Hi I think Tim Churches is more on track. Gerard appears to be describing a "problem" as I would understand it in POMR. An episode in natural language implies a discreet period of time and I would make a plea that we (you?) retain the meaning of any term that is closest to its natural meaning. An episode is an incident in a series of events or something along those lines. A problem can be 'active', 'inactive', or 'terminated'. An episode is 'active' or 'complete'. I propose that there can only be one episode effecting a person at one time. You can only be in one place at one time (except for some odd situations such as a person who takes leave from an inpatient facility for a couple of hours for some ongoing and completely unrelated treatment as an outpatient at private rooms. They may not even tell the inpatient facility why they want to go out. It may be better to call that two "concurrent" episodes for practical reasons because in this situation, he/she is behaving semantically like two people.) I propose the following definition: "An episode is a period of management of a patient from the time of presentation to a medical unit (which can be anything from the teams or "firms" in a teaching hospital to an individual practitioner) until the unit or a proxy "discharges" the patient." The proxy could be a unit (on the last unit) to which the patient is transferred during the course of the episode. (An example could be general surgery => cardiology => cardiac surgery => rehabilitation: all one episode.) I would be against using definitions based on legal responsibilities as that is truly nebulous, especially in common law jurisdictions and is ultimately at the whim of some judge. It is not very precise and can never be as each specialty and medical culture may have a different approach. However, almost everyone "knows" when an episode is done. That is why I propose that the treating unit "declare" the end of an episode. This is where the word "discharge" needs definition. It is an active, transitive verb and that is why the intention of the unit/doctor concerned should be the paramount consideration. It their intention to relinquish direct responsibility that is crucial. It is comparable to death in our jurisdiction. You are dead when a doctor says you are! (i.e. declares "life extinct", or in the case of "brain dead", two doctors after due deliberation but that is a special case.) Our hospital systems speak of a "separation" which befits a hospital as discharge is a form of separation. It might be more difficult in GP. I think an episode has to be considered separate from say just "discharge from hospital" which is better termed a "separation" or similar. An episode can involve a period of inpatient and outpatient treatment. The question of transfer between units is difficult. If a person is admitted under the abdominal surgeons with a stomach ulcer and is subsequently transferred to the cardiologists when it is established 24 hours later that it is a myocardial infarct, is that one or two episodes? Most people would consider it to be one episode in natural terms but there could be a rule requiring that this is two separate "incidents" for the purposes of remuneration for example. It would be up to the two units as to whether this would be called one or two episodes and could be handled semantically by allowing that an episode can involve semantically "seamless" transfer from one unit to another until a unit declares "DISCHARGE" and then the episode is done. Cheers CDC, Perth
----- Original Message ----- From: "Thomas Beale" <[email protected]> To: "Openehr-Technical" <openehr-technical at openehr.org> Sent: Sunday, November 21, 2004 9:02 AM Subject: Re: Episodes in openEHR > > 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 > > > - > 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
