As an observer it seems to me there has been a lot of effort to codify encounters and make the data in them computable and recallable.Then we create an entity called problem which has little formal connection with this data - it is the synthesis by a sophisticated clinician of a shorthand summary describing that patient in a useful way. This to me is the essence of what I do apart from management decisions of course. Without this the record is just a set of (relatively) raw data. I dont think computers are at the stage where they can replace the clinician in doing this - though it might an interesting AI problem.The synthesis of a relevant problem list is especially important in multimorbid patients which now form a large proportion of our work.To me SOAP is a structured way to think about an encounter and is not particularly relevant to a problem list - unless you see the "A" part as the Assessment for the whole patient.R
----- Original Message ----- From: "For openEHR clinical discussions" To: Cc: Sent:Wed, 3 Jul 2019 17:35:07 +0100 Subject:Re: Problem orientation in OpenEHR On 28/06/2019 06:48, Paul Miller wrote: > > I maybe don't quite understand yet the approach Thomas suggests for > SOAP persistence. In my head SOAP is a way of structuring an encounter > (not modelling a 'problem'), and various other such encounter headings > are present in other EHRs. Thus I think any encounter recorded in a > SOAP structure may relate to a 'problem', but not actually be the > definition of the problem itself. Although if an initial encounter > record using SOAP or whatever was persisted and curated I can see how > that may build a meaningful set of links, although still not sure we > have the 'Problem' defined there? well my epistemological (and non-MD) view is that thinking of a SOAP structure not just as the headings for a 'SOAP note', but as the headings for a 'problem summary' or similar, could create better quality problem-oriented data in the record. If there was a small catalogue of 'problems' (anything for which a SOAP structure summary already created in the past), each with a title that could be anything from a patient issue (chronic back pain) to a solid Dx (diabetes), then the UI could show that list, and when a new encounter occurred, the doc could create (structured) event notes as usual, and also (by some efficient drag-n-drop) choose an existing problem and attach some of those notes (e.g. patient stmt, phys exam, etc) to it, rather than just creating a new SOAP note. Or it might be the other way around, where one or more problems is chosen from the list, and the notes created inside them visually, which would still create independent event notes, and links from the relevant problems (i.e. the link could be removed or ignored in the future). If that kind of approach were used in a fairly disciplined way, it might lead to the emergence of some high-quality problem oriented content in the EHR, in theory making it progressively easier for docs seeing the patient later in time to get an efficient feel for what is going on with that patient. I don't know if any systems actually work like that, and it might not even work even theoretically in some cases, since it's easy enough to imagine that under the problem 'chest pain', on one day, the patient describes a minor feeling of heaviness, but a month later, true radiating pain angina symptoms. For that to work in one SOAP structure, you start having to have headings like 'progression', and somehow order the patient impressions from different points in time. On the other hand, if you chose 'angina' as your problem, non-angina chest pain would have to go somewhere else... All of this may well be too esoteric to be worthwhile. The more basic value of SOAP is still available for recording an encounter: it nicely separates the patient subjective impression from the HCP's observations, and separates both of those from assessment (which is not an observation, despite what some docs say!) - thomas _______________________________________________ openEHR-clinical mailing list [email protected] http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
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