Hello all
I am a lurker von this list - don't have the expertise of most of you
blokes
(BTW I play music with Sam Heard regularly)
However I thought I should comment on this issue
As I understand it one of the major advantages of a properly designed
data modelling system such as OpneEHR is that it is computable
For me one of the first tasks for an intelligent system of decision
support after things like flagging abnormal observations in a score
would be to create a "Careplan" ie a schedule of recalls and
interventions to manage Chronic Disease and Multimorbidiity. This
would of course depend on the relevant issues being defined as a
"problem" or diagnosis.
Each Careplan would be different depending on the client's problems
Yes I accept there is argument as to what constitiutes a "problem" -
for me it is an ongoing, significant discrete issue or group of
issues such as Diabetes, Renal failure, a cancer of some sort,
Ischaemic Heart Disease etc
Much of our work nowadays in Primary Care is managing the demands of
complex multimorbidty.
Would be interested in comments
R
----- Original Message -----
From: "For openEHR clinical discussions"
To:"For openEHR clinical discussions"
Cc:
Sent:Wed, 26 Jun 2019 15:25:02 +0100
Subject:Re: Problem orientation in OpenEHR
Hi Paul,
We can do it but I am increasingly of the view that although it makes
some clinicians very happy it makes many others very unhappy as proper
POMR requires huge discipline, and is hard to maintain. As others have
said ... links.. but manging those links both clinically and
technically is challenging.
I spent much of GP career advocating (and doing) POMR but I'm not now
at all convinced that the effort is worth it or sustainable.
Ian
Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: [email protected] [1]
twitter: @ianmcnicoll
Director, freshEHR Clinical Informatics Ltd.CCIO inidus Ltd.
[email protected] [2]Co-Chair, openEHR
Foundation [email protected] [3]
Hon. Senior Research Associate, CHIME, UCL
On Wed, 26 Jun 2019 at 14:35, Paul Miller wrote:
How would we do this?
There is a method of implementation in problem oriented records
whereby a header, generally the ‘problem’, is linked to other
record entries or elements that are to do with that problem.
So ‘chest pain’ as a problem may be linked to blood tests,
clinical notes, ECG, CXR and medications that were ordered or reported
as part of the work up of that condition.
In interfaces this allows for views of the record showing the Problem
and all linked events/entries/data. It’s essentially what Larry Weed
used to talk about.
Of course things may relate to more than one Problem, Problems may
link to each other, Problem headers and content will change over time.
There is usually a fair amount of manual curation, which may be very
contextual, but theoretical a lot of it could be automated.
By modelling this linkage in data it would become computable, and
potentially make some clinicians very happy in their work!
Is this something that is part of openEHR specification or that can be
modelled in archetypes? Or is it down to the application to manage
this?
Thanks for any help. As always slightly anxious that am missing
something completely obvious, so apologies if so!!
Paul
Dr Paul Miller
GP, Glenburn Medical Practice
Clinical Lead, NES Digital Service
Mobile/WhatsApp: +44 7711 346 938
--
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Dr Paul Miller
MBCHB MRCGP FFCI DRCOG DMI
Glenburn Medical Practice
Fairway Avenue
Paisley
PA2 8DX
Tel: 0141 884 7788
http://www.glenburnsurgery.scot.nhs.uk/ [5]
Clinical Lead
NES Digital Service
https://nds.nes.digital/ [6]
Mobile: +44 7711 346 928
Twitter: @docpaulmiller
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