Hi Thomas, --- In openhealth@yahoogroups.com, Thomas Beale <[EMAIL PROTECTED]> wrote: > > Nandalal Gunaratne wrote: > > The power of this approach is hard to appreciate > > > >> until you're in a > >> situation where lots of people have lots of things > >> they want to > >> characterize in a system. It allows non-developers > >> to own and > >> augment their own notions of what data matters to > >> them, without > >> altering the underlying database model. > >> > > > > This is important for clinicians in different > > specialities with various interests in the specifics. > > No FOSS EMR I tried/used, except OIO, allow this to be > > done easily by users. > > > > The Concept Dictionary approach seems to be similar to > > the Archetypes approach of OpenEHR, which goes a > > further step. > > > > > you can see a urinalysis archetype here: > http://svn.openehr.org/knowledge/archetypes/dev/html/en/openEHR-EHR-OBSERVATION.laboratory-urea_and_electrolytes.v1.html > (main page: http://svn.openehr.org/knowledge/archetypes/dev/index.html) > > - thomas beale >
Thanks for the link. It hasn't worked for me, but I'm familiar enough (I think) to have at least a cursory understanding of what archetypes are. Probably enough to be dangerous. :) Defining the relative metadata around medical concepts is typically a good thing, and for your work on that I applaud this effort. However, where I get worried with this approach is in both the vagaries of health care and practice patterns. A wise quote that I heard when I started medical informatics training was "a lot of what we practice today is wrong." I'm a pediatrician, and I can attest to this... and because of the constant evolution in best practices, there's always a "scattergram" of practice styles vs. best practices. That is, the urinalysis today, might not be the urinalysis of tomorrow. Some might continue to use the old urinalysis for a number of various reasons, and some of those reasons might be correct. Therefore, there arise various flavors and colors of a single "archetype" that I think I understand represent models of how certain care is delivered. These coexisting vagaries and various evolutions of medical concepts unfortunately I think are a necessary reality of health information system design. What we've attempted to do at Regenstrief (and within OpenMRS for that matter) is to abstract out one level further. That is, all medical concepts have descriptions, datatypes, "classes", and for a given combination of class, datatype some relative metadata. For example, a urine pH is a numeric datatype, and a test class. Therefore, it has metadata such as absolute, critical, and normal ranges, a unit designation, etc etc. These concepts live in the database right alongside the actual repository of data to serve as a general resource to the entire enterprise. Any user can populate the database with new concepts, and we're actively working on building a resource, the OCC (OpenMRS Concept Cooperative) to allow for imports/exports of these creations for the use of the entire community. That being said, it's probably a good idea for the community to try something that inherently feels more tightly defined and interoperable. We however, made the choice based on pragmatics. That is, the approach I've described has been road tested for a very long time with good success. We wanted to stack our odds for success, and were more reluctant to experiment. The OpenMRS group took advantage of our institution's work, added some extra details (such as the ability to pre and post-coordinate ccmplex questions and answers, richer synonymies, etc.) Best, -Paul
