On 2002-06-07 15:00, "Tim Benson" <tb at abies.co.uk> wrote:
> Gerard, > > I feel that the idea of the EHR as being essentially a data base made up of > bits of messages is a fundamental misconception that is at the bottom of > many of our problems in health informatics. As first approximation it works > for GPs but sadly, it does not scale across the whole healthcare spectrum. >>>> \ Tim, I agree with you. Messages used in logistics are messages used for logistics. The EHR is about narration. > > Any set structured information is designed for a primary purpose. This is > true of databases, documents, classifications and models. Any attempt to > use that information outside its original purpose is fraught with danger. > While it is true that a collection of documents can be thought of as an > electronic record, we have to take a lot of care when the information which > they contain is reused outside the original context of a message. > > CEN and HL7 messages are just that - messages - from someone, to someone and > about someone at a moment in time. They have more in common with electronic > mail than with database structures. Any attempt to take information from a > message and put it into a database is potentially dangerous and needs to be > done with a real understanding of the data. This can only be done when > messages are rooted in very clearly defined use cases. >>>>> I want to separate CEN from HL7. With CEN we focus on Documents with narrative in a structured form either stored or transported between persons. HL7 (v2 and v3) are about messages exchanged between databases for logistics purposes. They contain no real narrative. > > The scale of the problem is illustrated by thinking very clearly about ALL > of the potential users of medical records. In UK the Dept of Health > recognises more than 60 medical specialties. If you add in all of the other > clinical specialties then you have at least 100 distinct groups of people > who have their own specialised ways of working and requirements, including > audit and quality control issues, which ultimately determine how they need > their data to be structured. They cannot all use just one structure, > however much we would like this to be the case. > >>> Next to the many types of users there are 10-20 different functions of any EHR. > > Kind regards > > Tim -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
