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A setting observable is an entity which is determined by some agent (could be a human or an automatic system). Examples include targets, goals, parameters, settings, all which are not determined by observation but by decision. In principle, a setting might also be observed, e.g. one can observe a setting of some equipment or look up a target parameter in the medical record, but the cause of the setting value is ultimately some human intervention.

Slides

Proposal

Introduce a new high-level, primitive concept "Setting" which is a direct descendent of Observable entity which is the single stated primitive parent of all current target, goal, parameter, setting observables.

https://docs.google.com/presentation/d/1m6g6X4yZXItsJQdTkA5tesb_WOf16z1JvzqRRQy1Iu4/edit?usp=sharing

A setting might share the same quality/process characteristic/function attributes as the non-setting observable, e.g. a target heart rate can share the attributes of the heart rate observable with the addition of the "Setting" stated parent.

Possibly, a sub-hierarchy of "Setting" might include "Goal", "Target" etc. depending on future use cases.

Currently, modeled Observables are given stated primitive parents in the existing Observables hierarchy, so effectively, assigning a previously unused observable as a stated parent makes the settings and other observables disjunct. Any future development of Observables would have to consider which stated primitive parents are relevant, if any, and what impact those parents might have.




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12 Comments

  1. Suzanne Santamaria

    Jim Case ,

    Please see Daniel's Slides, proposal in text on this page, test task OBSERVABLE-227, and comments from the Nutrition Group. We would like your thoughts on this proposed approach as we need to agree upon a model soon.

    Thanks,

    Suzanne

    CC: Farzaneh Ashrafi

  2. Jim Case

    I have commented on the task.  As I mention in my comment, I have concerns about a vague observable such as Setting (observable entity)

  3. Daniel Karlsson

    I commented on the comment on the task. I'm happy to add the more specific concepts instead (goal/target, equipment setting) and if we find a good unambiguous term, we can add a super-concept later on.

    /Daniel

    1. Suzanne Santamaria

      Thanks, both. Is there a preference for using "goal" or "target" for these? "Target" has been used more often in SNOMED thus far. The Nutrition Group did not have a strong preference.

      1. Daniel Karlsson

        I have no preference. Both target and goal translates to the same Swedish word, with a variation of more specific synonyms in certain areas.

  4. Jim Case

    Suzanne Santamaria , I think there can be an argument for both goal and target.  Target (to me at least) refers to some quantitative measure such as target heart rate, target HBA1c, etc.  Goal seems to me to be more qualitative, such as ability to stand without assistance, able to feed self, etc.

    1. Daniel Karlsson

      Jim Case are you arguing for use of scale type (smile)

      Merriam-Webster defines target as "a goal to be achieved", goal "the end toward which effort is directed". Reproducibility might suffer.

      1. Jim Case

        Daniel Karlsson , 

        No not arguing for scale (you are a funny guy), but just the perception that (at least english-speaking) people have when hearing the words goals vs. target.  I am sure you are correct that reproducibility would be a challenge.  Maybe pick one  of the FSN and allow the other  as a synonym.

  5. Sarah Harry

    I think it would be better to limit 'goal' to things like therapeutic goals e.g. full range of movement, euhydration etc seen in Patient Related Outcome Measures (PROMS) etc. and NOT used interchangeably with target which would generally take a numeric value +UoM.

  6. James R. Campbell

    I think you are mixing apples and oranges and apple trees. (Which of these things is NOT like the other?)

    The editorial guide states that Observable entities are "Information about a quality/property to be observed and how it will be observed". I think it appropriate to say that a) recording the result of observing a glucose level in a patient's blood with a fingerstick glucometer and b) recording the pulse rate of the patient in beats per minute by palpation of the radial artery are reasonable members of the class. I further think that the respiratory therapist c) recording the dial reading on the ventilator that sets mandatory respiratory rate in breaths per minute at an instant in time (after they set it) is an acceptable observable entity concept definition tht SNOMED CT  must support.


    A goal has always been defined in my deployment of electronic healthcare systems as a desired or expected result of an observation to be made at some future point in time, such as ‘the goal of glucose management in this patient is to have a glycohemoglobin level between 6.5 and 8.0’. Targets are similarly 'futuristic' in context.  Hence an observable entity with accompanying value constraint might be considered as a component of the information model definition of a goal instance, but the SNOMED CT concept model demands that those elements be relegated to situations with explicit context and the context dependent features clearly included in the definition.

  7. Jim Case

    James R. Campbell,  not sure I understand your argument here,  The "goal" observables provide a way of recording a desired future observation value without precoordinating all of the potential values that can be precoordinated with the observation.  Am I missing something in your argument?  Also, as Situations are dependent on clinical finding or procedures, there is no current way to use observable entity-value pairs in the current situation model, notwithstanding the recognition that the situation model is highly underspecified.

  8. Daniel Karlsson

    I think I understand James R. Campbells position in that a goal or a target is not observable in the sense that you can observe it in reality in any way (they typically have not happened yet). They are really "settable entities". They are observable in the sense of the equipment setting being read, but really are not much better than goals/targets, you can observe the position of a dial not unlike you can read about a goal/target in the health record. Given all that, settables and (true) observables share that they both are about a property and thus share the same concept model.