Happy to hear this has been considered:) I do feel using provider is mostly good enough for practical usage.(8t’s also what my example note above implies, for efficiency purposes).
But I do think there is a subtle difference between attesting and providing information: if the composer does the abdominal exam he is the provider if the surgeon witnesses the exam he can attest the abdominal exam, but he is not the provider.
Isn’t the items attribute in the attestation class what I’m looking for?
Items attested, expressed as fully qualified runtime paths to the items in question. Although not recommended, these may include fine-grained items which have been attested in some other system. Otherwise it is assumed to be for the entire VERSION with which it is associated.”*
Also on the same page: “Normally the list of items being attested should be a single Entry or Composition, but there is nothing stopping it including fine-grained items, even though separate attestation of such items does not appear to be commensurate with good clinical information design or process.”
So I’m now fully at ease again with the technical design possibilities of the RM.
I guess my issue is mostly with the description of the composition class:
“ A Composition is considered the unit of modification of the record, the unit of transmission in record Extracts, and the unit of attestation by authorising clinicians.”
Re unit of modification: Is a correction to or addition of information in a single element in a previously created composition not a modification itself?
Rephrasing “unit of modification” to “unit of addition” or “unit of information recording” feels better.
Re unit of transmission: I expect often information will be transferred in way smaller chunks than a composition. E.g. a gp to nurse phone call: “what was the latest blood pressure?” “120/80”. Also with regards to GDL and patient proxy, if my systems wants to know the latest BP for a chadvasc your system has, I’ll query and transfer only that latest (interpretation off) BP, not the entire composition it’s part off. Maybe a case could be made that one should process the entire composition to properly interpret the single BP. But that’s not the way things are done in the real world.
Re unit of attestation: I think this sentence is inconsistent with the attestation class (description).