I agree that there needs to be more than one type of episode. In oncology,
there is often one illness fairly well defined where the patient lives or dies.
In other specialties, a disease is lifelong once it starts and the patient dies
with the disease and not of it. In that case the "episodes" are better thought
of as exacerbation which settle often for long periods. Each specialty may
have a different idea of what constitutes an episode. Is psoriasis one illness
and hence one episode as it may last 60+ years!
Cheers
CDC, Perth
----- Original Message -----
From: Thomas Beale
To: SMK
Cc: Christopher Clay ; Openehr-Technical
Sent: Wednesday, November 24, 2004 4:02 PM
Subject: Re: Episodes in openEHR
SMK wrote:
Greetings:
I am new to this discussion but had a couple of thoughts.
I am just in the final stages (actually finished) modeling some data for
oncology patients.
I would like to suggest that an "episode" be centered around a single
patient illness, and not dependent on whether that patient was in or out
of the hospital. This is speaking from a clinician's viewpoint which
involves a continuum of care, hospitalization being one event.
In regards to the Mayo model, my suggestion would be that the "episode"
for the patient mentioned be the injury, the MI a second "episode" etc.
If we speak of "episode" as a course of an illness to a point where no more
care is needed for that problem, (i.e. patient is a) returned to health, b)
sustainable stabilised (chronic patients) or c) died) you are right...but the
Mayo MICS uses the other definition of "episode" for its purposes - a period of
care delimited by acceptance of responsibility for care and discharge from care.
Let's not get too worked up about trying to have one sole definition for the
word "episode". I suggest we refer to the two types as
"episode-of-care-delivery" and "episode-of-a-problem" (not a very good name -
pregnancy falls under this categygory, and is not a problem for most people....)
I suggest that the issues of practical importance are:
a) decide if either or both of these ideas of episodes need to be modelled
explicitly in openEHR
b) if so, name them properly
c) define their data (i.e. model them)
Maarten Spook's problem is to have something which includes the data:
1.. startDateTime: the date-time the episode is started (medically)
2.. stopDateTime: the date-time the episode has ended (medically).
3.. createdDateTime: the date-time the episode was created (administrative)
4.. contributers: care providers and their role (participations?) It would
be clear to see who had added info and who is responsible for this episode etc
5.. structured annotation: a short description of the content / context of
the episode
This kind of episode is an episode-of-care-delivery. I come back to modelling
this with a Folder.
As I stated earlier, the other kind of episode - related to the course of an
illness, a pregnancy, or an 'epsiode' of some chronic disease - can be modelled
as Links between the relevant Entries, where each Link object can be classified
as relating to a particular problem, such as "diabetes" or "pregnancy".
How do we want to proceed. Is it likely that there are sufficiently standard
ideas of the two kinds of episode that they should be modelled in a more
concrete way than with Folders and Links?
- thomas beale
- If you have any questions about using this list, please send a message to
d.lloyd at openehr.org
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