Hi Pablo,
I am just catching up with some of these discussions.
Although in theory all OBSERVATIONS must also have associated ACTIONS
to record the execution of the process, in practice this is not
necessary or the Action will refer to a group of Observations e.g. the
Action to a request to "Take Vital Signs measurements". Even if this
is recorded as part of nursing workflow, it is unlikely that each
individual Vital sign will need to have its ACTION recorded.
My priority is to ensure that the information required to support the
'real' clinical process is always available to the person reviewing
the record. So if device details are important to the clinical
interpretation of the record, we should ensure that they are part of
the OBSERVATION. The associated ACTION may be important for monitoring
care delivery but it rarely affects clinical interpretation.
The complexity of healthcare, differing use cases between unplanned
and workflowed care, primary data entry vs. messaged summaries, and
the presence or absence of a device registry, are always going to make
these decisions difficult. It is certainly possible (and cleaner) to
have references to external entities rather than them being modelled
in-line but it causes other difficulties in complicating archetype
visualisation for clinical review and of course, de-referencing for
messaging purposes.
I do agree that it would be useful if CLUSTER archetypes could be
reused between the DEMOGRAPHIC and EHR models. In fact is it quite
easy to hack the ADL to change one to another just by reaching the
EHR/DEMOGRAPHIC model name in the archetypeID but it would be better
if the tools just ignored the model part of the id.
Ian
On 17 June 2012 17:48, pablo pazos wrote:
> Hi Gustavo,
>
> As Heather pointed out, the solution seems to be to reference the internal
> structure of a device (or any other demographic archetype) through a
> CLUSTER. But I think those demographic concepts should be also modelled as
> complete, separate demographic archetypes, referencing the same internal
> structure (CLUSTER). This allow us (developers) to create functionalities
> for searching and processing on demographic archetypes.
>
> About the internals of a test, I think most often includes both ACTION and
> ?OBSERVATION, because an ACTION could be used when you need to record
> information about the execution itself (being or not a clinical intervention
> on the patient, e.g. the recording of the device used to make the test
> should be part of the ACTION not of the OBSERVATION), then the
> OBSERVATION(s) could hold the information about the test result or
> information about clinical findings during the test. Then the whole record
> of a test execution should be recorded into a COMPOSITION that references
> those ACTION(s) and OBSERVATION(s).
>
> The INSTRUCTION of a test could reference to a device that should be used on
> the test, but during the test maybe another device was used, and that should
> be part of the ACTION that executes the INSTRUCTION.
>
> Does this makes sense to you? Please correct me if I'm wrong.
>
> My student detected some oftalmologic concepts that are not in the CKM,
> maybe I can put you both in contact to collaborate on the modelling of those
> concepts.
>
> --
> Kind regards,
> Ing. Pablo Pazos Guti?rrez
> LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez
> Blog: http://informatica-medica.blogspot.com/
> Twitter: http://twitter.com/ppazos
>
> ________________
> From: gbacelar at gmail.com
> Date: Sun, 17 Jun 2012 10:03:15 +0100
> Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible?
> To: openehr-clinical at lists.openehr.org
>
>
> Hi Pablo,
> I'm an ophthalmologist and would be gladful to help.
>
> There are some issues about the archetype class and the nature of the test.
> As it is a study test it must be considered the existence ?of an
> intervention. If it does not include, so the most appropriate would be to
> record as an OBSERVATION archetype for the test. If it includes an
> intervention, then the most appropriate is to record as ACTION. For both
> situations?use the "Device" CLUSTER on the CKM to record the device,
> remembering this archetype is not adequate to record a substance
> (e.g.?fluorescein).
>
> To record the device that should be used for the test?at an INSTRUCTION
> archetype, also consider the?element "Description of Procedure"?of
> "Procedure Request"?archetype on CKM, which could be used to specify the
> device.
>
> I hope it was helpful.
> --
> Gustavo Bacelar
> MD + MBA + Med Informatics
> gustavobacelar.com
> +351 91 203 2353
> +55 71 8831-2860
> Skype: gustavobacelar
>
>
> ___
