Saving tresholds in archetypes

Clinical (archive)
1

Hi all,

I am rather new to OpenEHR and archetypes. Most of the concept is
clear to me, but I have a small question at this moment.

We have to deal with parameters that have tresholds( for
decision-support). Those threshold-parameters can differ per patient.

I came to the following construct.

Is it a good solution to create a COMPOSITION-archetype, with in that two slots

  • An OBSERVATION-archetype containing the definition for the measurement-results
  • An EVALUATION-archetype which contains
    — the diagnoses/conclusion which can be derived from the comparison
    with the thresholds-parameters.
    — the thresholds (which can differ per patient) to which the
    measurement-results are compared with

Or should I store the thresholds via another archetype in a separate
COMPOSITION-… ENTRY?

Or are there more valid solutions?

Thanks in advance for suggestions.

Kind regards
Kevin Keene
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2

HI Kevin,

Normally such thresholds are regarded as 'reference information' or 'knowledge' that would be available somewhere else in the environment. Archetypes enable you to set limits on all kinds of values, but the limits are usually regarded as 'sanity' limits.

Using 'rules' in archetypes you could state limits dependent upon patient type, age etc, this is more complicated obviously. It will be technically doable in ADL 1.5, but I suspect it is not the right approach, because you would not want to hide (or replicate) these knowledge statements inside archetypes as fixed / static statements.

Better would be a system where limits on values could be stated to be a query that takes patient parameters and obtains the information from an external reference source. We don't do that kind of thing currently with archetypes, and I am not even sure that there would be agreement on this idea. The current way of solving the problem is at a higher application layer, where data entry is mediated by a connection to the relevant knowledge service (e.g. clinical protocols, etc).

ANother thing to note: the DV_QUANTIFIED data types in openEHR have normal and other reference ranges in them, which are used to enable lab systems to return the ranges that actually apply to that patient. This means that an analyte value could be returned with a 'normal' range, an 'alert' range and a 'critical' range. As far as I know, only normal ranges are in routine use.

- thomas