Yet another OBSERVATION vs. EVALUATION issue
> and panic attacks/hyper ventilation. These were my inferences about the > process inside the patient system. > > Only one was true and had to found out via trial and error diagnostics > and trial treatments. I fear that the best we can do in most circumstances > (as GP) is to code 'Reasons for ..' and do not use the word diagnosis too > often. > > Isn't that what we call 'differential diagnosis'? > > Anyhow. I agree that these DD or reasons for should be seperated and > clearly distinctable from the 'final' diangosis, preferably based on facts and > deduction. "final" diagnoses mainly exist with the field of pathology/the coroners office. Karsten
Yet another OBSERVATION vs. EVALUATION issue
Hello! Agree to practical solutions, and to not change but support what is going on in medicine. Is this a "general purpose" diagnosis archetype or is there any limit at least to some area? The discussion will be much easier and to the point if there is a usecase. Diagnosis is very different in places and I do not see a simple "one fits all" archetype soon. A "general purpose" diagnosis archetype in all bloom will not provide detailed interoperability. It will only be able to serve as search target, and readers will have to parse the content similar to free text. The Austrian hospital discharge summaries have very few and simple fields in the diagnosis part, some basic diagnostic codes and mostly free text. This made everybody happy for discharge management. However this will not support a group that is in the middel of developing a diagnosis. Therefore: What is your usecase? Greetings, Stefan Sauermann Program Director Biomedical Engineering Sciences (Master) University of Applied Sciences Technikum Wien Hoechstaedtplatz 5, 1200 Vienna, Austria P: +43 1 333 40 77 - 988 M: +43 664 6192555 E: stefan.sauermann at technikum-wien.at I: www.technikum-wien.at/mbe I: www.technikum-wien.at/ibmt I: www.healthy-interoperability.at Am 20.08.2012 15:14, schrieb Stef Verlinden: > I agree that we need a practical solution and that we can't change (at least > not overnight) what has been going on for ages. > > As an intermediate solution, it would be great if it is possible to see on > which facts a diagnosis is based (or a differential diagnose is rejected) and > which protocol is used in order to get to that diagnosis. > > As we discussed some time ago, a diagnoses (for example 'rheumatoid > arthitis') isn't a 'hard' diagnosis. Differerent hospitals/ groups of > doctors/ regions/ etc. use different protocols containing different criteria > to come to the diagnosis RA. > > So one RA diagnosis can't be directly compared to another RA diagnosis unless > they're based on the same criteria. > > Cheers, > > Stef > > Op 19 aug. 2012, om 23:52 heeft Thomas Beale het volgende geschreven: > >> In a way, having a 'diagnosis' archetype (whatever it is today, and whatever >> it evolves into) does do away with trying to define diagnosis - by providing >> its own extensional definition of data points that some clinical modellers >> have agreed are useful to collect. The 'meaning' of the word 'diagnosis' may >> continue to be debated forever, it won't affect anything material. I would >> call this a good example of practical interoperability. >> >> - thomas >> >> ___ >> openEHR-clinical mailing list >> openEHR-clinical at lists.openehr.org >> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > > ___ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
Yet another OBSERVATION vs. EVALUATION issue
I agree that we need a practical solution and that we can't change (at least not overnight) what has been going on for ages. As an intermediate solution, it would be great if it is possible to see on which facts a diagnosis is based (or a differential diagnose is rejected) and which protocol is used in order to get to that diagnosis. As we discussed some time ago, a diagnoses (for example 'rheumatoid arthitis') isn't a 'hard' diagnosis. Differerent hospitals/ groups of doctors/ regions/ etc. use different protocols containing different criteria to come to the diagnosis RA. So one RA diagnosis can't be directly compared to another RA diagnosis unless they're based on the same criteria. Cheers, Stef Op 19 aug. 2012, om 23:52 heeft Thomas Beale het volgende geschreven: > > In a way, having a 'diagnosis' archetype (whatever it is today, and whatever > it evolves into) does do away with trying to define diagnosis - by providing > its own extensional definition of data points that some clinical modellers > have agreed are useful to collect. The 'meaning' of the word 'diagnosis' may > continue to be debated forever, it won't affect anything material. I would > call this a good example of practical interoperability. > > - thomas > > ___ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
Yet another OBSERVATION vs. EVALUATION issue
Op 18 aug. 2012, om 10:41 heeft Gerard Freriks het volgende geschreven: > > > On 17 Aug 2012, at 19:38, Thomas Beale wrote: > >>> >>> Decisions of medical users do not depend on the fact that an item is >>> classified as "observation" or "evaluation". >> >> maybe not so much on how it is classified, but on whether it can be trusted >> or not. Erroneous conclusions can be drawn from evidence by mis-diagnosis, >> and diagnoses often have to be revisited in difficult cases. Observations >> might sometimes be declared faulty, but it is much less often the case, and >> the kinds of errors are generally less problematic than errors of diagnosis. > > > 20 something years of medical practice learned me to be humble and do not use > the word Diagnosis too lightly: > > - facts (e.g. measured things like lab results,or interventions/operations, > etc.) are trusted much better than opinions/evaluations/inferences > > - inferences are highly personal and context dependent. > (e.g. there are opinions be peers that one generally can trust more than > others. Some are never trusted. Even in the case of peers that are trusted, > each time the healthcare provider must be able to create his own opinion and > make his own judgement. > Personally I distrust all Diagnosis statements in the record. Even my own > statements. Diagnosis is always an inference about a (disease) process inside > the patient system. These processes we can no see; the only thing we can > perceive are the results of that process. It is much more realistic to record > in the EHR Reasons for Diagnostics and Reasons for Treatment than fuzzy > things such as 'Diagnosis'. The draft EN13606 Association SIAMS document > (Chapter 6) is about topics like these. > Before we can start to standardise how archetypes are produced we will have > to agree on a number of notions/concepts. > > Example: I know that within one day I suspected the patient to have shortness > of breath because of: asthma, pulmonary infection, cardiac failure and panic > attacks/hyper ventilation. These were my inferences about the process inside > the patient system. > Only one was true and had to found out via trial and error diagnostics and > trial treatments. I fear that the best we can do in most circumstances (as > GP) is to code 'Reasons for ..' and do not use the word diagnosis too often. Isn't that what we call 'differential diagnosis'? Anyhow. I agree that these DD or reasons for should be seperated and clearly distinctable from the 'final' diangosis, preferably based on facts and deduction. Cheers, Stef -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120820/85d8ed24/attachment.html>
Yet another OBSERVATION vs. EVALUATION issue
the 'diagnosis' concept, but it's not our job in a place
> like openEHR to dictate a new philosophy of medicine to the sector. We
> need instead to reflect the needs of what actually goes on. If
> 'diagnosis' is clearly used in acute care, but only weakly in general
> practice, we need to reflect that.
>
> This is one of the reasons for having a 'problem' archetype and a
> 'diagnosis' archetype, as has been done in openEHR. It becomes an
> optional extra to actually call the assessment a 'diagnosis', to code
> it, and to give it a status ('working' or whatever). There may be
> better ways to do that, but I don't think throwing out 'diagnosis' as
> an archetype concept is useful.
>
> - thomas
>
> On 18/08/2012 12:10, Gerard Freriks wrote:
>
> Good.
>
> lets ditch the term 'Diagnosis' completely.
> Or use it only when we are -as you write- scientifically certain.
> And use other terms. We (EN13606 Association) prefer the 'Reasons for ...'
> type of terms, because that is what they do in real life.
> They are the excuses to do something (or nothing); they are the cost
> drivers in healthcare; they must be documented.
>
> Words like 'symptom', 'sign', 'syndrome', 'diagnosis', are fuzzy terms
> that can mean too many things.
> We need well defined terms in our systems and standards as points of
> reference we agree on.
> Locally all users must be allowed to use their own fuzzy terms as long
> as they are mapped to (and used in accordance with) the reference terms.
>
> ___
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.opene
> hr.org
>
>
>
> ___
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.opene
> hr.org
--
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fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll at oceaninformatics.com
Clinical Modelling Consultant, Ocean Informatics, UK Director openEHR
Foundation www.openehr.org/knowledge Honorary Senior Research Associate,
CHIME, UCL SCIMP Working Group, NHS Scotland BCS Primary Health Care
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Yet another OBSERVATION vs. EVALUATION issue
Agree.
We can't ditch "diagnosis".
We may be unable to define it once and for all. However this is a
problem of our group. We do not (can not, do not want to) represent all
these grups who will populate and use the archetype in thousands of
diverse environments and contexts.
I agree with Tom in that we need to provide "free space" (very widely
defined archetypes e.g. "diagnosis", "problem", ... ) where others can
further restrict, code, detail, ... what they want to have.
At the moment we have to live with the fact that there still are
subgroups who will have contradictory content within their detailed
definitions and therefore no interoperability. Over time this will
become better.
Greetings from Vienna,
Stefan Sauermann
Program Director
Biomedical Engineering Sciences (Master)
University of Applied Sciences Technikum Wien
Hoechstaedtplatz 5, 1200 Vienna, Austria
P: +43 1 333 40 77 - 988
M: +43 664 6192555
E: stefan.sauermann at technikum-wien.at
I: www.technikum-wien.at/mbe
I: www.technikum-wien.at/ibmt
I: www.healthy-interoperability.at
Am 19.08.2012 13:24, schrieb Thomas Beale:
>
> We can't just ditch the word 'diagnosis' - it's not up to any
> standards community to do that. The diagnosis concept, which I agree
> can be weak/ambiguous in general practice, certainly isn't in the
> acute sector.
>
> I don't have a problem with philosophical arguments that question the
> meaning of the 'diagnosis' concept, but it's not our job in a place
> like openEHR to dictate a new philosophy of medicine to the sector. We
> need instead to reflect the needs of what actually goes on. If
> 'diagnosis' is clearly used in acute care, but only weakly in general
> practice, we need to reflect that.
>
> This is one of the reasons for having a 'problem' archetype and a
> 'diagnosis' archetype, as has been done in openEHR. It becomes an
> optional extra to actually call the assessment a 'diagnosis', to code
> it, and to give it a status ('working' or whatever). There may be
> better ways to do that, but I don't think throwing out 'diagnosis' as
> an archetype concept is useful.
>
> - thomas
>
> On 18/08/2012 12:10, Gerard Freriks wrote:
>> Good.
>>
>> lets ditch the term 'Diagnosis' completely.
>> Or use it only when we are -as you write- scientifically certain.
>> And use other terms. We (EN13606 Association) prefer the 'Reasons for
>> ...' type of terms, because that is what they do in real life.
>> They are the excuses to do something (or nothing); they are the cost
>> drivers in healthcare; they must be documented.
>>
>> Words like 'symptom', 'sign', 'syndrome', 'diagnosis', are fuzzy
>> terms that can mean too many things.
>> We need well defined terms in our systems and standards as points of
>> reference we agree on.
>> Locally all users must be allowed to use their own fuzzy terms as
>> long as they are mapped to (and used in accordance with) the
>> reference terms.
>> *
>> *
>
>
> ___
> openEHR-clinical mailing list
> openEHR-clinical at lists.openehr.org
> http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org
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Yet another OBSERVATION vs. EVALUATION issue
As I said it?s a matter of context. Jussara R?tzsch Md, MSc Director, OpenEHR Foundation Owner, Giant Global Graph ehealth Solutions <http://www.giantglobalgraph.com.br> On Mon, Aug 20, 2012 at 9:51 AM, Stef Verlinden wrote: > > Op 18 aug. 2012, om 10:41 heeft Gerard Freriks het volgende geschreven: > > > > On 17 Aug 2012, at 19:38, Thomas Beale wrote: > > > Decisions of medical users do not depend on the fact that an item is > classified as "observation" or "evaluation". > > > maybe not so much on how it is classified, but on whether it can be > trusted or not. Erroneous conclusions can be drawn from evidence by > mis-diagnosis, and diagnoses often have to be revisited in difficult cases. > Observations might sometimes be declared faulty, but it is much less often > the case, and the kinds of errors are generally less problematic than > errors of diagnosis. > > > > 20 something years of medical practice learned me to be humble and do not > use the word Diagnosis too lightly: > > - facts (e.g. measured things like lab results,or > interventions/operations, etc.) are trusted much better than > opinions/evaluations/inferences > > - inferences are highly personal and context dependent. > (e.g. there are opinions be peers that one generally can trust more than > others. Some are never trusted. Even in the case of peers that are > trusted, each time the healthcare provider must be able to create his own > opinion and make his own judgement. > Personally I distrust all Diagnosis statements in the record. Even my own > statements. Diagnosis is always an inference about a (disease) process > inside the patient system. These processes we can no see; the only thing we > can perceive are the results of that process. It is much more realistic to > record in the EHR *Reasons for* Diagnostics and Reasons for Treatment > than fuzzy things such as 'Diagnosis'. The *draft* EN13606 Association * > SIAMS* document (Chapter 6) is about topics like these. > Before we can start to standardise how archetypes are produced we will > have to agree on a number of notions/concepts. > > Example: I know that within one day I suspected the patient to have > shortness of breath because of: asthma, pulmonary infection, cardiac > failure and panic attacks/hyper ventilation. These were my inferences about > the process inside the patient system. > Only one was true and had to found out via trial and error diagnostics and > trial treatments. I fear that the best we can do in most circumstances (as > GP) is to code 'Reasons for ..' and do not use the word diagnosis too often. > > > Isn't that what we call 'differential diagnosis'? > > Anyhow. I agree that these DD or reasons for should be seperated and > clearly distinctable from the 'final' diangosis, preferably based on facts > and deduction. > > Cheers, > > Stef > > ___ > openEHR-clinical mailing list > openEHR-clinical at lists.openehr.org > > http://lists.openehr.org/mailman/listinfo/openehr-clinical_lists.openehr.org > -- next part -- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/pipermail/openehr-clinical_lists.openehr.org/attachments/20120820/184fbf91/attachment-0001.html>
