New CLUSTER archetype: Number of occurrences of an observed finding

Clinical
1

Hi,

As part of openEHR work (modelling MRI prostate) at Karolinska University Hospital in Sweden we have designed a new CLUSTER archetype for our need: Number of occurrences of an observed finding. (see the description below). We would now like to get some feedback from the community

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Concept name
Number of occurrences of an observed finding

Concept description
Number of occurrences of a finding that was observed during an examination of a specified body structure or region.

Keywords
occurrence, number, count, finding, metastasis, lesion, cyst, polyp, tumour, tumor, mass, nodule, calculus, thrombosus, abnormality, anomaly, foreign body

Purpose
To record the number of occurrences of a finding that was observed during an examination of a specified body structure or region.

Use
Used to record the number of occurrences of a finding that was observed during an examination of a specified body structure or region.

The finding may be
• an anomaly of some type, e.g., a metastasis, a lesion, a cyst or a polyp
• a foreign body
• some other sort of finding

The archetype was designed to document the number of occurrences of a finding that can occur multiple times and is countable. For example (1) the number of metastases that are observed in a brain or (2) the number of lesions that are observed in a prostate during imaging examination.

Misuse
Not to be used to record the sequence number of an observed anomaly. Use openEHR-EHR-CLUSTER.imaging_exam_anomaly.v0 (Imaging examination of an anomaly) for that.

*** Attribute descriptions ***
Finding name 0..1
The name of the finding that was observed during an examination.

Number of occurrences 1..1
Number of occurrences of the finding that was observed during an examination of a specified body structure or region, e.g., number of metastases of the brain or number of lesions in the prostate observed during imaging examination.

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2

Hi Claudia! I’m wondering where, within which other archetype(s), is this CLUSTER intended to be used? :smile:

1 Like
3

Hi Claudia,

It would be helpful to have more context for your requirements, as Silje has suggested. In the meantime, you may find the pattern used in Imaging examination of an ovary useful—specifically, how the Follicle count is recorded alongside a repeated Per follicle CLUSTER to capture detailed findings.

Sorry to be the wet blanket here but I suspect there are some challenges with the pattern you’re proposing, primarily because attributes like “number of occurrences” can appear in many archetypes. Sometimes we need to model these explicitly and precisely, as in the ovary example. Other times, we aim to design more generalisable and reusable patterns to represent groups of findings, such as in Examination of a lesion (for physical examination) or Imaging examination of an anomaly - both of which are still under review due to the complexity of the modelling and the need for multiple iterations.

Multi-attribute archetypes like these are generally more sustainable from a governance perspective, and they reduce the need to repeatedly model a new CLUSTER archetype containing the same hardcoded Finding name for every single attribute variation. On that basis, I’d push back against your proposed pattern; the proposed generic lesion or anomaly archetypes showing context and relationships between elements is not a simple or easy answer either but I think is the way to go, in principle. Creating a family of archetypes as you propose will be faster, simpler but will also result in a proliferation of very small archetypes which will be harder to govern and more difficult for new modellers to successfully locate the most appropriate one for their use case.

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