Hemant Shah wrote:
> Tom Beale Wrote:
>
> If I may add, the role of database in:
> - decision-support particularly self-learning tools - ANN, CBR etc. and data
> mining.
> - Different views for same data
> - Monitoring kind of situations where same data fields are required to be
> filled repeatedly for a single patient (in contrast to use of database to
> access records for a group)
> - Relational access from one process to another e.g. from clinical to
> administrative
etc. So it should be clear to people that rich information-structure based
records are needed, and so are database systems to store and manipulate them.
"Just documents" won't do it. THis does not of course mean that during some
processing - e.g. rendering of a piece of a record to a screen - that some of
the record might not be turned into a document (probably an XML one); just that
it is not a very useful paradigm for basing intelligent processing on.
> > You just have to ask yourself: how much do we really need to know about
> > patients? Do we need images, or just reports on images? Can we get
> > away with 90% historical data. Mike Roizen's editorial in the NEJM
> > seems to suggest that we can.
>
> It seems to me (as a non-physician) that there are two questions here.
>
> 1. Are all the images (tests, scans etc) we make of patients necessary? (If
> not, there needs to be a process to reduce clinical practice to its
> necessary level for medical care to occur properly.)
>
> 2. If (once such a process has taken place) we have images, scans etc -
> i.e. ones we deem necessary, then surely they want to be available in the
> record. Why take them in the first place?
I should add that I think it would be perfectly natural that scans etc would be
available on an optional basis. This is what GEHR specifies - that bulky
multimedia data, scans etc, can be left out or included when an EHR transaction
is retrieved. GPs are likely to leave it out, while hospital consultants are
more likely to want it. And in some cases, the scan (e.g ultrasound) may be
created at a local clinic, not at the hospital.
> How much data is right? In medicine, we constantly struggle with this basic
> .. another clinical problem or situation. Such data may influence seemingly
> unconnected problems in serendipitous ways. Therefore, it stands to reason
> that one opportunistically exploits such data in a situation even if it is
> not within the prescribed dataset for it. All data recorded for a patient
> has to be available for possible future use.
Yes, agree. But not all users might want certain kinds of data; for data where
there is an inherent cost involved in retrieval (download time, or even manual
searching by the provider), it is reasonable to make retrieval of certain kinds
of data optional.
- thomas beale
