Dear all, From the lengthy and educative discussions on this mail list, the last couple of weeks, the following occurred to me:
- observations are to do with gathering evidence - an evaluation is an activity of comparing data to a knowledge base (and draw a conclusion based on that comparison (SV)) (Both excellent definitions provided by Thomas Beale) The other thing that occurred to me is that the ?assessment? of data quality is an evaluation too, based on a knowledge base, which knowledge is summarized in a protocol. As one might recall, I?ve been struggling were to put the data quality protocol and the outcome of the evaluation. This ?insight? makes it much easier from my point of view, I can just ad an evaluation archetype data quality. Over thinking this I wondered if we should give these knowledge bases/ assessment protocols a firmer position in the evaluation archetypes To explain this I would like to start with a question: what?s the purpose of an EHR? I don?t know if there is a better definition but from my point of view it?s something like: to capture all healthcare related data of a patient/citizen in such a manner that his/her medical situation is represented as good and as complete as possible and that the (relevant) data is (re-) usable by all health care providers (and ultimately the agents) involved in a certain process. My interest is especially in the (re-) usability of available data and evaluations, since this is essential to improve the quality and efficacy of our healthcare system. On top of that, if the data is of good quality, some (parts of) processes can be fully automated which could even further increase quality and efficacy. If we look at the re-usability of data (as put down in observations), this is provided for in the current openEHR EHR. One can use this system to capture and share ?evidence?. This shared ?evidence? can then be (re-) used by any healthcare provider involved in the process to asses it to the desired protocol (either in ones head of written down in paper) to evaluate it. Everybody re-evaluates the available data every time in order to draw his/ her ?own? conclusion. This is a perfect valid way to do it, albeit cumbersome. If we look at the re-usability of evaluations, we still miss two things. I?ll enlarge the ?problem? a little in order to make it, but the point is that trust and re-usability are essential components for a, not only functional but, widely accepted and used EHR system Firstly: In order to be able to re-use an evaluation one needs to know against which protocol this conclusion is drawn. Only if this protocol aligns with or is similar to the protocol used locally, one can consider re-using the evaluation. To give an example: the diagnosis criteria for rheumatoid arthritis (RA) are not ?engraved in stone?. It varies over time and it varies locally. So in one situation RA is diagnosed if X joints are inflamed for Y weeks but in another situation the diagnoses is only given if at least one ?large? joint is involved and/or if Z joint are inflamed for Q weeks (I made this up, so don?t hold this against me:-) ). So if one doesn?t know which protocol is used to evaluate it, the diagnose RA doesn?t mean too much. Secondly: In order to obtain a reliable conclusion one needs to use ?evidence? of ?good quality?. Even if the protocol is known, an evaluation won?t be re-useable if the data quality of the underlying ?evidence? is poor/ unknown. Who would trust an evaluation if it?s possibly based on false assumptions? Similarly as with the evaluation of a medical situation, data quality has to be assessed against a (locally accepted) protocol. This assessment leads to a conclusion (f.i. good/poor/undetermined data quality). Also here, that conclusion isn?t worth much if it isn?t known against which protocol the assessment is made. I?ve looked into the current evaluation archetypes and although there is some room to reference to additional information (f.i. ?reference, useful information about this condition? in the EVALUATION.problem- diagnosis AT), there is not a dedicated place for the protocol used to draw a certain conclusion. So my suggestion is to add a field (?protocol used for evaluation?) to all the evaluation archetypes, in order to stimulate the re- usability of, not only observations but also, evaluations. Cheers, Stef PS Needless to say that I?m not a big fan of knowledge bases or protocols, which are only present in the head of a healthcare provider -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20071030/b868108d/attachment.html>
