Archetype content & style guide

Succinct name that encompasses the scope and intent of the archetype.
Sentence case - with the first letter uppercase and subsequent letters lowercase. Exceptions include proper nouns or acronyms.

Blood pressure

INSTRUCTION archetype names will include the word 'order' or equivalent.

Corresponding ACTION archetype names will just contain the concept, or a very specific scope for the archetype.

INSTRUCTION: "Service request" & ACTION: "Service"

INSTRUCTION: "Medication order" & ACTION: "Medication management"

When there is an abbreviation within the name of the archetype, the abbreviation should occur right after the words of which the abbreviation is made.

“Neurologic Assessment in Neuro-Oncology (NANO) scale.”, and not “Neurologic Assessment in Neuro-Oncology scale (NANO).”

Definition of the 'Concept name'. The intent of the description is to define the concept as clinicians apply it in clinical practice, not the academic or dictionary definition of the concept.

"The local measurement of arterial blood pressure which is a surrogate for arterial pressure in the systemic circulation."

Preface with "To record "... or similar.

COMPOSITION wording needs to be a little different to other clinical content - for example ”a named container for information provided by an individual, to support clear separation of patient generated from clinically genereated health data.”

• Preface with "Use to record "... or similar. Ensure alignment with Purpose if appropriate.

“Use to record all representations of systemic arterial blood pressure measurement, no matter which method or body location is used to record it.”

"This archetype has been specifically designed to be used in the 'Examination detail' SLOT within the CLUSTER.exam-mouth, CLUSTER.exam-cranial_nerves or OBSERVATION.exam archetypes, but can also be used within other ENTRY or CLUSTER archetypes, where clinically appropriate."

'Use to provide a framework in which CLUSTER archetypes can be nested in the 'Examination findings' SLOT to record additional structured physical examination findings."

Preface with "Not to be used"... or similar, followed by a description of the specific use case the archetype isn’t to be used for. Finish with a separate sentence describing which archetypes to use for the specified use case. If the archetypes to be used haven’t been created yet, make the final sentence “Use a specific archetype for this purpose.”

“Not to be used for recording physiological reactions to physical agents, such as heat, cold, sunlight, vibration, exercise activity, by infectious agents or food contaminants. Use the EVALUATION.problem/diagnosis or CLUSTER.symptom/sign archetypes for this purpose.”

“Not to be used to record reactions to transfusions of blood products. Use a specific archetype for this purpose.”

References within published archetypes should be consistent with Citing Medicine, 2nd edition - 
The NLM Style Guide for Authors, Editors, and Publishers

https://www.ncbi.nlm.nih.gov/books/NBK7256/?amp=&depth=2.

The National Library of Medicine provides an easy way to ensure consistent formatting through the use of a bibliography tool that can automatically configure citations for a variety of different publications. If the required citation is not found within the PubMed search then the link above will support manual formatting, eg for parts of websites.

https://www.ncbi.nlm.nih.gov/sites/myncbi/

References to other archetypes or parts of archetypes within CKM can be located on the 'Share with Colleague' tab for each archetype.

http://www.openehr.org/ckm/#showArchetype_1013.1.2741_SHAREWITHCOLLEAGUE

CKM discontinued

For example: "Derived from: Employment summary, draft archetype [Internet]. Australian Digital Health Agency (NEHTA), ADHA Clinical Knowledge Manager. No longer available."

Referencing a FHIR artifact

• Resource - Align with: "<Resource name> <release> [Internet]. Health Level Seven International; [cited: <year MON date >]. Available from: <permanent version- or release-specific URL>."
  For example, an R5 Resource - "AllergyIntolerance, HL7 FHIR Resource [Internet]. Health Level Seven International; [cited: 2024 Feb 05]. Available from: hfps://hl7.org/xir/R5/allergyintolerance.html.”
  Note: the FHIR website uses a single hyperlink to always access the latest version of a FHIR resource. To create a reference to a particular version of a FHIR resource see the FHIR publication history, where you will be able to locate a URL for the release, and a permanent URL for each resource within the release.

• Profile within an Implementation Guide - Align with “AllergyIntolerance profile, International Patient Summary Implementation Guide, [Internet]. Patient Care Working Group, Health Level Seven International; [cited: 2024 Feb 05]. Available from: hfps://build.xir.org/ig/HL7/xir-ips/StructureDefiniWonAllergyIntolerance-uv-ips.html.”

• Part of an Implementation Guide - Align with “Genomic background, Genomics Reporting Implementation Guide [Internet]. Clinical Genomics Working Group, Health Level Seven International; [cited 2024 May 09]. Available from https://build.fhir.org/ig/HL7/genomics-reporting/background.html”

Copyright statement

copyright = <"© openEHR Foundation">

Guideline for communicating external content copyright requirements to users

Include statement describing content copyright, formal copyright statement and access to information about permissions etc by the copyright holders.
For example:

While openEHR archetypes are all freely available under an open license, the specific content of this Clinical Frailty Scale archetype is copyright protected. Any use of this archetype within implementations must be in compliance with the terms established by the copyright owners.

Copyright statement: ©2009. Version 1.2_EN. All rights reserved. Geriatric Medicine Research, Dalhousie University, Halifax, Canada.

Copyright information: https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale.html.

["licence"] = <“This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.”>

Until tooling evolves to allow this to occur through a standard interface, add manually via Notepad or equivalent directly to "other_details = <"  section in the archetype ADL: 

["ip_acknowledgements"] = <"This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org.">

Usually mandatory, as if the actual object of the test or examination is not identified, then any subsequent data is not clearly identified.

The ear(s) to which the test stimulus is being presented.

• Right ear [The test stimuli were presented to the right ear only.] or [The right ear was examined.]

• Left ear [The test stimuli were presented to the left ear only.] or [The left ear was examined.]

• Binaural [The test stimuli were presented to both ears simultaneously in a soundfield.] 

The name and/or code for a particular type of the real world concept the archetype is about. For example lab test, problem/diagnosis or medication.

The intent of the description is to describe the element concept as clinicians apply it in clinical practice, not the academic or dictionary definition of the concept.

Description:

The name of the <XYZ> <...>.

Comment: 

Coding with an external terminology is preferred, where possible.

Coding with an external terminology is optional.

As per examination archetype pattern.

Narrative description of the overall findings observed during the physical examination.

Naming of a data element used to describe a start date for an activity or a duration for an age commenced.

Naming of a data element used to describe a stop date for an activity or a duration for an age ceased.

SLOT to carry the CLUSTER.multimedia archetype until the data type is updated to support all of the additional requirements explicitly modelled in the archetype.

Digital image, video or diagram representing the findings.

Digital representation of the evidence of consent.

Last data element in many archetypes to catch data that may not yet be structured, nor fit into any other general narrative description data element.

May have multiple occurrences, if necessary.

Additional narrative about the <insert appropriate phrase here, for example ‘test results and interpretation’> not captured in other fields.

Additional narrative about the measurement of body weight, not captured in other fields.

(Additional) Issues or factors that may impact on <the measurement of body temperature>, not captured in other fields.

As a default, “Any event” should have “0..*” occurrences, in order to have multiple recordings within one instance of the archetype.

Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.

Default, unspecified point in time event which may be explicitly defined in a template or at run-time.

Added to Protocol for every COMPOSITION or ENTRY archetype to allow for local extensions or potential alignment with other modelling paradigms.

Description:

Additional information required to extend the model with local content or to align with other reference models or formalisms.

Comment: 

For example: local information requirements; or additional metadata to align with FHIR.

ADL:

text = <"Extension">
description = <"Additional information required to extend the model with local content or to align with other reference models or formalisms.">
comment = <"For example: local information requirements; or additional metadata to align with FHIR.">

Some date and datetime elements are intended to allow partial dates, for examples a year only. For these, a comment should be added to specify this.

Comment: 

Can be a partial date, for example, only a year.

The recording of body sites is normally modelled as the combination of a Text element named “Body site” and a SLOT named “Structured body site” for a CLUSTER archetype. The SLOT should normally include one or more of CLUSTER.anatomical_location, CLUSTER.anatomical_location_circle, or CLUSTER.anatomical_location_relative.

Name:

Body site

/

Structured body site

Description:

Simple anatomical location for the identified body structure.

/

Structured details about the anatomical location of the identified body structure.

Comment:

For example: a lymph node group found in the right axilla. Coding of 'Body site' with a terminology, such as SNOMED CT, is desirable.

/

If the anatomical location of the identified body structure is known or it has been identified in the 'Body site' data element, this data element is redundant.

Model as the full name of the score or scale.

If the name is also used as an acronym, model the name in capitals, including the acronym in brackets.

If the most common known name is an acronym, use the acronym as the name.

Apgar score -  OBSERVATION.apgar
Braden scale - OBSERVATION.braden

Edmonton Symptom Assessment System Revised (ESAS-r) - OBSERVATION.esas_r

HAS-BLED score - OBSERVATION.has_bled
ACVPU score - OBSERVATION.acvpu
ECOG performance status - OBSERVATION.ecog

Obstetric National Early Warning score (ONEWS) - Sweden - with archetype ID OBSERVATION.onews_se

Obstetric National Early Warning score (ONEWS) - Norway - with archetype ID OBSERVATION.onews_no

Same as concept name but without the word 'scale' or 'score' - unless it is necessary to distinguish from another archetypes with a similar name.

See examples above. Also:
OBSERVATION.grace_admission and OBSERVATION.grace_discharge.

Record an explanation of the concept being recorded.

An assessment score used to predict the risk of stroke in patients with atrial fibrillation.

Record the reason for using this archetype to record data, not to describe the purpose of the score or scale itself.

To record the results for each component parameter and their total sum for the ATRIA stroke risk score.

Record how the archetype might be used in implementation, not how to perform the assessment.

Commence the first sentence with the standard phrase "Use to record..." unless there is a good reason not to do so.

Additional information might provide guidance to modellers or implementers about how to utilise the archetype in templates or clinical systems.

Use to record the results for each component parameter and their total sum for the ATRIA stroke risk score.

In a questionnaire type score or scale archetype, data elements should be named as the exact text of the question in the source material.
Reasoning:

• Making short form names creates an additional modelling burden, and introduces the risk of errors or misunderstandings

• Renaming the elements to the exact question text in templates, creates very long paths to the data elements

• Modifying the element names may deviate from the Intellectual Properties of the source material

• Using the original text makes reviewing easier

Use original descriptions, or leave empty.

Naming of the total score or calculated ratio should not contain the name of the score or scale. In this way in a UI could display the heading or grouping of Glasgow Coma Scale or P/F Score with the actual data element named more simply as ‘Total score’ or ‘Ratio’.

The total sum of each component parameter for the HScore.

Calculated ratio.

For scales or classifications that do not involve calculating a total score, the scale element(s) should be given the name of the scale or classification as you would expect it to be labelled in a user interface. For example: ‘Modified Rankin scale’, ‘ACVPU’, ‘NYHA Function capacity’ or ‘NYHA Objective assessment’.

Only to be added to a score if it is usually part of the formal score/scale representation.

After discussion (01 2020), future archetypes will not have 'Confounding factors' modelled explicitly, unless it is a specific component of the published instrument. Use the 'Extension' SLOT to allow a recording of confounding factors for specific use cases or clinical scenarios, if necessary.

After discussion (01 2020), future archetypes will not have an additional 'Comment' modelled explicitly, unless it is a specific component of the published instrument. Use the 'Extension' SLOT to allow a comment for specific use cases or clinical scenarios, if necessary.

After discussion (01 2020), future archetypes will not have any other elements modelled explicitly, unless they're specific components of the published instrument. Use the 'Extension' SLOT to allow a comment for specific use cases or clinical scenarios, if necessary.

If only to be used at a single point in time, set the default event to 'Any point in time event' (0..*) unless it is clinically reasonable to record interval events with multiple records committed over a time period, averages or maximums etc. This is unusual with scores or scales (as opposed to being a common requirement with clinical measurements such as weight or pulse rate).

Updated 30 Mar 2023 - Keep 'Any event' unconstrained for scores and scales to allow for outlier use cases where someone might want to record the maximum or minimum score over an interval. More specific constraints, such as changing to a point in time event can be set in the template as required.

Dot points

If dot points are required within the text, use hyphens ('-') followed by a space and then the subsequent text, not commencing with capitals

For example: 
Triggers for closing one episode and commencing a new one will largely reflect local data collection preferences, including if the individual:
- quits for a significant period of time (which will likely be locally defined); or
- significantly changes their amount of use or pattern of their usage.