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Approach
The Northern Territory approach to the creation of an electronic Pregnancy Health Record is to use clinically-agreed archetypes as the basis for an Antenatal software developmenta shared Pregnancy Health Record.
An archetype is a structured, computable specification for one single, discrete clinical concept. Examples include Blood Pressure; Clinical Synopsis; Medication order; or Adverse Reaction.
...
2. Map clinical concepts to archtypesarchetypes
Each of the clinical concepts were mapped to existing archetypes within the NEHTA Clinical Knowledge Manager (CKM), or the need identified for creation of a new archetype.
Some of the existing archetypes meet the requirements for the NT Pregnancy Record already; others needed modification or enhancement to meet the requirements.
The newly created archetypes have been uploaded to the CKM, and the ones requiring modification have been updated.
Within the CKM each archetype will then undergo review rounds by a range of clinicians, terminologists, software engineers, informaticians and other interested experts. The purpose of each review round will be to fine-tune each archetype so that it meets the requirements for each stakeholder group.
For the clinicians we seek to ensure that all relevant date elements are included, that the names and descriptions are correct etc – the end goal being that the archetype at the end of all review rounds is regarded as safe and 'fit for clinical purpose'. Any and all contributions are gratefully received from all reviewers, ranging from simple typo and grammar corrections, through wordsmithing descriptions, to challenges about incorrect or missing content.
Similarly terminologists, vendors, informaticians will all contribute according to their expertise, intending that the archetype is also fit for their purpose.
The aim is to collaboratively build a data pattern for a single clinical content that meets all stakeholder requirements.
Reviewers will receive email invitations to participate in the online review, which will usually be open for comment for a period of a few weeks. After each review round, Editors will review all comments from all reviewers, provide feedback to reviewers, update the archetype and initiate another review round.
Review rounds will continue until consensus has been achieved – surprisingly, in experience to date, the inclusive nature of the maximal data set has enabled consensus on the structure of the archetypes. If consensus is not achieved, then it will need a resolution process will allow for publication of the agreed parts of the model, allowing for further research and discussion and potential future revision of the archetype.
3. Analysis
The archetypes identified for this Pregnancy Health record are:
Clinical Concept | Comment | Corresponding archetype concept name | Status | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
Antenatal Plan | An overarching plan for the patient's antenatal care | <EVALUATION.antenatal_plan> |
| |||||||
Information Provided | Details of each piece of health education information discussed or provided to patient | Information Provided | ||||||||
Social Summary |
| Social Summary | ||||||||
Adverse Reaction List | Adverse Reaction list is made up of multiple Adverse Reaction entries | Adverse Reaction | ||||||||
Family History List | Family History list is made up of multiple Family History entries | Family History |
| |||||||
- Diagnosis | Problem lists, whether current or past are made up of multiple Problem/Diagnosis entries | Problem/Diagnosis | ||||||||
Procedure list | Procedure list is made up of multiple Procedure entries |
| ||||||||
Smoking consumption |
| Tobacco use | ||||||||
Alcohol consumption |
| Alcohol consumption | ||||||||
Obstetric Summary |
| Obstetric summary | ||||||||
Pregnancy Summary | An evolving summary of key data about a single pregnancy – either current or past | Pregnancy summary | ||||||||
Examination Findings |
| Examination Findings |
| |||||||
- Current Medication List | Medication list is made up of multiple Medication instruction entries | Medication instruction |
| Medication administered |
| Medication action | - Medication administered | List of Medications currently being taken and those administered as part of pregnancy | Medication action | |
Height |
| Height/Length | ||||||||
Weight |
| Body weight | ||||||||
Body Mass Index |
| Body Mass Index |
| |||||||
Blood Pressure |
| Blood Pressure |
| |||||||
Fetal Movements |
| Fetal Movements |
| |||||||
- Urinalysis | The pattern for urinalysis is identical to the pathology test results, and in some cases | Pathology test result | ||||||||
Ultrasound results |
| Imaging examination result |
|
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exam > |
23 clinical concepts were identified; represented by 21 archetypes.
The newly created archetypes have been uploaded to the CKM, and the ones requiring modification have been updated.
Click on the links in the table, above, to view the latest version of each of the archetypes in CKM.
4. CKM Review
Within CKM each archetype will undergo review rounds by a range of clinicians, terminologists, software engineers, informaticians and other interested experts. The purpose of each review round will be to fine-tune each archetype so that it meets the requirements for each stakeholder group.
CKM Videos:
<ul>
<li><a href="http://www.youtube.com/watch?v=2fb11902NQ4" target="_blank">CKM Introduction</a></li>
<li><a href="http://www.youtube.com/watch?v=Uy-LfrG5U7Y" target="_blank">CKM Archetype Reviews</a><span style="background-color: yellow;">
</span></li>
</ul>
For the clinicians we seek to ensure that all relevant date elements are included, that the names and descriptions are correct etc – the end goal being that the archetype at the end of all review rounds is regarded as safe and 'fit for clinical purpose'. Any and all contributions are gratefully received from all reviewers, ranging from simple typo and grammar corrections, through word-smithing descriptions, to challenges about incorrect or missing content.
Similarly terminologists, vendors, informaticians will all contribute according to their expertise, intending that the archetype is also fit for their purpose.
The aim is to collaboratively build a data pattern for a single clinical content that meets all stakeholder requirements.
Reviewers will receive email invitations to participate in the online review, which will usually be open for comment for a period of a few weeks. After each review round, Editors will review all comments from all reviewers, provide feedback to reviewers, update the archetype and initiate another review round.
Review rounds will continue until consensus has been achieved – surprisingly, in experience to date, the inclusive nature of the maximal data set has enabled consensus on the structure of the archetypes. If consensus is not achieved, then it will need a resolution process will allow for publication of the agreed parts of the model, allowing for further research and discussion and potential future revision of the archetype.
5. Create an openEHR template
Once community consensus is reached within CKM, the archetypes will be aggregated and constrained in a template to accurately represent the data requirements for the NT Pregnancy Health Record.
Each bold, black heading in the the following screenshot represents an archetype. The Pregnancy Summary archetype has been opened up to see the details. Black text indicates data elements that will be utilised in this use case; grey text indicates inactive data elements.
Decision Support
Possible functions:
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Background documents on NT project
Other Pregnancy Health records:
- Queensland Health: Pregnancy Health Record
Link to relevant sections of CARPA Manual