Differential diagnoses archetype ready for publication

The archetype has been through 3 review rounds. There seems to be consensus among the reviewers. Unless there are objections this archetype will be published on January 12, 2020.

Link to the archetype: https://ckm.openehr.org/ckm/archetypes/1013.1.1670

Please reply to this topic if you have any objections or comments.


Where do I find the latest editor feedback/conclusions after the latest review round? My latest review was nov 26 if I’m correct. I remember (again) having mayor confusion about the concept of the latest archetype regarding differential diagnosis as in 1: a single diagnosis that is still under consideration 2: an ordered list or narritve regarding the likely diagnoses explaining the health question/symptoms.

You can see the final revision in the link above.

The reviews and feedback are here: https://ckm.openehr.org/ckm/archetypes/1013.1.1670/reviewscontent after login

The concept is for the archetype to carry all differentials for a single clinical presentation.

An opportunity to describe the situation with all differentials is present in the Overall description as a narrative. Ability to tag each differential for ordering within the context of a list has been added.

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Hi Heather,
I realise that this will have been discussed within those reviews, but I’ll ask from an interop. point of view: the current model just has ‘status’ = accepted | excluded | possible, but no ‘confidence’ or other similar numeric qualification. I’m not suggesting you need it - if the clinical team that designed this don’t think so, I don’t suggest they are wrong.

I’m raising the question for a different reason: data coming from other sources might have numeric confidence (typically percentage) attached to the branches of a differential Dx, and the current archetype would not be able to represent this directly. This has probably also been thought about, but, since you mentioned imminent publication here, I just thought I’d be annoying and bring this question up :wink:


Hi Thomas, yes - it has been discussed quite carefully :face_with_monocle:.

A differential diagnosis is usually only a temporary or short term placeholder for one or more possible diagnoses, each of which then gets accepted as a diagnosis fit for transforming to the status of using the EVAL.problem_diagnosis or excluded - hence the states of possible/accepted/excluded.

The Problem/diagnosis qualifier archetype (nested within the EVAL.problem_diagnosis) tries to cater for all the various flavours of diagnoses used in different physical/professions/temporal contexts , including different types of certainty. It is a complex area, extremely variable and inconsistent in data sets. We decided not to add certainty in Differentials, but have added an ‘order’ element which could be used to indicate differentials that are more likely or are higher priority for further investigation.

To be perfectly honest, I’m not aware of differentials being shared, and certainly not with percentages. If we’ve missed something and anyone has use cases, please feel free to share before it is published.

This is why we post these notifications - another mechanism to get input in case we’ve missed inviting a critical reviewer.

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This concept clarification helps a lot and makes sense. Thanks Heather!
But if I click the link I only see my latest review comments, but not editor feedback (only from earlier editorial rounds)

I see I’m the only dissenter not in favour of accepting that version. I agree with the concept youndescribe in this thread but I remember feeling quite strongly the archetype version does not fit that description. But maybe I miss a newer version?

We resolved this in an editorial meeting just now.
Turns out the archetype was updated after my reviewer feedback in a great way! I just could not see the (most recent) editor feedback on CKM.
Great work on this nice archetype!