Setting thresholds

Sam Heard sam.heard at oceaninformatics.com
Thu Mar 1 16:47:40 EST 2018


HI All

Goals and targets are an example of ranges as data. The INR treatment range is a very common data set that the clinician populates as it is dependent on the history and other considerations.

Cheers, Sam

 

From: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org] On Behalf Of Jussara macedo
Sent: Wednesday, 28 February 2018 11:49 PM
To: For openEHR clinical discussions <openehr-clinical at lists.openehr.org>
Subject: Fwd: Setting thresholds

 

I think the functionality seeked here is a threshold to trigger some action, like an alert. The given example was BP, and as an observation archetype it only records the blood pressure, using  constraints to set up only the valid values, which are 0 to maybe up 300.

The ranges are additional information that you can put to help the clinician’s evaluation, but only rules can make the computer take some action.

That is what I meant

Jussara 

 

--------- Mensagem encaminhada ---------
De: Thomas Beale <thomas.beale at openehr.org <mailto:thomas.beale at openehr.org> >
Data: qua, 28 de fev de 2018 às 10:19
Assunto: Re: Setting thresholds
Para: <openehr-technical at lists.openehr.org <mailto:openehr-technical at lists.openehr.org> >, For openEHR clinical discussions <openehr-clinical at lists.openehr.org <mailto:openehr-clinical at lists.openehr.org> >

 

Although Jussara is right in terms of reference ranges generally, i.e. what you see in a pathology handbook as ref ranges for male / female / child for say Total Cholesterol or some other analyte, the openEHR Reference Model does allow reference ranges to be carried in DV_QUANTITY (see here on the UML site  <https://www.openehr.org/releases/trunk/UML/#Diagrams___18_1_83e026d_1433773263789_448306_5573> - DV_ORDERED.normal_range and other_reference_ranges). We do this for the same reasons Karsten explicates below.

The idea is that the normal range (and other ranges) specific to the patient type for the current test order (sex, age, sometimes 'race', e.g. African American cholesterol normal range is +10%) can be written into the data. So, say the patient is a 64 yo female caucasian, and the analyte is 'total cholesterol'. The ref range will be (something like):

*	normal range: 159-276 mg/dL or in SI, 4.12-7.15 mmol/L

that is just one row from a table of normal ranges keyed by sex, age and with the modifier for African Americans (I have a US path manual, probably it is just 'African' elsewhere).

The reference range data is often influenced by other factors depending on what it is, e.g. location, diet, and so on.

The point is, that the path lab can help the doc by including the relevant normal range with the measured value, and therefore also generate an 'abnormal' indicator in the result. This is a significant time-saver for doctors, and it also has the effect of writing into the EHR the reference range that was actually used to decide that the patient was abnormal for that analyte and to intervene - i.e. it's the reference knowledge for the assessment.

- thomas

 

On 28/02/2018 12:43, Karsten Hilbert wrote:

On Wed, Feb 28, 2018 at 12:18:24PM +0000, Jussara Macedo Rötzsch wrote:
 

Ranges  aren’t actually part   of the Information model, they are rules for
decision support, and therefore belong to the Application level, like a gdl
based CDS

In practice there are still needs to store ranges (with the data):
 
1) path labs will attach ranges to recommended interpretations
 
  those are best stored "with" the result(-interpretation)
 
  and, no, it is not sufficient to attach them to the test
  *type* of a measurement
 
2) ranges applied by a clinician upon which a conclusion
   has been made
 
  those will often end up as textual part of a SOAP note
 
Think of a patient with warfarin monitoring: The lab will cry
foul (if not properly informed) but the clinician is happy
when the INR is in the therapeutic range.
 
GNUmed "solves" that by allowing to attach both a "nominal"
and a "desired" range to each test result.
 
For what that's worth.
 
Karsten

 

-- 
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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Jussara Rötzsch Sent from Gmail Mobile

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