I was looking for an archetype which contained data elements for
family medical history, specifically
- medical condition (coded or free text)
- relation to patient (relative)
- presence of condition (present/not present)
There is an archetype called 'Risk of condition based on family
history' which seems to have everything I need - except that its usage
is to evaluate the risk.
Do you think this could be a specialization of a more general
archetype for family history - or what other alternatives are there?
thanks!
Greg
Family history is always interesting!
The argument for this way of handling family history in this fashion is that the statement (in a male patient) ‘Mother has bowel cancer’ is different from ‘mother has cervical cancer’, the former conveying an opinion that the patient is themselves at risk of developing the index condition, whilst the latter is important to the patient but does not convey any added risk of developing the index condition, equivalent to ‘wife has cervical cancer’ and might be better expressed as a simple Problem or as part of the social history.
I have mixed feelings about this approach. I think it is semantically correct but I wonder if in practice, the distinction may be too subtle for many clinicians e.g when insurance medicals ask for all family history (whether conferring risk or not). OTOH, none of the presence/significance elements are compulsory, so it might be reasonable to use this archetype to document potential ‘familial predispositions’ even though not part of a proper risk evaluation.
Thoughts?
Ian
Dr Ian McNicoll
office / fax +44(0)141 560 4657
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian@mcmi.co.uk
Clinical Analyst - Ocean Informatics ian.mcnicoll@oceaninformatics.com
Consultant - IRIS GP Accounts ian@gpacc.co.uk
Member of BCS Primary Health Care Specialist Group – www.phcsg.org
2008/10/23 Greg Caulton <caultonpos@gmail.com>
2008/10/23 Greg Caulton <caultonpos at gmail.com>
I was looking for an archetype which contained data elements for
family medical history, specifically
- medical condition (coded or free text)
- relation to patient (relative)
- presence of condition (present/not present)
There is an archetype called 'Risk of condition based on family
history' which seems to have everything I need - except that its usage
is to evaluate the risk.
Do you think this could be a specialization of a more general
archetype for family history - or what other alternatives are there?
thanks!
Greg
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Family history is always interesting!
The argument for this way of handling family history in this fashion is that
the statement (in a male patient) 'Mother has bowel cancer' is different
from 'mother has cervical cancer', the former conveying an opinion that the
patient is themselves at risk of developing the index condition, whilst the
latter is important to the patient but does not convey any added risk of
developing the index condition, equivalent to 'wife has cervical cancer' and
might be better expressed as a simple Problem or as part of the social
history.
I have mixed feelings about this approach. I think it is semantically
correct but I wonder if in practice, the distinction may be too subtle for
many clinicians e.g when insurance medicals ask for all family history
(whether conferring risk or not). OTOH, none of the presence/significance
elements are compulsory, so it might be reasonable to use this archetype to
document potential 'familial predispositions' even though not part of a
proper risk evaluation.
Thoughts?
Ian
Dr Ian McNicoll
office / fax +44(0)141 560 4657
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian at mcmi.co.uk
I get it, that makes sense. I have a couple of data element
suggestions on the archetype but I'll make those in CKM
thanks!
Greg
Hi Greg
I think Ian has already covered this, however the archetype was designed this way because in most cases, clinicians document family history to document the risk of a particular condition for the person - that’s actually what it means, otherwise it has little value in the EHR apart from social things that a condition might impose on the person such as a carer role. This should be documented in social history so that it doesn’t get mixed up with risk.
In my opinion, enabling clinicians to differentiate this is the role of the application, not the archetype.
regards Hugh
Greg Caulton wrote: