Archetypes for "Body fluid or substance" and "Bodily output"

Clinical (archive)
1

Hi!

We’re slowly getting into translating a small set of archetypes into Norwegian, and we’re a bit confused about some properties from the archetypes Body fluid or substance and Bodily output. Bodily output is described as “Recording of findings and measurement (or estimation) of bodily output such as fluid output and defaecation.”, and Body fluid or substance as “Details of the findings relating to a bodily fluid, secretion or substance.”.

In relation to these, we’re wondering why the parameters relating to measured quantity are in the archetype describing the fluid itself, instead of the archetype describing the measurement.

We would be very happy if someone would explain the rationale behind this! J

2

Hi!

We’re slowly getting into translating a small set of archetypes into Norwegian, and we’re a bit confused about some properties from the archetypes Body fluid or substance and Bodily output. Bodily output is described as “Recording of findings and measurement (or estimation) of bodily output such as fluid output and defaecation.”, and Body fluid or substance as “Details of the findings relating to a bodily fluid, secretion or substance.”.

In relation to these, we’re wondering why the parameters relating to measured quantity are in the archetype describing the fluid itself, instead of the archetype describing the measurement.

We would be very happy if someone would explain the rationale behind this! J

3

Hi Silje,

It may be that the descriptions need to be improved a little (or a lot!).

As Hugh suggests, the cluster archetype for fluid has been designed for re-use in multiple situations – which will be commonly in nursing fluid output charts etc, but potentially other places as well, eg describing the base of a weeping wound, hence modelling the quantity attributes within the cluster itself.

The intent of the OBSERVATION.bodily_output, as I understand it, is to support the recording of fluid loss within a nursing chart context and in practice the CLUSTER.fluid archetype is intended to be nested within this ENTRY every single time. We hope that the tooling will one day enable embedding of clusters where the intent is for them to be present in a slot 100% of the time, but that is not yet possible. In the meantime the metadata should definitely be enhanced to explain this further.

Ian modelled these specifically for recent use in a nursing system implementation. He reconfigured the CLUSTER significantly and we discussed it ‘robustly’ for some time to get them to this point. However as Hugh also suggested, that doesn’t mean they won’t be significantly improved with broader clinical input. Until there is a content review round for these archetypes, please record any comments in the discussion section of CKM:

· OBS.bodily_output: http://www.openehr.org/knowledge/OKM.html#showArchetype_1013.1.695_COMMENTS

· CLUSTER.fluid: http://www.openehr.org/knowledge/OKM.html#showArchetype_1013.1.23_COMMENTS

I hope that clarifies the intent and anticipated use… Ian (as author) will hopefully be able to comment when he returns from holiday.

Regards

Heather

4

Hi Silje,

Good to hear from you. Heather and Hugh are pretty well spot on with
their replies. I had to do a fair bit of re-thinking of the existing
archetypes to make them work across a range of contexts in a
paediatric hospital. Bodily output/fluid output turns out to be quite
tricky to model because of some overlapping requirements.

1. Record fluid output quantities within the context of a fluid chart,
possibly with some description or other comment on the fluid.
2. Record details of fluids e.g wound exudate, sweat, urine outside
the context of a fluid chart, but possible requiring the quantity to
be recorded.
3. In some (but not all) circumstances the quantities recorded in (2)
will be included or copied to (1).
4. Faeces is a little tricky since it can be both solid and fluid

Working from the existing CKM archetypes as Heather and Hugh have
described I now have

openEHR-EHR-OBSERVATION.fluid_output.v1
specialised to

openEHR-EHR-OBSERVATION.fluid_output-urine.v1
openEHR-EHR-OBSERVATION.fluid_output-faeces.v1
openEHR-EHR-OBSERVATION.fluid_output-vomiting.v1

and

openEHR-EHR-CLUSTER.bodily_substance.v1
specialised to

openEHR-EHR-CLUSTER.bodily_substance-faeces.v1
openEHR-EHR-CLUSTER.bodily_substance-sputum.v1
openEHR-EHR-CLUSTER.bodily_substance-sweat.v1
openEHR-EHR-CLUSTER.bodily_substance-urine.v1
openEHR-EHR-CLUSTER.bodily_substance-vomit.v1

the idea being that these cluster archetypes can be used in the non
Fluid_output context e.g. details of sputum in an aspirate. Heather
and I are scheduled to spend a little time kicking these into shape
for CKM, then get them up for review, when they will supercede the
CLUSTER.fluid.v1 archetype. They are very close to this archetype in
content and structure.

Similarly the OBSERVATION.fluid_output.v1 archetypes are pretty close
to the current bodily_output series.

I can easily send these new archetypes over to you (or anyone else)
who is interested but bear in mind that ANY draft archetypes are
subject to change and therefore my mess up your translations. I would
certainly be very interested to know if/how they meet your local
requirements. They are working well in the hospital application to
date but we are only now implementing the Fluid charting so some
changes may ensue.

Regards,

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

5

I should have added that the new OBSERVATIONS should replace the
current OBSERVATION.faeces.v1 and OBSERVATION.urine_output.v1
archetypes

Ian

Dr Ian McNicoll
office +44 (0)1536 414 994
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com

Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org

6

Hi Ian,

Thanks to Heather and Hugh for explaining the thinking behind these archetypes. Ian, we would be very interested in having a look at the new drafts you’ve made! We’re still just starting up, and it would be great to get major changes like this in early in the process.