Although Jussara is right in terms of reference ranges generally, i.e.
what you see in a pathology handbook as ref ranges for male / female /
child for say Total Cholesterol or some other analyte, the openEHR
Reference Model does allow reference ranges to be carried in DV_QUANTITY
(see here on the UML site
<https://www.openehr.org/releases/trunk/UML/#Diagrams___18_1_83e026d_1433773263789_448306_5573>-
DV_ORDERED.normal_range and other_reference_ranges). We do this for the
same reasons Karsten explicates below.
The idea is that the normal range (and other ranges) /specific to the
patient type for the current test order/ (sex, age, sometimes 'race',
e.g. African American cholesterol normal range is +10%) can be written
into the data. So, say the patient is a 64 yo female caucasian, and the
analyte is 'total cholesterol'. The ref range will be (something like):
* normal range: 159-276 mg/dL or in SI, 4.12-7.15 mmol/L
that is just one row from a table of normal ranges keyed by sex, age and
with the modifier for African Americans (I have a US path manual,
probably it is just 'African' elsewhere).
The reference range data is often influenced by other factors depending
on what it is, e.g. location, diet, and so on.
The point is, that the path lab can help the doc by including the
relevant normal range with the measured value, and therefore also
generate an 'abnormal' indicator in the result. This is a significant
time-saver for doctors, and it also has the effect of writing into the
EHR the reference range that was actually used to decide that the
patient was abnormal for that analyte and to intervene - i.e. it's the
reference knowledge for the assessment.
- thomas
On 28/02/2018 12:43, Karsten Hilbert wrote:
On Wed, Feb 28, 2018 at 12:18:24PM +0000, Jussara Macedo Rötzsch wrote:
Ranges aren’t actually part of the Information model, they are rules for
decision support, and therefore belong to the Application level, like a gdl
based CDS
In practice there are still needs to store ranges (with the data):
1) path labs will attach ranges to recommended interpretations
those are best stored "with" the result(-interpretation)
and, no, it is not sufficient to attach them to the test
*type* of a measurement
2) ranges applied by a clinician upon which a conclusion
has been made
those will often end up as textual part of a SOAP note
Think of a patient with warfarin monitoring: The lab will cry
foul (if not properly informed) but the clinician is happy
when the INR is in the therapeutic range.
GNUmed "solves" that by allowing to attach both a "nominal"
and a "desired" range to each test result.
For what that's worth.
Karsten
--
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Team, Intermountain Healthcare
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation
<http://www.openehr.org>
Chartered IT Professional Fellow, BCS, British Computer Society
<http://www.bcs.org/category/6044>
Health IT blog <http://wolandscat.net/> | Culture blog
<http://wolandsothercat.net/>
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