Instruction archetypes and overlaping nodes with INSTRUCTION.narrative

pablo pazos pazospablo at
Wed Oct 30 00:04:28 EDT 2013

Thanks Ian & Thomas,
It seems I have to add support for rules on EHRGen to define mappings between structured data and narrative text for INSTRUCTIONS.
That way, if there's no structured INSTRUCTION or there are no mapping rules, the narrative will appear on screen to let the user input free text, else if there's some structure (like the referral case) and there are mapping rules, the narrative should not appear on screen, and when the user input data on the structure, the mapping rules will be executed to get the narrative text.
Thinking of implementation: when there are mapping rules, at least one data point from the structure should be mandatory, so narrative is not empty, but there's no guarantee that the archetype defines that constraint, maybe we need to set that constraint in templates or just leave that to apps as an extra verification.
What do you think? Does this make sense?

Kind regards,
Eng. Pablo Pazos Gutiérrez

Date: Tue, 29 Oct 2013 10:01:59 +0000
From: thomas.beale at
To: openehr-technical at
Subject: Re: Instruction archetypes and overlaping nodes with	INSTRUCTION.narrative


      Just to re-iterate, the 'narrative' property is meant to carry the
      piece of text that would appear on a medication or with a
      medication as supplied by a pharmacy (including in a hospital).
      When the administering agent is a human - the patient, family
      member or a nurse - this is normally the concrete direction that
      is followed. 


      The computable form of the order / instruction says the same
      thing, but in a computable form, allowing structured querying,
      analysis, all the usual stuff.


      This is probably the only place where there is content duplication
      in openEHR, and as far as I can see, it needs to be like that,
      since there is no standard way to generate the narrative text in
      its correct form from the computable form (i.e. the Activities
      etc) - particularly since the text form can contain quite
      particular words, 'codes' (like '3td po') and so on. 


      If a 'standard' algorithm could be developed for this purpose it
      would obviate the need for the narrative property, but I suspect
      this is a long way off due to the medically & culturally
      specific content typical in the narrative today.


      - thomas



      On 29/10/2013 08:36, Ian McNicoll wrote:

      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

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)


Kind regards,
Eng. Pablo Pazos Gutiérrez

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