Christopher Feahr wrote: >Karsten, >I agree that the medical concepts shhould be carefully modeled first... >then extract the necessary terminologies... then build the necessary >code lists. I have not wanted to pay the $500 licence fee to look at >SNOMED CT, as it will be free for all in 3 months... so I apologize for >my ignorance there... but my understanding was the the SNOMED people had >already modeled complaints, signs/symproms, diagnosis, treatment plans, >prognosis, outcomes... the whole 9 yards. If that is true (seems too >good to be true!) then it may only require a (simple??) mapping of >SNOMED CT to a collection of EHR Archetypes. > >My presumption, given the magnitude of the task of producing such a >granular model... not to mention, the massive physician input and >necessary vetting, for which there is no efficient mechanism...I am >assuming that the SNOMED modeling effort is still at a very high >level.of abstraction. Can anyone fill ne in on the present state of >this work? SNOMED CT claims to already have "350,000 coded medical >concepts", but since it was constructed by a group of pathologists, I am >assuming that other care domains are not represented in great detail. > >Regards, >-Chris > >Christopher J. Feahr, O.D. >Optiserv Consulting (Vision Industry) >Office: (707) 579-4984 >Cell: (707) 529-2268 >http://Optiserv.com >http://VisionDataStandard.org >----- Original Message ----- >From: "Karsten Hilbert" <Karsten.Hilbert at gmx.net> >To: <openehr-technical at openehr.org> >Sent: Sunday, August 10, 2003 4:55 AM >Subject: Re: HISTORY DATA SET IN EPR > > > > >>>The concept of modelling the symptoms in a genric manner manner and >>> >>> >have > > >>>these called up whenever there is a need to record the details. >>> >>> >>I am not sure I fully understand what you want to say. What do >>you mean by "modelling the symptoms" ? >> >>Symptoms could be recorded as free text. This approach you >>describe as inadequate. It *is* inadequate if the goal is to >>process the input computationally. The solution is not, >>however, to use (inadequate) coding systems as is discussed in >>Slee, Slee, Schmidt, "The Endangered Medical Record" (excerpt >>available from http://www.tringa.com ). >> >>Another approach would be to really *model* symptoms based on >>openEHR archetypes. This promises to offer some degree of >>computationality yet preserve the free text. Others in this >>list have more experience with that. >> >>Data-mining, however, shouldn't be the aim of an EMR. It >>should be focussed on patient care. Data-mining will occur >>with aggregates of extracts *from* EMRs. >> >>Karsten Hilbert, MD >>-- >>GPG key ID E4071346 @ wwwkeys.pgp.net >>E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 >>- >>If you have any questions about using this list, >>please send a message to d.lloyd at openehr.org >> >> > >- >If you have any questions about using this list, >please send a message to d.lloyd at openehr.org > > > Hi All,
Precision and accuracy are two attributes that do not seem to fit the detection and reporting of symptoms. It also seems that neither are appropriate since healthcare knowledge is in a continual state of evolution. SARS is a recent example; many other exist. Many Patients complain about healthcare problems that are ignored or result in a diagnosis that makes literally no sense. I know of a Patient who has a neck operation, went to the original Physician complaining about severe problems and requesting pain-killer medication for those times when the pain was especially severe. The Physician wrote a prescription for Prozac but no pain killer. One can only presume that the symptoms suggested that the Patient should at least feel good about being in so more pain. Credibility will be really hard to establish in cases such as this. Moreover, the diagnosis would have to be rational and logical and based upon credible, proven history, the Patient's and the community. I think I have just eliminated the human Provider from the equation. Modeling is a great effort but fails quickly when it incorporates humans. I have no objections to humans, I object to incorporating humans in a procedure that involves accuracy and precision. They are better at receiving dissimilar information, evaluating it, developing alternatives, making decisions and following a course of action as long as it appears to be the right thing to do. Automatic, knowledge-based processes and procedures could serve the Patient and Provider well. Modelling the Patient-Provider is very difficult. -Thomas Clark - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
