Hi all,

Remember.

EN13606, openEHR are about documenting by a healthcare provider what  
he has (or want) to document about the treatment of his patient in an  
EHR.
So any investigation or treatment protocol, used as a plan, is part of  
the EHR.
Based on the protocol

And is not about a complete hospital information system, a system to  
perform quality control management related information.
Although these types of systems will use data and information  
documented in the EHR.


When talking about these concepts may I point at the European Norm  
System of Concepts for Continuity of Care. (ContSys)
The next url downloads the definitions.
http://tinyurl.com/2gfm42

The next url download the complete ContSys standard
http://tinyurl.com/2xx7g4

The next couple of relevant definitions occur in ContSys:
3.1
activities bundle
internally consistent set of health care activities (3.39) to be  
performed, being performed, or having been
performed for a subject of care (3.89) by one or more health care  
providers (3.52), in the context of one or
more care plans (3.6), within the framework of a programme of care  
(3.76)


3.6
care plan
description of planned and duly personalised activities bundles (3.1),  
addressing one or more health issues
(3.55), and encompassing all health care activities (3.53) to be  
provided to a subject of care (3.89) by one
health care professional (3.49), or several health care professionals  
having the same health care
professional entitlement (3.51)

3.10
clinical guideline
set of systematically developed statements to assist the decision of  
health care parties (3.48) about health
care activities (3.39) to be provided with regard to a health issue  
(3.55) in specified clinical circumstances

3.39
health care activity
activity performed for a subject of care (3.89) by a health care agent  
(3.40) with the intention of directly or
indirectly improving or maintaining the health of that subject of care

NOTE: Health Care Activity is an abstract construct, without any  
direct instantiation.


3.45
health care goal
desired achievement of a care plan (3.6), considered as an  
intermediate operational step to reach the
ultimate objective of a programme of care (3.76)

3.46
health care objective
desired ultimate achievement of a programme of care (3.76)

3.76
programme of care
description of planned and duly personalised activities bundles (3.1)  
adopted by one healthcare organisation,
typically informed by one or more protocols (3.77), addressing one or  
more health issues (3.55), accounting
for one or more health issue threads (3.56), and encompassing all  
health care activities (3.39) to be
performed for a subject of care (3.89) by one or more health care  
parties (3.48)


3.77
protocol
customisation of a clinical guideline (3.10) for use in a local context

NOTE: critical path(s), care plan(s), clinical pathway(s): plan, based  
on data gathered during (subject's of
care) assessment, that identifies the care needs, lists the strategy  
for providing services to meet those needs,
documents treatment goals and objectives, outlines the criteria for  
terminating specified interventions, and
4
documents the (subject's of care) progress in meeting specified goals  
and objectives. [ISO TR 18307:2001]
[JCAHO]




Gerard


On Dec 22, 2007, at 9:42 AM, Stef Verlinden wrote:
>
> Yesterday we had a lengthy discussion about quality assessment for
> management purposes: f.i. how many people in ward A have post-op
> wound infection and how does that relate to the overall rate of wound
> infection. This typically doesn't belong in an EHR but in a separate
> system. I was mixing these two things up:-)
>
> As for the clinical trial data and guidelines. Reasoning along the
> line above, this also should belong in the same EHR since it's about
> (the treatment, albeit experimental) of a patient.

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