Hi Paul,
things like Problem lists are 'interesting', and I consider them a
second order informational artefact. The short answer on how to do them
is probably something like this:
* creating an artefact to represent a specific problem such as chest
pain will mostly be done at execution time, by working clinicians
deciding what things are 'related to' the given problem;
o such choices are likely to be somewhat subjective, i.e. no
guarantee that two clinicians would make the same choices;
* technically a problem in the POMR sense could be represented as a
dedicated Composition containing LINKs or DV_EHR_URI references to
the bits and pieces of interest elsewhere in the EHR;
* tag(s) could be added a priori to EHR content (e.g. lab results,
physical exams, ECGs, etc) before it is committed, identifying it as
part of some particular problem(s), or similarly, Compositions could
be classified under Folders representing problems, just as they
already are under Folders representing episodes - but of course this
relies on health workers knowing what problems are 'defined' in the
EHR, and whether the new content should be added.
o Realistically, most linking of content to a problem is likely to
be a post hoc process.
As yet, the machinery to do this mostly exists, but there is little in
the way of standardised patterns or usage of it to achieve any kind of
standardised 'problem' document (NB: not the same as 'problem list' -
which is one level up, and is a managed list of issues considered to be
problems, usually inclding current Dxs such as diabetes etc).
To go further, e.g. to automate any of this would be a question of
creating rule-sets in which each rule detects a certain kind of content
being committed (using an AQL query or AQL path matcher or ADL match
expression), and adds a link to that content from the dedicated
Composition. Such rules would be evaluated on data commits to the EHR
inside a rule engine.
I suspect the best we can do at the moment is to standardise use of the
above mechanisms to create problem descriptions in a generic sense.
Experimentation with rules over time should eventually generate some
reliable patterns.
- thomas
On 26/06/2019 10:41, Bakke, Silje Ljosland via openEHR-clinical wrote:
Hi Paul!
Yes, this is part of the openEHR specification LINK class
(https://specifications.openehr.org/releases/RM/latest/docs/common.html#_link_class),
and it needs to be handled by the application. I know DIPS has started
using this in some functional areas like their hospital care plan
module, but I don’t remember the details. Maybe someone from DIPS can
elaborate.
Mvh.
*Silje*
*From:* openEHR-clinical <[email protected]>
*On Behalf Of *Paul Miller
*Sent:* Wednesday, June 26, 2019 3:36 PM
*To:* For openEHR clinical discussions
<[email protected]>
*Subject:* Problem orientation in OpenEHR
How would we do this?
There is a method of implementation in problem oriented records
whereby a header, generally the ‘problem’, is linked to other record
entries or elements that are to do with that problem.
So ‘chest pain’ as a problem may be linked to blood tests, clinical
notes, ECG, CXR and medications that were ordered or reported as part
of the work up of that condition.
In interfaces this allows for views of the record showing the Problem
and all linked events/entries/data. It’s essentially what Larry Weed
used to talk about.
Of course things may relate to more than one Problem, Problems may
link to each other, Problem headers and content will change over time.
There is usually a fair amount of manual curation, which may be very
contextual, but theoretical a lot of it could be automated.
By modelling this linkage in data it would become computable, and
potentially make some clinicians very happy in their work!
Is this something that is part of openEHR specification or that can be
modelled in archetypes? Or is it down to the application to manage this?
Thanks for any help. As always slightly anxious that am missing
something completely obvious, so apologies if so!!
Paul
Dr Paul Miller
GP, Glenburn Medical Practice
Clinical Lead, NES Digital Service
Mobile/WhatsApp: +44 7711 346 938
--
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Dr Paul Miller
MBCHB MRCGP FFCI DRCOG DMI
Glenburn Medical Practice
Fairway Avenue
Paisley
PA2 8DX
Tel: 0141 884 7788
http://www.glenburnsurgery.scot.nhs.uk/
Clinical Lead
NES Digital Service
https://nds.nes.digital/
Mobile: +44 7711 346 928
Twitter: @docpaulmiller
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Management Board, Specifications Program Lead, openEHR Foundation
<http://www.openehr.org>
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