This ontology of archetypes discoveries sound an awful lot like the nursing project of the early-mid 1990's on classification. The result of this project produced three classification schemes and defined the linkages between the three. These classifications include:
Nursing Interventions Classification (NIC) Nursing Outcomes Classification (NOC) North American Nursing Diagnosis Association (NANDA) From Sam's example below, the Diagnosis is roughly equivalent to an observation (NANDA), the intervention is the action (NIC)...and expected outcomes are not discussed...but seemingly might also be an action in Sam's example. The nursing classifications are comprehensive, but specific to nursing. I suspect the openEHR definition are targeted at the general practitioner, at least initially. Still, there may be some level of re-use possible from the Nursing classifications. The bottom line is we should look at the structure of the nursing classification scheme, and associated linkages between the classification. It provides a very organized way to represent clinical actions and reactions. It is roughly in keeping with the Archetype ontology Sam describes, but not an exact fit. For those who want further detail, here's a brief go at describing NIC and NOC in short. The publications do much more justice than this short synopsis. Each intervention has a succinct definition followed by a detailed listing of activities for that particular intervention (sequencing accounted for). Actions for openEHR and NIC activities appear roughly equivalent. An example of an intervention is Fluid Management defined as "Promotion of fluid balance and prevention of complications resulting from abnormal or undesired fluid levels". Activities for Fluid Management are two pages long, but include "Monitor vital signs, as appropriate; Maintain accurate intake and output record; Weigh daily and monitor trends; etc. Each outcome has a succinct definition followed by a detailed listing of indicator categories (and a 1 - 5 "level" for setting indicator severity). An example of a outcome is Electrolyte & Acid/Base Balance defined as "Balance of electrolytes and non-electrolytes in the intracellular and extracellular compartments of the body". Indicators for this outcome include (only a few from the page of indicators) Heart rate IER; Heart rhythm; respiratory rate; Serum Na; Serum K; Serum Cl; Serum Ca; Serum pH; BUN; Urine pH; mental alertness; etc. For each indicator a level of "1" for Extremely Compromised - to - "5" Not Compromised is indicated. There are interesting software packages that take the input of the nursing practices and provide disease and materials management capabilities. I believe that openEHR will find these classification schemes useful. It will require a fairly significant amount of research to duplicate such and effort, so it might be worth taking a looksee. At 06:01 AM 9/4/2002 +0930, Sam Heard wrote: >Dear all, > >I have been working hard to get an ontology of archetypes developed that >will show the health domain mapped into the openEHR architecture. I have >found a couple of things: > >1. That there is often a link between an instruction and subsequent >observations - which I think will be more important as knowledge bases are >developed in the future. I have called the link an action specification and >at present it is modelled as part of the instruction. Let me give a real >example. > >If you prescribe a medicine then there are a number of attributes of that >medication order - dose, form, route etc - and there is the frequency of >administration. When you record that a medication has been administered - >then you record the dose, form, route etc - but not the frequency. The link >is the specification of the action - but not the conditional elements of the >instruction. > >Many other things may be specified at the time that they are ordered and >there may be protocols etc that are to be followed. > >For this reason - I have two new subclasses in the ontology (not in >openEHR) - "openEHR Observation - action" and "openEHR action >specification". This allows me to say which action specification applies to >an instruction and which obeservations it applies to. > >2. It might be necessary to state the sequence of different instructions. >The French oncologists wish to state this for Surgery, Radiotherapy, >Chemotherapy etc. Clearly each of these will have a complex action >specification. How then to make it clear about the order of the >instructions - should one finish before the other starts? > >I welcome your ideas. I have put the zipped (45K) protege files on >www.gehr.org in the Watch this space section. > >Cheers, Sam >____________________________________________ >Dr Sam Heard >The Good Electronic Health Record >Ocean Informatics, openEHR >105 Rapid Creek Rd >Rapid Creek NT 0810 >Ph: +61 417 838 808 >sam.heard at bigpond.com >www.gehr.org >www.openEHR.org >__________________________________________ > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org --------------------------------------------- Mary E. Kratz Manager, Internet2 Health Sciences 3025 Boardwalk Ann Arbor, Michigan 48018 V: (734) 352-7004 C: (734) 604-9438 F: (734) 913-4255 For immediate response, please contact: Sharon Moskwiak Executive Assistant, Applications V: (734) 352- 7089 email: slmjam at internet2.edu - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
