Thanks for re-opening this discussion @Silje, as I think this is does require quite careful consideration, and thanks to the others contributors on the thread.
I doubt if there is much disagreement that physiologically (or from a biomedical ontology pov) , these concepts are quite different
- Electrical heart rate
- Heart beat
- Pulse as a proxy for heart rate/heart beat and sometimes rythm. It may be taken peripherally but only if it is felt to be a accurate reflection of 1 and/or 2 above
- Peripheral pulse as a measure of that peripheral pulse itself, not as a proxy of 1 and/or 2. I think that is
already explicitly out of scope of the current and proposed archetypes.
And of course there are very definitely clinical situations where 1,2,3 are disassociated and do need to be measured/labelled explicitly.
However, and I think at the core of Silje’s question, is the issue that by ‘volume of recording’, these kinds of events are extremely rare and that in the vast majority of cases where ‘pulse’ or ‘heart rate’ is measured, clinical recording practice makes no distinction. I had a look for example paper ‘vital signs
charts’ on Google and of the first 10 that I found, 8 described ‘pulse’ and 2 described ’ heart rate’. None talked about ‘heart beat’.
Even more specialised ICU charts talk about heart rate with no separate category for ‘heart beat’ or ‘pulse’.
So ‘routine recording practice’ very much blurs the different physiological concepts of heart rate, pulse and heart beat , mostly for the very good reason that they are, in practice, only very rarely disassociated.
I would prefer to find a means of accepting that ‘blurred’ reality of clinical recording practice, whilst allowing the disassociated concepts to be used, in the more rare circumstances that these are needed.
A very typical trajectory of ‘pulse’ recording might be a manual pulse, then a pulse oximeter is used to record ‘pulse’ then a single lead ECG is applied and measures heart rate.
‘Heart beat’ as the base concept does make some sense but paradoxically, in low tech environments, it is much more likely to be captured using a peripheral pulse or oximeter, with the need to record location or body position etc. If the new designs are accepted, I would probably recommend that people use the pulse specialisation be default, otherwise both heart beat and pulse specialisation will need to be carried in every simple vital signs template to cope with switching between the various measurement modalities.
I’d much prefer the base archetype to be extended so that it could be used for all the modalities, and then if required could be explicitly templated/specialised for the edge cases where the concepts are actually disassociated.
Of course, we need to be able to capture unusual clinical conditions, but I think we need to be able to reflect the ‘ontology of clinical record-keeping’ as well as the ‘ontology of biomedical concepts’.
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