On 02/11/2018 00:00, Heather Leslie wrote:

Hi Dileep,

From a clinician/modeller’s point of view, each of the consultations or visits that you describe as screening, consult encounter, revisit encounters are discrete events and need to be recorded using a separate event COMPOSITION. Each clinical consult will be recorded independently including identifying the changes from visit to visit. As part of a consult a diagnosis may be marked as resolved and that should be included as part of the consult record.

yep, this is the way it should be in openEHR, and logically in any EHR. If you don't do it like this, the data probably won't make sense to other openEHR software, applications etc.

This information needs to be recorded once for medicolegal purposes and sensible querying. Similar data that needs both event based recording and sensible updated representation in summaries or persistent lists include medications, problem/diagnosis, immunisations, adverse reactions, social history, tobacco/alcohol summaries etc.

The question of where that data should be actually 1) stored vs 2) copied and displayed vs 3)displayed as the result of a query or 4)<other technical solution outside my capability> is not implemented consistently as far as I understand. Implementers please correct me if you have documented consensus.

For medicolegal purposes the consult record needs to be able to be accurately displayed and reintegrated on request, even if the component data is stored in a mix of event and persistent COMPOSITIONS.

also correct.

I would think that you would also need to be able to keep a representation of the health summary, also primarily for medicolegal purposes, so that it could be determined precisely what the clinician viewed in that summary as they made a critical clinical decision, especially if it were to result in a bad outcome. That is one of the key reasons for the versioned persistent compositions.

And that will not prevent the patient summary being the last known status of the person – totally agree with your intent there. It’s just a question of how to be able to demonstrate what was the summary on a certain data, at a certain time.

You might consider the 'health summary' a 'document' of some sort, and you /could/ take the line that you are maintaining and updating just that summary rather than the constituent data. In that case, you could treat the summary as a persistent Composition and add versions to it as you say, but now your patient EHR doesn't contain any clinical event data, only the data of a manually pre-built summary of those events.

Generally it's much more useful to record the event Compositions and just compute the summary. This can be easily facilitated by use of Folders that represent episodes, in a fashion already done by some of the vendors (at least DIPS and Code24). There is a new change to the FOLDER type <https://openehr.atlassian.net/browse/SPECRM-56> in the RM that facilitates adding more data - this will appear in the next RM release, very soon.

hope this helps.

Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Project, Intermountain Healthcare <https://intermountainhealthcare.org/> Management Board, Specifications Program Lead, openEHR Foundation <http://www.openehr.org> Chartered IT Professional Fellow, BCS, British Computer Society <http://www.bcs.org/category/6044> Health IT blog <http://wolandscat.net/> | Culture blog <http://wolandsothercat.net/> | The Objective Stance <https://theobjectivestance.net/>
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