On Fri, Mar 02, 2018 at 10:55:47AM +0000, Bakke, Silje Ljosland wrote:

> 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 measurement.
> 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.

That about wraps it up.

Except that I was of the impression that the original
question was more about 2) rather than 1).

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