How about a problem list, let’s say the GP keeps a persistent problem list, now the patient is transferred to the hospital, (single EHR/federation/different EHR with post hoc data exchange) and the surgeon starts their own problem list, the GP’s one should be marked obsolete imho (and reactivated after discharge probably). Now we will end up at the same discussion probably, since I expect your view to be the surgeon should update the gp’s problem list, right?
I would again argue it’s unfeasible (technically impossible in the case of seperate EHRs afaik) and probably undesirable, since so much context (author, setting) and metadata (authorisations) has changed recorded in the composition. And most importantly the perspective has changed too much, GPs look at problems totally differently than surgeons do: DM to a gp is a condition that requires chronic management, to a surgeon it’s a higher risk of wound infection and someone you need to consult the diabetologist on to ‘fix those sugars’. If you take a nurses problem list and a doctors problem list, this difference in perspective grows even more problematic.
Now you may suggest in turn to have different views for surgeons, GPs and nursed on a single master problem list composition? And I than again would say you’ll run into issues like described above. Moreover would you be ok with recording DM2 three times(surgeon, gp, nurse) in that master composition? More info on the different perspectives on problem here: Audience specific problem name - #6 by ian.mcnicoll
(where from my previous thoughts, I still argues for the opposite I’m arguing now, I got convinced by Ian)
I do agree why you want to keep it closely together, it’s a single patient and single biochemical alteration off course. And integrating facilitates collaboration, and the current systems disjoint is one of the main reasons for working on openEHR. However I’ve come around to the idea that it’s better to record separate compositions and link problems together to keep them aligned.
This can even be using a single (medical) problem list, managed by a single doctor (if the healthcare system has such a coordinating person as the Netherlands does) that indexes other problem(lists). This can be done using a persistent composition with repeating DV_(EHR_)URI or FOLDERs, depending on whether it’s mostly a document or mostly an index.