Hi Jim, Sistine's document looks good. Unfortunately, the information being presented does not lend itself to a two-dimensional format. Combining information sources/handling and decision-based processes and structuring them into a presentation format is tough. Any attempt to do so is helpful, however, developing an active presentation for a Practitioner is more difficult.
DRUG DATABASES Electronic prescription is an area of interest. The commercially available drug databases do not include all potential/known side-effects, e.g., some cover around 70%. They also do not provide adequate warnings that this is the case. These same drug databases are selective in what drugs they include and do not include all known derivations and names. Hence, building a UI that places 100% reliance upon such a drug database would produce non-trivial "errors and omissions". To make such a drug database useful additional information would have to be provided to the Practitioner so that an individual decision could be made. This database becomes a tool in the hands of the practitioner who must then decide what to do with it. Precise, consistent decision support becomes a victim. This is unfortunate as in the omission of many compounds and techniques that are in common use and have been selected because of their beneficial effects. Practitioners may in need of information related to these non-standard items and if they are, the 'roadmaps' provided are not going to be effective. SPECIFIC CHRONIC DISEASE MANAGEMENT Developing an archetype (pattern, model, prototype) is really a good idea if it includes the Patient and accepts variability and responses therero. I lost track of the number of people who have been on a program that has made one or more aspects of their life totally miserable. In some cases this cannot be helped; in others the response of the practitioners has be to modify the drugs being consumed and/or prescribing additional drugs. Success must be measured by the Patient showing up for the next appointment. My focus is on Patient Centered Healthcare. Current programs, in my opinion, are running 'open-loop' (started professional life as a control systems engineer). Nature, as well as aircraft and rocket systems vendors, run 'closed-loop', which means that information is returned to the source so that decisions can be made regarding performance and effectiveness. One would avoid taking a trip on a commercial aircraft that avoids this technique. Perhaps people seek out herbalists because all they get from a medical Practitioner is another prescription, ignoring the current situation where the Patient cannot pay for the drugs. The UK NHS audit show that a substantial percentage of the drugs prescribed for Patient after surgery get entered in the circular file upon exiting the hospital (I believe about 75% was reported). That should be a message to someone. One would not want to run an economy nor a government 'open-loop', exceptions for certain groups, yet Patient feedback is regularly prevented, ignored or voided, e.g., HIPPA regulated permit Patient access and modification as many other do now. Patient feedback is not all that difficult to accommodate. Automatic medical diagnosis software applications have been handling it for years. The efficiency has been notable, along with the increased Practitioner productivity. I am NOT advocating elimination of the Practitioner; rather the inclusion of Patient feedback, onsite or not, and its integration into diagnosis and treatment. I remain searching for answers to the questions: 1)How does one measure the performance of the Healthcare industry? 2)How does one measure the effectiveness of diagnosis and treatment? 3)How does one handle change? (variability?) Each of these must include the Patient. Maintaining robots involves feedback; however, this is usually accomplished by different personnel. Funny scenario: A robot that has been modified to exhibit symptoms related to a severe chronic disease. How would the Engineering Technician handle this? How would the Medical Technician handle this? Feedback is essential to proper diagnosis and treatment. Good effort! Good luck! -Thomas Clark ----- Original Message ----- From: "Jim Warren" <[email protected]> To: <openehr-technical at openehr.org> Sent: Monday, May 05, 2003 2:12 AM Subject: FW: Encoding concept-relationships in openehr archetypes. > Dear Tom et al: > > This is my "de-lurking" for the list. For those of you who dont' know me, I'm > a computing academic whose area of interest will be adequately characterised by > my question... > > I'm trying to represent the structure of "normal" values of fields in > archetypes. I can see that there is of course some provision for a set of > allowed values, a default value and (in quantities) min and max. I want to go > further (because the information could be very useful in the user interface and > to integrate with decision support). > > For instance, I'd like to design fairly specific chronic disease management > archetypes. Without worrying whether it's clinically particularly worthy, take > as a convenient example the hypertension in diabetes algorithms at > http //www.tdh.state.tx.us/diabetes/algorithms/PDFfiles/HYPER.PDF. > > My PhD student, Sistine Barretto, has made a map of the relationship of > concepts from that guideline (see > http //winston.unisa.edu.au/demo/Share/Ontology.doc - and the goal here is not > to get too picky about the use of the term "ontology" either). > > From this analysis it falls out (unsurprisingly) that there are a set of drugs > (in particular, some drug types as well as a set of generics organised into > types) that are in the scope of compliance with the guideline. There are also > some relevant comorbidities and various other concepts (observations and > actions). > > How can I (should I?) represent the set of likely (in scope) drugs such that, > for example, a user interface could put them as options in a menu? > Furthermore, how can I relate the comorbidities and other indications for the > drugs to the values for a drug name field in a specialised medication > archetype? > > Admittedly, I'm slipping into the realm of decision support, but I think it > really is simply the structure of the domain of normal values in this specific > application. I'd like to use archetypes to represent this, just as a I might > use them to represent the min and max of a given quantity. Is the capability > all there already? If not, what's missing? > > Cheers, > Jim Warren > > Assoc. Prof. Jim Warren > Director, Health Informatics Laboratory > Advanced Computing Research Centre > University of South Australia > - > 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
