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
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:19.2.1
Wound
Root concept of the Wound information model. This root concept contains all data elements of the Wound information model.
Technical specifications in HL7v3 CDA and HL7 FHIR
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
Wound
WoundType
or as spreadsheet 