A clinical modelling conversation...

GF gfrer at luna.nl
Fri Aug 17 04:37:54 EDT 2018


Hi,

Imho the grass-roots editors need to (as you write)
- A set of generic patterns to start with. Patterns for any: Observation, Evaluation, Order, Action, for use in documentation of Medical aspects  and Administrative aspects about the Patient System.
Including generic concepts like (Diff) Diagnosis Lists, Episodes, (Family, Social, …) History, Problem List, Orderlist, ActionList, …
- Guidance, handbook, on how to use the patterns
- Model one set of coherent archetypes dealing with a clinical domain/speciality (such as: medication, physical exam eyes, ENS, breast exam, clinical pathway, …)

The generic Patterns need to be created, maintained by IT-modelling experts.
The medical professions need to model and maintain the Archetype packages.
Local healthcare providers will create Templates to be used in their context.


Gerard   Freriks
+31 620347088
  gfrer at luna.nl

Kattensingel  20
2801 CA Gouda
the Netherlands

> On 16 Aug 2018, at 13:41, Thomas Beale <thomas.beale at openehr.org> wrote:
> 
> A few thoughts come to mind:
> 
> sets of archetypes could potentially be developed closer to completion by the grass-roots level, before submission to CKM, which would reduce editorial time, if better guidelines on development rules, patterns, etc i.e. the fabled handbook existed
> consider a set such as for ante-natal care + birth + post-natal (6 weeks) - there might be 50 archetypes implicated here, with (we hope) at least half being generic (e.g. lab tests used in pregnancy are mostly not unique to pregnancy) - there is a lot of work here.
> It might be a better approach if development teams were to try to develop whole packages to a reasonable level, rather than just submitting single archetypes and wait for results of review
> whole package generally would be based on some process, care pathway etc, not just a data-oriented view. E.g. pregnancy; chemo+ monitoring; etc
> if the fabled handbook of patterns and criteria for good archetypes existed, more editors could be trained.


> is there any reason not to have just more people on the editorial group, e.g. 10?
> is it time to agree a set of major clinical sub-specialties (< 20) and designate an owner for each one (i.e. an editor; some editors could own more than one area)?
> we possibly need to distinguish two layers of archetypes, which would potentially change how editorial work is done:

Level three is the Template level for the local context.
> generic all-of-medicine archetypes:
> vital signs
> many signs and symptoms
> a reasonable number of labs
> general purpose assessment / evaluations, i.e. Dx, problem description etc, many things like lifestyle, substance use
> ?all of the persistent managed list types: medications, allergies, problem list, family history, social situation, consents, etc
> the specialties, for each:
> specific signs and symptoms
> specific physical exam
> specific labs
> specific plans
> more than one relationship between specialty archetypes and generic ones is possible, e.g. some are just new; some are formal specialisations in the ADL sense.
> My guess is there is a number of issues to consider. Whether any of the above are the main ones I don't know.
> 
> - thomas
> 
> 
> 

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