Thomas Beale wrote: > > Sam would be better able to give an idea of all the health professionals > who have been consulted, but certainly in Australia, Vince McCauley (a > pathologist) has been extremely helpful on pathology result detail. > Also, people like Heath Frankel and Grahame Grieve who have worked with > HL7v2 messages for years have provided quite a lot of input on details > (for example in Release 1.0, there is now a summary attribute for > Historical data structures, directly due to Grahame's advice on the > shape of lab data his software handles - see > http://www.openehr.org/uml/Browsable/_9_0_76d0249_1109157527311_729550_7234Report.html). > > > Is it enough? At this stage I would be fairly confident that the models > are good enough for most pathology data (certainly everything any of the > docs working with openEHR has seen). Are they perfect? Of course not. We > always need more input. The confidence level stuff implied by your > requirements (let's treat them as epi/public health data requirements) > would make things better; we just have to determine a) what scope of > data they apply to (e.g. how much sophistication do we need in the EHR > compared to say a dedicated data warehouse designed for statistical > studies?) and b) how to add them to the current model in a way > compatible with what is there.
Sure, that's a very reasonable position. I was not suggesting that openEHR *must* to accommodate such things, but as someone else opened the Pandora's Box of +/- accuracy as a data value property, as opposed to part of a higher-level Archetype construct,, I felt obliged to point out that there was more to it than there might appear at first glance. But a system for EHRs can't accommodate every subtlety of the Universe, so best to force the lid back down on the Box in this case. > I think that he idea of a workshop is a good one; I would prefer to see > clinical professionals here take up the suggestion and do something with > it; I don't see these kinds of discussions as being IT driven - they are > all about articulating requirements. Happy to participate and to suggest other participants if someone wishes to organise one. Tim C > Tim Churches wrote: >> Thomas Beale wrote: >> >>> Tim Churches wrote: >>> >>>> >>>> >>>>> Tim, if the accuracy_is_percent attribute was upgraded to a coded >>>>> value, could you suggest a set of meanings that would cover all the >>>>> epi/PH needs? >>>>> >>>> You'll have to tell me what that would involve. A single coded value? >>>> Upper and lower limits? Confidence level. Type of limit? >>>> >>> well, essentially what you are proposing >> >> Not proposing anything, I'm just asking the question "Have you thought >> about this?" >> >> >>> would require (let's not get >>> too pure about how I use the word "accuracy" here for the moment): >>> - lower accuracy limit: Real >>> - upper accuracy limit: Real >>> - accuracy limit type: coded term >>> - confidence level (or this could be part of the previous coded >>> attribute, since only a small number of confidence bands are used in >>> practice aren't they?) >>> >>> Now, what we currently have is a set of general purpose quantity classes >>> designed to enabled recording of any quantitative data we have come >>> across so far. Between various MDs such as Sam, Vince and others, I >>> think we have pathology covered from a practical point of view (well, we >>> do once we get this <, >, etc thing sorted). >>> >> >> Just curious: have you had much input from pathologists, microbiologists >> and lab scientists? The more one talks to such people, the more one >> discovers about the uncertainties inherent in certain assay techniques, >> and the differences in the scalar (and qualitative or Boolean) results >> produced by different assay kits and different labs. >> >> Oh, there's another form of uncertainty which typically is of relevance >> to Boolean/dichotomous results (positive/negative, detected/not detected >> etc) and that is the sensitivity and specificity of the test, or the >> related quantities PPV (positive predictive value) and NPV. (Note to >> computer scientists: "specificity" and "sensitivity" are cognate with >> "precision" and "recall".) >> >> >>> The real question is: what is the type & origin of data that need to >>> represented in the more sophisticated way that we are now suggesting? Is >>> it a different category of data? Should be leave the current DV_QUANTITY >>> as is and add a new subtype? Or is it that we should consider a quantity >>> with a 95% T-distribution confidence interval as a pretty normal thing? >>> Should we then start considering the "simple" idea of a symmetric >>> accuracy range (+/- xxx) as really just one specific type of a >>> confidence interval (it might translate to something like 98% on a >>> normal curve). In other words, should we generalise he "accuracy" notion >>> into a "confidence interval" notion? >>> >> >> I think that a one or two day workshop with a range of pathologists, >> microbiologists, lab scientists, epidemiologists and statisticians (and >> some clinicians and computer scientists, of course) would suffice to >> come up with sensible answer to your question. I'd be happy to >> participate and to suggest other participants. First half day would need >> to be spent bringing everyone up to speed on openEHR so they understand >> the nature of the question(s) to be addressed (and a good means of >> spreading the openEHR gospel while you're at it...). >> >> Might be possible to hold a cyber-workshop instead, via email or >> real-time conferencing. The former would be much slower, of course. >> >> Tim C >> >> >> >> > >
