Dear All
I would like to start a discussion about what we need to record in the EHR about vaccinations in the context of my thoughts about medication instructions. People may have some good references on this matter. It may be appropriate to start a wiki page on this - and medications in general - for the openEHR community?
First, on medications in general. I believe we should have a new activity in the medication order which is review - this can have its own timing and be carried out as required. The action archetype (review medication) will need the follow:
-
period of administration being reviewed
-
outcome - ? this needs to say something about effectiveness if appropriate (need to think of goal orientated - eg lipid and blood pressure lowering, symptom oriented eg NSAIDs, antacids, preventative - eg vaccinations…others?) - also allergy, major illness response and even death!
-
the amount taken (total, average daily or actual daily)
-
side effects (using the symptoms cluster)
-
compliance - ? a general statement or category?
If we do this then it is possible to link the side effects and monitoring to a particular medication instruction (which has advantages). It covers some of the issues of determining side effects in vaccinations. I would appreciate ideas in this space and will put up a medication review action archetype following this.
Next, we need to think of what is required for vaccinations:
- There is the notion of schedule to be followed - this can be different in different regions of a country (in larger countries) due to differing risks. This also changes with time and people transfer or remain on previous schedule depending on age
- There is the actual vaccine administered (same details as medication)
- There is one or more targets of each vaccine (it is important that patients have access to the target information e.g. diptheria, tetanus, polio and not just the name of the product)
- The site of administration (same as medication)
- There is the batch number and expiry date
- There is the dose number
- There is whether this is the primary (may be multidose) or subsequent (booster) vaccination
The instruction will tell us how many are to be given and when - perhaps the maximum and minimum intervals.
Any other ideas?
Cheers, Sam
(attachments)
