Great discussion. I think there are semantic issues at play here as well – the POMR use of ‘problem’ vs the ‘Problem<---->Diagnosis continuum’ that is used as part of the conclusion to a consult etc. Problems are problematic! Add in Contsys and then we start to get into tricky territory.
In my discussions over the years, I think Ian’s view is closest to mine. And in a world where the reality of getting up-to-date Medication Lists or Problem lists of raw/real problems, diagnoses and procedures is not easy, the notion of the synthesised, coordinated, connected POMR Problems seems like a distant pipe dream. The openEHR LINKs nicely allow for Marcus’ and Richard’s dreams of connecting items in the health record. But imagine curating this for each of our patients with chronic disease – time and lack of funding will crush it in most clinical environments as they stand at the moment. But let’s keep dreaming and planning. If we can put the building blocks in place, and there are many that are ready to go within openEHR now, with CDS, smart UI, AI etc maybe much of this could be automated, or at least collated presented to a clinician for verification. Regards Heather From: openEHR-clinical <[email protected]> On Behalf Of [email protected] Sent: Friday, 28 June 2019 10:04 AM To: For openEHR clinical discussions <[email protected]> Subject: Re: Problem orientation in OpenEHR Thanks for all the responses I guess I see "problem" as a high level construct, decided by an expert clinician as a way of "coding" the client's various ongoing, significant issues in a way that is relevant to management. It could be a formal diagnosis like Diabetes or a less structured problem like "smoker". I am not sure how this could be coded in a consistent way - the definition of a problem can be quite subjective and in general it is the task of a sophisticated clinician. Short term issues like "Upper respiratory tract infection" or even "abscess" would not normally be defined as problems in my practice. I agree with Marcus on the understanding - I have struggled with the whole concept of OpenEHR for a long time as a sophisticated clinician and perhaps somewhat less sophisticated IT enthusiast. I see it as a data modelling system accessible to clinicians to allow computable models - which in turn will allow decision support. But I think the "problem" concept ids an important one Perhaps we should relax a bit - allow the clinician to create problems at their discretion which are not necessarily connected to other elements of the record. This is effectively how it works now. R ----- Original Message ----- From: "For openEHR clinical discussions" <[email protected]<mailto:[email protected]>> To: <[email protected]<mailto:[email protected]>> Cc: Sent: Thu, 27 Jun 2019 17:05:35 -0300 Subject: Re: Problem orientation in OpenEHR In a slightly roundabout way, Links from Problem-SOAP Compositiions to Entries committed at other times is essentially the equivalent of tagging, and indeed the UI could easily be built to make it look exactly like tagging, by presenting a list of existing SOAP note problem names, and the 'tag this under problem X' action would create the relevant Link. Literal tagging causes some issues in versioned, medico-legal EHRs, because you are updating the link target, not the logical link source, when there is nothing changing in the target. it seems to me we should think a bit more about (?semi-)persistent SOAP Compositions, and maybe a related micro-service to make it easy to do logical tagging that actually does the correct linking... - thomas On 27/06/2019 16:33, Marcus Baw wrote: If I wanted to solve POMR in a simple way without repetition, I'd use Tagging You'd tag anything relevant to the Problem with that problem's Tag, you index by Tags too, in a background job Then when searching by Problem you get all entries Tagged as relevant. M On Thu, 27 Jun 2019 at 19:32, Gunnar Klein <[email protected]<mailto:[email protected]>> wrote: I do agree pomr has an important role in primary care and I like the proposal of Thomas to manage it in openEHR. I am not sure why pomr never took on in hospitals. Larry Weeds idea was not restricted to primary care. Gunnar Klein, GP an professor of health informatics
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