In een bericht met de datum 12-12-2007 11:52:14 West-Europa (standaardtijd),
schrijft thomas.beale at oceaninformatics.com:
> Hi William,
>
> this is new to me. Are you saying that you can create an artefact in HL7
> that reuses specific data elements from archetypes, which are themselves
> hierarchically nested (due to the structure of the RM)? E.g. if a BP
> RMIM had possibilities for {baseline, 5 min, 10 min, 1hr, 4hr} X
> {actual, max, min, avg} X {systolic, diatolic, ... + patient position,
> exercise, ...} that you can then build a 'template' that chooses only
> (say) 5min actual value for systolic diastolic, and poisition? All
> within a (say) vital signs Section structure of which only some headings
> are chosen, and all that within (say) a GP contact Composition? I am
> interested to know how Organisers do that...
>
> - thomas
BP measures at baseline, 5 min, 10 min, 1 hr, 4 hr are each small molecules
composed of discrete observations (sys / dias / position / cuff / excercise).
The suggested examples base, 5, 10, 1hr etc go in the RMIM "Lists"
You can set any limit or expansion.
A CP "list Act" keeps those OBS or Acts together that a clinician chooses.
This is useable with CDA, Care provision and clinical statement (at this
time).
It is possible in the time attribute to determine start time, end time, width
and so on to select particular times as you suggest above.
It is possible in the value attribute to determine start max and min value
to select particular values of BP (e.g with pregnancy a key variable for
referral is a maximum diastolic BP > 95 mm HG).
In in an additional observation class for body position it can be made
explicit as value what the position is (in the current R-MIM for blood
pressure).
Excercise is not in the R-MIM but can be instantiated and related via the
component relationship in the Choice box. Again, would use a value to express
the
excersice. Vocab could be chosen from Snomed CT or local. This vocab could
also be made such that position is excercising is part of the value set, some
choice here similar to archetyping.
If you need a calculation you make another OBS that has the derivation
expression such that the algorythm or mathematic is expressed and that the
value
resulting from the mathematic can be entered (e.g. the sum score of an Apgar,
or
in the BP case the average value). This can be linked to the above list of
predetermined timing.
"Template" as you define it above can be used as follows:
Define the R-MIM blood pressure plus all additional you / clinician want(s).
Query the data based on this to select only the parameters you want (time,
max, width)
If you want to see this in the section vital signs, you "hang" the organiser
Act to the BP and link BP to the vitals section.
If the vitals section is again part of a specified contact, it can be nested
via the organiser to this part. ( I mean the larger section is nested into
vitals section is nested into BP is nested into 4 discrete observations)/
I would however suggest to apply the List of GP contacts and link the BP
results you want: so a list A GP contacts related to List B specified set of
BP.
This is how we have modeled it several times and it has been used as
structure behind e.g. the EPD in Nijmegen and the stroke system by Portavita.
Still
more validation work necessary though!
Hope this clarifies why I consistently say that the approach RIM - archetype
- OE templates does not differ methodically from CP D-MIM - care information
model as specified RMIM for clinical detailed stuff to template is organising
single OBS into lists or groupings.
Sincerely yours,
dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
email: Results4Care at cs.com
phone + 31654614458
fax +3133 2570169
Dutch Chamber of Commerce number: 32121206 </HTML>
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