This became a very rich and interesting conversation, it is being very good to be learning so much with you all.
So EVALUATIONS are NOT limited to opinions or assessments, although that is a common misunderstanding.
I have to disagree, the paper “An Ontology-based Model of Clinical Information” says:
“In summary, the Opinion category is distinguished from the Observation category by representing inferences from evidence, rather than representing the evidence. Two investigators can form different interpretations of the same set of observations, but the observations themselves remain an objective picture of some aspect of the patient’s situation, within the limits of the observational method itself. Similarly, two investigators can formulate different goals and plans based on the same observations, and even the same diagnosis.”
And the Information Model document (p57-58), which is based on the paper “An Ontology-based Model of Clinical Information”, states:
“The name Evaluation has been present in openEHR for some years, and is retained for reasons of continuity.”
– The first in which we record now or at a specific point in time or averages usage over an identified period of time, and which is best represented in an OBSERVATION so that repeated and comparable records can be made over time – effectively a concrete smoking diary of actual smoking activity, whether now, on a certain day, or an actual average over the past 10 years.
– Secondly the data that fits more with an EVALUATION – for example, data that we will only ever need to record once and should be persisted, such as ‘Date commenced tobacco use’, or that we want recorded in one place only and choose to update over time with versioning of COMPOSITIONS, such as cumulative consumption in pack years etc.
I now understand your concerns about the separation of models, but an Observation CAN be data that we will only ever need to record once and should be persisted, such as mentioned in the Information Model document, for instance Family History includes “actual events / conditions in family members are recorded as Observations (e.g. father died of MI at 62)”. Also, as Heather wisely said in her paper openEHR - the World’s Record: “The archetypes contain a maximum data set about each clinical concept”.
I would have to disagree here - while a summary is not an assessment like diagnosis, it is an opinion, or ‘evaluation’ by the health professional in the sense of what he/she chooses to include as a summary of the patient situation, as understood by the current professional, for consumption by other professionals so that further care can continue. It is not an observation of anything on/from the patient - it is a creation from the mind of the professional based on previous observations, documenting what he thinks is important or otherwise for ongoing care. There is no primary ‘observation’ activity going on here.
I wasn´t thinking this way, but from this point of view, now I totally agree with you in the sense that the health professional can chooses what to include as a summary of the patient situation, so each health professional can develop a summary with different items.
But the problem is that data to be included in the Evaluation summary can not be chosen from an Observation and serve as substratum by the health professional. The data is already defined within the archetype and some of them aren’t within Observation (e.g. Tobacco use - Date commenced). Also, most of Evaluation summaries have no space to record different interpretations of the same set of Observations. Can it still be considered an Evaluation summary?
I agree with Ian’s solution of merging the archetypes into a single Observation archetype, to be used for different scenarios with slightly different templating.
In my opinion the relevance to correctly describe the classes goes beyond the query. It begins when someone decides to choose the archetypes to be used in an EHR. It may generate mistakes and lead to error and disillusions.
Cheers