Recently, a few questions came up regarding archetypes, particularly about choosing the correct one. To illustrate my doubts, let’s say we create a template using the Diagnosis archetype (https://ckm.openehr.org/ckm/archetypes/1013.1.169) , in which we record a diagnosis of diabetes.
Later, if I have a template used in a screening process, I would use the Diagnosis Screening archetype(https://ckm.openehr.org/ckm/archetypes/1013.1.4442), since it clearly matches the use case I’m working on. However, by doing this, wouldn’t I be duplicating information? Or would I be able to retrieve and reference previous diagnoses that were already mapped using the Diagnosis archetype?
Example of the process:
A patient comes in for a check-up. After all necessary tests and protocols, the doctor diagnoses them with Type 2 Diabetes Mellitus.
At a second visit, the patient is interviewed and fills out a screening form where they are asked about previous conditions, such as Type 2 Diabetes Mellitus.
Is there any guideline or set of best practices for modeling?
For example, I’ve noticed that it’s common to include an Exclusion Specific archetype when using Diagnosis, is this considered a good practice?
I would appreciate if there is any resource available as sometimes I am doubtful on which archetype from the wide variety of archetypes on the ckm, as many of them have similar purposes, making it difficult to know when to use one or another.
Yep, the CKM is full of archetypes, and the number is still growing. And hopefully move a lot of them to published state. It surely can be difficult to find the correct one to use even for experienced modellers . Luckily, you can ask here, and hopefully get help.
The Problem/Diagnosis screening questionnaire archetype is supposed to be used in typical questionnaire-like situations, as “Do you have diabetes", with alternative answers typically as Yes, No, Uncertain. If the patient has an established diagnosis of diabetes, it feels strange to ask about that in a follow up consultation, at least if it is in the same EHR. Maybe “Do you still have diabetes”, but still awkward. The last paragraph in Use section says something important about the questionnaire archetypes: “If the screening questionnaire identifies the presence of a problem or diagnosis, it is recommended that the clinical system record and persist the specific details about the problem or diagnosis … using the EVALUATION.problem_diagnosis archetype”.
This means the screening archetypes are more loose, and should not be regarded as verified data , a diagnosis in this case, and stored for persistence. In the consultation the clinician can record the diagnosis in another composition with the necessary details. It can be pre-filled with the diagnosis of diabetes type 2, of course, through logic in your application.
When it comes to the Exclusion archetypes, there has been debate about those for some time, and I think I should let others reply to that. @heather.leslie, @siljelb ?
