In a message dated 27-11-2010 2:38:22 W. Europe Standard Time, yampeku at gmail.com writes: > The concept (DCM) is the same, but the implementation in different > standards will differ, as two different standards will never have the > same way of representing the same concept. As DCM should be even > broader than archetypes and templates, generating them from the DCM > should not be dangerous at all: all the information that can be stored > in a standard is included. If something vital is being left out then > it means that the standard can not represent all the domain > constraints and another standard should be chosen. Take epSOS as an > example: HL7 CDA can not define correctly the active ingredients of a > medication in the way decided by the clinicians. The proposed solution > was to modify CDA schema to include the structure needed, creating a > new epSOS-CDA standard incompatible with current normative CDA. Next > epSOS will be supposedly based on a newer CDA version that should > support those things. The dangers for the patient are not on the well > defined concepts but in the standards without the ability to represent > all critical constraints
I agree with your first premise, the representation might differ, but it is safe to use the DCM to generate both an archetype and an HL7 clinical statement. I also agree with your second premise, that if a standard cannot accomodate the clinical concepts, the standard needs to be adjusted. That is the normal way HL7 messages and other artifacts are created, and maintained, based on use cases and clear business needs. However, epSOS did not choose for the HL7 v3 message that would have been able to accurately represent medication components, i.e. the Care Record R-MIM. The Care Record R-MIM is draft standard for trial use since 2007 and would have been a better choice for representing that particular case. However, back to 2nd premise, that also has limitations: 1] it is DSTU only (since 2007, so quite stable, but moving to normative will bring changes based on similar use cases as you describe here). 2] it can hold the medication and the breakdown in active ingredients is possible. However, the Care Record does not allow to actively prescribe medication. For that the pharmacy R-MIMs are required as a prerequisite. Met vriendelijke groet, Results 4 Care b.v. dr. William TF Goossen directeur De Stinse 15 3823 VM Amersfoort email: wgoossen at results4care.nl telefoon +31 (0)654614458 fax +31 (0)33 2570169 Kamer van Koophandel nummer: 32133713 -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101127/c4ce11b6/attachment.html>
