Hello all,
I recently had a little free time to read you: thank you for your work !
Thomas Beard gave me a brief archetype "short definition" (still in use ?).
It was: "concepts defined by constraints".
One formal remark: usually constraints (i.e. Horn clauses) can freely be
added, so the model is open to expansion without reconception (adding
constraints to a set reduces the size of the set, and does not redefine it).
By this way, an archetype could address at least 3 functions:
A* serve as a possible definition of the concept: so retrieve information
even when it is not explicitly specified;
B* serve as a definition of what a concept possibly underlies: so, let the
possibility of proposing a data input prototype;
C* serve as a definition of what a concept needs to be correct: so, check
the correctness/acceptability of an input;
Some examples/explanations of what I mean (sorry for my poor translation):
A: "nephrotic syndr?me" may be defined as the co-occurence of
"proteinuria", "declive oedems", and "hypoalbuminemia".
So I may search for in a specific record or set of records.
And so, if I also have another definition of the same concept, my
research results will possibly be a wider set.
Remark: This function/spec applies to data retrieval and mining (and
may be used for verifying data correctness), but does not affect the
existence of the EHR, nor the openEHR standard as an EHR data transmission
and interoperability standard.
B: I have recently discovered the evolution to separate the notion of (data
input) information prototypes. (Ph Ameline will recognize the concept of
"fils guides"). I strongly support this notion. I add the idea that, in
some cases, information prototypes could be deduced from specified archetypes.
Remark: This function/spec also applies to EHR applications "in use",
but does not affect the existence of the EHR, nor the openEHR standard as
an EHR data transmission and interoperability standard.
C: Analyze the correctness/ acceptability of data.
What for ? a few examples:
* Accept data input; for example,
> accept only valid values of glycosemia (which implies having
recognized the concept),
> accept toxoplasmosis serology prescription to gender female/
possibly pregnant people (which means ability to search the corresponding
information in the EHR, and also means the possibility to force/violate the
constraint : ie facing a suspect retinopathy);
* Trigger events/alarms/reactions on data occurences: for example,
> beep when systolic blood pressure is under 5 (which means having
the specification of the range of normal values);
> beep when a cephalosporin is prescribed to a patient allergic to
beta lactamins (which means dealing with ontologies);
> beep when a patient's size/weight ratio indicates obesity (which
means dealing with formulas);
* Validate / Propose posology: for example,
> compute the mg/kg ratio and propose the according posology of a
relevant treatment;
> compute the corporal surface ratio and propose the according
posology of a relevant treatment;
> compute the creatinin clairance ratio and propose the according
posology of a relevant treatment;
in a more general form, facing a treatment, compute the relevant
ratio/ bounds and propose the according posology;
> compute cost/ complications/ efficiency ratio and propose
alternative treatments;
* Check/Transmit for the visibility of data to users. for example,
> tell that patient habits in an EHR (for example: "zoophilia with
a macacus rhesus") may be transmitted to a concerned physician ("infectious
disease ?") but not to a non-physician (nurse ?, social worker ?, boss ?,
wife/husband ?, family ?, moral league ?, health insurance provider ?, bank
?). The EHR is not/must not become the way to practise a coming out. This
applies to EHR "in use", but also to transmitted EHRs.
In my meaning, some archetypes applies to EHR data (for examples, the
patients tells the physician: "this is not to be transmitted" or "this is
to be transmitted to physicians only", or "my religion is to be transmitted
to the concerned nurse") and some may apply to all EHRs.
I would suggest the future standard to be :
* simple -initially, as simple as possible, so it could be quickly
generalized-;
* open to evolution/adaptation;
* open to increase of the archetype/prototype database by addition of
archetypes/prototypes;
* open to the electronic transmission of archetypes/prototypes in
electronic form (and within EHRs);
> > Or is it more general: Are concepts related?
Yes
> > Then the problem is: what relations are there between concepts
> (archetypes)?
Do we need to define them all in the standard (if yes, we are sure to omit
some) ?
Can't we nominate a "archetypes relationships ontology group" to do the work,
publish his work in a pre-adopted, free "general relationships ontology",
and concentrate on what a generic relationship is ?
> > What semantics of these relationships between archetypes (concepts) do we
> > need to describe reallity (including decision support)?
Is this a priority ? Is it needed to publish the standard (my idea/Murphy law:
"any exhaustive enumeration only takes an infinite time to enumerate").
May be using cases and generalizing...
At 17:46 05/08/2003 +0930, you wrote:
>Gerard
>
>I am using the term 'assumed' value in the archetype editor. This seems
>helpful as it means that it does not have to be recorded and it is normal
>practice. A single BP reading is assumed to be sitting - possibly lying -
>but not standing. Weight is assumed to be measured in light clothing and
>without shoes...
>
>For legacy systems this approach seems beneficial as there will be a lot of
>data missing!
>
>Cheers, Sam
>
> > ----- (...)
> >
> > Hi,
> >
> > Is it?
> > Is it about how to represent the domain "normal values"?
> >
> > Or is it more general: Are concepts related?
> > Then the problem is: what relations are there between concepts
> > (archetypes)?
> > What semantics of these relationships between archetypes (concepts) do we
> > need to describe reallity (including decision support)?
> >
> > Gerard
> >
> >> ----- (...)
> >>
> > >> Admittedly, I'm slipping into the realm of decision support, but I think
> > >> it really is simply the structure of the domain of normal values in this
> > >> specific application.
> > >> I'd like to use archetypes to represent this, just as a I might
> > >> use them to represent the min and max of a given quantity.
> > >> Is the capability all there already? If not, what's missing?
> > >>
-- Patrick Lefebvre
"Ce que j'?cris n'engage que moi, et ce jusqu'? ma prochaine id?e."
"What I write is just the current status of my thinking."
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