RE: Top 10 of Detailed Clinical Models
Hi Sam,
I agree it is better to use names.
>From a user perspective
* The prescription is an Instruction
* Dispensing is an administrative action
* Taking (or being administered) the med is of most interest from my
point of view (clinical trials): if you have not got this record you
can fall back on the prescribed and dispensed med as a surrogate:
We record as many details as the patient/nurse is likely to be able to
tell us
* time of day
* frequency
* dose ( in whatever form)
* trade name or generic (we can look-up and cross-check either way,
though with more difficulty some foreign medications), including herbal
and alternative concoctions.
as a special case, trial medication that may be combinations of
actives and placebo.
* start date and stop date
http://www.nehta.gov.au/DGL/Resources/Downloads/Medication%20v1.0.pdf
has a good collection of attributes (that really need to be grouped
according to the openEHR model).
Regards,
Colin
-----Original Message-----
From: openehr-clinical-bounces@openehr.org on behalf of Sam Heard
Sent: Tue 25-Nov-08 5:47 AM
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
http://www.openehr.org/wiki/display/healthmod/Health+Information+Models+Home
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
Sent: Monday, 24 November 2008 8:15 AM
To: For openEHR clinical discussions
Subject: Re: Top 10 of Detailed Clinical Models
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:
http://www.vivici.nl/a_three_level_model_for_the_registration_of_drug_use/
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
Sent: Sunday, 23 November 2008 7:15 AM
To: openehr-clinical@openehr.org
Subject: Re: Top 10 of Detailed Clinical Models
Hi Thomas,
The Netherlands is implementing the exchange of medication messages in
order
to achieve the full list of a patient of current and past medications
and
prescriptions.
Current pharmacy and gp systems have a DSS system in place that tackles
interactions.
It is probably not perfect, but coming in the direction you suggest.
I agree that this is an interesting topic to tackle further and
harmonize.
A lot is already put into the HL7 CEN ISO CDISC and IHTSDO harmonization
work, where pharmacy is now a priority topic.
William
In a message dated 22-11-2008 12:20:57 W. Europe Standard Time,
thomas.beale@oceaninformatics.com writes:
Gerard Freriks wrote:
>When medication is considered be aware that there is already a huge
>amount of requirements collection in HL7v2, HL7v3 space and in
>European standards.
>I think that with a limited amount of work the Clinical Models can be
>produced and discussed.
>In addition we need this all over the world and there is one European
>project needing it : epSOS.
>
*
I would suggest that the 2 key requirements today are:
a) being able to merge medication lists for a given patient from
multiple sources
b) being able to handle entries in the list that were prescribed (and
that are recorded in some structured, standard way) and medications
that
the patient says they are on already, including non-prescription and
herbal etc.
Being able to do this would generate a list that can actually be used
for decision support (interactions testing) for a new prescription.
I don't think either of these is dealt with directly by any of the
current standards.
- thomas beale
Sincerely yours,
dr. William TF Goossen
director
Results 4 Care b.v.
De Stinse 15
3823 VM Amersfoort
the Netherlands
email: Results4Care@cs.com
phone + 31654614458
fax +3133 2570169
www.results4care.nl
Dutch Chamber of Commerce number: 32133713
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