Just to re-iterate, the 'narrative' property is meant to carry the piece 
of text that would appear on a medication or with a medication as 
supplied by a pharmacy (including in a hospital). When the administering 
agent is a human - the patient, family member or a nurse - this is 
normally the concrete direction that is followed.

The computable form of the order / instruction says the same thing, but 
in a computable form, allowing structured querying, analysis, all the 
usual stuff.

This is probably the only place where there is content duplication in 
openEHR, and as far as I can see, it needs to be like that, since there 
is no standard way to generate the narrative text in its correct form 
from the computable form (i.e. the Activities etc) - particularly since 
the text form can contain quite particular words, 'codes' (like '3td 
po') and so on.

If a 'standard' algorithm could be developed for this purpose it would 
obviate the need for the narrative property, but I suspect this is a 
long way off due to the medically & culturally specific content typical 
in the narrative today.

- thomas


On 29/10/2013 08:36, Ian McNicoll wrote:
> Hi Pablo,
>
> My understanding is that the purpose of the INSTRUCTION.narrative
> attribute is to carry a single 'human-friendly' version of what might
> be a very complex structured set of activities. The best example would
> be a complex medication order compromising multiple activities, each
> with a number of structured content. The idea of the 'narrative'
> attribute is that the key clinical content IS replicated for human
> consumption. In the work we are currently doing in the UK on
> medication orders we are concatenating the structured Medication name,
> dose and frequency to populate the narrative attribute. This makes
> good clinical sense for safety reasons, particularly when complex
> timings are involved but
> for a simple referral this is probably a bit over the top.
>
> I would just replicate the content of  the 'Reason for request' in the
> narrative attribute, unless you know that critical information will be
> carried in the Reason description, in which case I would concatenate
> the Reason + Description.
>
> Ian
>
> On 29 October 2013 02:50, pablo pazos <pazospablo at hotmail.com> wrote:
>> Hi, I'm reviewing archetypes for a project. Looking at referral request
>> archetype on the CKM, there are some nodes (Reason for request & Reason
>> description) that seems to match the semantics of INSTRUCTION.narrative
>> property.
>>
>> Using that archetype to generate the UI in EHRGen, the overlaping was clear
>> (I though if a doctor records the reason, he/she will have no information to
>> record on narrative). The problem is that narrative is mandatory on the IM,
>> and I doubt what to do in cases like this one.
>>
>> See the generated UI here: http://tinypic.com/r/ml5og5/5
>>
>>
>> Is there a real overlaping from the clinical point of view?
>>
>> If an archetype has nodes that represents the same semantics as narrative
>> instruction, is there a need to record narrative anyway? (Even though the
>> narrative is mandatory by the IM)
>>
>> Thanks!
>>
>> --
>> Kind regards,
>> Eng. Pablo Pazos Guti?rrez
>> http://cabolabs.com
>>
>> _______________________________________________
>> openEHR-technical mailing list
>> openEHR-technical at lists.openehr.org
>> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>
>


-- 
Ocean Informatics <http://www.oceaninformatics.com/>    *Thomas Beale
Chief Technology Officer*
+44 7792 403 613        Specification Program, /open/EHR 
<http://www.openehr.org/>
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