Looking for an archetype to store details regarding incapacity for work, sport, and travel

Clinical
1

We need to model a medical certificate that includes details regarding incapacity for work, sport and travel.

The archetype ‘openEHR-EHR-COMPOSITION.health_certificate.v1’ found in the international CKM provides a composition archetype for such a certificate. However, I was unable to find an archetype for storing the actual content.

For each individual case of incapacity for work, sport or travel, we must record :

  • Name of the restriction (e.g. incapacity for work, incapacity for sport, incapacity for travel, hospitalisation, outpatient treatment, exemption from driving)
  • Further details regarding the activity (only for inability to participate in sport: details of the sport concerned)
  • Percentage of incapacity for work (applies only to the restriction ‘incapacity for work’ )
  • Valid period start
  • Valid period end (may also be open-ended, or state ‘until further notice’).
  • Comment

An example of data for incapacity for work, sport and travel stored in a single medical certificate may be:

  • Hospitalisation from 10 May 2026 to 13 May 2026
  • Incapacity for work: 100% from 14 May 2026 to 21 May 2026
  • Incapacity to work: 50% from 22 May 2026 to 29 May 2026
  • Incapacity to travel: from 14 May 2026 to 29 May 2026
  • Incapacity to participate in sports (jumping sports): from 14 May 2026 until further notice

‘openEHR-EHR-OBSERVATION.functional_ability.v0’ would be a reasonably good fit. However, the following arguments speak against using this archetype for our use case:

  • This archetype belongs to the OBSERVATION class rather than the EV ALUATION class.
  • Misuse states: ‘Not to be used to record the outcome of a regulatory, occupational, or legal assessment for […] return-to-w ork clearance.’
  • ‘Duration’ cannot be set to ‘open’ (‘until f urther notice’) .
  • For the percentage of incapacity, the ‘Ability’ data element would have to be used with a data type (DV_TEXT) that is too unspecific for this purpose.

The predraft archetype ‘openEHR-EHR-ADMIN_ENTRY.legal_authority.v0’ also deals with this topic to some extent, but seems even less suitable for our use case.

My questions:

  • Can you recommend an existing archetype for recording incapacity for work, sport and travel?
  • Or should I create my own archetype?
2

@ana.milosev has been working on incapacity for work archetype based on Slovenian requirements. I suspect you will find that even if you use the health_certificate archetype, that it needs substantial local adptation, either to fit national legislation, or the exact circumstances - Fitness to dive is very, very different from fitness to return to work after an ankle sprain!!

The example you give would be very alien in a UK context as single certificate. Not sure functional ability is a great fit.

3

I suspect we don’t currently have this concept as an international archetype. I’d suggest you create it, although as Ian points out it’d probably have to be quite generic to be able to cover multiple use cases and jurisdictions.

4

Hi @emmanuel.eschmann.

Our template covers fitness assessments for multiple regulated populations - workers, drivers, train drivers, seafarers, firefighters, and athletes - each with its own legal framework, so the modelling challenge is similar to yours.

We used openEHR-EHR-EVALUATION.recommendation.v2 to carry the fitness assessment outcome (e.g. fit / fit with restrictions / unfit / unable to assess; field ‘Recommendation’), with each certificate subtype as a separate archetype with its own constrained value set. The ‘Rationale’ element handles free-text medical opinion where needed and can also be duplicated which helped us a lot.

For certificate issuance itself we used openEHR-EHR-ACTION.service.v1 (locally named “Certificate issuance”), capturing the certificate type and completion state. We created one national archetype slotted inside the Action, to carry Slovenian-specific certificate metadata including the validity period (start/end) and the certificate number. To support capturing details about the issuing and receiving organisation and doctor of the certificate we used openEHR-EHR-CLUSTER.person.v1 and openEHR-EHR-CLUSTER.organisation.v1 archetypes also slotted inside the Action. The percentage of incapacity for work/sport/travel isn’t a requirement in the Slovenian context so I can’t speak to that one.

As for an international archetype - I suspect it would be quite tricky given how much legislation varies country to country, but if you do decide to go down that path I’d be happy to be involved.

5

Some time ago I experimented with trying to model the UK Med 3 ‘Fit note’ typically issued by GPs. I created a composition archetype for ‘UK public sector certificates and reports’ and a separate ‘Med 3 fitnote’ admin entry archetype for the content, which, of course, is specific to the UK context. I used Diagnosis/Problem just to provide an element for the recording of the associated coded or textual diagnoses, although I think even that might have been too much detail, and a simple text value in the admin entry may have sufficed.

I spun this up just to illustrate how it might be done, as there had been some vague speculation about creating a generic service for managing these, so it never went through any reviews or anywhere near production.

My thinking was that this was largely an administrative record and did not really need to be part of the individual’s clinical record, nor did it need to capture the process specifically, thus the Admin Entry type. Compared to Ana’s description above, my approach was much less detailed, but that would probably have suited our use case.

Maybe I could have used the ‘Health certificate’ composition for this, but my thinking at the time was that there would be a benefit to having all UK admin certs under the same Composition from a grouping perspective, and having that on the UK Apperta CKM, which of course is now no more :frowning:

The models I used, I am sure, reflect my attitude to the UK medical certification process for illness-related fitness-to-work statements, which is often fairly cursory from a clinician’s perspective. I just wanted something simple, that was fairly bounded in context and meaning to just that purpose - so no process, care planning, recall, etc. - just a rubber-stamp admin entry for an admin purpose. If it had gone through wider review, it might have evolved more toward Ana’s approach, as perhaps others would not share my opinion!

If we want to record things like work absences or functional capabilities from a clinical perspective, I think there are other ways to do that. The Med3 data could not be trusted to be a reliable proxy for these things - it is often just an admin overhead on patients and their doctors.

Paul

6

Dear @ana.milosev , @Paulmiller , @siljelb , @ian.mcnicoll

Thank you very much for your helpful replies.

Before posting this question, I had assumed that medical certificates regarding incapacity for work, sport, or travel were broadly similar across countries, and that a shared international archetype would therefore make sense.

Your responses have made me realise that the national differences are much more significant than I had expected. Therefore, I now believe that a cross-border archetype is probably not sustainable .

Instead, I will create an archetype tailored to our requirements, using Paul’s suggestions as the main starting point, since his use case appears to be the closest match to ours.