If you are recording an event - perhaps a procedure - and you have complications to record, are these problem/diagnoses? the existing archetypes simply have complications : text (maybe coded). But aren’t these problems, just problems that may only have existed in the context of an event?
So you could actually use problem/diagnosis?
Grahame
That depends on clinical judgment in each case.
Karsten
Hi All
It would be good to include Heather here who has been working on operation
notes. I would have thought that complications within the procedure would
potentially be useful.
Cheers, Sam
Hi Sam
Procedure does have complications, but it’s a simple text / codeableText.
We’d rather use Problem/Diagnosis. So the real question is, does the definition
of Problem/Diagnosis exclude it’s use for for complications of a specific event.
Grahame
Grahame,
have a look at openEHR-EHR-ITEM_TREE.medication.v1 and the element Indication (at0011). It can either be a codable text or a URI. Brings a set of other issues concerning querying, but it gives the expressivity you ask for.
Regards,
Daniel
Hi Grahame,
The Complications data element is a DV_Text. So it can capture narrative text. It also has a 0..* Links available as a RM attribute, and so it could be used to Link to a formal recording of a Problem or Diagnosis using the specific Problem/Diagnosis archetype, such that it could be added to a Problem List etc if the clinician thought it warranted it.
From CKM, Link attributes: “A Link may be made between any two nodes in an EHR. Multiple links can be made and the meaning and type of link defined for each. For example, Links can be used to to associate elements of a Care Plan; to link a supporting Observation to a Diagnosis; or to link a Procedure and the Diagnosis recording a complication.
PDF UML
Heather
Hi Grahame,
The Complications data element is a DV_Text. So it can capture narrative text. It also has a 0..* Links available as a RM attribute, and so it could be used to Link to a formal recording of a Problem or Diagnosis using the specific Problem/Diagnosis archetype, such that it could be added to a Problem List etc if the clinician thought it warranted it.
From CKM, Link attributes: “A Link may be made between any two nodes in an EHR. Multiple links can be made and the meaning and type of link defined for each. For example, Links can be used to to associate elements of a Care Plan; to link a supporting Observation to a Diagnosis; or to link a Procedure and the Diagnosis recording a complication.
PDF UML
Heather
Hi Grahame,
The Complications data element is a DV_Text. So it can capture narrative text. It also has a 0..* Links available as a RM attribute, and so it could be used to Link to a formal recording of a Problem or Diagnosis using the specific Problem/Diagnosis archetype, such that it could be added to a Problem List etc if the clinician thought it warranted it.
From CKM, Link attributes: “A Link may be made between any two nodes in an EHR. Multiple links can be made and the meaning and type of link defined for each. For example, Links can be used to to associate elements of a Care Plan; to link a supporting Observation to a Diagnosis; or to link a Procedure and the Diagnosis recording a complication.
PDF UML
Heather
Ian replied much inline with my views. If it is a serious complication, such as pneumonia, it will have its own diagnosis as well, which may even contain a following aetiology statement to point back.
I would not directly embed the notion of a diagnosis in a procedure.
Cheers Sam
Dr Sam Heard
FRACGP, MRCGP, DRCOG, FACHI
Chairman, Ocean Informatics
Chairman, openEHR Foundation
Chairman, NTGPE
+61417838808
I think that many scenarios are possible.
Complications can occur at the time of procedure, can become apparent at a distant time and place, or occur at same place and within the same system at a later time.
In a complete EHR system there are a number of options. But it is the exchange scenario that is trickier.
I think there is probably some advantage in recording something explicit about Complication within the Procedure archetype that will point to the Problem/Diagnosis for details. And similarly if the Problem/Diagnosis is entered first, subsequently pointing to a Procedure ACTION as causal will be valuable. The link both ways are useful. But if procedure does not have any notion of complication within it and is separated from the rest of the EHR in a report or message or research aggregation, there is no indication to anyone receiving the data that something untoward may have happened.
Heather
hi
The principle concern I had was definitional - did the definition of problem preclude it’s use for complications of an event. There’s a notion of ongoing-ness hinted at in the definition, but nothing explicit. And there’s the question about whether (or which) complications of an event have ongoing implications or not.
Clearly there’s no definitional issue, and so I’m fine with that. Regarding the other discussion - since complications can indeed be real ongoing concerns, I think it would be good for complications to be actually problems, and explicitly, not using a reference model link. Though there might still be a use for pure complications, which might be more procedural in nature?
Grahame
Complications can be anything from a minor bruise to catastrophic effects and death.
Minor things like a bruise won’t need to be recorded anywhere else in the record.
Complications that are ongoing and are creating issues that warrant being included in the Problem List should be recorded explicitly in a Problem/Diagnosis archetype.
Some may be considered an adverse reaction eg to administration of a substance and need to be recorded using the Adverse Reaction archetype
There may be some that are also considered to be an adverse event and need to be recorded explicitly in an archetype for that purpose ie as a result of errors in clinical practice etc.
I don’t see that a complication is a candidate for an archetype in its own right, in the same way of any of these mentioned above.
Cheers
Heather