CCTOS Common : Patient Data

• Objectives:
• Common properties to all types of medical data related to a patient.
• Summary:
• Derived from Item.
• Scope:
• Here the basic and most generic concepts, common to all subtypes of medical data, which could be encountered in a patient record. At this level no further assumptions yet about the exact content of the medical data, to be defined in derived classes.
• Approaches:
• Subject of care, i.e. normally a patient.
• A document should at least have a type, a title, and of course the generic attributes derived from the root class "Item" (unique ID, version, responsible author, time, etc...)
• Groups of data:
• A medical document could be a container for a group of elementary medical data.  for example a group of images belonging to a radiology or pathology examination.
• Multimedia documents may be attached anywhere.  "Polymorphic" list of medical data, having a common purpose but which can be of different types, from a technical point of view (text, image, voice record, ...)
• Implementation of the access rights in function of :
• The profile of the user.
• The membership of the user in the care team.
• Optional attributes attached to the particular MedicalData.  Optionally a restricted list of Agents allowed to share the MedicalData.
• Context of data acquisition:
• Refernce to a mcare event which was to context of the data acquisition, for example a consultation.
• It may be useful to be able to retrieve all the information acquired during a previous medical event.  This may provide a better understanting of the situation than just an isolated medical item.
  
• Optional indexing in function of anatomical systems.
  
• Content representation:
• This class Medical Data makes here no assumption about the exact type of medical data.  This will be defined in more specialized derived classes.
• An ID of the subtype could however be useful at this level.
  
• ...
• Notes:
• Medical record structure:
• Inside a patient record, a rigid tree structure should be avoided.  What matter most is the possibility to navigate through the medical data according to several filters and paths:
• Full free text searches are technically possible but not recommended, because too depending on the spelling and on occasional spelling errors.
• Preference for a system in which a data item could be tagged or linked with any number of keys. For example: "is past history", "is surgery", is pathology", "is a lab xxx", "is a drug prescrition", "was said by Dr A", .... i.e. an approach in the direction of "semantic web" technologies. 
• MVC architecture:
• Logical data structure should remain independent from screen presentations.  This make possible to present the same information in different ways, for example common information presented to a doctor or presented to a nurse in a different way.
  Remark : a patient centric approach in order to avoid the development of completely independent projects for doctors and nurses, having of course later very difficult to share information.
• Epidemiologists need rigorous classifications, but the question is of the mean clinical users introducing medical information, would be able and motivated to do that immediately.