I have been developing the idea of part of the record that the patient can
write in - I have (Gates style) called it My Folder (eh?) and have two
subfolders in it at present - consent statements (as these will be written
by the patient) and appointments and notifications.
It is clear that the patient needs to write and interact with these. I have
thought recently that we may be best to develop a transaction for each of
the patient notifications - which will have all the details in it - rather
than process notifications into a collected transaction (like a calendar) -
this means that the application will need to process these.
I have thought that we could have an archive folder for when the patient has
done whatever was required - or declined to do so. This would mean perhaps
an archive folder and an entry for the outcome of the notification.
I think it's wonderful to take OpenEHR in that direction -- not sure what I
think of "My Folder" as a name per se :-\
It potentially creates a bit of complication for the app in that it'd need to
interface with the doctor/practice appointment book, but as a record concept it
seems great. Consent... well, as long as online consent has status.
There are of course lots of other folder possibilities:
1. My Goals. Patient goals in their own terms with ongoing patient (and
provider) assessment of attainment. Probably fit in exercise regimens here.
2. My Medications. A place for the patient to enter OTC and alternative
medications. GEHR handles the fact that this info derives from the patient.
The GP app could provide the ability to review-and-confirm the patient's
entries.
3. My Learning. A set of on-line learning links apropos to this patient,
preferrably including online quizzes and log of results.
[Perhaps all of the above, including the appointments, goes under My Plan.]
4. My Observations. Home blood glucose, BP, etc. log -- OK, I'm getting
carried away.
I like the overall direction a lot.
Jim
A/Prof Jim Warren
Director, Advanced Computing Research Centre
University of South Australia
Mawson Lakes SA 5095 AUSTRALIA
+61 8 8302 3446
warren@cs.unisa.edu.au
And FOLDERs are nestable and archetypable, so you can do just what you say Jim, and I can do something completely different in my EHR (although, if we both have the same archetype source, we might end up being the same....)
Of course I know about CPGs - just the acronym eluded me!
CPGs are very interesting from an EHR point of view. The issue here is the
generic CPG and the specific - how we allow specialisation to the particular
patient, how we merge a number of them sensibly, how we allow updates of
CPGs to influence future care.
Our learning in this area has a long way to go but we can start. The openEHR
entry called an instruction allows specific 'guidelines' to be entered into
the record - monitoring or notifications, therapies etc. This is relatively
straight forward - the issues start to arise when a generic guideline is
altered - what does this mean to someone who is adhering to the previous
guideline?
We can go with defaults - 2 years in Australia for a PAP test recall. So if
the Care Plan of a patient has a notification for a pap recall, and the
period is set to default, then the notification period can change with the
guideline. Not so bad - fixed recall periods will not be altered. There
might be some people however who need a 2 year one based on the evidence -
clinicians could learn to fix the period of anyone with any abnormality -
that seems solvable.
Then we get into the issue of a complex CPG such as immunisation - there are
many rules, temporal and sequencing, age at immunisation etc. Changing the
default guideline becomes very interesting and really requires a little
decision support engine to be available specifically for the purpose.
Information relating to a patient cinsits of possibly the following classes:
- Invariant Personal information like name, data of birth, gender, parents
- Variant Personal information: adresses, telphone numbers, maried, etc
- Financial/administrative personal information: insurance, etc
- acces control related information
- logistics related information: notifications, appointments, etc
- private health related information as entered by the patient. Personal
information.
- health related information as entered by a healthcare provider. Personal
information.
- sharable health related information
Aniket
Of course I know about CPGs - just the acronym eluded me!
CPGs are very interesting from an EHR point of view. The issue here is the
generic CPG and the specific - how we allow specialisation to the particular
patient, how we merge a number of them sensibly, how we allow updates of
CPGs to influence future care.
Our learning in this area has a long way to go but we can start. The openEHR
entry called an instruction allows specific 'guidelines' to be entered into
the record - monitoring or notifications, therapies etc. This is relatively
straight forward - the issues start to arise when a generic guideline is
altered - what does this mean to someone who is adhering to the previous
guideline?
We can go with defaults - 2 years in Australia for a PAP test recall. So if
the Care Plan of a patient has a notification for a pap recall, and the
period is set to default, then the notification period can change with the
guideline. Not so bad - fixed recall periods will not be altered. There
might be some people however who need a 2 year one based on the evidence -
clinicians could learn to fix the period of anyone with any abnormality -
that seems solvable.
Then we get into the issue of a complex CPG such as immunisation - there are
many rules, temporal and sequencing, age at immunisation etc. Changing the
default guideline becomes very interesting and really requires a little
decision support engine to be available specifically for the purpose.
What do you think?
Cheers, Sam
____________________________________________
Dr Sam Heard
The Good Electronic Health Record
Ocean Informatics, openEHR
105 Rapid Creek Rd
Rapid Creek NT 0810
Ph: +61 417 838 808
sam.heard@bigpond.com
www.gehr.org
www.openEHR.org
__________________________________________
From: aniket Joshi [mailto:anya_joshi@yahoo.com]
Sent: Wednesday, 27 November 2002 3:02 AM
To: Sam Heard
Subject: RE: Patient notifications
Clinical practice guidelines.
These can be incorporated in GEHR and thus we can have
a much more specific application development.
We can have mappings which will lead to particular set
of tests as per the CPGs.
This will ease the implementation of CPGs in clinical
practice.
Dr Aniket Joshi
Aniket
I am not aware of CPG ??
Sam
____________________________________________
Dr Sam Heard
The Good Electronic Health Record
Ocean Informatics, openEHR
105 Rapid Creek Rd
Rapid Creek NT 0810
Ph: +61 417 838 808
sam.heard@bigpond.com
www.gehr.org
www.openEHR.org
__________________________________________
From: aniket Joshi [mailto:anya_joshi@yahoo.com]
Sent: Monday, 25 November 2002 6:02 PM
To: Sam Heard
Subject: Re: Patient notifications
In our scenarios majority of the population is
illeterate,so interaction with the computers is
out of
question.We can record their videos and keep them
in
the folders.
Other non-medical communication which come from
the
HCPs can definitely be kept in the folder.
For the medical record of each appt a Hyperlink
can be
given so that we can have a vertical record.
Have gone through the CPGs and their application
in
GEHR?
DR ANIKET JOSHi
Dear All
I have been developing the idea of part of the
record that the patient can
write in - I have (Gates style) called it My
Folder
(eh?) and have two
subfolders in it at present - consent statements
(as
these will be written
by the patient) and appointments and
notifications.
It is clear that the patient needs to write and
interact with these. I have
thought recently that we may be best to develop
a
transaction for each of
the patient notifications - which will have all
the
details in it - rather
than process notifications into a collected
transaction (like a calendar) -
this means that the application will need to
process
these.
I have thought that we could have an archive
folder
for when the patient has
done whatever was required - or declined to do
so.
This would mean perhaps
an archive folder and an entry for the outcome
of
the notification.
What do you think?
Sam
____________________________________________
Dr Sam Heard
The Good Electronic Health Record
Ocean Informatics, openEHR
105 Rapid Creek Rd
Rapid Creek NT 0810
Ph: +61 417 838 808
sam.heard@bigpond.com
www.gehr.org
www.openEHR.org
__________________________________________
-
If you have any questions about using this list,
please send a message to d.lloyd@openehr.org
__________________________________________________
Do you Yahoo!?
Yahoo! Mail Plus Powerful. Affordable. Sign up