Wow, this is a very useful and interesting collection of reflections on the health informatics views on the (problem oriented) medical record.
I am thankful for the summary, this could become a goto starting point for new members of the community.
I do struggle a bit with the format though, what pieces of text are originally written by other authors and which are yours, Pedro? If you would be willing to clarify in the original post this would make it even more useful imho.
I agree btw that the problem orientation is very much fundamental for medical information. I’m having a hard time with coming up with examples of medical data that is not related to a problem. One example would be fitness devices like sportswatches measuring puls. But I feel this should only become of medical interest if there’s a problem (e.g. atrial fibrillation). Maybe the term ‘problem’ could be generalised to something like ‘health concern’ that would make it possible to list the sport watch pulse OBSERVATIONs to the patient ‘health concern’: ‘feelings healthy’ or ‘obesity prevention’.
Diving into this topic: Linking in openEHR: goals and problems
I think we have to conclude there is a lot more to learn and specify with regards to EHR design from a problem orientation perspective. And I feel we should invest in this from the openehr community including the technical specifications to help our members to tackle this hard topic.
At Nedap we have done a lot of work on care plans for nursing in elderly care in a legacy application. Currently we are working on a treatment/car plans for doctors in nursing homes and in a related project on treatment/care plans for mental healthcare practitioners (psychologist/psychiatrists).
Based on the advice in the thread mentioned above and a valuable conversation with @ian.mcnicoll we are leaning towards using FOLDERs to structure and link (semantically and technically) the information in a plan.
Let me know if anyone is interested to discuss our efforts.
Finally: touching on the patient ‘involvement’ in care planning by other authors and my example of self measuring by patients I feel also this topic deserves more investment. Currently I love openehr for all the thinking that has gone into it’s architecture from a medical informatics point of view. But in light of the developments around shared decision making, personal health records, Quantified self we could benefit hugely from a clear view on this from a health informatics point of view.