Hi Karsten, Karsten Hilbert wrote: > > Recording "substance use" is more intended to record a > *fact* about the lifestyle of an individual rather than an > *intent to treat* as with prescription drugs. > > There's a fine line as always: herbal teas, OTC drugs etc > may or may not have been intended to be treatment by the > provider. However, disambiguating such in a given case is at > the discreetion of the provider/patient in question. OpenEHR > needs to provide facilities for both.
It seems to me that 1) we want to provide a mechanism for recording _all_ substances used, and 2) for each, we want to record who 'prescribed' it. Patients "intend to treat" when they ingest herbal teas, OTC drugs, etc.. While I definitely see the value in recording the 'prescriber', I still don't see the value in creating a seperate archetype for 'substances' that are not provider prescribed. In fact, it seems to me to create unnecessary complexity. Example... A patient is undergoing chemotherapy. The patient finds that smoking marijuana helps control the nausea. If the patient lives in California their physician can prescribe the use of marijuana. It they live in Texas, its use cannot be prescribed. Another example... A patient wants to quit smoking cigarettes. The physician prescribes Nicorette gum. Then the FDA approves Nicorette for OTC sale. What would be the information value of recording this information with different archetypes? What would seperate archetypes allow me to do that I couldn't do as easily with a single archetype with a 'prescriber' attribute that could accomodate a value of 'self'? Thanks, Bill
