Philippe. 1- documentation in health and care, as you wrote, can have two points of focus: - focus: the healthcare provider: as author documenting in his EHR about the patient what this HcP has done - focus the patient: as subject of care allowing other HcProviders as authors to document what has been done The problem is to have these two focus points not only to co-exist, but be integrated.
My French is good enough to read 2 medical textbooks in French when I was training to become a GP. If possible share that article with me, I’m curious. 2-In my view ContSYS is one of the ingredients needed to integrate these two focus points. We need more than ContSys: - a model for the epistemology - archetypes designed using re-occuring standardised phrases - terminology providing primitive terms - a generic standardised solution for modifiers: (non-)presence, states, certainty - standardised services/interfaces for database, user screen/keyboard, messages, clinical reasoner - supporting terminology services (i.e converter into/from user friendly terms, …) - all based on orthogonal shared standardised models. Gerard Freriks +31 620347088 [email protected] Kattensingel 20 2801 CA Gouda the Netherlands > On 2 Apr 2018, at 21:15, Philippe Ameline <[email protected]> wrote: > > Le 02/04/2018 à 19:45, GF a écrit : >> 1- What stands AP)SA(A'P’) for? > > I guess that you know the SOAP as the 4 main "chapters" of a clinical > encounter (https://en.wikipedia.org/wiki/SOAP_note > <https://en.wikipedia.org/wiki/SOAP_note>). > From Lawrence Weed's concepts, a patient encounter should be recorded as a > "grid" with problems as columns and SOAP elements as line. > > This concept is theoretically sound for acute care since it starts with > patient's verbatim of the reasons for encounter (S standing for Subjective - > which is truly dated!). > > In the current "state of the medical art", always more chronic care oriented, > a patient often comes with an ongoing list of problems and treatments, hence > (AP)SO... and leaves with the same or a different list of A and P, hence > (AP)SO(A'P'). > > 14 years ago, I worked with a knowledge management research team on > establishing both the theoretical aspect and the user interface of such > concept, by the name "virtual staff". > To make it short, imagine the Ligne de vie, with the vertical "now" > separator... then spread this separator as a curtain in order to open the > patient encounter as a cognitive map located between the past (AP) and > the future (A'P'). > >> >> Here below some missing topics we need to have agreement about >> >> 2- Thinking about the health and care provission documentation process there >> are: >> - Observation process >> - Evaluation process (including, and restricted to, diagnosis, diff >> diagnosis, problem kist, episode list, etc >> - Planning process >> - Ordering process >> - Execution process of acts > > I am currently writing a paper (in French) telling a story of "boxes" and > "bubbles". Boxes are care places (say organizations at large) with roles > within a domain. Bubbles are the patients (say persons at large) with a > "polar reference frame vision" about "who is around and among them, who is > close or not so close". > > In the usual system, only boxes operate an information system... and they are > pretty bad when it comes to "continuity of X" (replace X with care, > education, employment, etc). > > Now, let's suppose that the reference information system is in the bubble. > And that service providers are just considered as contributors that can join > the current team that surround the person. > > In the ongoing paper, I am trying to describe what happens when "a bubble > steps through a box"... and it is an amazing model to make many things clear! > >> >> 3- We need to recognise that some data is de novo, other data is repeated >> after a querry >> >> 4- Systems need to be aware that some data is directly health care care >> related, other is administrativem process oriented >> >> 5- When that what is documented is used in shared working processes we need >> a common vocabulary: i.e. System of Concepts for Continuity of Care > > Thanks to François Mennerat, a glorious CISP Club founder, we have been aware > of Consys for many years... but "so many years" is also the problem! > > Philippe > > > _______________________________________________ > openEHR-technical mailing list > [email protected] > http://lists.openehr.org/mailman/listinfo/openehr-technical_lists.openehr.org
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