CCTOS: Information Flexibility and Navigation

• Issues:
  • Up to now many software applications are not going deeper than handling "documents" and forms, regardless of the meaning of their content.  For example discharge letters are archived as a 2 or 3 pages document in free text.  Structured information are limited to patient ID, date, author, ICD diagnose code, the rest being more or less free text.
    
  • Like paper charts most electronic archives are organized as trees.  Typical main usual branches are consultation notes, discharge letters, general lab, bacteriology lab, pathology lab, XRays, ...  A given document, or leave in hte tree, has only one access path.
    
• Approaches:
  • Items:
    • No more large documents nor rigid  "forms", but much more granularity in smaller entities of information.  An Item is in general the minimal entity of information making sense, technically speaking an "object" with several "attributes". 
      
    • For example one complaint, one observation (blood pressure), one lab test, one prescription, etc...
      
  • A much more granular approach become necessary. The basic unit of information can be defined as an item, .i.e. an object with a few attributes as
    • Generic Item Header:
      • Item ID, and version, Date, Time, Subject of care, Responsible author, Link to the Context (e.g. during a given consultation at a given location and time).
        
      • Item Type (Observation, Issue, Activity) and subtypes.
      • Optional Clinical Modifiers, as degree of belief, intensity, optional comments.
    • Item content:
      • Depending on the type.
      • Moreover a collection of Items may be represented by means of a kind of super Item.
        
      • Different types of content may have different methods of display.
        
  • Navigation:
    • No more a tree structure, but possible access by multiple "paths".
    • The use of "Semantic Web" technologies is considered, in order to manage navigation between
      • Related Items of medical information inside the patient record.
      • Links to medical knowledge bases.
    • Graphical representation of the links between knowledge nodes and clicking on a node in order to provide the details of the underlying information.
    • The links themselves should be qualified too, as above with author, date, degree of belief, etc... i.e. the links themselves could be seen as Items.
  • "Views":
    • Polymorphic collections, list of medical Items relevant for a given objective, but regardless of their technical formats.
      
    • Frequent search strategies should be facilitated by means of sets of rules recorded as common preferences, in general as well as individual preferences.