Coming late to this party, but I have a few observationsâŚ
How you represent such things depends on their content. If the âstrategyâ is literally just an assessment of some kind i.e. a judgment that a certain general treatment pathway should be followed, then it is some kind of âEvaluationâ. If it takes the form of worked out orders (e.g. for chemo, with dosages & timing etc determined), then it is some kind of âInstructionâ.
Having looked at a few of these kinds of things in the past, I would expect it is really more of a Care Plan, which will be some combination of the following:
- assessment / diagnosis (probably referring to some already reached diagnosis)
- = citation/ reference to prior Evaluation
- recommended treatment pathway in general terms for this patient, e.g. surgery + chemo but no radio
- = Evaluation representing a recommendation
- goal(s)
- = Evaluation representing goals
- order(s)
- for surgery
- headline order for a specific chemo protocol
- any other Rx, therapy
- etc
We donât need all the details here, Iâm just pointing out that you probably want to consider all the information relevant to the condition not just the notion of a ârecommendationâ in isolation.
However, it doesnât stop there obviously. The chemo part will take the form of order sets and a âPlanâ for administration, e.g. for Ewingâs Sarcoma, alternating cycles of vincristine/doxorubicin/cyclophosphamide and ifosfamide/etoposide (VDC/IE). openEHR currently has nothing that directly represents either âorder setâ or Plan. For the former, you can get by with a Composition containing Instructions, possibly with relevant Observations, e.g. of weight, body surface area etc, and any dose modifications from the standard form of the chosen protocol.
For the Plan, we ideally would use the Task Plan representation (see RCHOPS-21 plan here) Youâll see this Plan structure consists of Tasks, Wait states, Decision nodes and Events.
Outside of Task Planning (not yet implemented), there is no direct representation of these things available. The best you could do is represent the orders using Instructions above, and then the actual administrations using Actions (and any related Observations, e.g. patient reactions etc), but you have no easy way to represent the Plan.
Some of us have plans to make Plans a reality in the near future, but itâs not there today.
I would still recommend looking at the overall picture, since this ârecommendationâ item is just one fragment in the overall picture.