Ian, Allow me to join in on this one. The issues that it raises in my head are 1. provenance (who said it, when and why). This gives the clinican clues about how 'trustworthy' the information is. 2. credibility (did they understand the implications of what they were recording, were they being mischievous, could they have misunderstood or misheard) 3. relevance to the patient care decisions that may be made in the future (and therefore how necessary is it (or not) to be an input into the decision support engine) NB. 3 is not a static thing, relevance may change at some future time with a change in the patient's condition. What was thought not to be relevant may become so e.g. hallucinations as a side effect may turn out to be (or to cause) a psychotic event instead.
Other discussions (elsewhere) regarding the relevance of a reaction to a drug and severity of a reaction are related to these issues inasmuch as one severe reaction of one type may be much less relevant for future care than a mild reaction of another type. E.g. severe constipation may be much less important than mild bronchospasm. As you say, an interesting discussion Pauline Sweetman -----Original Message----- From: [email protected] [mailto:openehr-clinical-bounces at openehr.org] On Behalf Of Thomas Beale Sent: 13 July 2007 17:55 To: For openEHR clinical discussions Subject: Re: Data quality questions/ proposal Ian McNicoll wrote: > Thomas, > > As well as a textual reason, there may be a more generic requirement > to flag 'not thought suitable for decision support or secondary uses', > so that the result (or entry) is ignored by machine processing. The > standard practice in UK GP systems, where a Read coded item proves to > be unreliable, is to 'delete' the original and recreate it as a Text only uncoded item. > > yes, that has long been the thinking among people doing openEHR, CEN and related things. > This is a fascinating discussion!! > > It raises all sorts of issues in my head. In particular, Stef he > suggests that without reliable quality/trust markers, there will be > limitations to the vision of the single homogenous EHR. Whilst In > principle, I think he is correct, I think such limitations are > inevitable and as with others who have commented, feel that the cost > and effort of maintaining a *meaningful* quality marker system would > far outweigh the benefit. > if we look at it in a cost-benefit mode, then at what point do the costs of ignoring data from another source outweigh the supposed benefits? Ultimately quality of care and patient safety will become a question; if not then it is just academic anyway. - thomas _______________________________________________ openEHR-clinical mailing list openEHR-clinical at openehr.org http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-clinical ********************************************************************** This message may contain confidential and privileged information. If you are not the intended recipient please accept our apologies. Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents: to do so is strictly prohibited and may be unlawful. Please inform us that this message has gone astray before deleting it. Thank you for your co-operation. NHSmail is used daily by over 100,000 staff in the NHS. Over a million messages are sent every day by the system. To find out why more and more NHS personnel are switching to this NHS Connecting for Health system please visit www.connectingforhealth.nhs.uk/nhsmail **********************************************************************
