Hi All, What Gerard stated is correct regarding the objective of the OpenEHR effort. What Thomas stated is equally important.
On the Patient side positions become reversed, i.e., Importance is attached to Thomas's position and Gerard's position re 'what clinicians deemed important to say' yields data and information that the Patient can channel to another Clinician if needed. Overall the time the Patient spends in the Clinicians office performing an interview is typically a small spot on the time scale affected with uncertainty but important enough to yield a procedure that may restore Health to some prior state. On the Patient's side the need for EHRs (plural) is clear: a minimum of three EHRs, one for the Clinician, one for the Patient and a meta EHR that keeps the data and information organized and readily accessible. Translated into Developer English that is and OpenEHR project for Clinicians (because the Patient needs to capture the Clinician's diagnosis and course-of-treatment), and PatientEHR system capable of handling Patient-provided data and information, and a meta database for organisation and access. The same approach is applicable for the Patient. Recording 'what clinicians wanted to say' may be a life-saving measure. Applying a meta database would organize the data and information and can be considered the first level in a data mining system. The current OpenEHR approach minus 'what clinicians wanted to say' is an approach destined to block data mining, limit functionality and produce unresolvable points in the record (simply because of recording uncertainty; accurate, precise reproduction requires certainty). The proposed approach is not easy on the Patient's side. The benefits include a much expanded data capture operation that covers 24/7 Health. Reproduction is also hampered by uncertainty but overall reproducibility is much better. Being able to reproduce 'what clinicians wanted to say' is a major benefit. Regards! -Thomas Clark Thomas Beale wrote: > Gerard Freriks wrote: > >> The EHR is not invented to describe the real actual health status of >> the patient. >> It is there to document what clinicians deemed important to say ABOUT >> the health status of the patient. >> It always is an opinion of a professional about something. > > > yes, hopefully we all agree with this philosophy. > > But we need to add (contradict me if I'm wrong;-) that it is what > clinicians wanted to say which they deemed relevant to next steps - > either diagnostic or intervention. What to do next is not just based > on the doctor's confidence about what the symptoms might mean, but > also on: > - the urgency of treatment of that condition (cases like cerebral > meningitis, malaria...) > - the severity of the condition (e.g. cystic fibrosis) > - the severity of the consequences of the condition on others (CF, > huntington's, ...) > > ...so it seems to me that the indicator of what to do next when a > differential diagnosis is recorded relates strongly to the innate > characteristics of the conditions recorded, not just the doctor's > opinion of how likely it might be. If angina pectoris is a possible > diagnosis for "burning chest pain" at 5%, with the most probable > diagnosis (in the opinion of the physician) being "gastric reflux" at > 95%, and it is a 55-yo with a family history of coronary heart > disease, I presume that the angina pectoris possibility is the one > that drives the next steps? How are the confidences really decided? > > How are we to bridge the gap between the physician-recorded confidence > factor and the total list of factors which drive the next steps? What > do we need in the EHR? Is this "just" a decision support problem > (where the physician will be performing the decision support)? > >> >> He, himself, always makes statements with varying degrees of certainty. >> Physicians are no gods that know everything. > > > What? And I thought....oh no, my whole world is shattered...:-) > > - thomas > > - > 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
