Lifestyle: substance_use archetype

[Sam Heard]

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Lifestyle: substance_use archetype

[Sebastian Garde]

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




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Lifestyle: substance_use archetype

[Sam Heard]

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Lifestyle: substance_use archetype

[Bill Walton]

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



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Lifestyle: substance_use archetype

[Karsten Hilbert]

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

[Bill Walton]

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

[Gerard Freriks]

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

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Lifestyle: substance_use archetype

[Karsten Hilbert]

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

[Bill Walton]

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 

Lifestyle: substance_use archetype

[Thomas Beale]

Gerard Freriks wrote:
> 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"
that model above is pretty close to this: 
http://oceaninformatics.biz/archetypes/openEHR-EHR-OBSERVATION.substance_use.v1.html
but I guess the reality is that tobacco, alcohol and a few others 
deserve more detailed modelling, since they are of major importance and 
have their own specific questions attached.

Also, there is a difference between Observations of substance use (or 
any other activity of the patient, e.g. exercise) and therapeutic 
medication (including of herbal tea or suchlike). The latter is modelled 
as Instruction and the administration and other actions that occur (e.g. 
suspend, cancel etc) are modelled as Actions (a kind of Observation). 
The model and therefore the archetypes differentiate between consumed 
substances, and intentionally therapeutic interventions, even though at 
the physical level both may be describable as a person drink a glass of 
fluid

- thomas beale

Lifestyle: substance_use archetype

[Chunlan Ma]

The fact of "use of substances" is a little more complicated than these. 
For example, a person started smoking in 1995. He quit smoking after 
receiving smoking cessation therapy for two months in 2000. For some 
reason, he re-started smoking in 2001. How could we record the commence 
date and the re-commence date using the current archetype? How could we 
record the fact about quitting smoking, such as the times this person 
attempts to quit, with/without help, the therapies he received, etc.

Chunlan

Gerard Freriks wrote:

> 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 
>
>
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Lifestyle: substance_use archetype

[Gerard Freriks]

Yes.
Life is more complex than we can imagine most of the times.

What you are referring to is data and information dealing with  
addiction not the 'normal' use.
The meaning if "Addiction to a substance" is considerably  different  
from the "Use of a substance".
Extra data and information will have to be documented.

In my minds-eye I see an archetype "Observation: Addiction of a  
substance" and within it the use of "Observation: Use of substance".

Gerard

--   --
Gerard Freriks, arts
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

T: +31 252 544896
M: +31 653 108732



On 11-mei-2006, at 2:34, Chunlan Ma wrote:

> The fact of "use of substances" is a little more complicated than  
> these. For example, a person started smoking in 1995. He quit  
> smoking after receiving smoking cessation therapy for two months in  
> 2000. For some reason, he re-started smoking in 2001. How could we  
> record the commence date and the re-commence date using the current  
> archetype? How could we record the fact about quitting smoking,  
> such as the times this person attempts to quit, with/without help,  
> the therapies he received, etc.
>
> Chunlan

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Lifestyle: substance_use archetype

[Sam Heard]

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