Dear Rodrigo,
in the system I have helped develop, we have implemented a pragmatic approach well in line the statements made by Tom, Gerard and Dipak. In our experience, labs usually send their reference range values alongside the observed data. When that is the case, we integrate them in the instance of stored data. Some labs send two types of range values: normal range, and critical range. Thus, we have made those two available in the structure of measurement type entries, and store these data in the entries when available in the incoming messages. It is only by comparing each observed value instance with the reference range data stored in the same entry instance that a system can generate alerts and other such messages. Not always simple. However, what many labs also do is to add in their messages a marker for each result indicating whether they consider it "normal" or "abnormal". We also store that information in the corresponding entry (we call this 'severity index') - and can easily exploit it to issue warnings etc. When the data are generated from local measurements (instead of being part of a lab message), we offer an archetype with the same types of ranges (see example). The user can then define local default values for the ranges, adapted to their type of practice or patients, or they can edit these values as appropriate case by case. Alain Maskens _____ From: [email protected] [mailto:owner-openehr-clinical at openehr.org] On Behalf Of Rodrigo Filgueira Sent: samedi 2 septembre 2006 0:57 To: openehr-clinical at openehr.org Subject: Re: Normal and other ranges Thank you all for your answers. It's clear to me that Archetypes are not the place. And that openEHR does not offer any particular solution. But since we are developing a system which should provide alerts and messaging for abnormal results and "dangerous" combinations of data values, we need to solve it in some way. Any links or reference material on possible approaches to this issue would be very welcome. thank you all again Dipak Kalra wrote: Dear All, Pathologists and laboratory message standards developers have over many years made clear to me that it is always good practice to include the applicable normal range with individual instances of observed values, since those ranges are not fixed across measurement methods, devices, organisations or over time. Published reference ranges in clinical textbooks etc. are only a guide for those tests in which the variation is nowadays quite small. For this reason, right from Synapses days - a decade ago! - , we have not sought to put reference ranges into the archetype specification, but (as Tom has stated) only to ensure that the archetype caters for the inclusion of reference range instances along with the observed value(s). With best wishes, Dipak ________________________________________________________ Dr Dipak Kalra Clinical Senior Lecturer in Health Informatics CHIME, University College London Holborn Union Building, Highgate Hill, London N19 5LW Direct Line: +44-20-7288-3362 Fax: +44-20-7288-3322 Web site: <http://www.chime.ucl.ac.uk/> http://www.chime.ucl.ac.uk _____ _______________________________________________ openEHR-technical mailing list openEHR-technical at openehr.org http://www.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20060903/bcc0c55c/attachment.html> -------------- next part -------------- A non-text attachment was scrubbed... Name: image001.jpg Type: image/jpeg Size: 9620 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20060903/bcc0c55c/attachment.jpg>
