Hi Hans, Andr?s, Very interesting question. We faced this issue when modelling for a paediatric hospital and after some discussion decided to use the standard lab_test-glucose archetype but considered adding a Method element to protocol, to carry 'Test strip - visual; Test strip - automated; Laboratory analyser' as internal coded tests.
It is certainly clear that we may need to identify the methodology, and according to the guidance paper that Andres provided, we many also need to specify whether this is a whole-blood or plasma / plasma-calibrated measurement. My own feeling is that we should try to incorporate these within the same archetype. The general archetyping philosophy is try to try to model the clinical record and not the device or methodology. @Hans - I agree that there is a fair bit of lab-related overhead in protocol but this would just be templated out, so that would not debar use of the archetype for this purpose. I look forward to hearing other opinions. I willtry ot get some opinions from clinicians and other lab/diagnostics experts On 6 December 2012 06:51, andres gamboa <andreshgamboa at hotmail.com> wrote: > Hi Again! > > Well first i would like to say that this kind of discussions are very > enriching for me since I can learn so much, from all of you. I?m young and > very curios and with lot of things to learn. Don?t want to seem like I?m > arrogant. > > Regarding to EHR there are still lot of issues not resolved yet and one of > the main problems resides in the difficulty of consensus in clinical > concepts when one is trying to model the medical knowledge. I think that > despite the possible controversy about the concepts (clinically speaking), > what it is important in my personal opinion (And I would like to add that > Im not an expert in the area, just very interested in this matter) is that > the concept represented in the archetype must be clear enough to allow an > accurate assessment. Since glucometers are biosensors they could have error, > that depends of the device used to measure (and there are several) and > sometimes they must be calibrated and so forth in order to make this > measure more accurate and close to labtest results (gold standard). So > comparing its results with labtest results can be misleading. That?s why in > a previous email I suggested to treat them as different concepts. Now I > suggest that maybe this matter should be discussed by clinicians that work > in diabetes and reasearchers, and reviewed by engineers in order to find the > most convienent solution, and in some way to standarize the concept. There?s > a lot of people dealing with the same issue in diabetes. I think this > link could be useful > http://care.diabetesjournals.org/content/26/suppl_1/s106.long > There you can find the recomendations of the American Diabetes Association > for blood glucose monitoring. > > Lot of regards > > Andr?s > > ________________________________ > Date: Thu, 6 Dec 2012 16:26:59 +1100 > From: sam.heard at oceaninformatics.com > To: openehr-clinical at lists.openehr.org; Ian.McNicoll at > oceaninformatics.com > Subject: Re: Usage of Blood glucose archetype for self-monitoring > > > Hi > > I would be interested in Ian McNicoll's point of view. Personally, I do not > find the measurement of blood glucose different for home monitoring as long > as it is clear that this is the method. Self or carer entry of data, a > device suitable for near patient testing - these could be at a clinic or > done by a nurse or doctor. > > I would use the blood glucose measurement for all measurements of this as I > think it is the same thing. Others? > > Cheers, Sam > > On 6/12/2012 12:49 PM, andres gamboa wrote: > > Hi, > I agree with that. Indeed the test aren?t comparable. This creates the > necessity of re-defining the concept of Blood glucose. I suggest to create > an archetype such " blood glucose monitoring", that includes the different > technics for glucose blood measurement , as "serum glucose measurement" > mainly known as "Glycemia", Home blood glucose monitoring (with glucometer) > and Glycosylated hemoglobine, or something like that. > > Andres Gamboa > M.D, Msc Biomedical Engineering > > >> Date: Wed, 5 Dec 2012 16:32:37 +0100 >> From: demski at helmholtz-muenchen.de >> To: openehr-clinical at lists.openehr.org >> Subject: Usage of Blood glucose archetype for self-monitoring >> >> Hello, >> >> i am involved in a project that supports diabetics in self-monitoring >> their health status by collecting observations of daily living >> >> (http://www.empower-fp7.eu/about/collecting-observations-of-daily-living/). >> >> We are currently defining the knowledge models by using the archetype >> methodology. I think the archetypes for Body weight, Blood pressure and >> Medication action can be reused without problems for the purpuse of >> self-monitoring by the patient. >> As far as Blood glucose is concerned I am not sure if the labtest >> archetype (openEHR-EHR-OBSERVATION.lab_test-blood_glucose.v1) is >> appropriate for self-monitoring as it was defined as a labtest >> originally. In contrast to the labtest that is performed on serum of the >> blood, the patient measures blood glucose by using hand-held meter using >> test strips and capillary blood. Therefore I doubt that the two >> measurement methods are comparable. Moreover the whole Protocol section >> of the existing Blood glucose archetype is dedicated to labtests and not >> applicable to the self-measurement. >> >> I would like to hear your opinion if the existing Blood glucose >> "labtest" archetype should be used for collecting measurements done by >> the diabetic himself, or if you suggest to introduce a new archetype for >> Blood glucose self-measurements. >> >> Thank you for any hints and comments. >> Hans Demski >> >> >> >> >> Helmholtz Zentrum M?nchen >> Deutsches Forschungszentrum f?r Gesundheit und Umwelt (GmbH) >> Ingolst?dter Landstr. 1 >> 85764 Neuherberg >> www.helmholtz-muenchen.de >> Aufsichtsratsvorsitzende: MinDir?in B?rbel Brumme-Bothe >> Gesch?ftsf?hrer: Prof. Dr. G?nther Wess und Dr. Nikolaus Blum >> Registergericht: Amtsgericht M?nchen HRB 6466 >> USt-IdNr: DE 129521671 >> >> _______________________________________________ >> openEHR-clinical mailing list >> openEHR-clinical at lists.openehr.org >> >> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > > > _______________________________________________ openEHR-clinical mailing > list openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- Dr Ian McNicoll office +44 (0)1536 414 994 fax +44 (0)1536 516317 mobile +44 (0)775 209 7859 skype ianmcnicoll ian.mcnicoll at oceaninformatics.com Clinical Modelling Consultant, Ocean Informatics, UK Director openEHR Foundation www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care www.phcsg.org
