# Comment on openEHR-EHR-CLUSTER.inspection-skin-wound.v1 archetype **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2010-02-04 13:15 UTC **Views:** 3 **Replies:** 7 **URL:** https://discourse.openehr.org/t/comment-on-openehr-ehr-cluster-inspection-skin-wound-v1-archetype/14955 --- ## Post #1 by @Otavio_Silva Dear all, I would like to ask you to consider the inclusion in the "type of wound" of "animal agression". Because this kind of wound has proper features that should be differentiated of all the rest and so incluiding would avoid of making another archetype almost identical to openEHR-EHR-CLUSTER.inspection-skin-wound.v1 just to consider those wounds made by animals... Thanks in advance, Otavio --- ## Post #2 by @ian.mcnicoll Hi Otavio, Thanks for the input. There are a few of us looking at the wound archetypes via Google Wave at [https://wave.google.com/wave/#restored:wave:googlewave.com!w%252BsliTddCQD](https://wave.google.com/wave/#restored:wave:googlewave.com!w%252BsliTddCQD) Your contribution would be very welcome. If you need a Google Wave invitation, just let me know. Ian Dr Ian McNicoll office / fax +44(0)141 560 4657 mobile +44 (0)775 209 7859 skype ianmcnicoll [ian.mcnicoll@oceaninformatics.com](mailto:ian.mcnicoll@oceaninformatics.com) [ian@mcmi.co.uk](mailto:ian@mcmi.co.uk) Clinical Analyst Ocean Informatics openEHR Archetype Editorial Group Member BCS Primary Health Care SG Group [www.phcsg.org](http://www.phcsg.org) / BCS Health Scotland --- ## Post #3 by @Otavio_Silva Dear all, I have not found an archetype of the body parts. Various archetypes could refer to it (like the wounds archetype) and I think it might be an important issue to unify the body part ontologies in order to limit physicians "criativity"... I am just missing it, or I just don't know how to search the repositories? If it just doesn't exist I am volunteer to make it, a quick search in Google sent me to an interesting model, or something to begin with: [http://wwwn.cdc.gov/oiics/Trees/BodyPart.aspx](http://wwwn.cdc.gov/oiics/Trees/BodyPart.aspx) Thanks in advance... Otavio 2010/2/4 Otavio Silva <[otaviocsilva@gmail.com](mailto:otaviocsilva@gmail.com)> --- ## Post #4 by @heather.leslie Hi Otavio, As Ian has already suggested, there is currently some collaborative work being done around wounds and the group is exploring whether Google Wave is a good media to facilitate the discussion. It would be of great value to the community if you (and anyone else with queries, concerns or suggestions) could add any your comments into the Clinical Knowledge Manager directly, so that when the archetype is formally reviewed for publication, your comments can be considered and not lost in the email lists - [www.openEHR.org/knowledge](http://www.openEHR.org/knowledge). When you are viewing the archetype in CKM, the 'Discussion' icon is the eighth from the left - the person with the single speech bubble. You can include any comments here for other registered users to see and join in with as well. If you have identified that there are other attributes missing in the archetype that are required to capture inspection of animal bites, please add them as well. The archetype is a CLUSTER, and designed to be incorporated within the OBSERVATION.exam archetype , although the metadata is probably not clear enough about this and needs to be updated. The Use for OBSERVATION.exam archetype states "Designed as a container for nesting detailed examination-related clusters including the inspection, palpation, auscultation and percussion CLUSTERS and their specialisations". The inspection archetype can then sit alongside a (yet non-existent) palpation of skin/wound archetype within the OBSERVATION to bring together all exam findings. As this is an archetype for inspection of the wound, the intention is to be pure about the type of wound being observed and deliberately not attributing cause eg the types are currently abrasion, laceration, incision, puncture, penetration, gunshot. I can see that gunshot is similar to your suggestion of animal aggression, and its inclusion should be considered carefully during the review process. From memory gunshot was included specifically as it had very specific characteristics, but this will need to be discussed by domain experts more fully during the review process. There may be other attributes that need to be added, including ones to describe more complex wounds as well. Ideally the cause of wound should be captured during the history-taking process, and the inspection archetype should be recording just the observed findings eg a presence of puncture wound, which when considered with history etc the clinician can attribute to a diagnosis of an animal bite. Hope this helps Heather --- ## Post #5 by @Otavio_Silva Hi Heather, What you wrote make a lot of sense\.\.\.    I coudn't get trought the Waves yet, I already told Ian\.\.\. I must be doing something very silly\.\.\. I am in team of Luciana from UFF \(Brazil, RJ\) and we are working on the OSHIP application for openEHR, by now I am aiming to make a decision support engine using pyCLIPS on rabies prophilaxis, where the most important thing is whether the wound is done by an animal and the second is where it was\. So, if I could understand properly, and to be in consonance, I should work in an archetype that specialises the history\-taking process \(a specialisation of openEHR\-EHR\-OBSERVATION\.story\.v1?\), to work on an archetype of bodyparts and suggest that the wounds archetype has a link to some bodyparts archetype\.\.\.    I guess is quite a lot of work to do\.\.\. ;\-\)    Otavio --- ## Post #6 by @heather.leslie Hi Otavio, Some suggestions... My approach would be to build a template (- I'm obviously using the Ocean tools) comprising a COMPOSITION to capture an encounter - I assume this is recording a consultation in primary care or emergency for a patient after an animal bite. You can use SECTION/s if you need them. History: The Story entry is a great start for capturing the history - enables ability to simply record a free text narrative. If you want more detail, I'd consider using the CLUSTER.health_event or its specialisation CLUSTER.health_event-trauma. See if you think either of these will be fit for purpose, or if they need some refining. In principle it would be better to enhance these existing archetypes to record the bite situation but if you find there are a number of specific attributes we could think of specialising for this. I suspect that this will not be neccessary if we think through how to improve the existing ones first. Remember these are all draft at present and this is the kind of use case that will help to improve them prior to publishing. So I would hope that the history and details should be largely captured just using these existing archetypes - let me know how it goes. Examination findings: I'd use the OBSERVATION.exam archetype as the base ENTRY class. In a template it can be renamed to 'Examination of Bite'. There is ability to record a free text narrative again, OR insert detailed examination CLUSTERs into the slot: CLUSTER.inspection-skin-wound, and maybe the generic palpation archetypes. What requirement do you have for examination of the wound? Conclusion: EVALUATION.problem-diagnosis Plan & Follow-up: There are a few possible INSTRUCTIONs already in CKM that might be useful - depends what else you need. Hope this helps. Happy to keep chatting. Suggestions from others are welcome.... ;-) Regards Heather --- ## Post #7 by @Otavio_Silva Hi Heather,    \(And all: it seems that I am finaly "waving"\.\.\.\.\)    First I will introduce myself, a bit late, but never too late: I am in the last year of Medical School and my final monography is about openEHR, I have translated part of the documents to portuguese as part of it\.    A few last things just to make things a bit more clear before I begin the "hard job"\.\.\.    I have read the texts but only by working on it we get the actual knowledge\. I will need a template someday, of course, but I think I have some adjustments to do in the archetypes\. Of course I will tell the comunity \(by the ways you told me\) in order to discuss it\.    You said you use the Ocean tolls\.\.\. But they don't seems to work on Linux\. Is there someone on the list to help with it? I am working in the code\-line: slow and error\-prone\.\.\.    I guess that is it\.\.\. Give one month and I will give a feedback\.    B\.T\.W\.: The most important thing about rabies prophylaxis is where in the body was the wound\.\.\. That is why I felt we are in the need of a body\-parts archetype \(for the SECTION?\) to be used in the wounds and many other archetypes\.\.\. Is there any already done?    Thanks a lot\.\.\.    Otavio --- ## Post #8 by @ian.mcnicoll Hi Otavia, Glad you got Wave going. The Ocean tools are .net only. There are some Java based archetype editors available which I assume will run on Linux. [www.linkehr.com](http://www.linkehr.com) and [http://www.imt.liu.se/mi/ehr/tools/](http://www.imt.liu.se/mi/ehr/tools/) There are no open Template tools available yet, as far as I know, but the direction of travel for the Template object model, should make it relatively easy for archetype editors to add template support. Body parts: You should definitely look at the anatomical location archetype in CKM Link to Archetype: [http://www.openehr.org/knowledge/OKM.html#showArchetype_1013.1.356](http://www.openehr.org/knowledge/OKM.html#showArchetype_1013.1.356) The big problem is to define the terms to be held in the 'Name of location' element. I know you have been looking at at terminology produced by CDC for Occupational health purposes but Snomed is likely to fulfil this role in most circumstances. I would strongly suspect that tere are moves to make the CDC work Snomed aligned. Of course, the archetype itself is terminology neutral and you are free to use the CDC terminology if you wish. A big issue will be the range of granularity required to express body parts, depending on the clinical context. Ian Dr Ian McNicoll office / fax +44(0)141 560 4657 mobile +44 (0)775 209 7859 skype ianmcnicoll [ian.mcnicoll@oceaninformatics.com](mailto:ian.mcnicoll@oceaninformatics.com) [ian@mcmi.co.uk](mailto:ian@mcmi.co.uk) Clinical Analyst Ocean Informatics openEHR Archetype Editorial Group Member BCS Primary Health Care SG Group [www.phcsg.org](http://www.phcsg.org) / BCS Health Scotland --- **Canonical:** https://discourse.openehr.org/t/comment-on-openehr-ehr-cluster-inspection-skin-wound-v1-archetype/14955 **Original content:** https://discourse.openehr.org/t/comment-on-openehr-ehr-cluster-inspection-skin-wound-v1-archetype/14955