John Williams wrote:

> But there are problems that are being glossed over time and time again.
>
> Who will:
>         a)      define all of the tags that we need so that we can all
> be certain that they are what they seem to be
>         b)      decide which information items we want in all of the
> various situations where we want to share information
>         c)      ensure that when an HTML document visibly 'says' that
> something is a 'diagnosis' that the information really does have the
> correct (invisible) tags

Whoever it is, it needs to be clinically lead with representation from all
interested parties, including the commercial arena who tend to be the ones
to build the product.

>  Unless you actually check the tags for each item how will
> you know that every 'slot' has been tagged appropriately for what you
> see?

Presumably you would not write your Medical Markup Language file by hand in
Notepad, but would use the equivalent of an HTML editor on your desktop, so
that when you select "Asthma" in the problem title area it wraps around the
appropriate tags.

>
> Apart from display we will also want to store at least some of this
> information locally (or possibly centrally) so that we can use it to
> underpin decision support / audit etc etc.  If we are going to do that
> then it will need to be stored in a way that allows fast, reliable,
> unambiguous data retrieval.  HTML documents do not support that as yet,
> and I haven't seen any discussion on this list of how the 'document
> paradigm' will communicate with the 'database paradigm'.  EDIFACT is of
> course designed precisely to exchange data from one database to another.

I'm no techie but you can certainly parse appropriately tagged Markup into
databases, and extract from them to display of course.

>
> The debate that I recognise is the comparison of document based v
> database solutions - and that is a sensible debate worth having.  I hope
> that in future we will use the best of both in the most appropriate way.
>

As user I read and write text to the medical record, and also require it to
be able to extract the data so as to be able to search for
"diagnosis=asthmatic" which is better managed by a database app.

So (in pseudo HTML)...

<CURRENT_PROBLEMS>
	Asthma
	Diabetes Mellitus
</CURRENT_PROBLEMS>
<PFR>450</PFR>

Displays on my desktop as...
--------------
Current Problems : Asthma, Diabetes Mellitus
PFR=450L/min
-------------
...and is parsed into the database on my GP system for searches, summary
extraction etc. Vice versa at the (say) lab end, where the software is
written to talk to a dynamically evolving Markup standard.

As Adrian Midgely and I were discussing, maybe we can map the tags to Read
codes, or indeed use them as tags themselves.

Dr Paul Galloway
GP Oxford



%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%