SV: A clinical modelling conversation...

Vebjørn Arntzen varntzen at ous-hf.no
Mon Aug 20 06:39:09 EDT 2018


(I tried to respond the following Friday, but it seems not to have been sent/distributed to the list. If it actually happened, I apologize for the double up…)

Hi

Regarding

A set of generic patterns:
There is for example a generic CLUSTER to be used for examinations: https://ckm.openehr.org/ckm/#showArchetype_1013.1.2017
In the international CKM there is also a variety of other ENTRY archetypes to be inspired by. I strongly believe there is a lot of other good archetypes out there, but have never been uploaded to the int'nat CKM. That's a pity.

Guicance/Handbook:
I had an idea (with my colleague Hallvard Lærum) to write the book "The Ultimate And Final Guidance To Make Perfect Archetypes – The Draft". ☺ Unfortunately, that's not possible. The variety of concepts are far to broad, and the knowledge is ever expanding. But it's a good idea to make a basic guidance – available online. Who will finance this? I'm sure we can make it.

On the other hand, there has been training courses in Norway, UK and Germany during the last years, and they could (and should?) be available as streaming online. Again: Who will finance and do this?

Online official certification courses could also be available online, preferably through openEHR Foundation. Any money for this anywhere?

Today, there is both this clinical list available for asking questions. Could be used more pinpointed to concrete archetype design questions.
Also there is a Slack channel, where modelers can post questions and discuss design issues.

In my experience, making good archetypes is nothing that can be done in solitude. You need input from the community, and deep knowledge of existing archetypes to be able to make reasonable new ones. I'm afraid of leaving too much to local medical professionals.


Vebjørn Arntzen


Fra: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] På vegne av GF
Sendt: 17. august 2018 10:38
Til: For openEHR clinical discussions
Emne: Re: A clinical modelling conversation...

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<mailto: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<mailto: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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