ARCHETYPE Urinalysis (openEHR-EHR-OBSERVATION.urinalysis.v1)

ARCHETYPE IDopenEHR-EHR-OBSERVATION.urinalysis.v1
ConceptUrinalysis
DescriptionQualitative and semi-quantitative test array using reagent test strips to indicate possible abnormalities in a sample of urine, often performed as part of Point of Care Testing (POCT).
UseUse to record the results of a qualitative and semi-quantitative test array performed on a sample of urine, using reagent test strips. On exposure to urine, chemical pads on the reagent test strip change colour and the test result is read by visual comparison to a color chart at specified times after exposure or by an automated device. Different commercial products carry a variety of test /reagent pads. This archetype is heavily influenced by the commonly available Multistix test strips in Australia, recording ten commonly used analytes, but is intended to be generically applicable. If requirements for other parameters become apparent to meet the requirements for other test strips then product-specific urinalysis archetypes may need to be developed.
MisuseNot to be used for recording urine microscopy or quantitative test results. Use the OBSERVATION.laboratory_test family of archetypes for this purpose. Not to be used for recording urine pregnancy tests. Use the OBSERVATION.pregnancy_test for this purpose.
PurposeTo record the results of a qualitative and semi-quantitative test array using reagent test strips to indicate possible abnormalities in a sample of urine. This test may be performed by clinicians at the point of care, technicians in a laboratory setting or individuals at home.
ReferencesUrinalysis, unpublished archetype, National eHealth Transition Authority. NEHTA Clinical Knowledge Manager [Internet]. Authored: 08 Sep 2006. Available at: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.1071 (accessed Jan 23, 2015). Forked from original archetype on openEHR CKM to NEHTA CKM on 16 Jan 2012.

Urine Dipstick Multistix (R) 10SG, Johns Hopkins Hospital. The Johns Hopkins Hospital Point-of-Care Testing Program [Internet]. Revised: Oct 2010. Available at: http://pathology.jhu.edu/department/staff/poct/selfstudy/urinedipstick-10sg.pdf (Accessed Mar 4, 2015).

Multistix 9 (R) and Uristix (R) Urinalysis, UCSF Medical Center. Point of Care Testing [Internet]. Revision 2, version 1: Jun 2013. Available at: http://labmed.ucsf.edu/labmanual/mftlng-mtzn/dnld/poct-MultistixUristix.pdf (Accessed Mar 4, 2015).

Various product labels.
Copyright© openEHR Foundation
AuthorsAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2006-09-08
Other Details LanguageAuthor name: Heather Leslie
Organisation: Ocean Informatics
Email: heather.leslie@oceaninformatics.com
Date originally authored: 2006-09-08
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, references=Urinalysis, unpublished archetype, National eHealth Transition Authority. NEHTA Clinical Knowledge Manager [Internet]. Authored: 08 Sep 2006. Available at: http://dcm.nehta.org.au/ckm/#showArchetype_1013.1.1071 (accessed Jan 23, 2015). Forked from original archetype on openEHR CKM to NEHTA CKM on 16 Jan 2012. Urine Dipstick Multistix (R) 10SG, Johns Hopkins Hospital. The Johns Hopkins Hospital Point-of-Care Testing Program [Internet]. Revised: Oct 2010. Available at: http://pathology.jhu.edu/department/staff/poct/selfstudy/urinedipstick-10sg.pdf (Accessed Mar 4, 2015). Multistix 9 (R) and Uristix (R) Urinalysis, UCSF Medical Center. Point of Care Testing [Internet]. Revision 2, version 1: Jun 2013. Available at: http://labmed.ucsf.edu/labmanual/mftlng-mtzn/dnld/poct-MultistixUristix.pdf (Accessed Mar 4, 2015). Various product labels., 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=4A04DBD103EE94766F24EEB26D1A7CCA, build_uid=f2f8fe2a-27c5-4c9d-b427-bb9ebe3a10b4, revision=1.0.1}
Keywordsurine, test, dip-stick, strip, multistix, urinalysis, analysis, dipstick, urinalyses
Lifecyclepublished
UIDf80bb44d-5e4e-495f-8c45-694525dc1df4
Language useden
Citeable Identifier1013.1.150
Revision Number1.0.1
AllArchetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Qualitative and semi-quantitative test array using reagent test strips to indicate possible abnormalities in a sample of urine, often performed as part of Point of Care Testing (POCT)., archetypeConceptComment=null, otherContributors=Tomas Alme, DIPS, Norway
Koray Atalag, University of Auckland, New Zealand
Sandra Bertram, Ascribe, Australia
Rong Chen, Cambio Healthcare Systems, Sweden
Stephen Chu, NEHTA, Australia
Christian Ghan, The Chris O'Brien Lifehouse at RPA, Australia
Heather Grain, Llewelyn Grain Informatics, Australia
Sam Heard, Ocean Informatics, Australia
Oliver Hosking, Remote Health NT, Australia
Lars Karlsen, DIPS ASA, Norway
Sabine Leh, Haukeland University Hospital, Department of Pathology, Norway
Heather Leslie, Ocean Informatics, Australia (Editor)
Chunlan Ma, Ocean Informatics, Australia
Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (Editor)
Mona Saleh (Translator)
Rosalie Schultz, Anyinginyi Health Aboriginal Corporation, Australia
Fabian Schwarz, NT Health, Australia
Gary Sinclair, NT DoH, Australia
Micaela Thierley, Helse Bergen, Norway
Lin Zhang, BIPH, China, originalLanguage=en, translators=Spanish (Argentina): Dr. Leonardo Der Jachadurian, Bitios.com, Medical Doctor (Internal Medicine Specialist)
Slovak: ?
Arabic (Syria): ?
Chinese (PRC): Lin Zhang, Bethune International Peace Hospital, linforest@163.com, What go here?
, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={details=[], identities=[], source=[], credentials=[], context=[], description=[], ism_transition=[], events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002], code=at0002, itemType=POINT_EVENT, level=2, text=Point in Time, description=A specific date and/or time which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null]], content=[], items=[], capabilities=[], other_participations=[], contacts=[], target=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0050], code=at0050, itemType=ELEMENT, level=4, text=Glucose, description=Detection of glucose in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No glucose detected.]
2: Trace [Amount equivalent to 1/10 g/dl (100mg/dL or 5 mmol/L) detected.]
3: 1+ [Amount equivalent to 1/4 g/dL (250 mg/dL or 15 mmol/L) detected.]
4: 2+ [Amount equivalent to 1/2 g/dl (500mg/dL or 30 mmol/L) detected.]
5: 3+ [Amount equivalent to 1 g/dl (1000mg/dL or 60 mmol/L) detected.]
6: 4+ [Amount equivalent >2 g/dl (>2000mg/dL or >120 mmol/L) detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0062], code=at0062, itemType=ELEMENT, level=4, text=Bilirubin, description=Detection of bilirubin in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No bilirubin detected.]
2: 1+ [Small amount detected.]
3: 2+ [Moderate amount detected.]
4: 3+ [Large amount detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0037], code=at0037, itemType=ELEMENT, level=4, text=Ketones, description=Detection of ketones in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No ketones detected.]
2: Trace [Amount equivalent to 5mg/dL (or 0.5 mmol/L) detected.]
3: Small [Amount equivalent to 15mg/dL (or 1.5 mmlol/L) detected.]
4: Moderate [Amount equivalent to 40mg/dL (or 4.0 mmol/L) detected.]
5: Large [Amount equivalent to 80mg/dL (or 8.0 mmol/L) detected.]
6: Large+ [Amount equivalent to 160mg/dL (or 16 mmol/L) detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0151], code=at0151, itemType=ELEMENT, level=4, text=Specific gravity, description=Measurement of the concentration of substances dissolved (solutes) in the urine sample relative to distilled water., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: 1.000 [Specific gravity is equivalent to 1.000.]
2: 1.005 [Specific gravity is equivalent to 1.005.]
3: 1.010 [Specific gravity is equivalent to 1.010.]
4: 1.015 [Specific gravity is equivalent to 1.015.]
5: 1.020 [Specific gravity is equivalent to 1.020.]
6: 1.025 [Specific gravity is equivalent to 1.025.]
7: 1.030 [Specific gravity is equivalent to 1.030.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0032], code=at0032, itemType=ELEMENT, level=4, text=Blood, description=Detection of blood in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No blood detected.]
2: Non-haemolysed Trace [Trace of non-haemolysed blood detected.]
3: Non-haemolysed Moderate [Moderate amount of non-haemolysed blood detected.]
4: Haemolysed Trace [Trace of haemolysed blood detected.]
5: 1+ [Small amount of blood detected.]
6: 2+ [Moderate amount of blood detected.]
7: 3+ [Large amount of blood detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0126], code=at0126, itemType=ELEMENT, level=4, text=pH, description=Measurement of pH in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: 5.0 [pH of urine is equivalent to 5.0.]
2: 5.5 [pH of urine is equivalent to 5.5.]
3: 6.0 [pH of urine is equivalent to 6.0.]
4: 6.5 [pH of urine is equivalent to 6.5.]
5: 7.0 [pH of urine is equivalent to 7.0.]
6: 7.5 [pH of urine is equivalent to 7.5.]
7: 8.0 [pH of urine is equivalent to 8.0.]
8: 8.5 [pH of urine is equivalent to 8.5.]
9: 9.0 [pH of urine is equivalent to 9.0.]
10: 9.5 [pH of urine is equivalent to 9.5.]
11: 10.0 [pH of urine is equivalent to 10.0.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0095], code=at0095, itemType=ELEMENT, level=4, text=Protein, description=Detection of protein in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No protein detected.]
2: Trace [Trace of protein detected.]
3: 1+ [Amount equivalent to 30mg/dL (or 0.3 g/L) detected.]
4: 2+ [Amount equivalent to 100mg/dL (or 1.0 g/L) detected.]
5: 3+ [Amount equivalent to 300mg/dL (or 3.0 g/L) detected.]
6: 4+ [Amount equivalent to >2000mg/dL (or >20 g/L) detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0056], code=at0056, itemType=ELEMENT, level=4, text=Urobilinogen, description=Detection of urobilinogen in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Normal (lower) [Amount equivalent to 0.2 mg/dL detected.]
2: Normal (upper) [Amount equivalent to 1 mg/dL detected.]
3: 2 mg/dL [Amount equivalent to 2mg/dL detected.]
4: 4 mg/dL [Amount equivalent to 4mg/dL detected.]
5: 8 mg/dL [Amount equivalent to 8mg/dL detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0043], code=at0043, itemType=ELEMENT, level=4, text=Nitrite, description=Detection of nitrites in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No nitrites detected.]
2: Positive [Nitrites were detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0068], code=at0068, itemType=ELEMENT, level=4, text=Leukocytes, description=Detection of white blood cells in urine sample., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_ORDINAL, bindings=null, values=1: Negative [No leukocytes detected.]
2: Trace [Trace detected.]
3: 1+ [Small amount detected.]
4: 2+ [Moderate amount detected.]
5: 3+ [Large amount detected.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0182], code=at0182, itemType=SLOT, level=4, text=Additional details, description=Additional details about the point of care urinalysis, including macroscopic appearance or other tests not currently captured in the structured data., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.exam_body_fluid.v0 and specialisations Or
openEHR-EHR-CLUSTER.specimen.v0 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0181], code=at0181, itemType=ELEMENT, level=4, text=Clinical interpretation, description=Single word, phrase or brief description represents the clinical meaning and significance of the urinalysis findings., comment=Comment: Coding with a terminology is preferred, where possible. For example: normal urinalysis; mild proteinuria; or trace of blood. Multiple statements are allowed., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0002]/data[at0003]/items[at0030], code=at0030, itemType=ELEMENT, level=4, text=Comment, description=Narrative about the urinalysis not captured in other fields., comment=For example: the freshness or small volume of the urine sample, method of collection or any problems with testing., 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]/events[at0002]/data[at0003]/items[at0185], code=at0185, itemType=SLOT, level=4, text=Exam not done, description=Details to explicitly record that urinalysis was not performed., comment=Use this SLOT and associated CLUSTER archetype if there is an explicit need to record that the test was not done, for example, if urine could not be obtained from a child even though it was ordered or neccessary., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.exclusion_exam.v1 and specialisations, extendedValues=null]], relationships=[], state=[], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0180], code=at0180, itemType=SLOT, level=2, text=Reagent Strips, description=Details about the reagent strips used., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0186], code=at0186, itemType=ELEMENT, level=2, text=Method, description=Method by which the reagent strips were read., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Manual [The urinalysis results were detemined by a person.]
  • Automatic [The urinalysis results were detemined by a medical device.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0183], code=at0183, itemType=SLOT, level=2, text=Device, description=Details about the device used to automatically read the reagent strips., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0184], code=at0184, 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]], activities=[], provider=[]}, topLevelItems={data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0002]/data[at0003], code=at0003, itemType=ITEM_TREE, level=2, 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], protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0079], code=at0079, 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[at0079]/items[at0180], code=at0180, itemType=SLOT, level=2, text=Reagent Strips, description=Details about the reagent strips used., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0186], code=at0186, itemType=ELEMENT, level=2, text=Method, description=Method by which the reagent strips were read., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Manual [The urinalysis results were detemined by a person.]
  • Automatic [The urinalysis results were detemined by a medical device.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0079]/items[at0183], code=at0183, itemType=SLOT, level=2, text=Device, description=Details about the device used to automatically read the reagent strips., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:
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All not explicitly excluded archetypes, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null]