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.
>All of these are events - but in the record they will cause recordings that >are observations, instructions and evaluations. >a. heart attack >Might start with the patient observation of chest pain...an obseravtion of >ECG... an instruction to order a blood test.. an evaluation of a >differential diagnosis.. the observation of the result of the test.. a >diagnosis. > right - in general, there is no way for anyone to say that "X had a major MI" other than via the symptoms reported by X and/or the outwardly observable signs. >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
