Archetype conceptual and technical operational are 2 different things
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[Fwd: Modelling Medication Administration Control]
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Lifestyle: substance_use archetype
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[Fwd: Modelling Medication Administration Control]
My answer would be the following. I write it down to make clear I understood the reaction by Sam. -1- An EHR is there to document what has happened -2- An EHR doesn't contain workflow states. That is handled outside the EHR. It is in the EHR-system -3- There will be archetypes that help document a Plan, an Instruction, an Observation. E.g. to Plan for treatment, resulting in an Instruction to give medicines via injection , and the Observation that at the medication/ injection has been administered at a specific point in time by a specific healthcare provider. -4- Each archetype mentioned is almost the same has almost the same structure and will share common internal archetypes. There will be small subtle differences between these archetypes. Plans and Instruction can (but must not be always) less specific than the Observation when something has happened. The Observation is about a specific place, using specific methods, by specific person, at a specific time, etc. The Plan and Instruction can be more vague about the: where, when, what, with what, how, by whom, etc. Gerard -- -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 10-mei-2006, at 5:43, Sam Heard wrote: > Dear All > > I will take this slowly. The implementation and modelling processes > are different. > > Modelling: > > First, each action is a recording which leaves some > 'instruction' (which may or may not be recorded) in some state > (active, completed, cancelled etc). An Instruction is a recording > that calls for some action to take place, and may or may not lead > to a recording of this action in the EHR. It can be set to > time_out. Otherwise the current state is set by the action record > that is generated when someone does what is instructed. As the > machine states in which the 'action leaves the instruction' are > recorded as part of the action, the archetype of the care pathway > steps are in the action archetype. This was not immediately obvious > to me - but as soon as you consider that an action can be recorded > without an instruction, it is clear that this is where it must be. > Also, the instruction is not altered as the actions are being > carried out - a distinct advantage which will become clear with > more implementation experience. > > Summary: Actions are things done to patients in response to > instructions - in health care these are requests or orders by a > provider (generally). Instructions beget actions, and are left in a > known state after these actions. > > Implementation: > > It seems possible to predetermine all aspects of an action record > in the instruction record that generates the action. For example we > could say, "Give the baby her MMR vaccination" or we could say > "Give the baby her MMR vaccination using a 25G needle in the right > thigh laterally at 08:00 on 21/6/06 using batch no: AE43445". It is > unlikely but possible. > > What becomes clear from this is the specification for what could be > recorded is pretty much in line with the specification for what > could be instructed - the categorical difference is that an > instruction will have timing ( times a day after meals), whereas an > action will have a time (08:00 on 26/6/06). > > This is the reason that the archetypes for instructions and actions > are sharing a data structure - it is an embedded archetype and the > first time we have used this, although the openEHR model has been > geared for this from very early days. -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/a757ecb3/attachment.html>
Lifestyle: substance_use archetype
Sam, I believe the broad archetype is better in this instance, at least unless we could come up with a generic archetype that is sufficiently meaningful especially with regard to 'Consumption' It would then still be possible to specialise the 'other substance' in the broad archetype e.g. for use in a drug treatment centre. Should maybe add a generic 'consumption' and a 'type of substance' concept for 'other substance'. Sebastian From: owner-openehr-techni...@openehr.org [mailto:owner-openehr-technical at openehr.org] On Behalf Of Sam Heard Sent: Wednesday, 10 May 2006 1:54 PM To: Openehr-clinical Subject: Lifestyle: substance_use archetype Dear All I have been working on the archetypes for lifestyle and have approached them with trepidation. I am aware that there are lots of things that a person might like to record, and a lot of preferences. So we need to have a rich model for these things. The first one I have published is substance use and as designed includes alcohol, tobacco, caffeine and others - it is possible to nominate the others and have as many as you wish. The substance archetype is on the Ocean site: http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance _use.v1.html There is a link to the ADL on that page (second row) You will notice that I have not completed the descriptions in places, apologies. The question I have is whether it is best to deal with this as a broad archetype (deals with a number of substances although each slightly differently) or as specialisations. The current archetype is the former, but it would be possible to deal with these as three archetypes: Substance use \ _Alcohol \_Tobacco The advantage would be that you could look in the same place for the information and then see what the substance was, while the specialisation would provide the different recordings favoured for the different substances. The problem with this latter approach is that many people would probably use the unspecialised archetype for everything, and it would be difficult to get meaningful data about the most common substances leading to harm. For this reason, and the simplicity of use for software (templates mean that there could be three different templates that provided the same functionality), I favour the inclusive approach. I am interested in your thoughts, Sam -- Dr. Sam Heard MBBS, FRACGP, MRCGP, DRCOG, FACHI CEO and Clinical Director Ocean Informatics Pty. Ltd. <http://www.oceaninformatics.biz/> Adjunct Professor, Health Informatics, Central Queensland University Senior Visiting Research Fellow, CHIME, University College London Chair, Standards Australia, EHR Working Group (IT14-9-2) Ph: +61 (0)4 1783 8808 Fx: +61 (0)8 8948 0215 -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/8fbdd2d6/attachment.html>
Lifestyle: substance_use archetype
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Lifestyle: substance_use archetype
Hi Sam, Could you say more about the need for 'substance use' archetypes? I'm not sure I understand why it would be a good idea to record alcohol consumption differently from, for example, consumption of herbal teas. Or prescription drugs for that matter. I'm sure I'm missing something. Thanks, Bill - Original Message - From: Sam Heard To: Openehr-clinical Sent: Tuesday, May 09, 2006 10:54 PM Subject: Lifestyle: substance_use archetype Dear All I have been working on the archetypes for lifestyle and have approached them with trepidation. I am aware that there are lots of things that a person might like to record, and a lot of preferences. So we need to have a rich model for these things. The first one I have published is substance use and as designed includes alcohol, tobacco, caffeine and others - it is possible to nominate the others and have as many as you wish. The substance archetype is on the Ocean site: http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance_use.v1.html There is a link to the ADL on that page (second row) You will notice that I have not completed the descriptions in places, apologies. The question I have is whether it is best to deal with this as a broad archetype (deals with a number of substances although each slightly differently) or as specialisations. The current archetype is the former, but it would be possible to deal with these as three archetypes: Substance use \ _Alcohol \_Tobacco The advantage would be that you could look in the same place for the information and then see what the substance was, while the specialisation would provide the different recordings favoured for the different substances. The problem with this latter approach is that many people would probably use the unspecialised archetype for everything, and it would be difficult to get meaningful data about the most common substances leading to harm. For this reason, and the simplicity of use for software (templates mean that there could be three different templates that provided the same functionality), I favour the inclusive approach. I am interested in your thoughts, Sam -- Dr. Sam Heard MBBS, FRACGP, MRCGP, DRCOG, FACHI CEO and Clinical Director Ocean Informatics Pty. Ltd. Adjunct Professor, Health Informatics, Central Queensland University Senior Visiting Research Fellow, CHIME, University College London Chair, Standards Australia, EHR Working Group (IT14-9-2) Ph: +61 (0)4 1783 8808 Fx: +61 (0)8 8948 0215 -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/909b9f1c/attachment.html>
Lifestyle: substance_use archetype
On Wed, May 10, 2006 at 06:38:07AM -0500, Bill Walton wrote: > Could you say more about the need for 'substance use' > archetypes? I'm not sure I understand why it would be a > good idea to record alcohol consumption differently from, > for example, consumption of herbal teas. Or prescription > drugs for that matter. I'm sure I'm missing something. Recording "substance use" is more intended to record a *fact* about the lifestyle of an individual rather than an *intent to treat* as with prescription drugs. There's a fine line as always: herbal teas, OTC drugs etc may or may not have been intended to be treatment by the provider. However, disambiguating such in a given case is at the discreetion of the provider/patient in question. OpenEHR needs to provide facilities for both. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Lifestyle: substance_use archetype
Hi Karsten, Karsten Hilbert wrote: > > Recording "substance use" is more intended to record a > *fact* about the lifestyle of an individual rather than an > *intent to treat* as with prescription drugs. > > There's a fine line as always: herbal teas, OTC drugs etc > may or may not have been intended to be treatment by the > provider. However, disambiguating such in a given case is at > the discreetion of the provider/patient in question. OpenEHR > needs to provide facilities for both. It seems to me that 1) we want to provide a mechanism for recording _all_ substances used, and 2) for each, we want to record who 'prescribed' it. Patients "intend to treat" when they ingest herbal teas, OTC drugs, etc.. While I definitely see the value in recording the 'prescriber', I still don't see the value in creating a seperate archetype for 'substances' that are not provider prescribed. In fact, it seems to me to create unnecessary complexity. Example... A patient is undergoing chemotherapy. The patient finds that smoking marijuana helps control the nausea. If the patient lives in California their physician can prescribe the use of marijuana. It they live in Texas, its use cannot be prescribed. Another example... A patient wants to quit smoking cigarettes. The physician prescribes Nicorette gum. Then the FDA approves Nicorette for OTC sale. What would be the information value of recording this information with different archetypes? What would seperate archetypes allow me to do that I couldn't do as easily with a single archetype with a 'prescriber' attribute that could accomodate a value of 'self'? Thanks, Bill
Lifestyle: substance_use archetype
The EHR is about recording observed facts. One of those facts is the "use of substances". This means one has to document: - What - What for - How - How much - When - Prescribed by whom, when, where - Dispensed by whom, when, where - Administered by whom, when, where - Used when - ... Irrespective of a regular drug, herbal tea, food additive, smog, self medicated, prescribed, or taken by an involuntary action one always want to record the same things. Isn't it? So why not a generic Archetypes: "Observation: Substance Use" Gerard -- -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252 544896 M: +31 653 108732 On 10-mei-2006, at 15:53, Bill Walton wrote: > Hi Karsten, > > Karsten Hilbert wrote: >> >> Recording "substance use" is more intended to record a >> *fact* about the lifestyle of an individual rather than an >> *intent to treat* as with prescription drugs. >> >> There's a fine line as always: herbal teas, OTC drugs etc >> may or may not have been intended to be treatment by the >> provider. However, disambiguating such in a given case is at >> the discreetion of the provider/patient in question. OpenEHR >> needs to provide facilities for both. > > It seems to me that 1) we want to provide a mechanism for recording > _all_ substances used, and 2) for each, we want to record who > 'prescribed' it. Patients "intend to treat" when they ingest herbal > teas, OTC drugs, etc.. While I definitely see the value in > recording the 'prescriber', I still don't see the value in creating > a seperate archetype for 'substances' that are not provider > prescribed. In fact, it seems to me to create unnecessary complexity. > > Example... A patient is undergoing chemotherapy. The patient finds > that smoking marijuana helps control the nausea. If the patient > lives in California their physician can prescribe the use of > marijuana. It they live in Texas, its use cannot be prescribed. > > Another example... A patient wants to quit smoking cigarettes. The > physician prescribes Nicorette gum. Then the FDA approves > Nicorette for OTC sale. > > What would be the information value of recording this information > with different archetypes? What would seperate archetypes allow me > to do that I couldn't do as easily with a single archetype with a > 'prescriber' attribute that could accomodate a value of 'self'? > > Thanks, > Bill -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20060510/7eb8a429/attachment.html>
Lifestyle: substance_use archetype
On Wed, May 10, 2006 at 05:08:09PM +0200, Gerard Freriks wrote: > The EHR is about recording observed facts. > > One of those facts is the "use of substances". > Irrespective of a regular drug, herbal tea, food additive, smog, self > medicated, prescribed, or taken by an involuntary action > one always want to record the same things. > > So why not a generic Archetypes: "Observation: Substance Use" Concise, as always. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Lifestyle: substance_use archetype
Gerard Freriks wrote: > Irrespective of a regular drug, herbal tea, > food additive, smog, self medicated, prescribed, > or taken by an involuntary action one always want > to record the same things. Isn't it? My sentiments, precisely. > So why not a generic Archetypes: "Observation: Substance Use" Because, IMHO, the information would be more appropriately recorded under "Medications". The other "Observation" archetypes are much different than the "Substance Use" archetype. I can see where it would be appropriate to include info on 'substances' in that section when, for example, a urine test for the presence / absence of that substance needs to be recorded. But in lieu of test results, it seems to me that 1) the info Sam's included in the archetype isn't the same type of info as that included in the other Observation archetypes, and 2) adding this info to the EHR using the Medications archetypes would be both natural and a simple matter. Just my $0.02. Best regards, Bill
