> From: Gerard Freriks <gfrer at luna.nl> > Date: Fri, 07 Jun 2002 21:46:28 +0200 > > 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.
This comment seems to point to a mis-conception about what HL7 is doing now and what CEN has achieved over the past 10 years. Most existing HL7 implementations could be described as logistical, but the same is equally true of CEN implementations. Indeed the work has proceded in parallel with a good deal of duplication of effort. It is quite wrong to characterize the present work of HL7 as being "for logistics purposes" only. HL7 has about 30 different technical committees and special interest groups, and while some do have a logistical focus, many do not. The scope is so wide that few people have a full overview of all the work that is going on. I am not quite sure that I understand why you focus on the narrative perspective as being so crucial. Ideas about story-telling and narratology have been useful in understanding some of the ways in which GPs in particular use (and misuse) medical records, but they only illustrate one of the ways in which records are used (and these are mostly the ones where computability is least important). The primary use of narrative to to provide something that can be understood by a human being, while the value of structure is to have something that is computable. It is quite easy to produce a medical record which meets these requirements for a SINGLE group of users (such as GPs), but it is a different thing altogether to solve the problem for MULTIPLE groups. It is not the narrative that creates the problem, but the structure. Most structures use a version of a tree-like hierarchy, which can only support one perspective. The way forward is to use structures which support MANY different hierarchical structures at the same time. The key word above is MANY. Existing systems support several ways of looking at a medical record. Indeed the Abies GP system of 15 years ago allowed the user to view the record according to different types of date, by patient problem and by about 20 pre-defined characteristics (medication, diagnoses etc) and by groups of coded entries (using the Read Code hierarchy). Indeed the indexes for any medical record contained perhaps ten time as many entries as the record itself. This worked rather well for GPs, but did not migrate too well into secondary care, where there are multiple and conflicting ways that different groups wanted to look at the data. The solution to this problem is the evolution of virtual records for each group of users, based on their own specific use cases. But this has little to do with narrative... Kind regards Tim -- Tim Benson Abies Ltd, 24 Carlingford Road, London NW3 1RX, UK +44 (0) 20 7431 6428, tb at abies.co.uk - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
