Paul, See below.
- - - - - - - - On Feb 20, 2007, at 5:32 AM, Paul wrote: > 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. Can the OCC be accessed by non-OpenMRS sites? And, as a corollary, can non-OpenMRS sites contribute to the concept coop? Thanks! - - - - - - - - > > 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 > > > > > Yahoo! Groups Links > > > > [wr] - - - - - - - - will ross project manager mendocino health records exchange 216 west perkins street, suite 206 ukiah, california 95482 usa 707.462.6369 [office] 707.462.5015 [fax] www.mendocinohre.org - - - - - - - - "Getting people to adopt common standards is impeded by patents." Sir Tim Berners-Lee, BCS, 2006 - - - - - - - -
