Eric Browne wrote:
>Tom & Sam, > >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). > I think you are really campaiging for the general importance of social, human and other real-world events in the health status of the individual, which I cannot disagree with of course. As a non-clinician, I cannot say anything about how such things should be recorded, but I can say that (as far as we know) there is nothing to stop openEHR models of the EHR getting in the way of radically or even paradigmatically different ways of doig medicine (but we still think the activity of "recording" will continue to occur). >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. > Well, once pregnancy is diagnosed, the most likely date of conception is recorded. If the fact of pregnancy were marked in some way as an IMPORTANT EVENT, any application could use such a marker to make the event clear in the history of things on the screen. I don't see why this could not be done, and maybe it needs some investigation. >>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. > That's probably true - but on the other hand, even with the fact of Bali bomb reocrded as an event in the EHR, there is no way to guarantee which later symptoms and/or problems are due to it - this is only going to be possible in population studies, in which many instances are used to infer general patterns. But I think human management of the inferencing process is still needed. > > >I seem to have drawn the discussion away from the topic of this list. >Perhaps I should redirect further discussion to openehr-clinical instead? > that is probbaly the correct group, but don't worry, this discussion is interesting and may indeed lead to some new ideas. - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
