At the risk of sharing too early, today I’ve been experimenting with trying to support explicit linkages between parts of the health record via modelling techniques. This is in response to @LauraMoral’s query in this thread, and also @ian.mcnicoll’s earlier thread re inclusion of references to protocols and clinical trials.
In response, I’m offering for open discussion:
- a new ADMIN_ENTRY archetype ‘Health thread’ to define a virtual collection of related health data, such as a problem, diagnosis or pregnancy, along the lines of CONTSYS’ health thread concept.
- a new CLUSTER archetype ‘Clinical metadata’ to describe various IDs that support virtual linking to other parts of the health record eg via a health thread, to an existing care plan or to external resources such as a care protocol, pathway or guideline that may have triggered the need for the data being recorded. This archetype would be nested within COMPOSITIONs or ENTRYs to effectively act as a tag.
- a new persistent COMPOSITION archetype ‘Health threads’ to carry a curated list of active health threads.
To demonstrate some context for how these might be used I’ve also drafted up some dummy templates to start to explore how they might be used:
- a curated, persistent Health threads template for all problems and diagnoses - theoretically this goes some way to supporting Larry Weed’s POMR approach.
- a Pregnancy overview template used only for the duration of a single pregnancy
- and some example of how the CLUSTER.clinical_metadata might be used in other typical health record COMPOSITIONS:
— Antenatal visit - where a visit might be tagged as being a part of a specific pregnancy thread and an antenatal care plan.
— Lab test result - where the result might be tagged as a part of a specific pregnancy thread, antenatal care or gestation diabetes care plan, a treatment protocol or a clinical care pathway. The CLUSTER.clinical-metadata is nested in the COMPOSITION and refers to the whole report.
— Problem list - diagnoses may be part of more than one health thread. The CLUSTER.clinical-metadata is nested in the ENTRYs and refers to each problem or diagnosis.
— a Labour record - may be part of a health thread and aligned with a care protocol
Gentle feedback welcome!