William,
> In this formalism we need to be able to define discrete items (clinically:
> one observation
> or one measure, e.g. weight). Then we must be able to have archetypes that
> combine
> clinically natural combinations of discrete variables (blood pressure:
> systolic, diastolic,
> cuff size, position). Such examples can be globally standardized, at least to
> the level
> where the units are referenced appropriately, e.g. kg weight versus Lbs.
No argument from me here.
> The we must have archetype to represent clinical constructs, such as
> assessment
> scales / instruments. These have usually a clinimetric / psychometric
> research based set
> of characteristic, assuming a 100% correct technical representation. This is
> doable with
> archetyping, e.g. the apgar score and Barthel index examples.
No arguments here either - some scoring I imagine is different from
jurisdiction to jurisdiction (alcohol usage scoring etc) but universal ones
such as apgar can definately be globally standardised.
> In other words: archetypes will be globally definable, or at least referred
> to, where the
> template specifies many different implement able 'things' that will vary to
> purpose.
> The flexibility Heath mentions is absolutely required. E..g. a discharge
> summary after
> delivery will have similar components (template level) compared to discharge
> summary
> after stroke care, (e.g. blood pressure template, weight), but also differ
> (first has Apgar
> score archetype, second has Barthel index). The template thus must hold place
> for 1-n
> scales to be includable upon choice of clinicians and depending the actual
> technical
> implementation.
> For me encounter and medication list are definitely not archetypes: they
> differ too
> much in each circumstance, they are templates that will hold several to many
> archetypes.
I don't understand the distinction you make here - archetypes can hold other
archetypes and so I'm not sure why templates are introduced. For instance,
from the openehr sample archetypes
openEHR-EHR-SECTION.summary.v1
SECTION[at0000] matches { -- Summary
items cardinality matches {0..*; unordered} matches {
allow_archetype EVALUATION occurrences matches {0..1}
matches {
include
domain_concept matches
{/clinical_synopsis\.v1/}
domain_concept matches {/problem\.v1/}
domain_concept matches
{/problem-diagnosis\.v1/}
domain_concept matches
{/problem-diagnosis-histological\.v1/}
domain_concept matches
{/problem-genetic\.v1/}
domain_concept matches {/risk\.v1/}
}
}
}
So this summary defines this section to hold a collection
of other specified archetypes.
If this summary was 'included' as the content of a higher level
'discharge' archetype, you would have a flexible definition of a
discharge summary. Where does the template come into it?
What everyone seems to be saying is that clinicians need a lot of
flexibility in how they put together things such as encounters
and referrals. I 100% agree - which is why I would think each
jurisdiction would have its own compositional archetypes, suited
to its own particular use cases (maybe in a hierarchy of
australia discharge summary -> australia natal discharge summary etc).
These compositional archetypes would refer to globally
agree 'data items' archetypes wherever possible (blood pressure etc).
Instead my reading of the situation is that everyone wants
to just have a single global
openEHR-EHR-COMPOSITION.discharge.v1draft.adl
which seemingly adds no useful constraints at all, and then
instead constrain everything with templates (of which we
haven't yet seen a spec?).
Andrew
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