design description of lab archetypes

Colin Sutton Colin.Sutton at ctc.usyd.edu.au
Mon Jul 17 11:15:28 EDT 2017


Can I suggest that 'Sample date' (aka 'Collection date') and 'Analysis date' should be explicit in 'etc' and 'other details' respectively?
--
Colin

On 13 Jul 2017, at 2:43 pm, Thomas Beale <thomas.beale at openehr.org<mailto:thomas.beale at openehr.org>> wrote:


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
     *   one or more 'panels', e.g. a GP orders thyroid test, lipids and liver function
     *   one or more separate analytes, e.g. TSH, iron, ...
     *   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]
     *   order meta-data
     *   etc
     *   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
     *   requestor: Dr Silva, Hospital Clinicas Porto Alegre, ...
     *   order id: 1234
     *   etc
     *   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
     *   requestor: Dr Silva, Hospital Clinicas Porto Alegre, ...
     *   order id: 1234
     *   etc
     *   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<http://scanmail.trustwave.com/?c=1688&d=yurn2XvEJAqVqpX6dYS2AbIRW5ZHk0tLczDrnAcFxQ&u=https%3a%2f%2fopenehr%2eatlassian%2enet%2fwiki%2fspaces%2fhealthmod%2fpages%2f91139266%2fImplementing%2bLaboratory%2bTests%2bin%2bopenEHR>

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><mailto:openehr-clinical at lists.openehr.org>
Subject: Q: design description of lab archetypes




--
Thomas Beale
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