Hi Pablo, You can see an example of the Goal archetype in-use via the SHN Heart Failure template at
http://www.openehr.org/ckm/#showTemplate_1013.26.14 This was my interpretation, which I think aligns with Heather's but others may vary! To answer Mark's point, I think the archetpye does support defining a range of values via the Interval datatypes. As Thomas has said, this is the subject of some discussion in the CIMI world. Although some sort of epistemic status flag/mood code seems attractive, it works very badly for Goal/Target. It is pretty obvious that the contents of an archetype for Target Blood pressure is very different for that ob the measurement itself. The only part of the highly complex blood pressure measurement archetype which has any value in the blood pressure target archetype are the systolic, diastolic and perhaps MAP datapoints and even at that level the original observation data point is a single value , whereas the target is likely to be an interval. To make an epistemic flag work we would need to model the original measurement as an interval, which is entirely possible technically but requires us to further constrain the measurement archetype at template level to make it useable. As Heather has pointed out, it might be possible to re-model every key data point as an individual cluster or even element archetype but that imposes a very significant burden on the modelling work, particularly clinical review, where we would again effectively have to re-create the existing blood pressure measurement archetype as a template with all of the additional constraints and aggregation. I don't think the CIMI group have really taken this on-board. In a sense, at least for the 'Target/Goal' scenario, all that we want to do is to re-use the datatype and units from the original 'measurement' archetype. We probably need to use different SNOMED bindings and convert the data type to its INTERVAL equivalent. So I would question whether there is any real value in re-using the original constraint pattern. Arguably the only attribute which is actually copied intact is the unit. I think it might actually be more sensible to use the current approach where an existing archetype node is pointed to for information but that this is then used by tools to replicate/adapt the original constraints. i.e this is re-use via copy/paste/edit rather than direct re-use/inheritance.aggregation. I suppose it all comes down to the value of direct re-use. At least for the Target/Goal scenario, I suspect the overhead of doing this far outweighs any benefit, and I think may be another example of informaticians trying to construct ontologically pure and elegant solutions which actually just get in the way of implementation. The eHealth record is fundamentally anti-pattern. Ian Ian On 20 June 2014 06:32, Heather Leslie <heather.leslie at oceaninformatics.com> wrote: > Hi Pablo, > > > > Comments inline > > > > Heather > > > > From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] > On Behalf Of pablo pazos > Sent: Friday, 20 June 2014 10:09 AM > To: openEHR Clinical > > > Subject: RE: Link between goals and other clinical concepts > > > > Hi Heather! > > > > Yes, I was evaluating the goal archetype. Great, now I get what the "Target > archetype node" is for. > > > > About that I have a question, what's the role of the "Target measurement"? > My understanding was that's the value set for the goal (e.g. target body > weight), > > [HVL:] Agreed. Perhaps we should refine the name/description to make that > clearer. > > > > not the measurement to be evaluated against the goal (e.g. current body > weight). > > If that value is the measurement, where should the value for the goal be > set? Or the idea is not to set a value like quantity but set a text in > "Target". > > > > My question was focused on the relationship between the value set for the > target goal and the archetype used to record the measurements to be compared > with the value of the goal. Because the goal and the measurements should > comply the same constraints (magnitude, units, etc) > > [HVL:] Understood . That is what I was referring to with my comment > ?correlation with magnitude and unit constraints would be nice to have, but > is not currently easy to achieve.? We would currently do that manually in > the template. Alternatively we could specialise the goal archetype for each > measurement, but that has lots of overheads as well. > > > > If we were to look at changing the modelling patterns to allow for a common > CLUSTER to be used within both the measurement OBSERVATION and the > EVALUATION.goal then we could achieve what you asked for. In the current ADL > 1.4 world that would be an enormous modelling overhead as then no > measurement model is standalone and ready to go but needs to be combined > with others in order to be used in every modelling scenario. > > > > It is not clear that the requirements for goal justify the changed modelling > pattern scenario. The value and clarity of the standalone OBSERVATIONs is > huge. > > > > Also, what about when you have a goal for the BP and you need to specify a > value for systolic and diastolic? Should I create two instances of the goal? > (One for systolic and one for diastolic). > > [HVL:] Depends on what you are trying to achieve. You could do it the way > you describe, and then reaching each goal can be assessed independently. Or > if you want to reduce the BP as a whole, you could set a goal of ?Reduce BP? > and have two targets, one for Systolic and the other for Diastolic > > > > Thanks! > > > > > > -- > Kind regards, > Eng. Pablo Pazos Guti?rrez > http://cabolabs.com > > ________________________________ > > From: heather.leslie at oceaninformatics.com > To: openehr-clinical at lists.openehr.org > Subject: RE: Link between goals and other clinical concepts > Date: Wed, 18 Jun 2014 03:13:09 +0000 > > Hi Pablo, > > > > Is it safe to assume that you?ve seen the current archetype for Goal? It is > here: http://www.openehr.org/ckm/#showArchetype_1013.1.124 > > > > In it we have a data element that specifically identifies the archetype and > path of the specific node that should be used to capture the actual > measurement, eg the weight or height or systolic blood pressure. > > > > This combination of the EVALUATION.goal archetype with various target > OBSERVATIONs for recording the actual data is being used in implementations > in Australia as part of a personalised care plan, as Hugh has indicated. The > correlation with magnitude and unit constraints would be nice to have, but > is not currently easy to achieve. > > > > Regards > > > > Heather > > > > From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] > On Behalf Of pablo pazos > Sent: Saturday, 14 June 2014 5:21 AM > To: openEHR Clinical > Subject: Link between goals and other clinical concepts > > > > Hi, if I want to establish a goal for body weight, I think there's a need of > linking the goal concept with the body weight concept, but the body weight > archetype is for measuring the weight not to specify a goal for it. > > > > I understand the difference between a goal (what you want to achieve, fixed > value) and the measures (to control your progress and compare with the goal, > variable value through time). > > > > Also, I think the target measurement from the goal archetype will depend on > the specific concept I'm creating a goal for (body weight), I mean the > magnitude and units constraints should be inherited someway from the concept > I'm measuring (body weight) into the goal archetype. > > > > Does anyone has an idea of how will be a good way of modeling a goal related > to another concept like weight or BP? > > > > Thanks! > > > -- > Kind regards, > Eng. Pablo Pazos Guti?rrez > http://cabolabs.com > > > _______________________________________________ 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
