On Mon, Aug 20, 2018 at 10:04:45AM +0100, Thomas Beale wrote: > Some of these Contsys definitions are problematic:
> > ENCOUNTER > > > > But there is an encounter when the HcP interacts with the EHR without a > > Patient (Virtually) present. > > that would certainly be a subversion of the usual meaning of 'encounter' > (literally 'to meet') in English and all the latin languages at least... (in > Portuguese and Brazil health system, the word is 'atendimento', i.e. > attendance... - probably the same in Italian and Spanish). > > It would be better ontologically to call such an event something else - in > openEHR it is a commit of a Contribution. I agree. In GNUmed we tend to think of this as a "session", in quite a technical sense, between the technical system and _a_ ("one"-party, where one is by purpose, not by number) actor. So, a tumor board meeting is a session, as long as the patient (or a non-staff guarantor) is not present. Perhaps it's the difference between ABOUT the patient as opposed to WITH the patient. A session is the frame within which the commit of a Contribution occurs. An encounter does need a session (implicit or explicit) in order to technically manifest itself. But a session does not need an encounter. Waters get muddy when patient and system are involved only, due to information asymmetry: What if the patient interacts with the system and the system is programmed to reinforce adherence. Patient types into a "Question: ___________" GUI field: "Should I continue this medication ?" And the system answers: Generally, you should continue as previously decided. However, if you see fit to rethink that decision would you like to: - leave as is - revisit the previously documented decision details - decide something else now - contact a HcP now - book an appointment > I would suggest that most people think an episode of care is not limited to > one HCP, and is not always limited to one health issue, even if there is > usually one main 'problem' on admission. An episode of care is usually > thought of as care to resolve an issue for a patient by a team of HCPs > working in an integrated environment, e.g. a hospital. If the resolution of > the issue requires care that crosses institutions (usually the case), then a > different term is probably needed for that. In GP land it feels more helpful to think of Episodes of Care to relate to one "issue", "problem" each. Several episodes - about currently-thought-to-be-different issues can overlap. In GNUmed we over-arch episodes of care with "health issues". Each health issue can have several (non-overlapping) episodes over time. Each issue can be thought of to have several episodes (technically) going on at different institutions concurrently. Each problem manifests as a thread, an episode of care for that problem, running through one or several encounters. Each encounter can interweave several threads. Each problem may become identified to belong to a particular health issue, an underlying "cause". IOW, episodes and encounters are orthogonal in nature. Problems are the labels of episodes. Health issues are the containers for potentially several episodes. At least in GNUmed. Karsten -- GPG 40BE 5B0E C98E 1713 AFA6 5BC0 3BEA AC80 7D4F C89B _______________________________________________ openEHR-technical mailing list openEHR-technical@lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org