Yet another OBSERVATION vs. EVALUATION issue

Heather Leslie heather.leslie at
Wed Aug 15 06:33:58 EDT 2012

One comment.


From: openehr-clinical-bounces at
[mailto:openehr-clinical-bounces at] On Behalf Of Koray
Sent: Wednesday, 15 August 2012 6:43 PM
To: For openEHR clinical discussions
Subject: RE: Yet another OBSERVATION vs. EVALUATION issue


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...

[HL>] If you consider it as an extract from the source record, then this
makes sense to use the original archetypes as I suggest. 


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
[mailto:openehr-clinical-bounces at] On Behalf Of Heather
Sent: Wednesday, 15 August 2012 2:50 p.m.
To: For openEHR clinical discussions
Subject: RE: Yet another OBSERVATION vs. EVALUATION issue


Hi Koray,


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
[mailto:openehr-clinical-bounces at] On Behalf Of Koray
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 -


, smoking status

[HL>] EVALUATION.tobacco_use_summary -


and checklist for certain medications

[HL>] ACTION.medication -


. 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

[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 - - 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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