First of all, I hope all of you have enjoyed / are enjoying your summer holidays!
Here in Catalonia, we have started to work with a template regarding blood transfusion. The thing is that I have been trying to use the archetype openEHR-EHR-ACTION.transfusion.v0, but I miss some information to use it such as dates/times for the procedure, identifiers and a slot to join a cluster with this information missing. On the other hand, I think this is the most accurate archetype to use for this use case. Because of this problems, I decided to use, instead, the archetype openEHR-EHR-ACTION.procedure.v1 for the same use case, and I realised that I have all the information needed in this archetype. However, I think it is a pity that, if there is a specific archetype for transfusion, that I am not using it. So, I have three different possibilities:
I have thought to adopt the archetype openEHR-EHR-ACTION.transfusion.v0 and to make a proposal for changes to include some information that I think that it can be necessary to register a transfusion action.
To make the template using only the openEHR-EHR-ACTION.procedure.v1 archetype which includes all the elements that I need for my template.
To include both archetypes ( openEHR-EHR-ACTION.transfusion.v0 and openEHR-EHR-ACTION.procedure.v1 ) taking into account that I have 2 actions archetypes for the same action, and to try to relate those somehow (if the possibility exists… maybe someone more technical could answer this question).
Which one do you think it is the most suitable solution?
As the original author, this archetype certainly deserves some love & attention. It should be separate to the procedure, and largely because the pathway steps are complex.
If you are willing to show it some love & develop it further I’d be very happy to support you along the way
Thank you so much for your answer. After considering the solutions, we decided that the archetype
openEHR-EHR-ACTION.procedure.v1 fits better for our use case. However, I would like to propose a changes in the openEHR-EHR-ACTION.transfusion.v0. Mainly, what I see is that there is a lack of a slot to add a/some cluster/s, in case we need to add information to our template. Would you like me to make a proposal in the international CKM? I have already adopted the archetype and, in case that we would like to work with it, I would be more than happy to participate in the process.
Hi Laura, yes please contribute your ideas re enhancements.
You can either make a change request - Change requests OR Upload a revised version of the archetype to a branch - ‘Archetypes’ menu (top) > ‘Revise archetype’ > ‘Upload modified archetype’ and follow the prompts to checkout a branch and upload the model.
Thank you for bringing attention to this part of clinical modelling. There’s a lot to explore here.
I don’t think describing a single action (event where a specific action has been performed) using multiple ACTION archetypes is the right way to go. The RM as I understand it wasn’t designed that way. Could you confirm @thomas.beale ?
On the other hand if you can argue different ACTIONs describe different parts of a healthcare procedure, it could work. Technically it’s just including different ACTIONs in a single COMPOSITION I guess.
Interesting alternative strategies could be to make ACTION.transfusion a specialisation of ACTION.procedure.
And/or to move (some of) the content into reusable clusters.
I’m thinking in case of OR surgical, reports there might be many different ACTIONs, probably with lots of similar content. I’m thinking of the fractal pattern from the imaging_exam archetypes.
@LauraMoral I would be curious to understand a little more of the use case. It would be great if you could share some source materials.
I do recognise some of what Laura might be describing in terms of multiple Actions. We have something similar in Vaccination, where at least in primary care GP systems, vaccinations are handled/coded as procedures 1st primary immunisation etc, rather than as medication administrations, though sometimes as both.
It would be preferable if we could have a single ACTION and related careflow cycle but I would not rule out the need for multiple Actions. As ever, we just need to tease out what might be required
I agree that we should not be representing a single process with 2 Actions but sometimes there are actually independent processes that have common touch points.
Most likely not. If there are distinct actions in an overall care plan, e.g. medication, physiotherapy, wound management, etc each of those would be its own order + actions.
I would agree - there are quite a few generic ‘procedure’ data elements that could be re-used in any specific procedure.
Hi Laura, we are just working on blood transfusions as part of a project and wondered if you (or others) have done any more work on the ACTION.transfusion.v0 archetype and might wish to collaborate?
