Modeling reference ranges

[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

  
_
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Modeling reference ranges

[Ian McNicoll]

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
>
>
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Modeling reference ranges

[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_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
> 

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Modeling reference ranges

[Ian McNicoll]

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
>
>
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Modeling reference ranges

[pablo pazos]

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



  
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Modeling reference ranges

[pablo pazos]

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



  
_
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Modeling reference ranges

[pablo pazos]

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?.
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Modeling reference ranges

[Thomas Beale]

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Modeling reference ranges

[pablo pazos]

Hi Sam, Ian,

Thanks for your tips, I think we are far away from defining guidelines soon, 
but I think I can extend my templates to define this conditions/triggers there 
while we don't have a formal guideline to do so.

The objective of this project (it's my degree thesis) is: to build the first 
OpenEHR 100% medical record implementation in my country Uruguay, so if this is 
successful we can spread the word about OpenEHR works and how other can adopt 
it to build EHR systems. Now there are many initiatives to build EHRs but not 
much experience in how to do it, IMHO OpenEHR is the answer we are looking for, 
but I need something working to show it to the others :D

Cheers,
Pablo Pazos Gutierrez
http://pablo.swp.googlepages.com/



From: sam.he...@oceaninformatics.com
To: openehr-clinical at openehr.org
Subject: RE: Modeling reference ranges
Date: Wed, 14 Oct 2009 10:09:16 +0930



















I agree Ian ? though they are always triggers in reality. Australia
made more progress on Lipids when it changed labs from reporting actual norms
to target norms. Suddenly everyone had high cholesterols and down they have
come!

Cheers, Sam

 







From: openehr-clinical-boun...@openehr.org
[mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Ian McNicoll

Sent: Tuesday, 13 October 2009 9:42 AM

To: For openEHR technical discussions

Cc: openehr-clinical at openehr.org

Subject: Re: 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-boun...@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.













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