Modeling reference ranges
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Modeling reference ranges
Hi Sam, Thanks for your answer. That's exactly what I've tried to do, look for a constraint to the reference range of a Quantity. I think I can extend my templates to support this requirement, may be using the Assertion model. I'm using a custom template model. I have seen the datatype model, that's exactly what I whant to define with archetype/template model (if it's the right place to do it, now I see the archetypes are not a good place to do so). Thanks a lot! Cheers, Pablo. From: sam.he...@oceaninformatics.com To: openehr-technical at openehr.org; openehr-clinical at openehr.org Subject: RE: Modeling reference ranges Date: Tue, 13 Oct 2009 08:42:33 +0930 Hi Pablo The issue is that you do not see the reference model attributes in the archetype editor. A Quantity data type has a normal range and other reference ranges built in. We do not set the reference ranges in archetypes as these vary and archetypes are the absolute statement about things (what could possibly be true ever, anywhere). So it is in the form or data that you will get access to the reference range. You could set it in a template (not possible in our tools as yet). Generally the reference ranges come with the results from the lab or a dynamic depending on gender, age etc. I hope this is helpful ? have a look at the data type specs for clarification. The UML is at: http://www.openehr.org/uml/release-1.0.1/Browsable/_9_0_76d0249_1109599337877_94556_1510Report.html You will see an optional normal_range and 0..* other reference ranges as part of a root abstract class DV_ORDERED Cheers, Sam From: openehr-technical-boun...@openehr.org [mailto:openehr-technical-bounces at openehr.org] On Behalf Of pablo pazos Sent: Tuesday, 13 October 2009 8:02 AM To: openehr-clinical at openehr.org; openehr-technical at openehr.org Subject: Modeling reference ranges Hi, I'm playing around with archetypes trying to model an observation and its reference ranges, I mean something like "blood pressure" and some range to define what is "hypertension", but I can't found an archetype that defines a reference range for an observation. Any one has experience in modeling something like this? An archetype is the correct place to define a reference range for an observation value? Any ideas? Thak you! Cheers, Pablo Pazos Gutierrez Windows Live: Keep your friends up to date with what you do online. _ Windows Live Hotmail: Your friends can get your Facebook updates, right from Hotmail?. http://www.microsoft.com/middleeast/windows/windowslive/see-it-in-action/social-network-basics.aspx?ocid=PID23461::T:WLMTAGL:ON:WL:en-xm:SI_SB_4:092009 -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20091013/b9b7b7fb/attachment.html>
License and copyright of archetypes
Hi Sam! On Tue, Oct 13, 2009 at 01:04, Sam Heard wrote: > Richard has raised the issue of people copyrighting forms and other derived > works based on archetypes and perhaps claiming these cannot be copied. This > seems to be an argument in favour of SA... I'm not sure I understand your reasoning. 1. It seems to me that previously when you argued for Share Alike (SA) you said that derivative works (like GUIs) that were not archetypes should not be seen by the foundation as derivative works covered by the SA-requirement. (It still remains to be detailed if/how such a position by the foundation should be formalised.) 2. Now it sounds like you say that forms based on archetypes really should be considered derivative works and thus need to be released under SA too. Somehow you seem confident that this would solve more potential copyright issues than it would create. Don't you find the views 1 & 2 conflicting? Could you also detail how SA (in 2 above) would stop copy-fights in this setting, is it by disallowing all archetype based systems that are not published under a SA-license, leaving only open source solutions as permitted to use openEHR-hosted archetypes? (Since I like to use and create open source I would find this interesting, but I doubt it would be realistic in today's health care setting :-)) > > If you select CC-BY you can still require that any specialised or > > adapted archetypes _hosted_ by openEHR should be free under CC-BY. > Well, what if the specialised archetype is hosted in Brazil for instance. > What if you receive data from there? I assume you don't have a certain issue with projects based in Brazil (or do you?) and that you instead mean something like: "What if you receive data from a stupid organisation that wants to share data with you and does not understand that they need to release the related archetypes under a licence that allows you to use the related archetypes too?" The above situation may occur no matter what what licence the openEHR-hosted archetypes use (as long as openEHR does have a global monopoly on archetype creation). The way to cure this is not by SA, but by trying to educate stupid organisations on matters of reality. [Now jumping back to a previous part of the discussion...] On Tue, Oct 13, 2009 at 01:04, Sam Heard wrote: > Perhaps I could state what I personally see as the ideal state of > archetypes: > 1) That there is a community commitment to develop a shared set of > archetypes as well as detailed and summary display scripts (including > transforms to and from HL7 CDA, v2, CCR etc) which are freely available. This I believe is a goal for most of us involved in openEHR. It is the rules regarding the way to the goal that we are discussing. I question the value of SA as a means for this purpose and I think that a "community commitment" will be based on other things. If you don't have formal powers to force organisations to use your archetypes, and you don't have that since the openEHR specifications are OPEN, then you need to be as attractive as possible by other means (e.g. by having the most interesting and active community). Earlier I have stated why I think SA might make you less attractive and that it might provide a good starting ground for a competing non-SA community. A licence was not the tool to check integrity of archetypes (instead digital signing etc was). Likewise I doubt that a SA-licence would be the right tool to fight fragmentation of efforts. > 2) That these archetypes can be specialised for local use but that these > specialisations, should they be published, remain freely available to others > and under copyright of the openEHR Foundation so that other people can > specialise them further if appropriate. Whether the copyright of a CC-BY licenced archetype is assigned to openEHR or somebody else is irrelevant for this purpose. Anybody is free to build anything from a CC-BY work (including archetype specialisations) the same goes for a CC-BY-SA provided you release the new work as CC-BY-SA. > 4) That repositories for archetypes are federated to allow searching and > that specialisation is possible for any one searching these without seeking > permission from anyone (ie federated CKMs, national etc, use openEHR > copyright and licenses). Again, the copyright assignment is not an issue if you go for CC-BY. A well specified way/interface to query each others repositories (machine-to-machine, not GUI) would be a good thing here though. How do you for example query Ocean Informatics closed-source proprietary CKM (used by openEHR) from another program? Is there a specification published? Being able to extract the entire content contributed by the community would raise the credibility of the currently employed solution. > 5) That no one using archetypes could be accused of copying someone else's > forms or screen rendering based on archetypes. We could wish for this no matter what archetype licensing we use. Don't you thin
License and copyright of archetypes
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Modeling reference ranges
Hi Ian, thanks for the answer. I see, so the "reference range" is only for lab test results. Yes, what I like to do is something that for certain observation values it display something to the physician. Blood presure was just an example, the observations I have are: - Glasgow Comma Scale: <15 is a problem - Cardiac Frequency: <60 or >100 is a problem - Breath Frequency: <10 or >20 is a problem I'll look to Rong's work. Thanks a lot! Cheers, Pablo. From: ian.mcnic...@oceaninformatics.com Date: Mon, 12 Oct 2009 23:59:32 +0100 Subject: Re: Modeling reference ranges To: openehr-technical at openehr.org CC: openehr-clinical at openehr.org Hi Pablo, The Quantity datatype in the Reference model has built-in support for Reference ranges so these do have to be modelled overtly in archetypes. See http://www.openehr.org/svn/specification/TRUNK/publishing/architecture/rm/data_types_im.pdf This makes sense for lab tests etc where each test will report a reference range (which are often lab/analysis method dependent) along with the results themselves. However, you are talking about something different. There is really no such thing as a reference range for blood pressure, which might indicate hypertension. The definitions of hypertension vary, over time and by locality and the diagnosis will depend on many other factors than just the blood pressure itself. I think what you may be trying to capture is some thing more like a 'trigger blood pressure' which displays an alert to the clinician or initiates some other action if a set of criteria have been reached e.g 3 readings with a diasstolic > 100. This is more akin to a guideline or care pathway. You might want to have a look at the work Rong Chen has been doing using archetypes within computerised guidelines for chemotherapy. In this case the archetype does not represent actual patient data but an abstract of ALL patients who might fall within the guideline. See http://www.hst.aau.dk/~ska/MIE2009/papers/MIE2009p0653.pdf Hope this helps, Ian Dr Ian McNicoll office / fax +44(0)141 560 4657 mobile +44 (0)775 209 7859 skype ianmcnicoll ian at mcmi.co.uk Clinical Analyst Ocean Informatics ian.mcnicoll at oceaninformatics.com BCS Primary Health Care Specialist Group www.phcsg.org 2009/10/12 pablo pazos Hi, I'm playing around with archetypes trying to model an observation and its reference ranges, I mean something like "blood pressure" and some range to define what is "hypertension", but I can't found an archetype that defines a reference range for an observation. Any one has experience in modeling something like this? An archetype is the correct place to define a reference range for an observation value? Any ideas? Thak you! Cheers, Pablo Pazos Gutierrez Windows Live: Keep your friends up to date with what you do online. ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical _ Keep your friends updated?even when you?re not signed in. http://www.microsoft.com/middleeast/windows/windowslive/see-it-in-action/social-network-basics.aspx?ocid=PID23461::T:WLMTAGL:ON:WL:en-xm:SI_SB_5:092010 -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20091013/17208a5e/attachment.html>
Modeling reference ranges
Hi Ian, thanks for the answer. I see, so the "reference range" is only for lab test results. Yes, what I like to do is something that for certain observation values it display something to the physician. Blood presure was just an example, the observations I have are: - Glasgow Comma Scale: <15 is a problem - Cardiac Frequency: <60 or >100 is a problem - Breath Frequency: <10 or >20 is a problem I'll look to Rong's work. Thanks a lot! Cheers, Pablo. From: ian.mcnic...@oceaninformatics.com Date: Mon, 12 Oct 2009 23:59:32 +0100 Subject: Re: Modeling reference ranges To: openehr-technical at openehr.org CC: openehr-clinical at openehr.org Hi Pablo, The Quantity datatype in the Reference model has built-in support for Reference ranges so these do have to be modelled overtly in archetypes. See http://www.openehr.org/svn/specification/TRUNK/publishing/architecture/rm/data_types_im.pdf This makes sense for lab tests etc where each test will report a reference range (which are often lab/analysis method dependent) along with the results themselves. However, you are talking about something different. There is really no such thing as a reference range for blood pressure, which might indicate hypertension. The definitions of hypertension vary, over time and by locality and the diagnosis will depend on many other factors than just the blood pressure itself. I think what you may be trying to capture is some thing more like a 'trigger blood pressure' which displays an alert to the clinician or initiates some other action if a set of criteria have been reached e.g 3 readings with a diasstolic > 100. This is more akin to a guideline or care pathway. You might want to have a look at the work Rong Chen has been doing using archetypes within computerised guidelines for chemotherapy. In this case the archetype does not represent actual patient data but an abstract of ALL patients who might fall within the guideline. See http://www.hst.aau.dk/~ska/MIE2009/papers/MIE2009p0653.pdf Hope this helps, Ian Dr Ian McNicoll office / fax +44(0)141 560 4657 mobile +44 (0)775 209 7859 skype ianmcnicoll ian at mcmi.co.uk Clinical Analyst Ocean Informatics ian.mcnicoll at oceaninformatics.com BCS Primary Health Care Specialist Group www.phcsg.org 2009/10/12 pablo pazos Hi, I'm playing around with archetypes trying to model an observation and its reference ranges, I mean something like "blood pressure" and some range to define what is "hypertension", but I can't found an archetype that defines a reference range for an observation. Any one has experience in modeling something like this? An archetype is the correct place to define a reference range for an observation value? Any ideas? Thak you! Cheers, Pablo Pazos Gutierrez Windows Live: Keep your friends up to date with what you do online. ___ openEHR-technical mailing list openEHR-technical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical _ Windows Live: Keep your friends up to date with what you do online. http://www.microsoft.com/middleeast/windows/windowslive/see-it-in-action/social-network-basics.aspx?ocid=PID23461::T:WLMTAGL:ON:WL:en-xm:SI_SB_1:092010 -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20091013/5ec28ffc/attachment.html>
Modeling reference ranges
Hi Pablo The issue is that you do not see the reference model attributes in the archetype editor. A Quantity data type has a normal range and other reference ranges built in. We do not set the reference ranges in archetypes as these vary and archetypes are the absolute statement about things (what could possibly be true ever, anywhere). So it is in the form or data that you will get access to the reference range. You could set it in a template (not possible in our tools as yet). Generally the reference ranges come with the results from the lab or a dynamic depending on gender, age etc. I hope this is helpful - have a look at the data type specs for clarification. The UML is at: http://www.openehr.org/uml/release-1.0.1/Browsable/_9_0_76d0249_110959933787 7_94556_1510Report.html You will see an optional normal_range and 0..* other reference ranges as part of a root abstract class DV_ORDERED Cheers, Sam From: openehr-technical-boun...@openehr.org [mailto:openehr-technical-bounces at openehr.org] On Behalf Of pablo pazos Sent: Tuesday, 13 October 2009 8:02 AM To: openehr-clinical at openehr.org; openehr-technical at openehr.org Subject: Modeling reference ranges Hi, I'm playing around with archetypes trying to model an observation and its reference ranges, I mean something like "blood pressure" and some range to define what is "hypertension", but I can't found an archetype that defines a reference range for an observation. Any one has experience in modeling something like this? An archetype is the correct place to define a reference range for an observation value? Any ideas? Thak you! Cheers, Pablo Pazos Gutierrez _ Windows Live: Keep your friends up to date with what you do online. <http://www.microsoft.com/middleeast/windows/windowslive/see-it-in-action/so cial-network-basics.aspx?ocid=PID23461::T:WLMTAGL:ON:WL:en-xm:SI_SB_1:092010 > -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20091013/26ccfa3a/attachment.html>
License and copyright of archetypes
Thanks Erik and Richard, Richard has raised the issue of people copyrighting forms and other derived works based on archetypes and perhaps claiming these cannot be copied. This seems to be an argument in favour of SA... Perhaps I could state what I personally see as the ideal state of archetypes: 1) That there is a community commitment to develop a shared set of archetypes as well as detailed and summary display scripts (including transforms to and from HL7 CDA, v2, CCR etc) which are freely available. 2) That these archetypes can be specialised for local use but that these specialisations, should they be published, remain freely available to others and under copyright of the openEHR Foundation so that other people can specialise them further if appropriate. 3) That as many archetypes are copyright openEHR Foundation as possible to simplify the management of access and change, and certainly any released on the openEHR CKM. 4) That repositories for archetypes are federated to allow searching and that specialisation is possible for any one searching these without seeking permission from anyone (ie federated CKMs, national etc, use openEHR copyright and licenses). 5) That no one using archetypes could be accused of copying someone else's forms or screen rendering based on archetypes. So the tension here is between companies using archetypes being able to secure their investment in the software they produce and no one feeling threatened to use archetypes in their system. I must say, after reading Richard's post that I do think that the SA has advantages in not leading to legal issues when companies use archetypes. More on Eric's comments. > Sam, what matters here is not what _you_ think would be OK, but what > the license says if somebody wants to go to court e.g. to create > trouble for a competitor, and how that potentially scares > people/organisations away from using openEHR-hosted archetypes and > might instead build momentum for an alternative archetype community > using licenses that allow more freedoms. I agree. > > If we want to use a simple well known CC-license, then CC-BY, (or > possibly CC-0, http://creativecommons.org/about/cc0) would avoid these > issues. But the interesting thing here is probably not to make a list > of potential problems, but instead to see if there really are any real > benefits of a CC-BY-SA requirement that can't be met by just using > e.g. CC-BY. > If you select CC-BY you can still require that any specialised or > adapted archetypes _hosted_ by openEHR should be free under CC-BY. Well, what if the specialised archetype is hosted in Brazil for instance. What if you receive data from there? > Exchanging archetype based health data between organisations is pretty > pointless if you don't share the archetypes somehow, so I don't quite > see the driving force for organisations _not_ to use CC-BY for > archetypes used in data that they want to exchange with others. I think this needs to be explicit - you can use the data and archetypes. (For > commercial clinical trials there may be a case for secret/private > archetypes during the trial though since the archetype may reveal > things about the trial structure. Do we really want to forbid these to > in some cases be be specialisations of openEHR-hosted archetypes?) Surely the data is what must be secret, but if the archetypes are not published anywhere then I agree it would not be an issue. > wrote: > > As a director of the openEHR Foundation, I am concerned that we > > do not set up a situation where people merely collect or make minor > > adaptations of an archetype and make it commercially available. > > Sam could you clarify: Do you mean that your main worry is that you > are afraid that somebody will take CC-BY-licensed archetypes from the > openEHR-hosted repository, modify them a bit, and then redistribute > under a less free license and start charging for it? Or do you have > any other concerns that you can clarify? Yes > Won't your feared modified redistribution only be a problem to > interoperability if, all the following comes true: > a) If users will really consider the "commercial" versions to be a lot > better than the openEHR-hosted versions and are willing to pay for > something they used to get for free. The point is the collective investment in archetypes will be massive. How do we deal with the situation where someone creates a good archetype as a base idea and posts it on openEHR. Then someone specialises it quickly on the web and copyrights the archetype saying this is their archetype and no one else can make one like that? As someone said earlier on the list - these are all our collective ideas and it is inappropriate for anyone to claim them. But we have to have a collective governance structure that works and supports the processes that support communication of health records. > b) If the adaptations, if found useful by openEHR, are of such > innovation height that the modif
Modeling reference ranges
Thanks Sam, That was helpful but would you agree that is does not make much sense to use a reference range for blood pressure in the same manner as you would for a lab test. I have suggested that if Pablo is trying to set trigger conditions e;g a series of BPs over a particular level, then this properly belongs in the guideline/pathway space, rather than as ref ranges? Ian Dr Ian McNicoll office / fax +44(0)141 560 4657 mobile +44 (0)775 209 7859 skype ianmcnicoll ian at mcmi.co.uk Clinical Analyst Ocean Informatics ian.mcnicoll at oceaninformatics.com BCS Primary Health Care Specialist Group www.phcsg.org 2009/10/13 Sam Heard > Hi Pablo > > > > The issue is that you do not see the reference model attributes in the > archetype editor. A Quantity data type has a normal range and other > reference ranges built in. > > We do not set the reference ranges in archetypes as these vary and > archetypes are the absolute statement about things (what could possibly be > true ever, anywhere). > > > > So it is in the form or data that you will get access to the reference > range. You could set it in a template (not possible in our tools as yet). > Generally the reference ranges come with the results from the lab or a > dynamic depending on gender, age etc. > > > > I hope this is helpful ? have a look at the data type specs for > clarification. The UML is at: > > > http://www.openehr.org/uml/release-1.0.1/Browsable/_9_0_76d0249_1109599337877_94556_1510Report.html > > > > You will see an optional normal_range and 0..* other reference ranges as > part of a root abstract class DV_ORDERED > > > > Cheers, Sam > > > > *From:* openehr-technical-bounces at openehr.org [mailto: > openehr-technical-bounces at openehr.org] *On Behalf Of *pablo pazos > *Sent:* Tuesday, 13 October 2009 8:02 AM > *To:* openehr-clinical at openehr.org; openehr-technical at openehr.org > *Subject:* Modeling reference ranges > > > > Hi, > > I'm playing around with archetypes trying to model an observation and its > reference ranges, > I mean something like "blood pressure" and some range to define what is > "hypertension", but > I can't found an archetype that defines a reference range for an > observation. > > Any one has experience in modeling something like this? > An archetype is the correct place to define a reference range for an > observation value? > Any ideas? > > > Thak you! > > Cheers, > Pablo Pazos Gutierrez > > -- > > Windows Live: Keep your friends up to date with what you do > online.<http://www.microsoft.com/middleeast/windows/windowslive/see-it-in-action/social-network-basics.aspx?ocid=PID23461::T:WLMTAGL:ON:WL:en-xm:SI_SB_1:092010> > > ___ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > > -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20091013/1e268e17/attachment.html>
