Hi Hugh, The Exclusion archetype makes sense at a diagnosis or procedure level but does not work well for detailed clinical findings. In the case of the pathology archetypes it would result in the creation of scores of Exclusion archetypes and umanageable templates.
The problem Koray raises is actually quite complex and difficult. 1. There is crossover with the more generic problem of questionnaire type constructs which run counter to Clinical Statement type expressions e.g. (Name) 'Polyps present" =Y/N (value) as opposed to (Name) 'Polyp findings' = Polyps present/ polyps absent (value) 2. The handling of indeterminate/equivocal responses which is handled specifically in Snomed and by possibly by Null flavours in HL7/openEHR, though this can be difficult to acheive reliably e.g Some path models have both indeterminate AND equivocal. Others have more nuanced values etc. My policy when constructing the path archetypes was to model 'nulls' explicitly as Koray has done. This is frustrating and cumbersome but does make Snomed mapping much easier. 3. Koray is also identifying a need for a conditional statement which effectively switches on /off mandation for child elements. I understand Graham's point that this requirement is often pretty apparent from the model but it is an other aspect of domain clinical knowledge which should be captured, even if the condiitonal expression is too complex for a computable formalism and is expressed textually. 4. There is a related problem that I have identified from working with detailed findings. Quite often the initial requirement is just for a simple Present/Absent or Normal/Abnormal element e.g Polyps Y/N. However from experience we know that there is a strong possibility that this simple requirement is likely to expand to require a Cluster with far more detail. We are faced with a dilemma as whether we model as a simple element , which keeps the current expression clean and simple, or whether we immediately use a cluster which adds some (for now) unnecessary complexity. When thinking about this , it struck me that there may be a place for specifically supporting the detailed clinical finding to allow more natural expansion of the content without disturbing subsequent archetype paths. Furthermore, this seemed also to have relevance to work on aligning with Snomed post-coordination. I wish I could have claimed to have solved the problem but so far all that has emerged are pages of scribbled notes. My suggestion is that the 'Detailed Clinical finding' i.e. sub-Entry is a challenge which perhaps needs some fresh thinking, perhaps in combination with Snomed post-coordination work and addressing the Questionnaire conundrum. Ian Dr Ian McNicoll office / fax? +44(0)1536 414994 mobile +44 (0)775 209 7859 skype ianmcnicoll ian.mcnicoll at oceaninformatics.com Clinical analyst,?Ocean Informatics openEHR Clinical Knowledge Editor www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL BCS Primary Health Care SG Group www.phcsg.org On 15 December 2010 11:40, Hugh Leslie <hugh.leslie at oceaninformatics.com> wrote: > Hi Koray > > One way that we are handling this kind of issue is with a separate exclusion > archetype.? So for adverse reactions for instance, if you want to say that > this person has no known allergies, you use a separate archetype called an > exclusion archetype.? For data, this has the advantage of enabling an easy > query for "no allergies" rather than pulling up an adverse reaction instance > and having to look inside it for "no allergies".?? This works for many > different types of content and means that you don't have to hack archetypes > to try to add the negative.? So in your use case, you could have a specific > "No polyps" exclusion archetype which models the location. > > This is a common clinical pattern and problem. > > regards Hugh > > On 14/12/2010 9:44 PM, Koray Atalag wrote: > > Hi Tom, here is our response: > > > > We have so far came across two issues which we believe should be handled at > the clinical modelling levels (i.e. RM, archetypes and templates). These > have to do with the structure and semantics of the clinical information and > underpinned by domain knowledge. > > > > -- > > ________________________________________________ > Dr Hugh Leslie MBBS, Dip. Obs. RACOG, FRACGP, FACHI > Clinical Director > Ocean Informatics Pty Ltd > M: +61 404 033 767???E: hugh.leslie at oceaninformatics.com ?W: > www.oceaninformatics.com > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical > >
