Dear All Some further information on my thoughts on these matters.
1. Rubrics I believe that the textural entry in the record should be the only text that is carried - not the individual rubrics - as not only is this unnecessary - but it leads to the danger of use of the rubrics without access to the terminology service from which they are derived. Remember, if the codes are there then the rubrics are available if you have access to that terminology service - and the final 'rubric' or post coordinated string is always present. 2. Mode changing Alan's idea of mode is important - some 'modifiers' change the meaning of the term to something quite different. I suggest that such relationships have to be in the archetypes - such as 'risk of' or 'family history of' amd we have archetypes for these notions. The argument for this is that we need more than these term associations anyway - family history in the future will require the nature of the relationship and also if it was genetic or not. Risk will require quantification and almost certainly some details of how it has been calculated. Fear of probably does not fall into this category - and should not be available as a qualifier for this reason. I would suggest a specific place holder in the problem archetype for this - remebering that agorophobia is a precoordinated version of this anyway and we should be careful to ensure that there is some consistency about this. 3. Negation - there are limited terms that have sensible negation - but family history is an example where you may wish to say that there is no family history of XXX on the maternal side - as this may be significant. For this reason there is a negation placeholder in the family history archetype. This may be required in a number of places. Negation does not sit well at the term level - how would we describe the situation above - 'Family history - maternal relatives - not(ovarian cancer)'. This is not what we want to say - it should be 'not(Family history - in maternal relatives - of ovarian cancer)' - something that is only possible in the archetype structure. Although it is tempting to consider the utility of palpable having not-palpable as a negation - present and absent do not work so well - and most polar extremes such as high pitched and low pitched are not negations at all. What if someone records 'not(liver)'. These are my initial contributions to this debate. Cheers, Sam ____________________________________________ Dr Sam Heard The Good Electronic Health Record Ocean Informatics, openEHR 105 Rapid Creek Rd Rapid Creek NT 0810 Ph: +61 417 838 808 sam.heard at bigpond.com www.gehr.org www.openEHR.org __________________________________________ > > A new proposed draft of the openEHR data types is available at > http://www.deepthought.com.au/health/openEHR/data_types_1_5_2.pdf. This > draft includes a major rewrite of the explanation of text types (plain > text, coded text and friends). The model is not drastically different, > apart from the addition of a new attribute in DV_TEXT called mappings. > This is an important attribute, as explained in the text, and covers the > semantics of classifying terms, equivalents (HL7 "translations"), and > other scenarios where text (coded or otherwise) is mapped to other terms. > > OPEN QUESTIONs > > There are a few outstanding questions on the model, which terminology > experts on this list might like to respond to. > > 1. The use of rubrics in TERM_REFERENCE and DV_CODED_TEXT. > The "rubric" is the textual rendering corresponding to a code. We have > put it in TERM_REFERENCE, which models exactly the 1:1 asscociation of a > rubric and a code, and also in DV_CODED_TEXT, where it means the final > text string generated by the terminology service, taking into account > qualifiers. For almost all instances of DV_CODED_TEXT, there is only one > TERM_REFERENCE anyway, so the two rubrics are duplicates. For those > cases where post-coordination of a primary and one or more qualifiers is > generated by the terminology service (e.g "lung, left"), the rubric of > each TERM_REFERENCE will be the primary and the qualifier terms ("lung" > and "left", respectively), while the rubric of the DV_CODED_TEXT the > coordinated result ("lung, left"). > > Sam Heard suggests that there is no reason to keep the rubrics of the > TERM_REFERENCEs, since a) it is almost always a duplicated of the rubric > of the DV_CODED_TEXT, and b) it will never be needed even in cases where > qualifiers are used. > > Is there any reason to keep TERM_REFERENCE.rubric? > > > 2. Mode-changing term flag > We have not currently used a flag to indicate change of mode such as > "risk of", "history of" etc. Our analysis is that the proper use of > archtyped information structures obviates the need for any such special > indicator. > > Dipak Kalra and David Lloyd (and I suspect many others) argue that such > a flag or indicator is still needed. > > Are there other opinions on this matter? > > > 3. Negation flag > Simiarly, we don't believe that any special flag is needed for negation, > and in fact is likely to be dangerous. > > We know however that many might not agree, since almost all of us are > used to the "old" world in which EHR data was not constructed according > to well-defined models. Are there any arguments for adding a flag to > indicate negation to the DV_CODED_TEXT class - with evidence and > examples please. Please read the arguments in the document first, before > replying! > > > - 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
