RE: AQL on versioned compositions

[Heather Leslie]

Hi Dileep,

From a clinician/modeller’s point of view, each of the consultations or visits 
that you describe as screening, consult encounter, revisit encounters are 
discrete events and need to be recorded using a separate event COMPOSITION. 
Each clinical consult will be recorded independently including identifying the 
changes from visit to visit. As part of a consult a diagnosis may be marked as 
resolved and that should be included as part of the consult record.

This information needs to be recorded once for medicolegal purposes and 
sensible querying. Similar data that needs both event based recording and 
sensible updated representation in summaries or persistent lists include 
medications, problem/diagnosis, immunisations, adverse reactions, social 
history, tobacco/alcohol summaries etc.

The question of where that data should be actually 1) stored vs 2) copied and 
displayed vs 3)displayed as the result of a query or 4) is not implemented consistently as far as I 
understand. Implementers please correct me if you have documented consensus.

For medicolegal purposes the consult record needs to be able to be accurately 
displayed and reintegrated on request, even if the component data is stored in 
a mix of event and persistent COMPOSITIONS.

I would think that you would also need to be able to keep a representation of 
the health summary, also primarily for medicolegal purposes, so that it could 
be determined precisely what the clinician viewed in that summary as they made 
a critical clinical decision, especially if it were to result in a bad outcome. 
That is one of the key reasons for the versioned persistent compositions.

And that will not prevent the patient summary being the last known status of 
the person – totally agree with your intent there. It’s just a question of how 
to be able to demonstrate what was the summary on a certain data, at a certain 
time.

Not helping with folders, but hope this contributes regarding consideration of 
event and persistent COMPOSITIONS. And further complicated with some of our CKM 
persistent COMPOSITIONS currently being constrained as events while we wait for 
some RM changes to support addition of context to the persistent ones.

Kind regards

Heatehr


From: openEHR-technical  On Behalf 
Of Pablo Pazos
Sent: Friday, 2 November 2018 7:15 AM
To: For openEHR technical discussions 
Subject: Re: AQL on versioned compositions

Hi Dileep, from your description of complaint/diagnosis usage, it feels that 
should be a persistent composition. And as I see it, for clinical use, the last 
version is the one that should be used. Review of previous versiosn of data is 
more for audit IMO.


Best,
Pablo.

On Tue, Oct 30, 2018 at 8:44 AM Dileep V S 
mailto:dil...@healthelife.in>> wrote:
Hi Ian,

If we take an OP episode, it will consist of possibly a screening encounter, 
then a consult encounter and one or more revisit encounters. We will start with 
recording data such as complaints, diagnosis, medication order etc . This data 
will be reviewed and updated in every subsequent encounters. So a 
complaint/diagnosis recorded in the consult may get marked as resolved during 
one of the subsequent revisits or sometimes something new gets added. A 
medication order made during the consult may get discontinued and another added 
later

The folders representing each of the encounters maintain a pointer to the 
corresponding versions of the composition so that the snapshot of the patient 
status is preserved and can be accessed(using an aql of versioned composition) 
any time into the future.

We are not using persistent compositions anywhere. To display a persistent 
status(Active complaints, diagnosis or medications), we use an aql to filter on 
status to display the relevant information. We expect that the doctor will 
review and update status of active items during an encounter. This is important 
for us as we are approaching the problem from a person centric view where the 
health status of the person concerned is evolving with every health encounter. 
Our patient summary is thus, always the last known status of the person.

By default the clinical information view is limited to an episode using virtual 
folders. But a summary view across episodes is also possible if we run the 
query outside the virtual folder context. Also in our case the compositions can 
get versioned as an episode progresses.

I hope that helps. Do feel free to point out any problems with our approach

regards



[https://drive.google.com/uc?id=0BxQc41y9yqs6bkE5a1JQQVBjZG8]

Dileep V S

Founder

HealtheLife Ventures LLP

m:

+91 9632888113

a:

106, Innovation Centre, IIIT, Electronics City, Bangalore 560100

w:

healthelife.in  e: 
dil...@healthelife.in


On Tue, Oct 30, 2018 at 3:02 PM, Ian McNicoll 
mailto:i...@freshehr.com>> wrote:
Hi Dileep,

It should be possible to query on versioned compositions but I feel a bit 
uncomfortable about 

Re: AQL on versioned compositions

[Pablo Pazos]

Hi Dileep, from your description of complaint/diagnosis usage, it feels
that should be a persistent composition. And as I see it, for clinical use,
the last version is the one that should be used. Review of previous
versiosn of data is more for audit IMO.


Best,
Pablo.

On Tue, Oct 30, 2018 at 8:44 AM Dileep V S  wrote:

> Hi Ian,
>
> If we take an OP episode, it will consist of possibly a screening
> encounter, then a consult encounter and one or more revisit encounters. We
> will start with recording data such as complaints, diagnosis, medication
> order etc . This data will be reviewed and updated in every subsequent
> encounters. So a complaint/diagnosis recorded in the consult may get marked
> as resolved during one of the subsequent revisits or sometimes something
> new gets added. A medication order made during the consult may get
> discontinued and another added later
>
> The folders representing each of the encounters maintain a pointer to the
> corresponding versions of the composition so that the snapshot of the
> patient status is preserved and can be accessed(using an aql of versioned
> composition) any time into the future.
>
> We are not using persistent compositions anywhere. To display a persistent
> status(Active complaints, diagnosis or medications), we use an aql to
> filter on status to display the relevant information. We expect that the
> doctor will review and update status of active items during an encounter.
> This is important for us as we are approaching the problem from a person
> centric view where the health status of the person concerned is evolving
> with every health encounter. Our patient summary is thus, always the last
> known status of the person.
>
> By default the clinical information view is limited to an episode using
> virtual folders. But a summary view across episodes is also possible if we
> run the query outside the virtual folder context. Also in our case the
> compositions can get versioned as an episode progresses.
>
> I hope that helps. Do feel free to point out any problems with our approach
>
> regards
>
>
>
> Dileep V S
> *Founder*
> HealtheLife Ventures LLP
> m: +91 9632888113
> a: 106, Innovation Centre, IIIT, Electronics City, Bangalore 560100
> w: healthelife.in  e: dil...@healthelife.in
>
> On Tue, Oct 30, 2018 at 3:02 PM, Ian McNicoll  wrote:
>
>> Hi Dileep,
>>
>> It should be possible to query on versioned compositions but I feel a bit
>> uncomfortable about using versioned data this way. For event-type
>> compositions, I would only expect versions to be created as a result of an
>> error correction, not as part of routine recording. For persistent-type
>> compositions, new versions are routinely created but only when the previous
>> version is reallyof little interest e.g summaries, status-tracking.
>>
>> I'm uneasy about your suggested approach. Can you spell out an example/
>>
>> Ian
>> Dr Ian McNicoll
>> mobile +44 (0)775 209 7859
>> office +44 (0)1536 414994
>> skype: ianmcnicoll
>> email: i...@freshehr.com
>> twitter: @ianmcnicoll
>>
>>
>> Co-Chair, openEHR Foundation ian.mcnic...@openehr.org
>> Director, freshEHR Clinical Informatics Ltd.
>> Director, HANDIHealth CIC
>> Hon. Senior Research Associate, CHIME, UCL
>>
>>
>> On Tue, 30 Oct 2018 at 08:45, Dileep V S  wrote:
>>
>>> Hi,
>>> We are implementing virtual folders to organize compositions as per
>>> episodes of care and encounters. The plan is to keep track of versioned
>>> compositions in encounters to capture the change of information(Complaints
>>> and diagnosis getting resolved across encounters inside an episode).This
>>> will allow us to view the compositions as they were in any encounter and
>>> not the latest version always.
>>>
>>> For this we need to be able to query specific versions of compositions
>>> using aql. Can some body point me to the documentation or examples of how
>>> to do this?
>>>
>>> regards
>>> Dileep V S
>>> *Founder*
>>> HealtheLife Ventures LLP
>>> m: +91 9632888113
>>> a: 106, Innovation Centre, IIIT, Electronics City, Bangalore 560100
>>> w: healthelife.in  e: dil...@healthelife.in
>>> ___
>>> openEHR-technical mailing list
>>> openEHR-technical@lists.openehr.org
>>>
>>> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>>>
>>
>> ___
>> openEHR-technical mailing list
>> openEHR-technical@lists.openehr.org
>>
>> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>>
>>
> ___
> openEHR-technical mailing list
> openEHR-technical@lists.openehr.org
>
> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
>


-- 
*Ing. Pablo Pazos Gutiérrez*
pablo.pa...@cabolabs.com
+598 99 043 145
skype: cabolabs
Subscribe to our newsletter 

http://www.cabolabs.com
https://cloudehrserver.com

Re: AQL on versioned compositions

[Thomas Beale]

Dileep,

If you are querying the EHR (or demographics) repository for older 
versions, the usual way to understand this concept is similar to in e.g. 
Github or other DVCS systems, which is: you are stating a time-point in 
system time and you want to see the data versions that were current then.


AQL has the TIMEWINDOW clause to implement this 
. 
I don't know how widely this is implemented.


In addition, the EHR REST API 
 
allows access to the EHR directory (FOLDER structure) at given versions.


- thomas

On 30/10/2018 08:45, Dileep V S wrote:

Hi,
We are implementing virtual folders to organize compositions as per 
episodes of care and encounters. The plan is to keep track of 
versioned compositions in encounters to capture the change of 
information(Complaints and diagnosis getting resolved across 
encounters inside an episode).This will allow us to view the 
compositions as they were in any encounter and not the latest version 
always.


For this we need to be able to query specific versions of compositions 
using aql. Can some body point me to the documentation or examples of 
how to do this?


regards
Dileep V S
/Founder/
HealtheLife Ventures LLP
m:  +91 9632888113
a:  106, Innovation Centre, IIIT, Electronics City, Bangalore 560100
w: 	healthelife.in  e: dil...@healthelife.in 





___
openEHR-technical mailing list
openEHR-technical@lists.openehr.org
http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org


--
Thomas Beale
Principal, Ars Semantica 
Consultant, ABD Project, Intermountain Healthcare 

Management Board, Specifications Program Lead, openEHR Foundation 

Chartered IT Professional Fellow, BCS, British Computer Society 

Health IT blog  | Culture blog 
 | The Objective Stance 

___
openEHR-technical mailing list
openEHR-technical@lists.openehr.org
http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org

Re: e-health services landscape - initial proposal, open forum

[Thomas Beale]

A revised version of the services landscape is now available here 
.


___
openEHR-technical mailing list
openEHR-technical@lists.openehr.org
http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org