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Data Structures Information Model

Issuer: openEHR Specification Program

Release: latest

Status: STABLE

Revision: [latest_issue]

Date: [latest_issue_date]

Keywords: EHR, data structures, openehr

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Amendment Record

Issue Details Raiser Completed

R E L E A S E     1.0.3

1.7.2

SPECRM-42. Clarify definition of HISTORY.summary (addresses SPECPR-81.

I McNichol,
G Grieve

15 Nov 2015

R E L E A S E     1.0.2

1.7.1

SPEC-271. Correct minor inconsistencies in ITEM_TABLE specification and example.

R Chen

05 Nov 2008

SPEC-257: Correct minor typos and clarify text.

C Ma,
R Chen, T Cook

SPEC-255. Correct minor error in INTERVAL_EVENT.width documentation.

A Patterson

SPEC-283. Correct spelling of ELEMENT.null_flavor attribute to null_flavour.

H Frankel

R E L E A S E     1.0.1

1.7

SPEC-200. Correct Release 1.0 typographical errors. Minor cosmetic changes to diagrams. Correct return types of ITEM_TABLE functions to CLUSTER rather than List<ELEMENT>.

D Lloyd,
T Beale

26 Sep 2006

SPEC-207: Change ITEM_TABLE columns to rows.

S Heard

SPEC-219: Use constants instead of literals to refer to terminology in RM.

R Chen

SPEC-220: Tighten semantics of HISTORY.period and EVENT.time.

A Patterson

R E L E A S E     1.0

1.6

SPEC-14. Adjust History. Major simplifcation to package; make Events absolute in time.

S Heard
T Beale

16 Dec 2005

SPEC-155: Summary data.

S Heard

SPEC-183. Remove root node from ITEM_TREE.

G Grieve

SPEC-185. Improved EVENT model.

S Heard

SPEC-155: Summary data.

S Heard
G Grieve

SPEC-192: Add display-as-absolute facility to delta Events in History (added explanation only).

S Heard

SPEC-193: Simplify INTERVAL_EVENT for archetyping and paths. Revert to one math function per INTERVAL_EVENT.

S Heard

SPEC-196: Rename HISTORY.items to events.

S Heard

SPEC-192. Support change, increase and decrease Events in History.

S Heard
D Lloyd

R E L E A S E     0.96

R E L E A S E     0.95

1.5.1

SPEC-48. Pre-release review of documents. Fixed HISTORY UML diagram - remove superfluous T:XXX (no semantic change). Converted parameter types to UML box form.

D Lloyd

22 Feb 2005

1.5

SPEC-101. Improve modelling of Structure classes.

DSTC

10 Dec 2004

SPEC-100. Correct inheritance error in ITEM_STRUCTURE package.

T Beale

SPEC-24. Revert meaning to STRING and rename as archetype_node_id_.

S Heard,
T Beale

SPEC-118. Make package names lower case.

T Beale

SPEC-123. EVENT should inherit from LOCATABLE.

R Chen

SPEC-124. Fix path syntax in data structures IM document.

T Beale

R E L E A S E     0.9

1.4

SPEC-19. Add HISTORY and STRUCTURE supertype.

T Beale

09 Mar 2004

SPEC-28. Change name of STRUCTURE class to avoid clashes.

H Frankel

SPEC-89. Remove ITEM.displayed.

DSTC

SPEC-91. Correct anomalies in use of CODE_PHRASE and DV_CODED_TEXT.

T Beale

SPEC-67. Change EVENT class to enable math function interval A measurements. Renamed EVENT.duration and SINGLE_EVENT.duration to width.

S Heard

Formally validated using ISE Eiffel 5.4.

T Beale

1.3.3

SPEC-41. Visually differentiate primitive types in openEHR documents.

D Lloyd

04 Sep 2003

1.3.2

SPEC-13 Rename key classes - rename COMPOUND to CLUSTER to conform with CEN 13606.

D Kalra,
T Beale

20 Jun 2003

1.3.1

Improved heading layout, package naming. Made HISTORY.is_periodic a function.

T Beale,
Z Tun

18 Mar 2003

1.3

Formally validated using ISE Eiffel 5.2. No changes.

T Beale

20 Feb 2003

1.2.1

Minor corrections to terminology_id invariants.

Z Tun

08 Jan 2003

1.2

Defined packages properly and moved HISTORY classes from EHR RM. No change to semantics.

T Beale

18 Dec 2002

1.1.1

Minor corrections: SINGLE_S new function.

T Beale

10 Nov 2002

1.1

Minor adjustments due to change in DV_CODED_TEXT.

T Beale

01 Nov 2002

1.0

Taken from Common RM.

T Beale

11 Oct 2002

Acknowledgements

The work reported in this paper has been funded in by the following organisations:

  • University College London - Centre for Health Informatics and Multi-professional Education (CHIME);

  • Ocean Informatics;

  • Distributed Systems Technology Centre (DSTC), under the Cooperative Research Centres Program through the Department of the Prime Minister and Cabinet of the Commonwealth Government of Australia.

Thanks to Grahame Grieve of Kestral Computing, Australia for general input and examples relating to History data.

Special thanks to David Ingram, Emeritus Professor of Health Informatics at UCL, who provided a vision and collegial working environment ever since the days of GEHR (1992).

1. Preface

1.1. Purpose

This document describes the common data structures used in openEHR reference model, including lists, tables, trees, and history.

The intended audience includes:

  • Standards bodies producing health informatics standards;

  • Academic groups using openEHR;

  • The open source healthcare community;

  • Solution vendors;

  • Medical informaticians and clinicians interested in health information.

  • Health data managers.

Prerequisite documents for reading this document include:

1.3. Status

This specification is in the STABLE state. The development version of this document can be found at http://www.openehr.org/releases/RM/latest/data_structures.html.

Known omissions or questions are indicated in the text with a 'to be determined' paragraph, as follows:

TBD: (example To Be Determined paragraph)

Users are encouraged to comment on and/or advise on these paragraphs as well as the main content. Feedback should be provided either on the technical mailing list, or on the specifications issue tracker.

1.4. Conformance

Conformance of a data or software artifact to an openEHR Reference Model specification is determined by a formal test of that artifact against the relevant openEHR Implementation Technology Specification(s) (ITSs), such as an IDL interface or an XML-schema. Since ITSs are formal, automated derivations from the Reference Model, ITS conformance indicates RM conformance.

2. Background

2.1. Requirements

The requirements for structured data in the EHR and other systems are essentially that low-level data can be expressed in standard structures. The structures which are commonly required are as follows:

  • single values, e.g. weight, height, blood sugar;

  • lists of named/numbered elements, e.g. blood test results;

  • tables of values with named columns and/or named rows, e.g. visual acuity results;

  • trees of values, e.g. biochemistry, microbiology results;

  • histories of values, each of which takes any of the above forms, e.g. a time series of blood pressures, glucose levels, or imaging data.

2.2. Design Principles

The design principle which particularly applies to the data structure models described here is the need to provide explicit specifications for logical structures using the same generic representation, such as hierarchy. The logical structures include tables, lists, trees, and the concept of history.

Regardless of whether such structures are treated as pure presentation or as having semantic significance, there are at various reasons for explicitly including the semantics of logical structures which are represented in a generic way such as hierarchy, including:

  • it is essential for interoperability that a structure such as a logical table, list or linear history be encoded into the generic representation in the same way by all senders and receivers of information, otherwise there is no guarantee that any communicating party’s software processes the structures in the intended fashion;

  • software implementors can develop software which explicitly captures the logical structures as functional interfaces which are used as the only way of building such structures. Such interfaces (assuming they are bug-free) guarantee that all application software always creates correct structures - there is no need to rely on caller software each time making low level calls to create a table or list out of hierarchy elements;

  • the use of a functional interface for such types means that application software at the receiver’s end can always process incoming information in its intended form, enabling correct presentation of data on the screen.

One of the motivations for defining logical data structures explicitly is to remove the ambiguity in recording structure and time in previous EHR specifications and standards, such as CEN 13606, GEHR, GEHR Australia, and HL7v3 CDA specifications. The alternative in the past was to simply use generic hierarchical structures; there was no agreement in the standard about how a table might be represented, similarly, time had no standard representation. Where single values were recorded, an attribute meaning 'time of recording' was set appropriately; if a time series was required, there was no clear guideline as to how to model it. One way would have been to build a double list which is logically a two column table, whose first column was time-point data, but many other approaches are possible. The standardised approach removes all such ambiguity, and improves the quality of data and software.

3. Overview

The rm.data_structures package contains two packages: the item_structure package and the history package. The first describes generic, path-addressable data structures, while the latter describes a generic notion of linear history, for recording events in past time. The data_structures package is illustrated in the UML diagram below.

RM data structures
Figure 1. rm.data_structures Package

The data_structures package itself contains a single class, DATA_STRUCTURE, which is the ancestor of all openEHR data structures. Its only feature is the function as_hierarchy, which is implemented by each subtype of DATA_STRUCTURE, in order to generate a physical representation of the structure in CEN EN13606 form. The 13606 form is usually less optimal than the openEHR form, but is compatible with the less semantically rich standard, and is guaranteed (in theory) to be comprehensible to other systems which support CEN EN13606 as an interoperability standard.

3.1. Instance Structures

Diagrams of typical instances of the structures are included throughout this document. Each instance of shown in both physical and logical form. The physical form shows the instances which will occur in data if the structure is implemented using the representation package. The logical form shows the same instance in a logical form only - i.e. hiding the physical implementation. Only the latter form is used in other openEHR documents. In all instance diagrams, the following shorthand is used for well-known attribute names:

  • "m = xxxx" - means "meaning = xxxx", i.e. the meaning of the archetype_node_id attribute inherited from the LOCATABLE class.

  • "n = xxxx" - means "name = xxxx", i.e. the value of the name attribute inherited from the LOCATABLE class.

  • "v = xxxx" - means "value = xxxx", i.e. the value of the value attribute from the ELEMENT class.

3.2. Class Descriptions

3.2.1. DATA_STRUCTURE Class

Class

DATA_STRUCTURE (abstract)

Description

Abstract parent class of all data structure types. Includes the as_hierarchy function which can generate the equivalent CEN EN13606 single hierarchy for each subtype’s physical representation. For example, the physical representation of an ITEM_LIST is List<ELEMENT>; its implementation of as_hierarchy will generate a CLUSTER containing the set of ELEMENT nodes from the list.

Inherit

LOCATABLE

Functions

Signature

Meaning

as_hierarchy: ITEM

Hierarchical equivalent of the physical representation of each subtype, compatible with CEN EN 13606 structures.

4. Item Structure Package

4.1. Overview

The item_structure package classes presented here are a formalisation of the need for generic, archetypable data structures, and are used by all openEHR reference models.

The subtypes of the ITEM_STRUCTURE class explicitly model the logical data structure types which typically occur in health record data, and include ITEM_SINGLE (for single values such as a patient weight), ITEM_LIST (for lists such as parts of an address), ITEM_TREE (for hierarchically structured data such as a microbiology report) and ITEM_TABLE (for tabular data such as visual acuity or reflex test results). Each of these classes defines a functional interface, has an optimal physical representation using the basic types CLUSTER and ELEMENT from the representation package, and can generate a CEN EN13606-compliant hierarchical representation of its data. Any system implementing these types is guaranteed to create data which represents the logical structures of lists, tables and trees identically.

Data values are connected to spatial structures via the value attribute of the ELEMENT class of the representation cluster. This class also carries an important attribute null_flavour, whose value indicates how to read the value. A small domain termlist containing values such as "unknown", "not disclosed", "undetermined", etc, as described in the Flavours of Null vocabulary in the openEHR Support Information Model.

The openEHR class model for spatial structures is illustrated on the right-hand side of the figure rm.data_structures Package. It should be noted that these classes (ITEM_LIST etc) are not equivalents of similarly named classes (such as List<T>) in most data structure libraries - they also include per-node name, archetype_node_id and leaf node value and null flavour, and path capabilities.

4.2. CEN EN13606 Encoding Rules

4.2.1. ITEM_SINGLE

An ITEM_SINGLE object is encoded in EN13606 as a single ELEMENT object.

4.2.2. ITEM_LIST

An ITEM_LIST object is encoded in EN13606 as a CLUSTER object containing the set of ELEMENTs from the openEHR list.

4.2.3. ITEM_TABLE

The ITEM_TABLE encoding rules are as follows:

  • Each row is encoded as a Cluster containing a number of ELEMENTs, each corresponding to the value of a column in that row.

  • An empty/void column value for a row is represented by an ELEMENT containing no value, and with null_flavour set.

  • The names of the ELEMENT in a row are the column names.

  • The names of the containing CLUSTER of each row is the stringified number of the row in the overall table.

4.2.4. ITEM_TREE

Data of an ITEM_TREE instance are simply replicated as is to produce the correct EN13606 hierarchical form.

4.3. Class Descriptions

4.3.1. ITEM_STRUCTURE Class

Class

ITEM_STRUCTURE (abstract)

Description

Abstract parent class of all spatial data types.

Inherit

DATA_STRUCTURE

4.3.2. ITEM_SINGLE Class

Class

ITEM_SINGLE

Description

Logical single value data structure. Used to represent any data which is logically a single value, such as a person’s height or weight.

Inherit

ITEM_STRUCTURE

Attributes

Signature

Meaning

1..1

item: ELEMENT

Functions

Signature

Meaning

(effected)

as_hierarchy: ELEMENT

Generate a CEN EN13606-compatible hierarchy consisting of a single ELEMENT.

4.3.3. ITEM_LIST Class

Class

ITEM_LIST

Description

Logical list data structure, where each item has a value and can be referred to by a name and a positional index in the list. The list may be empty. Use Used to represent any data which is logically a list of values, such as blood pressure, most protocols, many blood tests etc.

Misuse: Not to be used for time-based lists, which should be represented with the proper temporal class, i.e. HISTORY.

Inherit

ITEM_STRUCTURE

Attributes

Signature

Meaning

0..1

items: List<ELEMENT>

Physical representation of the list.

Functions

Signature

Meaning

item_count: Integer

Count of all items.

names: List<DV_TEXT>

Retrieve the names of all items.

named_item (a_name: String): ELEMENT

Retrieve the item with name ‘a_name’.

ith_item (i: Integer): ELEMENT

Retrieve the i-th item with name.

(effected)

as_hierarchy: CLUSTER

Generate a CEN EN13606-compatible hierarchy consisting of a single CLUSTER containing the ELEMENTs of this list.

Invariant

Valid_structure: items.forall (i:ITEM | i.type = "ELEMENT")

4.3.4. ITEM_TABLE Class

Class

ITEM_TABLE

Description

Logical relational database style table data structure, in which columns are named and ordered with respect to each other. Implemented using Cluster-per-row encoding. Each row Cluster must have an identical number of Elements, each of which in turn must have identical names and value types in the corresponding positions in each row.

Some columns may be designated key' columns, containing key data for each row, in the manner of relational tables. This allows row-naming, where each row represents a body site, a blood antigen etc. All values in a column have the same data type.

Used for representing any data which is logically a table of values, such as blood pressure, most protocols, many blood tests etc.

Misuse: Not to be used for time-based data, which should be represented with the temporal class HISTORY. The table may be empty.

Inherit

ITEM_STRUCTURE

Attributes

Signature

Meaning

0..1

rows: List<CLUSTER>

Physical representation of the table as a list of CLUSTERs, each containing the data of one row of the table.

Functions

Signature

Meaning

row_count: Integer

column_count: Integer

row_names: List<DV_TEXT>

column_names: List<DV_TEXT>

ith_row (i: Integer): CLUSTER

has_row_with_name (a_key: String): Boolean

has_column_with_name (a_key: String): Boolean

named_row (a_key: String): CLUSTER

has_row_with_key (keys: List<String>): Boolean

row_with_key (keys: List<String>): CLUSTER

element_at_cell_ij (i, j: Integer): ELEMENT

(effected)

as_hierarchy: CLUSTER

Generate a CEN EN13606-compatible hierarchy consisting of a single CLUSTER containing the CLUSTERs representing the columns of this table.

Invariant

Valid_structure: rows.for_all (items.for_all (instance_of ("ELEMENT")))

4.3.5. ITEM_TREE Class

Class

ITEM_TREE

Description

Logical tree data structure. The tree may be empty. Used for representing data which are logically a tree such as audiology results, microbiology results, biochemistry results.

Inherit

ITEM_STRUCTURE

Attributes

Signature

Meaning

0..1

items: List<ITEM>

The items comprising the ITEM_TREE. Can include 0 or more CLUSTERs and/or 0 or more individual ELEMENTs.

Functions

Signature

Meaning

has_element_path (a_path: String): Boolean

True if path a_path' is a valid leaf path.

element_at_path (a_path: String): ELEMENT

Return the leaf element at the path a_path'.

(effected)

as_hierarchy: CLUSTER

Generate a CEN EN13606-compatible hierarchy, which is the same as the tree’s physical representation.

4.4. Instance Structures

4.4.1. ITEM_SINGLE Instance Structure

The figure below illustrates a ITEM_SINGLE instance, in both physical and logical forms.

instance item single
Figure 2. Instance Structure of ITEM_SINGLE

4.4.2. ITEM_LIST Instance Structure

The following figure illustrates a typical ITEM_LIST structure, in this case for a BP protocol.

instance item list
Figure 3. Instance Structure of ITEM_LIST

4.4.3. ITEM_TABLE Instance Structure

The next figure illustrates a table of visual acuity test results.

instance item table
Figure 4. Instance Structure of ITEM_TABLE

4.4.4. ITEM_TREE Instance Structure

The following figure illustrates te logical and physical form of an example ITEM_TREE instance, representing a biochemistry result.

instance item tree
Figure 5. Instance Structure of ITEM_TREE

5. Representation Package

5.1. Overview

This package contains classes for a simple hierarchical representation of any data structure, as shown on the lower right side of the figure rm.data_structures Package. These classes are compatible with the CEN EN13606 classes of the same names, and instances can be losslessly generated to and from EN13606 instances structures.

5.2. Class Descriptions

5.2.1. ITEM Class

Class

ITEM (abstract)

Description

The abstract parent of CLUSTER and ELEMENT representation classes.

Inherit

LOCATABLE

5.2.2. CLUSTER Class

Class

CLUSTER

Description

The grouping variant of ITEM, which may contain further instances of ITEM, in an ordered list.

Inherit

ITEM

Attributes

Signature

Meaning

1..1

items: List<ITEM>

Ordered list of items - CLUSTER or ELEMENT objects - under this CLUSTER.

5.2.3. ELEMENT Class

Class

ELEMENT

Description

The leaf variant of ITEM, to which a DATA_VALUE instance is attached.

Inherit

ITEM

Attributes

Signature

Meaning

0..1

null_flavour: DV_CODED_TEXT

Flavour of null value, e.g. indeterminate, not asked etc.

0..1

value: DATA_VALUE

Property representing leaf value object of ELEMENT. In real data, any concrete subtype of DATA_VALUE can be used.

Functions

Signature

Meaning

is_null: Boolean

True if value logically not known, e.g. if indeterminate, not asked etc.

Invariant

Is_null_valid: is_null = (value = Void)

Null_flavour_indicated: is_null xor null_flavour = Void

Null_flavour_valid: is_null implies terminology (Terminology_id_openehr).has_code_for_group_id (Group_id_null_flavour, null_flavour.defining_code)

6. History Package

6.1. Overview

The history package defines classes which formalise the concept of past, linear time, via which historical data of any structural complexity can be recorded. It supports both instantaneous and interval event samples within periodic and aperiodic series. Data recorded in interval events are tagged with a mathematical function, including 'point-in-time', 'mean', 'delta' and so on, as defined by the openEHR event_math_function vocabulary. It also supports the inclusion of "summary" data, i.e. a textual or image item which summarises in some way the entire history.

Regardless of whether the actual data consist of a single sample or many, they are represented in the same way: as a history of events, i.e. as a time series, allowing all software to access data in a uniform way, whether it is a single measurement of weight, a long series of three- or four-dimensional images, or even a series of encapsulated multimedia items.

The model defines the constrained generic (otherwise known as 'template' or 'parameterised') types HISTORY<T>, EVENT<T>, POINT_EVENT<T>, and INTERVAL_EVENT<T> where the type parameter is constrained to the ITEM_STRUCTURE type, and defines the type of the data recorded in an instance of HISTORY. The effect is that repeated instances of spatially complex data can recur in time, corresponding to the way data are actually measured. An aperiodic series of POINT_EVENT instances would typically be used to represent manual measurements repeated in time. Periodic histories of INTERVAL_EVENT instances would typically be used to represent vital signs monitor output (which is usually delivered in averaged form potentially with additional minimum and maximum values).

As with all other parts of the openEHR reference model, the history package is designed for archetyping; archetypes define the domain semantics of HISTORY instances. The history package is shown on the left of the figure rm.data_structures Package.

6.1.1. Basic Semantics

The intention of the History model is to represent time-based data for which every sample in the series is a measurement of the same phenomenon (e.g. patient heartrate) and is obtained using the same measurement method (e.g. pulse oximeter). Samples taken in this way can be reliably treated as representing changes in a phenomenon over time, and accordingly can be safely used for time-based computation, such as graphing, statistical analysis and so on. A History can contain any mixture of POINT_EVENT and INTERVAL_EVENT instances. Clearly it is impossible for the model to guarantee completely correct usage on its own, however there two major safeguards.

Firstly, the use of generic types forces the type of the data in each Event to be the same. A History of type HISTORY<ITEM_LIST> therefore constrains the type of the data at each Event (EVENT.item) to be of type ITEM_LIST and nothing else.

Secondly, the use of archetyping (typically within openEHR Observation archetypes) ensures the actual structure of the ITEM_STRUCTURE subtype is defined in the same way for every sample - e.g. a two-item list representing systolic and diastolic blood pressure.

6.1.2. Timing

An instance of the HISTORY class contains the origin: DV_DATE_TIME attribute, indicating what is considered the '0-point' of the time series, and a series of instances of the EVENT subtype, each containing a time: DV_DATE_TIME attribute representing the absolute time of the event. The relative offset of any Event is computed as the difference between the EVENT.time and HISTORY.origin by the EVENT.offset function. For Interval events (i.e. instances of INTERVAL_EVENT), the time attribute always refers to the end time of the event, since this is the time at which the data (e.g. average) are true.

The origin time of a History does not have to be the time of the first sample - it might be the time of an event such as child-birth with respect to which the samples are recorded, e.g. Apgar scores (Apgar is a 0-10 score indicating the health of a newborn based on breathing, heartrate, colour, muscletone and reflexes) at 1 and 3 minute offsets. Periodicity and aperiodicity are expressed via the is_periodic and period attributes. For a periodic time-series, period is set to the period duration value and is_periodic returns True. The total duration of the History is given by the HISTORY.duration function. The following figure illustrates a number of variations in History periodicity and Event type.

history period
Figure 6. Variation in History periodicity and Event width

6.1.3. Point Events

The simplest kind of Event in a History is a "point" event, expressed by instances of the class POINT_EVENT, representing an instantaneous value. A HISTORY instance may be composed solely of Point events, as would be the case with a number of blood pressure values measured over time as the patient changes position. An Apgar result is a typical example of aperiodic point data, typically consisting of 2 or 3 events, each containing 5 values and a 6th value repersenting the Apgar score for that time point. Point data may also be available from monitoring devices. For fine-granularity (e.g. 1 second) data, the number of samples may be too voluminous for the health record, and more efficient recording in the form of summary Interval events (see below) might be desired. The diagram below illustrates the structure of a HISTORY containing POINT_EVENTs.

history bp
Figure 7. Structure of HISTORY<T> of POINT_EVENTs

6.1.4. Interval Events

Instances of the INTERVAL_EVENT class are used to express values corresponding to an interval in time. The INTERVAL_EVENT.width attribute defines the duration of the interval; and the inherited time value corresponds to the trailing edge of the event.

The meaning of an Interval event in this model is that the values effectively summarise actual instantaneous values of a datum that have occurred during the period of the event interval. The mathematical meaning of the data of any particular interval event is given by the math_function attribute. This is coded by the openEHR Terminology group "event math function", and takes values such as "minimum", "maximum", "average", "delta" and so on. The particular math functions used in each Interval event in a History may vary throughout the History; for example, one 4-hour Interval event might contain data representing average values, while a following event might contain data representing maximum values. Such data can be conveniently used for generating sophisticated graphs of the underlying datum over time. The next figure illustrates a History containing 2 pairs of 4-hour blood pressure Interval events, with each pair containing maximum and mean blood pressure value structures for +4h and +8h timepoints (each of which consist of a systolic and diastolic value).

history bp math
Figure 8. Structure of HISTORY<T> of INTERVAL_EVENTs

Interval events can overlap other interval or point events within the same History. A common situation where this occurs is with measurement of different periods of vital signs, such as 4-hourly blood pressure events, overlapped by a 24-hour event which contains the values over a period of 6 x 4 hour periods. In general a long Interval event can overlap any combination of Point or Interval events, as shown in the following figure.

history event overlapping
Figure 9. Overlapping Events

6.1.5. Change Data

One subcategory of interval data that deserves mention is change data. There are three event math function terms used for indicating changes in data values as follows:

  • "change": this means that the value recorded is the difference between the value now and the value some time previously. It can be positive or negative;

  • "increase": the value recorded for the change is positive. The name (i.e. ELEMENT.name) chosen for the item in an archetype carries the semantic of positivity e.g. "increase of …​.; rise of…​.; …​.gain" etc;

  • "decrease": the value recorded for the change is positive. But the name chosen for the item carries the semantic of negativity e.g. "decrease of …​.; fall of …​.; …​. loss".

The following examples show how the data and these math functions are coordinated.

  • weight last week was 76 kg. Wait this week = 74 kg. Possible instances:

Item Name
in Archetype
Value
stored
Type Math Function

"weight change"

+ 2kg

DV_QUANTITY

"change"

"weight loss"

(+)2kg

DV_QUANTITY

"decrease"

"weight loss"

True

Boolean

"decrease"

  • weight last week was 80 kg. Weight this week = 83 kg. Possible instances:

Item Name
in Archetype
Value
stored
Type Math Function

"weight change"

(+)3kg

DV_QUANTITY

"change"

"weight increase"

(+)3kg

DV_QUANTITY

"increase"

"weight gain"

True

Boolean

"increase"

The use of these math function indicators allows the correct representation of change values, no matter how they were captured, in a computable form.

6.1.6. Summary Event Data

A relatively common situation particularly in laboratory testing is the existence of a "summarising" event which accompanies more detailed historical data. Examples where this arises include:

  • a series of exams with a single radiologist report for all of them (the report might include one or more key images);

  • graphical summary of a dynamic challenge test such as Glucose tolerance test;

  • some comment about the pattern of values on a set of observed values in series.

Such data are accommodated within the model via the optional HISTORY.summary attribute, which is itself a structure, archetypable separately from the structure of the main data. In the first example above, the summary data might consist of an ITEM_SINGLE object containing a textual report; in the second, an ITEM_SINGLE object containing a image within a DV_MULTIMEDIA instance.

6.1.7. Efficient Representation of Fine-grained Device Data

A useful practical consequence of the of Interval Events is that it allows long periods of relatively stable data to be represented with a single Interval event, while interesting perturbations will be represented with a number of fine-grained Interval or Point Events. In the example in the next figure, Event instances are used represent 4 hours of data consisting to 14,400 x 1 second samples from a blood pressure monitor. The optional INTERVAL_EVENT.sample_count attribute can be used to record the number of original samples summarised in the event. In the illustration, the math_function is shown as mean; clearly in the first long period, the monitored datum was not absolutely flat. The implication is that the recording software was configured to regard variations in a small band (e.g. 5mm Hg) as insignificant, and only to create new Event objects when the underlying values moved outside the band. Another approach woould have been to create two Interval Event objects for each long period, one giving minimum value, the other maxium value, still based on the principle of generating one such pair for periods when the underlying data remained within specified limits. Regardless of the details, this general approach provides a way to include hours of fine-grained data from devices like vital signs monitors in very little space; the data simply need to be transfomed into equivalent openEHR History form first.

history data compression
Figure 10. Data compression effect of History with Interval Events

6.1.8. State

A feature particular to a model of recording historical data for scientific and clinical use is the ability to record 'state'. In openEHR, 'state' is understood as information pertinent to the correct interpretation of the primary data. A simple example is where the primary datum is heartrate; useful state data would be the level of exertion of the subject (resting, after 3 minutes cycling etc). In clinical recording situations, the state data is often crucial to the safe use of the primary data, since the latter might be normal or abnormal depending on the patient state. In openEHR there are two ways of recording state. One is via the use of a separate HISTORY structure within the OBSERVATION class (see ehr.composition.content.entry package). The other is via the use of the state attribute of type ITEM_STRUCTURE defined in the class EVENT itself. Experience with openEHR archetypes and systems has shown that the latter method corresponds to the most common clinical need, which is to be able to record the state at the time of the event (the other method allows for the recording of independent state events). A simple example is the recording of 3 glucose levels during a glucose tolerance test. The state information for each event is, respectively (in a typical test):

  • 0-minute sample: "post 8-hour fast";

  • 1-hour sample: "post 75g oral glucose challenge";

  • 2-hour sample: "post 75g oral glucose challenge".

The History structure for this example is illustrated in the following figure.

history ogtt
Figure 11. State in HISTORY

6.2. Class Descriptions

6.2.1. HISTORY Class

Class

HISTORY

Description

Root object of a linear history, i.e. time series structure. For a periodic series of events, period will be set, and the time of each Event in the History must correspond; i.e. the EVENT.offset must be a multiple of period for each Event. Missing events in a period History are however allowed.

Inherit

DATA_STRUCTURE

Attributes

Signature

Meaning

1..1

origin: DV_DATE_TIME

Time origin of this event history. The first event is not necessarily at the origin point.

0..1

period: DV_DURATION

Period between samples in this segment if periodic.

0..1

duration: DV_DURATION

Duration of the entire History; either corresponds to the duration of all the events, and/or the duration represented by the summary, if it exists.

0..1

summary: ITEM_STRUCTURE

Optional summary data that aggregates, organizes, reduces and transforms the event series. This may be a text or image that presents a graphical presentation, or some data that assists with the interpretation of the data.

0..1

events: List<EVENT>

The events in the series.

Functions

Signature

Meaning

is_periodic: Boolean

Indicates whether history is periodic.

Invariant

Events_valid: (events /= Void and then not events.is_empty) or summary /= Void

Periodic_validity: is_periodic xor period = Void

Period_consistency: is_periodic implies events.for_all (e: EVENT | e.offset. to_seconds.mod(period.to_seconds) = 0)

6.2.2. EVENT Class

Class

EVENT (abstract)

Description

Defines the abstract notion of a single event in a series. This class is generic, allowing types to be generated which are locked to particular spatial types, such as EVENT<ITEM_LIST>. Subtypes express point or intveral data.

Inherit

LOCATABLE

Attributes

Signature

Meaning

1..1

time: DV_DATE_TIME

Time of this event. If the width is non-zero, it is the time point of the trailing edge of the event.

0..1

state: ITEM_STRUCTURE

Optional state data for this event.

1..1

data: ITEM_STRUCTURE

The data of this event.

Functions

Signature

Meaning

offset: DV_DURATION
Post_condition: Result = time.diff(parent.origin)

Offset of this event from origin, computed as time.diff(parent.origin).

Invariant

Offset_validity1: offset /= Void and then offset = time.diff (parent.origin)

6.2.3. POINT_EVENT Class

Class

POINT_EVENT

Description

Defines a single point event in a series.

Inherit

EVENT

6.2.4. INTERVAL_EVENT Class

Class

INTERVAL_EVENT

Description

Defines a single interval event in a series.

Inherit

EVENT

Attributes

Signature

Meaning

1..1

width: DV_DURATION

Length of the interval during which the state was true. Void if an instantaneous event.

0..1

sample_count: Integer

Optional count of original samples to which this event corresponds.

1..1

math_function: DV_CODED_TEXT

Mathematical function of the data of this event, e.g. maximum , mean etc. Coded using openEHR Terminology group event math function.

Functions

Signature

Meaning

interval_start_time: DV_DATE_TIME

Start time of the interval of this event.

Invariant

Math_function_validity: terminology (Terminology_id_openehr).has_code_for_group_id (Group_id_event_math_function, math_function.defining_code)

Interval_start_time_valid: interval_start_time = time - width

6.3. History Instance Structures

6.3.1. Single Sample

The following diagram illustrates a single weight measurement. The Event objects contain the timing information, which in this case is simply the time of measurement (the origin).

history single sample
Figure 12. Single sample Instance Structure

6.3.2. 5-minute Blood Pressure Averages

The next figure illustrates two Interval events representing 5 minute blood pressure averages, the first at 5 minutes' offset from an initial event and lasting 5 minutes, the second 5 minutes later.

history bp series instances
Figure 13. Blood Pressure Series History Instance Structure

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