[COAS-List] COAS - Various

["Richard Dixon" <R.M.Dixon@comhealth.hull.ac.uk>]

Dear All,
Firstly, let me apologise for not having responded here sooner.  I have
finally caught up with the RFP and backlog of emails (and there have been
quite a few!).

There are a number of points I would like to raise.  Since many of these
will refer to the EHCR-SupA project, I will explain that (for those who are
not aware of it) first.

EHCR-SupA (Electronic HealthCare Record Support Action) is an EU funded
project which officially began in October 1997.  Its aims are twofold:

 -  To gather in work that has been done on models for EHCRs across Europe
(and further afield where appropriate) and produce a revised EHCR
Architecture which will be proposed for CEN to adopt.
 -  To disseminate its work and the reasons for it, across Europe and
further afield as appropriate

The requirements, use case scenarios and models are/will be drawn from GEHR,
CEN, SYNAPSES, I4C, STAR, RICHE, NUCLEUS and many other projects and bodies
(also taking into account things coming out of e.g CORBAmed and HL-7).

The principles of the first version of the EHCRA have been received
favourably by CEN and are currently undergoing peer review.  Shortly after
this, it will be available in the public domain.

It has been mentioned before that (in COAS) we are not just considering
observations which are in a patient record.  Well, although in a sense
that may be true, equally I believe one could consider that any observation
 recorded about a patient anywhere in what ever format is part of a Health
Care Record Fragment.  Taking that stance, the principles and user
requirements that apply to the EHCR will, for the most part, apply to any
such fragment  at least from the COAS perspective.
As an aside, the user requirements/scenarios for EHCR-SupA which are the
distillation of requirements from all the contributory sources, is in the
process of  being collated  this is a very large document in itself.  We
(in EHCR-SupA) would welcome any additional requirements/use cases from the
folks in COAS which may have been overlooked.

Having read through the emails and the RFP, and  IMHO the results coming
from EHCR-SupA address most of the identified requirements and  scenarios
presented in COAS.  Interestingly, I also believe it solves (or goes a fair
way towards solving at least) the RLS issue of making a summary of
information available.

I had a long and really good discussion with Peter (Nicklin) recently to
compare our modelling thoughts and efforts.  I believe we both found it
productive but there is still more to discuss (Peter, I will probably follow
this email with a phonecall).
To address some specific issues arising from emails:

The question of grouping of data was one that, as I understand it, gave
CEN and implementors of their pre-standard, some headaches.  The EHCR-SupA
model for this (similar to the GEHR one) apparently allowed them to solve
many of these.  It is important to distinguish the levels at which things
could or should be grouped and the consequences of so doing.  For example,
the grouping of values within a sequence, the grouping of parts of a single
observation (e.g. Blood Pressure composed of Systolic and Diastloic
parts), the grouping of observations into a headed folder (e.g. all the
observations recorded in a Physical Examination), the grouping of
contextual information felt to be clinically relevant (e.g. the fact that
the seemingly abnormal blood pressure was because the patient had been
running) and the grouping of all information in the health record or
fragment.
Certianly COAS must take careful note of access controls.  The Information
may well have access rights attached to them which may prevent queriers from
returning the full information, as well as rights which may have been
imposed at the system, place or country level.

The question was raised as to how best to represent the QualifiedConcept
of LQS, as well as the question of guaranteeing or otherwise access to an
LQS.  A similar question arose on the way to EHCR-SupA and a compromise
position was arrived at.

IMHO, it may be too early to come up with a single model  and it may be
better to enhance the requirements and scenarios.  The people who have been
dealing with the various models will need to ensure they (we) can meet all
of these to a greater or lesser extent.  If eventually there are two or more
totally distinct workable approaches that satisfy this, (and IMHO I will be
surprised), then maybe there will need to be more than one solution put
forward.

My experience suggests that eventually the modellers will start to converge
but that this is a process that simply takes time  time to discuss the
issues with one another and to go away and think about them.  Attempts to
rush this process in the past have seen people dig their heels in and end up
with a fragmented solution.  Progress is occurring and I can see no reason
to rush with COAS.  I concur with Jon Farmers comment that the pure
analyst in us likes to exhaustively model the world and believe that we see
it all perfectly  and nobody will come up with a structure that breaks our
model  The realist always accomplishes more in the long haul.  There are
inevitably purists involved in all decent modelling efforts, as well as
realists  but we will not get purists to become realists overnight!

I would be happy to address any of these issues further but I guess
face-to-face is probably best.  I am hoping that one or more of the
EHCR-SupA deliverables will be available by Helsinki.

Our group is currently somewhat short of resources and I had previously
thought it impossible for me to find time to get to Helsinki.  However, I
would very much like to be there, if only for a very short period and am
currently looking to arrive on the Sunday and leave on the Tuesday, thereby
fitting in a full day on the Monday.  The remaining problem is (as ever)
money.  Fingers crossed.

Best regards,
Richard