Archetypes: Medication order, risks and goals

Dear All

The first instruction (based on the openEHR instruction model proposal) is available at:
  http://www.oceaninformatics.biz/archetypes

It is not complete and needs more work, but has many of the features of a medication order that are required in the health system. This is not a prescription (which is a set of medication orders) - all this information relates to a single order. It deals with the workflow and includes dispensing and administration.

The model describes the activity (details of the medication in this case, and how to administer it) and the work flow steps that might be recorded. It is worth noting that only the name of the medication is mandatory! This deals with existing systems.

Also, the idea of risk assessment has crept into the knowledge domain. The family history archetype is a specialisation of this. It is important to note that just recording that a relative had an MI is possible using the problem or problem-diagnosis archetypes, family history implies evaluation of risk.

There are also goal and target archetypes - the target archetype allows specification of a range of values for a particular patient attribute. A blood pressure goal-target will be blood pressure, systolic <140 mm[Hg], diastolic <90 mm[Hg]. It may not be clear from the target archetype that it enables such statements to be made unambiguosly (but experience will show!).

Finally, exclusions are also there - general statements like "No significant family history" or "No known allergies". Then there are specific exclusions like "No known reaction to" + "penicillin". Exclusions also deal with problems and past history.

I look forward to your comments on the list or to:

archetypes@oceaninformatics.biz

Cheers, Sam

Hi Sam,

As you may know, we have been working for nearly 3 years on "Archetypes" for goals (I don't clearly see the difference you make between a goal and a target).
We already have systems at work in real practice with the process : risk factors -> risk calculation -> goals proposal -> goals follow up

I would be happy to contribute to your work.

Can you first explicit the difference between a goal and a target ?

Cheers,

Philippe

Dear Philippe

Good to hear from you. I have responded to the need to state a goal in textural form as appropriate and to have a time set to achieve this, and one that it was achieved (if it ever was). This is also suitable for patients. This is the Goal archetype.

The target archetype adds the ability to be specific - by recording a range of values (interval) e.g. <140 mm[Hg], to aim for. This can be measured and the computer can determine if it has been achieved.

The targets may be a set of targets over a period of time.

So a goal as data would look (a little) like: