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Rajib Sengupta
May 14, 2012, 1:38:44 PM5/14/12
to implem...@openmrs.org
Hello All,
For all our implementation we are starting with the MVP dictionary and building on top of it .
Currently, we are implementing for an Oncology Hospital and we are adding several new concepts - we believe some other implementations may have done it already.
In one of the implementer's forum or university forum someone mentioned about PIH that they have built an oncology specific concept dictionary. I searched it in wiki but didn't find one. It will be great if PIH or any other oncology implementation can share their oncology specific concept dictionary
Thanks,
Rajib
Rajib Sengupta
May 14, 2012, 3:02:21 PM5/14/12
to implem...@openmrs.org
Sure. I will be able to send over the complete mapped out forms by this weekend.
Hee are few examples:
Say for "Breast" examination some of the concepts
|
Age at Childbirth |
Number | ||
| Hormanal Agent Use | Boolean | ||
| Hormanal Agent Detail | free form text | ||
| ER | "+ or -" | ||
| PR | "+ or -" | ||
| Her2neu | "+ or -" |
Then the actual location of the node and each of them should have the following characteristics -
Left Axilla -size,site,fixity,skin involvement,chest wall fixity, peu d' orange, comment
Left SCLN -size,site,fixity,skin involvement,chest wall fixity, peu d' orange, comment
Right Axilla - size,site,fixity,skin involvement,chest wall fixity, peu d' orange, comment
Left Axilla - size,site,fixity,skin involvement,chest wall fixity, peu d' orange, comment
Or for CNS/PNS examination
| CNS & PNS | Info | GCS | Number | Range 3 to 15 | ||
| Info | Raised ICT? | Yes/No | boolean | Yes/No | ||
| Info | Cognitive Impairement? | Yes/No | boolean | Yes/No | ||
| Info | Urinary Incontinence? | Yes/No | boolean | Yes/No | ||
| Info | Fecal Incontinence | Yes/No | boolean | Yes/No | ||
| Tone Table | R-Arm Tone | List | Increase/Decrease/Normal | |||
| Tone Table | L-Arm Tone | List | Increase/Decrease/Normal | |||
| Tone Table | L-Leg Tone | List | Increase/Decrease/Normal | |||
| Tone Table | R-Leg Tone | List | Increase/Decrease/Normal | |||
| Power Table | L-Arm Power | Numeric | Power - (0 to 5) | |||
| Power Table | R-leg Power | Numeric | Power - (0 to 5) | |||
| Power Table | R-Arm Power | Numeric | Power - (0 to 5) | |||
| Power Table | L-Leg Power | Numeric | Power - (0 to 5) | |||
| Reflex Table | R-Bicep-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Tricep-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Bicep-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Tricep-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | Leg Reflex table | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Knee-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Ankle-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Plantar-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Knee-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Ankle-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Plantar-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | Leg Reflex table | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Knee-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Ankle-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | R-Plantar-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Knee-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Ankle-Reflex | List | Normal/Brisk/Depressed | |||
| Reflex Table | L-Plantar-Reflex | List | Normal/Brisk/Depressed |
It is getting really complicated as we are trying to codify all the concepts from the current system which is basically free form text. The above are the few ones which we have been able to codify easily (though after few a month of tug-of-war with the doctors - they obviously wants just free form text :-) ). there are several more which we like to codify but without any existing exhaustive code/list, it seems we have to go back to the free form text entry.
Also, want to let you guys know the other issue that we are facing with openmrs implementation in oncology specific install is lack of drawing/pictures in openmrs.
A picture with the node location says a lot. Converting the location to a code is a very difficult proposition - and in data entry time it is a nightmare. Not sure if any other oncology implementation also have faced it or not - but this is the reason, we are eagerly waiting for two of the GSOC projects (upload image/file and/or natomical drawing)
Thanks,
Rajib
From: Michael Seaton <mse...@PIH.ORG>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 2:18 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 2:18 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Hi Rajib,
Thanks for reaching out. Do you have any specifications you can share as to what you are trying to do with your Oncology system?
We are in the process of working on our Oncology Concepts, and that work is still ongoing. I expect that we will be working closely with Andy Kanter's team working on CIEL / Maternal Concept Lab to come to consensus on Concepts and to publish them there. This would likely be the preferred way for us to share Concepts. I think we will likely have something to share within the next month or two.
Cheers,
Mike
Thanks for reaching out. Do you have any specifications you can share as to what you are trying to do with your Oncology system?
We are in the process of working on our Oncology Concepts, and that work is still ongoing. I expect that we will be working closely with Andy Kanter's team working on CIEL / Maternal Concept Lab to come to consensus on Concepts and to publish them there. This would likely be the preferred way for us to share Concepts. I think we will likely have something to share within the next month or two.
Cheers,
Mike
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Joaquín Blaya
May 15, 2012, 10:46:12 AM5/15/12
to implem...@openmrs.org
Andy and I are also working on a wiki page to describe how this collaboration would work. It's at https://wiki.openmrs.org/display/docs/Getting+and+using+the+MVP-CIEL+concept+dictionary and it's still a work in progress, but feel free to add comments or questions you might have in there.
Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems
Research Fellow, Escuela de Medicina de Harvard
Moderador, GHDOnline.org
Joaquín
___________________________________________________________________
Gerente de Desarrollo, eHealth Systems
Research Fellow, Escuela de Medicina de Harvard
Moderador, GHDOnline.org
On Tue, May 15, 2012 at 10:15 AM, Andrew Kanter <andy_...@yahoo.com> wrote:
Rajib,Just to be clear... I don't think you want to "build on top of" the CIEL/MVP dictionary... rather you want to work with us to include new concepts in the dictionary. If you add your own concepts to the dictionary you will no longer benefit from the standard maps, updates, and services that we provide through the standard dictionary. I would like to work with you on new concepts that are required and ensure that they work for the community in general, fit editorial policies and have proper maps to references, etc.Look forward to working with you,Andy--------------------
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical EpidemiologyColumbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 1:38 PM
Subject: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
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Rajib Sengupta
May 15, 2012, 11:12:17 AM5/15/12
to implem...@openmrs.org
trying to send my email again with the attachment as zipped file below 1 MB limit: -
==============================
Understood.
The only issue is we have to implement this by this month. So any help that you guys can provide to create these new concepts will be really appreciated.
Here is the paper form that we are trying to codify and implement in OpenMRS. Let me know what will be the best way to move forward.
Thanks,
Rajib
Rajib Sengupta
May 15, 2012, 2:03:33 PM5/15/12
to implem...@openmrs.org
Understood.
The only issue is we have to implement this by this month. So any help that you guys can provide from the community to move forward, will be really appreciated.
Here is the paper form that we are trying to codify and implement in OpenMRS. Let me know what will be the best way to move forward.
From: Andrew Kanter <andy_...@yahoo.com>
To: Rajib Sengupta <raji...@yahoo.com>; "openmrs-i...@LISTSERV.IUPUI.EDU" <openmrs-i...@LISTSERV.IUPUI.EDU>
Sent: Tuesday, May 15, 2012 10:15 AM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
To: Rajib Sengupta <raji...@yahoo.com>; "openmrs-i...@LISTSERV.IUPUI.EDU" <openmrs-i...@LISTSERV.IUPUI.EDU>
Sent: Tuesday, May 15, 2012 10:15 AM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Rajib,
Just to be clear... I don't think you want to "build on top of" the CIEL/MVP dictionary... rather you want to work with us to include new concepts in the dictionary. If you add your own concepts to the dictionary you will no longer benefit from the standard maps, updates, and services that we provide through the standard dictionary. I would like to work with you on new concepts that are required and ensure that they work for the community in general, fit editorial policies and have proper maps to references, etc.
Look forward to working with you,
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 1:38 PM
Subject: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Andrew Kanter
May 15, 2012, 3:02:00 PM5/15/12
to Rajib Sengupta, implem...@openmrs.org
Sorry that I can't seem to view this form. Can you please just email it to me? I have some ideas for you based on the information already provided in your last email...
One key for things like physical exam is not to build specific buckets for each pre-coordinated combination of findings. I think you want to identify a location and then findings in a particular array... such as
Body part | Laterality | Tone
Arm | Left | Normal/Increased/Decreased
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Sent: Tuesday, May 15, 2012 2:03 PM
Subject: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Rajib Sengupta
May 22, 2012, 12:38:12 AM5/22/12
to Andrew Kanter, implem...@openmrs.org
Andy,
I have a basic question on concept creation:
Here is a part from the paper form which shows the nodes examination in the Neck area.
| Left Neck Node | Length (cm) |
Breadth (cm) |
Number of Nodes |
Mobility of Nodes (Fixed/Mobile) |
Consistency of Nodes (Hard/Soft/Rubbery/Matted) |
Other Char of Nodes (Text) |
| Level IA | ||||||
| Level IB | ||||||
| Level IV | ||||||
| Level VA | ||||||
| Level VB | ||||||
| Level VI | ||||||
| Right Neck Node | Length (cm) |
Breadth (cm) |
Number of Nodes |
Mobility of Nodes (Fixed/Mobile) |
Consistency of Nodes (Hard/Soft/Rubbery/Matted) |
Other Char of Nodes (Text) |
| Level IA | ||||||
| Level IB | ||||||
| Level IIA | ||||||
| Level IIB | ||||||
| Level IV | ||||||
| Level VA |
I was thinking of the following two options for the concepts - Which one you think will be better?
Option 1:
| Concept | DataType | Answers |
| Node Site at Neck Level | Coded | IA,IB,IIA,IIB,III,IV,VA,VB, VI |
| Node Length(cm) | Numeric | |
| Node Breadth(cm) | Numeric | |
| Number of Nodes | Numeric | 1/2/3/4 etc |
| Mobility of Node | Coded | Mobile/Fixed |
| Consistency of Node | Coded | Hard/Soft/Rubbery/Matted |
| Other Char of Node | Text | Free form text |
Then in the form create two tables one for "Left Neck" and one for "Right Neck".
Option 2:
| Concept | DataType | Answers |
| Body Part | Coded | Neck Level IA Neck Level IB Neck Level IIA Neck Level IIB Neck Level III Neck Level IV Neck Level VA Neck Level VB Neck Level VI and others (Arms/Legs etc) |
| Laterality | Coded | Left/Right |
| Node Length(cm) | Numeric | |
| Node Breadth(cm) | Numeric | |
| Number of Nodes | Numeric | 1/2/3/4 etc |
| Mobility of Node | Coded | Mobile/Fixed |
| Consistency of Node | Coded | Hard/Soft/Rubbery/Matted |
| Other Char of Node | Text | Free form text |
Then in the form two tables will be created - the body part and laterality will be hardcoded (or will be only one value) -
One with Laterailty Left and the Body Parts for all the neck level and the other one will be laterailty right with all the neck level
Thanks,
Rajib
From: Andrew Kanter <andy_...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Tuesday, May 15, 2012 3:02 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Tuesday, May 15, 2012 3:02 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Sorry that I can't seem to view this form. Can you please just email it to me? I have some ideas for you based on the information already provided in your last email...
One key for things like physical exam is not to build specific buckets for each pre-coordinated combination of findings. I think you want to identify a location and then findings in a particular array... such as
Body part | Laterality | Tone
Arm | Left | Normal/Increased/Decreased
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Andrew Kanter
May 22, 2012, 1:46:52 PM5/22/12
to Rajib Sengupta, implem...@openmrs.org
Rajib,
I think this is basically a good approach. The idea is not to create duplicate concepts that have to be used over and over. The layout you have described is correct. The only question is whether the anatomical location is sufficient. For example, Neck Level IIA implies the neck, so all you really need to do is supply laterality. You could do this by adding a laterality dropdown with left/right/bilateral in it and then you only need one table. If you have two tables for form design purposes, just default laterality to left or right and make it readonly or hidden.
I have added all the neck regions to the dictionary. I will add the other concepts below and let you and MCL know when the new version is in the
dropbox.
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
From: Rajib Sengupta <raji...@yahoo.com>
To: Andrew Kanter <andy_...@yahoo.com>
Cc: "implem...@openmrs.org" <implem...@openmrs.org>
Sent: Tuesday, May 22, 2012 12:38 AM
Rajib Sengupta
May 22, 2012, 2:29:55 PM5/22/12
to Andrew Kanter, implem...@openmrs.org
So, If I understand correctly you are preferring option 2 instead of 1- Please confirm
Option 2:
| Concept | DataType | Answers |
| Body Part | Coded | Neck Level IA Neck Level IB Neck Level IIA Neck Level IIB Neck Level III Neck Level IV Neck Level VA Neck Level VB Neck Level VI and others (Arms/Legs etc) |
| Laterality | Coded | Left/Right |
==================================================================
Now building on this, I am trying to create the concepts of the other part of the forms. Please let me know if this is the correct approach.
A) Breast Node exam . This is the paper form
| Left Breast | Node Length(cm) | Node Breadth(cm) | Fixity | Skin Involvement |
Chest Wall Fixity |
Peu D' orange |
| Upper inner Quadrant | ||||||
| Upper outer Quadrant | ||||||
| Lower inner Quadrant | ||||||
| Upper outer Quadrant | ||||||
| Areoala/Central | ||||||
| Right Breast | Node Length(cm) | Node Breadth(cm) | Fixity | Skin Involvement |
Chest Wall Fixity |
Peu D' orange |
| Upper inner Quadrant | ||||||
| Upper outer Quadrant | ||||||
| Lower inner Quadrant | ||||||
| Upper outer Quadrant | ||||||
| Areoala/Central |
B) CNS & PNS exam . Here is the paper form
| Left Arm/Leg | Tone | Power | Reflex |
| Arm | |||
| Leg | |||
| Bicep | |||
| Tricep | |||
| Knee | |||
| Ankle | |||
| Plantar | |||
| Right Arm/Leg | Tone | Power | Reflex |
| Arm | |||
| Leg | |||
| Bicep | |||
| Tricep | |||
| Knee | |||
| Ankle | |||
| Plantar |
So basically we will be able to use the Body Part concept as is and going by option 2 as above the new concepts with answers will be
| Concept | DataType | Answers |
| Body Part | Coded |
| Neck Level IA Neck Level IB Neck Level IIA Neck Level IIB Neck Level III Neck Level IV Neck Level VA Neck Level VB Neck Level VI |
| Upper inner Quadrant of Breast Upper outer Quadrant of Breast Lower inner Quadrant of Breast Upper outer Quadrant of Breast Areoala of Breast Arm Leg Bicep Tricep Knee Ankle Plantar | ||
| Laterality | Coded | Left/Right/Center/Bilateral |
| Node Length(cm) | Numeric | |
| Node Breadth(cm) | Numeric | |
| Number of Nodes | Numeric | 1/2/3/4 etc |
| Mobility of Node | Coded | Mobile/Fixed |
| Consistency of Node | Coded | Hard/Soft/Rubbery/Matted |
| Other Char of Node | Text | Free form text |
| Fixity | List | Yes/No/NA |
| Skin Involvement | List | Yes/No/NA |
| Chest Wall Fixity | List | Yes/No/NA |
| Peu D' Orange | List | Yes/No/NA |
| Tone | List | Increase/Decrease/Normal |
| Power | List |
| Power - (0 to 5) |
| Reflex | List | Normal/Brisk/Depressed |
From: Andrew Kanter <andy_...@yahoo.com>
To: Rajib Sengupta <raji...@yahoo.com>
Cc: "implem...@openmrs.org" <implem...@openmrs.org>
Sent: Tuesday, May 22, 2012 1:46 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
To: Rajib Sengupta <raji...@yahoo.com>
Cc: "implem...@openmrs.org" <implem...@openmrs.org>
Sent: Tuesday, May 22, 2012 1:46 PM
Subject: Re: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Rajib,
I think this is basically a good approach. The idea is not to create duplicate concepts that have to be used over and over. The layout you have described is correct. The only question is whether the anatomical location is sufficient. For example, Neck Level IIA implies the neck, so all you really need to do is supply laterality. You could do this by adding a laterality dropdown with left/right/bilateral in it and then you only need one table. If you have two tables for form design purposes, just default laterality to left or right and make it readonly or hidden.
I have added all the neck regions to the dictionary. I will add the other concepts below and let you and MCL know when the new version is in the dropbox.
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia UniversityEmail: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421Office: +1 (212) 305-4842Skype: akanter-ippnwYahoo: andy_kanter
Columbia UniversityEmail: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421Office: +1 (212) 305-4842Skype: akanter-ippnwYahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Tuesday, May 15, 2012 2:03 PM
Subject: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Understood.
The only issue is we have to implement this by this month. So any help that you guys can provide from the community to move forward, will be really appreciated.Here is the paper form that we are trying to codify and implement in OpenMRS. Let me know what will be the best way to move forward.Thanks,Rajib
From: Andrew Kanter <andy_...@yahoo.com>
To: Rajib Sengupta <raji...@yahoo.com>; "openmrs-i...@LISTSERV.IUPUI.EDU" <openmrs-i...@LISTSERV.IUPUI.EDU>
Sent: Tuesday, May 15, 2012 10:15 AM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Rajib,Just to be clear... I don't think you want to "build on top of" the CIEL/MVP dictionary... rather you want to work with us to include new concepts in the dictionary. If you add your own concepts to the dictionary you will no longer benefit from the standard maps, updates, and services that we provide through the standard dictionary. I would like to work with you on new concepts that are required and ensure that they work for the community in general, fit editorial policies and have proper maps to references, etc.Look forward to working with you,Andy--------------------
Andrew S. Kanter, MD MPHAsst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia UniversityEmail: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421Office: +1 (212) 305-4842Skype: akanter-ippnwYahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 1:38 PM
Subject: [OPENMRS-IMPLEMENTERS] Concept Dictionary for OncologyClick here to unsubscribe from OpenMRS Implementers' mailing listHello All,For all our implementation we are starting with the MVP dictionary and building on top of it .Currently, we are implementing for an Oncology Hospital and we are adding several new concepts - we believe some other implementations may have done it already.In one of the implementer's forum or university forum someone mentioned about PIH that they have built an oncology specific concept dictionary. I searched it in wiki but didn't find one. It will be great if PIH or any other oncology implementation can share their oncology specific concept dictionaryThanks,Rajib
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Friedman, Roger (CDC/CGH/DGHA) (CTR)
May 22, 2012, 3:07:05 PM5/22/12
to implem...@openmrs.org
I've been refraining from replying to the HFE discussion of discrete numeric values but will here. How is "number of nodes" used? If you are going to sum the number of nodes from all body parts, or calculate the mean over patients, or something like that, then it should be numeric. If you are really interested in ranges or even specific values (0, 1-3, 4-7, 8, 9+), you should use coded text; you may need to pad with 0s to get things to sort properly (0000-0250,0250-0800,0800-1600,1600+)
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Andrew Kanter
May 22, 2012, 3:22:10 PM5/22/12
to Rajib Sengupta, implem...@openmrs.org
Basically, yes, but the concept in the first variable is location of nodes in neck (level 1a, 1b, etc.) Otherwise there will be too many answers. Also there are some body parts that do not have laterality. Do you have more examples of node locations which need to be modeled?
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
From: Rajib Sengupta <raji...@yahoo.com>
To: Andrew Kanter <andy_...@yahoo.com>
Cc: "implem...@openmrs.org" <implem...@openmrs.org>
Sent: Tuesday, May 22, 2012 2:29 PM
Columbia University Email: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421 Office: +1 (212) 305-4842 Skype: akanter-ippnw Yahoo: andy_kanter
Columbia University Email: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421 Office: +1 (212) 305-4842 Skype: akanter-ippnw Yahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Tuesday, May 15, 2012 2:03 PM
Subject: [OPENMRS-IMPLEMENTERS] Fw: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Understood.
The only issue is we have to implement this by this month. So any help that you guys can provide from the community to move forward, will be really appreciated.Here is the paper form that we are trying to codify and implement in OpenMRS. Let me know what will be the best way to move forward.Thanks,Rajib
From: Andrew Kanter <andy_...@yahoo.com>
To: Rajib Sengupta <raji...@yahoo.com>; "openmrs-i...@LISTSERV.IUPUI.EDU" <openmrs-i...@LISTSERV.IUPUI.EDU>
Sent: Tuesday, May 15, 2012 10:15 AM
Subject: Re: [OPENMRS-IMPLEMENTERS] Concept Dictionary for Oncology
Rajib,Just to be clear... I don't think you want to "build on top of" the CIEL/MVP dictionary... rather you want to work with us to include new concepts in the dictionary. If you add your own concepts to the dictionary you will no longer benefit from the standard maps, updates, and services that we provide through the standard dictionary. I would like to work with you on new concepts that are required and ensure that they work for the community in general, fit editorial policies and have proper maps to references, etc.Look forward to working with you,Andy--------------------
Andrew S. Kanter, MD MPHAsst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University Email: andrew...@dbmi.columbia.edu Mobile: +1 (646) 469-2421 Office: +1 (212) 305-4842 Skype: akanter-ippnw Yahoo: andy_kanter
From: Rajib Sengupta <raji...@YAHOO.COM>
To: openmrs-i...@LISTSERV.IUPUI.EDU
Sent: Monday, May 14, 2012 1:38 PM
Subject: [OPENMRS-IMPLEMENTERS] Concept Dictionary for OncologyClick here to unsubscribe from OpenMRS Implementers' mailing listHello All,For all our implementation we are starting with the MVP dictionary and building on top of it .Currently, we are implementing for an Oncology Hospital and we are adding several new concepts - we believe some other implementations may have done it already.In one of the implementer's forum or university forum someone mentioned about PIH that they have built an oncology specific concept dictionary. I searched it in wiki but didn't find one. It will be great if PIH or any other oncology implementation can share their oncology specific concept dictionaryThanks,Rajib
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Rajib Sengupta
May 22, 2012, 3:38:38 PM5/22/12
to implem...@openmrs.org
Roger,
You are right.
Really the number of nodes is to understand , is it a single node or multiple node at a particular site (say in the Oral Cavity, larynx or say Left Neck LevelIII) rather then the exact number.
So, I think we should make the "Number of Nodes" as a list with singular or multiple - or may be "Multiple Nodes" - yes/no/na
Thanks,
Rajib
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Hannan, Terry J
May 22, 2012, 4:57:01 PM5/22/12
to implem...@openmrs.org, Andrew Kanter
1. Re Staging in Oncology there exist international standards for this -?in coded formats- such as ECOG classifications.
2. “Breast Node exam”: the list is not for “node” it is for the primary tumour site. Again there are well defined and used classifications for this.
3. “CNS & PNS exam . Here is the paper form”-there is no Sensory classification.
Terry Hannan
Dr Terry J. Hannan MBBS;FRACP;FACHI;FACMI
Consultant Physician
Clinical Associate Professor School of Human Health Sciences, University of Tasmania Department of Medicine, Launceston General Hospital
Charles Street Launceston 7250
Past President Australasian College of Health Informatics(2007-9)
Visiting Professor, Universita di Modena, e reggio emelia, Italy (Sept-Nov 2010)
Moderator: http://www.ghdonline.org/
Ph. 61 3 6348 7578
Mob. 0417 144 881
Fax 61 3 6348 7577
Email terry....@dhhs.tas.gov.au
Web/Blog: www.austemrs.com.au
Skype: thehannans
From: implem...@openmrs.org [mailto:implem...@openmrs.org] On Behalf Of Rajib Sengupta
Sent: Wednesday, 23 May 2012 4:30 AM
To: Andrew Kanter
Cc: implem...@openmrs.org
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Rajib Sengupta
May 22, 2012, 11:40:16 PM5/22/12
to implem...@openmrs.org
Terry,
Whether this means you or your team have implemented an OpenMRS system in which these concepts has been created already.
If yes, it will be great if you can share them and/or the concept dictionary with the team. All will be benefitted (at-least we will be immensely benefitted).
Regarding each of the points that you mentioned:
1. For staging we want to include not only ECOG but Karnofsky score and when we deal with Children cancer then Lansky score also . Again if you have created these concepts please share
In the current maternal lab concept lab the Karnofsky score is a numeric value
Our suggestion is as following :
ECOG
| 0 : Fully active, able to carry on all pre-disease performance without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work 2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours 3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours 4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair 5 Dead |
KARNOFSKY
| 100 Normal no complaints; no evidence of disease. 90 Able to carry on normal activity; minor signs or symptoms of disease. 80 Normal activity with effort; some signs or symptoms of disease. 70 Cares for self; unable to carry on normal activity or to do active work. 60 Requires occasional assistance, but is able to care for most of his personal needs. 50 Requires considerable assistance and frequent medical care. 40 Disabled; requires special care and assistance. 30 Severely disabled; hospital admission is indicated although death not imminent. 20 Very sick; hospital admission necessary; active supportive treatment necessary. 10 Moribund; fatal processes progressing rapidly. 0 Dead |
2. This is for any tumour site. Again, if you have the concepts please share
3. CNS & PNS - This is only part of it. There are several other fields that the doctors have in the form including sensory :
| GCS | 3 to 15 |
| Raised ICT? | Yes/No |
| Cognitive Impairement? | Yes/No |
| Urinary Incontinence? | Yes/No |
| Fecal Incontinence | Yes/No |
| Brain | Free form text |
| Spinal Cord | Free form text |
| Cranial Nerves | Free form text |
| Sensory | Free form text |
| Autonomic | Free form text |
| Peripheral Nerves | Free form text |
First, we started to codify them but soon realize that we cannot codify this. So we will just go with free form text instead of creating any concepts.
So, if you have these already codified/classified and concepts in openmrs please share
I think , motto of my email is "can you please share all the classifications that you mentioned below?" for the community
Want to Get Healthy?The Tasmanian Government's Get Healthy Information and Coaching Service(R) provides free information and coaching support to Tasmanian adults who would like to learn healthier eating habits, be more active or achieve and maintain a healthy weight. Call 1300 806 258 between 8am and 8pm, Monday to Friday or visit www.gethealthy.tas.gov.au for more information."CONFIDENTIALITY NOTICE AND DISCLAIMERThe information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or
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Hannan, Terry J
May 22, 2012, 11:52:23 PM5/22/12
to implem...@openmrs.org
Rajib, than you for the notes. I was associated with a dictionary building in an Oncology system 1986-1992, and the early MMRS leading to AMPATH. I personally have not implemented OpenMRS but Paul and Burke took over from MMRS to build that with Hamish after I linked them in 2007. I commented as I thought your Tables/Lists were somewhat complete.
My CONCEPTS of dictionary structures stems from way back. See attached document [personal use only].
I follow the OpenMRS conversations closely but rarely comment.
Terry
Hannan, T.J., et al., The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya. Int J Med Inform, 2000. 60(1): p. 21-8.
2. Hannan, T.J., et al., The MOSORIOT medical record system (MMRS) phase I to phase II implementation: an outpatient computer-based medical record system in rural Kenya. Stud Health Technol Inform, 2001. 84(Pt 1): p. 619-22.
3. Rotich, J.K., et al., Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot Medical Record System. J Am Med Inform Assoc, 2003. 10(4): p. 295-303.
4. Siika, A.M., et al., An electronic medical record system for ambulatory care of HIV-infected patients in Kenya. Int J Med Inform, 2005. 74(5): p. 345-55.
Friedman, Roger (CDC/CGH/DGHA) (CTR)
May 23, 2012, 7:52:20 AM5/23/12
to implem...@openmrs.org
Rajib, perhaps you could help me understand Karnofsky scores. In theory, is the physician supposed to interpolate between the 10 point markers or just use the markers? (e.g. 52 = occasionally can take care of a few of his personal needs) In reality, do physicians interpolate or just use the markers? Is this supposed to be anything but a way of expressing a patient's status, e.g., a way to classify the degree of care in a ward or nursing home?
From: implem...@openmrs.org [mailto:implem...@openmrs.org]
On Behalf Of Rajib Sengupta
Sent: Tuesday, May 22, 2012 11:40 PM
To: implem...@openmrs.org
Subject: Re: Concept Dictionary for Oncology-models
Terry,
Hannan, Terry J
May 23, 2012, 8:18:55 AM5/23/12
to implem...@openmrs.org, implem...@openmrs.org
Roger, as a physician you in fact are challenging many aspects of our clinical decision making.
*the scores are the markers for protocol decision making and protocol adherence-as defined by the existing/current standards of care for a given disease entity.
*the other aspect is they help the clinician to 'interpolate' when educating or more importantly have to 'interpret' for the patient or other clinicians.
*the same markers are used for defining data research subsets when measuring care.
*they probably have a role in resource utilization such as labs,radiology,antibiotics,etc but this involves more complex during patient care decisions.
The complexities surrounding the myriad uses of such data is highlighted in the chapter on protocol directed care in "A clinical information system for oncology" by Enterline, Lenard Jr and Blum.
I hope this helps.
Terry
Sent from my iPad
Andrew Kanter
May 23, 2012, 9:23:43 AM5/23/12
to implem...@openmrs.org
This is a fundamental question for the dictionary. I believe scores should be numeric and only have the final score as a concept rather than having concepts for 10, 20, 30, etc. You would not be able to compare one Karnofsky score done in coded form from one captured numerically. UIs can be designed to put numeric entries into the field using a dropdown however...
Andy
--------------------
Andrew S. Kanter, MD MPH
Andrew S. Kanter, MD MPH
Asst. Prof. of Clinical Biomedical Informatics and Clinical Epidemiology
Columbia University
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Email: andrew...@dbmi.columbia.edu
Mobile: +1 (646) 469-2421
Office: +1 (212) 305-4842
Skype: akanter-ippnw
Yahoo: andy_kanter
Cc: implem...@openmrs.org
Sent: Wednesday, May 23, 2012 8:18 AM
Subject: Re: Concept Dictionary for Oncology-scores and their meaning
Friedman, Roger (CDC/CGH/DGHA) (CTR)
May 23, 2012, 9:34:03 AM5/23/12
to implem...@openmrs.org
Sorry, I guess I stated my questions poorly, I'm not challenging anything, I'm just trying to understand Karnofsky better. When I said "marker", I was referring to a point on the scale with a fixed meaning, i.e., the 10-point intervals in Rajib's e-mail. My first question was, is a Karnofsky of 52 meaningful/legitimate? My second question was, if 52 is meaningful/legitimate, would a physician, as a practical matter, actually use it or choose between 50 and 60 as best expressing the patient's state? My third question was directed to uses beyond individual patient care. For example, would quartiles of Karnofsky be some measure of a hospital's patient mix?
Rajib Sengupta
May 23, 2012, 10:19:19 AM5/23/12
to implem...@openmrs.org
I agree with all of you.
Frankly, it seems due to this range (and chance of interpretation) in the Karnofsky score , the doctors are primarily using the ECOG score which are coded discretely as 0,1,2,3,4,5
Attaching a filled up page from such a patient form.
I will get more information on the usage of karnofsky score by the doctors on field and will pass it on.
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