Hi Karsten, please see comments in-line. thanks. Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org ----- Original Message ----- From: "Karsten Hilbert" <[email protected]> To: <openehr-technical at openehr.org> Sent: Monday, August 11, 2003 3:53 PM Subject: Re: HISTORY DATA SET IN EPR
> > form. I think this is the promise of SNOMED CT. Doctors will likely > > support such a system if it allows them to easily put MORE information > > in the record than they do today... > Does *more* information also mean *more information that's > accurate* ? Likely not if data providers are significantly > limited by a restricted set of codes. Reasoning for this in > Slee, Slee, Schmid "The endangered Medical Record". My proposal is to structure what is possible to structure... but to do it with a standard. Any health information that is still too fuzzy for the chosen structure will have to be written freehand, as we do now. > > Eventually, they should reprogram their adjudication systems to consume > > the doctor's coded information, as it exists natively in the EHR. Not > > only will the content be richer and more potentially useful to the > > payer, but instead of sending a traditional "claim", the doctor could > > simply send the payer a standard "invoice" for services, with a pointer > > to the EHR data... if the payer cared to look at it. > While technically enticing, practically, uhm, no, no way (lest > I misunderstand your intent). Well... yes... I'm dreaming a little... I'll grant you that. But we should be attempting to increase/improve the structure of our records and data anyway... in order to improve care. Even if this still has to be mapped to the payer's old 5-character "dumb" codes, the claim-coding process will be potentially more automatic and better supported by the record in the event of payer audit. If we could point today (in the US) to the system that I am imagining... one in which payers could reach out as needed and query EHR systems for data to support adjudication, then payers would be hard-pressed to justify the enormous provider-expense of serving this information to them on silver claim-platters. By the end of 2003 I suspect that we will have more payer-specific variants of the HIPAA 837 transaction than we ever had of the NSF and UB92 combined. At the end of the day, each payer wants a virtually unique data set to support its claims. I think we should point them to the EHR-landfill and hand them a shovel... I have patients to see! > > > but doctors should be able to agree on just the right degree of > > precision to support the medical job... > What, doctors agreeing on something ? Yes, I'm being cynical :-) I'll admit... doctors do not make this easy! But doctors have "agreed" in the sense that they have not objected to "standards of care" concepts and "evidence based clinical practice guidelines". I believe that the acceptable minimum level of precision is documentable from existing literature. Practitioners can always add non-structured notes and information as necessary to beef up the precision of any structured/coded record information. > > > I' assuming that whatever precision level > > makes the doctors happy will also be sufficient for payers and > > governments. > That I tend to agree to. > > > and I'm suggesting that information should be > > reduced as much as possible to a standard set of codes. > If that means to reduce what I can put in my clinical notes > then No, thanks. I use the fuzziness of German when writing > progress notes to myself in order to capture the degree of > fuzziness of the specific ailment at hand and augment that with > commonly used scales (GCS, APGAR, Janda, ...) to map my notes > to more standard values when writing referral letters etc being > sent to colleagues. Of course I am not perfect in this and > could make use of a tool that facilitates my correctly > applying standard scales. > > Karsten > -- > GPG key ID E4071346 @ wwwkeys.pgp.net > E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 > - > 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
