain applied to the wound. | ||
Regel 330: | Regel 357: | ||
{| | {| | ||
|- | |- | ||
|[[Bestand: List2.png]]||[[#WoundDrainTypeCodelist|WoundDrainTypeCodelist]] | |[[Bestand: List2.png | link=#WoundDrainTypeCodelist]]||[[#WoundDrainTypeCodelist|WoundDrainTypeCodelist]] | ||
|} | |} | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: ED.png| 16px]] | |style = "text-align:center" |[[Bestand: ED.png| 16px | link=]] | ||
||NL-CM:19.2.15 | ||NL-CM:19.2.15 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: WondFoto">[[Bestand: arrowright.png | 10px]]WoundImage</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10723 Title="NL: WondFoto">[[Bestand: arrowright.png | 10px | link=]]WoundImage</span> | ||
|0..* | |0..* | ||
|A photo of the wound. | |A photo of the wound. | ||
Regel 342: | Regel 369: | ||
| | | | ||
|-style="vertical-align:top; background-color: transparent; " | |-style="vertical-align:top; background-color: transparent; " | ||
|style = "text-align:center" |[[Bestand: ST.png| 16px]] | |style = "text-align:center" |[[Bestand: ST.png| 16px | link=]] | ||
||NL-CM:19.2.9 | ||NL-CM:19.2.9 | ||
|style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | |style = "width: 7px; padding-left: 0px; padding-right: 0px; border-left: none; border-right: 1px dotted silver;" | | ||
|colspan ="5" style ="padding-left: 0px"|<span Title="NL: Toelichting">[[Bestand: arrowright.png | 10px]]Comment</span> | |colspan ="5" style ="padding-left: 0px"|<span Id=10125 Title="NL: Toelichting">[[Bestand: arrowright.png | 10px | link=]]Comment</span> | ||
|0..1 | |0..1 | ||
|Comment on the wound. | |Comment on the wound. | ||
Regel 363: | Regel 390: | ||
{|class="wikitable" width="621px" style= "font-size: 9.5pt;" | {|class="wikitable" width="621px" style= "font-size: 9.5pt;" | ||
|-style=vertical-align:top; | |-style=vertical-align:top; | ||
|colspan="2" style="background-color: #1F497D; width: 100%; color | |colspan="2" style="background-color: #1F497D; width: 100%; "|<font color=#FFFFFF><b>Wond</b></font> | ||
|-style=vertical-align:top; | |-style=vertical-align:top; | ||
| style="width: 42%; "|WondSoort | | style="width: 42%; "|WondSoort | ||
Regel 688: | Regel 715: | ||
==This information model in other releases== | |||
<ul> | |||
<li>[[Wound-v1.0(2015EN) | Release 2015, (Version 1.0)]]</li> | |||
<li>[[Wound-v3.0(2016EN) | Release 2016, (Version 3.0)]]</li> | |||
</ul> | |||
==More on this information model== | ==More on this information model== | ||
To exchange information based on health and care information models, additional, more technical specifications are required.<BR> | |||
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications: | |||
<ul> | |||
<li>HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment [http://decor.nictiz.nl/art-decor/decor-scenarios--zib2017bbr-?id=2.16.840.1.113883.2.4.3.11.60.7.4.2.19.2&effectiveDate=2017-09-04T00:00:00&language=en-US&scenariotree=false [[File:artdecor.jpg|16px|link=]]]</li> | |||
<li>HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR [https://simplifier.net/NictizSTU3/~resources?text=zib&category=StructureDefinition [[File:fhir.png|link=]]]</li> | |||
</ul> | |||
This information model is also available as [[Media:nl.zorg.Wound-v3.1(2017EN).pdf|pdf file]] [[File:PDF.png|link=]] or as [[Media:nl.zorg.Wound-v3.1(2017EN).xlsx|spreadsheet]] [[File:xlsx.png|link=]] | This information model is also available as [[Media:nl.zorg.Wound-v3.1(2017EN).pdf|pdf file]] [[File:PDF.png|link=]] or as [[Media:nl.zorg.Wound-v3.1(2017EN).xlsx|spreadsheet]] [[File:xlsx.png|link=]] | ||
==About this information== | ==About this information== | ||
The information in this wikipage is based on Prerelease 2017 #1 <BR> | The information in this wikipage is based on Prerelease 2017 #1 <BR> | ||
Conditions for use are located on the mainpage [[Bestand:list2.png|link=HCIM_Mainpage]]<BR> | Conditions for use are located on the mainpage [[Bestand:list2.png|link=HCIM_Mainpage]]<BR> | ||
This page is generated on | This page is generated on 30/11/2017 13:26:32 <BR> | ||
----- | ----- | ||
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Versie van 30 nov 2017 14:28
General information
Name: nl.zorg.Wound
Version: 3.1
HCIM Status:Final
Release: 2017
Release status: Prepublished
Release date: 04-09-2017
Metadata
DCM::CoderList | Werkgroep RadB Verpleegkundige Gegevens |
DCM::ContactInformation.Address | * |
DCM::ContactInformation.Name | * |
DCM::ContactInformation.Telecom | * |
DCM::ContentAuthorList | Werkgroep RadB Verpleegkundige Gegevens |
DCM::CreationDate | 7-7-2014 |
DCM::DeprecatedDate | |
DCM::DescriptionLanguage | nl |
DCM::EndorsingAuthority.Address | |
DCM::EndorsingAuthority.Name | PM |
DCM::EndorsingAuthority.Telecom | |
DCM::Id | 2.16.840.1.113883.2.4.3.11.60.40.3.19.2 |
DCM::KeywordList | Wond, wondzorg, WCS,TIME, ulcus |
DCM::LifecycleStatus | Final |
DCM::ModelerList | Werkgroep RadB Verpleegkundige Gegevens |
DCM::Name | nl.zorg.Wond |
DCM::PublicationDate | 04-09-2017 |
DCM::PublicationStatus | Prepublished |
DCM::ReviewerList | Projectgroep RadB Verpleegkundige Gegevens & Kerngroep Registratie aan de Bron |
DCM::RevisionDate | 04-09-2017 |
DCM::Superseeds | nl.zorg.Wond-v3.0 |
DCM::Version | 3.1 |
HCIM::PublicationLanguage | EN |
Revision History
Only available in Dutch
Publicatieversie 1.0 (01-07-2015)
Publicatieversie 3.0 (01-05-2016)
Publicatieversie 3.1 (04-09-2017)
ZIB-530 | Verwijzingen naar de bouwsteen Verpleegkundige Interventie verwijderd |
ZIB-533 | Toestaan dat de bouwsteen meer dan één foto kan bevatten |
ZIB-572 | Toevoegen code voor Skin Tear |
ZIB-585 | Toevoegen concept Lateraliteit aan het concept Anatomische Locatie |
.
Concept
A wound is an interruption of the continuity of the skin, often caused by external influences.
A commonly used model for documenting the wound properties is the TIME (‘Tissue’, ‘Infection’, ‘Moisture’, ‘Edge’) model, which can be used to systematically describe the wound. For wound tissue (T in the TIME model), the structure of the WCS model (Woundcare Consultant Society, WCS Kenniscentrum Wondzorg) is used. The WCS model is not suited for describing oncological ulcers. There is a separate classification for that.
Oncological ulcers are skin defects which result from the tumor process. They are different from wounds resulting from cancer treatment, such as radiotherapy, chemotherapy or surgery.
The concept does not describe decubitus wounds and burn wounds. For these, the relevant information models can be used.
Purpose
Information on the wound is recorded to share this information with other health professionals. This information can be used to monitor the wound’s healing process and provide insight into the implemented policy. In a transfer situation, it facilitates continuation of the treatment.
Evidence Base
Though the TIME model can be applied to all types of wounds in the list of wound types, the wound tissue classification (T in the TIME model) is different for different types.
The WCS classification is used for surgical wounds, trauma wounds, diabetic foot and venous ulcers. The following values are used:
- Red wound: granulation tissue
- Yellow wound: signs of infection or fibrin layer
- Black wound: with necrosis
(Source: www.wcs.nl)
Tissue in oncological ulcers is classified as follows:
- Degree I: intact epidermis with imminent damage to the skin through underlying tumor tissue
- Degree II: beginning damage to the subcutis
- Degree III: deep continued growth with damaged subcutis
- Degree IV: dry and/or liquefactive necrosis of up to 30% of the wound surface
- Degree V: dry and/or liquefactive necrosis of more than 30% of the wound surface
(Source: www.oncoline.nl)
Information Model
![Wound-v3.1Model(EN).png](/images/4/45/Wound-v3.1Model%28EN%29.png)
Type | Id | Concept | Card. | Definition | DefinitionCode | Reference | |||||||||
![]() |
NL-CM:19.2.1 | ![]() |
Root concept of the Wound information model. This root concept contains all data elements of the Wound information model. | ||||||||||||
![]() |
NL-CM:19.2.5 | ![]() |
1 | Description of the type of wound. |
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![]() |
NL-CM:19.2.4 | ![]() |
0..1 | Description of the tissue of the wound. For this, the WCS model can be used. A different classification is used for oncological ulcers. |
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![]() |
NL-CM:19.2.7 | ![]() |
0..1 | Indication stating whether the wound is infected. |
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![]() |
NL-CM:19.2.6 | ![]() |
0..1 | Description of the moisture in the wound. |
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![]() |
NL-CM:19.2.11 | ![]() |
0..1 | Description of the condition of the outer edges of the wound. |
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![]() |
NL-CM:19.2.12 | ![]() |
0..1 | The length of the wound. |
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![]() |
NL-CM:19.2.13 | ![]() |
0..1 | The width of the wound. |
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![]() |
NL-CM:19.2.14 | ![]() |
0..1 | The depth of the wound. |
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![]() |
NL-CM:19.2.8 | ![]() |
0..1 | The location of the wound on the body. |
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![]() |
NL-CM:19.2.18 | ![]() |
0..1 | Laterality adds information about body side to the anatomic location, e.g. left |
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![]() |
NL-CM:19.2.2 | ![]() |
0..1 | The date on which the wound appeared. | |||||||||||
![]() |
NL-CM:19.2.3 | ![]() |
0..1 | Date on which the dressing was last changed. | |||||||||||
![]() |
NL-CM:19.2.17 | ![]() |
0..1 | A drain is a medical aid placed to drain blood and exudate from the wound area. |
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| |||||||||
![]() |
NL-CM:10.1.3 | ![]() |
Type of drain applied to the wound. |
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![]() |
NL-CM:19.2.15 | ![]() |
0..* | A photo of the wound. | |||||||||||
![]() |
NL-CM:19.2.9 | ![]() |
0..1 | Comment on the wound. |
|
Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page
Example Instances
Only available in Dutch
Wond | |
WondSoort | Chirurgische wond |
AnatomischeLocatie | Bovenbuik |
Lateraliteit | Rechts |
WondOntstaansdatum | 10-10-2014 |
WondWeefsel | Gele wond |
WondInfectie | Nee |
WondVochtigheid | Vochtige wond |
WondRand | Ondermijning |
Wondlengte | 5 cm |
Wondbreedte | 2 cm |
Wonddiepte | 1 cm |
DatumLaatsteVerbandwissel | 18-10-2014 |
Toelichting | Wond lekt steeds minder. |
References
1. Richtlijn Wondzorg (Nederlandse Vereniging voor Heelkunde, 2013) [Online] Beschikbaar op:http://www.heelkunde.nl/uploads/o1/hI/o1hIRR2oR4QDojTm5pGjGA/Richtlijn-Wondzorg-final.pdf [Geraadpleegd: 13 februari 2015]
2. Richtlijn Oncologische ulcera (2010) [Online] Beschikbaar op:http://www.oncoline.nl/index.php?pagina=/richtlijn/item/pagina.php&id=32570&richtlijn_id=769 [Geraadpleegd: 13 februari 2015]
3. WCS [Online] Beschikbaar op:www.wcs.nl [Geraadpleegd: 13 februari 2015]
4. Oncoline [Online] Beschikbaar op:www.oncoline.nl [Geraadpleegd: 13 februari 2015]
Valuesets
WoundAnatomicalLocationCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.6 |
Conceptname | Codesystem name | Codesystem OID |
SNOMED CT: < 442083009 |Anatomical or acquired body structure| | SNOMED CT | 2.16.840.1.113883.6.96 |
WoundDrainTypeCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.7 |
Conceptname | Codesystem name | Codesystem OID |
SNOMED CT: << 32712000| drain | | SNOMED CT | 2.16.840.1.113883.6.96 |
WoundEdgeCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.5 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Wound epithelialisation | 449743005 | SNOMED CT | 2.16.840.1.113883.6.96 | Epithelisatie |
Skin irritation | 367466007 | SNOMED CT | 2.16.840.1.113883.6.96 | Irritatie |
Wound tissue undermining | 449752001 | SNOMED CT | 2.16.840.1.113883.6.96 | Ondermijning |
Macerated skin | 3644009 | SNOMED CT | 2.16.840.1.113883.6.96 | Verweking |
Other | OTH | NullFlavor | 2.16.840.1.113883.5.1008 | Anders |
WoundLateralityCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.8 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Left | 7771000 | SNOMED CT | 2.16.840.1.113883.6.96 | Links |
Right | 24028007 | SNOMED CT | 2.16.840.1.113883.6.96 | Rechts |
Right and left | 51440002 | SNOMED CT | 2.16.840.1.113883.6.96 | Rechts en links |
WoundMoistureCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.3 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Droge wond | DROOG | WondVochtigheid | 2.16.840.1.113883.2.4.3.11.60.40.4.7.3 | Droge wond |
Vochtige wond | VOCHTIG | WondVochtigheid | 2.16.840.1.113883.2.4.3.11.60.40.4.7.3 | Vochtige wond |
Natte wond | NAT | WondVochtigheid | 2.16.840.1.113883.2.4.3.11.60.40.4.7.3 | Natte wond |
WoundTissueOncoUlcerCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.2 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Graad I | GRAAD1 | OncoUlcerWeefsel | 2.16.840.1.113883.2.4.3.11.60.40.4.7.1 | Graad I |
Graad II | GRAAD2 | OncoUlcerWeefsel | 2.16.840.1.113883.2.4.3.11.60.40.4.7.1 | Graad II |
Graad III | GRAAD3 | OncoUlcerWeefsel | 2.16.840.1.113883.2.4.3.11.60.40.4.7.1 | Graad III |
Graad IV | GRAAD4 | OncoUlcerWeefsel | 2.16.840.1.113883.2.4.3.11.60.40.4.7.1 | Graad IV |
Graad V | GRAAD5 | OncoUlcerWeefsel | 2.16.840.1.113883.2.4.3.11.60.40.4.7.1 | Graad V |
WoundTissueWCSCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.1 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Rode wond | ROOD | WondWeefselWCS | 2.16.840.1.113883.2.4.3.11.60.40.4.7.2 | granulerend weefsel |
Gele wond | GEEL | WondWeefselWCS | 2.16.840.1.113883.2.4.3.11.60.40.4.7.2 | met infectieverschijnselen of fibrinebeslag |
Zwarte wond | ZWART | WondWeefselWCS | 2.16.840.1.113883.2.4.3.11.60.40.4.7.2 | met necrose |
WoundTypeCodelist
Valueset OID 2.16.840.1.113883.2.4.3.11.60.40.2.19.2.4 |
Conceptname | Conceptcode | Codesystem name | Codesystem OID | Description |
Surgical wound | 112633009 | SNOMED CT | 2.16.840.1.113883.6.96 | Chirurgische wond |
Wound | 416462003 | SNOMED CT | 2.16.840.1.113883.6.96 | Traumatische wond |
Ulcer of lower extremity | 95344007 | SNOMED CT | 2.16.840.1.113883.6.96 | Ulcus cruris |
Secondary malignant neoplasm of skin | 94579000 | SNOMED CT | 2.16.840.1.113883.6.96 | Oncologische ulcer |
Radiation ulcer | 403722002 | SNOMED CT | 2.16.840.1.113883.6.96 | Stralingswond |
Diabetic foot ulcer | 371087003 | SNOMED CT | 2.16.840.1.113883.6.96 | Ulcus van diabetische voet |
Skin tear | 428220001 | SNOMED CT | 2.16.840.1.113883.6.96 | Skin tear |
Other | OTH | NullFlavor | 2.16.840.1.113883.5.1008 | Anders |
This information model in other releases
More on this information model
To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
- HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
- HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR
This information model is also available as pdf file or as spreadsheet
About this information
The information in this wikipage is based on Prerelease 2017 #1
Conditions for use are located on the mainpage
This page is generated on 30/11/2017 13:26:32