Considerations on the Obstetric Summary archetype

Hi everyone,

For the past two weeks we’ve been reviewing the ‘Obstetric summary’ archetypes. Not only the content, but also the concepts and even the name.

We removed some data points and added others. You can see the draft result in this link:

https://ckm.openehr.org/ckm/archetypes/1013.1.4258

The purpose of this archetype is to record summary or persistent information about the obstetric history of a woman, including an overview of all pregnancies and the associated outcomes or interventions.

We agreed that the actual name is more appropriate for a template, with all the real obstetric summary (including the previous diseases).

The idea of this topic is to give it a better name, more adequate for the purpose of the obstetric “summary figures” (numbers of gestation, numbers of parity and so on) and history of the previous pregnancy.

Some suggestions?

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To expand a bit on the issue with the current name: The archetype is technically a subset of what an obstetrician would expect to find in a full obstetric summary, and will be supplemented by other archetypes for the complete data set. For this reason the name “Obstetric summary” leads obstetricians to believe the contents are more expansive than they currently are.

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You actually mention a possible name in your description:

“Obstetric history”

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We considered that name, but it’s not a history. A history would among other things include summaries of each previous (and current) pregnancy (EVALUATION.pregnancy_summary). This archetype is basically listing the number of different obstetrics related events.

How about “Obstetric statistics” or “Obstetric snapshot”?

regards

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One thing to consider here is the notion of ‘views’ i.e. the well-known ‘managed lists’ e.g. problem list, meds list etc. Based on some work of @ian.mcnicoll’ s we are looking at adding this capability to the RM to directly support such lists.

Now, if we think about how to construct an ‘obstetric history’, a large part of it is to with a ‘list’ whose contents are the result of a query looking for previous pregnancies / births / terminations and so on, to build a picture of risks and likely course of events for the current pregnancy. Now, it may be that such information is not in the EHR, even though the woman has had 2 children in the past - for the usual reasons. This way of doing things would say (similar to past procedures): add the information as proper past Actions / Obs / Evals and construct the list.

The current design of the list (view) is as a hand-built set of ‘citations’ pointing to other items in the record. If we had this feature, and tools that enable it to be archetyped, used at runtime etc, then we potentially don’t need an archetype for ‘obstetric history’, and even some of ‘obstetric summary’ becomes just the result of building this view structure.

We need to do more work on this, but I think it will simplify the problem of defining some of the obstetric archetypes that relate to past information designed to provide a picture of current risk.

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Keeping the name, might not be a problem if we rewrite “Purpose” and “Use” from:

“Summary or persistent information about the obstetric history of a woman, including a overview of all pregnancies and the associated outcomes or interventions.”

to:

“Countable core information about the obstetric history of a woman, including all previous and current pregnancies.”

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Or ‘obstetric event list’

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There is the issue of the likelihood of much of this data being spread across disparate systems and we need it to drive decision support, reporting etc. It is ubiquitous data in it’s own right.

If systems can auto-update when there is new data available, it would be neat, but we really do think we need to instantiate these numbers.

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Well I’m not arguing against that obviously - need all the prev pregnancy data in order to assess risk etc. But the situation is the same for Problem list, or list of Past procedures etc. So I am just wondering how we want to view the problem of absent data - it implies that each time a ‘historical view/list’ is constructed, it needs to contain directly entered data to make up for lack of historical data? I’m currently thinking about how this all works with a ‘proper’ problem list(s)!

Also… let’s say an obstetric summary/history is created for child #1… now the woman is pregnant with child #2. What will the obstetric summary look like in this EHR? Because the child #1 pregnancy + birth record is actually there. So would you repeat all that data in the pregnancy #2 obstetric summary? It seems to me we need to at least see what a historical query brings up, and then construct the latest summary in some way relating to that.

That’s why my suggestion above was that such historical information, if not already present, be created as a proper historical record - as I think you do with Dx and Rx that the patient tells the doc about (and where the doc believes it).

I suspect we need to articulate this question of what data are already there v what we have to capture de novo every time.

Following up on this discussion, we decided to keep the name, but change the concept description to “Counted data about previous pregnancies that is commonly used to support risk assessment in a new pregnancy.”

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We reviewed it and decided to keep the name and change the concept description today. But the name ‘Obstetric history’ is a name mentioned by so many health professionals (including myself). But we think this name could be a perfect name for a template with all outcomes for the previous pregnancies.

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@siljelb, @heatherleslie and @ian.mcnicoll,

Is there any place that I can send a proposal for an edition or a new archetype?
Especially the obstetric summary. I would love to submit an idea.
Not limited to, but this one also.
Where is the right place to do so?

Proposals for a new archetype: Archetype menu in CKM>Archetype proposals

Or a change request on the existing archetype.

BUT the archetype is undergoing final review facilitation - closed yesterday - and about to be published because of consensus achieved in this last review. You’d be better contributing this to the review immediately /cc @maritalice

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Thank you, Heather, to reply.
I found this place.
In fact, I’ve made my review in that archetype again.
But I had a proposal that might be clear when you see the archetype structure.
If @maritalice could have a look, I would appreciate.