Sam, I agree.
Suggestion In otherwords any clinical (or non-clinical) concept model must be able to express the view of the author about certainty. 3 states are sufficient for starters: likely (as default) not-likely certain When a person attaches new information to the EHR and is of the opinion that whole or parts of a received extract (or EHR) need an other qualifyer then via versioning he must be able to annotate this by adding his beliefs about certainty. Gerard -- <private> -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 27 Apr 2005, at 23:25, Sam Heard wrote: > Arild and Tim > > This is clearly an issue. In the CIP project the group wanted to be > able to say that a diagnosis was a working diagnosis. > > We have archetyped a number of concepts that I think will enable the > clinician to express these levels of uncertainty without resorting to > confidence ratings on all entries in the record. Arild has shown that > you could not possibly do a mastectomy without rating your certainty > at 100% - or you will be sued. And not treating a pneumonia in a > newborn with a certainty of only 20% will probably get you in trouble. > These sort of explicit ratings are - in my opinion - very problematic. > > The solution lies in the recording constructs used for many years: > > 1. To express differential diagnoses (with or without probabilities) > and to note key excluded diagnoses as well. > > 2. To express a diagnosis as a problem (such as lump in left breast) > even if the likelihood of cancer is 100% clinically until the > histology is returned. > > 3. To be able to label a diagnosis as a working diagnosis - ie it is > likely enough to warrant the current management - but not certain. > Appendicitis is a good example. > > So the archetypes for problem, problem-diagnosis (specialised) and > differential diagnosis should meet these needs. > > Comments? > > Sam -------------- next part -------------- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 1999 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050428/2b2579c2/attachment.bin>
