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> From: Peter Johnson <[log in to unmask]>
> I see the central problems to be these shareable tags, which everyone
> understands, agrees on the definition in all contexts of use. This isn't
a
> problem that is solved by SGML - this is a terminology, ontology problem.
It
> is a much bigger, more fundamental problem - and this is what seems to be
> getting glossed over. This foundation needs to be in place before issues
of
> technical solutions become useful. Otherwise we're building castles on
sand.
This is where the difficulties come in whatever the system. However we have
been happily communicating despite a lot of fudging so far. If I write
"Diagnosis pharyngitis" on a Lloyd George it is still useful to someone
else viewing the record although they may have come to the conclusion
"Diagnosis tonsillitis" with the same consultation. Of course neither are
"real" diagnoses, rather a description of my interpretation of the
appearance of the pharynx (and I biase toward tonsillitis when I want to Rx
a sore throat Pen V ;-)
Of course if I was an epidemiologist this would be infuriating, but I'm
not.
> >>d) The problems facing EMR use in the UK can be summarized as - we
> >>lack standardized, closely controlled definitions of concepts used
> >>in health care, which are independent of the context in which they
> >>were recorded. This wasn't realized until many years use of loosely
> >>structured EMR's, when people tried to use the data in these EMR's
> >>for other purposes.
My predecessor had set up local Read codes for subsets of Buddhism ! So
doctors observe differently, record differently, Read code differently. I
would be very surprised if that were to change. I want my practice computer
to fulfil my needs, I'm not too bothered that the local MAAG can't assume
that when I Read code Asthma it is the same as when you do. If I can read
your notes "Current Problems : Asthma" I will have a stab at reliability,
context, etc.
I would not expect a Markup language to overcome these difficulties.
However, what might be acheived is an "open" dynamic standard which could
evolve with the input from all interested parties for the viewing (and
transfer) of data across systems.
Dr Paul Galloway
GP Oxford
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