Link between goals and other clinical concepts

Ian McNicoll ian.mcnicoll at oceaninformatics.com
Sun Jun 22 08:41:47 EDT 2014


Hi Pablo,

You can see an example of the Goal archetype in-use via the SHN Heart
Failure template at

http://www.openehr.org/ckm/#showTemplate_1013.26.14

This was my interpretation, which I think aligns with Heather's but
others may vary!

To answer Mark's point, I think the archetpye does support defining a
range of values via the Interval datatypes.

As Thomas has said, this is the subject of some discussion in the CIMI
world. Although some sort of epistemic status flag/mood code seems
attractive, it works very badly for Goal/Target. It is pretty obvious
that the contents of an archetype for Target Blood pressure is very
different for that ob the measurement itself. The only part of the
highly complex blood pressure measurement archetype which has any
value in the blood pressure target archetype are the systolic,
diastolic and perhaps MAP datapoints and  even at that level the
original observation data point is a single value , whereas the target
is likely to be an interval. To make an epistemic flag work we would
need to model the original measurement as an interval, which is
entirely possible technically but requires us to further constrain the
measurement archetype at template level to make it useable.

As Heather has pointed out, it might be possible to re-model every key
data point as an individual cluster or even element archetype but that
imposes a very significant burden on the modelling work, particularly
clinical review, where we would again effectively have to re-create
the existing blood pressure measurement archetype as a template with
all of the additional constraints and aggregation. I don't think the
CIMI group have really taken this on-board.

In a sense, at least for the 'Target/Goal' scenario, all that we want
to do is to re-use the datatype and units from the original
'measurement' archetype. We probably need to use different SNOMED
bindings and convert the data type to its INTERVAL equivalent. So I
would question whether there  is any real value in re-using the
original constraint pattern. Arguably the only attribute which is
actually copied intact is the unit.

I think it might actually be more sensible to use the current approach
where an existing archetype node is pointed to for information but
that this is then used by tools to replicate/adapt the original
constraints. i.e this is re-use via copy/paste/edit rather than direct
re-use/inheritance.aggregation.

I suppose it all comes down to the value of direct re-use. At least
for the Target/Goal scenario, I suspect the overhead of doing this far
outweighs any benefit, and I think may be another example of
informaticians trying to construct ontologically pure and elegant
solutions which actually just get in the way of implementation.

The eHealth record is fundamentally anti-pattern.

Ian

Ian

On 20 June 2014 06:32, Heather Leslie
<heather.leslie at oceaninformatics.com> wrote:
> Hi Pablo,
>
>
>
> Comments inline
>
>
>
> Heather
>
>
>
> From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org]
> On Behalf Of pablo pazos
> Sent: Friday, 20 June 2014 10:09 AM
> To: openEHR Clinical
>
>
> Subject: RE: Link between goals and other clinical concepts
>
>
>
> Hi Heather!
>
>
>
> Yes, I was evaluating the goal archetype. Great, now I get what the "Target
> archetype node" is for.
>
>
>
> About that I have a question, what's the role of the "Target measurement"?
> My understanding was that's the value set for the goal (e.g. target body
> weight),
>
> [HVL:] Agreed. Perhaps we should refine the name/description to make that
> clearer.
>
>
>
> not the measurement to be evaluated against the goal (e.g. current body
> weight).
>
> If that value is the measurement, where should the value for the goal be
> set? Or the idea is not to set a value like quantity but set a text in
> "Target".
>
>
>
> My question was focused on the relationship between the value set for the
> target goal and the archetype used to record the measurements to be compared
> with the value of the goal. Because the goal and the measurements should
> comply the same constraints (magnitude, units, etc)
>
> [HVL:] Understood . That is what I was referring to with my comment
> “correlation with magnitude and unit constraints would be nice to have, but
> is not currently easy to achieve.” We would currently do that manually in
> the template. Alternatively we could specialise the goal archetype for each
> measurement, but that has lots of overheads as well.
>
>
>
> If we were to look at changing the modelling patterns to allow for a common
> CLUSTER to be used within both the measurement OBSERVATION and the
> EVALUATION.goal then we could achieve what you asked for. In the current ADL
> 1.4 world that would be an enormous modelling overhead as then no
> measurement model is standalone and ready to go but needs to be combined
> with others in order to be used in every modelling scenario.
>
>
>
> It is not clear that the requirements for goal justify the changed modelling
> pattern scenario. The value and clarity of the standalone OBSERVATIONs is
> huge.
>
>
>
> Also, what about when you have a goal for the BP and you need to specify a
> value for systolic and diastolic? Should I create two instances of the goal?
> (One for systolic and one for diastolic).
>
> [HVL:] Depends on what you are trying to achieve. You could do it the way
> you describe, and then reaching each goal can be assessed independently. Or
> if you want to reduce the BP as a whole, you could set a goal of ‘Reduce BP’
> and have two targets, one for Systolic and the other for Diastolic
>
>
>
> Thanks!
>
>
>
>
>
> --
> Kind regards,
> Eng. Pablo Pazos Gutiérrez
> http://cabolabs.com
>
> ________________________________
>
> From: heather.leslie at oceaninformatics.com
> To: openehr-clinical at lists.openehr.org
> Subject: RE: Link between goals and other clinical concepts
> Date: Wed, 18 Jun 2014 03:13:09 +0000
>
> Hi Pablo,
>
>
>
> Is it safe to assume that you’ve seen the current archetype for Goal? It is
> here: http://www.openehr.org/ckm/#showArchetype_1013.1.124
>
>
>
> In it we have a data element that specifically identifies the archetype and
> path of the specific node that should be used to capture the actual
> measurement, eg the weight or height or systolic blood pressure.
>
>
>
> This combination of the EVALUATION.goal archetype with various target
> OBSERVATIONs for recording the actual data is being used in implementations
> in Australia as part of a personalised care plan, as Hugh has indicated. The
> correlation with magnitude and unit constraints would be nice to have, but
> is not currently easy to achieve.
>
>
>
> Regards
>
>
>
> Heather
>
>
>
> From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org]
> On Behalf Of pablo pazos
> Sent: Saturday, 14 June 2014 5:21 AM
> To: openEHR Clinical
> Subject: Link between goals and other clinical concepts
>
>
>
> Hi, if I want to establish a goal for body weight, I think there's a need of
> linking the goal concept with the body weight concept, but the body weight
> archetype is for measuring the weight not to specify a goal for it.
>
>
>
> I understand the difference between a goal (what you want to achieve, fixed
> value) and the measures (to control your progress and compare with the goal,
> variable value through time).
>
>
>
> Also, I think the target measurement from the goal archetype will depend on
> the specific concept I'm creating a goal for (body weight), I mean the
> magnitude and units constraints should be inherited someway from the concept
> I'm measuring (body weight) into the goal archetype.
>
>
>
> Does anyone has an idea of how will be a good way of modeling a goal related
> to another concept like weight or BP?
>
>
>
> Thanks!
>
>
> --
> Kind regards,
> Eng. Pablo Pazos Gutiérrez
> http://cabolabs.com
>
>
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-- 
Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll at oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
Director openEHR Foundation  www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
SCIMP Working Group, NHS Scotland
BCS Primary Health Care  www.phcsg.org




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