Instruction archetypes and overlaping nodes with INSTRUCTION.narrative

Colin Sutton Colin.Sutton at ctc.usyd.edu.au
Wed Oct 30 00:58:02 EDT 2013


You might want the narrative to appear for data entry if there is no suitable structure for the user's case, or for others to code from it.
It should not appear there by default or the user might not bother trying to enter the structured data.

Regards,
Colin

From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of pablo pazos
Sent: Wednesday, 30 October 2013 3:04 PM
To: openeh technical; openEHR Clinical
Subject: RE: Instruction archetypes and overlaping nodes with INSTRUCTION.narrative

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
http://cabolabs.com<http://cabolabs.com/es/home>
________________________________
Date: Tue, 29 Oct 2013 10:01:59 +0000
From: thomas.beale at oceaninformatics.com<mailto:thomas.beale at oceaninformatics.com>
To: openehr-technical at lists.openehr.org<mailto:openehr-technical at lists.openehr.org>
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.



Ian



On 29 October 2013 02:50, pablo pazos <pazospablo at hotmail.com><mailto:pazospablo at hotmail.com> 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: http://tinypic.com/r/ml5og5/5





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

http://cabolabs.com



_______________________________________________

openEHR-technical mailing list

openEHR-technical at lists.openehr.org<mailto:openEHR-technical at lists.openehr.org>

http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org



--
[Ocean Informatics]<http://www.oceaninformatics.com/>

Thomas Beale
Chief Technology Officer
+44 7792 403 613

Specification Program, openEHR<http://www.openehr.org/>
Honorary Research Fellow, UCL<http://www.chime.ucl.ac.uk/>
Chartered IT Professional Fellow, BCS<http://www.bcs.org.uk/>
Health IT blog<http://wolandscat.net/category/health-informatics/>

[View Thomas Beale's profile on LinkedIn]<http://uk.linkedin.com/in/thomasbeale>



_______________________________________________ openEHR-technical mailing list openEHR-technical at lists.openehr.org<mailto:openEHR-technical at lists.openehr.org> http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org

#####################################################################################
Scanned by MailMarshal - M86 Security's comprehensive email content security solution. 
Download a free evaluation of MailMarshal at www.m86security.com
#####################################################################################
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20131030/7b9aee44/attachment.html>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.jpg
Type: image/jpeg
Size: 4085 bytes
Desc: image001.jpg
URL: <http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20131030/7b9aee44/attachment.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image002.png
Type: image/png
Size: 511 bytes
Desc: image002.png
URL: <http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20131030/7b9aee44/attachment.png>


More information about the openEHR-clinical mailing list