Hi Greg, I think that to wait until all archetypes are mapped to terminology reflects losing view of the value that the structured content found in archetypes brings to health informatics. The structure inherent in an archetype gives an excellent semantic handle on clinical content in the large majority of cases, and the strategic and appropriate mapping of terminology to these archetypes will (theoretically) enhance clarity and minimise any potential ambiguity and make the models VERY powerful. (Practical experience suggests that this is not as easy as some might think - and has been alluded to by some others previously.)
Indeed, there are data points in archetypes that are very dependent on mapping to terminology, such as lists of diagnoses or symptoms - the free text alternative here is not pretty nor particularly useful for querying. BUT THESE ARE VERY MUCH IN THE MINORITY, and will often have more of a role in terminology subsets applied in templates. Archetypes will only have terminology codes incorporated where it is universally applicable - the archetype by definition is designed as a maximal data set and for a universal usecase, so if there is doubt about the universality of a given terminology code, it probably needs to be applied within a template environment, rather than the archetype. And remember that Snomed/LOINC is not the only terminology that needs to be incorporated - there are a lot of places in the world that have no mandated terminology; that do not have a relevant language version of Snomed; that mandate an alternate terminology such as ICD-10 etc. So we have a number of terminologies to manage. The Clinical Knowledge Manager (CKM - the openEHR archetype repository) is being designed from the following point of view - lets model the clinical content as per clinician requirements in the archetypes, and get them reviewed, published and out there and being used - as they are increasingly being used in real implementations! And by all means, let's incorporate terminology as fast and as sensibly as we can. The reality is that terminology mapping is possibly a slower process than we think, yet one that can happen in parallel or following on from archetype publication. In the pending CKM, archetypes will be formally regarded as publishable based on agreement on both clinical content and design, by a combination of clinician teams and openEHR geeks. Terminology mapping can be commenced as soon as the content has been finalised (otherwise we don't know what content needs a code), but in the majority of archetypes can safely happen at a later date without major impact on semantic representation of clinical content. For the minority of archetypes that are identified as having immediate terminology requirements, then this process needs to happen simultaneously. Similarly, translations can only commence once the content is finalised and published, and will no doubt be an iterative process, with translations being dependant on need. The CKM is not far away and looking good - currently undergoing beta testing... Will keep you posted. Cheers Heather Greg Caulton wrote: > Hi, > > One of the things that has been holding me up is the conundrum around > coded clinical documentation. > > I would use OpenEHR exclusively but as I delve into the depths of > integration I am getting nervous that the archetypes have not yet been > mapped to LOINC or SNOMED. > > As an example comparison take a patients (non-birth) weight for > example. In pediatric hospitals and for patients receiving chemo it > has always been critical to differentiate between a carefully measured > weight suitable to weight dose calculations versus a weight perhaps > measured adhoc at an outpatient clinic. > > In SNOMED I find > > 27113001 : body weight - synonym of Body weight (observable entity) > > In OpenEHR we have > > openEHR-EHR-OBSERVATION.body_weight.v1.adl > > which defines the weight, clothing worn, and device used. > > In LOINC we have > > LOINC_COMPONENT PROPERTY TIME_ASPCT SYSTEM SCALE_TYP > METHOD_TYP > 3141-9 Body weight Mass Pt ^Patient Qn Measured > 3142-7 Body weight Mass Pt ^Patient Qn Stated > 50064-5 Body weight Mass Pt ^Patient Qn Ideal > 8335-2 Body weight Mass Pt ^Patient Qn > Estimated > > I expect the SNOMED term could be qualified - but I would have to > search around to figure out with which term would be appropriate > (illustrating the challenge). > > So I guess ultimately the question boils down to what is > everyone/anyone else doing > > - OpenEHR > - OpenEHR + LOINC > - OpenEHR + SNOMED > - All (tough especially as each system has its own set of terms and > concepts of what is what) > > And perhaps what does your average EMR doc want? > > I am not talking about ICD9/10 or CPT codes as I need to do those for > billing anyway. > > thanks! > > Greg > > > http://www.patientos.org > Open Source EMR in the making > _______________________________________________ > openEHR-clinical mailing list > openEHR-clinical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical > > > -- *Dr Heather Leslie* MBBS FRACGP FACHI Director of Clinical Modelling *Ocean Informatics <http://www.oceaninformatics.com/>* Phone (Aust) +61 (0)418 966 670 Phone (UK) +44 (0)77 2206 4546 Skype - heatherleslie
