| ARCHETYPE ID | openEHR-EHR-OBSERVATION.pregnancy_assertion.v0 |
|---|---|
| Concept | Pregnancy assertion |
| Description | A statement made by a clinician confirming the presence or confirmed absence of pregnancy at a specific point in time, considered accurate only at the date and time it is made. |
| Use | Use to record a clinician’s point-in-time assertion of confirmed presence or confirmed absence of a pregnancy. Assumed values and expressions of uncertainty are intentionally excluded. The assertion applies only at the time it is made and may be supported by a clinical ‘Justification’ documenting the evidence on which the assertion is based, such as relevant test results, documented organ inventory, or past diagnoses and procedures. Confirmation that pregnancy is present or absent is critical to safe clinical decision-making because it may alter diagnostic and management approaches. For example:
|
| Misuse | Not to be used to record summary information about a current or past pregnancy. Use the EVALUATION.pregnancy_summary archetype for this purpose. Not to be used to record the current pregnancy care context, including pregnancy being possible. Use the EVALUATION.pregnancy_care_context for this purpose. Not to be used to record details about procedures performed related to a pregnancy, for example terminations or instrumental deliveries. Use the ACTION.procedure for this purpose. Not to be used in the context of questionnaire-style representations, such as self-reported data with questions like 'Are you currently pregnant?' The need for a specific archetype for this purpose is acknowledged but had not yet been developed at the time of publication of this archetype. Not to be used to record absence of known pregnancy history. The need for a specific archetype for this purpose is acknowledged but had not yet been developed at the time of publication of this archetype. |
| Purpose | To record a clinician’s assertion of the presence or absence of pregnancy at a specific point in time, typically to support clinical decision-making. |
| References | |
| Copyright | © openEHR Foundation |
| Authors | Author name: Marit Alice Venheim Organisation: Helse Vest IKT AS Email: marit.alice.venheim@helse-vest-ikt-no Date originally authored: 2020-05-05 |
| Other Details Language | Author name: Marit Alice Venheim Organisation: Helse Vest IKT AS Email: marit.alice.venheim@helse-vest-ikt-no Date originally authored: 2020-05-05 |
| Other Details (Language Independent) |
|
| Keywords | pregnancy, pregnant, exclusion, confirmation |
| Lifecycle | in_development |
| UID | 752bdebc-9c67-4190-b872-db5361dab992 |
| Language used | en |
| Citeable Identifier | 1013.1.4720 |
| Revision Number | 0.0.1-alpha |
| events | |
| Any point in time event | Any point in time event: Default, unspecified point in time event which may be explicitly defined in a template or at run-time. |
| data | |
| Pregnancy assertion | Pregnancy assertion: A statement made by a clinician confirming the presence or confirmed absence of pregnancy at a specific point in time. This assertion is considered accurate only at the date and time it is made and typically to support safe clinical decision-making. Assumed values and expressions of uncertainty are intentionally excluded.
|
| Justification | Justification: Narrative description of the clinical evidence supporting the assertion. |
| Clinical evidence | Clinical evidence: Structured clinical evidence supporting the assertion. For example: examination findings; test results; organ inventory; diagnoses or past procedures. Include: openEHR-EHR-CLUSTER.clinical_ |
| Comment | Comment: Additional narrative about the pregnancy assertion, not captured in other fields. |
| protocol | |
| Extension | Extension: Additional information required to extend the model with local content or to align with other reference models or formalisms. For example: local information requirements; or additional metadata to align with FHIR. Include: All not explicitly excluded archetypes |
| Other contributors | Marit Alice Venheim, Helse Vest IKT, Norway Vebjørn Arntzen, Oslo University Hospital, Norway (openEHR Editor) Sparked AU, CSIRO, Australia Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor) SB Bhattacharyya, Bhattacharyyas Clinical Records Research & Informatics LLP, India Tara Bonet Chinillach, Catalan Health Service, Spain Hanne Marte Bårholm, Helse Vest IKT, Norway (openEHR Editor) Grete Hovde Bøe, Sykehuspartner HF, Norway (openEHR Editor) Michelle Currie, SavantSolutions4HIT, LLC, United States Inger Elise Engelund, Fagsenter for pasientrapporterte data, Helse Bergen HF, Norway Aleksander Furnes, Helse Nord IKT, Norway (openEHR Editor) Ciprian Gerstenberger, Helse Nord IKT, Norway (openEHR Editor) William Goossen, Results 4 Care, Netherlands Heather Grain, Llewelyn Grain Informatics, Australia Atle Hansen, Universitetssykehuset Nord-Norge, Norway Evelyn Hovenga, EJSH Consulting, Australia Henri Huttunen, UNA Oy, Finland Juliette Jager, Tietoevry, Norway June Marie Nepstad Knappskog, Helse Nord IKT AS, Norway (openEHR Editor), Norway (openEHR Editor) Elin Kristiansen, Sykehuspartner HF, Norway (openEHR Editor) Kanika Kuwelker, Helse Vest IKT, Norway (openEHR Editor) Jörgen Kuylenstierna, eWeave AB, Sweden Eli Larsen, UNN, Norway (openEHR Editor) Liv Laugen, Oslo University Hospital, Norway, Norway (openEHR Editor) Darin Leonhardt, PLRI für medizinische Informatik/ Medizinische Hochschule, Germany Heather Leslie, Atomica Informatics, Australia (openEHR Editor) June Marie Knappskog, Helse Nord IKT AS, Norway (openEHR Norway redaktør), Norway Cecilia Mascia, CRS4, Italy Ian McNicoll, freshEHR Clinical Informatics, United Kingdom Martin Milde, Helse Vest IKT, Norway (openEHR Editor) Olha Nikolaieva, University Hospital Basel, Switzerland Mikael Nyström, Cambio Healthcare Systems AB, Sweden Bjørn Næss, DIPS ASA, Norway Jayashree Panickar, India Ana Pascual Segura, Catsalut, Spain Anton Pichugin, GKU IAC at Department of Information Technologies of the city of Moscow (DIT Moscow), Russia Marlene Pérez Colman, Digital Health and Care Wales, United Kingdom Bipinkumar Rathod, NHS, United Kingdom Terje Sagmyr, Helse Vest IKT, Norway (openEHR Editor) Videha Sharma, University of Manchester, United Kingdom Norwegian Review Summary, Norwegian Public Hospitals, Norway Nyree Taylor, CSIRO, Australia John Tore Valand, Helse Vest IKT, Norway (openEHR Editor) Marte Vassli Gullesen, HNIKT, Norway Wouter Zanen, Eurotranplant, Netherlands Karsten Øvretveit, Helse Vest IKT, Norway (openEHR Editor) |
| Translators |
|