Matias Klein wrote:
> Hello All,
>
> We are making incredible progress with the openEHR framework!
> Recently we faced a requirement to create patient-facing data capture
> tools. Unfortunately we can't seem to find a place in the openEHR
> model where these types of propositions fit cleanly.
>
> For example if I have a patient intake form that has the question, "Do
> you have diabetes?" Obviously the patient's answer to the question
> could be modeled as an observation of "diabetes" mapped by the
> DV_CODED_TEXT datatype to SNOMED or ICD. However what I don't
> understand is how the proposition "Do you have diabetes?" should be
> modeled?
This is definitely an archetype question, and Sam or someone else will
most likely post a good clinical response to this. What I will say for
the moment:
* the reference model will allow you to do what you want
* if you want to capture user input which says "does / does not have X",
then the X is in the question, or what we think of as the 'name' of the
data node. So the ADL archetype fragment might look like:
LIST matches {
items cardinality matches {0..*} matches {
ELEMENT [at0045] matches { -- "diabetes"
name matches {
[local::at0145] -- "do you have diabetes?"
}
value matches {
BOOLEAN matches {*} -- True and False allowed
}
}
ELEMENT [at0046] matches { -- "hypertension"
name matches {
[local::at0146] -- "do you have hypertension?"
}
value matches {
BOOLEAN matches {*} -- True and False allowed
}
}
ELEMENT [at0047] matches {
-- etc
}
}
}
In this archetype, the actual questions are expressed as archetype-local
coded "terms" (try and do that in snomed!); this may not be necessary,
if your software can generate sensible questions like "do you have
<thing>?" where <thing> can be substituted from the archetype.
But - from a medical point of view, this is only summary information -
it's only useful for the patients who say 'no', or for a summary part of
the EHR. For those who say yes, you (or someone) probably wants to
characterise their problem properly - since "has diabetes" covers NIDDM,
IDDM, advanced, newly diagnosed, even gestational diabetes, if we take
the question literally. Well...you know all this of course, the question
is - how to model a more sophisticated version of this data? This is
where a different archetype design is needed. The idea might be to
capture diabetes information within a family history archetype; or a
diabetic diagnosis archetype, or a general problem diagnosis archetype.
I'll leave it to others to provide models for this.
The main point is to create data which makes for sensible querying. With
the archetype fragment above, you have to query for paths from e.g. a
problem diagnosis archetype where "diabetes" is part of the path (i.e.
part of the names); then when you find instances of that, you have to
find the ones with True as the value. If you capture data in the form
name = "problem"; value = "diabetes mellitus", then you can query using
the standard path something/something/problem and find instances with
the value "diabetes mellitus".
- thomas beale
-
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