# evaluate sport activity **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2011-12-21 11:39 UTC **Views:** 3 **Replies:** 27 **URL:** https://discourse.openehr.org/t/evaluate-sport-activity/15118 --- ## Post #1 by @system Hi all, Can someone give me a hint about how I should do following, which kind of entries are most suitable for this? There is a software\-requirement, I work with, which says that a patient should do sport, exercises\. And to encourage the patient, there must be some kind of decision support, which checks, the exercises the patient has done, and this evalution must be stored for a later look\-back how the patient is doing\. So, there must be an archetype which is able to decribe the exercise to do, and there must be an archetype for evaluation\-results\. I only need some hints to look at, so I am not foolish misusing some concepts\. I looked at the entry\-classes, evaluation, activity, instruction, and so on\. But I am not sure which one to use, because in the documentation, the seem to target other purposes\. Can someone give me a hint? Thanks Bert Verhees --- ## Post #2 by @Domingo_Liotta Hello Bert: I´m new to the community and have to get more experience using arquetypes but I´ll check in the database and see what I can find :\) Best regards Domingo Liotta --- ## Post #3 by @ian.mcnicoll Hi Bert, A quick response \- it really depends on the level of detail that needs to be monitored\. You might start with an INSTRUCTION if you needed to describe the exercise regimen in detail, though there is not an appropriate archetype for that in CKM at the moment, unless the exercise needs a formal referral\. You could express the goal/target via the EVALUATION\.goal archetype\. Do you need to monitor just the attendance at exercise classes, in which an ACTION archetype might be sufficient, or is more detailed monitoring e\.g exercise tolerance testing required in which case you might also need an OBSERVATION archetype\. Basically the requirements need to be much better elaborated before any sort of definitive answer can be given but I suspect that other then 'Goal' some new and perhaps very local archetypes may need to be created\. Ian Dr Ian McNicoll office \+44 \(0\)1536 414 994 fax \+44 \(0\)1536 516317 mobile \+44 \(0\)775 209 7859 skype ianmcnicoll ian\.mcnicoll@oceaninformatics\.com Clinical Modelling Consultant, Ocean Informatics, UK Director/Clinical Knowledge Editor openEHR Foundation www\.openehr\.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care www\.phcsg\.org --- ## Post #4 by @Eunice_Ab Hello Bert This sounds like an action plan for the patient i.e. to do exercise and the monitoring of such an action plan. Yes it would be interesting to see if there is any archetype for an action plan or care plan for the patient. Let's see if anyone knows whether one exists. Thanks. Eunice --- ## Post #5 by @ian.mcnicoll Hi Eunice, There are some care plan archetypes in local systems and the Swedes are developing some examples for national use\. However, these archetypes are really just controllers for the care plan process and a careplan /action plan is actually a whole document with a mixture of all kinds of entries relating to needs assessment, actions to be taken, subsidiary instructions, results of follow\-up etc\. Ian Dr Ian McNicoll office \+44 \(0\)1536 414 994 fax \+44 \(0\)1536 516317 mobile \+44 \(0\)775 209 7859 skype ianmcnicoll ian\.mcnicoll@oceaninformatics\.com Clinical Modelling Consultant, Ocean Informatics, UK Director/Clinical Knowledge Editor openEHR Foundation www\.openehr\.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care www\.phcsg\.org --- ## Post #6 by @Eunice_Ab Hi Ian Thanks for this .... true ... yes the care plan is a document consisting of various entries .... is there a way of identifying instructions, actions and results for which patients have a responsibility for delivery? ... I guess in the case of Bert's question. Thanks. Eunice --- ## Post #7 by @Domingo_Liotta Hello Bert: A quick database search revealed that the Arquetype: Level of exertion to be useful as you will need to register the patients “level of fitness” pre and post training\. Also you have the related clinical observations: blood pressure, heart rate, ECG recording It would be useful to create a Borg perception of exercise \(subjective\) as it correlates well with level of exertion\. I can be bold and try to make an Arquetype for: VO2max Testing which is my expertise\. I didn’t find any “exercise prescription” Arquetype\. \( I´d like to see that too\)\. I´ll help patch the pieces together if you want\. Be well Domingo Liotta --- ## Post #8 by @ian.mcnicoll Hi Eunice, I can see two approaches 1\. Just use the existing HealthCare Service Request but directed to the patient themselves, essentially regarding the patient as 'service provider', ties subsequent activities into formal workflow\. 2\. Create a specific "Instruction to patient" archetype Ian Dr Ian McNicoll office \+44 \(0\)1536 414 994 fax \+44 \(0\)1536 516317 mobile \+44 \(0\)775 209 7859 skype ianmcnicoll ian\.mcnicoll@oceaninformatics\.com Clinical Modelling Consultant, Ocean Informatics, UK Director/Clinical Knowledge Editor openEHR Foundation www\.openehr\.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care www\.phcsg\.org --- ## Post #9 by @ian.mcnicoll Hi Domingo, Your suggestions are very appropriate if a very detailed level of exercise surveillance is expected but I am not certain from Bert's description if this is actually needed\. I have an example of a pulmonary function test archetype which includes V02max\. It might be interesting for you to have a look at it and see if we can it fit enough for review on CKM\. Ian Dr Ian McNicoll office \+44 \(0\)1536 414 994 fax \+44 \(0\)1536 516317 mobile \+44 \(0\)775 209 7859 skype ianmcnicoll ian\.mcnicoll@oceaninformatics\.com Clinical Modelling Consultant, Ocean Informatics, UK Director/Clinical Knowledge Editor openEHR Foundation www\.openehr\.org/knowledge Honorary Senior Research Associate, CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care www\.phcsg\.org --- ## Post #10 by @Eunice_Ab Thanks Ian. Eunice --- ## Post #11 by @Dr.S.Jagannathan > Hi Bert
Just some hints/suggestions:

In my opinion the following information would be needed

1. Level of physical activity:
Dose: Comprises of Intensity, frequency and duration
Intensity: Absolute scale: Aerobic:


Dr. S Jagannathan
198 St Johns Road
Edinburgh
EH12 8SQ

--- On __Wed, 21/12/11, Eunice Ab **__ wrote:


> From: Eunice Ab
> Subject: Re: evaluate sport activity
> To: "For openEHR clinical discussions"
> Date: Wednesday, 21 December, 2011, 15:56
>
> Thanks Ian.
>
> Eunice
>
> -----Inline Attachment Follows-----
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical@openehr.org
> [http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical](http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical)

| --- ## Post #12 by @Dr.S.Jagannathan > Sorry that was an incomplete version sent by mistake.
A detailed version follows.

Dr. S Jagannathan
198 St Johns Road
Edinburgh
EH12 8SQ

--- On __Wed, 21/12/11, Eunice Ab **__ wrote:


> From: Eunice Ab
> Subject: Re: evaluate sport activity
> To: "For openEHR clinical discussions"
> Date: Wednesday, 21 December, 2011, 15:56
>
> Thanks Ian.
>
> Eunice
>
> -----Inline Attachment Follows-----
>
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical@openehr.org
> [http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical](http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical)

| --- ## Post #13 by @Domingo_Liotta Hello Ian: Of course\!\! I can review it\. I do VO2max in a cardiac \(rehabilitation\) service but the techic is the same\. Send me the arquetype by email please\. I didnt find it searching CKM Best regards Domingo --- ## Post #14 by @system Thank you all for your suggestions, it is very helpful\. At this moment, the level of surveillance will not be very detailed\. The project is to encourage people with certain serious diseases to do exercises\. It seems that treatment works better if they do, and the chance for surviving a serious disease is also higher\. They will be monitored by there smart\-phone\. It is just that they do exercises, that is all, it is not very important what they do, that also depends on the person\. But, in other projects, it may well be possible that a more detailed surveillance is required, for example for monitoring people which had a heart\-failure\. I have already written some archetypes before, and now I have inspiration to find my way to write these too\. I thank you all kind regards Bert Verhees --- ## Post #15 by @Dr.S.Jagannathan > Hi Bert
Here is a hint/suggestions:

1. Level of Physical activity:

Dose: consists of Intensity, frequency and duration.

Intensity: Absolute scale- Aerobic- METs
kcals/min
O2 consumption ml/kg/min
Speed distance/hour
Physiological response Heart rate bpm

Relative scale- Aerobic VO2 reserve
Physiological Heart rate reserve
Resistance Weight lifted or moved
Subjective scale 1-10

Frequency: (per week) Sessions
Bouts
Episodes

Duration: (minutes)

Volume: Total energy expenditure (EE) of the exercise exposure
Intensity x frequency x duration x longevity of programme


Attributes: Current or past.
Dates of recording the above will give the currency.


Intervention: WHO Recommendation or Local recommendation





Dr. S Jagannathan
198 St Johns Road
Edinburgh
EH12 8SQ

--- On __Wed, 21/12/11, Bert Verhees **__ wrote:


> From: Bert Verhees
> Subject: evaluate sport activity
> To: openehr-clinical@openehr.org
> Date: Wednesday, 21 December, 2011, 11:39
>
> Hi all,
>
> Can someone give me a hint about how I should do following, which kind
> of entries are most suitable for this?
>
> There is a software-requirement, I work with, which says that a patient
> should do sport, exercises.
> And to encourage the patient, there must be some kind of decision
> support, which checks, the exercises the patient has done, and this
> evalution must be stored for a later look-back how the patient is doing.
>
> So, there must be an archetype which is able to decribe the exercise to
> do, and there must be an archetype for evaluation-results.
>
> I only need some hints to look at, so I am not foolish misusing some
> concepts.
>
> I looked at the entry-classes, evaluation, activity, instruction, and so
> on. But I am not sure which one to use, because in the documentation,
> the seem to target other purposes.
>
> Can someone give me a hint?
>
> Thanks
> Bert Verhees
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical@openehr.org
> [http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical](http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical)

| --- ## Post #16 by @system Thanks, S, this is more detailed answer than I dared to hope for. Bert Verhees --- ## Post #17 by @Dr.S.Jagannathan > email problems-
here is the rest of my e mail



**Intervention:** WHO Recommendation







Attributes: Adherence: Adherent



Non adherent





Reason:
Happy to discuss in detail.
I have blatantly acquired the information from a WHO document on Physical activity.

Jag

Dr. S Jagannathan
198 St Johns Road
Edinburgh
EH12 8SQ

--- On __Wed, 21/12/11, Bert Verhees **__ wrote:


> From: Bert Verhees
> Subject: evaluate sport activity
> To: openehr-clinical@openehr.org
> Date: Wednesday, 21 December, 2011, 11:39
>
> Hi all,
>
> Can someone give me a hint about how I should do following, which kind
> of entries are most suitable for this?
>
> There is a software-requirement, I work with, which says that a patient
> should do sport, exercises.
> And to encourage the patient, there must be some kind of decision
> support, which checks, the exercises the patient has done, and this
> evalution must be stored for a later look-back how the patient is doing.
>
> So, there must be an archetype which is able to decribe the exercise to
> do, and there must be an archetype for evaluation-results.
>
> I only need some hints to look at, so I am not foolish misusing some
> concepts.
>
> I looked at the entry-classes, evaluation, activity, instruction, and so
> on. But I am not sure which one to use, because in the documentation,
> the seem to target other purposes.
>
> Can someone give me a hint?
>
> Thanks
> Bert Verhees
> _______________________________________________
> openEHR-clinical mailing list
> openEHR-clinical@openehr.org
> [http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical](http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical)

| --- ## Post #18 by @Domingo_Liotta Thanks Jag I look forward to reading it Sonrisa Be well Domingo --- ## Post #19 by @pablo Hi Bert, I had a similar requirement on a project recently. There were recommendations or indications of doing exercise, recorded by a doctor, this is recorded using an INSTRUCTION. The structure is very basic: a free text explaining the indication/recommendation, and a numeric value to evaluate results (that's another requirement). The idea is to have something like: - Walk for X minutes, Y days a week, for Z weeks. - Run X km a week. Then a follow-up proccess done by a nurse, an adminsitrative clerk or done by the patient itself, record the accomplishments: X minutes, X kilometers, etc. This is recorded into an ACTION. Later, the analysis process compares the INSTRUCTION with all the ACTIONS registered for that instruction to calculate a % of accomplishment of the indication, that helps to see if the patient is improving. --- ## Post #20 by @Domingo_Liotta Dear Pablo: Thanks for your input. I decided to try out a very first schematic Arquetype based on your sugestions. Ill send it to the group for review. Sorry its my first one Best regards Domingo [details="(attachments)"] [openEHR-EHR-INSTRUCTION.ejercicio.v1.adl|attachment](upload://ozuhioAlNSqB23ll3ewZ7fgt0Ui.adl) (3.32 KB) [/details] --- ## Post #21 by @Rikard_Lovstrom1 Dear all, There is a work in Sweden for a number of years now, of structuring medical evidence and details about physical activity as treatment of some thirty different conditions\. I am involved in the informatics work, preparing some development of the database\. The contents could be interesting to this discussion\. Particularly I think many of the parameters mentioned here, could be detailed with the help of this work\. I would personally be happy to contribute with thoughts regarding this as the work progresses\. English version: http://www.fyss.se/wp-content/uploads/2011/02/fyss_2010_english.pdf Best regards Rikard Lövström --- ## Post #22 by @system Very interesting, Rikard, Thanks for posting the link\. I'm afraid I won't be able to read it before Christmas, in fact, I go on holiday until after new year\. But after that, I will possibly come back to you regarding this subject\. The people I work with are very enthousiastic about the document, it correspondents to what we are busy with\. Thanks again Bert Verhees --- ## Post #23 by @Hugh_Leslie1 Hi Domingo and all Its really exciting to see people starting to discuss the approach to developing clinical content using archetypes and to see the level of maturity that people like Domingo show in terms of understanding around pulling generic archetypes together to create something more complex like an exercise prescription. I would encourage you all to try to capture this on the CKM application - probably in the forums so that the discussion here is not lost or separated from the content there. regards Hugh --- ## Post #24 by @system I don't know if it is of any use, I am not a medical educated person, I am just a programmer, but with experience in this domain. The case is, that people ask me sometimes, when I tell them about OpenEHR, trying to get some implementation-opportunities, they ask me who will write their archetypes. They expect more or less that I will do that. Of course that cannot be the case, but I have to communicate that message carefully. It is their classical way of application-thinking, single level modeling, in which the programmer needs to understand at least something of the medical domain he is writing for. So sometimes I have to write archetypes, I feel like a GP without education writing a description, but this is part of the dirty business which often hangs around new concepts. I think, I have to write archetypes to work with exercise-prescriptions myself, because I cannot simply download them, and my customer needs them. It is not a very complicated subject and I got some good ideas from this discussion about which entries to use, and how to. If it is of any use, I can post them in the CKM for others to look at them and possibly improve them. I can write them in two languages, English and Dutch. Is this possible? Something in this subject is better than nothing. You can see it as my contribution to the community. (probably as an example how not to do it? ....just kidding!) If this is the case, I can do that next month, when I have to write them. regards Bert Verhees --- ## Post #25 by @heather.leslie I too am very glad to see some activity around modelling. I agree with Hugh’s suggestion that a good place to be able to have a threaded conversation on the specifics is in the CKM itself – in recent updates a General Discussion area has been added (and not yet used) – available after logging in from the ‘General Discussion’ menu. Another use case around exercise is a summary of physical activity – I did make a first attempt on this and you can find it in the NEHTA CKM – openEHR-EHR-EVALUATION.physical_activity_summary.v1 [http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.932](http://dcm.nehta.org.au/ckm/OKM.html#showarchetype_1013.1.932). It is a start and will need more expert feedback, reflecting the kind of things a primary care physician might want to exchange/store in terms of risk factors/behaviour change. It should complement an exercise ACTION that will record the details about exactly what has been done. This might commonly be something that a patient might record in a Fitness app on their phone etc, these may be without a corresponding INSTRUCTION in this use case. Ian has outlined that a full exercise program/plan (COMPOSITION) might include multiple INSTRUCTIONs and corresponding ACTIONS. I agree. And INSTRUCTIONs might also be issued by someone as part of an exercise prescription. Collecting all the requirements for all these contexts/uses will be needed to work out the types of archetypes and the type of information each will carry – I’d suggest a mindmap eg XMind, might be a useful tool to help make the breakdown into individual archetypes more visually obvious. It is usually not easy to try to devise one archetype in isolation of its environment. What do you think? Regards Heather --- ## Post #26 by @Domingo_Liotta Hello Bert: As I mentioned in a previous message regarding the creation of this particular arquetype, I´ll be happy to assist. I´m a general practitioner but I work in a Cardiac Rehabilitation Service (public hospital) so exercise prescription is also important to me. Of course I´ll be happy to translate to spanish. Best regards Domingo --- ## Post #27 by @system Thanks for offering, Domingo. Maybe we can help each other, I'll come back to that in the next year. The archetype Heather Leslie showed us very inspiring, it shows that it does not has to be very complicated. But this is an evaluation-archetype. We also need archetypes to prescribe sport-activities. For Heather: I saw there is a copyright on the archetype. From National E-Health Transition Authority. What is their policy on copyright? regards Bert --- ## Post #28 by @heather.leslie Hi Bert, See my comment below. Heather --- **Canonical:** https://discourse.openehr.org/t/evaluate-sport-activity/15118 **Original content:** https://discourse.openehr.org/t/evaluate-sport-activity/15118