archetype (adl_version=1.4; uid=89cb37a0-2ce6-461e-b511-650700a4b33d)
	openEHR-EHR-OBSERVATION.acoustic_reflex_result.v0

concept
	[at0000]	-- Acoustic reflex test result
language
	original_language = <[ISO_639-1::en]>
description
	original_author = <
		["name"] = <"Kerrie Lee">
		["organisation"] = <"Hearing Health Program, Northern Territory, Australia">
		["email"] = <"kerrie.lee2@bigpond.com">
		["date"] = <"2013-03-12">
	>
	details = <
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record measurements from an acoustic reflex test, and their interpretation by a clnician.">
			use = <"Use to record measurements from a single acoustic reflext test, for diagnostic or screening purposes. Ipsilateral testing, contralateral testing or both, can be recorded per test ear.

Use to record the interpretation of all measurements for each single ear test configuration, and an overall interpretation (or audiological diagnosis).

Acoustic reflexes measure the eardrum movement generated by the stapedius and tensor tympani reflex in response to intense sound. The acoustic reflex threshold can be helpful in checking for particular types of hearing loss in situations where patient reliability is questionable. Acoustic reflex testing can also be done as part of a battery of tests to investigate central nervous system pathology, although this usage is now uncommon.">
			keywords = <"hearing", "test", "acoustic", "reflex", "decibels">
			misuse = <"">
			copyright = <"© Northern Territory Department of Health (Australia), openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Heather Leslie, Atomica Informatics, Australia (Editor)", "Ian McNicoll, freshEHR Informatics, United Kingdom">
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Derived from: Acoustic reflex test result, Draft archetype [Internet]. Australian Digital Health Agency (NEHTA), ADHA Clinical Knowledge Manager. Authored: 2013 Mar 12. Available at: http://dcm.nehta.org.au/ckm#showArchetype_1013.1.1328_3 (discontinued).">
		["current_contact"] = <"Heather Leslie, Atomica Informatics, Australia<heather.leslie@atomicainformatics.com>">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"239D8824091E48EB63993B5A6BCE6E79">
		["build_uid"] = <"52ddb96a-e19a-4994-bb63-caa7597f0957">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {	-- Acoustic reflex test result
		data matches {
			HISTORY[at0001] matches {	-- Event Series
				events cardinality matches {1..*; unordered} matches {
					POINT_EVENT[at0002] occurrences matches {0..1} matches {	-- Any Point-in-time Event
						data matches {
							ITEM_TREE[at0003] matches {	-- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {	-- Test Result Name
										value matches {
											DV_CODED_TEXT matches {
												defining_code matches {
													[local::
													at0005, 	-- Acoustic Reflex Test
													at0006]	-- Non Acoustic Reflex Test
												}
											}
										}
									}
									CLUSTER[at0007] occurrences matches {0..4} matches {	-- Result Details
										items cardinality matches {1..*; unordered} matches {
											ELEMENT[at0008] matches {	-- Test Ear Configuration
												value matches {
													DV_CODED_TEXT matches {
														defining_code matches {
															[local::
															at0009, 	-- Left Ipsilateral
															at0010, 	-- Right Ipsilateral
															at0011, 	-- Left Contralateral
															at0012]	-- Right Contralateral
														}
													}
												}
											}
											CLUSTER[at0013] occurrences matches {0..1} matches {	-- Diagnostic Test
												items cardinality matches {1..*; unordered} matches {
													CLUSTER[at0035] occurrences matches {0..*} matches {	-- Result
														items cardinality matches {1..*; unordered} matches {
															ELEMENT[at0022] occurrences matches {0..1} matches {	-- Test Signal
																value matches {
																	DV_CODED_TEXT matches {
																		defining_code matches {
																			[local::
																			at0025, 	-- Pure Tone - 500 Hz
																			at0026, 	-- Pure Tone - 1000 Hz
																			at0027, 	-- Pure Tone - 2000Hz
																			at0028, 	-- Pure Tone - 4000Hz
																			at0023, 	-- Broad Band Noise
																			at0024]	-- Narrow Band Noise
																		}
																	}
																}
															}
															ELEMENT[at0020] occurrences matches {0..1} matches {	-- Threshold Level
																value matches {
																	C_DV_QUANTITY <
																		property = <[openehr::123]>
																		list = <
																			["1"] = <
																				units = <"dB">
																				magnitude = <|1.0..110.0|>
																				precision = <|0|>
																			>
																		>
																	>
																}
															}
															ELEMENT[at0029] occurrences matches {0..1} matches {	-- Reflex Latency
																value matches {
																	C_DV_QUANTITY <
																		property = <[openehr::128]>
																		list = <
																			["1"] = <
																				units = <"ms">
																			>
																			["2"] = <
																				units = <"s">
																				precision = <|0|>
																			>
																		>
																	>
																}
															}
															ELEMENT[at0030] occurrences matches {0..1} matches {	-- Reflex Decay
																value matches {
																	C_DV_QUANTITY <
																		property = <[openehr::128]>
																		list = <
																			["1"] = <
																				units = <"ms">
																			>
																			["2"] = <
																				units = <"s">
																			>
																		>
																	>
																}
															}
														}
													}
													ELEMENT[at0031] occurrences matches {0..1} matches {	-- No Diagnostic Result
														value matches {
															DV_BOOLEAN matches {
																value matches {True, False}
															}
														}
													}
													ELEMENT[at0032] occurrences matches {0..1} matches {	-- Reason For No Test Result
														value matches {
															DV_TEXT matches {*}
														}
													}
													CLUSTER[at0021] occurrences matches {0..1} matches {	-- Clinical Interpretation
														items cardinality matches {1..*; unordered} matches {
															ELEMENT[at0034] occurrences matches {0..1} matches {	-- Intensity
																value matches {
																	DV_CODED_TEXT matches {
																		defining_code matches {
																			[local::
																			at0038, 	-- Normal Range
																			at0039, 	-- Absent
																			at0040]	-- Elevated
																		}
																	}
																}
															}
															ELEMENT[at0041] occurrences matches {0..1} matches {	-- Sensation Level
																value matches {
																	DV_CODED_TEXT matches {
																		defining_code matches {
																			[local::
																			at0042, 	-- Normal
																			at0043, 	-- Reduced
																			at0044, 	-- Elevated
																			at0045]	-- Absent
																		}
																	}
																}
															}
														}
													}
												}
											}
											CLUSTER[at0014] occurrences matches {0..1} matches {	-- Screening Result
												items cardinality matches {1..*; unordered} matches {
													ELEMENT[at0015] occurrences matches {0..1} matches {	-- Result
														value matches {
															DV_CODED_TEXT matches {
																defining_code matches {
																	[local::
																	at0016, 	-- Present
																	at0017]	-- Absent
																}
															}
														}
													}
													ELEMENT[at0018] occurrences matches {0..1} matches {	-- No Screening Result
														value matches {
															DV_BOOLEAN matches {
																value matches {True, False}
															}
														}
													}
													ELEMENT[at0019] occurrences matches {0..1} matches {	-- Reason For No Test Result
														value matches {
															DV_TEXT matches {*}
														}
													}
													ELEMENT[at0046] occurrences matches {0..1} matches {	-- Clinical Interpretation
														value matches {
															DV_TEXT matches {*}
														}
													}
												}
											}
										}
									}
									ELEMENT[at0033] occurrences matches {0..*} matches {	-- Overall Interpretation
										value matches {
											DV_TEXT matches {*}
										}
									}
									ELEMENT[at0037] occurrences matches {0..*} matches {	-- Test Result Image
										value matches {
											DV_MULTIMEDIA matches {
												media_type matches {
													[openEHR::
													425, 
													426, 
													427, 
													428, 
													429, 
													518]
												}
											}
										}
									}
									ELEMENT[at0036] occurrences matches {0..*} matches {	-- Comment
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
						state matches {
							ITEM_TREE[at0062] matches {	-- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0056] occurrences matches {0..1} matches {	-- Confounding Factors
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0047] matches {	-- Tree
				items cardinality matches {0..*; unordered} matches {
					ELEMENT[at0048] occurrences matches {0..1} matches {	-- Calibration Reference dB
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0049, 	-- dB SPL
									at0050]	-- dB HL
								}
							}
						}
					}
					ELEMENT[at0058] occurrences matches {0..1} matches {	-- Probe Tone Frequency
						value matches {
							DV_CODED_TEXT matches {
								defining_code matches {
									[local::
									at0059, 	-- 226Hz
									at0060]	-- 1000Hz
								}
							}
						}
					}
					CLUSTER[at0051] occurrences matches {0..1} matches {	-- Criteria for Screening Assessment Pass
						items cardinality matches {1..*; unordered} matches {
							ELEMENT[at0052] occurrences matches {0..1} matches {	-- Intensity
								value matches {
									C_DV_QUANTITY <
										property = <[openehr::123]>
										list = <
											["1"] = <
												units = <"dB">
											>
										>
									>
								}
							}
							ELEMENT[at0053] occurrences matches {0..1} matches {	-- Frequency
								value matches {
									C_DV_QUANTITY <
									>
								}
							}
							ELEMENT[at0054] occurrences matches {0..1} matches {	-- Test Signal Type
								value matches {
									DV_TEXT matches {*}
								}
							}
						}
					}
					allow_archetype CLUSTER[at0055] occurrences matches {0..*} matches {	-- Immittance Machine
						include
							archetype_id/value matches {/openEHR-EHR-CLUSTER\.device(-[a-zA-Z0-9_]+)*\.v1/}
					}
					ELEMENT[at0061] occurrences matches {0..1} matches {	-- Normal Range Definition
						value matches {
							DV_TEXT matches {*}
						}
					}
					ELEMENT[at0057] occurrences matches {0..*} matches {	-- Comment
						value matches {
							DV_TEXT matches {*}
						}
					}
					allow_archetype CLUSTER[at0063] occurrences matches {0..*} matches {	-- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Acoustic reflex test result">
					description = <"Record of measurements from an acoustic reflex test, and their clinical interpretation.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any Point-in-time Event">
					description = <"Default, unspecified point in time event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Test Result Name">
					description = <"Identification of the acoustic reflex test performed.">
					comment = <"The name of the test identifies the of type of stimulus used - either an acoustic or non acoustic stimulus.">
				>
				["at0005"] = <
					text = <"Acoustic Reflex Test">
					description = <"Test of the reflex elicited from the stapedius muscle in response to an acoustic stimulus.">
				>
				["at0006"] = <
					text = <"Non Acoustic Reflex Test">
					description = <"Test of the reflex elicited from the stapedius muscle in response to a non-acoustic stimulus e.g. tactile or orbital air-jet.">
				>
				["at0007"] = <
					text = <"Result Details">
					description = <"The test measurements and interpretations which can be recorded per ear, and includes ipsilateral and contralateral testing.">
				>
				["at0008"] = <
					text = <"Test Ear Configuration">
					description = <"Identification of the ear to which the stimulus is presented and the ear where the probe is situated.">
				>
				["at0009"] = <
					text = <"Left Ipsilateral">
					description = <"Stimulus presented to the left ear; probe is situated in left ear.">
				>
				["at0010"] = <
					text = <"Right Ipsilateral">
					description = <"Stimulus presented to the right ear; probe is situated in right ear.">
				>
				["at0011"] = <
					text = <"Left Contralateral">
					description = <"Stimulus presented to the left ear; probe is situated in right ear.">
				>
				["at0012"] = <
					text = <"Right Contralateral">
					description = <"Stimulus presented to the right ear; probe is situated in left ear.">
				>
				["at0013"] = <
					text = <"Diagnostic Test">
					description = <"Reflex test that measures threshold levelss, reflex latency, reflex amplitude and reflex decay.">
				>
				["at0014"] = <
					text = <"Screening Result">
					description = <"Reflex test that identifies the presence or absence of a reflex at a predetermined stimulation level.">
				>
				["at0015"] = <
					text = <"Result">
					description = <"Result of the test.">
				>
				["at0016"] = <
					text = <"Present">
					description = <"The reflex has been observed as present.">
				>
				["at0017"] = <
					text = <"Absent">
					description = <"The reflex has not been observed.">
				>
				["at0018"] = <
					text = <"No Screening Result">
					description = <"No screening test result is available for the test ear configuration.">
				>
				["at0019"] = <
					text = <"Reason For No Test Result">
					description = <"Reason why no screening test result is available for the test ear configuration.">
					comment = <"For example: ran out of time.">
				>
				["at0020"] = <
					text = <"Threshold Level">
					description = <"The lowest stimulation level at which a reflex could be measured by the probe.">
				>
				["at0021"] = <
					text = <"Clinical Interpretation">
					description = <"Clinical interpretation of all diagnostic results for the specified test ear configuration.">
				>
				["at0022"] = <
					text = <"Test Signal">
					description = <"Identification of the stimulation signal used for the test.">
				>
				["at0023"] = <
					text = <"Broad Band Noise">
					description = <"Noise with components over a wide range of frequencies.">
				>
				["at0024"] = <
					text = <"Narrow Band Noise">
					description = <"Noise centred on a specified frequency.">
				>
				["at0025"] = <
					text = <"Pure Tone - 500 Hz">
					description = <"A pure tone signal set at 500Hz.">
				>
				["at0026"] = <
					text = <"Pure Tone - 1000 Hz">
					description = <"A pure tone signal set at 1000Hz.">
				>
				["at0027"] = <
					text = <"Pure Tone - 2000Hz">
					description = <"A pure tone signal set at 2000Hz.">
				>
				["at0028"] = <
					text = <"Pure Tone - 4000Hz">
					description = <"A pure tone signal set at 4000Hz.">
				>
				["at0029"] = <
					text = <"Reflex Latency">
					description = <"Length of time from onset of the stimulation tone to the onset of the middle ear muscle reflex.">
				>
				["at0030"] = <
					text = <"Reflex Decay">
					description = <"Length of time that the reflex amplitude can be sustained.">
				>
				["at0031"] = <
					text = <"No Diagnostic Result">
					description = <"No diagnostic test result is available for the test ear configuration.">
				>
				["at0032"] = <
					text = <"Reason For No Test Result">
					description = <"Reason why no diagnostic test result is available for the test ear configuration.">
				>
				["at0033"] = <
					text = <"Overall Interpretation">
					description = <"Overall clinical interpretation of all of the results.">
					comment = <"Coding with a terminology is preferred, where possible.">
				>
				["at0034"] = <
					text = <"Intensity">
					description = <"Clinical interpretation of reflex threshold during diagnostic testing, based on intensity.">
				>
				["at0035"] = <
					text = <"Result">
					description = <"The result of the test.">
				>
				["at0036"] = <
					text = <"Comment">
					description = <"Additional narrative about the test results and intepretation not captured in other fields.">
				>
				["at0037"] = <
					text = <"Test Result Image">
					description = <"Digital representation of the entire result.">
					comment = <"Note: Multiple images can be recorded.">
				>
				["at0038"] = <
					text = <"Normal Range">
					description = <"The intensity range in dB at which a reflex is expected in a normal hearing ear.">
				>
				["at0039"] = <
					text = <"Absent">
					description = <"No reflex was elicited in response to a stimulation tone.">
				>
				["at0040"] = <
					text = <"Elevated">
					description = <"Reflex was elicited at an elevated stimulation level.">
				>
				["at0041"] = <
					text = <"Sensation Level">
					description = <"Clinical interpretation of reflex Threshold Level result based on sensation level.">
					comment = <"Sensation level is the difference between the intensity of the stimulation tone and the patient's hearing threshold as measured on the audiogram.">
				>
				["at0042"] = <
					text = <"Normal">
					description = <"The reflex was observed at a sensation level expected in a normal hearing ear.">
				>
				["at0043"] = <
					text = <"Reduced">
					description = <"The reflex was observed at a reduced sensation level compared to a normal hearing ear.">
				>
				["at0044"] = <
					text = <"Elevated">
					description = <"The reflex was observed at a higher sensation level than expected for a normal hearing ear.">
				>
				["at0045"] = <
					text = <"Absent">
					description = <"No reflex was elecited in response to a stimulation tone.">
				>
				["at0046"] = <
					text = <"Clinical Interpretation">
					description = <"Clinical interpretation of the screening test result.">
				>
				["at0047"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0048"] = <
					text = <"Calibration Reference dB">
					description = <"Scale used for acoustic calibration of the test signal.">
				>
				["at0049"] = <
					text = <"dB SPL">
					description = <"The test stimuli are calibrated using the sound pressure level scale.">
				>
				["at0050"] = <
					text = <"dB HL">
					description = <"The test stimuli are calibrated using the hearing level scale.">
				>
				["at0051"] = <
					text = <"Criteria for Screening Assessment Pass">
					description = <"The criteria by which the Screening Assessment is passed.">
					comment = <"These criteria are usually defined by authoritative guidelines, a central authority or by the local hearing program.">
				>
				["at0052"] = <
					text = <"Intensity">
					description = <"The loudness of the screening stimulus.">
				>
				["at0053"] = <
					text = <"Frequency">
					description = <"The frequency of the test signal.">
				>
				["at0054"] = <
					text = <"Test Signal Type">
					description = <"The type of stimulation used to elicit a reflex.">
					comment = <"For example: Pure Tone">
				>
				["at0055"] = <
					text = <"Immittance Machine">
					description = <"Details of immittance machine used to conduct the test.">
				>
				["at0056"] = <
					text = <"Confounding Factors">
					description = <"Description of incidental factors that may be contributing to the test result.">
					comment = <"For example: The infant was crying at the time of testing.">
				>
				["at0057"] = <
					text = <"Comment">
					description = <"Additional narrative about the method of testing not captured in other fields.">
				>
				["at0058"] = <
					text = <"Probe Tone Frequency">
					description = <"The frequency of the probe tone.">
				>
				["at0059"] = <
					text = <"226Hz">
					description = <"The probe tone frequency was set at 226Hz.">
				>
				["at0060"] = <
					text = <"1000Hz">
					description = <"The probe tone frequency was set at 1000Hz.">
				>
				["at0061"] = <
					text = <"Normal Range Definition">
					description = <"Definition of the 'Normal Range' value specified within the Intensity data element used for Clinical Interpretation of the Diagnostic Test.">
				>
				["at0062"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0063"] = <
					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.">
				>
			>
		>
	>