On Wed, Nov 19, 2014 at 02:12:31PM -0300, pablo pazos wrote:
> The question was not "how to do X in a POMR", the question
> was "how to model a POMR in openEHR". Please read my first
> message to the list.
I certainly did.
I was not precise in my first wording. What I wanted to point
out was that if we ask the question
How to _view_ (display) an existing medical record _as_ a POMR ?
we seem to have missed the fact (as to my understanding) that
any "existing medical record" very much IS a POMR and that it
"cannot be any other way".
Non-POMRs would seem to be data storage containers (of
instances of medical data) rather than clinically useful
_medical_ records. It is only the clinical integration of
biological data (of whichever quality or type) that turns
data into information and thusly a "medical record".
> Is not for me to define what a problem is, I don't
> need/care to do that, that's for a physician to define. What
> I need is to provide an structure in which a physician can do
> that, using openEHR of course.
What I've been wondering is that the need to turn data into
problem-related information (in order to be useful) will seem
so fundamental to any clinician that doing so would seem to
be one of the first and foremost functionality of any medical
record software.
> Also, POMR in this context is by Weed's definition, so it
> has a specific structure not every record has: a master
> problem list, statuses for each problem, progress notes for
> each problem, etc.
(I wasn't aware that Weed had defined statuses on problems --
is there a link for reading up on that ? So for I only found
http://www.geritech.org/2013/05/medicine-in-denial-problem-oriented-medical-record.html
)
I agree that the Weed model of POMR seems best suited to
comprehensive, longitudinal care but I would really like to
learn of just one counter-example to the following
proposition:
Any medical record lends itself to being structured
according to the POMR model.
Therefore it should in order to afford internal clinical
sense (what I am not saying here is that every clinician must
be presented with a problem oriented view or even that that
would best suit every clinicians workflow).
> In the other hand, yes, that information is in every MR,
> but you have to read a lot to find all the info relevant to a
> specific problem. What we need to do is to have that
> information linked in an explicit way to avoid that manual
> search, and have all the relevant info at one click of
> distance. IMO that was Weed's idea.
Here we are on the same side of things.
What I am stressing is that I would really expect any
_information_ model intended for clinical use as a
patient-centric medical record to easily afford the POMR
approach. In my personal view it should really even enforce
problem orientation internally. Otherwise said model would be
a _data_ model (of which being an excellent one is really
desirable).
So, back to your question, are we looking for where exactly
(and how) OpenEHR turns from a data model into an information
model (as per my attempt at definition above) ?
Karsten Hilbert
Declaration of potential conflict of interest: I have helped implement
a POMR.
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