# Top 10 of Detailed Clinical Models

**Category:** [Clinical (archive)](https://discourse.openehr.org/c/clinical-archive/153)
**Created:** 2008-11-21 10:21 UTC
**Views:** 4
**Replies:** 18
**URL:** https://discourse.openehr.org/t/top-10-of-detailed-clinical-models/14852

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## Post #1 by @williamtfgoossen

Dear all,

A while ago in discussions on Detailed Clinical Models we determined a Top 10 to start with. In practice these are only 9 examples.

My suggestion is to include the Braden Scale for pressure ulcer risk as number 10.

The other 9 items are:

1 weight
2 lenght
3 heart rate
4 temperature
5 blood pressure
6 breathing (frequency)
7 Apgar score
8 Barthel index
9 Glasgow Coma Scale.

Note that the blood pressure archetype that includes a lot of information that is in the DCM is currently reviewed against the additional knowledge from the BP DCM example.

Of course other items will be tackled later.

My questions is if there are any objections in modelling the Braden Scale as number 10.

The question is not about the most appropriate modelling, it is just on Braden Scale to be number 10 yes or no.

Sincerely yours,

dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
the Netherlands
email: Results4Care@cs.com
phone + 31654614458
fax +3133 2570169
www.results4care.nl
Dutch Chamber of Commerce number: 32133713

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## Post #2 by @Jessica_Gabin

Hi all,

The first 6 seem to be pertaining to the patients’ vitals. What about pulse oximetry then?

Kind Regards,

Jessica Gabin

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## Post #3 by @Stef_Verlinden1

From a 'necessity' prospective I would be in favor of a 'medication' DCM. I realize that this will be a complex one, which could be another reason to choose this it: if one can handle medication the rest is 'easy':-)

Cheers,

Stef

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## Post #4 by @williamtfgoossen

In a message dated 21-11-2008 11:48:15 W. Europe Standard Time, jessica.gabin@kith.no writes:

> Hi all,
>
> The first 6 seem to be pertaining to the patients’ vitals. What about pulse oximetry then?
>
> Kind Regards,
>
> Jessica Gabin

Oximetry is going to be put on the 2009 list.

Sincerely yours,

dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
the Netherlands
email: Results4Care@cs.com
phone + 31654614458
fax +3133 2570169
www.results4care.nl
Dutch Chamber of Commerce number: 32133713

---

## Post #5 by @williamtfgoossen

In a message dated 21-11-2008 12:08:08 W. Europe Standard Time, stef@vivici.nl writes:

> From a 'necessity' prospective I would be in favor of a 'medication' DCM. I realize that this will be a complex one, which could be another reason to choose this it: if one can handle medication the rest is 'easy':-)
>
> Cheers,
>
> Stef

Medication is not on the list of DCM at this stage, reason is indeed as you say: it is quite complex, a lot of national projects are dealing with it and the harmonization and standards development is going on. Not something I can manage before Christmas. :-)

Basically it is important and a good idea, but it is imposible to do in such a short time. Further, it would perhaps need a complete team to work on.

Sincerely yours,

dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
the Netherlands
email: Results4Care@cs.com
phone + 31654614458
fax +3133 2570169
www.results4care.nl
Dutch Chamber of Commerce number: 32133713

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## Post #6 by @Stef_Verlinden1

OK, I don't want to ruin your Christmas:-). Is it an idea to put it on the 2009 list?

Cheers,

Stef

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## Post #7 by @system

Please adopt that one as well – we want all that are important to people

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## Post #8 by @system

When medication is considered be aware that there is already a huge amount of requirements collection in HL7v2, HL7v3 space and in European standards.
I think that with a limited amount of work the Clinical Models can be produced and discussed.
In addition we need this all over the world and there is one European project needing it : epSOS.

Gerard

-- <private> --
Gerard Freriks, MD
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

T: +31 252544896
M: +31 620347088
E: [gfrer@luna.nl](mailto:gfrer@luna.nl)

Those who would give up essential Liberty, to purchase a little temporary
Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755

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## Post #9 by @Bentley_Steven_NHS_C

by the CIC I mean the HL7 Clinical Interoperability Council.

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## Post #10 by @thomas.beale

Gerard Freriks wrote:

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## Post #11 by @system

Thomas,

I agree that you have formulated two addition requirements.

Gerard

-- <private> --
Gerard Freriks, MD
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

T: +31 252544896
M: +31 620347088
E: [gfrer@luna.nl](mailto:gfrer@luna.nl)

Those who would give up essential Liberty, to purchase a little temporary
Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755

---

## Post #12 by @Bigpond

Thomas Beale wrote:
> Gerard Freriks wrote:
>&nbsp;&nbsp;
>> When medication is considered be aware that there is already a huge
>> amount of requirements collection in HL7v2, HL7v3 space and in
>> European standards\.
>> I think that with a limited amount of work the Clinical Models can be
>> produced and discussed\.
>> In addition we need this all over the world and there is one European
>> project needing it : epSOS\.
>>
>
> \*
> I would suggest that the 2 key requirements today are:
> a\) being able to merge medication lists for a given patient from
> multiple sources
> b\) being able to handle entries in the list that were prescribed \(and
> that are recorded in some structured, standard way\) and medications that
> the patient says they are on already, including non\-prescription and
> herbal etc\.
>
> Being able to do this would generate a list that can actually be used
> for decision support \(interactions testing\) for a new prescription\.
>
> I don&#39;t think either of these is dealt with directly by any of the
> current standards\.
>
> \- thomas beale
>
> \*
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> openEHR\-clinical mailing list
> openEHR\-clinical@openehr\.org
> http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical
>

How would the original sources of truth be monitored / recorded if you
merge two or more lists from say different authors or sources? Would
there be anyway for the decision support algorithm to know it was
dealing with two different authors and then possibly a third for the
final concatenated list\. Certainly that would be needed for any
medico\-legal audit if errors in one or other of the originals were
responsible for a negative outcome\. How might you deal with two
identical \(or maybe slightly different\) medications in each list \- would
you sum the amounts \(not good\), ignore one \(which is the more correct
and how would an alogorithm know\), ignore both and seek advice \(not
optimal\) or keep both with some form of flag back to originating list
supplier and not publish\)?

Interesting issues\.

David

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## Post #13 by @williamtfgoossen

Hi Thomas,

The Netherlands is implementing the exchange of medication messages in order to achieve the full list of a patient of current and past medications and prescriptions.
Current pharmacy and gp systems have a DSS system in place that tackles interactions.

It is probably not perfect, but coming in the direction you suggest.

I agree that this is an interesting topic to tackle further and harmonize.
A lot is already put into the HL7 CEN ISO CDISC and IHTSDO harmonization work, where pharmacy is now a priority topic.

William

In a message dated 22-11-2008 12:20:57 W. Europe Standard Time, thomas.beale@oceaninformatics.com writes:

> Gerard Freriks wrote:
> >When medication is considered be aware that there is already a huge
> >amount of requirements collection in HL7v2, HL7v3 space and in
> >European standards.
> >I think that with a limited amount of work the Clinical Models can be
> >produced and discussed.
> >In addition we need this all over the world and there is one European
> >project needing it : epSOS.
> >
> *
> I would suggest that the 2 key requirements today are:
> a) being able to merge medication lists for a given patient from
> multiple sources
> b) being able to handle entries in the list that were prescribed (and
> that are recorded in some structured, standard way) and medications that
> the patient says they are on already, including non-prescription and
> herbal etc.
>
> Being able to do this would generate a list that can actually be used
> for decision support (interactions testing) for a new prescription.
>
> I don't think either of these is dealt with directly by any of the
> current standards.
>
> - thomas beale

Sincerely yours,

dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
the Netherlands
email: Results4Care@cs.com
phone + 31654614458
fax +3133 2570169
www.results4care.nl
Dutch Chamber of Commerce number: 32133713

---

## Post #14 by @system

Thanks William.

So lets do a medication archetype that contains all the standard information constructs required to do this, and CCD and CCR. We can include Microsoft if we want as well just to have the world reasonably covered off.

The point here is there are a plethora of specifications being developed and no one knows quite what they mean or how to use them. Lets do it in openEHR and try to nail it down.

Cheers, Sam

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## Post #15 by @Stef_Verlinden1

I couldn't agree more.

Since I've been trying to work this out for quite some time now, I finally took the time to write down my thoughts on this topic. For those of you interested it can be found here:
[http://www.vivici.nl/a_three_level_model_for_the_registration_of_drug_use/](http://www.vivici.nl/a_three_level_model_for_the_registration_of_drug_use/)

Maybe this can be of some help in the discussions coming...

Cheers,

Stef

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## Post #16 by @system

Hi Stefan

I think this is an excellent place to start. There are a few things to say:

1. Can you please add this to the openEHR wiki under
[http://www.openehr.org/wiki/display/healthmod/Health+Information+Models+Home](http://www.openehr.org/wiki/display/healthmod/Health+Information+Models+Home)

2. Dispensing is used for pharmacy delivery

3. We need to think of all the different points at which it may be appropriate and I think naming them will be better than levels. Why? Because prescribing a drug does not mean it is being taken, even dispensing. So the near patient reporting is always critical to know exactly what is being taken. We need lookups that patients can use to enter medication they are taking – bar code readers may be in home computers soon for recording all sorts of things – or perhaps in the phone (you can already use a camera for this with tickets etc)

a. I would suggest we use:

i. At prescription

ii. At dispensing

iii. Near patient with medication present

iv. By report (professional, patient or carer)

How does that sound?

The issues that are outstanding at the moment from my perspective are:

· How to allow concatenation of Drug, form and dose at varying degrees of granularity. Ie Ibuprofen; tablet; 400mg as three items, Ibuprofen tablet; 400mg as two items, Ibuprofen 400mg; tablet as two items, Ibuprofen tablet 400mg as one item.

· What to record in terms of the drug name – do we include the trade and generic – either or both. We also need to allow in many jurisdictions for the fact that the pharmacist may be able to substitute another brand even if the trade name is given.

· How comprehensive to make it in regard to all the possible complexities of drug administration. I think we should start with the root that will allow growth to immunisations, formulations and more complex orders (specifically medications in infustions)

Cheers, Sam

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## Post #17 by @Bentley_Steven_NHS_C

Dear All,

The Medication work in NHS CFH uses a model that can be found in the following document (page 10 has the overview diagram)

[http://www.connectingforhealth.nhs.uk/systemsandservices/data/scg/publications/SCG0002.pdf](http://www.connectingforhealth.nhs.uk/systemsandservices/data/scg/publications/SCG0002.pdf)

The other issues mentioned see in line comments

The issues that are outstanding at the moment from my perspective are:

· How to allow concatenation of Drug, form and dose at varying degrees of granularity. I.e. Ibuprofen; tablet; 400mg as three items, Ibuprofen tablet; 400mg as two items, Ibuprofen 400mg; tablet as two items, Ibuprofen tablet 400mg as one item. There is ongoing work to look at this and come up with a means that all are equivalent - not sure how far this has got - will chase up

· What to record in terms of the drug name – do we include the trade and generic – either or both. We also need to allow in many jurisdictions for the fact that the pharmacist may be able to substitute another brand even if the trade name is given. In my opinion you must record the actual drug which is given to the patient so in dm+d terms (dictionary of medical devices and drug) a pharmacist states the AMPP (actual medical product pack - antipressan 50mg (Tera UK Ltd) 28 tablet (2x14 tablets)) that is dispensed. When prescribing it is reasonable for this to be done by stating VTM (Virtual therapeutic moeity - e.g. atenolol), VMP (virtual medicinal product - atentolol 50mg tablets) or AMP (Actual medicinal product - antipressan 50mg (Tera UK Ltd)

· How comprehensive to make it in regard to all the possible complexities of drug administration. I think we should start with the root that will allow growth to immunisations, formulations and more complex orders (specifically medications in infustions)

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## Post #18 by @system

In the Netherlands we use the G-Standard where a lot of these topics have been covered.

[http://www.knmp.nl/over-de-knmp/algemeen/the-g-standaard-the-medicines-standard-in-healthcare](http://www.knmp.nl/over-de-knmp/algemeen/the-g-standaard-the-medicines-standard-in-healthcare)

Gerard

-- <private> --
Gerard Freriks, MD
Huigsloterdijk 378
2158 LR Buitenkaag
The Netherlands

T: +31 252544896
M: +31 620347088
E: [gfrer@luna.nl](mailto:gfrer@luna.nl)

Those who would give up essential Liberty, to purchase a little temporary
Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755

---

## Post #19 by @Colin_Sutton

Hi  Sam,

I agree it is better to use names\.

> From a user perspective

\* The prescription is an Instruction
\* Dispensing is an administrative action
\* Taking \(or being administered\) the med is of most interest from my point of view \(clinical trials\): if you have not got this record you can fall back on the prescribed and dispensed med as a surrogate:

We record as many details as the patient/nurse is likely to be able to tell us
\* time of day
\* frequency
\* dose \( in whatever form\)
\* trade name or generic \(we can look\-up and cross\-check either way, though with more difficulty some foreign medications\), including herbal and alternative concoctions\.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;as a special case, trial medication that may be combinations of actives and placebo\.
\* start date and stop date

http://www.nehta.gov.au/DGL/Resources/Downloads/Medication%20v1.0.pdf has a good collection of attributes \(that really need to be grouped according to the openEHR model\)\.

Regards,
Colin

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**Canonical:** https://discourse.openehr.org/t/top-10-of-detailed-clinical-models/14852
**Original content:** https://discourse.openehr.org/t/top-10-of-detailed-clinical-models/14852