An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Gustavo, There are situations where it is helpful to use ACTIONS to record the process of an OBSERVATION (or group of Observations) e.g to monitor the progress of a lab test order or a request to perform regular Vital Signs monitoring, This will become much more common as we move towards care pathways and distributed workflow but in general I agree that in most cases we do not need or want to record an ACTION for every OBSERVATION. I agree with Pablo that it would be good to document why and how we adopt particular approaches but we are all learning in this situation and as you have discovered with Tobacco use, we are all still unearthing a mixture of use cases that need to be represented and often break or at least challenge current classification guidance. I do like the idea of explaining how we did it rather than presenting our experiences as guidance. I am sure best practice and guidance will emerge but we still have some way to go. Ian On 20 June 2012 17:41, Gustavo Bacelar gbacelar at gmail.com wrote: Hi Pablo, Yes, all ENTRY subtypes can include data about devices because ENTRY has a protocol attribute. I believe (correct me if I'm wrong) the protocol attribute of an OBSERVATION can record the device and other information about the execution itself, but this should be directly related with the observed values, e.g. I don't think I will record data about the lab device that analyzes blood samples on the blood test result. If this data is needed, maybe I record it in the ACTION that models the execution of the test, that ACTION also makes the INSTRUCTION state change to active. I think I understand why an ACTION is only related to interventions, it because otherwise almost everything else would be an ACTION. If there is an INSTRUCTION to measure the Blood Pressure once a week. Then would be an ACTION to Blood Pressure too. It is important to have an ACTION archetype?to interventions because it is not a normal situation, so the actor must describes what happened and record it (e.g. surgery report). The solution to this could be to an attribute to the Archetype Model to express the criteria/rationale used to classify a concept into a certain class of the EHR Information Model, so other modellers could agree on that criteria or not and create a better classification criteria.?Another idea is to created guidelines as annex to the specs to clarify gray areas with examples of modelled concepts. Good ideas! -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- Dr Ian McNicoll office +44 (0)1536 414 994 fax +44 (0)1536 516317 mobile +44 (0)775 209 7859 skype ianmcnicoll ian.mcnicoll at oceaninformatics.com Clinical Modelling Consultant,?Ocean Informatics, UK Director openEHR Foundation ?www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care ?www.phcsg.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Grahame, I agree that all real-world Observations contain some element of human interpretation. I think this is well understood and that the break point is whether that interpretation applies to the test or to the patient as a whole, when in openEHR terms it becomes an Evaluation, which equates pretty closely to the AORTIS definition of synthesis. I think clinical recording practice recognises the difference between an ECG diagnosis of atiral fibrillation as a human or computer interpretation of an ECG waveform as against a Diagnosis of atrial fibrillation' applied to the patient. Even where ECG diagnosis is regarded as the Gold Standard, I think we are still some way off an ECG machine being empowered to update a patient's problem list. Similarly a 'pathological diagnosis' of Lung cancer does not have the same status in a clinical record, or in practice, as This patient has Lung Cancer. It is interesting that with the exception of 'summaries', there are virtually no new EVALUATION archetypes in any of the CKM repositories or in the local systems I have worked with. I am beginning to think that Summaries is possibly one of the few grey areas left. Any insights from FHIR? Ian On 19 June 2012 16:22, Grahame Grieve grahame at healthintersections.com.au wrote: All observations are the result of evaluations of generated data. I think the difference is whether the evaluation concerns the data itself, or the significance of the data to the patient's treatment. The problem I have with Evautation vs Observation is that most real world processes seamlessly mix both - diagnostic tests are a classic example - some contain almost wholly observation, and some contain both, and a few are nearly all evaluation. Grahame On Wed, Jun 20, 2012 at 1:17 AM, pablo pazos pazospablo at hotmail.com wrote: Hi Jussara, I've been struggling with this example from some time now and it would be nice to have a clinical oppinion :) On imaging tests, the result of the test is not the images itself, but the imaging report/radiology report. The report is an EVALUATION (there is interpretation here) of an image and the image could be seen as an OBSERVATION. Should be the report considered as an OBSERVATION or as an EVALUATION? Another example is on complex lab tests. Last year I've worked with software providers of a private lab and they told me that for some tests they manually interpret the results to detect problems and fire alerts. They do not have a CDSS to make an automatic process, so the rules where executed by lab profesionals, and the result of they interpretation was part of the study result. I know this is weird but reality is weird :D -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: jussara.macedo at gmail.com Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? Date: Sun, 17 Jun 2012 17:56:50 -0300 To: openehr-clinical at lists.openehr.org Hi, guys While observation is a sheer report of findings, without any judgement of value by the observator, while evaluation is the interpretation of the findings made by the interviewer, like a syndrom, a diagnosis. In psychatry is very ( or should) very easy to distinguish, mental status examination findings are observacional entries, while psychiatric case summary should be coded as evaluation ones. Sent from my iPad On Jun 17, 2012, at 4:39 PM, Diego Bosc? yampeku at gmail.com wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' Eport I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelar gbacelar at gmail.com: Ation Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Everything documented in an EHR is based on human interpretation. Therefor human interpretation is not a discriminator when we want to define the specialisations of an Entry. And neither is the fact whether something is located in time. An neither is the fact whether it applies to the patient as a whole or part of it. It is my conclusion that in openEHR for sometime now the wrong definitions are used. And thereby archetypes get the wrong semantic annotations. Gerard Freriks EN13606 Association p/a Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands M: +31 620347088 E: gerard.freriks at EN13606.org W: http:www.en13606.org Gerard Freriks +31 620347088 gfrer at luna.nl On 21 Jun 2012, at 10:42, Ian McNicoll wrote: Hi Grahame, I agree that all real-world Observations contain some element of human interpretation. I think this is well understood and that the break point is whether that interpretation applies to the test or to the patient as a whole, when in openEHR terms it becomes an Evaluation, which equates pretty closely to the AORTIS definition of synthesis. -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120621/dc6ae339/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Gerard, The last time I look at your alternative definitions, they seemed pretty close to the original openEHR ones. EVALUATION: class in the Target Reference Model that can be used for the documentation about an inferred process in the patient system using observations, expertise and knowledge, or about plans with, or risk assessments about, the Patient system Observe: Evaluations are based on observations and can lead to instructions. How would you categorise Tobacco Use, Evaluation, Observation or both? How would you model an ECG diagnosis of atrial fibrillation? Is that about the patient system or the I am pretty sure that whatever definitions are used they will fail to apply correctly in all circumstances, or lead to That has been the history of all clinical modelling efforts up until now and I don't see why anything should change. The harder we try to model things 'correctly' from an ontological perspective, the more we fragmenting the models into components that are hard to understand and harder to implement and ask clinicians to understand whatever we throw at them. Ian On 21 June 2012 10:14, Gerard Freriks gfrer at luna.nl wrote: Everything documented in an EHR is based on human interpretation. Therefor human interpretation is not a discriminator when we want to define the specialisations of an Entry. And neither is the fact whether something is located in time. An neither is the fact whether it applies to the patient as a whole or part of it. It is my conclusion that??in openEHR?for sometime now the wrong definitions are used. And thereby archetypes get the wrong semantic annotations. Gerard Freriks EN13606 Association p/a Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands M:? +31 620347088 E:? ???gerard.freriks at EN13606.org W: http:www.en13606.org Gerard Freriks +31 620347088 gfrer at luna.nl On 21 Jun 2012, at 10:42, Ian McNicoll wrote: Hi Grahame, I agree that all real-world Observations contain some element of human interpretation. I think this is well understood and that the break point is whether that interpretation applies to the test or to the patient as a whole, when in openEHR terms it becomes an Evaluation, which equates pretty closely to the AORTIS definition of synthesis. ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- Dr Ian McNicoll office +44 (0)1536 414 994 fax +44 (0)1536 516317 mobile +44 (0)775 209 7859 skype ianmcnicoll ian.mcnicoll at oceaninformatics.com Clinical Modelling Consultant,?Ocean Informatics, UK Director openEHR Foundation ?www.openehr.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care ?www.phcsg.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hello! Just a few cents, as Gerard wrote: Everything documented in an EHR is based on human interpretation. A raw, non-validated, blood glucose value is not based on human interpretation. It comes out of a machine. It is a requirement for EHRs to support the clinical validation process. I therefore conclude that some EHRs need to store information that is not based on human interpretation. Hope this helps, greetings from Vienna, Stefan Sauermann Program Director Biomedical Engineering Sciences (Master) University of Applied Sciences Technikum Wien Hoechstaedtplatz 5, 1200 Vienna, Austria P: +43 1 333 40 77 - 988 M: +43 664 6192555 E: stefan.sauermann at technikum-wien.at I: www.technikum-wien.at/mbe I: www.technikum-wien.at/ibmt I: www.healthy-interoperability.at Am 21.06.2012 11:14, schrieb Gerard Freriks:
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Everyone, I would go even furhter. In many observation procedures effort is made to reduce the effect of human interference to a level where the fact that, as Gerard says, what's documented always goes through a human mind is insignificant. My interpretation of the openEHR OBSERVATION-EVALUATION distinction is just that, if the human interpretation is of significance or not. So even if the blood glucose is checked, validated, etc. by lab staff I would still argue that that human interpretation is (more or less) insignificant to the (later stage) interpretation of the blood glucose result. /Daniel On Thu, 2012-06-21 at 12:18 +0200, Stefan Sauermann wrote: Hello! Just a few cents, as Gerard wrote: Everything documented in an EHR is based on human interpretation. A raw, non-validated, blood glucose value is not based on human interpretation. It comes out of a machine. It is a requirement for EHRs to support the clinical validation process. I therefore conclude that some EHRs need to store information that is not based on human interpretation. Hope this helps, greetings from Vienna, Stefan Sauermann Program Director Biomedical Engineering Sciences (Master) University of Applied Sciences Technikum Wien Hoechstaedtplatz 5, 1200 Vienna, Austria P: +43 1 333 40 77 - 988 M: +43 664 6192555 E: stefan.sauermann at technikum-wien.at I: www.technikum-wien.at/mbe I: www.technikum-wien.at/ibmt I: www.healthy-interoperability.at Am 21.06.2012 11:14, schrieb Gerard Freriks: ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120621/7c45fb3a/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Dear colleagues,
What is wrong with the definitions we use in the EN13606 Association?
Paraphrasing:
Observation: is about phenomena generated by states in the patient system and
that are observed using the faculties of any human (seeing, smelling, etc)
Evaluation: is about Inferences about any process in the patient system
Instruction: is about Plans to change a state or process in the patient system
Action: is about the planned execution of a protocol or an unplanned event
('Act of God') that influences a state or process in the patient system
A patient system is:
- any component of the body
- the body/person as a whole
- its environment ( family, coworkers, physical environment, etc.)
- a set of processes that can be inferred
- a set of phenomena, generated by processes, that can be observed.
Some of these specialisations of the Entry class involve others than the
patient and the author: other persons, devices, services.
All are agents, actors, that need to be documented when they play a role in the
healthcare provision process as documented in any EHR.
I consider each of these types of actors as kind of resources that contributed
or will contribute data/information to the EHR.
Each of these resources will have its specific specialisation of a Cluster
Model pattern that allows the recording of relevant specific data about the
resource.
There will be Resource Models (Cluster models) for persons, organisations,
devices, various services.
Gerard Freriks
+31 620347088
gfrer at luna.nl
On 21 Jun 2012, at 13:01, Daniel Karlsson wrote:
Hi Everyone,
I would go even furhter. In many observation procedures effort is made to
reduce the effect of human interference to a level where the fact that, as
Gerard says, what's documented always goes through a human mind is
insignificant. My interpretation of the openEHR OBSERVATION-EVALUATION
distinction is just that, if the human interpretation is of significance or
not. So even if the blood glucose is checked, validated, etc. by lab staff I
would still argue that that human interpretation is (more or less)
insignificant to the (later stage) interpretation of the blood glucose result.
/Daniel
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An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Gerard
I don't have a problem with the definitions. I am interested in how you
would apply these to the ECG diagnosis and tobacco use examples I gave
before. I am sure we can always apply better definitions but I have found
that this does not necessary resolve these sort of issues. The more
abstract the definition, the more open to interpretation, the more specific
the definition the more edge cases break the rules or force us into
creating unnatural constructs solely to meet the definitions.
Ian
Dr Ian McNicoll
Clinical modelling consultant Ocean Informatics
Mobile +44 (0) 775 209 7859
Skype imcnicoll
On 21 Jun 2012, at 12:32, Gerard Freriks gfrer at luna.nl wrote:
Dear colleagues,
*What is wrong with the definitions we use in the EN13606 Association?*
*
*
*Paraphrasing:*
*Observation*: is about phenomena generated by *states* in the patient
system and that are observed using the faculties of any human (seeing,
smelling, etc)
*Evaluation:* is about Inferences about any *process* in the patient system
*Instruction:* is about Plans to change a *state or process *in the patient
system
*Action:* is about the planned execution of a protocol or an unplanned
event ('Act of God') that influences a *state or process* in the patient
system
*A patient system is:*
- any component of the body
- the body/person as a whole
- its environment ( family, coworkers, physical environment, etc.)
- a set of processes that can be inferred
- a set of phenomena, generated by processes, that can be observed.
Some of these specialisations of the Entry class involve others than the
patient and the author: other persons, devices, services.
All are agents, actors, that need to be documented when they play a role in
the healthcare provision process as documented in any EHR.
I consider each of these types of actors as kind of resources that
contributed or will contribute data/information to the EHR.
Each of these resources will have its specific specialisation of a Cluster
Model pattern that allows the recording of relevant specific data about the
resource.
There will be Resource Models (Cluster models) for persons, organisations,
devices, various services.
Gerard Freriks
+31 620347088
gfrer at luna.nl
On 21 Jun 2012, at 13:01, Daniel Karlsson wrote:
Hi Everyone,
I would go even furhter. In many observation procedures effort is made to
reduce the effect of human interference to a level where the fact that, as
Gerard says, what's documented always goes through a human mind is
insignificant. My interpretation of the openEHR OBSERVATION-EVALUATION
distinction is just that, if the human interpretation is of significance or
not. So even if the blood glucose is checked, validated, etc. by lab staff
I would still argue that that human interpretation is (more or less)
insignificant to the (later stage) interpretation of the blood glucose
result.
/Daniel
___
openEHR-clinical mailing list
openEHR-clinical at lists.openehr.org
http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
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An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Ian, Thanks. 'ECG diagnosis': You mean an interpretation of the ECG like:'atrium fibrillation' or 'pattern conforms to infarction in the left lower cardiac artery'? In 'my book' the first is an Observation provided by a an Action that defined the device/service that produced it. In 'my book' the second is an Evaluation of an Observed pattern as provided by a Action that defined the device/service that produced it. Both Observation and Evaluation need to be confirmed/committed by the author of either one. 'Tobacco use' For example the amount of cigarettes used per day is clearly is an Observation (a state at point in time) because it is not about the process inside the patient system it can be seen, heard, smelled, etc.. For example the addiction to nicotine is a process (a condition) inside the patient system and therefor an Evaluation. The process can not bee seen, smelled, heard. Only inferred and phenomena that are produced because of the addiction can be observed. Are our definitions helping to resolve these complex things? Gerard Freriks +31 620347088 gfrer at luna.nl On 21 Jun 2012, at 16:05, Ian McNicoll wrote: Hi Gerard I don't have a problem with the definitions. I am interested in how you would apply these to the ECG diagnosis and tobacco use examples I gave before. I am sure we can always apply better definitions but I have found that this does not necessary resolve these sort of issues. The more abstract the definition, the more open to interpretation, the more specific the definition the more edge cases break the rules or force us into creating unnatural constructs solely to meet the definitions. Ian Dr Ian McNicoll Clinical modelling consultant Ocean Informatics Mobile +44 (0) 775 209 7859 Skype imcnicoll -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120621/f85d7edb/attachment-0001.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
All observations are the result of evaluations of generated data. I think the difference is whether the evaluation concerns the data itself, or the significance of the data to the patient's treatment. The problem I have with Evautation vs Observation is that most real world processes seamlessly mix both - diagnostic tests are a classic example - some contain almost wholly observation, and some contain both, and a few are nearly all evaluation. Grahame On Wed, Jun 20, 2012 at 1:17 AM, pablo pazos pazospablo at hotmail.com wrote: Hi Jussara, I've been struggling with this example from some time now and it would be nice to have a clinical oppinion :) On imaging tests, the result of the test is not the images itself, but the imaging report/radiology report. The report is an EVALUATION (there is interpretation here) of an image and the image could be seen as an OBSERVATION. Should be the report considered as an OBSERVATION or as an EVALUATION? Another example is on complex lab tests. Last year I've worked with software providers of a private lab and they told me that for some tests they manually interpret the results to detect problems and fire alerts. They do not have a CDSS to make an automatic process, so the rules where executed by lab profesionals, and the result of they interpretation was part of the study result. I know this is weird but reality is weird :D -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: jussara.macedo at gmail.com Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? Date: Sun, 17 Jun 2012 17:56:50 -0300 To: openehr-clinical at lists.openehr.org Hi, guys While observation is a sheer report of findings, without any judgement of value by the observator, while evaluation is the interpretation of the findings made by the interviewer, like a syndrom, a diagnosis. In psychatry is very ( or should) very easy to distinguish, mental status examination findings are observacional entries, while psychiatric case summary should be coded as evaluation ones. Sent from my iPad On Jun 17, 2012, at 4:39 PM, Diego Bosc? yampeku at gmail.com wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' Eport I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelar gbacelar at gmail.com: Ation Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- - http://www.healthintersections.com.au / grahame at healthintersections.com.au / +61 411 867 065
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Diego, I think we have found that the idea of protocol (method, metadata etc) applies to virtually every clinical data collection. I think Evaluation is the catch all for the reason you have identified. The history of this is: Care Entry - data + protocol Requirement to deal with serial observations, interval measurements etc. Differentiate to Evaluation Observation (the first system was built using only these classes) Requirement to deal with Workflow - Instructions and Actions arising, recognising that Actions may occur without recorded Instructions Differentiate Evaluation to Instruction and Action. As people have more experience with these classes they will see how important these classes are for systems to run in a distributed environment. It would be possible to archetype each part and then specialise for the different archetypes, but very difficult to ensure that the fundamental requirements are met using models which can evolve independent of the core system. Admin Entry is actually the Generic Entry you talk seek - this class is for administrative data as the need for protocol is not required and it does differentiate data which is of an administrative nature without using a complex ontology. This allows access for administrative purposes in a well controlled manner. Cheers, Sam On 20/06/2012 2:38 AM, Diego Bosc? wrote: So if that is the case, why don't stick with a generic Entry and use the ontology described on your paper (T. Beale et al. / An Ontology-based Model of Clinical Information) to clearly describe (bind) the root node of an archetype? If you use classes and an ontology with meaning you have the potential to assign snomed codes which could be semantically wrong (e.g. a Snomed 'finding' code on a wrong RM class) 2012/6/19 Thomas Bealethomas.beale at oceaninformatics.com: On Archetypes and Ontologies... Ian often says: 'it doesn't really matter in the end, what matters is whether you know how to query'. From a practical perspective, this is correct, and it is what we should be focussed on, not being over-theoretical about the ontological side of things. So the basic rule is: no matter what RM class you base your archetype on, once you have made your choice, and built your archetype, then it is 100% clear how to query the data, because the path set is known. The real ontological job isn't to obsess about the reference model class, it is to connect the archetype into a purpose built ontology of clinical information types, built using e.g. Snomed CT technology, and/or in OBO/OWL form. These latter resource types are flexible, in particular, multi-hierarchical, and the archetype can be classified in multiple detailed ways - as a summary, as an 'observation' of some kind (if that indeed makes sense), and as any of the content types Ian referred to yesterday, and in any number of clinical ways. The utility of 'indexing' archetypes via proper ontology is that we can then easily discover within a population of (possibly thousands of) archetypes, where the data points for any given thing are, and how to construct queries for them. As Ian has also often said, noone is going to query for Observations and Evaluations, based on the RM classes and nothing more. With proper ontological indexing in place, this is undoubtedly true. I suggest that this approach is the real future of ontological thinking around archetypes; the Observation/Evaluation question is interesting for a coffee break debate, but its only real importance is: which one has the appropriate data structure? So what we should be concentrating on is a) working with ontologists on building the 'indexing' ontology/ies and b) wasting as little time as possible on building good quality clinical models. - thomas On 19/06/2012 13:03, Ian McNicoll wrote: Hi Heather, As you know we have both gone round in circles on this, and I have certainly changed my opinion rather more often than I prefer to admit. As you know I am uncomfortable about trying to express something as basic as 'Smoking History' in two different archetype classes. Leaving aside the complexity of the way that people record smoking details inside the archetype, I think we recognised 4 differing use-cases 1. A pro-active smoking log where the user documents their daily smoking habit. 2. Where smoking history (implying life-long use ) is collected as part of a history, perhaps in GP consultation or first hospital appt, within the context of a some sort of Encounter i.e an event composition. 3. A variation on (2) where the patient is asked about their smoking history with respect to a particular event e.g. Before you knew you were pregnant Since you found out you needed an operation. Again collected within the context of an Encounter or other event composition. 4. The need to maintain some sort of 'Current smoking status' / longitudinal 'summary' view both to assist quick
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Because it happens that the generic entry class (which exists in openEHR) is only useful for a) what we call Evaluations b) what we call Admininstrative Entries (AdminEntry) and c) legacy data a la 13606. It's no use for Observations, Actions or Orders, which comprise the majority of clinical data. It's all about data structures. The potential to assign a wrong code always exists, everywhere, all the time. That's just human error, and quality assurance of archetypes would try to minimise that. Just as Snomed CT's authors try their best to minimise mistakes, nevertheless, Snomed is full of them (but they are now being reduced thankfully). - thomas On 19/06/2012 18:08, Diego Bosc? wrote: So if that is the case, why don't stick with a generic Entry and use the ontology described on your paper (T. Beale et al. / An Ontology-based Model of Clinical Information) to clearly describe (bind) the root node of an archetype? If you use classes and an ontology with meaning you have the potential to assign snomed codes which could be semantically wrong (e.g. a Snomed 'finding' code on a wrong RM class) * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120620/30988793/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Pablo, I am just catching up with some of these discussions. Although in theory all OBSERVATIONS must also have associated ACTIONS to record the execution of the process, in practice this is not necessary or the Action will refer to a group of Observations e.g. the Action to a request to Take Vital Signs measurements. Even if this is recorded as part of nursing workflow, it is unlikely that each individual Vital sign will need to have its ACTION recorded. My priority is to ensure that the information required to support the 'real' clinical process is always available to the person reviewing the record. So if device details are important to the clinical interpretation of the record, we should ensure that they are part of the OBSERVATION. The associated ACTION may be important for monitoring care delivery but it rarely affects clinical interpretation. The complexity of healthcare, differing use cases between unplanned and workflowed care, primary data entry vs. messaged summaries, and the presence or absence of a device registry, are always going to make these decisions difficult. It is certainly possible (and cleaner) to have references to external entities rather than them being modelled in-line but it causes other difficulties in complicating archetype visualisation for clinical review and of course, de-referencing for messaging purposes. I do agree that it would be useful if CLUSTER archetypes could be reused between the DEMOGRAPHIC and EHR models. In fact is it quite easy to hack the ADL to change one to another just by reaching the EHR/DEMOGRAPHIC model name in the archetypeID but it would be better if the tools just ignored the model part of the id. Ian On 17 June 2012 17:48, pablo pazos pazospablo at hotmail.com wrote: Hi Gustavo, As Heather pointed out, the solution seems to be to reference the internal structure of a device (or any other demographic archetype) through a CLUSTER. But I think those demographic concepts should be also modelled as complete, separate demographic archetypes, referencing the same internal structure (CLUSTER). This allow us (developers) to create functionalities for searching and processing on demographic archetypes. About the internals of a test, I think most often includes both ACTION and ?OBSERVATION, because an ACTION could be used when you need to record information about the execution itself (being or not a clinical intervention on the patient, e.g. the recording of the device used to make the test should be part of the ACTION not of the OBSERVATION), then the OBSERVATION(s) could hold the information about the test result or information about clinical findings during the test. Then the whole record of a test execution should be recorded into a COMPOSITION that references those ACTION(s) and OBSERVATION(s). The INSTRUCTION of a test could reference to a device that should be used on the test, but during the test maybe another device was used, and that should be part of the ACTION that executes the INSTRUCTION. Does this makes sense to you? Please correct me if I'm wrong. My student detected some oftalmologic concepts that are not in the CKM, maybe I can put you both in contact to collaborate on the modelling of those concepts. -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: gbacelar at gmail.com Date: Sun, 17 Jun 2012 10:03:15 +0100 Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? To: openehr-clinical at lists.openehr.org Hi Pablo, I'm an ophthalmologist and would be gladful to help. There are some issues about the archetype class and the nature of the test. As it is a study test it must be considered the existence ?of an intervention. If it does not include, so the most appropriate would be to record as an OBSERVATION archetype for the test. If it includes an intervention, then the most appropriate is to record as ACTION. For both situations?use the Device CLUSTER on the CKM to record the device, remembering this archetype is not adequate to record a substance (e.g.?fluorescein). To record the device that should be used for the test?at an INSTRUCTION archetype, also consider the?element Description of Procedure?of Procedure Request?archetype on CKM, which could be used to specify the device. I hope it was helpful. -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-technical mailing list openEHR-technical at lists.openehr.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
This became a very rich and interesting conversation, it is being very good to be learning so much with you all. So EVALUATIONS are NOT limited to opinions or assessments, although that is a common misunderstanding. I have to disagree, the paper An Ontology-based Model of Clinical Information says: In summary, the Opinion category is distinguished from the Observation category by representing inferences from evidence, rather than representing the evidence. Two investigators can form different interpretations of the same set of observations, but the observations themselves remain an objective picture of some aspect of the patient?s situation, within the limits of the observational method itself. Similarly, two investigators can formulate different goals and plans based on the same observations, and even the same diagnosis. And the Information Model document (p57-58), which is based on the paper An Ontology-based Model of Clinical Information, states: *The name Evaluation has been present in openEHR for some years, and is retained for reasons of continuity*. ?**The first in which we record now or at a specific point in time or averages usage over an identified period of time, and which is best represented in an OBSERVATION so that repeated and comparable records can be made over time ? effectively a concrete smoking diary of actual smoking activity, whether now, on a certain day, or an actual average over the past 10 years. ?**Secondly the data that fits more with an EVALUATION ? for example, data that we will only ever need to record once and should be persisted, such as ?Date commenced tobacco use?, or that we want recorded in one place only and choose to update over time with versioning of COMPOSITIONS, such as cumulative consumption in pack years etc. ** ** ** I now understand your concerns about the separation of models, but an Observation CAN be *data that we will only ever need to record once and should be persisted,* such as mentioned in the Information Model document, for instance Family History includes actual events / conditions in family members are recorded as Observations (e.g. father died of MI at 62). Also, as Heather wisely said in her paper openEHR - the World?s Record: The archetypes contain a maximum data set about each clinical concept. I would have to disagree here - while a summary is not an assessment like diagnosis, it is an opinion, or 'evaluation' by the health professional in the sense of what he/she *chooses to include* as a summary of the patient situation, as understood by the current professional, for consumption by other professionals so that further care can continue. It is not an observation of anything on/from the patient - it is a creation from the mind of the professional based on previous observations, documenting what he thinks is important or otherwise for ongoing care. There is no primary 'observation' activity going on here. I wasn?t thinking this way, but from this point of view, now I totally agree with you in the sense that the health professional can *chooses what to include* as a summary of the patient situation, so each health professional can develop a summary with different items. But the problem is that data to be included in the Evaluation summary can not be chosen from an Observation and serve as substratum by the health professional. The data is already defined within the archetype and some of them aren't within Observation (e.g. Tobacco use - Date commenced). Also, most of Evaluation summaries have no space to record different interpretations of the same set of Observations. Can it still be considered an Evaluation summary? I agree with Ian's solution of merging the archetypes into a single Observation archetype, to be used for different scenarios with slightly different templating. In my opinion the relevance to correctly describe the classes goes beyond the query. It begins when someone decides to choose the archetypes to be used in an EHR. It may generate mistakes and lead to error and disillusions. Cheers -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120620/9dac94c4/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Dear colleagues, A SUMMARY in the terms of the definitions as defined in the EN13606 Association document is: an ad-hoc collection of subjectively selected facts, thoughts, and plans. In our 'book' it is therefor a SECTION archetype where Observations, Evaluations, Instructions and Actions are (re-)used to provide the details. Gerard Freriks +31 620347088 gfrer at luna.nl On 18 Jun 2012, at 10:32, Thomas Beale wrote: I would have to disagree here - while a summary is not an assessment like diagnosis, it is an opinion, or 'evaluation' by the health professional in the sense of what he/shechooses to include as a summary of the patient situation, as understood by the current professional, for consumption by other professionals so that further care can continue. It is not an observation of anything on/from the patient - it is a creation from the mind of the professional based on previous observations, documenting what he thinks is important or otherwise for ongoing care. There is no primary 'observation' activity going on here. -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/b83462f8/attachment-0001.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Jussara, I've been struggling with this example from some time now and it would be nice to have a clinical oppinion :) On imaging tests, the result of the test is not the images itself, but the imaging report/radiology report.The report is an EVALUATION (there is interpretation here) of an image and the image could be seen as an OBSERVATION. Should be the report considered as an OBSERVATION or as an EVALUATION? Another example is on complex lab tests. Last year I've worked with software providers of a private lab and they told me that for some tests they manually interpret the results to detect problems and fire alerts. They do not have a CDSS to make an automatic process, so the rules where executed by lab profesionals, and the result of they interpretation was part of the study result. I know this is weird but reality is weird :D -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: jussara.macedo at gmail.com Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? Date: Sun, 17 Jun 2012 17:56:50 -0300 To: openehr-clinical at lists.openehr.org Hi, guys While observation is a sheer report of findings, without any judgement of value by the observator, while evaluation is the interpretation of the findings made by the interviewer, like a syndrom, a diagnosis. In psychatry is very ( or should) very easy to distinguish, mental status examination findings are observacional entries, while psychiatric case summary should be coded as evaluation ones. Sent from my iPad On Jun 17, 2012, at 4:39 PM, Diego Bosc? yampeku at gmail.com wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' Eport I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelar gbacelar at gmail.com: Ation Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/bf8a5660/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Sam, Date: Mon, 18 Jun 2012 06:17:13 +0930 From: sam.he...@oceaninformatics.com To: openehr-clinical at lists.openehr.org Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? Hi All The idea of a device as an agent is interesting and at some point devices will have features of agents. The use of a re-useable cluster is clearly the solution - regardless of which part of openEHR it belongs. I just followed the specs definition of an AGENT: Generic concept of any kind of agent, including devices, software systems, but not humans or organisations. The problem here is that we have demographic and EHR models - that share some classes - and an ID that requires declaration. Generally, I think the best approach is to think if information might be in the EHR - if so, then it needs to use EHR or common classes. I think some kind of criteria or guideline should be defined here, because having both EHR and DEMOGRAPHIC models, a modeller could first model some concepts on the EHR side and other on the DEMOGRAPHIC side, and when the EHR needs to record information about DEMOGRAPHIC concepts, the CLUSTER approach could be used. I didn't get the part of the ID declaration, you mean to create references between the EHR and DEMOGRAPHIC classes instances? Until we have a commitment to use an authorative source of IDs for archetypes regardless of where they are generated, I think we will struggle. I will say more in another post. Cheers, Sam -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/fbdf95d0/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Gustavo, I agree with you and Jussara, and it's a good definition to use at modelling time, but the problem behind this is at modelling time you don't have the contents. A definition used for modelling coudn't relly on the contents because you can't control what a clinician will record on the system at execution time. And a system can't say hey! do not make any interpretation of this information to record as an OBSERVATION. Another way to look at the definition of the ENTRY subclasses is not as a hard classification, but as a guideline to modelling with quality. What do you think? -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: gbace...@gmail.com Date: Sun, 17 Jun 2012 23:13:42 +0100 Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? To: openehr-clinical at lists.openehr.org Hello everyone,I agree with Jussara. I think it depends on the nature of the entry. A summary is not necessarily an opinion. If a summary is about patient's data (e.g. physical activity summary, from NEHTA) so it should be an OBSERVATION summary. It does not include any Opinion from a healthcare professional, as it was well said by Jussara, without any judgement of value by the observer, and as defined on the Information Model document, an OBSERVATION is any phenomenon or state of interest to do with the patient, (...) as told by the patient to the doctor, patient answers to physician questions during a physical examination, and responses to a psychological assessment questionnaire.. I agree that a summary can be an EVALUATION class, but only when its content is really an Opinion (based on OBSERVATIONS, published knowledge and personal knowledge). For example, I think the archetype EVALUATION.clinical_synopsis.v1 is well described according to the Information Model as a summary or overview about a patient, specifically from the perspective of a healthcare provider, and with or without associated interpretations. But on the other hand, I think the EVALUATION.substance_use_summary-alcohol.v1 is not an EVALUATION (there is no Opinion, it is all about the patient answers) and it should be incorporated within the OBSERVATION.substance_use-alcohol.v1 because it has data not included in the other alcohol archetype, e.g. Age commenced, it is also necessary to know these kind of data about alcohol use. I'd like to know your opinion, please let me know if my understanding is wrong. Best regards -- Gustavo BacelarMD + MBA + Med Informatics gustavobacelar.com+351 91 203 2353 +55 71 8831-2860Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/d55213ba/attachment-0001.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
All that is documented by an author is subjective and evaluated by the author. So we need to have a better discriminator. ERS proposed to have as discriminator the relation with, the effect on, the patient system. In short: Observation: the documentation by the author of a state in the Patient System by means of using its faculties for observation. EValuation: the documentation by the author of an inference on a process in the Patient System Instruction: the documentation by the author of plans that have the intention to change the Patient System Action: the documentation by the author of events that have the intention to change either the state or process in the Patient System It think that when these definitions are adopted we all know what the function of each of these specialisations of the ENTRY class are. Who has a better way to define and discriminate these ENTRY specialisations. Gerard Freriks +31 620347088 gfrer at luna.nl On 19 Jun 2012, at 17:22, Grahame Grieve wrote: All observations are the result of evaluations of generated data. I think the difference is whether the evaluation concerns the data itself, or the significance of the data to the patient's treatment. The problem I have with Evautation vs Observation is that most real world processes seamlessly mix both - diagnostic tests are a classic example - some contain almost wholly observation, and some contain both, and a few are nearly all evaluation. Grahame -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/0174289d/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
The definition of ENTRY specialisations are essential when data is to be interpreted and processed by clinical Decision Support Systems. The semantic meaning must be clear for 100%. Gerard Freriks +31 620347088 gfrer at luna.nl On 19 Jun 2012, at 17:34, pablo pazos wrote: Hi Gustavo, I agree with you and Jussara, and it's a good definition to use at modelling time, but the problem behind this is at modelling time you don't have the contents. A definition used for modelling coudn't relly on the contents because you can't control what a clinician will record on the system at execution time. And a system can't say hey! do not make any interpretation of this information to record as an OBSERVATION. Another way to look at the definition of the ENTRY subclasses is not as a hard classification, but as a guideline to modelling with quality. What do you think? -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/4109b21f/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
On 19/06/2012 16:25, pablo pazos wrote: Hi Sam, Date: Mon, 18 Jun 2012 06:17:13 +0930 From: sam.heard at oceaninformatics.com To: openehr-clinical at lists.openehr.org Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? Hi All The idea of a device as an agent is interesting and at some point devices will have features of agents. The use of a re-useable cluster is clearly the solution - regardless of which part of openEHR it belongs. I just followed the specs definition of an AGENT: /Generic concept of any kind of agent, including devices, software systems, but not humans or organisations./ to be clearer, the intention is that an 'agent' is any of this things 'acting' in some autonomous way, rather than being 'used' passively by a human or other user. A syringe is in the latter category; at least some ICU monitoring machines can be considered in the former category. But in the end, the actions performed and information generated by any device or robot have to have been sanctioned in advance by some human / group, and are implicitly sanctioned all the time by that responsible agent. So the idea of who is ultimately the 'responsible healthcare professional' doesn't disappear, even if the authorship of some data items in the EHR now appear to be software or other such 'agents'. - thomas -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/a6089ff4/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
If we continue to use the word 'Evaluation' in all its possible senses in English, this comment is undoubtedly true. But its meaning in openEHR is narrower than that - it is a 'clinical opinion about the subject based on previously collected evidence'. So although a doctor manually 'observing' e.g. mitral regurgitation is making an 'evaluation' in some low-level cognitive sense, she isn't forming a clinical opinion on the patient, she is just performing an observation with an imperfect instrument (her stethoscope, ears, knowledge of what sounds to look for) which any competent physician could replicate. If you don't like the name 'Evaluation' we used in openEHR, think of it as 'clinical opinion' or 'clinical assessment' of the subject of care. We can always have the debate about whether there is any reality other than our own 'subjective' experiences, i.e. that says that 'everything is an opinion'. Philosophically speaking this is true, but not practically interesting. For normal life, the 'opinion' that a trained doctor has that there is mitral regurgitation happening simply doesn't have the same status as the later diagnosis of 'mitral valve prolapse', which is a (potentially) treatable condition. Having said that, some of Grahame's favourite lab test result + interpretation examples may really be examples of Observation + Evaluation. It depends heavily on whether the pathologist has the patient data relevant to /interpreting the result for that patient/, if so, then it probably is a real Evaluation (in the openEHR sense); if not, then all he is doing is reporting the 'meaning' of the result for a 'normal person', i.e. a textbook interpretation. In all such cases, I would expect the patient's physician to make the 'real interpretation', so that such results should be recorded as Observations. - thomas On 19/06/2012 16:22, Grahame Grieve wrote: All observations are the result of evaluations of generated data. I think the difference is whether the evaluation concerns the data itself, or the significance of the data to the patient's treatment. The problem I have with Evautation vs Observation is that most real world processes seamlessly mix both - diagnostic tests are a classic example - some contain almost wholly observation, and some contain both, and a few are nearly all evaluation. * * -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120619/fd7718a6/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
So if that is the case, why don't stick with a generic Entry and use the ontology described on your paper (T. Beale et al. / An Ontology-based Model of Clinical Information) to clearly describe (bind) the root node of an archetype? If you use classes and an ontology with meaning you have the potential to assign snomed codes which could be semantically wrong (e.g. a Snomed 'finding' code on a wrong RM class) 2012/6/19 Thomas Beale thomas.beale at oceaninformatics.com: On Archetypes and Ontologies... Ian often says: 'it doesn't really matter in the end, what matters is whether you know how to query'. From a practical perspective, this is correct, and it is what we should be focussed on, not being over-theoretical about the ontological side of things. So the basic rule is: no matter what RM class you base your archetype on, once you have made your choice, and built your archetype, then it is 100% clear how to query the data, because the path set is known. The real ontological job isn't to obsess about the reference model class, it is to connect the archetype into a purpose built ontology of clinical information types, built using e.g. Snomed CT technology, and/or in OBO/OWL form. These latter resource types are flexible, in particular, multi-hierarchical, and the archetype can be classified in multiple detailed ways - as a summary, as an 'observation' of some kind (if that indeed makes sense), and as any of the content types Ian referred to yesterday, and in any number of clinical ways. The utility of 'indexing' archetypes via proper ontology is that we can then easily discover within a population of (possibly thousands of) archetypes, where the data points for any given thing are, and how to construct queries for them. As Ian has also often said, noone is going to query for Observations and Evaluations, based on the RM classes and nothing more. With proper ontological indexing in place, this is undoubtedly true. I suggest that this approach is the real future of ontological thinking around archetypes; the Observation/Evaluation question is interesting for a coffee break debate, but its only real importance is: which one has the appropriate data structure? So what we should be concentrating on is a) working with ontologists on building the 'indexing' ontology/ies and b) wasting as little time as possible on building good quality clinical models. - thomas On 19/06/2012 13:03, Ian McNicoll wrote: Hi Heather, As you know we have both gone round in circles on this, and I have certainly changed my opinion rather more often than I prefer to admit. As you know I am uncomfortable about trying to express something as basic as 'Smoking History' in two different archetype classes. Leaving aside the complexity of the way that people record smoking details inside the archetype, I think we recognised 4 differing use-cases 1. A pro-active smoking log where the user documents their daily smoking habit. 2. Where smoking history (implying life-long use ) is collected as part of a history, perhaps in GP consultation or first hospital appt, within the context of a some sort of Encounter i.e an event composition. 3. A variation on (2) where the patient is asked about their smoking history with respect to a particular event e.g. Before you knew you were pregnant Since you found out you needed an operation. Again collected within the context of an Encounter or other event composition. 4. The need to maintain some sort of 'Current smoking status' / longitudinal 'summary' view both to assist quick human understanding and as the 'source of truth' for decision support. This needs to be a persistent Composition (or part of a persistent Composition) and might be entered directly, or more likely updated via (2 or 3). There are a number of archetypes where, strictly speaking, we munge content that strictly speaking belongs in 2 different classes - Adverse Reaction is a good example and I think Tobacco use is one where we could safely merge things like tobacco status and pack days into a single Observation archetype, to be used for scenarios 1-4 above, with slightly different templating. ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Diego, I think the point is that for most of the models there is a pretty clear distinction between what is an Observation and what is an Evaluation, and in the majority of cases the 'ontological' classification matches up with the structural class. There are a few grey areas where the congruence of the class and the ontology is more tricky or strictly speaking might be properly expressed as 2 classes - tobacco usage is a good example. The problem, IMO, is that clinical information is so complex and the requirements so varied that whatever ontological or structural approach we choose, that there will be grey areas like this, and , for the most part, they do not really matter. I have sympathy with your suggestion of using a generic ENTRY and an ontological label to classify it as an Evaluation but it is really not that important in system use. What does it matter, in real use, whether we label something as an Evaluation with a class name or with some sort of ontological label, rather than a generic ENTRY? Nothing happens because something is labelled as Evaluation. I never query for is_an evaluation - I query on is_a problem or is_a goal. Ian On 19 June 2012 18:08, Diego Bosc? yampeku at gmail.com wrote: So if that is the case, why don't stick with a generic Entry and use the ontology described on your paper (T. Beale et al. / An Ontology-based Model of Clinical Information) to clearly describe (bind) the root node of an archetype? If you use classes and an ontology with meaning you have the potential to assign snomed codes which could be semantically wrong (e.g. a Snomed 'finding' code on a wrong RM class) 2012/6/19 Thomas Beale thomas.beale at oceaninformatics.com: On Archetypes and Ontologies... Ian often says: 'it doesn't really matter in the end, what matters is whether you know how to query'. From a practical perspective, this is correct, and it is what we should be focussed on, not being over-theoretical about the ontological side of things. So the basic rule is: no matter what RM class you base your archetype on, once you have made your choice, and built your archetype, then it is 100% clear how to query the data, because the path set is known. The real ontological job isn't to obsess about the reference model class, it is to connect the archetype into a purpose built ontology of clinical information types, built using e.g. Snomed CT technology, and/or in OBO/OWL form. These latter resource types are flexible, in particular, multi-hierarchical, and the archetype can be classified in multiple detailed ways - as a summary, as an 'observation' of some kind (if that indeed makes sense), and as any of the content types Ian referred to yesterday, and in any number of clinical ways. The utility of 'indexing' archetypes via proper ontology is that we can then easily discover within a population of (possibly thousands of) archetypes, where the data points for any given thing are, and how to construct queries for them. As Ian has also often said, noone is going to query for Observations and Evaluations, based on the RM classes and nothing more. With proper ontological indexing in place, this is undoubtedly true. I suggest that this approach is the real future of ontological thinking around archetypes; the Observation/Evaluation question is interesting for a coffee break debate, but its only real importance is: which one has the appropriate data structure? So what we should be concentrating on is a) working with ontologists on building the 'indexing' ontology/ies and b) wasting as little time as possible on building good quality clinical models. - thomas On 19/06/2012 13:03, Ian McNicoll wrote: Hi Heather, As you know we have both gone round in circles on this, and I have certainly changed my opinion rather more often than I prefer to admit. As you know I am uncomfortable about trying to express something as basic as 'Smoking History' in two different archetype classes. Leaving aside the complexity of the way that people record smoking details inside the archetype, I think we recognised 4 differing use-cases 1. A pro-active smoking log where the user documents their daily smoking habit. 2. Where smoking history (implying life-long use ) is collected as part of a history, perhaps in GP consultation or first hospital appt, within the context of a some sort of Encounter i.e an event composition. 3. A variation on (2) where the patient is asked about their smoking history with respect to a particular event e.g. Before you knew you were pregnant Since you found out you needed an operation. Again collected within the context of an Encounter or other event composition. 4. The need to maintain some sort of 'Current smoking status' / longitudinal 'summary' view both to assist quick human understanding and as the 'source of truth' for decision support. This needs to be a persistent Composition (or part of a persistent
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi All The idea of a device as an agent is interesting and at some point devices will have features of agents. The use of a re-useable cluster is clearly the solution - regardless of which part of openEHR it belongs. The problem here is that we have demographic and EHR models - that share some classes - and an ID that requires declaration. Generally, I think the best approach is to think if information might be in the EHR - if so, then it needs to use EHR or common classes. Until we have a commitment to use an authorative source of IDs for archetypes regardless of where they are generated, I think we will struggle. I will say more in another post. Cheers, Sam On 18/06/2012 2:18 AM, pablo pazos wrote: Hi Gustavo, As Heather pointed out, the solution seems to be to reference the internal structure of a device (or any other demographic archetype) through a CLUSTER. But I think those demographic concepts should be also modelled as complete, separate demographic archetypes, referencing the same internal structure (CLUSTER). This allow us (developers) to create functionalities for searching and processing on demographic archetypes. About the internals of a test, I think most often includes both ACTION and OBSERVATION, because an ACTION could be used when you need to record information about the execution itself (being or not a clinical intervention on the patient, e.g. the recording of the device used to make the test should be part of the ACTION not of the OBSERVATION), then the OBSERVATION(s) could hold the information about the test result or information about clinical findings during the test. Then the whole record of a test execution should be recorded into a COMPOSITION that references those ACTION(s) and OBSERVATION(s). The INSTRUCTION of a test could reference to a device that should be used on the test, but during the test maybe another device was used, and that should be part of the ACTION that executes the INSTRUCTION. Does this makes sense to you? Please correct me if I'm wrong. My student detected some oftalmologic concepts that are not in the CKM, maybe I can put you both in contact to collaborate on the modelling of those concepts. -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos From: gbacelar at gmail.com Date: Sun, 17 Jun 2012 10:03:15 +0100 Subject: Re: An ACTION or INSTRUCTION referencing an AGENT, is it possible? To: openehr-clinical at lists.openehr.org Hi Pablo, I'm an ophthalmologist and would be gladful to help. There are some issues about the archetype class and the nature of the test. As it is a study test it must be considered the existence of an intervention. If it does not include, so the most appropriate would be to record as an OBSERVATION archetype for the test. If it includes an intervention, then the most appropriate is to record as ACTION. For both situations use the Device CLUSTER on the CKM to record the device, remembering this archetype is not adequate to record a substance (e.g. fluorescein). To record the device that should be used for the test at an INSTRUCTION archetype, also consider the element Description of Procedure of Procedure Request archetype on CKM, which could be used to specify the device. I hope it was helpful. -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com http://gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120618/616b7287/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Diego At the end of the day the EVALUATION is an information class. We have created other classes over the years to cope with information requirements that require consistent representation for computing. A lot of the information stored in this class meets the ontological scope of evaluative or summary statements - hence the name. You feeling that it is a catch all is clearly right in the current scheme - except for administrative entries. Cheers, Sam On 18/06/2012 5:09 AM, Diego Bosc? wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelargbacelar at gmail.com: Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hello everyone, I agree with Jussara. I think it depends on the nature of the entry. A summary is not necessarily an opinion. If a summary is about patient's data (e.g. physical activity summary, from NEHTA) so it should be an OBSERVATION summary. It does not include any Opinion from a healthcare professional, as it was well said by Jussara, without any judgement of value by the observer, and as defined on the Information Model document, an OBSERVATION is any phenomenon or state of interest to do with the patient, (...) as told by the patient to the doctor, patient answers to physician questions during a physical examination, and responses to a psychological assessment questionnaire.. I agree that a summary can be an EVALUATION class, but only when its content is really an Opinion (based on OBSERVATIONS, published knowledge and personal knowledge). For example, I think the archetype EVALUATION.clinical_synopsis.v1 is well described according to the Information Model as a summary or overview about a patient, specifically from the perspective of a healthcare provider, and with or without associated interpretations. But on the other hand, I think the EVALUATION.substance_use_summary-alcohol.v1 is not an EVALUATION (there is no Opinion, it is all about the patient answers) and it should be incorporated within the OBSERVATION.substance_use-alcohol.v1 because it has data not included in the other alcohol archetype, e.g. Age commenced, it is also necessary to know these kind of data about alcohol use. I'd like to know your opinion, please let me know if my understanding is wrong. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120617/f302a6e2/attachment-0001.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi everyone, The naming of the classes sometimes causes some confusion. The classic cycle diagram commonly used in training (http://www.openehr.org/wiki/download/attachments/23167000/archetype%20class es.gif), represents the classes rather simplisticly as reflecting clinical processes. And they do, to a considerable degree, but it is never quite so simple J When deciding on an archetype class it is fundamental to decide the kind of attributes required. Usually Instruction and Action are easy to determine. Similarly most use of OBSERVATION occurs when you want to record data that is seen, touched or measured using the same method/protocol and additionally requires any or all of: recording anytime/now, at a specific point in time or during an interval of time; mathematical/aggregate value attributes such as maximal, minimal (usually over an identified interval of time) etc; or a known state of the patient in order to interpret the data. I usually describe OBSERVATIONS as 'the evidence' and so some archetypes such as story don't obviously have timing requirements (although it could potentially be useful) are modelled in this way. And lastly, EVALUATION: quoted from http://www.openehr.org/wiki/pages/viewpage.action?pageId=786529 - The evaluation class is the simplest of the care oriented Entry classes. It is therefore the most able to handle diverse data. The other classes are designed to meet specific requirements. The result is that the Evaluation class is best suited for information deriving from other observations where the information is of a more long-standing nature than minute to minute observations. This class also lends itself to summary or review information. Dates and times have to be explicitly represented in this class (as part of the archetype). So EVALUATIONS are NOT limited to opinions or assessments, although that is a common misunderstanding. I estimate that I have probably spent more cumulative hours trying to derive the right balance in the patterns for the alcohol tobacco consumption archetypes than I have for any other family of models. I have tried to tease out the patterns (that are very similar), resulting in an OBSERVATION and an EVALUATION for each. I'm still not convinced it is absolutely correct yet, but while I have had a reasonable amount of pushback on the separation of models into two types, I have a very strong belief that combining them into one model will not work either - it just ain't that simple! From my point of view there are two types of alcohol/smoking data we are working with: -The first in which we record now or at a specific point in time or averages usage over an identified period of time, and which is best represented in an OBSERVATION so that repeated and comparable records can be made over time - effectively a concrete smoking diary of actual smoking activity, whether now, on a certain day, or an actual average over the past 10 years. -Secondly the data that fits more with an EVALUATION - for example, data that we will only ever need to record once and should be persisted, such as 'Date commenced tobacco use', or that we want recorded in one place only and choose to update over time with versioning of COMPOSITIONS, such as cumulative consumption in pack years etc. The reality is that while some of this data can be differentiated easily into one or either model, some is not so clear. For example, recording smoking status is not as simple as recording 'currently smoking' Yes or No in an OBSERVATION today as our clinical world, and especially the secondary reporting world, commonly uses a value set of 'Current smoker', 'past or ex-smoker' and 'never smoked' - with differing temporal implications. In addition, some value sets including national data dictionaries also add qualifier values such as 'past light smoker' and 'past heavy smoker', plus all the rest of examples we've all seen. Smoking is modelled so differently in so many places, and usually not very well - I haven't identified a gold standard on which to base the archetypes on and would appreciate any input anyone can provide. Certainly Current smoker is implied if you enter any amount of smoking in the OBSERVATION, but while 'never smoked' or 'ex-smoker' can be recorded today, it is particularly useful to persist in records and update only if that changes. One way to consider recording a Smoking History in an EHR might start with a persistent COMPOSITION that would be re-versioned with each smoking-related update, and comprise: -a single EVALUATION reflecting the 'record once only summary data' or the 'record in one place only' such as cumulative consumption and which is updated as necessary, plus -one or more instances, or links to the instances, of OBSERVATION data reflecting each 'smoking diary' data captured over time. What do you think? Cheers Heather From: openehr-clinical-boun...@lists.openehr.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
On 17/06/2012 20:39, Diego Bosc? wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' I have seen plenty references to both and I am curious which one is the 'correct' one. * * the answer is in this paper http://www.openehr.org/publications/health_ict/MedInfo2007-BealeHeard.pdf. There is a 20-page version with the detailed description of the ontology, if anyone wants it, let me know. - thomas -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120618/ceb33f0a/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi, I'm correcting student papers for the openEHR course in spanish.A student has modelled oftalmologic studies for diabetic patients, with a demographic archetype of AGENT class to model all the devices used on the test. It could be very usefull to let record the device information in the ACTION archetype to say this is the device we use for this test, or at the INSTRUCTION archetype to say this is the device that should be used for the test. I'm sure some of you have solved this requirement, and I'll be very thankful if you can enlight me, because I don't see how the information model can solve this. Thanks a lot. -- Kind regards, Ing. Pablo Pazos Guti?rrez LinkedIn: http://uy.linkedin.com/in/pablopazosgutierrez Blog: http://informatica-medica.blogspot.com/ Twitter: http://twitter.com/ppazos -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120617/dd0449f6/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Pablo, I'm an ophthalmologist and would be gladful to help. There are some issues about the archetype class and the nature of the test. As it is a study test it must be considered the existence of an intervention. If it does not include, so the most appropriate would be to record as an OBSERVATION archetype for the test. If it includes an intervention, then the most appropriate is to record as ACTION. For both situations use the Device CLUSTER on the CKM to record the device, remembering this archetype is not adequate to record a substance (e.g. fluorescein). To record the device that should be used for the test at an INSTRUCTION archetype, also consider the element Description of Procedure of Procedure Request archetype on CKM, which could be used to specify the device. I hope it was helpful. -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120617/fd2c839c/attachment.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar -- next part -- An HTML attachment was scrubbed... URL: http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120617/a2f972e2/attachment-0001.html
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelar gbacelar at gmail.com: Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An?OBSERVATION can record?information about the execution itself, The ECG recording archetype, for example, includes?the device. There are other?OBSERVATION?archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify?OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption).?EVALUATION is an Opinion considering the Healthcare professional knowledge and?OBSERVATION, not a summary of observations.?But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the?ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
An ACTION or INSTRUCTION referencing an AGENT, is it possible?
Hi, guys While observation is a sheer report of findings, without any judgement of value by the observator, while evaluation is the interpretation of the findings made by the interviewer, like a syndrom, a diagnosis. In psychatry is very ( or should) very easy to distinguish, mental status examination findings are observacional entries, while psychiatric case summary should be coded as evaluation ones. Sent from my iPad On Jun 17, 2012, at 4:39 PM, Diego Bosc? yampeku at gmail.com wrote: I would say there is not a common opinion of what an evaluation is. Some people agree with your definition, but others say that EVALUATION is just 'the generic health care record entry with protocol' Eport I have seen plenty references to both and I am curious which one is the 'correct' one. 2012/6/17 Gustavo Bacelar gbacelar at gmail.com: Ation Hi Pablo, it is a common mistake to tell apart ACTION and OBSERVATION. The Information Model document says: Observations are distinguished from Actions in that Actions are interventions whereas Observations record only information relating to the situation of the patient, not what is done to him/her. An OBSERVATION can record information about the execution itself, The ECG recording archetype, for example, includes the device. There are other OBSERVATION archetypes that include the Device CLUSTER (e.g. Body temperature). Another common mistake I've found in CKM is to classify OBSERVATION as EVALUATION (e.g. Tobacco and Alcohol consumption). EVALUATION is an Opinion considering the Healthcare professional knowledge and OBSERVATION, not a summary of observations. But it is another topic. I've also detected many ophthalmologic concepts which are not in the CKM and I have already done some of them. I'd be glad to contact your student (I was also a student of your 1st Course) so we can collaborate with each other to improve the ophthalmologic archetypes in CKM. Best regards -- Gustavo Bacelar MD + MBA + Med Informatics gustavobacelar.com +351 91 203 2353 +55 71 8831-2860 Skype: gustavobacelar ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org ___ openEHR-clinical mailing list openEHR-clinical at lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
