HL7 and negation

Bakke, Silje Ljosland silje.ljosland.bakke at nasjonalikt.no
Wed Jun 8 09:50:48 EDT 2016

Hi Gerard,

I don’t have time to look through the use cases right now, but I thought I should give a general outline to how we handle negation in openEHR archetypes.

Basically, there isn’t a single way that works for all use cases, but we’ve worked out a few patterns that seem to work:

·       Some concepts are very safety critical, where you should never be able to confuse positive presence with negation. Examples of these are medications, adverse reactions, problems/diagnoses, family history, procedures, in some cases symptoms, and possibly implants. Negation of these need to be handled by separate “Exclusion of X” archetypes, which makes it impossible to query for something and inadvertently mix up presence and absence.

o   Symptoms are a special case, where we have both the ability to use an explicit negation using the “Exclusion of a symptom” archetype, or the softer “no more than usual” “Nil significant” boolean element.

·       Some concepts aren’t as safety critical, or are more of a specific status that should be updated in one single place of the health record. An example of this is smoking status, where both “Former smoker” and “Never smoked” could be seen as negations of “Current smoker”. This is handled as a value set in the main data element of the smoking summary archetype.

·       Specific physical examinations sometimes need to be excluded, to be able to say “I didn’t perform the examination of the left eye because the patient has an artificial left eye”. This is handled using a separate cluster that’s reused within each examination cluster.

·       Specific observations or scorings sometimes need to be excluded, to be able to say “Children’s Global Assessment Scale wasn’t performed for this child, because they’re younger than 4 years old”. This is an emerging pattern, but for now it looks like it’ll be similar to the examination exclusion, using a separate cluster that’s reused between the observations. We still don’t know for sure what to call this cluster, as “Examination of observation” can easily be mixed up with the archetype class OBSERVATION.

·       There’s also the issue of how to specify the presence or non-presence of something in the context of an examination of the same thing. A good example of this is body fluids, which archetype is out for review right now. If anyone would like to have their say on this and isn’t invited to this review, please adopt this archetype to be invited: http://openehr.org/ckm/#showArchetype_1013.1.2255

I might have forgotten something, but I think these are the basic patterns of negation/exclusion we’re using/exploring as of now.

Kind regards,
Silje Ljosland Bakke

Information Architect, RN
Coordinator, National Editorial Board for Archetypes
National ICT Norway
Tel. +47 40203298
Web: http://arketyper.no<http://arketyper.no/> / Twitter: @arketyper_no<https://twitter.com/arketyper_no>

From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of GF
Sent: Wednesday, June 8, 2016 8:54 AM
To: For openEHR clinical discussions <openehr-clinical at lists.openehr.org>
Subject: HL7 and negation

Dear Colleagues,

HL7 is thinking about the problem of negation.
The group discussing it created a document with negation use cases.

My questions are:
- Can you let us know your reaction to this list of use cases?
- How should ‘negation’ be handled the best in respect of semantic interpretability?

My personal opinions:
- the boolean should not be used
- try to translate the ‘negation’ problem into ‘presence and absence’. A concept is or is not present, a numeric result is of is not present.
- do not use pre- and post co-ordinated concepts using SNOMED but use the SNOMED primitives.

I’m curious to learn what your opinion is.

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