Karsten,
Out of interest, is there a diagram or other GNUmed documentation /
explanation of all this. It's pretty close to what I think openEHR is or
should be doing; you have formalised more of this than we have so far,
so it's good to have some reference points available.
- thomas
On 20/08/2018 10:28, Karsten Hilbert wrote:
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
--
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Project, Intermountain Healthcare
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation
<http://www.openehr.org>
Chartered IT Professional Fellow, BCS, British Computer Society
<http://www.bcs.org/category/6044>
Health IT blog <http://wolandscat.net/> | Culture blog
<http://wolandsothercat.net/> | The Objective Stance
<https://theobjectivestance.net/>
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