| TEMPLATE ID | Follow-up schedule for the treatment of wet AMD |
|---|---|
| Concept | Follow-up schedule for the treatment of wet AMD |
| Description | To record the diagnostic tests requested to monitor the treatment of wet AMD. |
| Purpose | To record the diagnostic tests requested to monitor the treatment of wet AMD. |
| References | |
| Authors | name: Aitor Eguzkitza; organisation: Universidad Pública de Navarra - Complejo Hospitalario de Navarra; email: aitor.eguzkiza@unavarra.es; date: 2016-07-29 |
| Other Details Language | name: Aitor Eguzkitza; organisation: Universidad Pública de Navarra - Complejo Hospitalario de Navarra; email: aitor.eguzkiza@unavarra.es; date: 2016-07-29 |
| Other Details (Language Independent) |
|
| Language used | en |
| Citeable Identifier | 1013.26.114 |
| Root archetype id | openEHR-EHR-COMPOSITION.request.v1 |
| Request for service | Request for service: Document sent from one treating healthcare provider or organisation to another, for the purpose of requesting advice, a service or transfer of care. |
| Diagnostic test planning | Diagnostic test planning: Schedules each patient to perform the diagnostic tests necessary to assess a specific disease. |
| Care Plan | Care Plan: Order or instruction for the creation and sequence of activities to achieve a specified management goal or treatment outcome, carried out by health professionals and/or the subject. |
| Activity | Activity: Current Activity. |
| Description | |
| Care Plan Name | Care Plan Name: Identification of the care plan. Default value: Service for monitoring the treatment of wet AMD |
| Description | Description: Description of the care plan scope, intent and proposed activities. Default value: Treatment monitoring comprised by VA, NMR, and OCT tests. |
| Indication | Indication: Indication for the care plan. For example: a known diagnosis; or a specific goal. Default value: To review the effectiveness of anti-VEGF therapy to treat wet AMD. |
| Date of Onset | Date of Onset: Date of onset for the care plan. |
| Comment | Comment: Additional narrative about the care plan order not captured in other fields. |
| Care Plan | Care Plan: Plan or sequence of discrete activities developed to achieve a specified management goal or treatment outcome, carried out by health professionals and/or the patient. |
| Description | |
| Care Plan Name | Care Plan Name: Name of care plan. Default value: Service for monitoring the treatment of wet AMD |
| Description | Description: Description of activity performed/enacted against the plan. |
| Reason | Reason: Reason for activity being performed /enacted against the plan. |
| Protocol | |
| Care Plan ID | Care Plan ID: Identification of care plan. |
| Expiry Date | Expiry Date: Anticipated date beyond which the care plan can be deemed 'expired'. |
| Referral request | Referral request: Request for provision of a specified service by another healthcare provider or organisation. |
| Request | Request: Current Activity. |
| Description | |
| Service requested | Service requested: Identification of the service requested. This is often coded with an external terminology. Default value: Visual acuity test |
| Description of service | Description of service: A detailed narrative description of the service requested. Default value: Request to undertake the visual acuity test. |
| Acquisition details on eye fundus images | Acquisition details on eye fundus images: Defines specific details about the acquisition of images from eye fundus. |
| Laterality | Laterality: Eye/s from which the eye fundus is examined.
|
| Method | Method: Method chosen to perform the funduscopic examination.
|
| Attempts Allowed | Attempts Allowed: Limit on the number of attempts allowed to conduct the acquisition (doesn't compute if test is repeated by a specific recognized technical failure). >=1 Assumed value: 3 |
| Zone of Retina | Zone of Retina: Anatomical structures from retina in which the study of eye fundus is focused. Value set: ac0001 |
| Study Fields Photographed | Study Fields Photographed: Specifies which fields from a specific subdivision of the retina are photographed in the study of eye fundus. Value set: ac0002 |
| Mosaic | Mosaic: If true, the study includes a mosaic image that combines all eye fundus fields acquired into a single picture. Assumed value: false |
| Reason for request | Reason for request: A short description of the reason for the request. This is often coded with an external terminology. Default value: To monitor the treatment of wet AMD. |
| Intent | Intent: Stated intent of the request by the referrer. |
| Urgency | Urgency: Urgency of the request.
|
| Date &/or time service required | Date &/or time service required: The date and time that the service should be performed or completed. |
| Latest date service required | Latest date service required: The latest date that is acceptable for the service to be completed. |
| Supplementary information to follow | Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results. Default value: true |
| Supplementary information expected | Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results. Default value: Eye fundus examination and ophthalmic tomography imaging tests. |
| Protocol | |
| Requestor Identifier | Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier. |
| Receiver identifier | Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier. |
| Request status | Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information. |
| Imaging examination request NMR | Imaging examination request NMR: Generic request for an imaging examination request. |
| Request | Request: Current Activity. |
| Description | |
| Examination requested | Examination requested: Identification of the examination requested. This is often coded with an external terminology. Default value: Imaging examination of eye fundus |
| Description of examination | Description of examination: A detailed narrative description of the examination requested. Default value: Request to undertake the imaging examination of eye fundus. |
| Acquisition details on eye fundus images | Acquisition details on eye fundus images: Defines specific details about the acquisition of images from eye fundus. |
| Laterality | Laterality: Eye/s from which the eye fundus is examined.
|
| Method | Method: Method chosen to perform the funduscopic examination.
|
| Attempts Allowed | Attempts Allowed: Limit on the number of attempts allowed to conduct the acquisition (doesn't compute if test is repeated by a specific recognized technical failure). >=1 Assumed value: 3 |
| Zone of Retina | Zone of Retina: Anatomical structures from retina in which the study of eye fundus is focused. Value set: ac0001 |
| Study Fields Photographed | Study Fields Photographed: Specifies which fields from a specific subdivision of the retina are photographed in the study of eye fundus. Value set: ac0002 |
| Mosaic | Mosaic: If true, the study includes a mosaic image that combines all eye fundus fields acquired into a single picture. Assumed value: false |
| Reason for request | Reason for request: A short description of the reason for the request. This is often coded with an external terminology. Default value: To monitor the treatment of wet AMD. |
| Intent | Intent: Stated intent of the request by the referrer. |
| Urgency | Urgency: Urgency of the request.
|
| Date &/or time service required | Date &/or time service required: The date and time that the service should be performed or completed. |
| Latest date service required | Latest date service required: The latest date that is acceptable for the service to be completed. |
| Supplementary information to follow | Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results. Default value: true |
| Supplementary information expected | Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results. Default value: Visual acuity and ophthalmic tomography tests. |
| Protocol | |
| Requestor Identifier | Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier. |
| Receiver identifier | Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier. |
| Request status | Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information. |
| Imaging Examination Request OCT | Imaging Examination Request OCT: Generic request for an imaging examination request. |
| Request | Request: Current Activity. |
| Description | |
| Examination requested | Examination requested: Identification of the examination requested. This is often coded with an external terminology. Default value: Ophthalmic tomography examination |
| Description of examination | Description of examination: A detailed narrative description of the examination requested. Default value: Request to undertake the ophthalmic tomography imaging test. |
| Acquisition details on ophthalmic tomography | Acquisition details on ophthalmic tomography: Defines specific details about ophthalmic tomography studies. |
| Laterality | Laterality: Eye/s included in the study.
|
| Acquisition method | Acquisition method: Acquisition method chosen to perform the ophthalmic tomography study. It is based on the Table CID 4210 of DICOM standard.
|
| Study outcome | Study outcome: Identifies the type of analyses which must be obtained from the study.
|
| Predefined scan | Predefined scan: Choice among predefined settings provided by the ophthalmic tomography for scanning the eye structure. |
| Study type | Study type: Subject of study of the ophthalmic tomography.
|
| Predefined scans | Predefined scans: Choice of a predefined scan patterns from the device to conduct the study.
|
| Custom scan | Custom scan: Description of characteristics for a personalized scan. |
| Scan pattern | Scan pattern: Defines the pattern used to scan structures inside the eye.
|
| Position of scan pattern | Position of scan pattern: Eye structure in which the scan is centred. Value set: ac0001 |
| Scan size (width or diameter) | Scan size (width or diameter): Width of the frame (or diameter in case of circle scan pattern). Units: ° |
| Scan size (height) | Scan size (height): Height of the frame. Units: ° |
| Distance between sections | Distance between sections: Distance between sections scanned consecutively. Units: μm |
| Section scans | Section scans: Number of sections included in the scan. >=1 |
| Reason for request | Reason for request: A short description of the reason for the request. This is often coded with an external terminology. Default value: To monitor the treatment of wet AMD. |
| Intent | Intent: Stated intent of the request by the referrer. |
| Urgency | Urgency: Urgency of the request.
|
| Date &/or time service required | Date &/or time service required: The date and time that the service should be performed or completed. |
| Latest date service required | Latest date service required: The latest date that is acceptable for the service to be completed. |
| Supplementary information to follow | Supplementary information to follow: True indicates that additional information has been identified and will be forwarded when available eg incomplete pathology test results. Default value: true |
| Supplementary information expected | Supplementary information expected: Details of the nature of supplementary information that is to follow e.g name of laboratory results. Default value: Visual acuity and eye fundus examination tests. |
| Protocol | |
| Requestor Identifier | Requestor Identifier: The local ID assigned to the order by the healthcare provider or organisation requesting the service. This is also referred to as Placer Order Identifier. |
| Receiver identifier | Receiver identifier: The ID assigned to the order by the healthcare provider or organisation receiving the request for service. This is also referred to as Filler Order Identifier. |
| Request status | Request status: The status of the request for service as indicated by the requester. Status is used to denote whether this is the initial request, or a follow-up request to change or provide supplementary information. |
| Other contributors | Jose Andonegui, Complejo hospitalario de Navarra (CHN), jose.andonegui.navarro@cfnavarra.es; Luis Serrano, Universidad Pública de Navarra (UPNA), lserrano@unavarra.es; Jesús D. Trigo, Universidad Pública de Navarra (UPNA), jesusdaniel.trigo@unavarra.es |