I'm not ready to give up on POMR just yet. It is a lot of work and difficult to maintain, as Ian points out, but as a locum GP, when I work in practices that use problem orientation it is MUCH easier and safer to treat people you don't know. Practices that just dump everything into the record without Problem Orientation are just asking for trouble medicolegally IMO.
What worries me about this conversation is that, among UK GPs, I'm probably in the upper 0.1th percentile of health technology understanding among them. I've been learning about openEHR since 2012. And I *still* don't fully understand this conversation. Is it me? Or are we going to have a bit of a problem getting your average clinician to participate in the design of future POMRs unless we make it much less technical? Marcus On Thu, 27 Jun 2019 at 07:40, GF <[email protected]> wrote: > A few of my thoughts abd advice: > > 1- have a look at the CEN/ISO standard defining the concepts related to > Continuity of Care. > 2- For may years Dutch GP’s use the SOEP method of documenting the > provision of health and care. (SOEP=Subjective, Objective, Evaluation, Plan) > 3- For many years we collected data items under the heading of Problem in > a Problem List f(PrL) or use by one Healthcare Provider (HcP) > 4- Then the Episode (Ep) was introduced because GP’s started to > collaborate with other HcP’s. > 5-The progression of the developments in the Patient System over time > cause changes in the title of the PrL and Ep. > E.g. PL title = Reason for Encounter (cough); then PL title=Pulmonary > infection; then PL title=Tuberculosis; > Ep titles probably will have the same titles. > 6- The Continuity of Care standard provides a lot a fine detail. In order > to make things simple I used my compatible version of the medical treatment > model of that standard, > > 1. *Observation* in the Patient system (PS) that is documented > 2. *Evaluation* of the Observations, PrL, EL, etc leading to > differential diagnosis, working diagnosis or determined diagnosis > 3. *Planning*. Differential Diagnosis will lead to plans with goals to > prove or disprove diagnosis or start treatment > 4. *Actions*. Plans a re broken down to actioned and documented > procedures influencing the PS or other (non-PS) systems for administrative > purposes such as data exchange, requests, scheduling, updating the PL > and/or Ep > 5. Followed by Observations that are documented. > > > Steps i to 4 each have a fixed Pattern Archetype as ENTRY archetype > All PS and Ep’s are collected in distinct FOLDERs the FOLDER shows the > progress of the health and care process over time. > > > Gerard Freriks > +31 620 34 70 88 > +31 182 22 59 46 > [email protected] > > Kattensingel 20 > 2801 CA Gouda > the Netherlands > > On 26 Jun 2019, at 22:30, Thomas Beale <[email protected]> wrote: > > > On 26/06/2019 11:07, Thomas Beale wrote: > > As yet, the machinery to do this mostly exists, but there is little in the > way of standardised patterns or usage of it to achieve any kind of > standardised 'problem' document (NB: not the same as 'problem list' - which > is one level up, and is a managed list of issues considered to be problems, > usually inclding current Dxs such as diabete > > other than the SOAP heading structure, of course, as described in another > post on this thread. > Thomas Beale > Principal, Ars Semantica <http://www.arssemantica.com/> > Consultant, ABD Project, Intermountain Healthcare > <https://intermountainhealthcare.org/> > Management Board, Specifications Program Lead, openEHR Foundation > <http://www.openehr.org/> > Health IT blog <http://wolandscat.net/> | Culture blog > <http://wolandsothercat.net/> | The Objective Stance > <https://theobjectivestance.net/> > _______________________________________________ > openEHR-clinical mailing list > [email protected] > > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > > _______________________________________________ > openEHR-clinical mailing list > [email protected] > > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org >
_______________________________________________ openEHR-clinical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
