Tom, This area is interesting within the concept of the EHR as we have developed it. Firstly, the place holders for key information may be an organiser rather than an entry. For example with adverse reactions to medication - a statement that the patient reports no known adverse reactions or even allergies is worth knowing - but it is not an entry of the type allergy or adverse reaction.
A negative report such as this requires updating - how long is it reasonable to assume that no new allergies have developed? - whereas a report of an allergy of penicillin if well documented will probably have the same status from that point on. Reporting that someone is a non-smoker is not of the same order - it is a negative finding but if the person is an adult you would anticipate that it is a stable finding - whereas ex-smoker has a different 'half-life' - it is also likely to be included in an entry about smoking - how many per day, perhaps the number of pack years, and the person's current smoking status. So negative recordings might be different. The difference then is that a state of tobacco intake = 0 i.e. a non-smoker is different than the state of having no known allergies - the count of allergies = 0 but this is not an attribute of most people's health record. I would propose that we have an entry that is EMPTY and returns a DV_TEXT that can be displayed if required - but will be dated and we will know who added it. This will allow organisers to be useful mandatory placeholders and know unambiguously that there are no allergies for example (and when it was asked and by whom) Cheers, Sam > One thing to be clear on - we must differentiate between "not recorded" > and "not there". Not recording someone's weight does not make them > "weightless" (don't worry I understood the joke, but this is a serious > point as well). A better example would be - not recording smoking status > doesn't make the patient a non-smoker. > > There are 5 possible situations I know of that can occur with data: > > 1. it is not recorded (nothing is recorded) > 2. it was asked (e.g. by an application GUI) but remains unknown due to > various reasons (patient uncounscious, refused to divulge, etc) > 3. it is completely known and recorded > 4. it is recorded, but there are bits missing > 5. it is recorded, but in the negative (no known allergies, no previous > surgery, etc etc) > > Cases 2, 4and 5 have not always been properly catered for in systems. > > Case 2 is dealt with in by the use of what i would call "data quality > markers", i.e. what HL7 calls "flavours of Null". Actually, we call them > that in the openEHR model, and use HL7's flavours of null (although we > use them in a different way) > > Case 4 is dealt in openEHR by partial data types e.g. DV_PARTIAL_DATE, > and with Null Flavours in HL7. > > Case 5 requires proper structurinng of the health record, so that > negatives can be recorded; archetypes/templates help in this. > > - thomas beale > > > Douglas Carnall wrote: > > >In my previous mail to this list (openehr-technical at openehr.org) I wrote: > > > >>>If I see a patient who subsequently turns out to have > thyrotoxicosis, but do > >>>not record the presence or absence of certain key clinical > findings (e.g. > >>>pulse, weight, tremor) > >>> > > > >Hmm. If I saw a patient with an absent pulse and failed to note that > >finding, either mentally or in a clinical record, I think I > might rightly be > >accused of being a poor observer of the human condition. Come to think of > >it, a weightless patient would be interesting too :-) > > > >And everyone has a physiological tremor, though it is often > exaggerated in > >moderate to severe untreated thyrotoxicosis. > > > >So in fact, now I come to think about it again, I didn't mean presence or > >absence of pulse, weight or tremor, but presence or absence > of--all right, > >use the word, fuzzy, values for pulse, weight or tremor. > > > >But you knew what I meant didn't you? > > > >;-) > > > >D. > > > > -- > .............................................................. > Deep Thought Informatics Pty Ltd > > mailto:thomas at deepthought.com.au > open EHR - http://www.openEHR.org > Archetype Methodology - http://www.deepthought.com.au/it/archetypes.html Community Informatics - http://www.deepthought.com.au/ci/rii/Output/mainTOC.html .............................................................. - If you have any questions about using this list, please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
