An interesting wiki from Heather Leslie
https://openehr.atlassian.net/wiki/spaces/healthmod/pages/90507705/Archetype+Design+Patterns
She concludes that pattern are necessary, I agree with that, and she
also concludes that clinicians are better modelers then technicians.
Well, that depends, of course it is very important to have
domain-knowledge when modeling data, and clinicians have the best
domain-knowledge. So from that point of view, she is right.
But what we have seen until now is that clinicians create archetypes
with unpredictable paths. And that is bad, because it makes it very
difficult to find data and it makes it easy to miss important data,
because some data were on a path where one did not expect them.
OpenEhr works fine to find data which are on a known or predictable
path, but what if data are on an unknown path?
Let me explain by comparing this to a classical relational
health-application. There are similarities.
I have seen classical relational systems which experienced a wild-grow
in number of tables, I have seen once in a prestigious
university-hospital where they had a grown of 7000 tables in 20 years,
more then one per day!! No one understood the meaning of all the tables
and data, no one dared to use data he did not understand, many data were
and still are redundant. Every new development in the ICT starts with
designing new tables.
How can in such a situation a clinician research a persons medical
record, even with the help of the current technical staff, this is often
impossible. So, important information can get lost. Adding to this are
software-updates which often cause a clean-up, and that clean-up is also
done by people who do not always know what they clean up. People live
long, and a medical problem they had 30 years ago can be important to
find to solve a current problem. So old data, and understand them, and
be able to find them, can be important.
This can also happen with archetypes. Every new development in a
application can start with a new archetype, and at a moment there can be
thousands. It is impossible for a clinician to search all possible paths
for medical information, even with the help of the current technical
staff this can be impossible.
The old data-hell situation will not be solved by OpenEhr if there is
not something behind it. And that something, that is: PATTERN
It is not only a clinical thing to understand how pattern in paths are
best modeled, it is in fact also a technical thing. Clinical knowledge
is not stable, the thinking about clinical facts change all the time,
what now is important is tomorrow maybe not. So the pattern need a
technical, mathematical base, that, something like Codd-normalization,
but of course then applicable to archetypes.
The Wiki from Heather Leslie is a good starting point for the design of
pattern and stop the proliferation of paths.
I described an approach to solve this problem in a blog, one and a half
year ago.
http://www.bertverhees.nl/openehr/medical-data-context/
I had some discussion about that, but many had problems against the use
of SNOMED in this context. So, maybe read it and forget SNOMED ad find
something else to structure the medical data.
Bert
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