Thomas, I'm curious to know if your comments are based on a review of SNOMED CT or of ontology/terminology systems, in general? As you probably know, SNOMED was designed expressly to support clinical information needs. I do not have the impression that it was an academic or theoretical exercise. In fact, the US govt. just paid $35 Million for a perpetual license to the SNOMED Clinical Terms database, which it plans to offer free, worldwide starting in Jan, 04. SNOMED is being positioned as a major piece in the healthcare part of our ambitious e-Gov initiative. Operational cost reduction is the principal driver for e-Gov and the Consolidated Health Informatics component.
Unfortunately, I have not been able to get a look at the database of terms yet because they are still working out the terms of the "deal" with DHHS. 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: "Thomas Beale" <tho...@deepthought.com.au> To: <openehr-technical at openehr.org> Sent: Tuesday, August 12, 2003 6:20 PM Subject: Re: HISTORY DATA SET IN EPR > Christopher Feahr wrote: > > >. 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. > > > this is a bit question. The key thing to remember is that: > > - terminologies/ontologies (attempt to) model reality, e.g. their model > of symptoms related to tropical parasite infections will/could be a > detailed semantic net of nodes describing in great detail the symptoms > at every point of e.g. plasmodium lifecycle during malaria infection - > textbook stuff in other words. > > - but the doctor in a hospital is interested in recording observations > about the patient, ordering tests, making decisions, following progres > and so on. The information he/she wants to record and read is to do with > the observation and care process, not with the scientific description of > the life history of plasmodium. This is the area of archetypes and > templates - providing highly configurable models of this information and > processes, during the clinical care path. > > - terminologies are necessary as a knowledge base during the use of > archeytpes - they provide names of things of course, but more > importantly, semantic networks support inferencing. So one can imagine a > doctor recording symptoms and signs in their info system, and thinking > that so far, it could be malaria or some other fever-inducing > infection... if they have detailed enough observations, it may be that > the ontology can provide some guesses as to what the patient has. > > So - we have two kinds of models here: terminology/ontology is about > modelling the real world, and facts we have learned and appear to be > dependable; archetypes and templates are about modelling patterns of > information *in use*, and they depend on ontology for meaning of items > they mention. Archetypes provide for a lot of optionality, whereas this > is not part of ontology (except ontologies modelling decision making > processes themselves perhaps). > > - thomas beale > > > - > 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
