Hi!
We are investigating how to implement the use of medical devices with archetypes/templates. E.g. a doctor says that a patient needs to have a drain tube from tomorrow and for a few days. A nurse inserts the drain tube as the doctor has ordered. After a while she needs to change it and when she does she also register how much fluid that has exited the body. She continues doing this in the period of the doctors order.
When we investigate the archetypes and documentation from openEHR.org, we (think we) find the following:
· “a doctor says that a patient needs to have a drain tube from tomorrow and for a few days.” → Instruction (e.g. request-procedure)
· “A nurse inserts the drain tube as the doctor has ordered.” → Action connected to the instruction (e.g. procedure)
· “After a while she needs to change it” → A new instance of the same action connected to the same instruction(?)
· “and when she does she also register how much fluid that has exited the body.” → Where do we put information like this? The action might have an “outcome”-field, but this information is more an observation, isn’t it? We want to use this type of information in another setting (e.g. the fluid management of the patient), so this measurement must be stored so that our system can find it. If we choose to use an observation for this information, how could the instruction/action be linked with the observation? Or are we on the wrong track here? J
· “She continues doing this in the period of the doctors order.” → As indicated in the instruction
Does anyone have thoughts/experience with this?
Regards,
Annette Lund Lillegaard
www.dips.no
Hi Annette,
This is almost exactly how I have approached this problem in a live
hospital system. We actually have done a bit of work on the various
related archetypes, especially fluid output and devices which we are
preparing for upload to CKM. I would be happy to share these with you
if they would be of interest.
Do you have access to the Ocean Template Designer as it would probably
be the easiest way to pass them though?
Ian
Dr Ian McNicoll
office +44 (0)1536 414 994
+44 (0)2032 392 970
fax +44 (0)1536 516317
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skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com
Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org
Hi Annette, Ian
As a point of information on coded representation of Medical Devices: There is work underway by IHTSDO to ensure that coded representation of Medical Devices will be very well supported in SNOMED CT, there is work underway to hold in SNOMED CT those devices currently identified by GMDN. The outlook as far as I am aware is for this to be released in SNOMED CT with the July 2012 release, so free to use in IHTSDO member countries.
http://www.gmdnagency.com/
Tom Seabury
Hi Tom, Ian, Annette
It was just like Tom read my mind. I was just going to ask whether the coding / description of the medical device was being considered.
Just out of curiosity, will the medical device have an archetype defined for it to be embedded in the clinical activity or would it just be defined as an item or attribute of the activity for which it is used?
Many thanks
Eunice
Hi Tom, Ian, Eunice! J
Ian, we are using the Template Designer and I would like to see some examples from you! J
We hadn’t startet discussing how to describe the medical device… I guess I thought we could use slot linking to a device cluster or internal codes in a textfield, but if the devices are gathered in SNOMED terminology codes, that would be much better! But still, if we later on want to create e.g. any overview over devices linked to a patient, I guess we have to use an archetype for the devicedefinition (that is defined to use the SNOMED codes)!?
Another thing we are discussing here:
I the archetype instruction.request-procedure from CKM I can’t see that one can pinpoint specific times the device is to be used. There is a “Date &/or time service required” and a “Latest date service required”, but nothing in between that if you e.g. wanted to say that this device is to be used every morning at 8. When I look at the similar medication archetypes there is a dose instruction that is described to also contain frequency, but this is just a text-field. We are looking for something that would tell our system where (in the future, in a timeline) to indicate that a device (or medication) is to be inserted/used/given. Has anyone got any solution for this?
Thanks!
Annette
avl@dips.no
This was bounced yesterday…
Hi Heather
Thank you so much for this.
I guess the archetype covers medical devices, lab equipment and drug devices e.g. insulin pumps.
What do you think?
Best regards
Eunice
In the case of diagnostic devices there may be further information required.
Are the results patient results, QC sample results, External QA sample results?
Does the device indicate in its message the last date or time of calibration; or last date or time of QC sample; or an authorisation message that confirms these have been done to the satisfaction of the reporting doctor. Does the device message have a link to the reporting doctor or responsible clinician’s name?
I don’t know how many of these are important, and leave it to the clinical laboratory members of the discussion group to lead this conversation any further – or bury it!
Wilton Braund
Dear Wilton
I wondered whether the thing to do is to link the device to its associated test activity.
The test activity then links to its the relevant results. The activities and results each include responsible clinician, reporting doctor and the sample data.
I wondered how this is currently done in practice.
Eunice
Keep in mind that my experience is a few (6+?) years ago. Maybe newer
device allow for some of these.
In the case of diagnostic devices there may be further information required.
Are the results patient results, QC sample results, External QA sample
results?
AFAIK,there are no provisions o the machine for these. They are
recorded by the biomed techs as a report.
Does the device indicate in its message the last date or time of
calibration; or last date or time of QC sample; or an authorisation message
that confirms these have been done to the satisfaction of the reporting
doctor.
Reporting healthcare providers can only go by a sticker affixed to the device.
Does the device message have a link to the reporting doctor or
responsible clinician’s name?
I can almost guarantee this is still not the norm. If it exists at
all. The best you can hope for is make/model/serial numbers are
linked to a biomed tech database.
I don’t know how many of these are important, and leave it to the clinical
laboratory members of the discussion group to lead this conversation any
further – or bury it!
I think they are all important; but HOW important to the clinical staff?
In general, if the device is within its inspection period and has been
certified as accurate. That is sufficient.
--Tim