Hello, I read opinions expressed on the topic. This question is important in France. The government took the decision that all citizen is going to have an electronic medical file.personal (DMP acronym) In principle all physicians with the authorization of the patient will have an access to this medical file for me it is about a medical file published a little like a weblog (to private and controlled acc?s) It is completely different of the electronic medical file that every physician must create and hold up to date for his/her/its patient in his/her/its cabinet. we call it the software profession.( logiciel m?tier in french ) This DMP should receive information exported from the software profession of the physician. The difficulty is to decide: 1 - what information must be published, 2 - this information is it reliable, so that another physician can use him and not to ask for a new exam 3 - if the physician producer of information, has a space of liberty, so that his/her/its responsibility implication is not systematically.? The solution would be can be to differentiate well: 1 - an information validated by the physician and that gives him the opposable information statute. He/it accepts to hire his/her/its responsibility. It is an information that is certified by documents as the imagery, the biopsy, the biologic analyses. 2 - an information proposed by the physician and that gives him the likely, possible information statute, but of which the level of certainty is not sufficient to have the opposable information statute. In this case the responsibility of the physician, be able to not be put in reason, while using this information no validated like proof. It is a legislative and legal probl?me, that is different of a computer analysis, but that is real.
Indulgence for my English and thank you. Dr R LONJON France Selon Gerard Freriks <gfrer at luna.nl>: > Sam, > > I agree. > > Suggestion > In otherwords any clinical (or non-clinical) concept model must be > able to express the view of the author about certainty. > 3 states are sufficient for starters: > likely (as default) > not-likely > certain > > When a person attaches new information to the EHR and is of the opinion > that whole or parts of a received extract (or EHR) need an other > qualifyer then via versioning he must be able to annotate this by > adding his beliefs about certainty. > > > Gerard > > -- <private> -- > Gerard Freriks, arts > Huigsloterdijk 378 > 2158 LR Buitenkaag > The Netherlands > > +31 252 544896 > +31 654 792800 > On 27 Apr 2005, at 23:25, Sam Heard wrote: > > > Arild and Tim > > > > This is clearly an issue. In the CIP project the group wanted to be > > able to say that a diagnosis was a working diagnosis. > > > > We have archetyped a number of concepts that I think will enable the > > clinician to express these levels of uncertainty without resorting to > > confidence ratings on all entries in the record. Arild has shown that > > you could not possibly do a mastectomy without rating your certainty > > at 100% - or you will be sued. And not treating a pneumonia in a > > newborn with a certainty of only 20% will probably get you in trouble. > > These sort of explicit ratings are - in my opinion - very problematic. > > > > The solution lies in the recording constructs used for many years: > > > > 1. To express differential diagnoses (with or without probabilities) > > and to note key excluded diagnoses as well. > > > > 2. To express a diagnosis as a problem (such as lump in left breast) > > even if the likelihood of cancer is 100% clinically until the > > histology is returned. > > > > 3. To be able to label a diagnosis as a working diagnosis - ie it is > > likely enough to warrant the current management - but not certain. > > Appendicitis is a good example. > > > > So the archetypes for problem, problem-diagnosis (specialised) and > > differential diagnosis should meet these needs. > > > > Comments? > > > > Sam -- - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
