--- Stef Verlinden <stef at vivici.nl> wrote:
> Dear all, > > For me it's quite simple: the birthweight belongs to > the baby (and > not to the mother) and should be noted in the EHR of > the baby (for > example in > openEHR-EHR-OBSERVATION.body_weight-birth.v1.adl). I > can't > think of any example right now, but if (an > abnormal) birthweight of > the baby is relevant for the interpretation of > health situation of > the mother this could be (separately) noted in the > EHR (for example > in a pregnancy archetype) of the mother. My guess > is, that in most > cases this option won't be used. There are situations like a diabetic mother, pre-eclampsia, which are conditions that do affect the mother in each of her pregnancies. There are also unusuallly large or small birth-weights that may have to be recorded to warn the clinicins in the subsequent pregnancies. It could also be used in some research programs. It is also possible that the newborn baby may not have any identifiers to create a record for it. Nanda > > In general: observations should be noted in the EHR > of the subject to > which this observation belongs (birthweight > obviously belongs to the > baby, as does (for example) the APGAR score). Only > in the case that > an observation has impact on another subject (i.e. > the mother) the > same observation should separately be noted in the > EHR of that > subject. This 'separation' is also relevant when, > for example, one of > the parents has an inherited disorder. This > observation obviously > belongs to/ in the EHR of this parent. If this > observation might be > of influence to the health situation of the > baby/child, this > observation can be (with permission of the parent!) > separately noted > in the EHR of the child. > > Cheers, > > Stef Verlinden > > > Op 20-jul-2006, om 1:29 heeft Chunlan Ma het > volgende geschreven: > > > Dear All, > > > > I think some information is missing in the current > pregnancy > > archetype, e.g. birth plan (or preferred birth > choice), pregnancy > > complications (maybe should have a link between > the pregnancy > > archetype and the complications), indications of > high risk > > pregnancy (e.g. number of miscarriage, fertility > treatment etc.), > > previous laboring history, caesarean history and > the reasons for > > caesarean. > > > > In addition, the birth weight should go with the > birth details. > > Both the mother's record and the baby's record > need the birth > > weight. I don't see it is appropriate to include > Breast fed > > information in the Pregnancy archetype. I also > don't think the > > "Date ceased breast feeding" and "Age ceased > breast feeding" should > > be in the pregnancy archetype. > > > > Cheers, > > Chunlan > > > > Sam Heard wrote: > >> Omer > >> > >> The pregnancy archetype is a new approach and > therefore draft - > >> but I think it will be a more common approach in > the future - I > >> could be wrong! We are debating this at the > moment and I am not > >> sure of the final outcome. The pregnancy > archetype has the > >> benefit, at the moment, of keeping key > information about a > >> pregnancy in one place - a coherent data set that > can persist over > >> a long period, be shared and copied - find its > way into the baby's > >> health record etc. It is an evaluation, as it has > a lot of dates, > >> even decisions. > >> > >> While we can enter the birth_weight of each baby > in the mother's > >> record - and we probably will have compositions > that relate to the > >> child - this information as a single data item is > an observation - > >> and so will be recorded at a particular time - by > someone - > >> perhaps with some method involved (although it is > a simple > >> observation). > >> > >> The choice here is: > >> 1. Do we create an element archetype (ie one > quantity) and set the > >> constraints to Gm or Kg and the values - and then > embed it in an > >> observation called birthweight as well as the > pregnancy archetype. > >> This will no longer be a specialisation of weight > - as it is at > >> present and so will not be able to be graphed > with other weights > >> of the baby etc without special processing. There > are more > >> problems of this approach - the data subject of > the weight is the > >> baby and the pregnancy is the mother - an entry > can only have one > >> subject of data. So this approach is not going to > work. The > >> decisions to have one data subject per entry is a > compromise in > >> openEHR to make queries fast and safe - this is a > negative > >> consequence - but there are many positive > consequences. > >> > >> 2. Second, do we point from the pregnancy > archetype to the > >> birth_weight record in the EHR and have it as a > strong link (ie - > >> it will move with the pregnancy data whereever > this is sent and > >> copied? We can definitely do this - it will end > up in the > >> Obstetric history or some other persistent > information bucket and > >> work. For viewing purposes this will be fine - > but, if the data is > >> entered retrospectively this will be very messy. > It will also > >> require a lot more smarts in application software > to display this > >> usefully. > >> > >> 3. Currently we duplicate this information here. > This requires > >> some smarts in the software - ie populating the > data point - but > >> can be managed by humans without a great > overhead. I think this is > >> the best approach and will cause the least > problems and errors. We > >> will have to be sure that our Archetype ontology > knows about this > >> - but clinicians will be wise enough on their own > to go looking > >> here for this information. Software will soon be > able to duplicate > >> the information if required. > >> > >> The same issue will arise with some other data > points in the > >> pregnancy archetype - e.g. LMP and the details of > the menstruation > >> that will also be in another archetype. The > design here is really > >> for the shared health record - and as such may be > differ a little > >> from the approach one would take in a standalone > health record. > >> Also, these data points are optional, so it will > be possible to > >> take a different approach in the future when we > get more > >> sophisticated. It is not immediately obvious to > IT people or > >> clinicians that data entered in a linear way on > the screen might > >> end up in different places in the EHR. So we > might enter > >> information about the onset of labour in the > pregancy archetype at > >> the same time as we enter a vaginal examination > record and > >> administer oxytocin in a drip in the event record > which becomes > >> part of the ongoing labour record. > >> > === message truncated === __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com
