Representation of Diagnosis and Nursing Interventions in OpenEHR Archetypes

Author:

Gomes Denilsen Carvalho1,Abreu Nuno2,Sousa Paulino3,Moro Claudia1,Carvalho Deborah Ribeiro1,Cubas Marcia Regina1

Affiliation:

1. Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil

2. Department of Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal

3. Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal

Abstract

Abstract Objective The study aimed to represent the content of nursing diagnosis and interventions in the openEHR standard. Methods This is a developmental study with the models developed according to ISO 18104: 2014. The Ocean Archetype Editor tool from the openEHR Foundation was used. Results Two archetypes were created; one to represent the nursing diagnosis concept and the other the nursing intervention concept. Existing archetypes available in the Clinical Knowledge Manager were reused in modeling. Conclusion The representation of nursing diagnosis and interventions based on the openEHR standard contributes to representing nursing care phenomena and needs in health information systems.

Funder

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Publisher

Georg Thieme Verlag KG

Subject

Health Information Management,Computer Science Applications,Health Informatics

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