RE: Top 10 of Detailed Clinical Models
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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)
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) From: openehr-clinical-bounces@openehr.org [mailto:openehr-clinical-bounces@openehr.org] On Behalf Of Sam Heard Sent: 24 November 2008 18:47 To: 'For openEHR clinical discussions' Subject: RE: Top 10 of Detailed Clinical Models 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 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 From:
openehr-clinical-bounces@openehr.org
[mailto:openehr-clinical-bounces@openehr.org] On Behalf Of Stef
Verlinden I couldn't agree more. From my perspective I would like to advocate that this
DCM/archetype takes the self-registration of drug use by the patient/ citizen
into account. I really think that for the coming years self-registration will be
the fastest route to a drug use registration that provides the best possible
reflection of the reality. Also if we don't come up with a good solution that
allows citizen involved, other parties, who might have less interest in open
standards, could take over that domain. 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: Maybe this can be of some help in the discussions
coming... Cheers, Stef Op 23-nov-2008, om 20:21 heeft Sam Heard het volgende
geschreven: 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 From:
openehr-clinical-bounces@openehr.org [mailto:openehr-clinical-bounces@openehr.org]
On Behalf Of Williamtfgoossen@cs.com Hi Thomas,
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