I think that the 'pebbles & nuggets' characterisation is probably right, although I don't think anyone knows what the balance is, i.e. at what point it ceases to be worthwhile to trawl back in time. The trouble is you get patients like a 12 yo child with a history of chronic tonsilitis that is only visible by looking at say 10 years of data. Or try the other end of the spectrum - notes by GPs over some years may turn out to be indicative of alzheimers, but only when a diagnostic guideline is applied to say 5 or even 10 years of data. So how far is far enough?
I think that what will be needed in the future is a way of filtering out the useless pebbles on the way so to speak. Perhaps when data were archived onto slower media. I wonder if anyone has seen research to indicate how far back data might be useful based on specific morbidities? - thomas beale On 23/10/2010 05:26, Derek Meyer wrote: > Tim, > > I don't claim that all old information is useless. > > My hypothesis is that clinical care generates vast amounts of > information, and very little of this vast amount is useful. > > (This is an empirical hypothesis, and so could be measured, although I > don't know of a study that has. Perhaps a study that > > a) converts real patient records into facts, and the counts the number > of facts, > b) requires patients to be seen without a written health record and a > treatment plan formulated, > c) reviews the treatment plans in the light of the written record, and > d) counts facts which result in changes to the treatment plan, > e) calculates the ratio of facts that were useful in altering the > treatment plan compared with the total number of facts.) > > My hunch is that there are gold nuggets in historical records, but we > have to capture and store too many pebbles to get the nuggets we > need. If there was zero cost to capture and storage this wouldn't > matter, but unfortunately this is not the case with current technology. > > This is an economic problem, and the solution is to look for economic > benefits at the other side of the time spectrum. If information could > be sent to the person who needs it quickly, this time saving could > justify the cost of capturing and structuring the information. Once > data are structured and captured, it becomes cost effective to do a > large number of other things with these data. > > This is not an argument against openEHR - just another way of using > openEHR. > > Best, > > Derek. > > > > > On 22/10/10, *Tim Cook * <timothywayne.cook at gmail.com> wrote: >> On Fri, 2010-10-22 at 17:12 +0100, Derek Meyer wrote: >> > Tony, >> > >> > This is very impressive piece of work. Every since I first came >> > across openEHR I have intuitively felt that it is closer to the >> > 'solution' than more static attempts at standardization. So why is >> > progress so slow? I've appplied some lateral thinking to this, and >> > come up with what many people on this list may (at best) think >> > contrarian - but at the risk of being flamed.... >> > >> > The Case for NPfIT 2.0 www.nationalhealthexecutive.com page 52-53. >> > >> > (I'll go get my hard hat now...) >> >> All I can say Derek; is that if you think my past medical, mental and >> social history older than six months is useless information. Much less >> my familial history of a few generations. >> >> I am very happy that you are not my physician. >> >> Maybe if you had all of that information in a meaningful semantically >> connected network. You could practice better preventive healthcare as >> opposed to band-aid, reactive medicine??? :-) >> >> >> >> Cheers, >> Tim >> >> >> -- >> *************************************************************** >> Timothy Cook, MSc >> Project Lead - Multi-Level Healthcare Information Modeling >> http://www.mlhim.org >> >> LinkedIn Profile:http://www.linkedin.com/in/timothywaynecook >> Skype ID == timothy.cook >> Academic.Edu Profile: http://uff.academia.edu/TimothyCook >> >> You may get my Public GPG key from popular keyservers or >> from this link http://timothywayne.cook.googlepages.com/home >> > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at openehr.org > http://lists.chime.ucl.ac.uk/mailman/listinfo/openehr-technical -- Ocean Informatics *Thomas Beale Chief Technology Officer, Ocean Informatics <http://www.oceaninformatics.com/>* Chair Architectural Review Board, /open/EHR Foundation <http://www.openehr.org/> Honorary Research Fellow, University College London <http://www.chime.ucl.ac.uk/> Chartered IT Professional Fellow, BCS, British Computer Society <http://www.bcs.org.uk/> Health IT blog <http://www.wolandscat.net/> * * -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101024/e8cc9e5f/attachment.html> -------------- next part -------------- A non-text attachment was scrubbed... Name: ocean_full_small.jpg Type: image/jpeg Size: 5828 bytes Desc: not available URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20101024/e8cc9e5f/attachment.jpg>
