My situation:
Currently, I am designing the template for the medication order in the archetype designer provided by tools.openehr.org.
My problem:
In order to fulfill the given use case, I want to create a cluster named “Flag” that covers the scope and definition as specified by HL7 FHIR for the resource “Flag”. Based on this specification, I intend to map the field “identifier” in the resource Flag onto the created cluster “Flag”. In the cluster Flag, I aim to have this field as “Parsable text”. Unfortunately, I am not able to find this input field as an option in the archetype designer.
To add datatypes that do not have specific button in the toolbar you can use the Available Type field
So typically add a Text element - add Parsable as a datatype and then remove the original text Type - it will now be a Parsable datatype.
However, I don’t think you need a new archetype, or perhaps even the parsable Identifier
We use the Precaution archetype for the ‘alerts list’ in the London UCP and it is a very close match to Flag
What information would you expect to carry in the Identifier element - normally this would not be required in an openEHR system, unless you need to capture an external identifier coming from a source system, in which case you can use the feeder_audit structures provided by the Reference model.
Thank you so much for your answer and your help for how to create a parsable text in archetype designer.
As well as your insight on the archetype “Precaution”. Unfortunately, I haven’t thought of that. After reading the definition of the archetype “Precaution”, I realized, that I also want to create warnings that are independent of a condition or a state of the individual as well as current treatments/procedures such as
A particular provider is unavailable for referrals over a given period (subject = Practitioner, FHIR R5)
Special guidance or caveats to know when following a protocol (subject=PlanDefinition, FHIR R5)
Warnings about using a drug in a formulary requires special approval (subject=Medication, FHIR R5)
Patient currently undergoing quarantine due to whatever infection
Some examples are drawn for the definition of Flag in FHIR R5 (marked as such), but are examples, that we also require in our data model. Consequently, I wanted to ask you
Are the archetype “Precaution” in openEHR and the resource “Flag” in FHIR R5 the same?
Overall, my model definition of a Flag in archetype designer overlaps quite well with Precaution, such that I can use it.
A particular provider is unavailable for referrals over a given period (subject = Practitioner, FHIR R5)
This needs to be in some sort of resource, either associated with the practitioner or practitioner role , not in the openEHR patient record, so not in scope for the CDR
Special guidance or caveats to know when following a protocol (subject=PlanDefinition, FHIR R5)
I think that belongs in the protocol which is probably not part of the patient record - so not in the CDR at all.
Warnings about using a drug in a formulary requires special approval (subject=Medication, FHIR R5)
I would expect that to be carried in some sort of definitional resource external to the CDR e.g a drug reference terminology or formulary document i.e. not in the patient record. The record of approval could be carried in the patient record e.g. Cluster Archetype: Medication authorisation [openEHR Clinical Knowledge Manager] → Prescriber endorsement
Patient currently undergoing quarantine due to whatever infection
That is be a good use case for a openEHR Precaution though officially it is designed for ‘Therapeutic precautions’, however I know it is being used in e.g. London for wider Alerts exactly as you are suggesting.
I wanted to provide an update to the archetype Precaution, which is very similar to the FHIR R5 resource Flag, and what we decided to model for the use case medication administration and others.
The archetype Precaution is of type EVALUATION and this caused an issue for us, when we wanted to model “Flags” onto specific drugs. The CLUSTER Medication details provides the slot Structured details, where I would have included the archetype Precaution. But in the Archetype Designer it only allows CLUSTERs and not EVALUATIONs - by design. Consequently, we modeled a new cluster named Flag - very original - which actually is an almost identical copy of the FHIR R5 resource Flag, but with one exception: It includes the attribute Cohort to allow users to specify additional information on the flag, such as in a quarantine or trial, which has been explicitly stated as a requirement by our product manager.
To sum up, the Precaution might have a new cousin named Flag. Both are very similar, but Flag is more versatile and goes along well with the CLUSTER Medication details. The archetype has been proposed as archetype in CKM on August 06, 2024, 17:00.
We have actually done some work with Karolinska on a cluster to plug into Medication to support Clinical trials.
I would not bundle quarantine together with trial information. As the requirements for each expands, you will find that you are mixing up very different concepts.
Sorry -I can’t point you at the AD repo right now as there is an issue.
Can you give an example of what is meant by ‘Quarantine’ in this context?
Thanks for your clarification. Flag shall not replace the use case you mentioned. It specifically covers the use case as defined by HL7 FHIR for the resource flag. A flag has a well-defined purpose, namely to rub information - deemed as important - under the nose of the actual user, and the system shall enforce this behavior when encountered.
A cluster is versatile enough, to associate such information at the level of the data structure, where it belongs. This is not possible with the archetype Precaution.
A flag is furthermore not bound to study trials and shall not support clinical trials as you stated above. A flag is by definition a mixing endeavor, as what is deemed a warning or notification is also heavily reliant on the requirements by the healthcare facility. Finally, it fulfills the scope and usage as defined by HL7 FHIR Release 5 for Flag, which explicitly states the scope and usage including “a patient who is enrolled in a clinical trial (subject = Group)” (external link) . And we need this flag in production, especially when we share information with other departments using FHIR.
Why I mentioned quarantine and study trials in this thread, is because, this initiated the postulation of this modeling and conclusion. Flag will be expanded to fulfill the scope and usage as defined by HL7 along the modeling of further use cases.
- which actually is an almost identical copy of the FHIR R5 resource Flag, but with one exception: It includes the attribute Cohort to allow users to specify additional information on the flag, such as in a quarantine or trial, which has been explicitly stated as a requirement by our product manager.