Eric I have archetyped this to some extent based on health care pathways and external payments/insurance etc in such circumstances.
I have called it Accident/Injury/Poisoning - this sounds like your non-health care event. It has information about the insurance company (if relevant). It does not, at present, have any features not dealt with in openEHR entry.observation class. Pregnancy is also modelled as an observation - it is does not include the antenatal visits - as these are recordings made during pregnancy. The fact that a (persistent) pregnancy recording might contain links to these (event) recordings is optional. One day, archetypes might be accepted nationally that make this mandatory? The pregnancy observation includes (as I have archetyped it) Date of LMP Date of EDD (can be revised as required) Active (is this pregnancy still active) (to cope with multiple births) [Name of child] \ date and time of birth [Name of child] \ location of birth [Name of child] \ mode of birth [Name of child] \ Birth weight (Then a whole lot on complications....) Fertility procedure This may not prove to be the best approach - but it is clearly persistent information. Cheers, Sam > -----Original Message----- > From: Eric Browne [mailto:eric at montagesystems.com.au] > Sent: Saturday, 7 December 2002 2:25 PM > To: Thomas Beale > Cc: Sam Heard; openehr-technical at openehr.org > Subject: Re: Categorising EHR Content > > > Tom & Sam, > > Thanks for taking the time to explain the openEHR use of OBSERVATION, > EVALUATION and INSTRUCTION and how these do not limit the ability > to express state and events in a variety of clinical models. When > one moves from thinking in the healthcare space to thinking in the > recording space it is easy to misinterpret terminology, particularly > in simplistically mapping state to OBSERVATION and healthcare actions > to INSTRUCTION. > > I would, however, still like to crusade for the importance of the > notion of non-care event, and its usefulness in future care. I > appreciate it can easily be catered for in archetypes, but would like > to re-stress its importance. > > To start with your statement, Tom, regarding the usefulness of recording > the Bali-bombing in a subject's EHR: > > > yep. And consider: while it would in theory be possible to put something > > in the EHR indicating the fact of the Bali bombing, this is in fact of > > no use to patient care - we have to the know the patient's point of > > view, not just the independently reported fact from the ABC reporter. > > Were they in the nightclub? Around the corner? Heard the blast (ear > > damage)? > > > The very knowledge of the event totally transforms the care that is > provided, as you, yourself indicate. I doubt that a person admitted to an > ICU with burns to his/her foot would normally be tested for hearing loss! > > The normal course of healthcare is one of deducing the event. From thence > forth, domain knowledge, harnessed from many similar events to other > subjects, is used to guide the course of analysis and treatment. The > analysis and treatment is, of course, modulated by the individual's > symptoms, as you suggest. In fact, this process occurs so frequently that > the first part of it is given a special name - diagnosis. It's just that > diagnosis is usually limited to a subset of the event space (i.e. those > change_of_state events that are taught in medical schools). > > Again, consider a 25 year old female who presents at a clinic having > missed 2 successive periods. The GP, having considerable knowledge > of a generalised pregnancy event, suspects, tests for, and diagnoses > pregnancy. The event, and domain knowledge thereof, is more important > than the recording of the observation "missed 2 successive periods". > Now one could view pregnancy as an aggregation of observations. One could > view pregnancy as an evaluation from observations. One could view > pregnancy as an event, about which special data should be stored ( > subject's weight, estimated date of conception, HbA1c, etc. ) I think > that there is value in the last of these views, independent of the first > two. > > From an epidemiological point of view, it is useful to store non-care > events. In their absence, one could trawl through a population's > set of EHR's and discover a correlation between first degree burns, > hearing loss and trauma. But I am not convinced this would lead to > a clinical guideline for dealing with bomb victims. > > I seem to have drawn the discussion away from the topic of this list. > Perhaps I should redirect further discussion to openehr-clinical instead? > > Thanks again for your explanations. > regards, > eric > -------------------------------------------------------------------- > > On Fri, 6 Dec 2002, Thomas Beale wrote: > > > > > Sam Heard wrote: > > > > >Eric > > > > > >You are into the territory that Computing and Health care have > been swimming > > >in for many years - how to model health care - rather than health care > > >recording. > > > > > exactly right. The models we have developed describe in a regular way > > the concept of "recording" - whcih they have to, because there is no > > other way for information to be committed to any medium. Thus, a model > > of recording has to have phenomenologically primacy in any list of > > models which apply to the information in question. Models of concepts > > like "real world event", "accident" etc will appear as archetypes. > > > > > > >b. bali bombing > > >Observation .. was in Kuta and hit by debri ... evaluation .. Very > > >distressed and requires counselling .. Instruction - referral > to counsellor > > >who is working with such clients. > > > > > yep. And consider: while it would in theory be possible to put something > > in the EHR indicating the fact of the Bali bombing, this is in fact of > > now use to patient care - we have to the know the patient's point of > > view, not just the independently reported fact from the ABC reporter. > > Were they in the nightclub? Around the corner? Heard the blast (ear > > damage)? etc Again - we need the patient's account (or that of other > > relevent person, e.g. patient's friend, or other bystander who knows > > what happened to te patient) - and this is recorded as OBSERVATIONs > > whose content include statements by the patient and/or others, and > > clinical observations. > > > > >c. job redundancy > > > > > >Observation .. made redundant... evaluation ,, this is a > problem that is > > >worth noting in persistent data. > > > > > - similar argument - we need the patient's experience of this, not a > > news report from The Australian. > > > > It is worth remembering that Acts or Events can be quite easily be > > modelled using archetypes, and this is the view of information that the > > GUI user will see. The constructs of OBSERVATION, EVALUATION and > > INSTRUCTION are very broad categories, and are derived from a > > philosophical conceptualisation of recording information, i.e. > > "knowing", also the epistemological categories of knowledge (OBSERVATION > > = empirical; EVALUATION = a priori ideas; INSTRUCTION = knowledge of how > > or what to do) > > > > - thomas beale > > > > > > > - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
