Tom & Sam, Thanks for taking the time to explain the openEHR use of OBSERVATION, EVALUATION and INSTRUCTION and how these do not limit the ability to express state and events in a variety of clinical models. When one moves from thinking in the healthcare space to thinking in the recording space it is easy to misinterpret terminology, particularly in simplistically mapping state to OBSERVATION and healthcare actions to INSTRUCTION.
I would, however, still like to crusade for the importance of the notion of non-care event, and its usefulness in future care. I appreciate it can easily be catered for in archetypes, but would like to re-stress its importance. To start with your statement, Tom, regarding the usefulness of recording the Bali-bombing in a subject's EHR: > yep. And consider: while it would in theory be possible to put something > in the EHR indicating the fact of the Bali bombing, this is in fact of > no use to patient care - we have to the know the patient's point of > view, not just the independently reported fact from the ABC reporter. > Were they in the nightclub? Around the corner? Heard the blast (ear > damage)? The very knowledge of the event totally transforms the care that is provided, as you, yourself indicate. I doubt that a person admitted to an ICU with burns to his/her foot would normally be tested for hearing loss! The normal course of healthcare is one of deducing the event. From thence forth, domain knowledge, harnessed from many similar events to other subjects, is used to guide the course of analysis and treatment. The analysis and treatment is, of course, modulated by the individual's symptoms, as you suggest. In fact, this process occurs so frequently that the first part of it is given a special name - diagnosis. It's just that diagnosis is usually limited to a subset of the event space (i.e. those change_of_state events that are taught in medical schools). Again, consider a 25 year old female who presents at a clinic having missed 2 successive periods. The GP, having considerable knowledge of a generalised pregnancy event, suspects, tests for, and diagnoses pregnancy. The event, and domain knowledge thereof, is more important than the recording of the observation "missed 2 successive periods". Now one could view pregnancy as an aggregation of observations. One could view pregnancy as an evaluation from observations. One could view pregnancy as an event, about which special data should be stored ( subject's weight, estimated date of conception, HbA1c, etc. ) I think that there is value in the last of these views, independent of the first two. >From an epidemiological point of view, it is useful to store non-care events. In their absence, one could trawl through a population's set of EHR's and discover a correlation between first degree burns, hearing loss and trauma. But I am not convinced this would lead to a clinical guideline for dealing with bomb victims. I seem to have drawn the discussion away from the topic of this list. Perhaps I should redirect further discussion to openehr-clinical instead? Thanks again for your explanations. regards, eric -------------------------------------------------------------------- On Fri, 6 Dec 2002, Thomas Beale wrote: > > Sam Heard wrote: > > >Eric > > > >You are into the territory that Computing and Health care have been swimming > >in for many years - how to model health care - rather than health care > >recording. > > > exactly right. The models we have developed describe in a regular way > the concept of "recording" - whcih they have to, because there is no > other way for information to be committed to any medium. Thus, a model > of recording has to have phenomenologically primacy in any list of > models which apply to the information in question. Models of concepts > like "real world event", "accident" etc will appear as archetypes. > > > >b. bali bombing > >Observation .. was in Kuta and hit by debri ... evaluation .. Very > >distressed and requires counselling .. Instruction - referral to counsellor > >who is working with such clients. > > > yep. And consider: while it would in theory be possible to put something > in the EHR indicating the fact of the Bali bombing, this is in fact of > now use to patient care - we have to the know the patient's point of > view, not just the independently reported fact from the ABC reporter. > Were they in the nightclub? Around the corner? Heard the blast (ear > damage)? etc Again - we need the patient's account (or that of other > relevent person, e.g. patient's friend, or other bystander who knows > what happened to te patient) - and this is recorded as OBSERVATIONs > whose content include statements by the patient and/or others, and > clinical observations. > > >c. job redundancy > > > >Observation .. made redundant... evaluation ,, this is a problem that is > >worth noting in persistent data. > > > - similar argument - we need the patient's experience of this, not a > news report from The Australian. > > It is worth remembering that Acts or Events can be quite easily be > modelled using archetypes, and this is the view of information that the > GUI user will see. The constructs of OBSERVATION, EVALUATION and > INSTRUCTION are very broad categories, and are derived from a > philosophical conceptualisation of recording information, i.e. > "knowing", also the epistemological categories of knowledge (OBSERVATION > = empirical; EVALUATION = a priori ideas; INSTRUCTION = knowledge of how > or what to do) > > - thomas beale > > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
