Hi Sam, What yo usuggest is OK . But the issue is who is to decide what is right and what is wrong. Should it not be the prerogative of the clinician.
There are situations where medical decisions are based upon results which trigger clinical decisions. How would you hide a wrong result once it has been acted upon by the clinician. Example a report of Serum Potassium of say 6.0 has been sent to the clinician. This is a medical emergency and the clinician has to act upon it to reduce the high level. His action is based upon the result. If he does not act it will be an act of medical negligence. The lab thereafter does a correction and replaces the result of the test say Potassium of 4.0. In the scenario suggested by you this would mean that the result will be filtered out and not be available to the clinician. The question that will arise is the support for the action taken by the clinicians would in the absence of the report be an act of negligence. In reality the result has been withdrawn. This would raise the possibility of a malpractice suit. Alternatively the patient has an adverse event because of the action of the doctor and the support team views the results and find that there is no Result to support the clinicians action the clinicians action giving rise to another conflict situation. All reports which have been released shall not be available for being withdrawn and replaced for legal and professional standpoint a report can be appended to and not cancelled. The audit trail is necessary and a mandatory keeping in mind the laws that are coming into place to deal with electronic transaction. For any successful system once the report has been released there is to be no way that result can be withdrawn by the releasing department in this case the pathology department so that it is no longer visible. It is essential that ability to modify / alter/ change shall be through an audit trail and the old and new values are to be available within the pathology module. The ability to modify should how ever be restricted to the pathology department till the time the report has not been released. Once released they(pathology Dept) will also have no rite to cancel it in anti time. This report can then be acted upon through a way that could be that the value is to be blocked would be through a date and time stamp and marking the result with a flag that says for example " to be ignored". This will cover the clinician in case any action has been taken by him and the lab has corrected itself and maintain the sanctity of the record being generated. RGDS Bhupinder ----- Original Message ----- From: "Sam Heard" <sam.he...@bigpond.com> To: "Bhupinder Singh" <bobdog at sancharnet.in>; "Thomas Beale" <thomas at deepthought.com.au>; "Openehr-Technical" <openehr-technical at openehr.org> Sent: Sunday, October 26, 2003 6:11 PM Subject: RE: Pathology requirements TIMED MEASUREMENTS > Bhupinder > > The only values we are not wanting to show are those that are wrong - and > have been changed in a later version. The idea behind this is to store the > information in an openEHR system inside the Pathology service and then send > an extract - rather than develop a lot of messages. > > Cheers, Sam > > > -----Original Message----- > > From: owner-openehr-technical at openehr.org > > [mailto:owner-openehr-technical at openehr.org]On Behalf Of Bhupinder Singh > > Sent: Sunday, 26 October 2003 11:50 PM > > To: Thomas Beale; Openehr-Technical > > Subject: Re: Pathology requirements TIMED MEASUREMENTS > > > > > > What you say is one possibility. > > What is important is when there are two results out of the > > scenario and the > > readings are different. Would it be correct to take a mean. The difference > > in the reading may be on account of a number of causes starting from > > --Machine error > > --Human Error etc. > > The question is that there is a difference and this needs to be > > gone into in > > fact this requires to be highlighted and not covered through a mean value > > generated. Graphical representation should show both values and > > leave it to > > the clinician to decide what action he prefers to take. Textual display > > should show both values too. > > > > Bhupinder > > > > ----- Original Message ----- > > From: "Thomas Beale" <thomas at deepthought.com.au> > > To: "Openehr-Technical" <openehr-technical at openehr.org> > > Sent: Friday, October 24, 2003 4:29 AM > > Subject: Re: Pathology requirements TIMED MEASUREMENTS > > > > > > > Bhupinder Singh <bobdog at sancharnet.in> wrote: > > > > > > > Dear Sam, > > > > What you say is correct. > > > > In clinical practice it is also possible that the same sample > > is sent to > > two > > > > labs for the same test and the protocol followed by both the labs is > > same so > > > > is the est method and the unit of reporting. The sample date > > and time is > > the > > > > same. These two results have to be viewed and stored. Thus > > there should > > be a > > > > method to store and retrieve values where the date and time of sample > > and > > > > the test type and method and the UOM is the same needs to be > > available. > > > > Eg Blood Sugar reporting unit and test method are the same so is the > > date > > > > and time of the sample. > > > > Bhupinder > > > > > > this is an inteersting scenario actually, since even if there are two > > > perfectly legitimate test results (let's say submitted to the EHR a day > > after > > > each other) they don't really represent distinct results - they are the > > same > > > result (presumably) submitted at same or different times. Wen doing > > > statistical or other queries we have to be careful - if we draw > > the values > > on > > > a graph for example of bsl over last five days, there might be > > two values > > at > > > the one timepoint (where the timepoints are the times of taking samples, > > not > > > doing the test - i.e. the biologically significant point in > > time). One way > > to > > > look at thist situation is to say that all test results where there is > > just a > > > single result are just a special case of a statistical testing situation > > in > > > which at any point in "body time", a sample might be tested any > > number of > > > times (and more than one sample might be made as well) - giving a > > > constellation of results. Where there are multiple results for the one > > > biological timepoint, we could consider it as a statistical > > strengthening > > of > > > the confidence in the result. Probably what applications processing the > > > results should do is consider N results at the same biological timepoint > > to be > > > the same as one, whoe value is the mean of the N, and whose > > confidence is > > some > > > higher value than that attributed to single value samples. > > > > > > - thomas beale > > > > > > - > > > 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 > > - > 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
