From my POV, I’d prefer to protect this archetype as a factual collection of actual environmental conditions but suggest that we think about developing a ‘softer’ CLUSTER archetype to carry patient perceptions re their environment, including a ‘category, type or status’ with a value set such as you suggest, and an accompanying optional narrative description for more detail.
It could be nested within the Environmental conditions CLUSTER if both need to be recorded simultaneously.
Are there other data fields that you have identified?
Or should it be an OBSERVATION of a broader range of patient perceptions that would provide context to other data stored in the same COMPOSITION? No specific use case in mind, just thinking laterally and out loud here.
Technically, ‘state’ in Observation means ‘state of the patient (as a whole)’ e.g.:
consumed 75g glucose 2h ago
not conscious
just ran 10k
and so on.
The weather is really an environmental condition which might influence a person’s symptoms, or even cause them. Environmental conditions like extreme heat or cold obviously relate closely to difficulty breathing, hypothermia etc, but we tend to treat ambient temperature as something like patient state, rather than separating out environmental conditions.
In an ideal model, there is probably a good argument for adding a /environmental branch of Observation (alongside /data, /state and /protocol) to properly capture environment conditions, but that’s a change to the RM (which is perfectly possible, since it’s an addition, it won’t break anything).
Avoiding breaking the RM could be solved by adding in a generic Environmental condition slot under Observation.state. Which is pretty much your conclusion
Technically true, but environment data would only be added if the clinician thought it relevant to the patient note. Mostly it wouldn’t be. But a lack of heating or air-conditioning in the homes of less well off people is a very common ‘social determinant of health’ (SDOH).
I think the case under discussion here though really is more like subjective patient story kind of stuff, not objective observation by the clinician.
I’d suggest environmental conditions more generally are often of interest to record e.g.:
Of course, we have a long-standing example of this in the Body temperature archetype - a SLOT in State to capture the ambient temperature/wet bulb etc at the time when the body temperature was measured, eg in extreme climate exposure situations or immediately after death to assist in establishing the time of death. This was the original use case for the CLUSTER.environmental_conditions and assumed it could be reused within the context of other ENTRY archetypes.
I work on the CALM-QE project that Severin posted above. Among other things, we record environmental conditions in the patients homes with a mobile weather station. I was also thinking to use the Cluster archetype “environmental conditions” for temperature, pressure and humidty. But I don’t know where to include this cluster. If I got it correctly then the original intention was to include environmental conditions into the “body temperature” observation archetype (under State). However since we’re not recording a patients body temperature but only the ambient temperature in their homes, I was thinking to include it in the “Temperature” observation archetype (openEHR-EHR-OBSERVATION.temperature.v0). Unfortunately for the latter, there is no State information with the respective cluster slot available. Is there an option to include a slot for environmental conditions in the “Temperature” archetype as well? Or does anybody have a suggestion for an appropriate slot in other archetypes?
The Temperature OBSERVATION is intended to record a measurement of temperature of a specified object, for example the temperature of an donor organ prior to transplantation. It is probably not quite right for your use case.
The CLUSTER was originally intended to provide context about the state of the patient at the time of body temperature measurement, to enable appropriate interpretation of the measurement.
However, given the other comments in this thread, perhaps we do need to think how best to create a standalone, purpose specific archetype for Environmental conditions that is potentially broader in scope than the current CLUSTER.
Option 1: To transform the CLUSTER.environmental_conditions into OBSERVATION.environmental_conditions. This would effectively abandon the CLUSTER and only use an OBSERVATION external to the other measurement archetypes. This means we LOSE the ability to record the environmental conditions directly in the State, and lose the direct comparison between body and environmental temp which is critical in extreme heat or cold exposure situations.
Option 2: Create an empty OBSERVATION.environmental_conditions containing only a SLOT in which to nest the CLUSTER.environmental_conditions to support reuse both in this new OBS and also other Vital signs archetypes, as per the original intent. This second option is an ugly modelling solution, but we also want to ensure that we don’t duplicate data elements in more than one archetype.
Any more inspired possible solutions from other modellers?
Id agree withese 2 options but would go for option 2. We have something similar with ambient oxygen which is needed in the context of some soecific archetypes like pulse oximetry or lab gases but in news tyoe assessments is often recorded outside any individual specifc observation.
I suspect some analysis of use cases might give a clearer answer - possibly a hybrid solution. I’m thinking along the lines of:
Create an OBSERVATION containing only data elements used to record the true ‘weather station’ context such as the atmospheric pressure, pollution/pollen measurements, whether it is physically raining outside the window.
Keep the CLUSTER as is, and nest it within the OBSERVATION above and the other clinical measurement OBSERVATIONs as before, to prevent duplication and promote reuse.
For personal running (and some other physical activities), the ambient temperature and relative humidity have obviously affected my running performance today, including pace decreased and heart rate increased.
Hi Vanessa,
If you are using a phone to collect the data, the app can record the environmental conditions at the time and place, without recording the place of the phone.
