Hi Bob, An 'international awareness' must be developed in advance and evolved continuously. The EHR community is part of the bedrock of future Healthcare policies, procedures and practices. It must be based on facts and incorporate all available information.
The Legal community requires facts in the form of admissible evidence and information in the form of testimony, inferences, deductions and interpretation. It renders judgments in accordance with established law and in some cases remedies for parties before the Court. In the presence of this certainty it makes 'big' mistakes and sometimes loses its way. As an example, Forensic Science has upset many judgments and caused the restructuring of many policies, procedures and practices. A complaint often heard is that Forensic Science, and genetics in particular, has in a short time caused more change than years of reasoned thought within the Community. With jurisdictions releasing prisoners from Death Row for crimes they did not commit to ineffective FDA-approved drugs, with fatal side effects, for specific conditions being withdrawn change is 'in the air'. A recent humorous complaint from the bench comments on juries demanding to have Forensic data and analysis prior to deliberations. It might be that 'fact-based outcome-oriented' Healthcare is becoming popular. "... tickle the need for some common upper ontology for the domains of governance which includes the process by which the legal environments are created and maintained in various countries ... the question of governance in standards bodies ... ..." This is not an easy task due to the supremacy of the Administrative, Legislative and Judicial branches of governments plus the diversity and number of governments. The following is a simple example of how technology, science and legal processes can work in one jurisdiction. BRAIN FINGERPRINTING *IN THE SUPREME COURT OF IOWA** *No. 122 / 01-0653 Filed February 26, 2003 TERRY J. HARRINGTON, Appellant vs. STATE OF IOWA, Apellee http://www.judicial.state.ia.us/supreme/opinions/20030226/01-0653.asp "... Upon our review of the record and the arguments of the parties, we conclude (1) Harrington?s appeal is timely; (2) this action is not time barred; (3) Harrington is entitled to relief on the basis of a due process violation; and (4) Harrington?s motion for conditional remand is moot. Accordingly, we reverse the district court judgment, and remand for entry of an order vacating Harrington?s conviction and sentence, and granting him a new trial. We deny Harrington?s motion for remand on the basis of mootness ..." Brain Fingerprinting Laboratories http://www.brainwavescience.com/Ruled%20Admissable.php "... In order to be admissible under the prevailing Daubert standard, the science utilized in a technology is evaluated based on the following four criteria: (The Iowa courts are not bound by the Daubert criteria used in the federal courts, but they do use them when determining the admissibility of novel scientific evidence.) 1. Has the science been tested? 2. Has the science been peer reviewed and published? 3. Is the science accurate? 4. Is the science well accepted in the scientific community? The judge ruled that Brain Fingerprinting testing met all four of the legal requirements for being admitted as valid scientific evidence. The ruling stated: "The test is based on a 'P300 effect.'? "The P300 effect has been studied by psycho-physiologists?The P300 effect has been recognized for nearly twenty years. The P300 effect has been subject to testing and peer review in the scientific community. The consensus in the community of psycho-physiologists is that the P300 effect is valid ..." This example identifies one approach to modifying existing legal processes. There are close to 200 countries in the UN and each maintains significant diversity. An approach taken within the US is based upon a set of 'Model Codes' (see the Legal Information Institute at: http://www.law.cornell.edu/statutes.html ). A recommended approach to addressing Healthcare under the Law, Legal requirements, handling and interpretations of EHRs, and related Legal processes is to: 1)Expand the Model Codes to cover EHRs 2)Include appropriate provisions with the EHR standards to build-in compatibility with the Model Codes 3)Include processes to handle change. Separate Legislatures and Judicial systems reference the Model Codes now, i.e., When in doubt look at what others have built. Since Judicial systems interpret the laws that the Legislatures have enacted the opportunity to impact the system to achieve goals for the common good in the shortest time lie with the Model Codes. At least this approach can be considered foundational. Regards! -Thomas Clark Bob Smith wrote: >Hello David and Thomas, > > >You said: > > > >>>You speak much sense!! >>> >>> > > > >>>"The Legal environment in particular requires reconstruction." >>> >>> > >When you combine these ideas of "Sense Making" and "Reconstructing the legal >environment's relationships to medical communities of _EHR practice" we >tickle the need for some common upper ontology for the domains of governance >which includes the process by which the legal environments are created and >maintained in various countries. > >Several of us involved in a US NHIN_EHR Request for Information process have >begun muddling the question of governance in standards bodies such as OASIS >and considering the processes by which XML evolved under Jon Bosak and >others a decade ago as the basis for building some US Natl Health >Info/Knowledge Networks to support standards for _EHR deployment and use. > >So an intenational awareness is essential, but how far has the openEHR >community explored these dynamic issues? And how are the relationships being >expressed? > >Bob > > > >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of Bigpond >Sent: Saturday, March 05, 2005 4:25 AM >To: openehr-technical at openehr.org >Subject: RE: Demographics service > >You speak much sense!! > >"The Legal environment in particular requires reconstruction." > >Oh that was the best one I heard today - it's in the order of when the warp >drive emerges. > >Need to think more on your wise thoughts though. > >David >-----Original Message----- >From: owner-openehr-technical at openehr.org >[mailto:owner-openehr-technical at openehr.org] On Behalf Of >lakewood at copper.net >Sent: Saturday, 5 March 2005 3:36 AM >To: openehr-technical at openehr.org >Subject: Re: Demographics service > >Hi David, > >Significant problem! However, software configuration management has >solved this >before. In the Legal or secure OS environments the contributions of >individuals are >in fact part of the record even through the 'end-game' is an update that >merges the >contributions of all, e.g., a composite record. > >It is critical that 'information' is not lost nor corrupted. Efforts to >'crunch' multiple >records into a satisfactory record usually fail this requirement at some >point. > >A reasonable objective is to permit multiple Practitioners to enter >information >simultaneously, maintain original context and content, build a composite >record >that is compatible with the target record-handling system, and support 100% >re-assembly of all sources of information. A 'build-and-submit' or >'interactive-entry' >architecture can yield multiple 'composite' records that may also be >linked by one >or more events, e.g., surgery and lab work. > >It may also be necessary to declare a higher-order event (in a record) >to which >subsequent events can be linked (extra-record, meaning the event can >transcend >a collection of records, e.g., multiple contacts-same cause). > >Information organization is a virtue; lack of it may well impact >information retrieval. > >Try coordinating the activities and results of 20+ Software Engineers >working on a >release. Things happen in parallel. The Legal environment in particular >requires >reconstruction. > >Regards! > >-Thomas Clark > > >Bigpond wrote: > > > >>The EHR is rather a unique document and a layered approach is necessary as >>old data must never be altered - may not necessarily be accessible but must >>never be altered. Errors can be corrected but the error must remain totally >>accessible in the manner it was presented to the clinician when it was >>relied upon - eg clinical results, medications. >>The concept of layering new information on old is important. >>There does have to be lock outs or transaction controls when new data is >>being entered in but there is no need for old material (old may be seconds >>of course)to be locked out cause it can't or shouldn't be changed. >>If two doctors are entering elements of say a discharge summary then one >>cannot edit while another is adding - it needs a message indicating someone >>else is working on the current document and wait. It is more complex than >>that but the basic principle applies old data never changes even old >>addresses must stay. >>Legally it is important to be able to reproduce exactly the circumstances >>that the computer presented to the clinician at any point in time for >>inquests, litigation etc. >>We are dealing with these issues today with our CIS and it is a challenge. >> >>David Evans >>Brisbane Australia >> >> >> >>- >>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 > > >- >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 > > > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
