Clearly this discussion will run a while longer, and we can hope to hear
from other clinicians, and from a variety of geographical locations and
clinical cultures. At this point, can we suggest that:
1. there are "episodes of care", which are to do with a)
accounting/reporting and/or b) acceptance / discharge of legal
responsibility for care ("separation")
2. there are "episodes of illness", which are to do with the course of a
problem/issue/disease. What about pregnancy, chronic asthma, and
conditions which seem to slide from being chronic to being solved to
relapses (e.g. back pain)?
I think "episodes of illness" can be modelled with openEHR (and CEN
13606; possibly CDA as well) - it is done using links between Entries,
Compositions etc to create "threads" (which may be branching) of
recorded items relating to each problem. Each link indicates which
problem it is about. A single given recording may be multiply classified
as data relating to more than one problem. Of course we need more
experience with this aspect of the models to see how well it will work.
Philippe Ameline's system is probably ahead of any others I have seen in
this respect - maybe he wants to add some wisdom here.
I would like to know who would agree with the proposition that an
"episode of care" is bounded by acceptance & discharge of legal
responsibility for care provision by a given provide (institution).
- thomas
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