My go at the correct interpretation.
Good to see the lists hotting up with some questions..
here is one I have had to ponder recently.
I have an evaluation being made directly from an observation.
Specifically - I have a particular type of athletic session
from which an ‘maximum power’ number is being derived.
The ‘evaluation’ is done by an algorithm and creates a second (derived) observation (‘maximum power number’) via post-processing.
For the healthcare provider (coach) this was and stays an observation.
This observation is in the record in the in-tray.
It is my opinion that only the owner (a human) can commit data and information to the record proper.
Admission to the record must be a conscious human act.
Until formally committed is stays in the In-Tray , in a state of organised limbo. (status= received, not committed)
Whilst the calculation is automatic, the coach is
‘evaluating’ the automatically generated score before it is
put into the system (to make sure that the number is
sensible given what he knows of the athlete).
The coach observes in the In-Tray the data item with the state received, not committed and commits it.
The next step is that he makes a judgement to change or not to change the value.
This creates or does not create a new version of the value.
Some questions
- is this even an evaluation?? Where does observation finish
and evaluation start in a world where computers do more and
more analysis..
We must remember: the EHR is not what happened exactly with and around the patient in its healthcare provision process.
For the EHR we are not to model the complete healthcare process in its most fine grained detail.
It is what gets documented by a responsible person.
In the use case above we only see observations with a committed and not-committed state,
observations that are or are not changed (versioned).
Evaluation is what happened as the result of the interpretation in the head of a healthcare provider (coach).
The observation is processed in the context of the patient and the expertise and knowledge of the coach with the aim to reduce the list of possible diagnosis, to make a plan, to set a goal.
Computers are computers. Always a human must be in the loop (in general) to commit data to the EHR.
EHR’s facilitate the obligation of a responsible person to document the treatment of its patient.
- how can this linkage between evaluation and observation be
recorded. If someone does a delete on the composition
containing the Observation (perhaps they uploaded the wrong
athlete data), the evaluation should also clearly be deleted. Can
this linkage be expressed?
Any change will lead to a new version of the composition. Reasons for change can be recorded via the functionality in the Reference Model.
In addition the RM allows to have semantic links between any part in the record. This an extra facility to record what things recorded earlier played a role in a decision/change, etc.
- would tracking linkages cause us to descend into madness??
Obviously many evaluations are based on the sum total of information
present in the EHR - the clinician doesn’t explicitly indicate each
piece of information that led to the evaluation.. so the general case
seems to not require linkage data. Is the case of
Specific Observation → Specific Evaluation even worth worrying about?
Many times links between observed facts, evaluations are implicit.
The composition indicating that the patient is dead as an evaluation by itself is enough.
I image that in certain circumstances (contexts) extra information must be given.
Extra information explicitly (fully structured): This can be in the form of semantic links to supporting items in the record, when we have to (or want) to record explicitly the reasoning of the author.
Extra information implicitly (not or partially structured): This extra information can be given as well in a comment field or structured via a specific template not using semantic links.
Remark: Although the OpenEHR RM has the feature of inserting semantic links this is available not present in most systems.
