One of the things that has been holding up the next release is the
conundrum around coded clinical documentation. I assume (correct me
if I am wrong !) that most people would prefer to have the system
provide some coded clinical documentation - so each organization does
not have to reinvent the wheel. Meaning that instead of recording a
data element arbitrarily called 'weight' that instead you PICK a data
element that is CODIFIED as 'weight'.
But what coding to use? The traditional coding system is SNOMED CT
which has probably the most extensive list of clinical coded terms.
The issue with SNOMED is that it is primarily made up of atomic terms
and to achieve context you combine codes together - such as Severe +
Burn - but each implementation could arrange concepts differently
making it more difficult to map from system to system. Still one
option would be for the PatientOS community content to primarily use
However on the open source side there is a movement called OpenEHR
which consists of a community driven effort to design archetypes -
which arrange the data elements into hierarchies to provide context to
the data element. So another option would be to leverage the
archetypes built. The issue there is they are not as extensive as
SNOMED and may not map to commercial systems as and when interfaces
are needed (or at the least a new effort would be required to do it).
Another coding system is LOINC which has a comprehensive list of tests
and while not as extensive as SNOMED in breadth - the content is very
good. So another option is to limit scope to using LOINC.
As an example comparison take a patients (non-birth) weight for
example. In SNOMED I find
27113001 : body weight - synonym of Body weight (observable entity)
In OpenEHR we have
which defines the weight, clothing worn, and device used.
In LOINC we have
LOINC_COMPONENT PROPERTY TIME_ASPCT SYSTEM SCALE_TYP METHOD_TYP
3141-9 Body weight Mass Pt ^Patient Qn Measured
3142-7 Body weight Mass Pt ^Patient Qn Stated
50064-5 Body weight Mass Pt ^Patient Qn Ideal
8335-2 Body weight Mass Pt ^Patient Qn Estimated
I expect the SNOMED term could be qualified - but I would have to
search around to figure out with which term would be appropriate
(illustrating the challenge).
So I guess ultimately the question boils down to what to support initially
- Nothing, just user defined data elements (optionally coded as needed)
- SNOMED + LOINC
- OpenEHR + LOINC
- wait for eMDs to open source Medicapedia
- All (tough especially as each system has its own set of terms and
concepts of what is what)
Anyway I will post a poll to the forum...
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