Re: A question of Demographics

["Peter Nicklin" <peter.nicklin@newcastle.ac.uk>]

Jinny

You raise interesting questions.  I'll deal with them in-line.

> Why dont we begin with Demographics, which pretty clearly is part of EM?
> Where do you think the demographics information fits in the Patient's
> record? As I understand, we would be interested in some
> Demographic information for Persons who may not be Patients.
> That includes Guarantors, NextOfKin, people who are in some contract with
> the HCP. Does this list  include Physicians? Nurses?

I think Patient Demographics is just as much a part of the patient 
record as it is a part of the management of the encounter.  However, 
*Person* Demographics may be thought of as having a broader role, 
where some persons have no patient role at all, but are nontheless 
described in some detail (this would especially apply to clinicians).

> Suppose we call these roles of a Person. Is demographics a property of a
> Person or his/her role? In case of former, how do you determine the 
> demographic properties, given knowedge of a particular role? For the
> latter, we can foresee scenarios where roles of the same Person share
> demographic properties.

It depends which properties you are talking about.  Let's work by 
example:

A Person has some properties which are not dependent upon role.  
Examples would be: DoB, Gender, Primary language, ethnicity, 
Primary name, home address, next of kin.  We might also include such 
things as professional qualifications, experience, demonstrable 
skills, although we might argue that these have some broad role or, 
at least, domain.

For a model of this aspect of demographics, see: 

corbamed/98-03-10: Person Demographics

on the OMG site.

On the other hand we have very role dependent properties for a 
person.  A nurse may be authorised to perform certain types of 
professional activities in certain organisational contexts, for 
example, theatre nursing for this particular hospital (or trust as we 
call them here).  Her nursing qualifications are part of a very broad 
role as a *nurse*, and if we want to view the whole of the healthcare 
systems, including the professional bodies, as a domain, then 
"qualified nurse" is a role.  Otherwise it's just a property of that 
individual.

> Also while we chew this over, would anybody care to comment on what they
> think is an Encounter? It would be a good idea to see where people stand
> with the meaning of the word. Ofcourse, if this turns out to be a
> heavy topic, we can move it to another thread!

It's a seriously heavy topic that kept us very busy at the CORBAmed 
meeting in Helsinki.  The relationships between healthcare providers 
and patients can be various.  Examples:

1. An encounter that is the basic unit of accounting and is set up on 
at the start of a period of care, and continues to exist as a 
charging reference until deemed to be complete (whenever that may 
be).  (In the UK we sometimes call this a "completed consultant 
episode").

2. An inpatient or outpatient visit.

3. A visit to a particular specialist: say cardiologist or 
radiologist/radiographer.

4. The *clinical* responsibility that a medic, nurse or PAM has for a 
patient, the nature of that responsibility, its start timepoint and 
end timepoint.

5. An episode of a disease or morbidity, the clinical activities 
performed to manage, control or cure it, its start and end 
timepoints and who defined that episode.

I'm sure others can think of more.

Peter Nicklin

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