Bhupinder Singh <bobdog at sancharnet.in> > 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.
what he means here is that in normal processing, using the latest historical state of the record, the 6.0 will no longe be picked up in queries, the 4.0 will. But the versions are still there, and in the case of a medico-legal investigation, a snapshot of the EHR exactly as it was at the time of the clinician's decision can be generated (just like getting a prior version of Linux kernel from a CVS server) and it can be shown what evidence the clinician's actions were based on. So the version control system does two things: it enables the current cut of the record to reflect the curent information about the patient, plans etc, and it allows any prior decision to be investigated medico-legally by going backwards in time and reconstructing the record as it was at that moment - i.e. it enables one to know what the EHR looked like at any prior moment in time. So whatever the outcome (even adverse) the clinician can be shown to have acted reasonably, given the information at his/her disposal. > 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 reality the result has been withdrawn.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. As I say, this can't happen - that's what the whole version control/chnage management system is all about. > > 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. correct - all this is still available - nothing in the EHR is ever deleted. What is visible at a moment in time depends on the semantics of versioning. It's just like a bug in software - go back through the CVS server and you can find the version with the bug (in case someone wants to prove that the software used to act differently), but today, in teh current snapshot, the bug is gone, since we don't want it operationally affecting us now. - thomas beale - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
