openEHR Process Examples
| Issuer: openEHR Specification Program | |
|---|---|
Release: PROC latest |
Status: DEVELOPMENT |
Revision: [latest_issue] |
Date: [latest_issue_date] |
Keywords: process, task planning, decision logic, examples, workflow |
|
| © 2017 - 2021 The openEHR Foundation | |
|---|---|
The openEHR Foundation is an independent, non-profit foundation, facilitating the sharing of health records by consumers and clinicians via open specifications, clinical models and open platform implementations. |
|
Licence |
|
Support |
Issues: Problem Reports |
Amendment Record
| Issue | Details | Raiser | Completed |
|---|---|---|---|
PROC Release 1.5.0 |
|||
PROC Release 1.0.0 |
|||
Update perinatal care DLM. |
D S Alves |
||
0.1.1 |
Replace 'manual notification' callback by normal Handoff followed by manual notification Task wait state. |
M Polajnar, |
16 Apr 2020 |
0.1.0 |
Initial writing. |
T Beale, |
25 Apr 2019 |
Acknowledgements
1. Preface
1.1. Purpose
This document contains elaborated examples of the openEHR Process framework, including Task Plans and Decision Logic Modules, with diagrams in TP-VML.
The intended audience includes:
-
Plan and Guideline authors;
-
Tool vendors.
1.3. Status
This specification is in the DEVELOPMENT state. The development version of this document can be found at https://specifications.openehr.org/releases/PROC/latest/process_examples.html.
Known omissions or questions are indicated in the text with a 'to be determined' paragraph, as follows:
TBD: (example To Be Determined paragraph)
1.4. Feedback
Feedback may be provided on the process specifications forum.
Issues may be raised on the specifications Problem Report tracker.
To see changes made due to previously reported issues, see the PROC component Change Request tracker.
2. Overview
3. Teamwork
The examples in this section illustrate the use of TP for team-based work plans, including hand-offs, callbacks and other kinds of coordination.
3.1. Out-patient Eye Clinic Encounter
This example is based on the original description of DIPS Eye encounter example.
3.1.1. Plan Overview
As for all Plans defined in the Task Planning formalism, it must be remembered that the Plan definition above is what the TP engine executes. It is the result of the execution (including worker allocation and communication, which is not shown in the definition) that causes workers in the real world to do things. Additionally, what the TP engine knows about the real world is limited to what it is told - many actions and events can occur outside the TP computing environment that will remain unknown to the system unless it is informed (e.g. by Manual notification).
The Work Plan consists of two top-level Task Plans, one for the patient and one for the clinic administrator / reception. The latter has two sub-plans linked by hand-off Tasks.
The purpose of the patient top-level Task Plan is to allow the system to notify the patient of the visit, via a reminder on the day of the visit, or some fixed time beforehand. The driving event is the calendar appointment, which is waited on by both the patient and the clinic admin Task Plans. It is assumed that longer term reminders, opportunities for changing appointments and so on are managed by another system that see the same calendar events, and is responsible for setting the calendar events in the first place. Thus, in the model above, the patient top-level plan is not really necessary (he/she will be notified by the appointment system), and is mainly included for purposes of demonstration.
3.1.2. Detailed Description
The main work of the Work Plan is in the other three Task Plans, which essentially encode the following logic:
Clinic Administrator:
-
clinic has a live Task Plan waiting on appointment A for patient P, at 2019-02-15 09:30:00;
-
when this calendar timepoint is reached, the TP system 'opens' the appointment via a System Request to the clinic appointment system (details not shown);
-
WAIT: the clinic Task Plan enters a new wait state for patient P, for appointment A;
Patient:
-
patient arrives at clinic (modelled as a Manual notification);
Clinic Administrator:
-
receive patient, record presence;
-
Hand-off: pass to consultation (e.g. send to waiting area);
-
WAIT: until manual notification (patient returns)
Nurse:
-
receive patient & check EMR
-
review eye function, decide on whether to send to doc or not:
-
EITHER: return to reception
-
OR: pass to doctor
-
Specialist:
-
receive patient and check EMR
-
perform examination
-
update EMR
-
send patient back to reception.
4. Order Management
The examples in this section illustrate the use of TP for order management, where openEHR Instructions and Actions (or other non-openEHR equivalents) are created and tracked.
4.1. Order Coordination
This example is based on a standard Moscow City clinic protocol, and covers a 12 month period.
4.1.1. Plan Overview
The Work Plan shown above defines the tasks for a 'standard health check' that includes a chest x-ray, a full blood panel and a hypertension checkup. The Plan executes over the periof a year, and consists of a health coordinator creating orders for the three items, via UI forms. The result of creating these orders will be the creation of a normal Composition and Instruction in the openEHR EHR for the patient. At some later point in time, the coordinator will action these orders, which will cause the EHR data to be used to create appropriate API calls / messages to the relevant target systems (radiology clinic, pathology lab, consultant) that will further cause appointments and attendances in the normal way by the patient. Each of these 'execute order' Tasks will block and wait for appropriate callbacks resulting from each of the orders being fulfilled and corresponding Actions being committed to the EHR (or else timeouts, if nothing happens). With the received results, the coordinator creates a health summary for the patient and commits that to the EHR.
5. Multi-drug Chemotherapy
This section illustrates multi-drug chemotherapy with complex dosing and timing arrangements.
This example is based on the version of RCHOPS-21 documented by NHS Thames Valley Cancer Network.
5.1. Limitations
The following elements of the plan are not yet included (mainly for brevity of the example):
-
Vincristine dose modification due to hepatic impairment;
-
Concurrent meds only shown in summarised form;
-
Exception pathways to handle patient reactions not shown.
5.2. Plan Definition
The following shows the pre-medication phase.
The following shows the main regime, including conditional addition of Rituximab / methotrexate for high IPI patients.
5.3. RCHOPS21 Decision Logic Module
dlm RCHOPS21
language
original_language = <[ISO_639-1::en]>
description
lifecycle_state = <"unmanaged">
original_author = <
["name"] = <"Dr Spock">
["organisation"] = <"Acme healthcare">
["date"] = <"2020-03-22">
>
details = <
["en"] = <
language = <[ISO_639-1::en]>
purpose = <"NHS CHOPS-21 chemotherapy guideline ....">
>
>
use
BSA: Body_surface_area
preconditions
has_lymphoma_diagnosis
reference
paracetamol_dose: Quantity = 1g
chlorphenamine_dose: Quantity = 10mg
prednisolone_dose_per_m2: Quantity = 40mg
rituximab_dose_per_m2: Quantity = 375mg
doxorubicin_dose_per_m2: Quantity = 50mg
vincristine_dose_per_m2: Quantity = 1.4mg
cyclophosphamide_dose_per_m2: Quantity = 750mg
cycle_period: Duration = 3w
cycle_repeats: Integer = 6
input -- State
has_lymphoma_diagnosis: Boolean
time_window = tw_current_episode
input -- Tracked state
staging: Terminology_term «ann_arbor_staging»
currency = 30 days
time_window = tw_current_episode
has_metastases: Boolean
currency = 30 days
time_window = tw_current_episode
neutrophils: Quantity
currency = 3d
ranges =
----------------------------------
[normal]: |>1 x 10^9/L|,
[low]: |0.5 - 1 x 10^9/L|,
[very_low]: |<0.5 x 10^9/L|
----------------------------------
;
platelets: Quantity
currency = 12h
ranges =
----------------------------------
[normal]: |>75 x 10^9/L|,
[low]: |50 - 74 x 10^9/L|,
[very_low]: |<50 x 10^9/L|
----------------------------------
;
bilirubin: Quantity
currency = 12h
ranges =
----------------------------------
[normal]: |<20 mmol/L|,
[high]: |20 - 51 mmol/L|,
[very_high]: |51 - 85 mmol/L|,
[crit_high]: |>85 mmol/L|
----------------------------------
;
gfr: Quantity
currency = 24h
ranges =
----------------------------------
[normal]: |>20 mL/min|,
[low]: |10 - 20 mL/min|,
[very_low]: |<10 mL/min|
----------------------------------
;
ldh: Quantity
currency = 24h
ranges =
----------------------------------
[normal]: |>20 mL/min|,
[low]: |10 - 20 mL/min|,
[very_low]: |<10 mL/min|
----------------------------------
;
rules -- Conditions
high_ipi:
Result := ipi_risk ∈ {[ipi_high_risk], [ipi_intermediate_high_risk]}
rules -- Main
|
| patient fit to undertake regime
|
patient_fit:
Result := not
(platelets.in_range ([very_low]) or
neutrophils.in_range ([very_low]))
prednisolone_dose: Quantity
Result := prednisolone_dose_per_m2 * BSA.bsa_m2
rituximab_dose: Quantity
Result := rituximab_dose_per_m2 * BSA.bsa_m2
doxorubicin_dose: Quantity
Result := doxorubicin_dose_per_m2 * BSA.bsa_m2
* case bilirubin.range in
===================
[high]: 0.5,
[very_high]: 0.25,
[crit_high]: 0.0
===================
;
|
| TODO: hepatic impairment dose modification
|
vincristine_dose: Quantity
Result := vincristine_dose_per_m2 * BSA.bsa_m2
|
| CHECK: is low platelets and GFR dose modification
| cumulative?
|
cyclophosphamide_dose: Quantity
Result := cyclophosphamide_dose_per_m2 * BSA.bsa_m2
* case platelets.range in
===================
[normal]: 1,
[low]: 0.75
===================
* case gfr.range in {
===================
[normal]: 1,
[low]: 0.75,
[very_low]: 0.5
===================
;
|
| International Prognostic Index
| ref: https:|en.wikipedia.org/wiki/International_Prognostic_Index
|
| One point is assigned for each of the following risk factors:
| Age greater than 60 years
| Stage III or IV disease
| Elevated serum LDH
| ECOG/Zubrod performance status of 2, 3, or 4
| More than 1 extranodal site
|
| The sum of the points allotted correlates with the following risk groups:
| Low risk (0-1 points) - 5-year survival of 73%
| Low-intermediate risk (2 points) - 5-year survival of 51%
| High-intermediate risk (3 points) - 5-year survival of 43%
| High risk (4-5 points) - 5-year survival of 26%
|
ipi_raw_score: Integer
Result.add (
---------------------------------------------
age > 60 ? 1 : 0,
staging ∈ {[stage_III], [stage_IV]} ? 1 : 0,
ldh.in_range ([normal]) ? 1 : 0,
ecog > 1 ? 1 : 0,
extranodal_sites > 1 ? 1 : 0
---------------------------------------------
)
ipi_risk: Terminology_code
Result :=
case ipi_raw_score in
=======================================
|0..1| : [ipi_low_risk],
|2| : [ipi_intermediate_low_risk],
|3| : [ipi_intermediate_high_risk],
|4..5| : [ipi_high_risk];
=======================================
;
terminology
term_definitions = <
["en"] = <
["paracetamol_dose"] = <
text = <"paracetamol dose">
description = <"paracetamol base dose level per sq. m of BSA">
>
["chlorphenamine_dose"] = <
text = <"chlorphenamine dose">
description = <"chlorphenamine base dose level per sq. m of BSA">
>
...
["staging"] = <
text = <"Cancer staging">
description = <"Cancer staging (Ann Arbor system)">
>
["has_metastases"] = <
text = <"Metastatic status">
description = <"Status of metastasis of cancer">
>
...
["neutrophils"] = <
text = <"neutrophils">
description = <"neutrophils level">
>
["platelets"] = <
text = <"platelets">
description = <"platelets level">
>
...
["ipi_low_risk"] = <
text = <"low risk: 5y survival - 73%">
description = <"..">
>
["ipi_intermediate_low_risk"] = <
text = <"intermediate-low risk: 5y survival - 51%">
description = <"..">
>
["ipi_intermediate_high_risk"] = <
text = <"intermediate-high risk: 5y survival - 43%">
description = <"...">
>
["ipi_high_risk"] = <
text = <"high risk: 5y survival - 26%">
description = <"...">
>
>
>
6. Antenatal Care
The following pregnancy care DLM was developed by Danielle S Alves (RN, midwife) as part of her PhD thesis at Federal University of Pernambuco (UFPE), Brazil.
6.1. Work Plan
The following Work Plan is the standard risk assessment for an antenatal visit.
6.2. Pregnancy Risk Assessment DLM
dlm ruleset Obstetric_pregnancy
preconditions
is_pregnant
types
Risk_value ::= Ordinal
map =
-------------------
[emergency]: 2,
[high_risk]: 1,
[low_risk]: 0
-------------------
;
input -- State
is_type1_diabetic: Boolean
previous_obstetric_hypertension: Boolean
previous_pre_eclampsia: Boolean
previous_eclampsia: Boolean
previous_gestational_diabetes: Boolean
family_history_of_diabetes: Boolean
race_related_diabetes_risk: Boolean
|
| Macrosomic baby from any previous pregnancy
|
previous_macrosomic_baby: Boolean
is_pregnant: Boolean
has_gestational_diabetes: Boolean
has_pregnancy_hypertension: Boolean
has_pre_eclampsia: Boolean
has_eclampsia: Boolean
has_anaemia_of_pregnancy: Boolean
input -- Tracked State
bmi: Quantity
currency = 30d
ranges =
------------------------------------
[high]: |>30 kg/m^2|,
[normal]: |>=15 .. <= 30 kg/m^2|,
[low]: |< 15 kg/m^2|
------------------------------------
;
|
| Possible values:
| |premature rupture|,
| |polyhydramnios|, |oligohydramnios|,
| |severe polyhydramnios|, |severe oligohydramnios|
|
amniotic_fluid_state: Terminology_term
currency = 24h
uterine_fundal_height: Quantity
currency = 24h
vaginal_blood_flow: Quantity
currency = 30mins
ranges =
[critical_high]: |> 500 mL/hr|
|
| Assessment of vaginal bleeding, pain, confirm
| with ultrasound. Result value-set includes
| |placenta previa|, |risk of miscarriage|,
| |ectopic pregnancy| etc
|
vaginal_physical_exam_assessment: Terminology_term
currency = 48h
vomiting_assessment: Terminology_term
currency = 48h
ultrasound_finding: Terminology_term
currency = 48h
amniotic_volume: Real
currency = 24h
ranges =
------------------------------------
[polyhydramnios]: |> 14|,
[normal]: |>= 5 .. <= 14|,
[oligohydramnios]: |< 5|
------------------------------------
;
labour_onset_assessment: Terminology_term
currency = 24h
rules
|
| Possible values:
| |excluded|, |anaemia of pregnancy|
|
anaemia_type: Terminology_term
Result := not has_anaemia_of_pregnancy ? [excluded] : [anaemia_of_pregnancy]
|
| Return the highest level risk of any of the
| assessed risks
|
effective_risk: Risk_value
Result := Result.max ({fundal_height_related_risk,
amniotic_fluid_risk,
vaginal_bleeding_related_risk,
hypertension_risk,
hyperemesis_related_risk,
gestational_diabetes_risk,
anaemia_risk})
;
ultrasound_required: Boolean
Result := fundal_height_related_risk != [low_risk] or
amniotic_fluid_risk != [low_risk] or
vaginal_bleeding_related_risk != [low_risk]
anaemia_risk: Risk_value
Result := case anaemia_type in
============================================
[severe_anaemia_of_pregnancy]: [emergency],
--------------------------------------------
[anaemia_of_pregnancy]: [high_risk],
--------------------------------------------
*: [low_risk]
============================================
;
fundal_height_related_risk: Risk_value
Result := case ultrasound_finding in
=================================================
[interuterine_growth_retardation],
[multiple_pregnancy],
[macrosomia]: [high_risk],
-------------------------------------------------
*: [low_risk]
=================================================
;
amniotic_fluid_risk: Risk_value
Result := case amniotic_fluid_state in
=========================================
[premature_rupture],
[severe_oligohydramnios],
[severe_polyhydramnios]: [emergency],
-----------------------------------------
[polyhydramnios],
[oligohydramnios]: [high_risk],
-----------------------------------------
*: [low_risk]
=========================================
;
vaginal_bleeding_related_risk: Risk_value
Result := case vaginal_physical_exam_assessment in
=================================================
[ectopic_pregnancy],
[gestational_trophoblastic_disease]: [emergency],
-------------------------------------------------
[placenta_previa],
[risk_of_miscarriage]: [high_risk],
-------------------------------------------------
*: [low_risk]
=================================================
;
gestational_diabetes_risk: Risk_value
Result := choice of
=================================================
bmi.in_range ([high]) or
previous_macrosomic_baby or
previous_gestational_diabetes or
family_history_of_diabetes or
race_related_diabetes_risk or
has_gestational_diabetes or
is_type1_diabetic: [high_risk],
-------------------------------------------------
*: [low_risk]
=================================================
;
hypertension_risk: Risk_value
Result := choice of
=================================================
has_pre_eclampsia or
has_eclampsia: [emergency],
-------------------------------------------------
previous_obstetric_hypertension or
previous_pre_eclampsia or
previous_eclampsia or
has_pregnancy_hypertension: [high_risk],
-------------------------------------------------
*: [low_risk]
=================================================
;
labour_onset_pathway: Terminology
Result := case labour_onset_assessment in
====================================
[placental_abruption],
[premature_labour]: [emergency],
------------------------------------
[onset_of_labour],
[labour_first_stage]: [maternity],
------------------------------------
*: [observation]
====================================
;
terminology
term_definitions = <
["en"] = <
["low_risk"] = <
text = <"Normal obstetric care">
description = <"...">
>
["emergency"] = <
text = <"Obstetric emergency">
description = <"...">
>
["high_risk"] = <
text = <"Refer to high risk care">
description = <"...">
>
["premature_rupture"] = <
text = <"Premature rupture of membranes">
description = <"...">
>
["polyhydramnios"] = <
text = <"polyhydramnios">
description = <"...">
>
["oligohydramnios"] = <
text = <"oligohydramnios">
description = <"...">
>
["severe polyhydramnios"] = <
text = <"severe polyhydramnios">
description = <"...">
>
["severe oligohydramnios"] = <
text = <"severe oligohydramnios">
description = <"...">
>
["severe_anaemia_of_pregnancy"] = <
text = <"anaemia of pregnancy, severe">
description = <"...">
>
["anaemia_of_pregnancy"] = <
text = <"anaemia of pregnancy">
description = <"...">
>
["amniotic_fluid_risk"] = <
text = <"Risk of pregnancy-related amniotic fluid">
description = <"...">
>
["hypertension_risk"] = <
text = <"Risk of pregnancy-related hypertension">
description = <"...">
>
["diabetes_risk"] = <
text = <"Risk of pregnancy-related diabetes">
description = <"...">
>
["anaemia_risk"] = <
text = <"Risk of pregnancy-related anaemia">
description = <"...">
>
["previous_macrosomic_baby"] = <
text = <"Baby weighing 4.5kg or above">
description = <"...">
>
["previous_gestational_diabetes"] = <
text = <"xxx">
description = <"...">
>
["ectopic_pregnancy"] = <
text = <"Ectopic pregnancy">
description = <"...">
>
["gestational_trophoblastic_disease"] = <
text = <"Gestational trophoblastic disease">
description = <"...">
>
["previous_macrosomic_baby"] = <
text = <"Baby weighing 4.5kg or above">
description = <"...">
>
["previous_gestational_diabetes"] = <
text = <"xxx">
description = <"...">
>
>
>
7. Breast Cancer Decision Protocol
7.1. Decision Logic Module
dlm guideline Oncology_breast_cancer.v0.5.0
input -- State
has_heart_failure_class_II: Boolean
has_heart_failure_class_III: Boolean
has_heart_failure_class_IV: Boolean
has_allergy_to_taxanes: Boolean
input -- Tracked State
tnm_t: String
currency = 60 days
tnm_n: String
currency = 60 days
tnm_m: String
currency = 60 days
tnm_g: String
currency = 60 days
estrogen_receptor: Terminology_term «pos_neg_vs»
currency = 60 days
progesterone_receptor: Terminology_term «pos_neg_vs»
currency = 60 days
her2_expression: Terminology_term «pos_neg_vs»
currency = 60 days
ki67: Quantity
currency = 60 days
ranges =
-------------------
[high]: |>= 14%|,
[normal]: |< 14%|
-------------------
;
ejection_fraction: Quantity
currency = 60 days
ranges =
--------------------
[normal]: |>= 40%|,
[low] : |< 40%|
--------------------
;
rules -- Conditions
er_negative:
Result := estrogen_receptor = [negative]
er_positive:
Result := estrogen_receptor = [positive]
pr_negative:
Result := progesterone_receptor = [negative]
pr_positive:
Result := progesterone_receptor = [positive]
her2_negative:
Result := her2_expression = [negative]
her2_positive:
Result := her2_expression = [positive]
has_non_class_I_heart_failure:
Result := has_heart_failure_class_II
or has_heart_failure_class_III
or has_heart_failure_class_IV
anthracyclines_contraindicated:
Result := has_transmural_MI
or ejection_fraction.in_range ([low])
or has_non_class_I_heart_failure
taxanes_contraindicated:
Result := is_type1_diabetic
or has_allergy_to_taxanes
or has_intolerance ([taxanes])
rules -- Guideline
molecular_subtype: Terminology_term
Result :=
choice of
=========================================================
er_positive and
her2_negative and
not ki67.in_range ([high]): [luminal_A],
---------------------------------------------------------
er_positive and
her2_negative and
ki67.in_range ([high]): [luminal_B_HER2_negative],
---------------------------------------------------------
er_positive and
her2_positive: [luminal_B_HER2_positive],
---------------------------------------------------------
er_negative and
pr_negative and
her2_positive and
ki67.in_range ([high]): [HER2],
---------------------------------------------------------
er_negative and
pr_negative and
her2_negative and
ki67.in_range ([high]): [triple_negative],
---------------------------------------------------------
*: [none];
=========================================================
;
chemotherapy_regime: Terminology_term
Result :=
choice of
================================================================================
not metastatic:
choice of
========================================================================
molecular_subtype in
{[luminal_B_HER2_negative],
[triple_negative]} and
(tnm_t > '1a' or tnm_n > '0'): [taxanes],
------------------------------------------------------------------------
molecular_subtype = [luminal_A] and
(tnm_t >= '3' or tnm_n >= '2' or tnm_g >= '3'): [anthracyclines],
------------------------------------------------------------------------
molecular_subtype = [luminal_B_HER2_positive] and
(tnm_t = '1b' or tnm_t = '1c' and tnm_n = '0') or
molecular_subtype = [HER2_positive] and
(tnm_t = '1b' and tnm_n = '0'): [paditaxel_trastuzumab]
========================================================================
;,
--------------------------------------------------------------------------------
*:
choice of
=====================
yyy: aaa,
---------------------
xxx: bbb,
---------------------
*: ccc
=====================
;
=================================================================================
;
terminology
term_definitions = <
["en"] = <
["luminal_A"] = <
text = <"xxx">
description = <"...">
>
["luminal_B_HER2_positive"] = <
text = <"xxx">
description = <"...">
>
["luminal_B_HER2_negative"] = <
text = <"xxx">
description = <"...">
>
["HER2_positive"] = <
text = <"xxx">
description = <"...">
>
["HER2_megative"] = <
text = <"xxx">
description = <"...">
>
["triple_negative"] = <
text = <"xxx">
description = <"...">
>
["oligohydramnios"] = <
text = <"xxx">
description = <"...">
>
8. Covid19 Severity Classification
This guideline is a formal expression of the American College of Emergency Physicians (ACEP) Covid19 Severity Classification tool and as an Interactive tool.
8.1. Work Plan
The following work plan is a rendition of the ACEP Covid19 severity guideline multi-step structure.
8.2. Decision Logic Module
dlm ACEP_COVID19_severity_classification.v0.5.0
language
original_language = <[ISO_639-1::en]>
description
lifecycle_state = <"unmanaged">
original_author = <
["name"] = <"Thomas Beale">
["email"] = <"thomas.beale@openEHR.org">
["organisation"] = <"openEHR Foundation <http://www.openEHR.org>">
["date"] = <"2020-12-02">
>
details = <
["en"] = <
language = <[ISO_639-1::en]>
purpose = <"This tool was developed by ACEP and EvidenceCare to assist
in determining the appropriate evaluation and disposition for adult
patients with suspected or confirmed COVID-19.">
>
>
copyright = <"© 2020 openEHR Foundation">
licence = <"Creative Commons CC-BY <https://creativecommons.org/licenses/by/3.0/>">
ip_acknowledgements = <
["ACEP_EvidenceCare"] = <"This content developed from original publication of
© 2020 American College of Emergency Physicians (ACEP), EvidenceCare,
see https://www.acep.org/globalassets/sites/acep/media/covid-19-main/acep_evidencecare_covid19severitytool.pdf">
>
use
BASIC: Basic_patient_data
BMI: Body_mass_index
input -- Administrative
is_LT_care_resident: Boolean
;
input -- State
|
| Extract from master problem list or ask patient
|
has_cardiovascular_disease: Boolean
;
|
| Extract from master problem list or ask patient
|
has cerebrovascular_disease: Boolean
;
|
| Extract from master problem list or ask patient
|
has_COPD: Boolean
;
|
| Extract from master problem list or ask patient
|
is_type_2_diabetic: Boolean
;
|
| Extract from master problem list or ask patient
|
has_hypertension: Boolean
;
|
| True if any cancer diagnosis on master problem list
| or ask patient
|
has_malignancy: Boolean
;
input -- Tracked State
heart_rate: Count
currency = 1 min
ranges =
------------------------------------
[mild_low_risk]: |<= 99 /min|,
[mild_at_risk]: |100 .. 120 /min|,
[moderate_risk]: |>= 121 /min|
------------------------------------
;
systolic_BP: Quantity
currency = 10 min
ranges =
--------------------------------
[critical_risk]: |< 90 mm[Hg]|,
[normal_risk]: |>= 90 mm[Hg]|
--------------------------------
;
|
| Minimum documented within last 8 hrs
|
lowest_SpO2: Quantity
currency = 8 hr
ranges =
------------------------------
[mild_low_risk]: |>= 93 %|,
[moderate_risk]: |89 .. 92 %|,
[severe_risk]: |<= 88 %|
------------------------------
;
respiratory_rate: Quantity
currency = 2 min
ranges =
----------------------------------
[mild_low_risk]: |<= 22 /min|,
[moderate_risk]: |23 .. 28 /min|,
[severe_risk]: |>= 29 /min|
----------------------------------
;
O2_flow_rate: Quantity
currency = 2 min
ranges =
---------------------------------
[mild_low_risk]: |= 0 L/min|,
[mild_at_risk]: |1 .. 2 L/min|,
[moderate_risk]: |3 .. 4 L/min|,
[severe_risk]: |>= 5 L/min|
---------------------------------
;
has_altered_LOC: Boolean
currency = 5 min
;
has_hemoptysis: Boolean
currency = 5 min
;
has_persistent_dyspnea: Boolean
currency = 5 min
;
|
| Reference SpO2 for exertional test: a 1-minute sit-to-stand
| test can be performed within the patient’s room.
| With this, they sit and stand as many as they can over the
| course of 1 minute.
| * A 3% drop in pulse oximeter reading is considered a positive test
|
SpO2_exertion_reference: Quantity
currency = 5 min
;
|
| Post exertion SpO2
|
SpO2_exertion_post: Quantity
currency = 5 min
;
rules
heart_rate_score: Integer
Result := case heart_rate in
=====================
*: 0
=====================
;
systolic_BP_score: Integer
Result := case systolic_BP in
=====================
*: 0
=====================
;
SpO2_score: Integer
Result := case lowest_SpO2 in
=====================
[mild_low_risk]: 0,
---------------------
[moderate_risk]: 2,
---------------------
[severe_risk]: 5,
---------------------
*: 0
=====================
;
respiratory_rate_score: Integer
Result := case respiratory_rate in
=====================
[mild_low_risk]: 0,
---------------------
[mild_at_risk]: 1,
---------------------
[moderate_risk]: 2,
---------------------
*: 0
=====================
;
O2_flow_rate_score: Integer
Result := case O2_flow_rate in
=====================
[mild_low_risk],
[mild_at_risk]: 0,
---------------------
[moderate_risk]: 4,
---------------------
[severe_risk]: 5,
---------------------
*: 0
=====================
;
|
| Compute the qCSI score from vital signs sub-scores
|
qCSI_score: Integer
Result := heart_rate_score +
systolic_BP_score +
SpO2_score +
respiratory_rate_score +
O2_flow_rate_score
;
|
| ACEP step 2 assessment
|
qCSI_risk: Terminology_code
Result := case qCSI_score in
============================
0: [mild_low_risk],
----------------------------
|1..2|: [mild_at_risk],
----------------------------
|3..5|: [moderate_risk],
----------------------------
|6..8|: [severe_risk],
----------------------------
|>= 9|: [critical_risk]
============================
;
|
| Count demographic related risk factors
|
risk_factors_demographic_count: Integer
Result.add (
------------------------------------
BASIC.sex = [male] ? 1 : 0,
BASIC.age > 60 ? 1 : 0,
BASIC.race = [black_race] ? 1 : 0
------------------------------------
);
|
| Count medical / history related risk factors
|
risk_factors_medical_count: Integer
Result.add (
--------------------------------------
has_cardiovascular_disease ? 1 : 0,
has cerebrovascular_disease ? 1 : 0,
has_COPD ? 1 : 0,
is_type_2_diabetic ? 1 : 0,
has_hypertension ? 1 : 0,
has_malignancy ? 1 : 0,
BMI.bmi > 30 ? 1 : 0,
has_renal_disease ? 1 : 0
--------------------------------------
);
|
| Total pre-existing risk factors count
|
risk_factors_count: Integer
Result := risk_factors_demographic_count +
risk_factors_medical_count
;
|
| ACEP step 3 assessment
| NB: must be assessed in highest -> lowest order
|
symptoms_related_risk: Terminology_code
Result := choice of
====================================================
has_altered_LOC: [critical_risk],
----------------------------------------------------
has_hemoptysis: [severe_risk],
----------------------------------------------------
has_persistent_dyspnea or
is_LT_care_resident: [moderate_risk],
----------------------------------------------------
risk_factors_count ∈ {|>= 2|}: [mild_at_risk],
----------------------------------------------------
risk_factors_count ∈ {|0..1|}: [mild_low_risk]
====================================================
;
|
| Discharge home rule based on various criteria
|
can_discharge: Boolean
Result :=
qCSI_risk = [mild_low_risk] and
symptoms_related_risk = [mild_low_risk] and
exertional_SpO2_drop = [normal] and
TO BE COMPLETED
;
|
| Generate a % drop in SpO2 over 1 min sit/stand exertion test;
| NB: A fall in SpO2 generates a +ve result value.
|
exertional_SpO2_drop: Quantity
Result := (SpO2_exertion_reference - SpO2_exertion_post)/SpO2_exertion_reference * 100
;
exertional_SpO2_result: Terminology_code
Result := case exertional_SpO2_drop in
========================
|< 3%|: [normal],
------------------------
|>= 3%|: [mild_at_risk]
========================
;