I would be interested to know if anyone has worked with ICF?
ICF is a classification for body functions, activities, environmental factors and body structures.
My first idea was to use the problem/diagnosis archetype. (Clinical Knowledge Manager)
But with the ICF I don’t necessarily have to record a problem - I can also record that a patient doesn’t have a problem with XYZ.
Maybe it makes sense to start developing a new ICF archetype?
I look forward to your answers.
Can you tell us a bit more about the context of your project and how ICF is expected to be used?
My guess would be that this is either for reporting purposes or some kind or registry/analytics purpose, which tends to push us down a different modelling approach.
So yes Problem /Diagnosis archetype might be appropriate
or you might find the Problem/Diagnosis screening questionnaire (Tabbed View) and better match if Yes/No/Unknown type of responses are required
Are other terminologies in play like SNOMED CT or LOINC?
please excuse the delay in answering. i think that is also why the discussion has developed in a different direction.
In fact, my current concern is oriented towards the point of care. It is about the longitudinal view of a patient. Is my patient’s condition improving or deteriorating? How can or should I adjust my patient’s treatment?
I am definitely thinking in the direction of a managed list in the sense of Clinical Knowledge Manager.
The open question is “only” whether the archetype problem/diagnosis would be conceptually misused here, since ICF also classifies positive aspects and statements.
Regarding other terminologies.
A patient will definitely also have a classical diagnosis, e.g. ICD10.
An example may help to clarify this:
A patient had a stroke.
(–> problem/diagnosis ICD10: I64)
With ICF I would like to record:
- pain in the shoulders (b280)
- reduced muscle strength in arms and hands. (b730)
- difficulty dressing/dressing (d540)
- difficulty washing herself (d510)
- is very sociable and socially well integrated. (e310 / e320)
Nursing diagnoses have a similar issue in that some of the diagnoses are “positive” (from the patient’s well being point of view, not the point of view of testing), for example ICNP 10029065 No Pressure Ulcer. However, these are usually used as goals and evaluation results, and not as “problems”.
I suspect functional assessments done with for example ICF may be a separate area we currently haven’t covered in archetype modelling. I don’t have a clear picture how this would be structured, but I suspect one or more archetypes that we haven’t currently modelled would be required.
We looked at functional assessments a couple of years ago and modelled a bunch of archetypes, which are on Apperta CKM: Clinical Knowledge Manager
These include an Personal care needs EVALUATION archetype to which specific CLUSTER archetypes (such as Dressing self and Washing self) can be nested in. We also created a similar framework for Mobility related archetypes. As part of the modelling process, we looked at ICF and other existing models, along with examples from front-line social care practice. I belive the ADL assessment OBSERVATION archetype on the international CKM was designed as an alternative, more generic approach for modelling functional assessments, but it is still in draft status.
So far we’ve used our archetypes only for demonstrative purposes but we now have a real use case in the UK that includes functional assessments, so will be reviewing these in due course. It would be interesting to see examples from other countries and explore whether it is possible to come up with a pattern/framework that would work internationally. We’d be more than happy to collaborate with anyone interested!
I think you’re right that the ADL assessment archetype was created as an attempt to generalise the concepts of the Personal care needs and Mobility archetypes in the Apperta CKM. In this case, the initial “yes/no/unknown” questions in those archetypes would be represented using the Problem/diagnosis screening questionnaire archetype.
I suspect none of these archetypes match the even more generic ICF functional assessment use case though.
We have a similar requirement. Where patient assessment for elderly rehabilitation is done for five domains: Somatic (e.g stroke) Functional (inability to walk indecent due to hemiparesis) Social (inability to visit family due to difficulty walking) Psychological (feelings of loss leading to sleep deprivation) Communicative (difficulty speaking leading to feeling frustrated). Since the assessment is formulated in the form of problems (something to be improved) I used to problem/diagnosis archetype. With a cluster stating the domain it falls in (SFSPC). I think this is acceptable. But the issue is often something that’s not a problem: “happily marrie, 2 involved children.”which is really useful info in the context of rehab. it’s prone to abuse.
Archetypes at archetype-editor.Nedap.healthcare “plan” repo.
A similar problem will arise once we start modelling nursing “issues” which are often not problems. As shown by a previous reply. And are often recorded as part of a risk assessment. Eg “adequate weight, but risk of malnutrition”, I think it would be wrong to model that as a problem/diagnosis.