Re: [COAS-List] COAS - Various

[Bob Glicksman <bobg@medgrid.philips.com>]

Please allow me to remind the ever-growing COAS submitter's team ONE MORE
TIME that the original intent of COAS was to consider the COMMON problems
associated with observational data (e.g. identification, location, access)
and to solve these, leaving the specifics for later RFPs and responses.
Richard -- I couldn't agree with you more that the whole problem space of
clinical observations is HUGE and will take longer than the indicated time
to model (perhaps longer than our working lifetimes)!  So PLEASE -- let's
refocus our efforts and come up with an immediate solution to the specific
FRAMEWORK problem space.  

Please note that I am trying to put together a CIAS submitters team to
consider all of the issues involved in the limited space of accessing
non-diagnostic clinical image data.  Other RFPs are in process for
transcribed reports, and I'd like to see the Lab folks get one going too.
Let's eat this elephant one bite at a time and NOT try to figure out how to
swallow it whole.  If we do, we will all starve amid the adundance of food!

If anyone REALLY wants to tackle anything OTHER than the framework and
measurement data as the required (by the RFP) specific data type, then
PLEASE avail yourselves of your rights to form a competing team and
submission of your own.  We really will not be offended -- we will get two
or more submissions which will be easier to harmonize that trying to do
everythin on one team (IMHO).

Richard, Peter and other modelers -- I'm 99.999% sure that your models can
be harmonized rapidly at the "framework" level.  Let's please get together
and feast on this elephant, one bite at a time!  Please!


At 03:28 PM 7/16/98 +0100, Richard Dixon wrote:
>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
>
>
>
>
_____________________________________
Bob Glicksman  
Director, MedGRiD Program 
Integrated Clinical Solutions
                   
bobg@medgrid.philips.com              Philips Medical Systems   
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