Hi, I agree with Thomas, probably because we are engineers and ask ourselves "If they don't record this information for further action, why do they record it anyway ?".
I can perfectly understand the way Gerard thinks to it, in an EHRcom way : "I use this EHR for myself, and I can send you a part of MY EHR record to complete yours" (sorry Gerard if it seems over-simple). From my own point of view (at least for the kind of systems I am working on), the members of a patient's health team are contributors on a common working place, and, (if we don't ask them to be God) we expect for more involvment and accuracy in the process. Cheers, Philippe Thomas Beale wrote: > Gerard Freriks wrote: > >> The EHR is not invented to describe the real actual health status of >> the patient. >> It is there to document what clinicians deemed important to say ABOUT >> the health status of the patient. >> It always is an opinion of a professional about something. > > > yes, hopefully we all agree with this philosophy. > > But we need to add (contradict me if I'm wrong;-) that it is what > clinicians wanted to say which they deemed relevant to next steps - > either diagnostic or intervention. What to do next is not just based > on the doctor's confidence about what the symptoms might mean, but > also on: > - the urgency of treatment of that condition (cases like cerebral > meningitis, malaria...) > - the severity of the condition (e.g. cystic fibrosis) > - the severity of the consequences of the condition on others (CF, > huntington's, ...) > > ...so it seems to me that the indicator of what to do next when a > differential diagnosis is recorded relates strongly to the innate > characteristics of the conditions recorded, not just the doctor's > opinion of how likely it might be. If angina pectoris is a possible > diagnosis for "burning chest pain" at 5%, with the most probable > diagnosis (in the opinion of the physician) being "gastric reflux" at > 95%, and it is a 55-yo with a family history of coronary heart > disease, I presume that the angina pectoris possibility is the one > that drives the next steps? How are the confidences really decided? > > How are we to bridge the gap between the physician-recorded confidence > factor and the total list of factors which drive the next steps? What > do we need in the EHR? Is this "just" a decision support problem > (where the physician will be performing the decision support)? > >> >> He, himself, always makes statements with varying degrees of certainty. >> Physicians are no gods that know everything. > > > What? And I thought....oh no, my whole world is shattered...:-) > > - 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
