Hi Sam,
Having re-examined your original post, can I suggest a further possibility?
You mentioned that your customer wants to embed some of the structured
content (medication) within the narrative. Can I suggest leaving the
narrative section as pure text and considering using 'structured
narrative' within the structured / 'duplicate' section This is
becoming an increasingly popular approach and I think will become the
predominant solution, eventually making the unstructured narrative
part of CDA redundant and allowing easier support for the kind of NLP
driven interfaces that Peter Elkin and NHS CUI have been developing.
To use your example, something like the following would appear in the
structured section equivalent (very rough schematics!):
<StructuredNarrative>Saw JJ today and seemed OK. <content ref= 1>A
cough for 2 weeks.</content><content ref=2>Temp 36</content><content
ref= 3>, BP 146/82<content><content ref= 4>Prescribed Amoxycillin
250mg tid</content></StructuredNarrative>
Symptom "Cough" <content ref=1/>
duration "2 weeks"
Temperature 36 C <content ref=2/>
Blood pressure <content ref=3/>
systolic 146
diastolic 82
Medication <content ref= 4/>
amoxicillin 250mg
</Structured>
There have been some attempts to do this sort of thing with CDA:
e.g. Johnson SB, Bakken S, Dine D, et al. An Electronic Health Record
Based on Structured Narrative. J Am Med Inform Assoc.
2008;15(1):54-64.
+ the NHS has some similar HL7 based constructs for handling
structured narrative within GP2GP messages in England.
I am supposed to be figuring our how best to do this in openEHR for my
MSc project.
For the pure narrative 'section', which will be required for CDA
compatibility, why not create a simple 'Unstructured Narrative'
archetype containing only a single Text node, rather than a series of
sections?
Ian
Dr Ian McNicoll
office / fax +44(0)141 560 4657
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian at mcmi.co.uk
Clinical Analyst - Ocean Informatics ian.mcnicoll at oceaninformatics.com
Consultant - IRIS GP Accounts ian at gpacc.co.uk
Member of BCS Primary Health Care Specialist Group ? www.phcsg.org
2008/8/19 Sam Heard <sam.heard at oceaninformatics.com>:
> >From discussions on the technical list:
>
> It appears the best approach is to have a section which has two subsections
> Duplicate
> Primary
> Duplicate
>
> We would leave the display concerns to the environment but a simple display
> script for such a section would involve displaying data in the first section
> and either not displaying the second or displaying it in small text in a box
> or on a tab or something.
>
> Does that sound OK?
>
> Cheers, Sam
>
> Andrew Patterson wrote:
>
> Woops, forgot to CC the clinical list as well..
> (make sure you fix the to/cc if you reply to this post or
> I will have created some sort of cross post list monster)
>
> Andrew
>
>
> ---------- Forwarded message ----------
> From: Andrew Patterson <andrewpatto at gmail.com>
> Date: Tue, Aug 19, 2008 at 11:35 PM
> Subject: Re: Differential display
> To: heath.frankel at oceaninformatics.com, For openEHR technical
> discussions <openehr-technical at openehr.org>
>
>
>
>
> Actually the use case is as follows:
>
>
> We can call it the MD2 use case! :)
>
>
>
> This may not seem idealistic but this the reality of what existing systems
> do and existing users are used to. If openEHR is to be taken up by existing
> system vendors and accepted by their users, we must support this existing
> non-idealistic paradigm in a way that does not too much overhead on the
> system and its implementers.
>
>
> I don't understand why this requires anything special at all regarding
> archetypes? Surely it is a composition with some sections, and in
> those sections might be an uncoded 'story' about the encounter, and
> then some other coded archetypes.
>
> If there is duplication of information, then IMHO
> they will need to see the duplicate information - once, as you say, they
> have
> copied the structured content into the note as text it has indeed lost its
> connection to the original data. I can't see how you could in good
> faith then indicate that any of the coded structured data is
> 'duplicate' information unless you could
> actually ensure that the text is also still present in the uncoded
> story - and if you can do that strong linking check with
> any degree of reliability then the whole problem doesn't really exist?
>
> Andrew
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical at openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
>
>
>
>
> --
>
> Dr Sam Heard
> Chief Executive Officer
> Director, openEHR Foundation
> Senior Visiting Research Fellow, University College London
> 214 Victoria Avenue
> Chatswood, NSW, 2067
> Phone: +61 2 9415 4994
> Mobile: +61 4 1783 8808 21 Chester Cres
> London E8 2PH
> Phone: +44 20 7249 7085
> Mobile: +44 77 9871 0980
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical at openehr.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
>
