Aids and equipment

Hi all,

We have a use case where we need to record whether a person has any aids or equipment in the context of an urgent care plan. There are two data points: a question with a Yes/No/Don’t know answer and a free text box for additional details. I think the equipment recorded here would be mainly mobility or manual handling aids but could cover other types as well, e.g. communication aids. These regularly come up in other anticipatory care planning documents too.

I’ve looked at the description of the Medical device archetype and, while it is quite broad, it doesn’t feel like the right fit for these types of equipment. A medical device is described as “An instrument, apparatus, implant, material or similar, used in the provision of healthcare”, but how should we model aids and equipment that are used in the provision of social care? They obviously overlap so it’s quite a grey area.

So my question is, how do others handle information about aids and equipment (such as walking and transfer aids, eating/drinking aids, communication aids etc) at the moment? Has anyone worked on a specific archetype for aids/equipment or interested in collaborating on it together?

Thanks,
Heidi

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Hi Heidi! I think this sentence is key; to me you’re describing a questionnaire here. The Medical device CLUSTER archetype describes a device, and can be used in any context where you need identification and/or details about a device. If I understand your requirement correctly, you have a question about whether an individual has either any aid or device, or a specific aid/device, fitted or otherwise in use. To me this sounds like it fits nicely with the screening questionnaire family of archetypes, which can be found here: Clinical Knowledge Manager

I think this may require another archetype within this family, for usage of devices. Conceivable use cases could be hearing aids, implants such as venous access ports or pacemakers, walking aids, etc etc.

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Hi Silje, thanks for your reply :slight_smile:

Yes you’re right, this use case is about that high-level information about any aid/device so it is a type of screening. I should’ve mentioned that we were looking at using the Medical device summary EVAL archetype (not the Medical device CLUSTER) but it doesn’t really seem like a great fit. A screening questionnaire for usage of devices as you suggest would work better here.

Thinking ahead, if we had a use case where we needed to handle more structured information about a particular aid/piece of equipment (such as a walking frame or an ACC device) - would it be correct to use the Medical device CLUSTER? Or are these types of aids/equipment conceptually different?

In this same use case we also have questions about whether the person receives any help with personal or domestic care, and whether they receive any support from family members - is there a screening (or any other) archetype that could be used for those kind of questions?

I was initially thinking about creating a new archetype based on the Help from others ZIB model: HelpFromOthers-v3.01(2020EN) - Zorginformatiebouwstenen but it’s part of the social context/support network/responsibilities territory so it would be good to have a wider discussion about it if anyone is interested? :slight_smile:

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Yes, I think so. The way I’m thinking about this you would use the Medical device CLUSTER within the screening questionnaire (if the data was “throwaway” questionnaire info only), OR the EVALUATION Medical device (if the data was to be part of a record of devices for further reuse).

There is a Social context screening questionnaire archetype. Currently it’s focused on problems, but I suppose it could be used for interventions too? What do you think, @heather.leslie ?

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Thanks for helping tease this out. Good discussion.

Although the immediate need is as part of an Urgent Care plan, the wider intent is that ‘Equipment’ is recorded ‘once’ in a persistent composition and available for many other condition or circumstance-specific care plans and situations.

So although there is present/absent type questionnaire feel, we would hope that this record can be a maintained over time as a single high-level source of truth, so in that sense maybe has more similarity with the Evaluation Medical device, in future intent.

This is definitely not in the realms of a detailed Equipment service management (ordered, supplied, removed) kind of space nor a specific detailed mobility assessment. Just a high -level view that can be shared across a number of contexts.

A key question is whether ‘Equipment’ is fundamentally different from Medical device, or can we extend the scope of the existing ‘Device archetypes’ and if so is this just a change of the metadata use, or do we need something to indicate Category i.e. Medical device vs Equipment vs. ?? , or if that distinction does need to be made locally, whether just to rename in the template.

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For that purpose, I’d use a screening questionnaire archetype to represent the yes/no/unknown question/answer, and whenever a ‘yes’ appears add in an EVALUATION to represent the positive presence. Does that make sense?

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Agreed.

Agreed

This is the deliberately broad intent of the Device summary - hearing aids, glasses, walking frames, implants, hip replacements etc.

I think the original intent was to be as broad as possible.

The name of the device would ideally be coded, which would imply a category. I would think that the recording context in the health record would also be helpful. Do you have a use case where the category of Device vs Equipment needs to be recorded in data?

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We’re also in need of a persistent list of devices aan individual depends on. We’re thinking of recording them as actions ”use a hearing aid!” Instruction archetype with the device cluster in an episodic COMPOSITION.care_plan. Then filter or query the care plan if you want only the list of devices prescribed. But an evaluation in a persistent list of “aids and implants” similar to problem and interventions lists might be even better.
We also want to use it for a doctor to be able to query for a list of with which of the organisations devices (wheelchairs etc) are with which of her patients.

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Actions do make sense if you want to (and are able to) ‘track’ the use of a particular device or equipment by an individual, but it is really quite difficult to achieve safely and reliably, especially for something like a hip implant. There is certainly a case for ‘tracking’ but I think we will always need the backup of a somewhat curated list.

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I’ve uploaded a new draft archetype Device screening questionnaire.

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Thank you all for your comments and @siljelb for making the Device screening archetype! That will work well for for the high level question in our use case. We also need a free text field for additional information about the aids/equipment so would it be possible to add an overall Description or Comment field to the screening archetype? There is a Comment field inside the Specific device cluster but presumably it’s not to be used for overall comments.

It would be great if the scope of the Social context screening archetype could be extended to cover support arrangements/interventions as you mentioned @siljelb. Similarly to above, would it be possible to add an overall Description/Comment field?

Thank you for clarifying the scope of the Medical device archetypes @siljelb and @heather.leslie - it does make life easier if we can use the the same models for all devices and equipment. I wasn’t sure about their use because of some of the descriptions - e.g. Medical device summary is described as “An ongoing and persistent overview about medical devices that have been fitted or implanted.”

I’ve done some reading and found this quite a helpful explanation about medical devices vs. aids for daily living: What is a Medical Device ( Deffinition) which states that:

“The phrase ‘assistive technology’ is often used to describe products or systems that support and assist individuals with disabilities, restricted mobility or other impairments to perform functions that might otherwise be difficult or impossible. An assistive technology product can be classed either as a medical device, which needs a CE mark and is regulated by the applicable legislation or it can be an ‘aid for daily living’. It depends on the claims made by the manufacturer.”

It also gives the following as examples of aids for daily living which are not medical devices:

  • bariatric chairs and stools
  • bath with easy access door
  • chair riser
  • grab rails (at doorways, stairs, beds etc.)
  • personal alarm systems (including fall alarms)
  • portable ramps, wheelchair vehicle restraints
  • rise and recline chairs
  • shower chair
  • special water taps
  • stair lifts
  • toilet equipment (toilets seats, shower seats, commodes)

So I’m wondering whether the names and descriptions of the Medical device archetypes should be more inclusive if their intention is to cover all aids and equipment, including the examples above?

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Agreed. And they can live side by side. With implementers can build a client where changes to one trigger an interaction to the user to update the other.

These feel like very different concepts: social problems vs informal care. So I struggle to see how they fit in one archetype. Could you help me understand, since both CKAs see this as a good fit? Interventions is a confusing word to me in this context, I’m worried it gets misused for recording surgeries and medications etc.

Re the zib model:
There’s an interesting modelling choice to separate out professional care from informal care. in apperta ckm there’s a ADMIN_ENTRY.careteam_CC based on a FHIR model, that’s integrated the two.
My view on the subject is there is no conceptual difference between formal and informal care. So the archetypes should be integrated/aligned.
For our work on care plans we also have a requirement who is involved and in what role in the execution of the plan, this is currently a custom archetype that syncs a subset of a care team from our non openEHR demographics solution.

The archetype’s concept is about social context, and my comment about being focussed on problems was referring to examples and such. The ‘Use’ section specifically mentions both issues and social support, but I think this should be clarified.

Also, remember that this is just the screening questionnaire type of archetype which is intended to be quite loose, not the positive presence type of archetype. A parallell would be the Condition screening questionnaire vs Problem/diagnosis.

“Interventions” was just the first word that popped into my head. I’m happy to use something else that fits better. :smile:

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Thank you for elaborating Silje, maybe I need to see a draft of what the archetype would look like to help me understand(a)

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It’s here: Clinical Knowledge Manager

That archetype (and the related components) are basically a clone of the FHIR Care Team resource with a minor addition of ‘other comments’.

We have encountered both patterns as you described - mixing formal and informal carers, or separating them , and I would say that, whatever becomes the official CKM archetype, that it should support both patterns interchangeably, which may well be the case already, just by cloning and templating.

Here is an example of the split pattern - exactly the same archetypes, just templated differently.

https://tools.openehr.org/designer/#/viewer/shared/Pz9zaGFyZWRJZD0xJGFlODFkZDkxZDNkNDQxMDVhNzkwMmQ0NDBlYjNmMGQx

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Just had a look, but I didn’t see anything related to ‘aids/interventions/help from others’ yet, right?

Nothing specific, no. I think the same elements as for issues should be usable though.