an archetype for a home-based device composition
The openehr spec details how COMPOSITION's can occur without any event_context for the case of home monitoring devices etc. I am in a situation where I will be constructing compositions along these lines, but now I need an archetype that corresponds to such a composition. Has any standard approach to this been considered in the NHS work? It's essentially a pretty empty archetype - so I'm sure I could knock one up - but would defer to those with more experience in this area if someone already has a plan for a standard archetype along these lines. Andrew
Data quality questions/ proposal
Dear all, When I was a student, I presented a physical examination of a case for the professor. The professor asked me, Did you really see the patient eye? While I presented that the patient's palpebral conjunctivae was not anemic, the professor had the laboratory data that his hemoglobin is 7g/dl. The professor also said Don't you think physical examination is irrelevant. It is true that you feel he is not anemic, but laboratory data is not so. Our clinical decision was confirmed beyond such discrepancy through many data, Tha subjective data are sometimes irelevant and obvious, but it is just real for the data taker at that time. Although it is important to evaluate the acuracy of such data, the evaluation is also subjective and obvious. For clinical decision making, I always remarks the production process of the data, how the data was bringed up for me, who made the data, and when mede the data. For example, the data made by a resident has less prior than the data made by expert. On Sun, 15 Jul 2007 11:04:36 -0400 William E Hammond hammo001 at mc.duke.edu wrote: Stef, I would like to share your e-mail with ACMi to see what responses we get. It is an interesting proposition. Question, why not just require excellent/good measurement? Ed Hammond Stef Verlinden stef at vivici.nl Sent by: To openehr-clinical- For openEHR clinical discussions bounces at openehr.o openehr-clinical at openehr.org rg cc Subject 07/10/2007 05:41 Data quality questions/ proposal AM Please respond to For openEHR clinical discussions openehr-clinical @openehr.org One of the major requirements we have is what I call a ?data quality marker?. So the blood pressure recorded is 88/124 but what is the ?value/ quality? of this measurement. IMHO any recorded value is useless unless the quality of this measurement can be established and taken into account when interpreting the data In order to establish this data quality we need to add some attributes to the observation archetypes used to record such measurement. So far as we can see now we think that these attributes are a data quality field and a device/instrument reference (which requires a device archetype) and this is what we would like to propose to the community. Since I don?t know exactly how to do that and we still have many unanswered questions I?ll describe what we?re thinking about. It?s very well possible that these thing are already in place, in that case we?re aren?t aware of that and would like to be pointed in the right direction. In our ?model? data quality can be described as: excellent, good, doubtful and insufficient. Here the first hurdle arises: one needs a protocol to define what is excellent, good etc. These are probably ?local? criteria, so the can?t be embedded in a general archetype. Our idea is to create a specialisation of the observation archetype in question, in which the local protocol is attached. For instance this blood pressure archetype with the local Dutch data quality criteria would be openEHR-EHR-OBSERVATION.blood_pressure-data_qualityNL.v1.adl To give an example these are the criteria for blood pressure we?re thinking off: Excellent: data measured/obtained by a qualified healthcare provider, with a certified instrument/device that?s calibrated against a ?golden standard?, the measurement error is within a tight bandwidth (5%), the validity duration of the calibration isn?t expired, maintained on time and by qualified personal (This can?t be met when self-measuring in the home situation) Good: data measured/obtained by a qualified person (this can also be a properly trained
an archetype for a home-based device composition
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Data quality questions/ proposal
Dear Tom, The purpose of the flag is not to tell you anything about the uncertainty within an ENTRY, but only to tell you that it needs to be reviewed as a whole by a person or process capable of reviewing it. It is not the case that all you have is a flag, but rather that you have a flag in addition to the contents to warn you that extracting a single part of this ENTRY such as an ELEMENT value through a query might not be safe because some other parts of the ENTRY might be indicating that there is a caveat or caution about the value's interpretation. The ENTRY contents still need to provide the appropriate details to inform the reviewer, as captured by the original author. It would be nice if we could be more clever than that, but the complexity of this challenge is such that a single unambiguous and consistently used representation of each kind of uncertainty or caution is not yet feasible (as we all know). What we found to be appropriate for the standard is to put a label on the box to say open with caution, don't just drill down blindly and pluck out an isolated value. This is by no means a perfect solution but reflects the extent of confidence in the field at present, and what current systems vendors felt could be handled in the near future. With best wishes, Dipak Dr Dipak Kalra Clinical Senior Lecturer in Health Informatics CHIME, University College London Holborn Union Building, Highgate Hill, London N19 5LW Phone: +44-20-7288-5966 Fax: +44-20-7288-3322 Web site: http://www.chime.ucl.ac.uk
Microsoft/NHS common health interface and openEHR datatypes
Hi Sam and Thomas and others! Just a quick followup - a while ago you mentioned that you were thinking of uploading your Microsoft code to the openEHR website. Are you still considering doing this? I would absolutely like to see what you have done. Even if you could only upload a few samples to illustrate what is working well, and what areas are not working so well, that would be excellent. Regards Gunther -Original Message- From: openehr-clinical-boun...@openehr.org [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Thomas Beale Sent: Thursday, July 19, 2007 4:48 AM To: For openEHR clinical discussions Subject: Re: Microsoft/NHS common health interface and openEHR datatypes Grahame Grieve wrote: I'm a long way behind, and playing email catch up. just a technical clarification: last year - it is problematic, as it prevents you from using well-known bits of other open source code, because it is primarily designed to a) avoid encumbrance of the code by other licenses of any kind and b) ensure that changes to code in the Eclipse code base can be done without reference to anyone else. We couldn't even use it for the openEHR (GPL'd) java kernel because the latter uses libraries that wouldn't be allowed by the EPL. The EPL induction process is also painful - it takes weeks/months to get your code 'reviewed' by Eclipse people to certify it as 'unencumbered'...meanwhile it will have changed.. I don't think (a) is a property of the EPL license itself. But it is certainly exactly how the Eclipse Foundation vets code that will be posted to the official eclipse cvs. I'm not trying to be critical as such - its just that Rong found code that we would be prevented from using if we converted the license to EPL. In the end, I don't think I am really convinced by the need to have a special license for the Eclipse project; there are clearly some license that the code can't use, but it seems unrealistic to me to try and make it one. But prepared to be shown the light - thomas ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
Microsoft/NHS common health interface and openEHR datatypes
I don't think (a) is a property of the EPL license itself. But it is certainly exactly how the Eclipse Foundation vets code that will be posted to the official eclipse cvs. I'm not trying to be critical as such - its just that Rong found code that we would be prevented from using if we converted the license to EPL. yeah, this is not easy. (though as I said, it's not just converting to EPL, it's subjecting to the full eclipse processes) In the end, I don't think I am really convinced by the need to have a special license for the Eclipse project; there are clearly some license that the code can't use, but it seems unrealistic to me to try and make it one. But prepared to be shown the light well, I look at it this way: eclipse is a reliable proposition for everyone: no surprises. I doubt that we (kestral) could use the openEHR java kernel corporately because of GPL issues. I do not have the skills or the time to find out exactly what I can and cannot do without inadvertantly subjecting my corporate stuff to GPL. But if I use eclipse code (not just EPL), I know that appropriately skilled and highly motivated people have done this for me. So for a project to become eclipse, and to actually mean putting the code up on eclipse, it has to jump these hurdles. Why do this? pros: - will increase target market of the code substantially. however, while in tools market, the corporate benefits of eclipse in this regard are well recognised, I don't think there's the same brand penetration in the healthcare sector regarding Eclipse sanitising your code for you - will allow a full engagement between multiple communities, in particular, the community that is growing around eclipse cons: - have to jump the hurdle. It can be quite high and painful. The more mature the project, the more painful, (and possibly the pros are reduced here too) If I was you, I wouldn't be making the change right now either. I think that the correlation of forces will change in the future, and then I will ask you to re-evaluate. In the meantime, we are pursuing alternate pathways that will enable community collaboration with more flexibility about how the price is paid and when. There should be public announcements soon. Grahame
Antw: Re: Antw: RE: an archetype for a home-based device composition
In een bericht met de datum 19-7-2007 11:39:54 West-Europa (zomertijd), schrijft thomas.beale at OceanInformatics.biz: I know, we will be going to work on that :-) Unfortunately it is all in Dutch. if this was in archetype form, translations could be accommodated seamlessly. I am serious! - thomas beale Sincerely yours, dr. William TF Goossen director Results 4 Care b.v. De Stinse 15 3823 VM Amersfoort email: Results4Care at cs.com phone + 31654614458 fax +3133 2570169 Dutch Chamber of Commerce number: 32121206 /HTML -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20070719/c0a4f715/attachment.html
an archetype for a home-based device composition
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Data quality questions/ proposal
Dipak, I should point out that I am not aiming for any heavy debate of this right now - it's been done before and is a serious topic. On the other hand we have all learned more in different areas over the last few years, so it's interesting to bring up a few points and see if anyone's thoughts have changed. I have mainly questions. Dipak Kalra wrote: Dear Tom, The purpose of the flag is not to tell you anything about the uncertainty within an ENTRY, but only to tell you that it needs to be reviewed as a whole by a person or process capable of reviewing it. this is the question isn't it? What does 'reviewed' mean? If the information is credible (even if wrong) how can the reviewer tell, when there is no measure of how wrong? It is not the case that all you have is a flag, but rather that you have a flag in addition to the contents to warn you that extracting a single part of this ENTRY such as an ELEMENT value through a query might not be safe because some other parts of the ENTRY might be indicating that there is a caveat or caution about the value's interpretation. The ENTRY contents still need to provide the appropriate details to inform the reviewer, as captured by the original author. various questions come to mind: * are you saying that any original representation of error etc is retained in the data? * So the flag is really a marker on an Entry to say 'somewhere buried in here is/are one or more indicators of (in)accuracy'? * What if all the Quantities have accuracy markers on them (is this possible with the CEN QTY data type?) - and the accuracies are e.g. +/- 5% (i..e pretty good) - do you set the flag or not? * What if there were 50 quantities with high accuracy and one of low accuracy, does the flag get set or not? * What if there are differential diagnoses indicating confidence levels? * You wouldn't set the flag on this would you, since the information is 100% correctly representing what the physician said * how hard would it be for software to set this flag? * the ultimate question is: does this flag give you any more useful information than the raw data? ...or am I missing the point of this altogether? It would be nice if we could be more clever than that, but the complexity of this challenge is such that a single unambiguous and consistently used representation of each kind of uncertainty or caution is not yet feasible (as we all know). What we found to be appropriate for the standard is to put a label on the box to say open with caution, don't just drill down blindly and pluck out an isolated value. how should software react to this? - thomas
Antw: RE: an archetype for a home-based device composition
Op 19-jul-2007, om 9:33 heeft Williamtfgoossen at cs.com het volgende geschreven: We are using the composisitions in HL7 format (13606-5 implementation version) based on the organiser class in HL7. We have individual items / simple scoring systems that are grouped together with use of an organiser, where the organiser gets a unique code. e.g. a code for vital signs, where the underlying data items are temperature, blood pressure, breathing rate, pulse rate. this structure with organisers we have used a lot for home care / community care / nursing home, especially for the acceptance to care messaging. E.g. for mobility, for risks, for daily living, for living conditions, household, expectations of the future, social situation, medical care, generic assessment, feeding, etc. Unfortunately it is all in Dutch. Are these in some 'public' place? If possible I would like to see them and Dutch is no problem:-) Cheers, Stef William Goossen In een bericht met de datum 18-7-2007 17:29:21 West-Europa (zomertijd), schrijft laura.sato at nhs.net: From: openehr-clinical-bounces at openehr.org [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Andrew Patterson Sent: 18 July 2007 16:16 To: For openEHR clinical discussions Subject: an archetype for a home-based device composition The openehr spec details how COMPOSITION's can occur without any event_context for the case of home monitoring devices etc. I am in a situation where I will be constructing compositions along these lines, but now I need an archetype that corresponds to such a composition. Has any standard approach to this been considered in the NHS work? It's essentially a pretty empty archetype - so I'm sure I could knock one up - but would defer to those with more experience in this area if someone already has a plan for a standard archetype along these lines. Andrew ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical Sincerely yours, dr. William TF Goossen director Results 4 Care b.v. De Stinse 15 3823 VM Amersfoort email: Results4Care at cs.com phone + 31654614458 fax +3133 2570169 Dutch Chamber of Commerce number: 32121206 ___ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20070719/262f2a51/attachment.html
