BMI archetype

Bert Verhees bert.verhees at rosa.nl
Tue Apr 11 03:54:33 EDT 2017


It is clear to me.

Not only our senses observe, mostly we use devices to observe. Sometimes 
very complex devices, like MRI, their are a lot of calculations in those 
devices, billions of calculations.

BMI is something that often takes two devices to measure, but it could 
be possible to create a single device which does this. So in that case 
it would be an Observation? Than it will also be if not a computer does 
the math, but a human being.

To judge however if a BMI is a sign of obesity, that is subjective. For 
a normal person, a BMI of 28 could be obese, but for a weightlifter, 
because of all those heavy muscles, a BMI of 30 still is not obese. So 
that would be evaluations.

Bert


On 11-04-17 09:15, GF wrote:
> Sam,
>
> I reserve Observation for all that can be _observed_ by the five human 
> _senses_.
> All that is _derived_ by, for instance, a calculation, or rules, or a 
> thought process, is an Evaluation.
>
> This means that sometimes BMI is read or heard and therefor an 
> Observation.
> Or derived using observed values like Weight and Body length and there 
> for an Evaluation.
>
> I disagree with the definitions as provided by Silje.
> Each item in the EHR has an associated point in time, since life 
> unrolls in time as does documentation.
> A definition that is based on exclusions only is not correct.
> E.g. 'Something is a bee, because it is NOT a lion, Not a tulip, and 
> NOT a mosquito’ does NOT qualify as a correct sensible definition.
>
> What are the _formal_ definitions of Observation and Evaluation in the 
> context of an EHR?
>
> Gerard   Freriks
> +31 620347088
> gfrer at luna.nl <mailto:gfrer at luna.nl>
>
> Kattensingel  20
> 2801 CA Gouda
> the Netherlands
>
>> On 10 Apr 2017, at 23:12, Sam Heard <sam.heard at oceaninformatics.com 
>> <mailto:sam.heard at oceaninformatics.com>> wrote:
>>
>> HI All
>> The fact that BMI is derived from two other measurements does not 
>> make it an evaluation. It is objective and when it was measured, max, 
>> min, average etc are all of interest.
>> An evaluation is a clinical statement of persistent relevance. 
>> Silje’s example of Obesity or Malnutrition are good examples.  There 
>> may be a date of onset but there may not be. Personality disorder is 
>> an example of the latter. Dates in evaluation archetypes tend to be 
>> specific to that concept.
>> Cheers, Sam
>> Sent fromMail <https://go.microsoft.com/fwlink/?LinkId=550986>for 
>> Windows 10
>> *From:*Bert Verhees <mailto:bert.verhees at rosa.nl>
>> *Sent:*Tuesday, 11 April 2017 4:52 AM
>> *To:*For openEHR clinical discussions 
>> <mailto:openehr-clinical at lists.openehr.org>
>> *Subject:*Re: BMI archetype
>>
>> Thanks Silje,
>>
>> to my personal opinion, I think this is the best answer, at least the 
>> first part. The second part consist of negation, I would like a more 
>> positive description about when to use an evaluation. That is per 
>> example in the third part of your answer.
>>
>> I like to thank all for your considerations shared on this mailinglist.
>>
>> Best regards
>>
>> Bert Verhees
>>
>> On 10-04-17 09:46, Bakke, Silje Ljosland wrote:
>>
>>     I think this is a case of putting too much weight into the names
>>     of the archetype classes.
>>
>>     Basically:
>>     ·         OBSERVATIONs are used when you need a point in time
>>     event (or series of them) or an interval event with or without a
>>     math function, ie want the same thing done over and over again
>>     with the same protocol, or you need to specify the patient state.
>>
>>     · EVALUATIONs are used when you don’t need any of the above, and
>>     the use case doesn’t fit with ACTIONs, INSTRUCTIONs or
>>     ADMIN_ENTRY either.
>>
>>     BMI is evidence that is reached by calculation of measurements,
>>     it’s not a clinical assessment. Based on the BMI, you could draw
>>     a conclusion that the person is obese, which would be recorded in
>>     an EVALUATION archetype (typically EVALUATION.problem_diagnosis).
>>
>>     Regards,
>>     *Silje*
>>
>>     *From:*openEHR-clinical
>>     [mailto:openehr-clinical-bounces at lists.openehr.org]*On Behalf Of*GF
>>     *Sent:*Monday, April 10, 2017 9:33 AM
>>     *To:*For openEHR clinical
>>     discussions<openehr-clinical at lists.openehr.org>
>>     <mailto:openehr-clinical at lists.openehr.org>
>>     *Subject:*Re: BMI archetype
>>
>>     My ‘definitions'
>>
>>     *Observation*: a result obtained by an author using human senses
>>     *Calculation*: a kind of Evaluation by a human or device using
>>     Observations and knowledge (rules, formula)
>>     *Evaluation/assessment*: Interpreting observations caused by
>>     processes using existing knowledge
>>     *Diagnosis*: Special case of Evaluation. The process pertains to
>>     processes in the Patient system.
>>
>>     Gerard   Freriks
>>     +31 620347088
>>     gfrer at luna.nl <mailto:gfrer at luna.nl>
>>
>>     Kattensingel  20
>>     2801 CA Gouda
>>     the Netherlands
>>
>>         On 10 Apr 2017, at 09:10, Pablo Pazos
>>         <pablo.pazos at cabolabs.com <mailto:pablo.pazos at cabolabs.com>>
>>         wrote:
>>
>>         from ehr_im
>>
>>         OBSERVATION (for all observed phenomena,including
>>         mechanically or manually measured, and responses in interview)
>>         My interpretation is automatic calculations are included in
>>         "mechanically measured".
>>         Also
>>
>>         EVALUATION (for assessments, diagnoses, plans, risks,
>>         recommendations)
>>         I don't see an evaluation in the execution of a numeric
>>         formula, but I can see it in the recording of an evaluation
>>         in terms of the result of executing the formula. Similar case
>>         the calculation of the mean systolic BP based on a series of
>>         events = 140 mmHg (is OBS), and stating "high BP" or
>>         "hypertension" is EV).
>>
>>         On Mon, Apr 10, 2017 at 3:55 AM, Bert Verhees
>>         <bert.verhees at rosa.nl <mailto:bert.verhees at rosa.nl>> wrote:
>>
>>             Op 10-4-2017 om 8:52 schreef GF:
>>
>>                 I would say one needs both:
>>                 Evaluation: when calculating by the author the
>>                 BMI-number using existing weight/height data
>>                 Observation: when reading/copying by the author aa a
>>                 BMI-result from a source
>>
>>
>>             Also a good argument ;-)
>>
>>             A good solution would then be, put it in a cluster, so it
>>             can be sticked into whatever is right for the situation.
>>
>>
>>             Bert
>>
>>             _______________________________________________
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>>
>>
>>
>>
>>         --
>>         Ing. Pablo Pazos Gutiérrez
>>         Cel:(00598) 99 043 145
>>         Skype: cabolabs
>>         	
>>
>>         _http://www.cabolabs.com_
>>         _pablo.pazos at cabolabs.com_
>>         _Subscribe to our newsletter_ <http://cabolabs.com/>
>>
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