Hi Ian and Pablo, Although I don't like commenting on how others implement their systems I would hate for this discussion to become the defacto standard on how the API works in the context of persistent compositions. Although I understand Ian's position on best clinical practice of a single medication list represented as a persistent composition in a person's EHR, there is nothing stated about this in the specifications. I would be interested in other vendors implementations in this area, but as a service implementation I do not like makinging these application oriented decisions unless they are in the specification. There are way too many use cases where our service is used and many will break this scenario like merges, distributed EHRs and cross organisational shared records. I think it is the application that needs to apply these business rules. I think this needs to be addressed by the API SEC before recommendations that appear normative are made on the lists. Personally we have had big problems with persistent compositions due to lack of context, although we are working on fixing these, I still feel that perhaps we are not ready to have the category attribute constrained in the archetypes that we currently state are persistent for these same reasons. I have seen cases where there is a desire for different problem lists from different clinical perspectives, in particular a consumers view vs a GP vs a specialist.
Regards Heath On Sun, Apr 3, 2016 at 11:34 AM -0700, "Ian McNicoll" <i...@freshehr.com<mailto:i...@freshehr.com>> wrote: That looks correct to me :) Ian Dr Ian McNicoll mobile +44 (0)775 209 7859 office +44 (0)1536 414994 skype: ianmcnicoll email: i...@freshehr.com twitter: @ianmcnicoll Co-Chair, openEHR Foundation ian.mcnic...@openehr.org Director, freshEHR Clinical Informatics Ltd. Director, HANDIHealth CIC Hon. Senior Research Associate, CHIME, UCL On 3 April 2016 at 19:20, pablo pazos <pazospa...@hotmail.com> wrote: > @Bert, no worries :) > > @Ian, for now, I'll add a rule like this: > > If committed compo is persistent > If there is no versioned_compo for the root archetype of the committed > compo // this check is new > If change_type == creation // only allows to create one persistent > compo, all other commits should be modifications > create versioned_compo with version v1 > return 200 OK > Else > return 400 Bad Request > Else > If change_type in [amendment, modification] > create new version in existing versioned_compo // this will create v2, > v3, ... > return 200 OK > Else // not considering delete for now, this do not allows to create > another instace v1 for the same persistent compo archetype > return 400 Bad Request > > > For event compos, it just follows the common versioning flow, allowing to > create any number of v1 instances with change_type creation, and version > them using amendment or modification. > > Does this makes sense? If yes, maybe this can help other implementations :) > > -- > Kind regards, > Eng. Pablo Pazos Gutiérrez > http://cabolabs.com > >> From: i...@freshehr.com >> Date: Sun, 3 Apr 2016 11:06:53 +0100 >> Subject: Re: Composition commit and change types >> To: pazospa...@hotmail.com >> CC: openehr-technical@lists.openehr.org > >> >> " I would focus on intra hospital longitudinal lists since it is very >> difficult to reach agreement in the enterprise." >> >> I agree. These decisions are partly technical but largely down to the >> level of commitment/ consensus you can get in your clinical community >> to jointly curate these lists over time. The value of longitudinal >> persistence only accrues if everyone has commitment to the on-going >> curation process and is prepared to work within a common governance >> framework, rights and responsibilities. >> >> http://www.bcs.org/content/conWebDoc/17923 >> >> Ian >> Dr Ian McNicoll >> mobile +44 (0)775 209 7859 >> office +44 (0)1536 414994 >> skype: ianmcnicoll >> email: i...@freshehr.com >> twitter: @ianmcnicoll >> >> Co-Chair, openEHR Foundation ian.mcnic...@openehr.org >> Director, freshEHR Clinical Informatics Ltd. >> Director, HANDIHealth CIC >> Hon. Senior Research Associate, CHIME, UCL >> >> >> On 3 April 2016 at 09:07, pazospa...@hotmail.com <pazospa...@hotmail.com> >> wrote: >> > Good info and the criteria makes sense. >> > >> > >> > I would use episodic for things like hospitalization and treatments that >> > are >> > not a knee time thing (event), maybe with help of folders. Also I would >> > focus on intra hospital longitudinal lists since it is very difficult to >> > reach agreement in the enterprise. And when that time comes, I would >> > just >> > implement a new set of rules for the enterprise :) >> > >> > >> > Thanks! >> > >> > >> > Sent from my LG Mobile >> > >> > ------ Original message------ >> > >> > From: Ian McNicoll >> > >> > Date: Sat, Apr 2, 2016 15:50 >> > >> > To: For openEHR technical discussions; >> > >> > Subject:Re: Composition commit and change types >> > >> > Hi Pablo,When I am advising implementers on this, I use the following >> > categories ...## Composition Commit StylesDepending on the clinical >> > requirement, 3 styles of commit strategy aresuggested.1. **’Event’**e.g >> > Nursing observations, clinical encounters, reports.Each time the >> > composition >> > is committed, create a new instance via a POST.Generally only do a PUT >> > if an >> > error needs to be corrected2. **’Episodic’**Create a new composition via >> > POST for each Period of Care i.e anadmission. If it needs to updated, >> > use a >> > PUT to modify i.e Eachpatient has a single instance per Period of >> > Care.3. >> > **’Longitudinal’**Create a new composition via POST for each patient. If >> > it >> > needs toupdated use a PUT to modify i.e. each patient has only a >> > singleinstance over their lifetime. This will be unusual in a >> > hospitalrecord >> > where there is generally limited ability to curate the patientrecord in >> > this >> > way.So your persistence uses cases are either 2/3. Currently to >> > manageEpisodic persistence, you need ot set the composition category >> > toevent, as the RM currently forces a 'persistent' composition to >> > becontextless i.e. the context attribute is 0...0. This will change inan >> > upcoming RM revision.The decision about when/where to maintain >> > persistent/curated lists isone which will vary between implementations. >> > I >> > would generally expectMedication lists, Allergies and some documents >> > such as >> > Resuscitationpreferences to be maintained as single, persistent >> > instances. >> > AlthoughProblems and Procedures should also probably be maintained that >> > way,there are valid situations where departmental problem lists e.g >> > Renalmedicine have validity.There are strong arguments, at least in UK >> > practice, for maintaining asingle cross-organisation >> > outpatient/community >> > medication record buteach inpatient medication list should be separately >> > maintianed foreach instiution/episode of care.IanDr Ian McNicollmobile >> > +44 >> > (0)775 209 7859office +44 (0)1536 414994skype: ianmcnicollemail: >> > ian@freshehr.comtwitter: @ianmcnicollCo-Chair, openEHR Foundation >> > ian.mcnicoll@openehr.orgDirector, freshEHR Clinical Informatics >> > Ltd.Director, HANDIHealth CICHon. Senior Research Associate, CHIME, >> > UCLOn 2 >> > April 2016 at 06:59, pazospa...@hotmail.com wrote:> Hi all, I'm testing >> > some cases in the EHRServer and I want to confirn some> grey areas.>>> >> > If >> > the EHR receives a commit of a persistent composition and the change >> > type> >> > is creation, should the EHR create a new composition?>>> i.e. I don't >> > see an >> > EHR having two different medication lists, is that> possible?>>> I guess >> > persistent compos can only be created one time per archetype (one> >> > medication list, one problem list, one vaccination list, etc. per >> > patient),> >> > and after the creation, all commits should be modification. Does this >> > make> >> > any sense?>>> If this is OK, to avoid errors from client applications, I >> > would return an> error when a creation is committed for a persistent >> > compo >> > archetype that> already has a conpo instance.>>> And about the first >> > commit. >> > Should, lets say, the medication list be created> when the first >> > medication >> > is recorded or can it be created empty? What do> other implementations >> > out >> > there do?>>> Thanks a lot!>>> >> > _______________________________________________> openEHR-technical >> > mailing >> > list> openEHR-technical@lists.openehr.org> >> > >> > http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org_______________________________________________openEHR-technical >> > mailing >> > >> > listopenEHR-technical@lists.openehr.orghttp://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org _______________________________________________ openEHR-technical mailing list openEHR-technical@lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
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