Hello again! Looking for some feedback. I believe we may have found a way of making maintainable symptom questionnaires with chunks of related question that can be maintained as embeddable templates potentially reused between different forms. (We have also appreciated the dilemma duscussions in Philosophy fun - model questionnaires literally or via existing archetypes?)
Our use case is self-reported symptoms from chemotherapy that need to be stored in a CDR as self reported data and then evaluated by a clinician (and often discussed with the patient) before the next treatment. The clinician’s EHR note from the evaluation is not using the same template as the patient form, examples of desired differences are that…
- we want to use more compact language than the patient form’s question+answer and use normal symptom archetypes etc
- we don’t want to record negative findings (e.g. “fatigue : No”) in the note.
…but parts of the evaluation could be pre-filled by the system as a suggestion based on what the patient answered in their form. The clinician’s evaluation note (or a separate form) could also optionally be used to report adverese reactions using CTCAE-scores.
The enhanced requirements document for the patient form (plus potentially related CTCAE-stuff) looks like this in excel-format:
Underlag_Symptomkontroll_sv+en_2023-03-09.xlsx (29.9 KB)
The template structure of the patient form (now in it’s forth experimantal iteration) looks like below before we apply a pattern of embedded templates. (Note some hopefully pedagogical hints within [brackets] in the node names.)
The maintenance-imporiving-magic (hopefully) happens when we convert/extract e.g. the entire Fatigue cluster to an embedded archetype:
And then everything regarding fatigue can be maintained (and reused in other forms) as a neat little multilingual and terminology bound package, both the initial Yes/No and any followup questions regarding severity etc:
Questions:
- Do you see any problems with modeling this way? (Good to know before we start using this approach live for real data farily soon.)
- Would it be of interest to standardise and add the openEHR-EHR-CLUSTER.specific_sign_question.v0.adl archetype to the CKM? (So that others also can use this pattern to make modular embeddable templates in symptom/sign forms. I copied the content including translations from the corresponding subtree in the Questionnaire archeteype - the metadata will need to be further updated before CKM submission of course.)
P.S. Next experiment is to add reusable display logic patterns in the embeddable templates as discussed in Agreeing on optional user interface hints in templates - #19 by erik.sundvall and after that looking at structuring and pre-filling of the clinician’s note (not shown in this post).
P.P.S. The models are in https://github.com/regionstockholm/CKM-mirror-via-modellbibliotek/tree/chemotherapy-symptoms Note that you need the branch chemotherapy-symptom, not master, and tht this is volatile working branch where things may break and previous experiments with strange archetypes and templates are not cleaned up yet.