Yet another OBSERVATION vs. EVALUATION issue

Stefan Sauermann sauermann at
Mon Aug 20 04:26:54 EDT 2012

We can't ditch "diagnosis".

We may be unable to define it once and for all. However this is a 
problem of our group. We do not (can not, do not want to) represent all 
these grups who will populate and use the archetype in thousands of 
diverse environments and contexts.

I agree with Tom in that we need to provide "free space" (very widely 
defined archetypes e.g. "diagnosis", "problem", ... ) where others can 
further restrict, code, detail, ...  what they want to have.

At the moment we have to live with the fact that there still are 
subgroups who will have contradictory content within their detailed 
definitions and therefore no interoperability. Over time this will 
become better.

Greetings from Vienna,

Stefan Sauermann

Program Director
Biomedical Engineering Sciences (Master)

University of Applied Sciences Technikum Wien
Hoechstaedtplatz 5, 1200 Vienna, Austria
P: +43 1 333 40 77 - 988
M: +43 664 6192555
E: stefan.sauermann at


Am 19.08.2012 13:24, schrieb Thomas Beale:
> We can't just ditch the word 'diagnosis' - it's not up to any 
> standards community to do that. The diagnosis concept, which I agree 
> can be weak/ambiguous in general practice, certainly isn't in the 
> acute sector.
> I don't have a problem with philosophical arguments that question the 
> meaning of the 'diagnosis' concept, but it's not our job in a place 
> like openEHR to dictate a new philosophy of medicine to the sector. We 
> need instead to reflect the needs of what actually goes on. If 
> 'diagnosis' is clearly used in acute care, but only weakly in general 
> practice, we need to reflect that.
> This is one of the reasons for having a 'problem' archetype and a 
> 'diagnosis' archetype, as has been done in openEHR. It becomes an 
> optional extra to actually call the assessment a 'diagnosis', to code 
> it, and to give it a status ('working' or whatever). There may be 
> better ways to do that, but I don't think throwing out 'diagnosis' as 
> an archetype concept is useful.
> - thomas
> On 18/08/2012 12:10, Gerard Freriks wrote:
>> Good.
>> lets ditch the term 'Diagnosis' completely.
>> Or use it only when we are -as you write- scientifically certain.
>> And use other terms. We (EN13606 Association) prefer the 'Reasons for 
>> ...' type of terms, because that is what they do in real life.
>> They are the excuses to do something (or nothing); they are the cost 
>> drivers in healthcare; they must be documented.
>> Words like 'symptom', 'sign', 'syndrome', 'diagnosis', are fuzzy 
>> terms that can mean too many things.
>> We need well defined terms in our systems and standards as points of 
>> reference we agree on.
>> Locally all users must be allowed to use their own fuzzy terms as 
>> long as they are mapped to (and used in accordance with) the 
>> reference terms.
>> *
>> *
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