Hello
doctor created diagnosis record using template f.e. admission template. Patient is in hospital, he is recovering. Doctor want set this state to diagnosis, using doctor’s ward template. Do we should copy existing diagnosis to this template so he can edit it and create new instance of diagnosis, or we can somehow edit diagnosis from admission template inside ward template?
Thank you.
Hi - another great question and surprisingly difficult to answer.
My ‘perfect’ approach would be.
Record the ‘diagnosis’ in the context at which it was made e.g the ‘Admission diagnosis’ in the ‘Admission template’, the ‘ward diagnosis’ in the Ward template, and this where it gets complex the poor junior doc who has to make a diagnosis at 4am for some other issue, perhaps a related UTI but not the ‘principal diagnosis’ under consideration.
Maintain a separate contextual problem list for this hospital admission which has an idea of a principal diagnosis, co-morbidities and other problems (for this admission). This is the real source of truth for what I think you are trying to acheive - to be able to update and refine the ‘principal diagnosis’ as the case progresses.
Technically this can be done most easily by maintaining a separate ‘episode persistent’ Problem list composition, and just cloning the contents of the original diagnoses. A better approach is to hold links and references in the problem list composition back to the original records, but that is more complex to manage technically and in querying.
Thank you. So there is no standard approach of editing diagnosis state from another template, so we can’t use unmodified open source openEHR back-end . In that case reference to diagnosis looks good, if user updates diagnosis state in ward template then this will be saved to referenced diagnose, so changes would be visible in both template data. I think this behavior will be common in our system, because we want help doctors using workflow, every step of workflow can have own template but same data as previous workflow step. (instance steps of workflow can be for example: admission, ward, ward, ward, dissmiss from hospital - so mostly editing previous data in more focused form for current step)
I agree with Ian.
1- Each author records his ideas in a specific context, at a specific time, for a specific purpose. Each (possibly) using its own Template.
2-The Problem List describes at a high level the recent medical patient status wrt complaints/diagnosis at a point in time and provide reasons for further testing and/or treatment This Problem List/Episode List, will be a Folder containing links to the EHR entries.
I think that correct documentation and full use of the OpenEHR Ref Model is better then one cutting corners.
Technically, the usual approach would be to query the other template and pull out the data items you want/need then apply them to the current composition. So it is not a challenge at all at that level, and I would probably allow the clinician to pull through that ‘suggestion’ based on the admission diagnosis, but of course allow them to override it. But one way or another you are going to have to decide what is the source of truth for the ‘principal diagnosis’. As the system gets more complex, you will potentially have many diagnostic statements made that should never be regarded as being applicable as a ‘principal diagnosis’.
There is nothing to stop you from making the ‘Ward diagnosis’ as the source of truth and linking / referencing that record but I would start with the idea of a separate problem list ‘conttexually’ organised for your kind of scenario (a Community/GP system might well be different).
https://ckm.apperta.org/ckm/templates/1051.57.191
built by @johnmeredith is an example of the pattern we think might be useful, although this is a hardwired example with inline data not references.