Instruction archetypes and overlaping nodes with INSTRUCTION.narrative

Ian McNicoll Ian.McNicoll at
Tue Oct 29 04:36:41 EDT 2013

Hi Pablo,

My understanding is that the purpose of the INSTRUCTION.narrative
attribute is to carry a single 'human-friendly' version of what might
be a very complex structured set of activities. The best example would
be a complex medication order compromising multiple activities, each
with a number of structured content. The idea of the 'narrative'
attribute is that the key clinical content IS replicated for human
consumption. In the work we are currently doing in the UK on
medication orders we are concatenating the structured Medication name,
dose and frequency to populate the narrative attribute. This makes
good clinical sense for safety reasons, particularly when complex
timings are involved but
for a simple referral this is probably a bit over the top.

I would just replicate the content of  the 'Reason for request' in the
narrative attribute, unless you know that critical information will be
carried in the Reason description, in which case I would concatenate
the Reason + Description.


On 29 October 2013 02:50, pablo pazos <pazospablo at> wrote:
> Hi, I'm reviewing archetypes for a project. Looking at referral request
> archetype on the CKM, there are some nodes (Reason for request & Reason
> description) that seems to match the semantics of INSTRUCTION.narrative
> property.
> Using that archetype to generate the UI in EHRGen, the overlaping was clear
> (I though if a doctor records the reason, he/she will have no information to
> record on narrative). The problem is that narrative is mandatory on the IM,
> and I doubt what to do in cases like this one.
> See the generated UI here:
> Is there a real overlaping from the clinical point of view?
> If an archetype has nodes that represents the same semantics as narrative
> instruction, is there a need to record narrative anyway? (Even though the
> narrative is mandatory by the IM)
> Thanks!
> --
> Kind regards,
> Eng. Pablo Pazos Gutiérrez
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Dr Ian McNicoll
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Clinical Modelling Consultant, Ocean Informatics, UK
Director openEHR Foundation
Honorary Senior Research Associate, CHIME, UCL
SCIMP Working Group, NHS Scotland
BCS Primary Health Care

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