design description of lab archetypes

Thomas Beale thomas.beale at openehr.org
Thu Jul 13 08:42:13 EDT 2017


Heather,

thanks that's a page I was looking for. I assume the laboratory analyte 
archetype is newer than this? It is not mentioned.

I think we need more explanation about the basic intended structure. 
There are at least the following scenarios to cope with for the 'simple 
tabular' types like biochemistry.

 1. The doc orders (taking thyroid as an example) a standard thyroid
    test, without nominating things like TSH, TS4, etc (because they
    know what they will get back)
 2. The doc orders just a specific analyte, e.g. TSH
 3. any combination of the above in a single order? I believe this is
    possible and normal in some places. This could mean
     1. one or more 'panels', e.g. a GP orders thyroid test, lipids and
        liver function
     2. one or more separate analytes, e.g. TSH, iron, ...
     3. a mixture of 'panels' and single analytes.

There are two things we want to achieve in representing the data (apart 
from the obvious one that we don't lose information from the original 
data provided by the lab when converting to openEHR):

  * no matter if just a single analyte, or panel is ordered, the
    specific analyte results are represented in the same way. In the
    thryoid example, TSH must be queryable in exactly the same way no
    matter whether received as part of a thyroid test panel, or just on
    its own.
  * coding of panels and analyte results with LOINC should be optional
    (but probably encouraged). I.e. there must be a way of querying that
    works even if LOINC is not used.

To achieve this, I would propose that we always consider that there is a 
panel in the openEHR representation, regardless of whether a single 
analyte was ordered. This means a structure like the following:

  * Lab report [corresponds to one order]
      o order meta-data
      o etc
      o *Lab Test [*]* (= container for all content for a single test)
          + conclusions
          + method
          + other details...
          + sample
          + *Lab Panel [*]*
              # *Analyte [*]*
                  * value
                  * method [0..1]
                  * comment [0..1]
                  * other detail [0..1]

So for the TSH example, ordered in a Thyroid panel, we have something like:

  * Lab report
      o requestor: Dr Silva, Hospital Clinicas Porto Alegre, ...
      o order id: 1234
      o etc
      o Lab Test: *Thyroid test*
          + conclusions
          + method
          + other details...
          + Lab Panel - *Thyroid*
              # *TSH*
                  * value
                  * method [0..1]
                  * comment [0..1]
                  * other detail [0..1]
              # *TS4*
                  * value
                  * method [0..1]
                  * comment [0..1]
                  * other detail [0..1]

If TSH is ordered on its own, we get:

  * Lab report
      o requestor: Dr Silva, Hospital Clinicas Porto Alegre, ...
      o order id: 1234
      o etc
      o Lab Test: *Thyroid test ?? or maybe just TSH?*
          + conclusions
          + method
          + other details...
          + Lab Panel - *TSH* (synthesised, or maybe 'thyroid' can be
            inferred)
              # *TSH*
                  * value
                  * method [0..1]
                  * comment [0..1]
                  * other detail [0..1]


In these structures, the TSH result is always in the same place from the 
point of view of AQL querying.

The bold items /could be /(shoud be?) coded. By LOINC or by SNOMED? If 
no coding is available the generic archetypes used to represent the 
above could be specialised to build typical lab result structures e.g. 
thyroid panel etc. In such archetypes there will be direct archetype 
paths to TSH, TS4 etc, and a TDS will contain tags of these names. The 
LOINC or SNOMED codes can still be included in bindings.

how does this sound?

- thomas



On 13/07/2017 03:46, Heather Leslie wrote:
>
> Hi Thomas,
>
> This might help you: 
> https://openehr.atlassian.net/wiki/spaces/healthmod/pages/91139266/Implementing+Laboratory+Tests+in+openEHR
>
> Heather
>
> *From:*openEHR-clinical 
> [mailto:openehr-clinical-bounces at lists.openehr.org] *On Behalf Of 
> *Thomas Beale
> *Sent:* Thursday, 13 July 2017 1:22 AM
> *To:* For openEHR clinical discussions 
> <openehr-clinical at lists.openehr.org>
> *Subject:* Q: design description of lab archetypes
>
>

-- 
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Team, Intermountain Healthcare 
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation 
<http://www.openehr.org>
Chartered IT Professional Fellow, BCS, British Computer Society 
<http://www.bcs.org/category/6044>
Health IT blog <http://wolandscat.net/> | Culture blog 
<http://wolandsothercat.net/>
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