Re: Problem-oriented records and querying by problem

sam.heard at sam.heard at
Mon Jan 5 16:07:00 EST 2015


There are a number of possibilities and it will inevitably vary.

First, some things get into “persistent” lists that are not ongoing. These are generally removed or demoted to being inactive.

Second, some things need to stay in “persistent” lists and are very important even if there is no idea of care - breast cancer for example. The risk of recurrence gets very small after 10 years but it is never zero.

Third, care plans will be multiple but need to be as consolidated as possible. There might be a different care plan for different professionals or activities linked to different professionals within the same care plan. A nursing care plan during respite care for a disabled person may be very different from that person’s ongoing care plan in the community.

The interventions for hypertension, hyperlipidaemia, obesity, diabetes type II and ischaemic heart disease overlap massively.

So the principles as I see them are:

As few care plans as possible - certainly not one per problem

The scope of the care plan to be visible - hospital, aged-care facility, community

Care plans need to be merged and separated and updated and closed.

I think that a collection of instructions in a composition linked to actions undertaken is the best technical solution. If you want that linked to a particular problem or set of problems we could archetype that in the links….or have an explicit data point for the problem (with a link).

Time will tell.

Cheers, Sam

From: Thomas Beale
Sent: ‎Wednesday‎, ‎19‎ ‎November‎ ‎2014 ‎11‎:‎05‎ ‎PM
To: For openEHR technical discussions
Cc: For openEHR clinical discussions

On 18/11/2014 03:34, pablo pazos wrote:

Hi all, just re-sending this question on the clinical list too. 

I'm wondering how to handle the link between documents and health problems in a problem-oriented record. 

I think the future will be that a Care Plan informational construct (note: for US, something very closely related to an 'order set'), partially manually written, partially machine populated with links to relevant items, will be the thing that ties it together. Consider: the proof that something really is considered a 'problem', out of all the non-problems and trivial problems (e.g. one-off throat infection) is that some clinical professional wants to create a care plan, to define ongoing treatment and track interventions (all medications, other interventions etc).

A flexible model of a Care Plan (for each major ailment) that allows tying together of such information, and is machine-updated, I think will end up being the main way clinical professionals can interact with the raw data. We can imagine a Care Plan 'service' with an API for add/update/remove items/rules and apps for looking at care plans. 

Behind the Care Plan(s) in the EHR we still need managed medication list(s) and problem list.

I see the latter two as 2nd order informational constructs, and Care Plans as 3rd order constructs. 

- thomas
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