[COAS-List] Various Issues

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

Hi everyone,

I realise that over the past week or so, some of the points I want to
raise/clarify may well have been answered, but in case not, here they are
(in several emails).  (BTW hope the Burlingame meeting went well).

(i)  Headings/Categories

It sounds like a patient record may have things like lists of allergies,
history, problems, etc.  One question  ...  are these Observations?
... when I have asked some other knowledgeable people in this area they
indicated that allergy lists etc. are categories, NOT Observations

I would agree that they are not observations, but IMHO the problem here is
that the wrong question is being asked.  At the moment, people are saying
We will model an Observation  what is an Observation and what is not?
What I believe you should be asking is What are the things we are modelling
here?  Is Observation a sensible word for them all?

This is was what made EHCR-SupA and CEN move away from calling things
Observation to calling them Record Item or Record Entry.  Now,
personally, I care not what they are called, but it does need top be a term
that is fairly generic and does not restrict peoples view of what it
covers.

As for things like allergies, history, problems etc., I would agree that
(even with the sloightly wider scope of Observation), these are and arent
the same beast.  In the GEHR and current EHCR-SupA model there is a
distinction between the individual entries (composed or not) and the
Headings under which they appear.  Such Headings could probably be coped
with with the ObservationReference, but it was (and currently still is)
believed that these were (like the composed entries) somewhat fundamental.

As a (not written by a clinician) example:

Physical Examination
   Weight = 76 kg
   Blood Pressure  {Systolic BP = 120; Diastolic BP = 80 }
   ...

Reason For Consultation = <Patient Complained of ...>

Past History
   Diagnosis = <xyz>, in <ddmmyyyy>
   Treated for <xyz> in <ddmmyyyy>
    ...
Allergies
   Allergic to <abc>
   Possible adverse reaction to <def>
   ...

Problems
   Patient has <hij>
   Possible <klm>
   ...

Now the entries (Observations) themselves will stand alone without the
Headings under which they have been labelled, but 'Headings' like these do
form a common and useful annotation to the observations in the record.
I would recommend that the model considers/reflects these Headings (see
the current EHCR-SupA model for reference)


Richard



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FN:Dr Richard Dixon
ORG:Medical Informatics Group
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