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Re: Relationship (Service?)
Chuck
This debate gets more and more interesting....
I think we are talking about a number of different things here. Let
me try to list them:
1. General authorisations: a doctor is authorised to perform
"general surgical duties" - a type of activity or set of
activity types.
2. Enterprise relationships: the same "doctor is an authorised
agent of hospital trust Y".
3. The operational relationships derived from these general
authorisations; "responsible for surgical duties for patient X
in the context of hospital trust Y".
I imagine that HRAC needs to know about all three types. However,
only 2 and 3 really qualify as relationships.
In the RICHE context, 1 and 2 are maintained and supplied by the
Enterprise manager, whilst 3 is most decidedly in the sphere of the
subject of care. Whilst this reflects the bias that I bring to this
issue (because it is what i am familiar with!), i think that the much
finer grained objects that we have in CORBA tend to change the basis
of the debate.
I think that these are critical issues for the Roadmap/CHST - we are
meeting on Sunday 8th at Burlingame and one of the topics is
Relationships. Hopefully we can really get some of this stuff
set-out and adopt a view on it. I'll also be very interested to see
the response from HALFEM.
BTW - you mention that COAS can retrieve and/or express relationship
instances. Is this so? I don't see how it can be done from the
model issued on 7th October - Observation qualifier would return a
reference to a relationship, but i don't see how it would return the
relationship itself (i gather that there are other COAS models
circulating - perhaps I haven't seen this one yet :-) ).
Regards
Peter
> I agree with your comments 100%.
> To answer your question(s) at the end, I am not sure we need a
> "relationship" service as much as we need an "authority" service, which may
> be part of HRAC (or may not). I don't think we need a service that stores
> or "serves" relationships. What service would it actually provide.
> Instead I think we need a service that can be asked about the roles of a
> care giver with respect to a subject of care and a health care enterprise,
> and their authority to perform those roles (the HRAC may cover the
> authority part, but may not feel that the assignment of roles to care
> givers is part of its scope).
> What do you think?
>
> Chuck
>
> P.S. Reading over what I have just written, maybe we need to define
> "relationship". It is clear to me that COAS will be able to express,
> retrieve, etc. relationship instances. It is also clear to me that a
> health care enterprise needs to manage the activities, roles, and care
> givers who perform these activities in the various roles. Some mechanism
> is clearly needed to help with this management activity. I am not sure I
> would call it a relationship service though.
>
> At 02:29 PM 10/20/98 +0000, you wrote:
> >Jinny
> >
> >I am sending this message to the COAS list because there are COAS
> >comments. For the COAS folk who have not been following this debate,
> >we are thinking about the possible role of a relationship service, as
> >described below by Jinny......
> >
> >
> >Jinny wrote..............
> >> The way I see it, there are two types of relationships we are talking
> >> about: demographic relationships (that can be obtained from the
> >> demographic service) and others (shall we call them clinical?). The
> >> dmeographic relationships would be accesible from the demo-service. It is
> >> the other type of relationships, like physician-isPrimaryCareOf-patient
> >> type relations that we need a relationship service for.
> >
> >Let's take the example of "physician-isPrimaryCareOf-patient" from
> >your message because it's a good one. The difficulty I have with a
> >simple -relationship- service to handle this is that there are
> >clinical actions and findings that must use this relationship as a
> >context. So, when the patient is referred to hospital it has
> >been done by a primary care physician and therefore the
> >"physician-isPrimaryCareOf-patient" relationship is relevant to that
> >referral (in the UK, it is the responsibility of primary care
> >physicians to control initial referrals to secondary care).
> >Therefore relationships are very much part of the Patient record
> >(whatever that may be).
> >
> >To some extent this point is implicitly taken on board by COAS,
> >because the latest COAS model has an "Observation Qualifier" which,
> >inter alia, is intended as a means of recording the identity of the
> >"observer". On reflection, I would say that COAS should be thinking
> >about recording the identity of the -relationship- between the
> >observer and observed (usually the patient) rather than just the
> >identity of the observer. In so many clinical contexts it is the
> >relationship that authorises (or legitimates) the observation and
> >also provides extra information that is integral to the observation
> >itself (e.g. a proposed action by the clinician with key
> >responsibility for the patient would be more seriously considered tha
> >a proposal from someone more peripherally involved). To rephrase,
> >the relationship has medico-legal and clinical importance. Against
> >this, it might be argued that if activity A was performed by
> >clinician C in the context or relationship R between C and Patient P,
> >then the very fact that C performed A on P whilst R was current would
> >tell us what we needed to know about C's authority. I wouldn't
> >accept this. C may have more than one relationship with P (and we
> >need to know which is the actual context) or may even be acting
> >outside the authority of R.
> >
> >So, do we need an actual relationship service, or are relationships
> >so deeply embedded into other services, such as Record locator,
> >Demographics, Encounter management, Enterprise management and even
> >COAS and CIAS that, ultimately, a relationship service would
> >imply a separation of concerns that would be impossible to achieve?
> >On the other hand, the appearence of relationships in so many places,
> >suggests the need for reuse.
> >
> >I don't know the answer to this - but I do know that it is important
> >to the Roadmap to get it sorted out.
> >
> >Regards
> >
> >Peter
> >
> >_____________________________________________________________________
> >Peter Nicklin, NHS IMC,
> >c/o CHSR, 21 Claremont Place, Newcastle Upon Tyne, NE2 4AA, UK
> >Tel: +44 191 230 3614 Fax: +44 191 230 4563 Mobile: +44 831 198319
> >X400: imc/G=Peter/S=Nicklin/O=nhs_imc/OU=cbs@mhs.attmail.com
> >
> >
> For details regarding list subscriptions and the list archive see:
> http://cadse.cs.fiu.edu/omg/halfem-rfi/
>
_____________________________________________________________________
Peter Nicklin, NHS IMC,
c/o CHSR, 21 Claremont Place, Newcastle Upon Tyne, NE2 4AA, UK
Tel: +44 191 230 3614 Fax: +44 191 230 4563 Mobile: +44 831 198319
X400: imc/G=Peter/S=Nicklin/O=nhs_imc/OU=cbs@mhs.attmail.com
For details regarding list subscriptions and the list archive see:
http://cadse.cs.fiu.edu/omg/halfem-rfi/