> record and think that the two dates were probably the > same, and that it > was therefore the same fracture. I would guess that this > is a real > contrived long shot, and probably unrealistic, but we > need some more > evidence from clinicians...
*** CAUTION *** This turned into a rambling about sociological issues and may have no technical merit. I am not a clinician, but .............. I believe this is NOT unrealistic. It is 'how' people think. Especially so when confronted with a question they did not expect in a usually stressful environment. Yes, a family physician's office is a stressful environment for most people. It is unfamiliar, they are usually ill and the questions seem to come from out of nowhere. Physician's tend to put together puzzles about their patients and they seldom have all the pieces at one time. We probably cannot name a system (at this time) that allows physicians to quickly and easily put those pieces together. But, if given a place to store those pieces, "in context", an implementation of this model will be able to perform those type of retrieval functions. Envision being able to scan a medical record for all partial dates. Retrieve those dates along with some context of the CONTRIBUTION. A computer could do very little with that information in most cases. But a human mind (physician) could probably see relationships/patterns very quickly. The 'idea' of an EHR should be to provide the clinician with appropriate information quickly, so they can do their job better (improved patient care). Dr. Robert Shepherd so aptly describes the real benefits an EHR (with or without decision support) provides to a family physician. I hope I can paraphrase it in an understandable way. He says that a family doc will spend 90% of their clinical time on things they are familiar with. The other 10% is where they benefit the most from the added information that an EHR can provide quickly. That information may come in the form of linked guidelines, accurate and searchable documentation (possibly from other patients EHR's), current patient's history and problem list or sophisticated decision support system. Dr. Shepherd supports this with community / sociological reasoning. So even though a family doc is a generalist, they tend to specialize to some degree because of these social realities. So, for these reasons I believe that providing ways to capture imprecise dates/times in other than DV_TEXT is of benefit and allowing for them to contain only 1/3 of the total data is not without merit. --- Tim Cook - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
