ARCHETYPE Contraindication (openEHR-EHR-EVALUATION.contraindication.v1)

ARCHETYPE IDopenEHR-EHR-EVALUATION.contraindication.v1
ConceptContraindication
DescriptionA clinical intervention (including, but not limited to, use of a treatment or performance of a test or procedure) that should not be carried out due to the likelihood, or possibility, of harm being caused to an individual.
UseTo record a contraindication for a clinical intervention in the health record of an individual due to the likelihood, or possibility, of causing harm to the individual if the identified intervention is carried out. This archetype may also be used to record a contraindication for a clinical intervention in the health record of the individual, even though the resulting clinical effect may cause harm to others and not directly on the individual. For example: administration of live vaccines should be contraindicated in an individual who has a family member in an immunosuppressed state or actively taking immunosuppressive therapy, as that family member may be at significant risk of contracting the infectious disease. This archetype should be regarded as a critical archetype by any clinical decision support system testing for any relevant therapeutic precautions as a clinician commences a new clinical Intervention for an individual. This contraindication may be identified in a number of ways including, but not limited to: - previous experience of a procedure being performed and subsequent clinical assessment that this should not be repeated; - implantation of a metal device which precludes some imaging examinations - genomic test results that indicate an adverse event may take place if a treatment or medication is administered; or - adverse experience by a family member to a similar treatment, medication or procedure. In the case of medications or vaccines, this archetype complements the EVALUATION.adverse_reaction_risk archetype by identifying other reasons why a medication or vaccine should not be administered, other than an adverse reaction. In view of this, clinical decision support for prescribing should include reference to this archetype plus the EVALUATION.adverse_reaction_risk as part of a safe prescribing process.
MisuseNot to be used to record the occurrence of an adverse reaction to a substance or agent. Adverse reaction risk is a very specific type of contradiction and because of its ubiquity has been modelled separately as EVALUATION.adverse_reaction_risk for this purpose. Not to be used to record a condition or state of the individual that is clinically significant and unique or idiosyncratic for this individual, and is considered vital information when making treatment decisions. Use EVALUATION.precaution for this purpose. Not to be used to record personal preferences of the individual. Use specific archetypes for this purpose.
PurposeTo record a contraindication for a clinical intervention (including, but not limited to, a treatment, test or procedure) that should not be carried out due to the likelihood, or possibility, of harm being caused to an individual.
References
Copyright© openEHR Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 14-11-2012
Other Details LanguageAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 14-11-2012
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=openEHR Foundation, current_contact=Heather Leslie, Ocean Informatics, heather.leslie@oceaninformatics.com, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=E8577B01551E86CECEC24BF700D50146, build_uid=1ab441e6-8769-434f-a585-a1dbcc56849f, revision=1.0.0}
Keywordscontraindication, prevent, avoid, adverse event, caution, alert, warning
Lifecyclepublished
UIDc1665474-ff4a-4ff2-ab22-f2c8661c3589
Language useden
Citeable Identifier1013.1.1388
Revision Number1.0.0
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=A clinical intervention (including, but not limited to, use of a treatment or performance of a test or procedure) that should not be carried out due to the likelihood, or possibility, of harm being caused to an individual., archetypeConceptComment=null, otherContributors=Fatima Almeida, Critical SW, Portugal
Tomas Alme, DIPS, Norway
Vebjørn Arntzen, Oslo University Hospital, Norway
Koray Atalag, University of Auckland, New Zealand
Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor)
Lars Bitsch-Larsen, Haukeland University hospital, Norway
Hildegard Franke, freshEHR Clinical Informatics Ltd., United Kingdom
Heather Grain, Llewelyn Grain Informatics, Australia
Sam Heard, Ocean Informatics, Australia
Evelyn Hovenga, EJSH Consulting, Australia
Lars Karlsen, DIPS ASA, Norway
Lars Morgan Karlsen, DIPS ASA, Norway
Heather Leslie, Atomica Informatics, Australia (openEHR Editor)
Hildegard McNicoll, freshEHR Clinical Informatics Ltd., United Kingdom
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor)
Bjoern Naess, DIPS ASA, Norway
Bjørn Næss, DIPS ASA, Norway
Andrej Orel, Marand d.o.o., Slovenia
John Tore Valand, Helse Bergen, Norway, originalLanguage=en, translators=, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={identities=[], other_participations=[], credentials=[], description=[], relationships=[], ism_transition=[], activities=[], items=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0002], code=at0002, itemType=ELEMENT, level=2, text=Contraindicated intervention, description=Identification, by name, of a clinical intervention or class of intervention including, but not limited to, a treatment, test or procedure that should not be performed., comment=Coding of the identified 'Contraindicated intervention' with a terminology is desirable, where possible., uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0014], code=at0014, itemType=ELEMENT, level=2, text=Status, description=Assertion about the certainty or potential future risk, of the identified 'Contraindicated intervention'., comment=Decision support would typically raise alerts for 'Suspected', 'Likely', 'Confirmed', and ignore a 'Refuted' reaction. Clinical systems may choose not to display Contraindication entries with a 'Refuted' status in the Contraindication list. However, 'Refuted' may be useful for reconciliation of the Contraindication list or when communicating between systems . Some implementations may choose to make this field mandatory. 'Resolved' may be used variably across systems, depending on clinical use and context. The free text data type will allow for local variation by enabling other value sets to be applied to this data element in a template - in this situation it is recommended that values should be coded using a terminology., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:
  •  Coded Text
    • Suspected [A low level of clinical certainty that carrying out the 'Contraindicated intervention' will cause harm to the individual or family member.]
    • Likely [A reasonable level of clinical certainty that carrying out the 'Contraindicated intervention' will cause harm to the individual or family member.]
    • Confirmed [A high level of clinical certainty that carrying out the 'Contraindicated intervention' will cause harm to the individual or family member.]
    • Resolved [The previous assertion that the subject should not be exposed to the 'Contraindicated intervention' has been clinically reassessed and considered no longer to be an active risk.]
    • Refuted [The previous assertion that the subject should not be exposed to the 'Contraindicated intervention' has been clinically reassessed or has been disproved with a high level of clinical certainty by testing.]
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0007], code=at0007, itemType=ELEMENT, level=2, text=Criticality, description=An indication of the potential for critical system organ damage or life threatening consequence., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Low [Carrying out of the 'Contraindicated intervention' is unlikely to result in critical system organ damage or life threatening consequences for the individual or family member. Future exposure to the identified intervention should be considered a relative contraindication in normal clinical circumstances.]
  • High [Carrying out of the 'Contraindicated intervention' may result in critical organ system damage or life threatening consequences for the individual or family member. Future exposure to the identified intervention should be considered an absolute contraindication in normal clinical circumstances.]
  • Indeterminate [Unable to assess with information available.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0021], code=at0021, itemType=ELEMENT, level=2, text=Clinical indication, description=Identification of the clinical reason why the identified 'Contraindicated intervention' should not be used or performed., comment=In the context of this contraindication archetype, this 'Indication' data element represents the clinical reason why the identified Intervention should not be used or performed. Example: 'Pacemaker inserted' as indication to avoid performing an MRI Intervention. Coding of the 'Indication' with a terminology is desirable, where possible. Please note: an optional URI link to evidence within the health record is also permitted using Reference Model attributes. As this URI link may not be accessible from a message or by receiving clinical system it is desirable that a narrative description of the rationale should be explicitly recorded., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0003], code=at0003, itemType=ELEMENT, level=2, text=Rationale, description=Narrative description explaining the relationship between the 'Indication' and the 'Contraindicated intervention'., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0013], code=at0013, itemType=ELEMENT, level=2, text=Category, description=Category of the identified 'Contraindicated intervention'., comment=This data element has been included because it is currently being captured in some clinical systems. This information could be derived from the Intervention where coding systems are used, and is effectively redundant in that situation., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/items[at0008], code=at0008, itemType=ELEMENT, level=2, text=Comment, description=Additional narrative about the contraindication, not captured in other fields., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], capabilities=[], state=[], context=[], events=[], source=[], content=[], target=[], details=[], provider=[], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0020], code=at0020, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0022], code=at0022, itemType=ELEMENT, level=2, text=Valid period start, description=Date/time when the contraindication becomes active., comment=This data element is intended for use when a contraindication is identified to start at some time in the future. For example: the contraindication for MRI would only be relevant after the date of the procedure for insertion of the pacemaker., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0009], code=at0009, itemType=ELEMENT, level=2, text=Review date, description=Date when next due for review by a clinician., comment=In circumstances where contraindications are not indefinite or life-long, use this data element to record when this contraindication should be reassessed in the context of the clinical circumstances at the time. For example: schedule a review date that matches when it is expected that the family member will cease taking immunosuppressive therapy, such that live vaccines could safely be administered to the individual again and the contraindication is effectively resolved., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0004], code=at0004, itemType=ELEMENT, level=2, text=Last updated, description=Date when the contraindication information was last updated., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null]], contacts=[]}, topLevelItems={data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001], code=at0001, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..1, cardinalityText=mandatory, subCardinalityFormal=1..*, subCardinalityText=, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0006], code=at0006, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..1, cardinalityText=mandatory, subCardinalityFormal=0..*, subCardinalityText=Minimum of 0 items, dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0020], code=at0020, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local content or to align with other reference models/formalisms., comment=For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0022], code=at0022, itemType=ELEMENT, level=2, text=Valid period start, description=Date/time when the contraindication becomes active., comment=This data element is intended for use when a contraindication is identified to start at some time in the future. For example: the contraindication for MRI would only be relevant after the date of the procedure for insertion of the pacemaker., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0009], code=at0009, itemType=ELEMENT, level=2, text=Review date, description=Date when next due for review by a clinician., comment=In circumstances where contraindications are not indefinite or life-long, use this data element to record when this contraindication should be reassessed in the context of the clinical circumstances at the time. For example: schedule a review date that matches when it is expected that the family member will cease taking immunosuppressive therapy, such that live vaccines could safely be administered to the individual again and the contraindication is effectively resolved., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0006]/items[at0004], code=at0004, itemType=ELEMENT, level=2, text=Last updated, description=Date when the contraindication information was last updated., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]