Hi Vipul,
Thanks for the clarification on the notes.
See below for comments:
Dan
Kashyap, Vipul wrote:
Dan,
Thanks for pointing this out. Would like to clarify that these notes
are taken by a scribe in a telcon and sometimes the context of the
statement is not captured accurately.
To correct the mis-statement: The HL7 Observation standards for
EMR's have been in use since the 1990's in both HL7 2.x standards
and the new HL7 RIM-based standards found in CDA documents and
other RIM-based standards. These RIM-based standards are now
chosen by national government bodies including US (ONC contracts),
Canada (Infoway), Australia (NEHTA), and the UK (NHS). Therefore,
there are widely used standards for observations in EMR design.
[VK] The specific context in which this comment was made was
that of clinical decision support and clinical research protocols.
For the most part HL7 standards used for interoperability and storage.
Specifically Detailed Clinical Models have been developed
by Stan Huff et. al. for clinical decision support and
documentation, use cases for which HL7 2.x standards are typically
not used (correct me if I am wrong).
At the same time, DCMs are HL7 compliantl and I believe
are going through the standards process within HL7. So in some
sense they might be "future HL7 standards".
<dan> Clinical decision support has long been implemented with HL7
Arden in commercial products that describequeries against
databases populated with HL7 2.x observations. These queries could
not be standardized in the HL7 2.x environment, but the
observations themselves often were standardized in OBX segments
utilizing LOINC codes. That is not to argue that 2.x observation
models or Arden decision support models are optimum in today's
environment. We just need to recognize the history before
inventing something new. Regarding Detailed Clinical Models...The
current standards in HL7 CCD use templateID's to specify templated
clinical structures. These are the standards today for composite
observations that need to be taken into account.. As you suggest,
Detailed Clinical Model work may have some impact on future HL7
standards, but most DCM are compositions of observations. Not
quite the same as the simple observation itself. One might look at
HL7 Care Record Query messages for standards on querying composite
observations. </dan>
Hope the work of the Clinical Observation Interoperability group
makes sure that an effort is made to harmonize clinical trial
observation standards with both of these older, widely-used HL7
standards for patient care....Dan
[VK] Absolutely, our goal is to re-use and incorporate widely
used standards such as HL7/DCM and SDTM using Semantic Web
specifications.
Will be great if some folks from the Clinical side of
Oracle could participate in this activity.
<dan> I'll forward to the Oracle Clinicals crowd />
Cheers,
---Vipul
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