At 23:42 28/12/96 +0100, Gerard wrote:

>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.

Day to day communication is different from recording for posterity.
Conversation can be extremely abstract, because it is a two way interchange
involving much (often non verbal) interchange to confirm that participants
are sharing a common understanding. The Watergate tapes are an excellent
example of how extreme this abstraction becomes. But anyone not involved can
then have great difficulty in recreating the same understanding as someone
who was present. Human language evolved for efficient two way communication,
relying on error correcting techniques when the shared understanding of what
is being said differs. If we wish to share the medical record widely, we
must make sure the concepts we talk about are understood in the same way by
all who use the record.

>
>Without explicit definition we know what a NAME or ADRESS mean.

Not necessarily. Do you mean my full name? My surname? The name I am known
by? My maiden name? And is that my email address, or my home address? The
address where I am registered for medico-legal purposes?  Of course it is
very task dependent. Ahh. You are the General Medical Council and you want
to send me my certificate of registration. That will be my registered
address then. No it isn't the same as my home address. Now you are the
pharmacy, and you want to deliver my prescription. That will be where I am
resident. These are distinctions made for good reason in existing systems!

>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.

Not that we change it when we know who we are communicating to, and we
change it depending on the task we are undertaking. So it isn't so simple.

>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.

Ahh! I agree. If we can define what it is, in a way which everyone is happy
will not be misconstrued. And this is the difficult bit to get right.


>SGML is a vehiculum with a lot of nice properties to do that: in a
>forgiving way, without system, application, version dependencies.

Yes it is just that, a vehicle, once we have decided what we are going to
talk about and how we are going to say it.

>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.

Agreed too. So we can forget SGML as applied informatics, and get down to
some basics.

>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.

Ouch! Rearranging data after the event is generally frowned upon.

>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.

applied informatics... But seriously, it doesn't matter how it is archived
so long as it can be retrieved without loss at the knowledge level. This is
a serious problem, for which there are many possible solutions, but I don't
believe this is relevant to this discussion.

Pete

---
Peter Johnson
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(+44) 1525 261432



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