I would prefer to see the archetypes categorized by clinical domain rather than than the technical ‘type’ of archetype.
I actually do that inside our tools but it would be nice to have a consistent organization.
Not as important as getting more content into CKM though.
Greg Caulton wrote:
I would prefer to see the archetypes categorized by clinical domain
rather than than the technical 'type' of archetype.I actually do that inside our tools but it would be nice to have a
consistent organization.Not as important as getting more content into CKM though.
*I would suggest that there are different classifications for different
purposes and audiences. The current one is roughly an ontological one,
based on the 'Clinical Investigator Ontology' (see
http://www.openehr.org/publications/health_ict/MedInfo2007-BealeHeard.pdf)
- the principle here is ontological categories of information. Under
this approach, all things like diagnoses, prognoses, recommendations,
plans etc are 'opinions' of one kind or another, based on some
previously recorded or known evidence. We call the opinion type
EVALUATION in openEHR (no guarantee that it is the best name, but it
seemed better than others we considered), and the evidence category
OBSERVATION. These two ontological categories have different truth
values (or if you want, warrant different levels of 'justified true
belief', as philosophers would say). This is because observations are
direct sense information from the world, about an individual, while
opinions are an assessment of what category (of previously discovered
knowledge) the individual fits into (e.g. 'diabetic people' or 'people
who have asthma'). The other types of information INSTRUCTION and ACTION
also fit into this overall scheme, and together the 4 types correspond
to information types generated by a rational scientific investigation
process.
However, a clinical classification, e.g. along the lines of 'mental
health', 'gastro-intestinal', 'obstetrics', 'paediatrics' etc is of
course another perfectly useful classification, and probably the tools
need to support it in a more obvious way than just by querying. In this
approach, we have to be conscious of where to put archetypes like 'blood
pressure measurement', presumably in some kind of 'general medicine'
category, from which specialties 'inherit'. Agreeing this classification
is the work of clinical people, and technically needs to be supported by
an ontology. It partly is today, but this needs improvement.
There are undoubtedly other schemes of classification, e.g. across the
broad lines of primary care, acute, tertiary, aged etc.
All of these in the end require an underlying ontology, and a way of
classifying each archetype within each ontology. We are not there yet,
but the seeds are there.
- thomas beale
HI Greg
Have you seen the classifications in CKM – do these meet your needs? We can link the concept codes to SNOMED where appropriate.
Cheers, Sam