SV: ECG archetype advice required

Heather Leslie heather.leslie at atomicainformatics.com
Thu Sep 6 05:10:59 EDT 2018


Hi Ian,

FHIR has included {Beats}/min in its limited demo list at https://www.hl7.org/fhir/valueset-ucum-units.html.

/min is in artefacts too.

So the message is a little confusing.

H

From: openEHR-clinical <openehr-clinical-bounces at lists.openehr.org> On Behalf Of Ian McNicoll
Sent: Thursday, 6 September 2018 5:32 PM
To: For openEHR clinical discussions <openehr-clinical at lists.openehr.org>
Cc: For openEHR technical discussions <openehr-technical at lists.openehr.org>
Subject: Re: SV: ECG archetype advice required

I agree with /min. I doubt if the dicom approach has much real world traction. Fhir seems to have picked /min and is much more likely to have majority take up.

Ian

On 6 Sep 2018 at 07:50, <Ivar Yrke<mailto:iyr at dips.no>> wrote:
Give people options and they will end up with variation. It is NOT WRONG to use {H.B.}/minute, nor would it be wrong to use liters{blood}/minute or meters{travelled}/second. It is just unnecessary overkill(!). Adding {H.B.} to a value that is itself a pure dimensionless number only adds value when the magnitude is taken out of context. But out of context the magnitude itself becomes meaningless, whichever meaning you add to the number.

No need to follow the path of Dicom here, converting between the two is trivial.

Vennlig hilsen
Ivar Yrke
Senior systemutvikler
DIPS AS
Telefon +47 75 59 24 06
Mobil +47 90 78 89 33


Fra: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org<mailto:openehr-clinical-bounces at lists.openehr.org>] På vegne av Heather Leslie
Sendt: 6. september 2018 07:44
Til: For openEHR clinical discussions <openehr-clinical at lists.openehr.org<mailto:openehr-clinical at lists.openehr.org>>
Kopi: For openEHR technical discussions <openehr-technical at lists.openehr.org<mailto:openehr-technical at lists.openehr.org>>
Emne: RE: ECG archetype advice required

Hi everyone,

Thanks for the rapid response and clinical/modeller consensus of 3, regarding units of frequency for heart rate as 1/min

I’ve now included the technical list in this thread as I’ve found this reference to a DICOM standard - http://dicom.nema.org/medical/dicom/current/output/html/part16.html#sect_CID_3230 – particularly Table TIC 3713, see below.
Atrial heart rate is a synonym of at0094 ‘PP rate’ in the latest version of the archetype - https://ckm.openehr.org/ckm/#showArchetype_1013.1.276
Ventricular heart rate is a synonym of at0013 ‘RR rate’.
In both examples the units from this Dicom document are {H.B.}/min.

[cid:image001.jpg at 01D44615.57F49010]

Thoughts?

Regards

Heather

From: openEHR-clinical <openehr-clinical-bounces at lists.openehr.org<mailto:openehr-clinical-bounces at lists.openehr.org>> On Behalf Of Marcus Baw
Sent: Wednesday, 5 September 2018 5:50 PM
To: For openEHR clinical discussions <openehr-clinical at lists.openehr.org<mailto:openehr-clinical at lists.openehr.org>>
Subject: Re: ECG archetype advice required

+1

I would echo Ivar's comments - keep it simple and use 1/min. It is clear we are talking about the rate of cardiac electrical activity from the context. The use of the word 'beats' would also undoubtedly (rightly) come under fire from cardiological/intensivist pedants like me - as a 'beat' is an old word deriving from the observation of heart sounds, whereas what you are measuring is cardiac electrical activity - and it's perfectly possible for the two to be different things, as in a PEA cardiac arrest.

Also, any of the more specific units such as '{beats}/min' could possibly confuse and make it harder to programmatically compare or display alongside other clinically relevant 'frequencies' expressed as 1/min such as: frequency of ventricular pacing spikes, frequency of aortic balloon pump counterpulsations, etc

Marcus

On Wed, 5 Sep 2018 at 08:39, Ivar Yrke <iyr at dips.no<mailto:iyr at dips.no>> wrote:
1/min, definitely!

Cardiac output is measured as liters/minute. Liters of what? We could have used the unit liters{blood}/minute, but I have never seen that done. It is considered obvious from the context. Likewise with other units. Velocity is measure as meters/second, not meters{travelled}/second. One could argue that meters{travelled} makes it clear that it is not meters{altitude}, but that is generally considered obvious from the context.

For some reason there is this temptation to add a fictive unit ({beats}, {count} etc.) when the number itself is unit less. This is not necessary. The context is always sufficient, just like in the cases that have a unit. Let us cut through the unclarity of UCUM and keep it simple and basic.

My argument is probably influenced by my background as a physicist. But if no one has objected to 1/min in pulse/heartbeat, then I see no reason to deviate from the basics in ECG or to modify pulse/heartbeat.

Vennlig hilsen
Ivar Yrke
Senior systemutvikler
DIPS AS
Telefon +47 75 59 24 06
Mobil +47 90 78 89 33


Fra: openEHR-clinical [mailto:openehr-clinical-bounces at lists.openehr.org<mailto:openehr-clinical-bounces at lists.openehr.org>] På vegne av Heather Leslie
Sendt: 5. september 2018 08:00
Til: For openEHR clinical discussions <openehr-clinical at lists.openehr.org<mailto:openehr-clinical at lists.openehr.org>>
Emne: ECG archetype advice required

Hi everyone,

I’ve just been facilitating the most recent reviews on the ECG archetype and would appreciate some advice on two issues.

The current atrial and ventricular rates are modelled as a Quantity (frequency) ie 1/min. However UCUM is unclear and there seems to be a few options, including {Beats}/min, {beats}/min and {H.B} is represented in another context, so maybe {H.B}/min is valid as well. Note that if we decide that it is appropriate to modify to one of these specific UCUM units, then to be consistent we will need to consider modifying the Pulse/heartbeat OBSERVATION as well – currently also modelled as a frequency of 1/min.

In addition, I’d appreciate some advice as to how we could get access to the latest draft of the ISO/IEEE standard for ECG – I think it is ISO/IEEE 11073-10406. We’d like to make sure there is alignment between the standard and the archetype before further reviews.

Kind regards

Heather

Dr Heather Leslie
MB BS, FRACGP, FACHI, GAICD
M +61 418 966 670
Skype: heatherleslie
Twitter: @atomicainfo, @clinicalmodels & @omowizard
www.atomicainformatics.com<http://www.atomicainformatics.com>
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(frequ
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