I've hesitated to participate in this discussion, but I think I have a couple 
of points to add now, as I think there are two different problems being 
discussed here:

1.       The original problem, which in my opinion is how and where to store 
reference ranges for clinical observations such as for instance blood pressure. 
These reference ranges are often based on clinical research, and may change 
with time as new research emerges. In my opinion these shouldn't be stored with 
the original observation data, but can (when needed) be stored with any 
interpretation where the data is used to reach a conclusion, for example a 
symptom, diagnosis or even just an instruction. The reference ranges that are 
current at any point in time however, should be stored and accessed from a 
knowledge base outside the EHR, as they don't relate to the data of a specific 
patient. However, that knowledge base may well be linked to specific archetypes 
and archetype elements to facilitate its usage, for example to the systolic, 
diastolic and position elements of the blood pressure archetype, if the 
reference ranges vary based on the position of the patient at the time of 

2.       The problem of reference ranges that are intricately bound to specific 
observations and their methods, such as lab results. These should be, and are 
commonly, stored with the observations in the EHR because the details of 
analytic method and other factors that affect them are far too complex to 
include in the EHR data. The RM attributes "normal_range" and 
"other_reference_ranges" (and "normal_status") of the Quantity data type are 
well suited for these reference ranges.


-----Original Message-----
From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] On 
Behalf Of Karsten Hilbert
Sent: Friday, March 2, 2018 11:28 AM
To: openehr-technical@lists.openehr.org
Subject: Re: Setting thresholds

On Fri, Mar 02, 2018 at 10:07:24AM +0100, David Moner wrote:

> You are talking about a future reuse or validation of the data. But

> what it was discused here is how to define the reference ranges for

> any data to take an action at the moment of data registry. And, as

> Gerard said, those references must be stored for future interpretation

> of the data. Thus, I'm of the opinion that ideally this should be

> stored together with the archetype/templates as it is part of the domain 
> knowledge at that moment.

The ranges will be different across labs and across types of measurement due to 
"precision available", "reagants used", "technology applied", and a variety of 
other ugly real-world factors. Even for the very same LOINC from the very same 

I don't think this knowledge should (or can) live in the archetype but rather 
be stored with the data and/or the interpretation of the data.



GPG key ID E4071346 @ eu.pool.sks-keyservers.net

E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346


openEHR-technical mailing list


openEHR-technical mailing list

Reply via email to