Yet another OBSERVATION vs. EVALUATION issue
k.atalag at nihi.auckland.ac.nz
Wed Aug 15 04:42:34 EDT 2012
Hi Heather, all others - many thanks for your responses.
I agree that risk is an evaluation - no question with that. However I reckon I couldn't explain the issue I had clearly:
My question was when documenting a patient's health information at a point in time base on past diagnoses, medications and smoking status not necessarily assessed by the same physician, should these be observations or evaluation? I'm not really asking about risk assessment - in that case the physician (or decision support tool) is considering past observations etc. against a knowledgebase and making a clinical judgement. That should clearly be an evaluation
To give an example: a medical student is reading problem list, medication list and smoking status from patient's EHR and putting on a form to present to a physician - is the stuff on that form Observation of Evaluation? Heather I take your point that in order to reuse data it is best to stay faithful to original models...
So that makes me think whether we find a smarter way of dealing with Observation vs. Evaluation types. Kind of multiple inheritance where, depending on a particular usage, they can inherit contextual parts of either Observation or Evaluation. I can see this will save a lot of hassle and still enable us to reason using the ontological Clinical_Entry classes. Probably same is true for Instruction/Action types as well.... Anyway this is probably even a bigger discussion!
From: openehr-clinical-bounces at lists.openehr.org [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of Heather Leslie
Sent: Wednesday, 15 August 2012 2:50 p.m.
To: For openEHR clinical discussions
Subject: RE: Yet another OBSERVATION vs. EVALUATION issue
Some of the latest versions of existing archetypes might suit your purpose - the most recent are currently on the NEHTA CKM and we are looking to transport them across to the openEHR CKM.
More details below...
From: openehr-clinical-bounces at lists.openehr.org<mailto:openehr-clinical-bounces at lists.openehr.org> [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of Koray Atalag
Sent: Tuesday, 14 August 2012 2:28 PM
To: For openEHR clinical discussions
Subject: Yet another OBSERVATION vs. EVALUATION issue
There's a CVD risk assessment tool I'm working on which prepopulates clinical info from GP software. This includes diagnoses
[HL>] EVALUATION.problem_diagnosis - http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.896
, smoking status
[HL>] EVALUATION.tobacco_use_summary - http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.1026
and checklist for certain medications
[HL>] ACTION.medication - http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.876
. Note that some of the underlying info might be coming from previous visits (e.g. problem list type) but also can be newly entered as a result of GP's assessment. Now, regardless of what happens in GP software, when it is transferred onto this tool (whether automatically prepopulating and/or manual entry) are these Observations or Evaluations?
[HL>] If you see this work as part of a broader ecosystem of data and this could be extended, the data re-used etc, then I'd strongly advise that you use the existing archetypes as described above. This is clearly the ideal situation and recommended from a pure modelling perspective, maximising the opportunity to re-use or re-purpose or extend data in the future.
Note that the GP does not make any further clinical judgement here, just rephrase existing data for a different purpose. My gut feeling is the former (Observation).
[HL>] The actual recording of risk itself will be captured using an EVALUATION - where the evidence from multiple sources is synthesized and an expression of risk is calculated or stated. There is a very early archetype - EVALUATION.risk - http://www.openehr.org/knowledge/OKM.html#showarchetype_1013.1.176_1 - on the openEHR CKM that probably needs to be modified, but gives you a sense of the likely structure. It has long been on my mind to scope out the 'risk ecosystem' and devise a generic risk model, probably much as you see it now, but with a more generic index data element (ie take away 'condition') and probably some related specialisations for Risk of Condition etc. Yet to be determined, I'm afraid.
Hope this helps
I know this is tricky and has been brought to this list many times here but thoughts? Masters?
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