HL7 and negation

Thomas Beale thomas.beale at openehr.org
Sat Jun 11 06:29:05 EDT 2016


very nice analysis. Points 3 and 4 are a 'not applicable' idea, which 
needs to be catered for as such I think.

- thomas

On 08/06/2016 14:50, Bakke, Silje Ljosland wrote:
> 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.
> oSymptoms 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.

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