This discussion page is intended to capture and track all views and opinions expressed by contributors to the Health Concern topic.
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Thoughts and Views
Email from Kevin Coonan 12 October 2013
From: Kevin Coonan, MD
Date: Saturday, October 12, 2013
Subject: Health Concern Topic - request for assistance with DAM Use Cases
To: Anita Walden <email@example.com>, Elaine Ayres <firstname.lastname@example.org>
Cc: email@example.com, firstname.lastname@example.org
How can you be furloughed from an all-volunteer organization? The current gov’t shutdown should mean that federally funded co-chairs have more free time to devote.
I am reworking the definition of a Health Concern to make it more approachable. What I have today is more a description than a definition. Any sort of review, questions, comments, criticisms are most welcome: A Health Concern is any health-related issue which persists over time, and is of sufficient importance that someone in the health care environment has identified it as requiring tracking. Health Concerns may be identified by protocol, decision support systems, patients (and/or their parents/care takers), social workers, physicians, nutritionists, respiratory therapists, podiatrists, physical therapists, nurses and any other credentialed user of the health record information system. Health Concerns are anticipated to be managed by software such as electronic health record systems (EHRS) and other clinical information systems. They are also expected to be exchanged and managed between systems to support continuity of care for patients who receive care from multiple entities. A comprehensive EHRS may track a multitude of Health Concerns for each patient, and surface this information to users via views or filters. These views include common models-of-use, such as the problem list, past medical history, and allergy list. These models-of-use are dynamic, in that they are expected to change over time. Any capture/recording of these models-of-use (e.g. in a CDA) are snapshots of the patient at a specific point in time. These models-of-use will likely be dependent on the context of use, and different users/actors may very well see different information even in commonly understood cases. For example, the problem list for a patient may vary in detail, types of problem, problem status, and associated information depending on whether the problem list is being used by the patient, a specialist consultant, their primary care provider or other members of the healthcare team.
A Health Concern contains no semantics beyond that needed for tracking, excepting the link between a Condition (which is an ObservationEvent or ObservationRisk conveying a Clinical Finding, Disorder, Event, etc.) which names the Health Concern. Other properties (associations) of a Health Concern include the identities of the patient, the individual who created the Health Concern, and the system responsible for maintaining it.
Outstanding issues in the definition (which we likely will struggle with for the DAM):
- - What is the cardinality of the naming Condition
- - Management of Condition status (it will likely be 1..n Observations and not Condition.status)
- - Split and merge of Health Concerns
- - Linking non-Condition Acts to Health Concern (I have some ideas on how this would be implemented but getting people to believe that you can associate every diagnostic study or H&P element with a health concern is going to be a tough sell—we need to focus people on what you can do once this is done, as well as what is the right way to represent the information. How EHRS designers will actually deliver the needed functionality is out of scope).