Changes between Version 16 and Version 17 of Archtectural Overview Design of the openEHR EHR

Timestamp:

Sep 17, 2007, 12:07:19 AM (17 years ago)

Author:

KOBAYASHI, Shinji

Comment:

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Archtectural Overview Design of the openEHR EHR

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 This figure shows the cycle of information creation due to an iterative, problem solving process typical not just of clinical medicine but of science in general. The "system" as a whole is made up of two parts: the "patient system" and the "clinical investigator system". The latter consists of health carers, and may include the patient (at points in time when the patient performs observational or therapeutic activities), and is responsible for understanding the state of the patient system and delivering care to it. A problem is solved by making observations, forming opinions (hypotheses), and prescribing actions (instructions) for next steps, which may be further investigation, or may be interventions designed to resolve the problem, and finally, executing the instructions (actions).
 
-このプロセスモデルはLawrence WeedのEHR記録における「問題指向」(problem-oreinted)をはじめ、あとで関連する業績として、Rector, Nowland, Kayによるモデル[[FootNote(Rector A L, Nowlan W A, Kay S. Foundations for an Electronic Medical Record. The IMIA Yearbook of Medical Informatics 1992 (Eds. van Bemmel J, McRay A). Stuttgart Schattauer 1994.)]]や「仮説演繹」推論モデル[[FootNote(Elstein AS, Shulman LS, Sprafka SA. Medical problem solving: an analysis of clinical reasoning. Cambridge, MA: Harvard University Press, 1978)]]を合成して作られている。しかしながら、仮説をたてて検証していくことは臨床家にとって唯一の成功のためのプロセスではない。エビデンスは
+このプロセスモデルはLawrence WeedのEHR記録における「問題指向」(problem-oreinted)をはじめ、あとで関連する業績として、Rector, Nowland, Kayによるモデル[[FootNote(Rector A L, Nowlan W A, Kay S. Foundations for an Electronic Medical Record. The IMIA Yearbook of Medical Informatics 1992 (Eds. van Bemmel J, McRay A). Stuttgart Schattauer 1994.)]]や「仮説演繹」推論モデル[[FootNote(Elstein AS, Shulman LS, Sprafka SA. Medical problem solving: an analysis of clinical reasoning. Cambridge, MA: Harvard University Press, 1978)]]を合成して作られている。しかしながら、仮説をたてて検証していくことは臨床家にとって唯一の成功のためのプロセスではない。エビデンスは(年齢が高く経験を積んでいるほど)パターン認識に大きく依存しており、以前に経験した同じような患者やプロトタイプモデルで使われたプランを直接利用することがある。openEHRで使われている調査プロセスモデルは、認知的方法にも準拠している。なぜなら、意見がどのように形成されるのか，結論までにどれくらいプロセスを繰り返さなければいけないのか、繰り返しの間に存在する全てのステップが要求されるかどうかさえも明らかにされていないからである。(例えば，一般内科医(General Physician)は確定診断に至る前に処方することがよくある）結局のところ，openEHRのEntryモデルはプロセスモデルを押し付けるものではなく、起こりうる情報がとりうる型をあらわしている。
 
 This process model is a synthesis of Lawrence Weed's "problem-oriented" method of EHR recording, and later related efforts, including the model of Rector, Nowlan & Kay [7], and the "hypothetico-deductive" model of reasoning (see e.g. [3]). However hypothesis-making and testing is not the only successful process used by clinical professionals - evidence shows that many (particularly those older and more experienced) rely on pattern recognition and direct retrieval of plans used previously with similar patients or prototype models. The investigator process model used in openEHR is compatible with both cognitive approaches, since it does not say how opinions are formed, nor imply any specific number or size of iterations to bring the process to a conclusion, nor even require all steps to be present while iterating (e.g. GPs often prescribe without making a firm diagnosis). Consequently, the openEHR Entry model does not impose a process model, it only provides the possible types of information that might occur.
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+==== Entry型のオントロジー ====
 
 Ontology of Entry Types