Greetings:
I am new to this discussion but had a couple of thoughts.
I am just in the final stages (actually finished) modeling some data for
oncology patients.
I would like to suggest that an "episode" be centered around a single
patient illness, and not dependent on whether that patient was in or out
of the hospital. This is speaking from a clinician's viewpoint which
involves a continuum of care, hospitalization being one event.
In regards to the Mayo model, my suggestion would be that the "episode"
for the patient mentioned be the injury, the MI a second "episode" etc.
The physicians associated with that patient's care are linked via
connecting tables, and the lead physician designated in the linking
table if that is desirable. That episode has many events associated with
it, including hospital admission, discharge, tests, procedures. All of
those things are housed in other linked tables.
In regards to the GI ulcer and MI patient mentioned below, my suggestion
would be two episodes, one of which was closed (ulcer question).
Physicians need something slightly different than institutions because
our focus is on responding to the disease episode, in or out of the
hospital, so none of this may apply. Just thought I'd jump in a little.
Regards,
Sally M. Knox, MD, FACS
Baylor Univ Medical Center
Dallas, Tx
Greetings:
I am new to this discussion but had a couple of thoughts.
I am just in the final stages (actually finished) modeling some data for
oncology patients.
I would like to suggest that an "episode" be centered around a single
patient illness, and not dependent on whether that patient was in or out
of the hospital. This is speaking from a clinician's viewpoint which
involves a continuum of care, hospitalization being one event.
In regards to the Mayo model, my suggestion would be that the "episode"
for the patient mentioned be the injury, the MI a second "episode" etc.
If we speak of “episode” as a course of an illness to a point where no more care is needed for that problem, (i.e. patient is a) returned to health, b) sustainable stabilised (chronic patients) or c) died) you are right…but the Mayo MICS uses the other definition of “episode” for its purposes - a period of care delimited by acceptance of responsibility for care and discharge from care.
Let’s not get too worked up about trying to have one sole definition for the word “episode”. I suggest we refer to the two types as “episode-of-care-delivery” and “episode-of-a-problem” (not a very good name - pregnancy falls under this categygory, and is not a problem for most people…)
I suggest that the issues of practical importance are:
a) decide if either or both of these ideas of episodes need to be modelled explicitly in openEHR
b) if so, name them properly
c) define their data (i.e. model them)
Maarten Spook’s problem is to have something which includes the data:
startDateTime: the date-time the episode is started (medically)
stopDateTime: the date-time the episode has ended (medically).
createdDateTime: the date-time the episode was created (administrative)
contributers: care providers and their role (participations?) It would be clear to see who had added info and who is responsible for this episode etc
structured annotation: a short description of the content / context of the episode
This kind of episode is an episode-of-care-delivery. I come back to modelling this with a Folder.
As I stated earlier, the other kind of episode - related to the course of an illness, a pregnancy, or an ‘epsiode’ of some chronic disease - can be modelled as Links between the relevant Entries, where each Link object can be classified as relating to a particular problem, such as “diabetes” or “pregnancy”.
How do we want to proceed. Is it likely that there are sufficiently standard ideas of the two kinds of episode that they should be modelled in a more concrete way than with Folders and Links?
thomas beale
If you have any questions about using this list, please send a message to d.lloyd@openehr.org
Greetings:
I am new to this discussion but had a couple of thoughts.
I am just in the final stages (actually finished) modeling some data for
oncology patients.
I would like to suggest that an "episode" be centered around a single
patient illness, and not dependent on whether that patient was in or out
of the hospital. This is speaking from a clinician's viewpoint which
involves a continuum of care, hospitalization being one event.
In regards to the Mayo model, my suggestion would be that the "episode"
for the patient mentioned be the injury, the MI a second "episode" etc.
If we speak of “episode” as a course of an illness to a point where no more care is needed for that problem, (i.e. patient is a) returned to health, b) sustainable stabilised (chronic patients) or c) died) you are right…but the Mayo MICS uses the other definition of “episode” for its purposes - a period of care delimited by acceptance of responsibility for care and discharge from care.
Let’s not get too worked up about trying to have one sole definition for the word “episode”. I suggest we refer to the two types as “episode-of-care-delivery” and “episode-of-a-problem” (not a very good name - pregnancy falls under this categygory, and is not a problem for most people…)
I suggest that the issues of practical importance are:
a) decide if either or both of these ideas of episodes need to be modelled explicitly in openEHR
b) if so, name them properly
c) define their data (i.e. model them)
Maarten Spook’s problem is to have something which includes the data:
startDateTime: the date-time the episode is started (medically)
stopDateTime: the date-time the episode has ended (medically).
createdDateTime: the date-time the episode was created (administrative)
contributers: care providers and their role (participations?) It would be clear to see who had added info and who is responsible for this episode etc
structured annotation: a short description of the content / context of the episode
This kind of episode is an episode-of-care-delivery. I come back to modelling this with a Folder.
As I stated earlier, the other kind of episode - related to the course of an illness, a pregnancy, or an ‘epsiode’ of some chronic disease - can be modelled as Links between the relevant Entries, where each Link object can be classified as relating to a particular problem, such as “diabetes” or “pregnancy”.
How do we want to proceed. Is it likely that there are sufficiently standard ideas of the two kinds of episode that they should be modelled in a more concrete way than with Folders and Links?
thomas beale
If you have any questions about using this list, please send a message to d.lloyd@openehr.org
I agree that there needs to be more than one type of episode. In oncology, there is often one illness fairly well defined where the patient lives or dies. In other specialties, a disease is lifelong once it starts and the patient dies with the disease and not of it. In that case the “episodes” are better thought of as exacerbation which settle often for long periods. Each specialty may have a different idea of what constitutes an episode. Is psoriasis one illness and hence one episode as it may last 60+ years!
Cheers
CDC, Perth