Melvin Reynolds wrote:
> Once again I agree (mostly!) - and certainly did not want to imply > different levels of medico-legal requirement within any particular > jurisdiction. > The integrated healthcare record is very usefully regarded as a single > repository which contains, either directly or by reference, all the > data that relates to the process of actually clinical care (not the > facilitating aspects of the healthcare infrastructure*) - but upon > which there are appropriate "views" according to the use context. > However, the difficulty I have is with the "throwaway" statements > (perhaps just intended as 'shorthand' but if so not sufficiently > specific to be helpful at this stage of development and email > communication) which if taken literally will result in flawed design: > > "generally not come from messages - there is no other place for this > data to come from but the GP application" > "generally" and "there is no other place" is the problem here, "often" > would be more accurate because, as an example, the giving of > vaccinations to children in school is not likely to be noted through > the multiple GP systems related to the children - but through a > Community system (of whatever sort) - and then "messaged" back to the > EHR as seen by the GP - so there's clearly an "other place". > Similarly Social history information may well arrive from the Social > services system ... ah well - I guess I was talking in the idea future world of EHRs being everywhere, not today. In the future of a shared care, community-based EHR I would expect both types of carers you mention to be entering the data into the EHR, not in some other system... maybe I am wrong here. Anyway, I accept what you say - let's just say that now and in the future, in many instances, the data for the transaction types i mention will come from GPs and other carers accessing and modifying the EHR. > "instead come through the application / EHR kernel API," > fine, so long as this means: > "through *an* application *and/or* the kernel API" yes - whatever application being used. > "and create EHR data on the fly." > fine, so long as this means, for example: > "receive (and store) message data, > acknowledge message data if appropriate according to implementation > requirements, > assign message data to EHR as agreed by all users of EHR *or* > reject message data for EHR as agreed by all users of EHR (but in this > case log receipt of message data even if not available for 'default > display')." well I wasn't talking about messages here - I was talking about communication through a network-visible API, which is what you get with .net, SOAP, Corba etc. > This should have read "Sorry if I have missed *something*". I guess > from mails on another thread that these issues will get another airing > in Baltimore. What it underlines for me is the need for precision in > our use of terms - and I plead guilt to imprecision when doing/saying > things in haste, and sometimes at other times too :). me too;-) - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
