Sam would be better able to give an idea of all the health professionals who have been consulted, but certainly in Australia, Vince McCauley (a pathologist) has been extremely helpful on pathology result detail. Also, people like Heath Frankel and Grahame Grieve who have worked with HL7v2 messages for years have provided quite a lot of input on details (for example in Release 1.0, there is now a summary attribute for Historical data structures, directly due to Grahame's advice on the shape of lab data his software handles - see http://www.openehr.org/uml/Browsable/_9_0_76d0249_1109157527311_729550_7234Report.html).
Is it enough? At this stage I would be fairly confident that the models are good enough for most pathology data (certainly everything any of the docs working with openEHR has seen). Are they perfect? Of course not. We always need more input. The confidence level stuff implied by your requirements (let's treat them as epi/public health data requirements) would make things better; we just have to determine a) what scope of data they apply to (e.g. how much sophistication do we need in the EHR compared to say a dedicated data warehouse designed for statistical studies?) and b) how to add them to the current model in a way compatible with what is there. I think that he idea of a workshop is a good one; I would prefer to see clinical professionals here take up the suggestion and do something with it; I don't see these kinds of discussions as being IT driven - they are all about articulating requirements. - t Tim Churches wrote: > Thomas Beale wrote: > >> Tim Churches wrote: >> >>> >>> >>>> Tim, if the accuracy_is_percent attribute was upgraded to a coded >>>> value, could you suggest a set of meanings that would cover all the >>>> epi/PH needs? >>>> >>>> >>> You'll have to tell me what that would involve. A single coded value? >>> Upper and lower limits? Confidence level. Type of limit? >>> >>> >> well, essentially what you are proposing >> > > Not proposing anything, I'm just asking the question "Have you thought > about this?" > > >> would require (let's not get >> too pure about how I use the word "accuracy" here for the moment): >> - lower accuracy limit: Real >> - upper accuracy limit: Real >> - accuracy limit type: coded term >> - confidence level (or this could be part of the previous coded >> attribute, since only a small number of confidence bands are used in >> practice aren't they?) >> >> Now, what we currently have is a set of general purpose quantity classes >> designed to enabled recording of any quantitative data we have come >> across so far. Between various MDs such as Sam, Vince and others, I >> think we have pathology covered from a practical point of view (well, we >> do once we get this <, >, etc thing sorted). >> > > Just curious: have you had much input from pathologists, microbiologists > and lab scientists? The more one talks to such people, the more one > discovers about the uncertainties inherent in certain assay techniques, > and the differences in the scalar (and qualitative or Boolean) results > produced by different assay kits and different labs. > > Oh, there's another form of uncertainty which typically is of relevance > to Boolean/dichotomous results (positive/negative, detected/not detected > etc) and that is the sensitivity and specificity of the test, or the > related quantities PPV (positive predictive value) and NPV. (Note to > computer scientists: "specificity" and "sensitivity" are cognate with > "precision" and "recall".) > > >> The real question is: what is the type & origin of data that need to >> represented in the more sophisticated way that we are now suggesting? Is >> it a different category of data? Should be leave the current DV_QUANTITY >> as is and add a new subtype? Or is it that we should consider a quantity >> with a 95% T-distribution confidence interval as a pretty normal thing? >> Should we then start considering the "simple" idea of a symmetric >> accuracy range (+/- xxx) as really just one specific type of a >> confidence interval (it might translate to something like 98% on a >> normal curve). In other words, should we generalise he "accuracy" notion >> into a "confidence interval" notion? >> > > I think that a one or two day workshop with a range of pathologists, > microbiologists, lab scientists, epidemiologists and statisticians (and > some clinicians and computer scientists, of course) would suffice to > come up with sensible answer to your question. I'd be happy to > participate and to suggest other participants. First half day would need > to be spent bringing everyone up to speed on openEHR so they understand > the nature of the question(s) to be addressed (and a good means of > spreading the openEHR gospel while you're at it...). > > Might be possible to hold a cyber-workshop instead, via email or > real-time conferencing. The former would be much slower, of course. > > Tim C > > > > -- ___________________________________________________________________________________ CTO Ocean Informatics (http://www.OceanInformatics.biz) Research Fellow, University College London (http://www.chime.ucl.ac.uk) Chair Architectural Review Board, openEHR (http://www.openEHR.org)
