Re: openEHR @ StackExchange - getting close
done signing up and upvoting. ___ openEHR-technical mailing list openEHR-technical@lists.openehr.org http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
modeling non-medical data
But the purpose then would not be to collect data for healthcare purposes - i.e. this post is about the use of open EHR standards and technologies for to answer a scientific question? Arild Faxvaag Den 2. jul. 2007 kl. 06.06 skrev Andrew Patterson: > I have come across an interesting opportunity to do some openehr > modeling in a sports science context. However, whilst half of > the data is medical (heart rate etc), the other half is > raw physical data (GPS location, cadence etc) related to in > this case a bike.. > > So I would have one large history consisting of heart rate over > time which can be modeled with existing archetypes. For the > other data (the corresponding cadence over time), > I will obviously need to construct my own > archetypes. Does anyone have any experience at modeling > this sort of non-clinical data? What would I name the > archetypes - are they in the EHR namespace? Are there any > composition archetypes suited to this non-healthcare > related data input? How does one decide what goes in > an archetype for data that comes from a bike (an archetype > for each data item, or one archetype to group the data > items together?) > > (I realise it may just be easier to store that data in a > non-openehr system but doing it the openehr way has certain > attractions - some of which are that provides a unified mechanism > for all the data, and can be extended to more clinical > sports science data if that becomes important) > > Andrew > ___ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- Arild Faxvaag MD, PhD Associate professor / Rheumatologist Norwegian Research Centre for Electronic Patient Records (NSEP) Medisinsk teknisk forskningssenter N-7489 Trondheim Phone: +47 9821 6825 http://folk.ntnu.no/arildfa/
position available - associate professor in health informatics at NTNU, Norway
d doctoral candidates in his/her
discipline. He/she must agree to participate in administrative work.
He/she is obliged to follow the regulations that concern changes and
developments within the discipline and/or the organizational changes
concerning activities at the University.
Newly-appointed staffs in academic positions who do not already master
a Scandinavian language are expected to acquire knowledge of Norwegian
or another Scandinavian language within three years of appointment at a
standard equivalent to level three in the Norwegian for Foreigners
courses provided by the Department of Applied Linguistics. NTNU offers
such courses.
The appointment is to be made in accordance with the regulations in
force concerning State Employees and Civil Servants.
A research position is remunerated according to wage levels 54 to 75 on
the Norwegian government salary scale, with gross salary from NOK
378.200 to NOK 558.700 a year. The position as Two per cent of the
salary will be deducted as an obligatory premium to the Norwegian
Public Service Pension Fund.
Further details about the position can be obtained from professor
Anders Grimsmo, tel. +47?909 24?691, e-mail anders.grimsmo at ntnu.no
Applicants are asked to give an account of their pedagogical
qualifications according prepared guidelines ("Documentation of an
applicant?s pedagogical qualifications") which can be obtained from
following address on internet:
http://www.ntnu.no/administrasjon/avdelinger/personal/
momentliste_ped_kval_e.html.
As NTNU would like to increase the percentage of females in academic
positions, women are particularly encouraged to apply.
Applicants should submit 5 copies of the application together with
their CV (curriculum vitae) and a list of publications. In addition,
the applicant should submit a description of the academic work that
s/he finds most significant and that s/he wants the evaluation
committee to pay particular attention to. In addition, the applicant
should enclose 10 papers that he/she would like the committee to put
particular emphasis on during the evaluation.
Joint works will also be evaluated. If it is difficult to identify the
contributions from individuals in a joint piece of work, applicants are
to enclose a short descriptive summary of what he/she did in this
connection.
Applicants are asked to give an account of their educational
qualifications according prepared guidelines ("Documentation of an
applicant?s educational qualifications") which can be obtained from
following internet address:
http://www.ntnu.no/administrasjon/avdelinger/personal/
momentliste_ped_kval_e.html
Applications should be sent to:
The Medical Faculty, the Norwegian University of Science and Technology
Faculty of Medicine, Medisinsk Teknisk Forskningssenter, N-7489
Trondheim, Norway (Phone +47?7359 8859 - Fax +47?7359 8865)
regards
--
Arild Faxvaag
associate professor / rheumatologist
Adress / Office St.Olavs hospital:
Department of Rheumatology, St.Olavs hospital N-7006 Trondheim, Norway
Phone Dept of Rheumatology 47 7386 7263
Adress / Office NTNU
Norwegian center for electronic patient records research (NSEP)
Medisinsk teknisk forskningssenter
N-7489 Trondheim
Cellphone: 47 9821 6825
http://www.ntnu.no/~arildfa/ (home page NTNU)
http://www.usemed.com (weblog on e-medicine)
http://www.ehr.ntnu.no/e (Norwegian Centre for Electronic Health
Records Research)
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uncertainty in medical problem solving and decision making (Was: Dr R LONJON Confidence indicator !
> In ?25% of the extremely wel researched patients in one University > Hospital we not diagnosed correctly during their life time. > As could be concluded after an autopsy. > So what do we really know about disease and complaints? > What is certainty? > What is it refering to? > Do we understand this mine field well enough? I recommend this book: "Decision making in health and medicine Integrating evidence and values" by M Hunink and P Glasziou. Speaking with experience from rheumatology and general practice in Norway, I agree that the state of the diagnosis in medical records is lousy. Just a few points: - as stated by Gerard, physicians very often come up with the wrong diagnosis, sometimes with fatal consequences. - how strong the physician believes in the diagnostic hypothesis is not stated explicitly. -- whether this certainty/probability is above or below the test-treat threshold (depends among others on the expected utility of the treatment) is not stated. -- whether this certainty/probability is above or below the no treat (wait) - test threshold - too many resources are spent on excuding differential diagnoses whose (pretest) probabilities already are below the no treat - test threshold --this to maintain the trust from the patient / avoid the risk of litigation. The actions of health care personnel have norms. What entity a "diagnosis" is can also be evaluated according to what the norms say it _should_ be. The diagnosis _ought_ to be an inferrence drawn from medical knowledge and information which stems from the patient. It is not the underlying disease but the physician's inferred diagnosis that form the basis of all health interventions. Because of this, it deserves to be represented as more than a subjective statement. In an EHR system, it should be possible to link the diagnosis statement with its underlying premises. It should also be possible to link the diagnosis to the set of plans/actions that follows as a consequence. This would lay the foundation for EHR systems that visualizes the consequences of physician's actions in a much better ways than in systems of today. regards Arild fax - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
The Uncertainty Decision was: Dr R LONJON Confidence indicator !
P? 7. mai. 2005 kl. 15.12 skrev Thomas Beale: > Gerard Freriks wrote: > >> The EHR is not invented to describe the real actual health status of >> the patient. >> It is there to document what clinicians deemed important to say ABOUT >> the health status of the patient. >> It always is an opinion of a professional about something. > > yes, hopefully we all agree with this philosophy. > I can agree that the doctors hypothesis is an opinion, but those parts of the EHR that are pure descriptions of phenomena and symptoms, plans and descriptions of actions are not. > But we need to add (contradict me if I'm wrong;-) that it is what > clinicians wanted to say which they deemed relevant to next steps - > either diagnostic or intervention. What to do next is not just based > on the doctor's confidence about what the symptoms might mean, but > also on: > - the urgency of treatment of that condition (cases like cerebral > meningitis, malaria...) > - the severity of the condition (e.g. cystic fibrosis) > - the severity of the consequences of the condition on others (CF, > huntington's, ...) > The issues here are - the severity of the disease - the course of the disease if not treated - the potential benefits of the intervention - the probability of the patient actually achieving these benefits - the cost and complexity of the intervention - the potential side effects of the intervention - the probability of these to develop - the patient's preferences (some patients are risk takers, others are not) one can also add - the need to convince the patient (replace the patient's hypothesis with that of the physician). - the need to maintain the patients trust in the provider (unless the patient might withdraw the care mandate / not give his consence to the plans suggested by the physician). > ...so it seems to me that the indicator of what to do next when a > differential diagnosis is recorded relates strongly to the innate > characteristics of the conditions recorded, not just the doctor's > opinion of how likely it might be. If angina pectoris is a possible > diagnosis for "burning chest pain" at 5%, with the most probable > diagnosis (in the opinion of the physician) being "gastric reflux" at > 95%, and it is a 55-yo with a family history of coronary heart > disease, I presume that the angina pectoris possibility is the one > that drives the next steps? How are the confidences really decided? > > How are we to bridge the gap between the physician-recorded confidence > factor and the total list of factors which drive the next steps? What > do we need in the EHR? Is this "just" a decision support problem > (where the physician will be performing the decision support)? Very briefly,, here are some factors (using terminology adapted from risk analysis): - Being healthy is something of high value. - Posessing a (unexplained) health problem implies being exposed to a potential threat to ones health. - When the patients seek a doctor he gives responsibility to the doctor and thereby partially transfer the risk to him (partially the health care person, partially the organisation who employs this person). - Diagnostics can be considered risk exploitation. - Therapeutics can be considered risk managment. - The patients confidence in the provider is a prerequisite for both diagnostics and therapeutics and is therefore (from the perspective of the provider) something which has high value in its own (and therefore must be maintained). - Services from health personell to patients are therefore justified for two reasons -- to maintain the patients health -- to maintain the patients trust in the provider This leads to the perspective on the EHR system as a tool for exploitation and managment of risks that can harm the patient or his trust in the provider. Can this shed new light on the issue of the confidence indicator? Arild Faxvaag -- next part -- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 3978 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050509/c362aeec/attachment.bin>
The Uncertainty Decision was: Dr R LONJON Confidence indicator !
Tim Cook wrote: While it might be an interesting exercise for us to record how confident a clinician was at the time of recording a diagnosis, it will have no impact on the health care of that patient. If we were to do this would we ask them to do so in 10% steps, 5% steps or .01% steps? I assert that any one of these would seriously impact the usability of an EHR in a negative manner and would result in the clinician taking the option that presents the least liability on their part. So back to the short answer above.is it really relevant to assert ANY confidence factor in the EHR? My opinion is that there indeed is highly relevant to assert a confidence factor in the EHR. ln decision analysis one talks about treatment thresholds for diagnostic uncertainity as "the probability of disease at which the expected value of treatment and no treatment are exactly equal, and ne ither option is clearly preferable." (Hunik and Glasziiou "Decision making in health and biomedicine"). Factors influencing the treatment threshold are the expected benefit and the expected harm of the treatment. Example: Treatment threshold is much lower for pneumonia (treatment: penicillin) than for cancer of the left mamma (treatment: Mastectomy) Thus: How confident a clinician is at the time of recording a diagnosis has high impact on the health care of that patient. Comments on this? regards, Arild Faxvaag -- next part -- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 1527 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050427/be6e62a1/attachment.bin>
uncertainty in medical problem solving and decision making (Was: Dr R LONJON Confidence indicator !
We could say that physicians _infer_ diagnostic hypotheses based on - knowledge of the tentative underlying disease, - the patients subjective experiences - phenomena registered in the patients body Phrases such as "cannot be exluded" might be due to", "probably", "definitely", "beyond doubt" are statements of probability of the inferrence being correct (and what to do next). Can one say that diagnoses belong to the class of statements whereas the disease itself belong to the class of natural phenomena? The diagnosis establishes a relation between the subjective experiences / phenomena and the disease that induces those symptoms and findings. Example: Experiences and phenomena: Pain in the wrist joints, feeling of joint stiffness, joint tenderness, joint swelling, elevated sedimentation rate. Diagnostic inferrence: Rheumatoid arthritis. Relation: Might be induced by/due to Can statements of probability be considered statements regarding the strength of these relations?? Comments on this? regards, Arild Faxvaag - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
uncertainty in medical problem solving and decision making (Was: Dr R LONJON Confidence indicator !
Hi all. This is an important topic. Here are some references / pointers for those who wish to read more: "Decision making in health and medicine. Integrating evidence and values" Myriam Hunink and Paul Glasziou Cambridge university press (ISBN 0 521 77029 7) Society for Medical Decision Making: http://www.smdm.org/ I also recommend journal articles written by Wimla L Patel (Colombia university, New York), for instance: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11418539 (A primer on aspects of cognition for medical informatics) regards arild Faxvaag P? 22. apr. 2005 kl. 07.42 skrev Gerard Freriks: > -1- Almost never a diagnosis is 100% certain. > -2- Almost always a test result has uncertainty attached to it > -3- Many times a conclusion is reached based on many uncertain and > conflicting facts > -4- Quite often a condition, a diagnosis, is assumed that gives rise > to a treatment. Not indicating that the patient is suffering from this > condition but using treatment as a test procedure. Doing nothing is > such a test procedure. > > Eric Wulff (from Danmark) published philisophical texts about health > care and these topics. > > gerard > > -- -- > Gerard Freriks, arts > Huigsloterdijk 378 > 2158 LR Buitenkaag > The Netherlands > > +31 252 544896 > +31 654 792800 > On 20 Apr 2005, at 13:58, Thomas Beale wrote: > >> I'm wondering if there is a meta-algorithm of some sort lurking >> behind the scenes, which takes account of uncertainty in a note, and >> also severity of non-discounted possibilities, as a way of deciding >> what to do next. There is undoubtedly published work on this... >> >> thoughts? >> >> - thomas beale >> -- Arild Faxvaag associate professor / rheumatologist Adress / Office St.Olavs hospital: Department of Rheumatology, St.Olavs hospital N-7006 Trondheim, Norway Phone Dept of Rheumatology 47 7386 7263 Adress / Office NTNU Norwegian center for electronic patient records research (NSEP) Medisinsk teknisk forskningssenter N-7489 Trondheim Cellphone: 47 9821 6825 http://www.ntnu.no/~arildfa/ (home page NTNU) http://www.usemed.com (weblog on e-medicine) http://www.ehr.ntnu.no/e (Norwegian Centre for Electronic Health Records Research) -- next part -- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 2315 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050426/9447967b/attachment.bin>
Systems of Concepts to Support Continuity of Care
Seen this: http://www.centc251.org/TCMeet/Doclist/TCdoc00/N00-053.pdf Arild FAxvaag - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
is there a relation between clinical data sets and archetypes
See http://www.prorec.it/efmiStc/recommendations.htm Is clinical datasets identical to archetype repositories? regards Arild Faxvaag - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
use case documents from the health care domain
Dear all. Has someone tried to establish a collection of use case documents with descriptions of information-related tasks by health care workers? Would you developers consider it useful if such a collection existed? kindly regards -- Arild Faxvaag associate professor / rheumatologist Department of Rheumatology, St.Olavs hospital N-7006 Trondheim, Norway Phone Dept of Rheumatology 47 7386 7263 Phone DigiMed FOU 47 7355 0307 Cellphone: 47 9821 6825 arild.faxvaag at medisin.ntnu.no http://www.ntnu.no/~arildfa/ (home page NTNU) http://www.usemed.com (weblog on e-medicine) http://www.medisin.ntnu.no/ibl/revmat/default.shtml (rheumatology at NTNU (norwegian)) http://www.digimed.no (medical informatics research group (norwegian)). - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
