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More generally, a free mixture of Panels and single Analytes could be used.

Another example in which some analytes may have more than one DATA_VALUE, e.g. % and abs values:

• OBSERVATION – Lab test result - openEHR-EHR-OBSERVATION.laboratory_test_result.v1
  • data/events/data:
    •  ITEM_TREE
      • items:
        • ELEMENT – Test Name
        • CLUSTER – Specimen detail ← Archetype
        • etc
        • CLUSTER – Test Findings ← Archetype lab test panel - openEHR-EHR-CLUSTER.laboratory_test_panel.v0
          
          • CLUSTER – Test Findings ← Archetype lab analyte - Leukocytes - openEHR-EHR-CLUSTER.laboratory_test_analyte.v1
            • items
              • ELEMENT
                • value
                  • QUANTITY
          • CLUSTER – Test Findings ← Archetype lab analyte - LDL - openEHR-EHR-CLUSTER.laboratory_test_analyte.v1
            • items
              • ELEMENT
                • value
                  • QUANTITY
          • CLUSTER – Test Findings ← Archetype lab analyte - HDL - openEHR-EHR-CLUSTER.laboratory_test_analyte.v1
            • items
              • ELEMENT
                • value
                  • QUANTITY

PROBLEM: querying paths are different if one pattern is not consistently used for the same kinds of analyte. E.g. if serum sodium and serum potassium are imported from a message feed and included under a panel by one implementation, but directly by another, and both implementations feed data to the same health record, there will be a problem querying, unless the CONTAINS operator is usedPROBLEM: querying paths are different if one pattern is not consistently used for the same kinds of analyte. E.g. if serum sodium and serum potassium are imported from a message feed and included under a panel by one implementation, but directly by another, and both implementations feed data to the same health record, there will be a problem querying, unless the CONTAINS operator is used.

Use Cases

Analytes in same test result with relative (%) and absolute Quantity values

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

Leucogram (Panel)
(analyte)Leucocytes	      -		5.800/mm3
(analyte)Linfocytes	    19%		1.102/mm3
(analyte)Eosinophiles	 1%		   58/mm3

Results in absolute and relative values. The relative representation is not mandatory. In this example, leucocytes are only reported as absolute values, since they are the parameter for the relative calculation of the other analytes in white cell count.

This implies an analyte archetype structure like the following:

-- ADL2 syntax

CLUSTER[id9] matches {
    items matches {
		ELEMENT[id2.1] matches {	-- absolute value
    		value matches {
				DV_QUANTITY[id0.1] matches {
					normal_range matches {
						DV_INTERVAL<DV_QUANTITY>[id0.2] 
					}
					other_reference_ranges matches {
						REFERENCE_RANGE<DV_QUANTITY>[id0.3]
					}
				}
			}
        }
		ELEMENT[id2.2] matches {	-- relative value
    		value matches {
				DV_QUANTITY[id0.4] matches {
					units matches {"%"}
					normal_range matches {
						DV_INTERVAL<DV_QUANTITY>[id0.5] 
					}
					other_reference_ranges matches {
						REFERENCE_RANGE<DV_QUANTITY>[id0.6]
					}
				}
			}
        }
    }
}

Quantitative analytes in same test result with 2 units

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

Some labs report results for the same analyte in 2 different units for better interpretation, e.g. (nmol/L; pg/mL) (mg/dL; mmol/L), resulting in two distinct values for the same analyte. At the same time, labs may adopt different units for the same exam.

Analytes with both Quantity and Text/code value

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

Antibiogram (Panel)
(analyte) Amoxicillin	  > 2 mcg/mL 	Sensible
(analyte) Sulfadiazine	 > 64 mcg/mL	Resistant
(analyte) Cefalexine	> 0,5 mcg/mL	Sensible

This example illustrates scenarios in which some labs may use only one data type, whereas others may report the same result in two different ways.

This implies an analyte archetype structure like the following:

-- ADL2 syntax

CLUSTER[id9] matches {
    items matches {
		ELEMENT[id2.1] matches {	-- quantity
    		value matches {
				DV_QUANTITY[id0.1] matches {
					normal_range matches {
						DV_INTERVAL<DV_QUANTITY>[id0.2] 
					}
					other_reference_ranges matches {
						REFERENCE_RANGE<DV_QUANTITY>[id0.3]
					}
				}
			}
        }
		ELEMENT[id2.2] matches {	-- text value
    		value matches {
				DV_TEXT[id0.4]
			}
        }
    }
}

Microbiology result - what is the analyte?

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

Blood culture (panel)

Streptococcus pneumoniae	> 100.000 CFU/mL

This is specifically related to microbiology results, how to deal with analyte elements when the result of the exam is the analyte itself, being a DATA_VALUE for the Result data element? There is no specific analyte being searched (in most cases) in this scenario. How to query?
This is an example of two DATA_VALUEs for the same exam.

Analyte with quantitative value and qualitative reference range

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

Urianalysis (panel)	
						(val)	(reference)
(analyte)Glucose		+++		Absent

This implies a DV_ORDINAL  for the value but a code/text for the normal_range and reference_ranges. This could be simulated by using DV_ORDINAL for both, i.e. something like this:

-- ADL2 syntax

CLUSTER[id9] matches {
    items matches {
		ELEMENT[id2.1] matches {	-- quantity
    		value matches {
				DV_ORDINAL[id0.1] matches {
					normal_range matches {
						DV_INTERVAL<DV_ORDINAL>[id0.2] 
					}
					other_reference_ranges matches {
						REFERENCE_RANGE<DV_ORDINAL>[id0.3]
					}
				}
			}
        }
    }
}

Same result in different format, depending on lab

(Ack: Former user (Deleted) from Core Consulting, Brasilia)

In the following, Lab1 is reporting bilirubin as an ordinal with a code or text reference range, while lab 2 is reporting using two codes.

Lab1
Urianalysis (panel)

						Result 		Reference range
(analyte)Bilirubin		+++			Absent


Lab2
Urianalysis (panel)
						Result		Reference range
(analyte)Bilirubin		Moderate	Absent

Result format may vary depending on the analysis result. In urine strips testing, lab interpretation may present results as texts, scales or quantities, in different units. For example, protein analysis may result in "negative", "traces", "++" or "30 mg/dL". All this DATA-VALUES must be allowed in the result element. Not all results are automatic. Some are manual testings

Issue: how to register reference ranges for DV_TEXT, DV_ORDINAL results? Reference ranges often expands the "Normal"/"High" ranges, such as interpretation of clinical risks: cardiovascular risks, diabetes risk. Others may be interpreted as evidence for bacterial infection or viral infection depending on the result value (eg, for C-RP exams). There are examples that includes value ranges for specific interpretations, as: Negative: < 1,6 UI/mL; Indeterminate: 1,60 - 2,0 UI/mL; Positive: >= 3,00 UI/mL.

Template examples

Template for use in message-driven contexts.

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