BMI archetype

Bert Verhees bert.verhees at rosa.nl
Tue Apr 11 04:58:36 EDT 2017


Saying this, it comes to my mind that often complex devices, also 
supported by computers, AI-algorithms, etc, not only observe but also 
evaluate/interpret.

So what comes out of the machine can be a mixture of observations and 
evaluations, hard to distinguish, and also rather academical to distinguish.

Maybe the reference-model is in need of another term, that can be partly 
observation and partly evaluation. And when we have that term, it is 
questionable if that term shouldn't have been there at the first place.

Bert


On 11-04-17 09:54, Bert Verhees wrote:
>
> 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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>>
>>
>>
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