I agree with Anne?s cases based on my experience. Keep in mind that the structured data is optional and that the narrative may be all we have.
Heath From: openEHR-technical [mailto:[email protected]] On Behalf Of Ann Wrightson (NWIS - Enterprise Architecture) Sent: Tuesday, 29 October 2013 10:38 PM To: For openEHR technical discussions Subject: RE: Instruction archetypes and overlaping nodes with INSTRUCTION.narrative A slightly different angle from Thomas? response, from my implementation experience in similar situations: There are two clear ?base cases?: 1. If there is a comprehensive narrative entered by a human then that is the narrative, i.e. any structured or coded data is regarded as supplementary machine-readable content. 2. If there is structured data without a narrative, then as Ian describes a human readable narrative is constructed from the data. In practice, I would expect a fair bit of discussion around these options with the lead clinical users who assure and accept a particular solution (& often a formal patient safety review too). As a result of such discussion-in-context, a hybrid solution may be preferred where for example the narrative as entered is shown first, followed by an algorithmic textual rendering of key data items for patient safety such as medications. Regards, Ann W. Ann M Wrightson Pensaer TG | Lead Technical Design Architect Gwasanaeth Gwybodeg GIG Cymru | NHS Wales Informatics Service Caernarfon: Ff?n/Tel: 01286 674226 Pencoed: WHTN: 01808 8940 Ff?n/Tel: 01656 778940 Symudol/Mobile: 07535 481797 From: openEHR-technical [mailto:[email protected]] On Behalf Of Thomas Beale Sent: 29 October 2013 11:34 To: openehr-technical at lists.openehr.org Subject: Re: Instruction archetypes and overlaping nodes with INSTRUCTION.narrative I knew that question was coming ;-) Firstly, how would you detect an inconsistency? It can only be done by a human being, or else a quite sophisticated piece of software. Now, what does it mean if there is a difference? Firstly they are not quite 'duplicates'. The narrative is a directive to a human agent to do something, in a slightly coded language that is supposed to be understood unambiguously by the author and the reader. The structured representation is just that - a structure representing the medication order activities, timing etc. If they don't say the same thing it could mean: * the software that created the structural representation has an error, and creates structures different from the clinical intention * the software that created the narrative has an error, and created a different text from that required by the clinician As for any other data in the record, there is no 100% guarantee that any of it is right. The correct comparison is not just between the two, but between both of them and the original clinical intention, which is the reference. This comparison will only be made during testing, where the purpose is to ensure the software is bug-free. In routine use, inconsistencies probably won't be detected - the doctor will just assume the software works properly. So it's just a question of making sure the software works properly... - thomas On 29/10/2013 10:07, Diego Bosc? wrote: And if an inconsistency is detected, which one is supposed to be right? 2013/10/29 Thomas Beale <thomas.beale at oceaninformatics.com> 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 _____ Mae?r wybodaeth a gynhwysir yn y neges e-bost hon ac yn unrhyw atodiadau?n gyfrinachol. Os ydych yn ei derbyn ar gam, rhowch wybod i?r anfonwr a?i dileu?n ddi-oed. Ni fwriedir i ddatgelu i unrhyw un heblaw am y derbynnydd, boed yn anfwriadol neu fel arall, hepgor cyfrinachedd. 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