Hi Karsten, I think in practice you will see a variety of care plans depending on the context.
The endocrinologist will be using a diabetes care plan for their care of the patient, and likely not having access to, nor particularly interested in, what other specialists might be scheduling. The cardiologist will be using a cardiology-protocol-based care plan, probably developed in splendid isolation from the endocrinologist activities. The rehab specialist will be using a purpose-built care plan for the patient's recovery from a knee replacement. However it will be critical that the GP or coordinating primary care provider develop/need a single global care plan, (which can be separated out for the different purposes, if needed) that provides an overview of all activities that the patient requires - what is due, overdue, planned etc. This will ensure that the blood glucose and renal function tests required by both the endocrinologist and cardiologist iare coordinated, if clinically appropriate and tests/appts not repeated unnecessarily. They will have access to a 'master' plan that will detail all reviews/goals/test/appointments for each 'specialty' plan and have the ability to coordinate the components to suit the best interests of the patient as a whole - a care plan for the patient, not just one per problem. The patient or the parent/caregiver will also benefit with being able to schedule appointments/tests etc. And we will need to be able to break down that master care plan to see which components belong with each problem, or are shared between problems, and for context-based sharing with other health care providers. Regards Heather > -----Original Message----- > From: openEHR-technical [mailto:openehr-technical- > bounces at lists.openehr.org] On Behalf Of Karsten Hilbert > Sent: Thursday, 20 November 2014 1:04 PM > To: openehr-technical at lists.openehr.org > Subject: Re: Problem-oriented records and querying by problem > > On Wed, Nov 19, 2014 at 02:00:46PM +0000, Seref Arikan wrote: > > > Maybe I'm losing some clinical context by adopting a data view of the > > setting but would not a problem oriented record be a 'view' on > > clinical data ? > > Ah, putting it that way makes sense, too: the POMR approach to be a view > integrating "data" into "information". > > My point would be that problem orientation is so fundamental a "view" that it > should really be mandatory (even if only internally -- if physicians can't be > bothered with thinking about which problem to attribute items to a coarsely > grained ordering, say along the lines of ICPC, might get applied based on, > say, > provider speciality or some such). > > > The clinical problem is obviously context dependant (cancer, diabetes > > etc) so this sounds like a higher order view on top of clinical data > > to me. I'd see problem list as a 2nd order construct like you, but I > > guess I'd consider problem oriented record at 3rd and Care plan at 4th > > level. > > Interesting idea: "comprehensive" care plan, not necessarily per-problem. > Maybe per-goal (for which health goals must not be per-problem ;-) ? > > > If care plan is what the name implies than it involves actions to be > > taken on top of a particular problem view so I'd feel safer having > > that in its own layer. So I'd consider something like: > > > > Say an EHR with ~100 compositions (1st level). > > IOW, a data store rather than an EHR. > > > A problem list as a persistence composition (2nd level), > > The minimum requirement for the data store to become an EHR. > > Thanks, > Karsten > -- > GPG key ID E4071346 @ eu.pool.sks-keyservers.net > E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 > > _______________________________________________ > openEHR-technical mailing list > openEHR-technical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
