# [NEW][ARCHETYPE][BRAINSTORM] Fracture **Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153) **Created:** 2008-07-07 03:12 UTC **Views:** 2 **Replies:** 4 **URL:** https://discourse.openehr.org/t/new-archetype-brainstorm-fracture/14793 --- ## Post #1 by @Nik_Nizan Hi there, This is my first try at creating an archetype\. I have read the Building Archetypes PDF Heather kindly posted a couple of days ago \(what great timing\!\)\. Tried to read the Reference Model and all that but find it rather techinical\. So here I am dwelving into the unknown\. Background: I'm currently involved in an orthopaedic study: Open Fracture of the Long Bones with a local university where they enter a set of data into a paper\-based performa\. Any patient that comes through the ER with a fracture of the long bones \(humerus, radius, ulna, femur, tibia, fibula\) is qualified for this study\. The patient will be followed\-up for a year after discharge \(calculated from the date of admission\), but if he has a repeat procedure that requires admission, this data will be captured by the study\. Outcomes are summarized at 6 month and 1 year interval exactly\. So last Friday, we had a second meeting to finalize what the study required in terms of data capture and we used FreeMind for that\. I've attached the file to this post\. I think from this study, I can at least build the Fracture Archetype which I've searched in the repository and there was none\. Other archetype might already be there eg Demographic Data and Prescription\. I'll take a closer look at that later\. For now, this post is about the Fracture Archetype\. If that is indeed the right thing to do\. Any inputs would http://www.nabble.com/file/p18309358/Open%2BFracture%2Bof%2BLong%2BBones%2BStudy.mm Open\+Fracture\+of\+Long\+Bones\+Study\.mm be greatly appreciated\. Thanks for reading\! Warm regards, Nik Nizan Montoque SB Malaysia --- ## Post #2 by @heather.leslie Hi Nik, Great mind map\. You've outlined all the issues you need to cover very extensively\. I think the issue that is being missed here is that all the information you want to record is not ideal for one archetype\. This is the ideal situation for a template comprised of multiple reusable archetypes of which, many of which you'll be pleased to know have already been developed to some degree\. Template specifications are currently being formalized for publication on the openEHR website\. So if you go looking at present there is not a lot of information currently about them\. I think that this is the best place to keep an eye out for developments \- http://www.openehr.org/wiki/display/spec/openEHR+Templates+and+Specialised+A rchetypes\. I suggest that you take a look at the template developed for the NHS around examination of a patient presenting to the Emergency Department with limb pain or injury \- http://svn.openehr.org/knowledge/TAGS/dev-uk-nhs/Lorenzo_3.5/pub/ContentRele ase\-1\.0\.1/templates/gen/html/Emergency\-LimbPainOrBoneInjury\.v1draft\.html\. Each separate archetype is in bold, black text\. This particular template was one of the first developed early 2007, and the template comprises 42 separate archetypes to provide the full clinical context that was required \(but not including demographics and provider details which were regarded as being kept separately and not part of this clinical modelling task\)\. The archetypes used are below, each to specify a single small concept, and which when combined together can be used to represent a task or activity\. I expect that the archetypes required for your work would be largely similar\. exam\-abdomen exam\_heart exam\_lung oedema symptom\-pain adverse check\_list\-condition\-third\_party check\_list\-condition check\_list\-medication check\_list\-surgical\_procedure problem\-diagnosis problem disposition imaging intravenous\_fluid\_order medication non\_drug\_therapy procedure referral disposition gas\_administration imaging intravenous\_fluids medication referral body\_weight CNS\_exam\_brief exam\-heart exam\-lung Musculoskeletal\_examination personal\_and\_social\_history placeholder pregnancy\_test story substance\_use\-alcohol substance\_use\-tobacco\. substance\_use emergency\_assessment general\_investigations review\_of\_systems vital\_signs free\_text These archetypes are amongst those on http://svn.openehr.org/knowledge/TAGS/dev-uk-nhs/Lorenzo_3.5/pub/ContentRele ase\-1\.0\.1/archetypes/gen/html/index\_en\.html You might be particularly interested in how the injury has been modeled fairly generically here\. The musculoskeletal examination OBSERVATION assumes no particular outcome, although a fracture is certainly one of the possible outcomes\. And in addition, I would suggest that this archetype would ideally be broken up into separate reusable cluster archetypes each focused on inspection, palpation, and movement, and each probably specialized for limbs and/or joints\. There are a lot of other templates displayed at the NHS website that might give you more of an idea \- the format is not ideal, but hopefully can give you some more insight\. Hope this helps Cheers Heather --- ## Post #3 by @system > Hi Nik, > > Great mind map\. You've outlined all the issues you need to cover very > extensively\. > \.\.\. >   > I suggest that you take a look at the template developed for the NHS around > examination of a patient presenting to the Emergency Department with limb > pain or injury \- > http://svn.openehr.org/knowledge/TAGS/dev-uk-nhs/Lorenzo_3.5/pub/ContentRele > ase\-1\.0\.1/templates/gen/html/Emergency\-LimbPainOrBoneInjury\.v1draft\.html\. > Each separate archetype is in bold, black text\. >   Hello Heather, being very new to archetypes, templates, I had a look anyway at this link\. I have to admit that I cannot map any of the bold, black text lines to one of the archetypes mentioned in the list below\. Probably this is also due to the fact that I don't know the meaning of the icons used\. Is there a legenda somewhere available? As an aside, maybe a nice feature of future templates visualized in html might be making the currently 'bold, black text' :\-/ behave as links to the archetypes used\. > This particular template was one of the first developed early 2007, and the > template comprises 42 separate archetypes to provide the full clinical > context that was required \(but not including demographics and provider > details which were regarded as being kept separately and not part of this > clinical modelling task\)\. >   Can you explain why some archetypes \(e\.g\. exam\-heart, exam\-lung, medication, referral, medication, imaging\) are listed multiple times below? To me it's paradoxical that a maximum\-data structure is used more than once\.\.\. Maybe it should have been a tree\-list instead of a flat list? Thanks for all your explanations on these lists, Roger > The archetypes used are below, each to specify a single small concept, and > which when combined together can be used to represent a task or activity\. I > expect that the archetypes required for your work would be largely similar\. > > exam\-abdomen > exam\_heart > exam\_lung > oedema > symptom\-pain > adverse > check\_list\-condition\-third\_party > check\_list\-condition > check\_list\-medication > check\_list\-surgical\_procedure > problem\-diagnosis > problem > disposition > imaging > intravenous\_fluid\_order > medication > non\_drug\_therapy > procedure > referral > disposition > gas\_administration > imaging > intravenous\_fluids > medication > referral > body\_weight > CNS\_exam\_brief > exam\-heart > exam\-lung > Musculoskeletal\_examination > personal\_and\_social\_history > placeholder > pregnancy\_test > story > substance\_use\-alcohol > substance\_use\-tobacco\. > substance\_use > emergency\_assessment > general\_investigations > review\_of\_systems > vital\_signs > free\_text > These archetypes are amongst those on > http://svn.openehr.org/knowledge/TAGS/dev-uk-nhs/Lorenzo_3.5/pub/ContentRele > ase\-1\.0\.1/archetypes/gen/html/index\_en\.html >   \.\.\. --- ## Post #4 by @heather.leslie Hi Roger, Comments inline re your specific issues\. Your difficulties are a perfect example of the confusion that can happen if we have groups of archetypes scattered here, there and everywhere\. And templates that use archetypes from different sources\. These templates were created at a time when these archetypes were the only ones available, and there was only one or two places to source them\. This situation is rapidly changing\. In response to this we have been focussing on archetype governance \(in the first instance\)\. Next week we will be opening up the new openEHR knowledge repository to the list \- it will become a central source of archetypes for download, and be the focus for international review\. It is a complex product in its first release, so further sophistication will come, but will be a huge step forward in coordinating archetype development and publication\. Regards Heather Roger Erens wrote: >   > I suggest that you take a look at the template developed for the NHS > around >> examination of a patient presenting to the Emergency Department with limb >> pain or injury \- >> http://svn.openehr.org/knowledge/TAGS/dev-uk-nhs/Lorenzo_3.5/pub/ContentRele >> ase\-1\.0\.1/templates/gen/html/Emergency\-LimbPainOrBoneInjury\.v1draft\.html\. >> Each separate archetype is in bold, black text\. >>   > > Hello Heather, > > being very new to archetypes, templates, I had a look anyway at this > link\. I have to admit that I cannot map any of the bold, black text > lines to one of the archetypes mentioned in the list below\. Probably > this is also due to the fact that I don't know the meaning of the icons > used\. There is no doubt that this format could be refined considerably\. There has been a lot of discussion around the optimal way to display the templates without the Template Designer\. At the time that this work was done, the HTML view was developed as a tool for us to walk and talk clinicians through the models in face to face meetings \- so with the aid of some guidance, it filled the gap in the short term\. > Is there a legenda somewhere available? > As an aside, maybe a nice > feature of future templates visualized in html might be making the > currently 'bold, black text' :\-/ behave as links to the archetypes used\. >   Understood and agreed that at least it would assist \- I'm not sure that the way forward here has been resolved\. In the meantime I have manually linked the template through to the current NHS pool of archetypes \- see\* http://www.openehr.org/wiki/display/healthmod/HTML+Template+example* \. The match is not exact and I may have picked the wrong version of an archetype if there were a few to pick from, but I hope it will help give you more perspective between the template and the archetype:\-\) >> This particular template was one of the first developed early 2007, and the >> template comprises 42 separate archetypes to provide the full clinical >> context that was required \(but not including demographics and provider >> details which were regarded as being kept separately and not part of this >> clinical modelling task\)\. >>   > > Can you explain why some archetypes \(e\.g\. exam\-heart, exam\-lung, > medication, referral, medication, imaging\) are listed multiple times > below? To me it's paradoxical that a maximum\-data structure is used more > than once\.\.\. Maybe it should have been a tree\-list instead of a flat list? >   And now that I've looked at the html template in detail, I think there has been some changes to this list anyway\. I retrieved this list from a spreadsheet that was created when the template was first made, but I think the template has moved on\.\.\.;\-\( But more detail on that list helps \- sorry, I tried to keep it simple, but it only created \(quite understandably in retrospect\) confusion \- see below, there are clusters and observations with the same/similar names\.    CLUSTER exam\-abdomen\.v2draft CLUSTER exam\_heart\.v1 CLUSTER exam\_lung\.v1 CLUSTER oedema\.v2draft CLUSTER symptom\-pain\.v3 EVALUATION adverse\.v1 EVALUATION check\_list\-condition\-third\_party\.v2 EVALUATION check\_list\-condition\.v2 EVALUATION check\_list\-medication\.v2 EVALUATION check\_list\-surgical\_procedure\.v2 EVALUATION problem\-diagnosis\.v2 EVALUATION problem\.v2 INSTRUCTION disposition\.v2draft INSTRUCTION imaging\.v2 INSTRUCTION intravenous\_fluid\_order\.v1draft INSTRUCTION medication\.v2draft INSTRUCTION non\_drug\_therapy\.v1draft INSTRUCTION procedure\.v2draft INSTRUCTION referral\.v1 ITEM\_TREE disposition\.v2draft ITEM\_TREE gas\_administration\.v1draft ITEM\_TREE imaging\.v3 ITEM\_TREE intravenous\_fluids\.v1draft ITEM\_TREE medication\.v2draft ITEM\_TREE referral\.v1 OBSERVATION body\_weight\.v1 OBSERVATION CNS\_exam\_brief\.v1draft OBSERVATION exam\-heart\.v1 OBSERVATION exam\-lung\.v1 OBSERVATION Musculoskeletal\_examination\.v1draft OBSERVATION personal\_and\_social\_history\.v3 OBSERVATION placeholder\.v1 OBSERVATION pregnancy\_test\.v1 OBSERVATION story\.v2 OBSERVATION substance\_use\-alcohol\.v2 OBSERVATION substance\_use\-tobacco\.v2 OBSERVATION substance\_use\.v2 SECTION emergency\_assessment\.v2draft SECTION general\_investigations\.v1draft SECTION review\_of\_systems\.v2 SECTION vital\_signs\.v2 CLUSTER free\_text\.v1 --- ## Post #5 by @system Hi Nik I have loaded the map into Mindomo and sent you a link. We are looking at getting a licence for this for the teams building archetypes so I would be pleased to have your opinion. For people unable to read MM files - here is an HTML link. [http://www.mindomo.com/view.htm?m=165b747ad8964fe7b7ef94776d7b5f53](http://www.mindomo.com/view.htm?m=165b747ad8964fe7b7ef94776d7b5f53) Cheers, Sam NikNizan wrote: [details="(attachments)"] ![OceanInformaticsl.JPG|183x82](upload://2lcnRHcC3QqDv6AeaDZuo8M9Qlv.jpeg) [/details] --- **Canonical:** https://discourse.openehr.org/t/new-archetype-brainstorm-fracture/14793 **Original content:** https://discourse.openehr.org/t/new-archetype-brainstorm-fracture/14793