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
