Archetypes and Terminology
Dear All This area is difficult and we must learn as we go. There are a few conclusions I have come to from an EHR system point of view.. 1. The data structures and term sets that are required for clinical care and communication must be able to be instituted both prior to and after the standardisation processes have been published. 2. Special requirements that are not contrary to agreed standards should be able to be implemented without difficulty - this is the norm rather than the exception. 3. Where terminologies required in archetypes are small and generally agreed, these should be primarily expressed in the archetype itself - not to do so is to add to the unrealistic demands on external terminologies. 4. Translations will be safest inside archetypes where the meaning is clear - the context is highly specified. This is a reason to extend the role of internal terminologies of archetypes. So, the new statements I would make are: 1. Archetypes should have no language or terminology primacy - and these should be able to be added post-hoc. 2. Terminologies internal to the archetype will always be safer to translate and provide synonyms and specialisations. Despite the feeling of some in the business, this does not really diminish the need for external terminologies. I am also aware that the comprehensive approach of Philippe and the Odyssey Project and the text processing of Peter Elkin. I believe these efforts will remain as relevant, but more focussed within an archetype driven information model. Cheers, Sam Heard Dr Sam Heard Ocean Informatics, openEHR Co-Chair, EHR-SIG, HL7 Chair EHR IT-14-9-2, Standards Australia Hon. Senior Research Fellow, UCL, London 105 Rapid Creek Rd Rapid Creek NT 0810 Ph: +61 417 838 808 sam.heard at bigpond.com www.openEHR.org www.HL7.org __ -Original Message- From: owner-openehr-technical at openehr.org [mailto:owner-openehr-technical at openehr.org]On Behalf Of Thomas Beale Sent: Thursday, 2 October 2003 8:46 PM To: openehr-technical at openehr.org Subject: Archetypes and Terminology (was Re: Antw: Re: Open Source EHR at the Americal Academy of Family Physicians ...) Philippe AMELINE wrote: Hi to all, We are currently experiencing such things ; it is not easy to have people understand the difference between description (As accurate as possible), local study (question 5 can be answered 5.1, 5.2...) and studies using classifications such as ICD or ICPC where you just can use concepts inside the classification (and it is sometimes complicated since, for example, send to the hospital as no entry inside ICPC). I don't think you can expect adressing all these issues through Archetypes I would not either...we just need some good oontologies... Yes, a validated scale on a particular issue around human functioning could be part of an ontology, but perhaps not always. The Barthel index or the APGAR score e.g. have distinct and different variables that probably would not stand beside each other in an ontology. Or, it would be an ontology with many to many parent - child relationships. The way we solve this kind of problem is that we incorporated inside the ontology concepts as ICD10 code, ICPC code and so on. These ontology concepts are given the code as a value in the same way patient size (cm) would be given 180 as a value. the ADL supports this more or less as well... - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Antw: RE: Archetypes and Terminology
In een bericht met de datum 5-10-2003 22:37:25 West-Europa (zomertijd), schrijft sam.heard at bigpond.com: Dear Sam, I agree, but perhaps your points need to be sharpened a little to distinghuish form one term and a terminology system. See my comments. Dear All This area is difficult and we must learn as we go. There are a few conclusions I have come to from an EHR system point of view.. 1. The data structures and term sets that are required for clinical care and communication must be able to be instituted both prior to and after the standardisation processes have been published. Yes, this will always be true, since the archetype should allow for new research results to be added, independend from where the standardisation process is. E.g. if a new scale for prediction of rehabilitation of stroke patients comes up after the standardisation process around archetypes / templates / models is finished, such a new archetype to represent this scale must be possible. 2. Special requirements that are not contrary to agreed standards should be able to be implemented without difficulty - this is the norm rather than the exception. See 1. If new instruments for clinical practice require additional characteristics, these must fit into slots of the archetype. This would imply that the archetype materials allow for such additions with a predefined 'free text'/ 'free format' section to do this. 3. Where terminologies required in archetypes are small and generally agreed, these should be primarily expressed in the archetype itself - not to do so is to add to the unrealistic demands on external terminologies. I agree, the goal is to develop a archetype and to use base material from external terminologies where relevant, feasible and possible. 4. Translations will be safest inside archetypes where the meaning is clear - the context is highly specified. This is a reason to extend the role of internal terminologies of archetypes. This is no different (procedure like) as within HL7 RIM the internal and external vocabularies are specified. See HL7 materials for the different portions. So, the new statements I would make are: 1. Archetypes should have no language or terminology primacy - and these should be able to be added post-hoc. Except for the archetype meta language and vocab itself. These should be explained / defined explicitly. There will be a primacy for the actual wording / terms used to describe the clinical content and context for this particular archetype. However, using particular words in the archetype should not a priori be based on one terminological system. Post hoc linkage from the actual wording in the archetype to terminological systems should be allowed. Perhaps, therefore it is better to reword this statement as 1. Archetypes should have no primacy for a language or terminology system or vocabulary - and these should be able to be added post-hoc. 2. Terminologies internal to the archetype will always be safer to translate and provide synonyms and specialisations. OK, but again see the suggestion to explicitly define internal and external terminologies within the archetype stuff. Despite the feeling of some in the business, this does not really diminish the need for external terminologies. I am also aware that the comprehensive approach of Philippe and the Odyssey Project and the text processing of Peter Elkin. I believe these efforts will remain as relevant, but more focussed within an archetype driven information model. Cheers, Sam Heard Thanks, William Goossen -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20031006/c65099e0/attachment.html
