Chapter 2: Data Formats and Structures

The effectiveness of any healthcare information standard depends fundamentally on its data models and formats. Well-designed data structures enable seamless information exchange, support interoperability across systems, facilitate analytics and decision support, and ensure data integrity and consistency. The WIA-SENIOR-002 Dementia Care Standard establishes comprehensive data formats spanning all aspects of dementia care technology—from cognitive assessments and safety events to care activities and caregiver observations. These formats build upon established healthcare standards while addressing the unique requirements of dementia care, creating a robust foundation for the next generation of integrated care systems.

This chapter explores the data formats and structures specified by WIA-SENIOR-002 in detail. We examine the core data models for cognitive assessment results, safety monitoring events, medication management records, care coordination information, and caregiver support data. We discuss how these formats integrate with existing healthcare standards including HL7 FHIR (Fast Healthcare Interoperability Resources), ensuring compatibility with electronic health record systems and broader health information exchanges. We also address critical considerations including data privacy and security requirements, versioning and extensibility mechanisms, and validation approaches that ensure data quality while maintaining flexibility.

Understanding these data formats is essential for anyone implementing dementia care technology systems compliant with WIA-SENIOR-002. Software developers building cognitive assessment tools, safety monitoring devices, care coordination platforms, or integrated care ecosystems must adhere to these specifications to achieve interoperability. Healthcare organizations seeking to implement standardized dementia care technology will recognize how these formats facilitate information flow across systems and care settings. Researchers analyzing dementia care data will appreciate how standardization enables large-scale data aggregation and analysis while protecting individual privacy.

Core Data Model Architecture

The WIA-SENIOR-002 data model employs a layered architecture consisting of base resources, domain-specific profiles, and extension mechanisms. Base resources define fundamental data structures common across all dementia care data—patient demographics, timestamps, identifiers, and provenance information. Domain-specific profiles extend these base resources with specialized fields for cognitive assessment, safety monitoring, medication management, and other dementia care functions. Extension mechanisms allow implementers to add custom fields when needed while maintaining interoperability for core data elements.

This architecture draws inspiration from HL7 FHIR's resource-based approach while optimizing for dementia care use cases. Each data type is defined as a JSON schema with required fields, optional fields, data types, value constraints, and validation rules. JSON was selected as the primary serialization format due to its ubiquity in modern web and mobile applications, human readability facilitating debugging, compact size optimizing network transmission, and extensive tool support across programming languages. Alternative formats including XML and Protocol Buffers are supported through transformation specifications.

Base Resource Structure

All WIA-SENIOR-002 data resources share a common base structure providing essential metadata and ensuring consistent handling across systems. This base structure includes a resource type identifier specifying the data category, a unique resource ID enabling unambiguous references, version information supporting data evolution, timestamps recording creation and modification times, and provenance data documenting information sources and processing history.

{
    "resourceType": "DementiaCare.BaseResource",
    "id": "550e8400-e29b-41d4-a716-446655440000",
    "meta": {
        "versionId": "1",
        "lastUpdated": "2025-01-15T10:30:00Z",
        "profile": ["http://wia.org/fhir/StructureDefinition/DementiaCare"]
    },
    "standard": "WIA-SENIOR-002",
    "standardVersion": "1.0.0",
    "subject": {
        "reference": "Patient/example-patient-123",
        "display": "Anonymous Patient"
    },
    "source": {
        "device": "CognitiveAssessment/device-001",
        "system": "MindTrack Pro v2.1",
        "timestamp": "2025-01-15T10:29:45Z"
    }
}

Table 2.1: Base Resource Fields
Field	Type	Required	Description
resourceType	string	Yes	Identifies the specific resource type
id	UUID	Yes	Globally unique identifier (UUID v4)
meta	object	Yes	Metadata including version and profile
standard	string	Yes	Always "WIA-SENIOR-002"
standardVersion	semver	Yes	Version of standard used (e.g., "1.0.0")
subject	Reference	Yes	Patient reference (may be de-identified)
source	object	Yes	Origin information for provenance tracking

Cognitive Assessment Data Structures

Cognitive assessment data represents one of the most critical information types in dementia care, documenting cognitive status over time and enabling detection of decline or response to interventions. The WIA-SENIOR-002 cognitive assessment format accommodates diverse assessment types—from brief screening tools like MMSE or MoCA to comprehensive neuropsychological batteries to digital game-based assessments—while maintaining consistency in core data elements.

Assessment Session Resource

Each cognitive assessment session is represented as a comprehensive resource capturing all relevant information about the assessment context, administration, and results. The session resource includes assessment metadata identifying the instrument used and administration conditions, temporal information recording when the assessment occurred, performance metrics quantifying cognitive function across domains, and contextual factors that might influence results such as time of day, environmental conditions, or recent life events.

{
    "resourceType": "DementiaCare.CognitiveAssessment",
    "id": "ca-2025-01-15-001",
    "meta": {
        "versionId": "1",
        "lastUpdated": "2025-01-15T11:00:00Z"
    },
    "standard": "WIA-SENIOR-002",
    "standardVersion": "1.0.0",
    "subject": {
        "reference": "Patient/p-12345",
        "display": "Patient 12345"
    },
    "assessmentType": "MMSE",
    "assessmentVersion": "2001",
    "administeredBy": {
        "reference": "Practitioner/dr-smith",
        "display": "Dr. Jane Smith, MD"
    },
    "assessmentDate": "2025-01-15",
    "assessmentTime": "10:30:00Z",
    "duration": "PT15M",
    "setting": "clinic",
    "domains": [
        {
            "name": "orientation",
            "maxScore": 10,
            "achievedScore": 8,
            "percentile": 80,
            "severity": "mild-impairment"
        },
        {
            "name": "memory",
            "maxScore": 6,
            "achievedScore": 3,
            "percentile": 50,
            "severity": "moderate-impairment"
        },
        {
            "name": "attention",
            "maxScore": 5,
            "achievedScore": 4,
            "percentile": 80,
            "severity": "mild-impairment"
        },
        {
            "name": "language",
            "maxScore": 8,
            "achievedScore": 7,
            "percentile": 87.5,
            "severity": "minimal-impairment"
        },
        {
            "name": "visuospatial",
            "maxScore": 1,
            "achievedScore": 1,
            "percentile": 100,
            "severity": "normal"
        }
    ],
    "totalScore": {
        "maxScore": 30,
        "achievedScore": 23,
        "percentile": 76.67,
        "interpretation": "mild-cognitive-impairment"
    },
    "contextualFactors": {
        "timeOfDay": "morning",
        "patientMood": "cooperative",
        "environmentalDistractions": "minimal",
        "medicationTiming": "1-hour-post-dose"
    },
    "notes": "Patient showed particular difficulty with delayed recall tasks. Attention and concentration adequate. No significant change from previous assessment 3 months ago."
}

Domain-Specific Scoring

Cognitive assessments evaluate multiple cognitive domains, each requiring detailed scoring and interpretation. The WIA-SENIOR-002 format standardizes domain representation across different assessment instruments, enabling cross-instrument comparisons and longitudinal tracking even when assessment methods change. Each domain includes the domain name using standardized terminology, raw scores representing actual performance, normalized scores enabling comparisons across assessments, percentile rankings contextualizing performance, and severity classifications providing clinical interpretation.

Table 2.2: Cognitive Domain Standardization
Standard Domain	MMSE Component	MoCA Component	Digital Game Equivalent
Orientation	Time + Place orientation	Date + Place orientation	Context awareness tasks
Memory	Registration + Recall	Memory recall tasks	Sequence remembering games
Attention	Serial 7s / WORLD backward	Digit span + vigilance	Focus and concentration tasks
Executive Function	N/A in standard MMSE	Trail making + abstraction	Problem-solving challenges
Language	Naming + repetition + command	Naming + fluency	Vocabulary and communication
Visuospatial	Pentagon copying	Cube + clock drawing	Spatial reasoning puzzles

Safety Event Data Models

Safety monitoring generates critical real-time data requiring immediate action and careful documentation. The WIA-SENIOR-002 safety event format supports diverse event types—falls, wandering episodes, medication errors, environmental hazards, and behavioral safety concerns—while maintaining consistent structure enabling automated processing and alerting.

Fall Detection Event

Falls represent one of the most serious safety concerns for individuals with dementia. The fall event resource captures comprehensive information supporting immediate response and long-term fall prevention. This includes precise event timing enabling response time analysis, location information guiding responders, sensor data from wearables or environmental monitors, impact characteristics indicating severity, patient status following the fall, and response actions taken.

{
    "resourceType": "DementiaCare.SafetyEvent.Fall",
    "id": "fall-event-2025-01-15-003",
    "standard": "WIA-SENIOR-002",
    "standardVersion": "1.0.0",
    "subject": {
        "reference": "Patient/p-12345"
    },
    "eventType": "fall-detected",
    "severity": "moderate",
    "detectionMethod": "wearable-accelerometer",
    "timestamp": "2025-01-15T14:23:17.342Z",
    "location": {
        "type": "indoor",
        "room": "bathroom",
        "gpsCoordinates": {
            "latitude": 37.7749,
            "longitude": -122.4194,
            "accuracy": "5m"
        },
        "beaconId": "beacon-bathroom-001"
    },
    "sensorData": {
        "accelerometer": {
            "x": 2.3,
            "y": -9.8,
            "z": 1.2,
            "magnitude": 10.2
        },
        "impactForce": 8.7,
        "impactDuration": "0.45s"
    },
    "patientStatus": {
        "conscious": true,
        "responsive": true,
        "injured": false,
        "mobility": "assisted-standing"
    },
    "response": {
        "alertSent": "2025-01-15T14:23:18.100Z",
        "alertRecipients": ["caregiver-primary", "emergency-contact-1"],
        "firstResponder": "caregiver-alice",
        "arrivalTime": "2025-01-15T14:25:30Z",
        "responseTime": "PT2M13S",
        "actionsTaken": [
            "assessed-patient-condition",
            "checked-for-injuries",
            "assisted-patient-to-chair",
            "monitored-vital-signs"
        ],
        "medicalAttentionRequired": false
    },
    "environmentalFactors": {
        "lighting": "adequate",
        "floorCondition": "dry",
        "obstacles": "none-noted",
        "assistiveDevices": "walker-not-used"
    },
    "notes": "Patient attempted to stand from toilet without using grab bars. No apparent injuries. Reminded to use safety equipment."
}

Wandering Event

Wandering behavior poses significant safety risks and creates substantial caregiver anxiety. The wandering event resource documents departure from safe areas, movement patterns, location tracking data, and safe return or intervention outcomes. This information supports immediate response while building historical patterns that inform prevention strategies.

Privacy Consideration: Location data is highly sensitive and must be handled with extreme care. WIA-SENIOR-002 specifies encryption requirements for location data at rest and in transit, access controls limiting who can view precise locations, retention limits requiring deletion after specified periods, and anonymization approaches for research and analytics. Consent processes must explicitly address location tracking, and individuals or their representatives must be able to restrict tracking during specific times or locations.

Care Activity Documentation

Documenting care activities enables coordination among caregivers, supports quality improvement, facilitates reimbursement, and provides evidence of care delivery. The WIA-SENIOR-002 care activity format accommodates diverse activities—personal care assistance, medication administration, social engagement, therapy sessions, and care coordination meetings—while maintaining structure supporting analysis and reporting.

{
    "resourceType": "DementiaCare.CareActivity",
    "id": "activity-2025-01-15-042",
    "standard": "WIA-SENIOR-002",
    "standardVersion": "1.0.0",
    "subject": {
        "reference": "Patient/p-12345"
    },
    "activityType": "personal-care",
    "activityCategory": "bathing-assistance",
    "performedBy": {
        "reference": "Caregiver/alice-jones",
        "role": "home-health-aide",
        "certifications": ["CNA", "dementia-care-specialist"]
    },
    "scheduledTime": "2025-01-15T09:00:00Z",
    "actualStartTime": "2025-01-15T09:05:00Z",
    "actualEndTime": "2025-01-15T09:35:00Z",
    "duration": "PT30M",
    "location": "home-bathroom",
    "status": "completed",
    "patientCooperation": "good",
    "patientMood": "pleasant",
    "notesAndObservations": "Patient cooperative during bathing. Noticed slight redness on left heel - will monitor. Patient enjoyed selecting clothes for the day.",
    "skillsRequired": ["bathing-assistance", "fall-prevention", "dementia-communication"],
    "equipmentUsed": ["shower-chair", "grab-bars", "non-slip-mat"],
    "safetyConcerns": "none",
    "careplanAlignment": "activity-aligns-with-careplan-hygiene-003",
    "qualityMetrics": {
        "patientSatisfaction": 5,
        "safetyCompliance": true,
        "timeEfficiency": 1.0
    }
}

Medication Management Data

Medication management data tracks medication administration, adherence, and related events. The WIA-SENIOR-002 medication format extends standard medication resources with dementia-specific considerations including cognitive status during administration, administration assistance level, patient comprehension of medication purpose, and behavioral factors affecting adherence.

Table 2.3: Medication Event Types
Event Type	Description	Required Actions	Alert Priority
administered-as-scheduled	Medication given on time as prescribed	Documentation only	None
administered-late	Medication given past scheduled time	Document reason, adjust next dose timing	Low
dose-refused	Patient refused medication	Document reason, notify prescriber	Medium
dose-missed	Medication not administered	Document reason, contact prescriber	High
adverse-reaction	Negative response to medication	Immediate medical attention	Critical
dose-error	Wrong medication, dose, route, or time	Immediate correction, incident report	Critical

Integration with HL7 FHIR

The WIA-SENIOR-002 standard is designed for seamless integration with HL7 FHIR, the leading standard for healthcare data exchange. This integration enables dementia care data to flow into electronic health records, health information exchanges, and other clinical systems while maintaining compatibility with the broader healthcare ecosystem. The standard provides FHIR mapping specifications showing how each WIA-SENIOR-002 resource maps to FHIR resources and extensions.

FHIR Resource Mapping

WIA-SENIOR-002 cognitive assessments map to FHIR Observation resources with specialized profiles. Safety events map to DetectedIssue resources for immediate concerns and Procedure resources for interventions. Care activities map to CarePlan and Procedure resources. Medication data maps directly to MedicationStatement and MedicationAdministration resources. These mappings preserve all dementia-specific data through standardized FHIR extensions while maintaining core FHIR compatibility.

// Example: WIA-SENIOR-002 Cognitive Assessment to FHIR Observation
{
    "resourceType": "Observation",
    "id": "cognitive-assessment-mmse-001",
    "meta": {
        "profile": ["http://wia.org/fhir/StructureDefinition/DementiaCognitiveAssessment"]
    },
    "status": "final",
    "category": [{
        "coding": [{
            "system": "http://terminology.hl7.org/CodeSystem/observation-category",
            "code": "survey",
            "display": "Survey"
        }]
    }],
    "code": {
        "coding": [{
            "system": "http://loinc.org",
            "code": "72107-6",
            "display": "Mini-Mental State Examination"
        }]
    },
    "subject": {
        "reference": "Patient/p-12345"
    },
    "effectiveDateTime": "2025-01-15T10:30:00Z",
    "performer": [{
        "reference": "Practitioner/dr-smith"
    }],
    "valueQuantity": {
        "value": 23,
        "unit": "points",
        "system": "http://unitsofmeasure.org",
        "code": "1"
    },
    "interpretation": [{
        "coding": [{
            "system": "http://wia.org/fhir/CodeSystem/cognitive-severity",
            "code": "mild-impairment",
            "display": "Mild Cognitive Impairment"
        }]
    }],
    "component": [
        {
            "code": {
                "coding": [{
                    "system": "http://wia.org/fhir/CodeSystem/cognitive-domain",
                    "code": "orientation",
                    "display": "Orientation"
                }]
            },
            "valueQuantity": {
                "value": 8,
                "unit": "points"
            }
        },
        {
            "code": {
                "coding": [{
                    "system": "http://wia.org/fhir/CodeSystem/cognitive-domain",
                    "code": "memory",
                    "display": "Memory"
                }]
            },
            "valueQuantity": {
                "value": 3,
                "unit": "points"
            }
        }
    ]
}

Data Security and Privacy Requirements

Dementia care data includes some of the most sensitive health information, requiring robust security and privacy protections. The WIA-SENIOR-002 standard specifies comprehensive security requirements covering encryption, access control, audit logging, and consent management. All data must be encrypted at rest using AES-256 or equivalent and in transit using TLS 1.3 or higher. Access controls must implement role-based permissions with principle of least privilege. Comprehensive audit logs must record all data access, modification, and sharing events.

弘益人間

Benefit All Humanity

The 弘益人間 (Benefit All Humanity) philosophy guides the WIA-SENIOR-002 data format design. Standardized data formats enable global sharing of anonymized data for research advancing dementia care. Open specifications ensure accessibility regardless of resources or geography. Careful privacy protections maintain trust while enabling beneficial data uses. By creating common data formats, we enable collaboration and knowledge sharing that benefits all individuals affected by dementia worldwide.

Chapter Summary

Key Takeaways:

WIA-SENIOR-002 establishes comprehensive data formats for all aspects of dementia care technology including cognitive assessments, safety events, care activities, and medication management. These formats use JSON as the primary serialization with well-defined schemas ensuring consistency and interoperability across implementations.
The standard employs a layered architecture with base resources providing common metadata, domain-specific profiles adding specialized fields, and extension mechanisms enabling customization while maintaining interoperability. This architecture balances standardization with flexibility, accommodating diverse implementation needs.
Cognitive assessment data captures detailed performance across multiple cognitive domains with standardized domain definitions enabling cross-instrument comparisons and longitudinal tracking. The format accommodates traditional paper-and-pencil assessments, digital assessments, and passive monitoring approaches within a unified structure.
Safety event formats document falls, wandering episodes, medication errors, and environmental hazards with sufficient detail to support immediate response while building historical patterns informing prevention. Privacy protections are especially critical for location data associated with wandering monitoring.
Integration with HL7 FHIR enables dementia care data to flow seamlessly into electronic health records and health information exchanges. Standardized mapping specifications preserve all dementia-specific information through FHIR extensions while maintaining core FHIR compatibility, ensuring broad healthcare ecosystem integration.

Review Questions

Explain the three-layer architecture of WIA-SENIOR-002 data models (base resources, domain profiles, and extensions). Why is this layered approach beneficial for both standardization and flexibility? Provide an example of how each layer would be used in a cognitive assessment data structure.
Describe the base resource structure that all WIA-SENIOR-002 data resources share. What metadata fields are required, and why is each important for data integrity and interoperability? How does the versioning approach support data evolution?
Compare how MMSE, MoCA, and digital game-based assessments would be represented using WIA-SENIOR-002's standardized cognitive domain structure. What are the advantages of domain standardization for longitudinal cognitive monitoring?
Analyze the fall detection event resource structure. What information is captured immediately for emergency response versus information documented for fall prevention analysis? How do environmental factors contribute to fall prevention strategies?
Discuss privacy considerations specific to location data in wandering event resources. What protections does WIA-SENIOR-002 specify for location data? How can systems balance safety benefits of location tracking with privacy rights and dignity?
Explain how WIA-SENIOR-002 data resources map to HL7 FHIR resources. Why is FHIR integration important for dementia care technology? What challenges arise when mapping dementia-specific data to general healthcare standards, and how does WIA-SENIOR-002 address them?

Looking Ahead

Chapter 3 examines the Cognitive Assessment APIs specified by WIA-SENIOR-002, showing how applications submit assessment data, retrieve historical results, analyze trends, and generate reports. Understanding these APIs builds upon the data formats covered in this chapter, demonstrating how standardized data structures enable powerful interoperable systems.

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