At 19:21 +0000 on 28-12-1996, John Williams wrote:


> In article <[log in to unmask]>, Peter Johnson
> <[log in to unmask]> writes
> >My area of interest in this is to aid decision support systems - this means
> >using the EMR for a task which the user did not have in mind (most likely)
> >when he recorded the entry. The reason why I still pursue this goal, is that
> >there are workers (only a few, I admit) in AI who believe that it is
> >possible to get to the holy grail of task independent knowledge, and a great
> >many who believe it is possible to get close to this, if not actually reach
> >it. What we should be able to achieve is a great improvement on the current
> >situation. That may be enough to achieve what we want. But I'm sure the use
> >of SGML per se isn't going to solve these problems.
>
> Is there not a core of 'informatics' type problems that is largely
> independent of the technology?  Surely we should be using the various
> tech. tools that become available appropriately to help solve these
> problems, and also build on the lessons we have learned or are currently
> learning.  As a clinician user rather than a technician or an academic
> informatician I believe that Peter's comments about 'task independent
> knowledge' are highly relevant.  This has as much to do with human
> knowledge, skills and attitudes as it has to do with the technology.
> When you actually try to tackle the problems of data interchange or
> information sharing - even using crude (?) tools like EDIFACT - this
> becomes blindingly obvious.  The same kinds of problems will still go on
> going on whether you opt for ASTM, SGML, HTML etc.  I cannot see how
> these issues can be bypassed, assuming that it continues to be desirable
> for human patients to continue to be treated by human health care
> professionals.  There is a lot of work to be done to get HCPs to
> understand and agree what they want to convey to each other, why and how
> - what ever the means of communication
> --

There must be a level of abstraction that we humans have and use in out day
to day communication. These are not allways the concepts we put into
databases.

Without explicit definition we know what a NAME or ADRESS mean. It is this
general knowledge of things we share, we must be able to use in
communication using electronic messages. The General Knowledge will be
rather stable over time. In specific area's like medicine we, phycisians,
share worldwide a General Medical Knowledge we use when we communicate. But
the more specialised the Domain the less General the knowledge will be.
Somewhere there must be an optimum.

This Optimum General Knowledge must be represented in electronic messages.
SGML is a vehiculum with a lot of nice properties to do that: in a
forgiving way, without system, application, version dependencies.

So next to SGML, as a good way to label the General Contexts, we need an
understanding of the generalities, an understanding of  General (Medical)
Information in Messages. This is what I consider the real Medical
Informatics. As opposed to the applied (medical) Informatics which is
dealing with the technical aspects of storing, transporting, retrieving
medical data.

A lot of the Labels we need are task independent, some are taskdependent
(e.g. request for lab tests). But these tasks are easily generalised into a
few general ones.

All the fine details which will get into the messages have to be delt with
in an ad hoc basis at later times. The basics first.

Technical means like SGML will make it possible to enter the medical
information in one way. (To let the doctor write his medical tale about the
patient and his problem as the story develops during the consultation) And
there after (automaticaly) rearrange the medical data in an flexible
(personal) way as we physicians like to write it down in a more logical
order.

An other feature of SGML will be the archival problem.
Storing the information in databases will make it difficult to store part
of the not-active information in an archive and store and retreive
correctly all the links in a database. Let alone the problems of versions,
propriety formats, etc
Using SGML will make it more easily possible to store in ASCII all the
Data, with its Context and all the links in one single patient-file.



Gerard Freriks,huisarts, MD
C. Sterrenburgstr 54
3151JG Hoek van Holland
the Netherlands  		Telephone: (+31) (0)174-384296/ Fax: -386249
				Mobile   : (+31) (0)6-54792800
ARS LONGA, VITA BREVIS




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