Hi David,
On 24/11/2016 08:18, David Moner wrote:
Hi,
I'm not sure if this is a correct approach. What in the example you
call a function can be in fact a full Action that is being done. That
is, if the function is so relevant that you can even assign a
dedicated participant to it, it should be also enough important to be
represented and documented as an individual entry of the EHR: coded,
with start and end times, etc. If the case is that a complex procedure
is composed by other simpler procedures, then we should document and
link all of them.
I think that argument is generally correct, but what we see implementers
(i.e. their customers) wanting is extremely variable across specialties,
institutions and settings. For example, a lot of simple procedures
require a simple IV cleaning sub-procedure. It's easy to imagine one
institution wants all the steps fully modelled and to create detailed
actions in the EHR, and another just wants to treat it as a single
action that can be signed off.
I see the case of Silje from a different perspective. What she is
asking is if we can document the participants of each Element inside
the Entry. So far this is not possible, as Entries have been always
seen as a whole clinical statement, with all participants assigned to
that level.
From a realist perspective, the phrase 'participants of an Element'
doesn't completely make sense - an Element is just an atom of
information that is part of something else. You can only participate in
an 'activity' (an Activity that has been performed in openEHR is an
Action; an activity that generates information is usually an
Observation, with the protocol part indicating how it was done), and to
express the activity generally takes 1..N Elements in some sort of
structure, including timing etc. If two different activities are being
reported inside the same Entry, there are two possible conclusions:
1. it should really be two Entries
2. they are just considered detailed items within the larger activity
documented by he Entry.
I think we need to be more careful on the meanings of the primitives in
the RM - in any RM in fact - they are regularly abused within all RMs I
see, including CDA, FHIR, even HL7v2. It always seems OK from a human
perspective, but we say good-bye to computable information when we do that.
- thomas
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