On 28/11/2014 04:17, Koray Atalag wrote: > Hi Karsten, > > I agree about episodicity not being particularly an issue with problem > orientation. > Re randomness I couldn't find the best expression I guess...What I was > referring to is the fact that the information captured by today's systems can > be quite diverse and that stems not from the differences about data entry, > coding etc. but more to do with human factors such as the care setting, > qualifications and interest of the health professional capturing information, > business rules of the organisation, organisational culture and sometimes pure > chance. So if the patient has seen been seen by a nurse, a GP, community > worker, specialist etc. they may all have own views of the problems and their > relationships to goals and actions etc. and eventually any causality type > links to observations. > > I think the EHR specification and its implementation should provide firm > hooks in the data collected to be able to generate different kinds of Problem > Oriented Views. I assume this is one solid reason to incorporate some > clinical semantics into RM as openEHR does. >
one of the lessons we learned in the past is that hooks are needed for the epistemic information types (observation, evaluation, action, instruction, admin) that occur in clinical process, but an ideal version of the process itself can not be a /requirement/. The Danish board of digital health instituted a model called G-EPJ in about 2005, which had a lot of similarities to the openEHR core Entry types and process. However, in G-EPJ, they made the idealised process, that is, the links from Observation -> Diagnosis -> Intervention etc, a requirement, and they published XML schemas and other artefacts that forced e.g. a Dx to be present as an 'indication' for every medication administration, and similar kinds of links. This didn't work with industry, for reasons Koray mentions here - in reality GPs sometimes prescribe without a diagnosis as such, nurses and docs administer drugs in hospital without always having an order. And of course historical records of such events can easily be incomplete, making it impossible to reconstruct data from a legacy EHR into the new required form. This Danish work was conceptually very good, but a bit naive, and we learned from that - provide appropriate information types, and make it possible to have process links but don't require them. There are some improvements that could be done today to this, but the basic decision has turned out to be right I believe, based on intervening years of use. - thomas -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/pipermail/openehr-technical_lists.openehr.org/attachments/20141128/bc3f9465/attachment.html>
