Bill and all This is a very important consideration and one that we need to get right for lots of reasons.
Tom has been proposing an aggregation approach - allowing us to find all data that relates to something - a disease, care at an institution etc. It is clear that there are aspects of the episode that are specific to the care setting and administrative and billing requirements. We could have a composition that held information about the administrative aspects of the episode....for billing purposes or secondary data collection. It would be possible to archetype an 'episode' folder to contain one of these - and possible to define what is held within it should that be appropriate. It is clear that a simple aggregation model is not enough, but we also do not want to have lots of folders to describe one episode from different perspectives. The Mayo can only have one episode per patient at any time....this ensures that the person who opens an episode is responsible for closing it - and summarising it, tying up lose ends etc. This is a very important quality issue in distributed care environments. But in the Australian setting where we have primary and secondary care separated - the notion of secondary care episode is largely a billing or funding issue - although we have discharge referrals back to primary care. In primary care, the idea of an episode - a single one at a time - is appealing to me - meaning it is non-routine care for the problems the person has. It stops what Michael Balint called the "collusion of anonymity" - a destructive outcome of 'shared' or 'parallel' care. Cheers, Sam > Hi Thomas, > > Thomas Beale wrote: > >>Someone could come along later in the same >>institution, and define a new kind of episode, and >>retrospectively create all the Folders for that kind >>of episode in certain EHRs. This also won't >>change any of the underlying data. Episode >>Folders could also be removed, renamed, their >>references added to or removed - none of this >>changes any of the data either. > > > Do you envision this being done manually? Or is there a programmatic > solution? The question this thread has raised in my mind is well > illustrated by your comment below. > > >>I think any institution has to have a firm model >>for what it thinks an episode is > > > Assuming that different institutions will adopt models that differ, what are > the implications for the exchange of data and the creation of a lifelong > EHR? > > Thanks, > Bill > > - > 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
