Dear all, -1- Medicine is an art. An art practiced by people. Using imprecise language to document complex processes.
-2- The EHR is there to document what needs to be documented. For now and later. For here and there. For us and them. -3- Points 1 and 2 describe the problem of semantic interoperability: The semantic interoperability needs a scientific rigor. People need semantic freedom to document their art in their community. Semantic Interoperability demands that we are as precise as we can be, as language, culture, independent as we can be. So when we record a size, we record a size and use international units of measurements. In Templates the esteemed healthcare providers must be able to attach any name to any size (range). The main thing is that size is expressed in units of measurement what ever the local name people want to use. Creating semantic interoperability in diverse cultures is only possible as long as we use the real universal scientific meaning for things and allow, as one of the facets of the thing, as many display names as local communities need. -4- Things (measuring devices in this case) have characteristics. Physical characteristics and non-physical characteristics. In Archetypes and Templates we must be able to record all of the relevant ones. Physical things are expressed in physical measurements. Each of these physical measurements will have different names in each culture, language, etc. Non-Physical things are names for the manufacturer, importer. etc People use things and give it intention. By itself things have no intention. Therefor to use in a list, describing physical characteristics of a thing, we can not include the subjective (human) intentions. When people give physical things a subjective context dependent name they are free to do this. Semantic interoperability demands that irrespective of the subjective name we use for physical things we use objective physical things to characterize it unequivocally. -5- Archetypes are the essential artifacts that provide stable long term culture, language, geography, temporal, inflexible, independent way to make possible real semantic interoperability between IT-systems that are used by humans for documentation. Templates are the essential artifacts that provide the unstable, short and long term, culture, language, geography, temporal, very flexible and very dependent way to make in a human way co-operability possible between humans using IT-systems for documentation. -6- We must study the work of Ontologists like Barry Smith. They describe two types of Upper Ontology. SNAP and SPAN. http://tinyurl.com/3xdtmx SNAP and SPAN stocks and flows commodities and services product and process anatomy and physiology SNAP and SPAN SNAP entities - have continuous existence in time - preserve their identity through change - exist in toto if they exist at all SPAN entities - have temporal parts - unfold themselves phase by phase - exist only in their phases/stages Physical things and their characteristics are SNAP. The way we name them, group them, are SPAN. -7- Conclusions Archetypes must be as precise and scientific as possible. Archetypes sometimes describe physical things. Archetypes sometimes describe process things like diagnosis. Templates must be as imprecise and unscientific as human co-operation demands. Templates express the human condition building upon the precise and scientific Archetypes. Archetypes describing physical things in a physical way are SNAP Archetypes describing process related things are SPAN. Templates are always SPAN but composed of SPAN and SNAP parts. Gerard -- <private> -- Gerard Freriks, MD Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands T: +31 252544896 M: +31 620347088 E: gfrer at luna.nl Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety. Benjamin Franklin 11 Nov 1755 On Jan 5, 2008, at 4:57 AM, Heather Leslie wrote: > Medicine is not an exact science in many ways!! Different names, > different brands etc as Gerard points out. Presumably there is not > a BP bladder sizing standard. > > Based on the feedback last year on this topic I had enhanced the BP > archetype. One of the provided references defined a cuff name with > an approximate bladder size for the cuff which seemed to make good > sense to me ? see attached. > > In protocol the cuff options are included as internal codes with > ?nominal names? and the explanation (try double clicking on each > cuff entry) includes the bladder size. I remember someone else > objecting to ?Standard Adult? ? so now we have Small Adult, Adult > and Large Adult ? with ?Adult? being the usual/standard size > available, I guess. > > I thought this was a pragmatic way to give a reasonable choice on > cuff size. > > Finger is not currently available as a location ? I have had mixed > advice about its use. However if there are people out there taking > their blood pressure with a home system on their finger then we > should be capturing that data, and should add it ? and avoid getting > into the advisability of taking a BP from a finger reading > argument. Also will allow Melvin to use an infant cuff on the > finger if he wants! > > Cheers > > Heather -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-clinical_lists.openehr.org/attachments/20080105/302e8a65/attachment.html>
