Re: [COAS-List] SGML Thread on Report Types

[Wayne Wilson <wwilson@umich.edu>]

Tim Brinson wrote:
> 
>  Given that each
> Observation has a QualifiedCode for the observation type it would be
> used for the report type in this case.  Now, who defines the codes for
> reports is another matter.  Over time there may be some standardized
> ones but a lot of them will be locally defined by a hospital or maybe
> even by providers.  COAS should be able to work with any of these.
> 
BUT, one movement afoot is to provide each report with structure, ala a
DTD.  Then one can standardize on DTD's (or not!).  Another approach
with XML is based on HyTime where any number of reports can be
dynamically defined according to a standardized meta-structure
represented by a DTD! (this is the architecture Rachel refers to in her
discussion with Wes.)  In fact, I would submit this a crux of the
discussion thread:  should we exhaustively enumerate and standardize
DTD's for all medical reports or should we standardize on a mechanism
allowing us to dynamically create and define and use any number of
reports (and their labels)?

  Another issue here is that if reports have structure, treating them as
a single thing from COAS's perspective will be the logical equivalent of
BLOB's in RDBMS's, not very useful at the end of the day. So you need a
generic mechanism to represent parts and then structure.

> Another part of the thread that was interesting was the discussion on
> headings/catagories.  It sounds like a patient record may have things
> like lists of alergies, history, problems, etc.
> 
>         One question I pose to ALL of us - are these Observations?
> 
This point and the discussion which followed it highlight the issue of
what structure a medical record for a person would take.  One answer, is
that a medical record will contain whatever the care providers and
administrative folks want to put in it and store as a legal document. 
This will most likely be quite open ended.  

 A quite different discussion ensues when one wishes to present
clinically useful information in the context of patient care at a point
in time.  This is almost always a sub-set of what constitutes a medical
record and in many cases is not a proper sub-set at all because it
includes things like preliminary lab results and unsigned/unedited
dictation.  While there is certain commonality across all care
providers, the constant theme that arises is customization of this
presentation to the care task of the provider.

  It had been my understanding that COAS attempted to provide a
universal access mechanism to satisfy this latter scenario.