Here was an earlier effort by me based on the Contsys approach. https://github.com/openehr-clinical/shn-contsys
Ian Dr Ian McNicoll mobile +44 (0)775 209 7859 office +44 (0)1536 414994 skype: ianmcnicoll email: [email protected] twitter: @ianmcnicoll Director, freshEHR Clinical Informatics Ltd. CCIO inidus Ltd. [email protected] Co-Chair, openEHR Foundation [email protected] Hon. Senior Research Associate, CHIME, UCL On Wed, 26 Jun 2019 at 15:07, Thomas Beale <[email protected]> wrote: > Hi Paul, > > things like Problem lists are 'interesting', and I consider them a second > order informational artefact. The short answer on how to do them is > probably something like this: > > - creating an artefact to represent a specific problem such as chest > pain will mostly be done at execution time, by working clinicians deciding > what things are 'related to' the given problem; > - such choices are likely to be somewhat subjective, i.e. no > guarantee that two clinicians would make the same choices; > - technically a problem in the POMR sense could be represented as a > dedicated Composition containing LINKs or DV_EHR_URI references to the bits > and pieces of interest elsewhere in the EHR; > - tag(s) could be added a priori to EHR content (e.g. lab results, > physical exams, ECGs, etc) before it is committed, identifying it as part > of some particular problem(s), or similarly, Compositions could be > classified under Folders representing problems, just as they already are > under Folders representing episodes - but of course this relies on health > workers knowing what problems are 'defined' in the EHR, and whether the new > content should be added. > - Realistically, most linking of content to a problem is likely to > be a post hoc process. > > As yet, the machinery to do this mostly exists, but there is little in the > way of standardised patterns or usage of it to achieve any kind of > standardised 'problem' document (NB: not the same as 'problem list' - which > is one level up, and is a managed list of issues considered to be problems, > usually inclding current Dxs such as diabetes etc). > > To go further, e.g. to automate any of this would be a question of > creating rule-sets in which each rule detects a certain kind of content > being committed (using an AQL query or AQL path matcher or ADL match > expression), and adds a link to that content from the dedicated > Composition. Such rules would be evaluated on data commits to the EHR > inside a rule engine. > > I suspect the best we can do at the moment is to standardise use of the > above mechanisms to create problem descriptions in a generic sense. > Experimentation with rules over time should eventually generate some > reliable patterns. > > - thomas > On 26/06/2019 10:41, Bakke, Silje Ljosland via openEHR-clinical wrote: > > Hi Paul! > > > > Yes, this is part of the openEHR specification LINK class ( > https://specifications.openehr.org/releases/RM/latest/docs/common.html#_link_class > ), and it needs to be handled by the application. I know DIPS has started > using this in some functional areas like their hospital care plan module, > but I don’t remember the details. Maybe someone from DIPS can elaborate. > > > > Mvh. > > *Silje* > > > > *From:* openEHR-clinical <[email protected]> > <[email protected]> *On Behalf Of *Paul Miller > *Sent:* Wednesday, June 26, 2019 3:36 PM > *To:* For openEHR clinical discussions > <[email protected]> <[email protected]> > *Subject:* Problem orientation in OpenEHR > > > > How would we do this? > > > > There is a method of implementation in problem oriented records whereby a > header, generally the ‘problem’, is linked to other record entries or > elements that are to do with that problem. > > > > So ‘chest pain’ as a problem may be linked to blood tests, clinical notes, > ECG, CXR and medications that were ordered or reported as part of the work > up of that condition. > > > > In interfaces this allows for views of the record showing the Problem and > all linked events/entries/data. It’s essentially what Larry Weed used to > talk about. > > > > Of course things may relate to more than one Problem, Problems may link to > each other, Problem headers and content will change over time. There is > usually a fair amount of manual curation, which may be very contextual, but > theoretical a lot of it could be automated. > > > > By modelling this linkage in data it would become computable, and > potentially make some clinicians very happy in their work! > > > > Is this something that is part of openEHR specification or that can be > modelled in archetypes? Or is it down to the application to manage this? > > > > Thanks for any help. As always slightly anxious that am missing something > completely obvious, so apologies if so!! > > > > Paul > > Dr Paul Miller > > GP, Glenburn Medical Practice > > Clinical Lead, NES Digital Service > > Mobile/WhatsApp: +44 7711 346 938 > > > -- > > -- > > Dr Paul Miller > > MBCHB MRCGP FFCI DRCOG DMI > Glenburn Medical Practice > Fairway Avenue > Paisley > PA2 8DX > Tel: 0141 884 7788 > > http://www.glenburnsurgery.scot.nhs.uk/ > > > > Clinical Lead > > NES Digital Service > > https://nds.nes.digital/ > > > > Mobile: +44 7711 346 928 > > Twitter: @docpaulmiller > > _______________________________________________ > openEHR-clinical mailing > [email protected]http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > -- > Thomas Beale > Principal, Ars Semantica <http://www.arssemantica.com> > Consultant, ABD Project, Intermountain Healthcare > <https://intermountainhealthcare.org/> > Management Board, Specifications Program Lead, openEHR Foundation > <http://www.openehr.org> > Health IT blog <http://wolandscat.net/> | Culture blog > <http://wolandsothercat.net/> | The Objective Stance > <https://theobjectivestance.net/> > _______________________________________________ > openEHR-clinical mailing list > [email protected] > > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org >
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