I think the functionality seeked here is a threshold to trigger some action, like an alert. The given example was BP, and as an observation archetype it only records the blood pressure, using constraints to set up only the valid values, which are 0 to maybe up 300. The ranges are additional information that you can put to help the clinician’s evaluation, but only rules can make the computer take some action. That is what I meant Jussara
--------- Mensagem encaminhada --------- De: Thomas Beale <thomas.be...@openehr.org> Data: qua, 28 de fev de 2018 às 10:19 Assunto: Re: Setting thresholds Para: <openehr-techni...@lists.openehr.org>, For openEHR clinical discussions <openehr-clinical@lists.openehr.org> 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/> _______________________________________________ openEHR-clinical mailing list openEHR-clinical@lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- Jussara Rötzsch Sent from Gmail Mobile
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