Tim Cook wrote: While it might be an interesting exercise for us to record how confident a clinician was at the time of recording a diagnosis, it will have no impact on the health care of that patient. If we were to do this would we ask them to do so in <sarcasm>10% steps, 5% steps or .01% steps</sarcasm>? I assert that any one of these would seriously impact the usability of an EHR in a negative manner and would result in the clinician taking the option that presents the least liability on their part.
So back to the short answer above.....is it really relevant to assert ANY confidence factor in the EHR? My opinion is that there indeed is highly relevant to assert a confidence factor in the EHR. ln decision analysis one talks about treatment thresholds for diagnostic uncertainity as "the probability of disease at which the expected value of treatment and no treatment are exactly equal, and ne ither option is clearly preferable." (Hunik and Glasziiou "Decision making in health and biomedicine"). Factors influencing the treatment threshold are the expected benefit and the expected harm of the treatment. Example: Treatment threshold is much lower for pneumonia (treatment: penicillin) than for cancer of the left mamma (treatment: Mastectomy) Thus: How confident a clinician is at the time of recording a diagnosis has high impact on the health care of that patient. Comments on this? regards, Arild Faxvaag -------------- next part -------------- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 1527 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050427/be6e62a1/attachment.bin>
