Sorry for late response here. Days are too short!
With “ugly” and “monster-archetypes” I mean separate archetypes made for one purpose only, even though the data points are clinically valid and stored in their correct archetypes. One report form = One archetype and (at least some of the) data is duplicated.
For example the “Sick leave note”, which is a big form - approx. 100 elements - and consists of a variety of information: Date the individual got sick, the ability to work, reason for the leave, is it related to pregnancy? or injury? if the individual can work some hours - at what percentage?, … and it goes on and on. But two elements are interesting: Diagnose (-s) and Employeer. Those are in published archetypes. If we use those “proper” archetypes, say the Diagnose/Problem, it is not always the medical “truth” - and will in queries and in display not be correct.
Other example: A report to a quality registry of a particular diagnose or group of diagnoses, which can be a mix of observations during a hospital stay, some aggregated data, and also subsets of data, or even “the most relevant value from a number of registred values”. If this is to be made in a query, which data points to pick? Even though the specification from the registry is clear enough, it’s still needed for a clinician to evaluate and make decisions. “Which of the 15 systolic BP’s measured is the one representing the BP during the stay?”. It may be an average, but that is not a measured value at the time of recording, it’s just in the BP archetype for reporting. By storing the data in the clinically correct archetypes, we intoduce erronous data, as the data entries for this reporting purpose is a duplicate, or even “made up”.
And as the form for this reporting ideally should “grow” during the stay, it will be populated by a number of clinicians, at several times: “Radiology showed this and this finding, a lab result showing this value, then decision to do surgery date, the procedure, <which of theese 4 medications were given>, then complications (if any), outcome, and so on <50 - 100 data points>”. If this is to be stored in their “proper” clinical archetypes , how do we show the previously recorded values from a user earlier in the stay, to the next clinician to register his/hers data points?