How to use exclusion archetypes - does not make it work in a clinical setting

Clinical
1

Hi.
We often struggle with the use of exclusion archetypes as they do not really work in a clinical setting. The last use case we had is for a solution where to register vaccines. Sometimes we need to register that a vaccine is not given. This should - theoretically be modelled by use with the openEHR-EHR-EVALUATION.exclusion_specific.v1 archetype. But in the application it is necessary not only to register that the vaccine is not given, but also to write a reason why it is not given, and a time frame, that is whether the reason lasts for a short time or forever, e.g an allergy. Those facts need to be stated together with the exclusion and the comment element is not right to register those. I think we should have a slot for more structured information that describes the exclusion. The vaccine is only the last example, we did have the same problem earlier, I think we might have had a discussion on Slack, but I am not sure.
I also want to question whether the exclusion archetypes are in the right class. They actually only apply to this moment in time, so I think they should rather be observations.
And i also think that that fact that exclusions stand alone are problematic and would like to discuss the model. I would rather like to have it included in the diagnosis, or symptom or procedure archetype. I am aware that the composition can hold all together but in my eyes it makes everything unnecessary complicated.

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Hi Anca,

I would definitely not use an Exclusion archetype for the vaccination use-case you mention.

I would use either the ACTION.medication archetype with specialisation or templating to cover the vaccine requirements and the ACTION.current_status, careflow_steps to record that the vaccine was not given - either dose ommitted/deffered for a temporary issue (nuwell) or a cancelled state if the whole course should be stopped.

Exclusion archetypes are really not intended for this kind of situaiton.

THe Global exclusions are for things like ‘No history of vaccinations’ and the specifics might be in response to a something like ‘No known penicilin allergy’ or ‘No history of Covid-vacciniation’ as part of information gathering.

We all agree that the current Exclusion handling can seem a bit messy about it was designed to ensure that we avoid confusion when querying between a positive statement and a negation i.e mixing up ‘has a diagnosis of diabetes’ vs ‘Diabetes excluded’.

Thisis definitly worth a wider conversation though, so please do create a Discourse discussion.

For the Vaccination record example though , the ACTION careflow_steps are exactly what you need, I think, not Exclusions.

https://ckm.apperta.org/ckm/templates/1051.57.276 is one example

Ian

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