CCTOS Common : Health Issues, Problems
health issue is here an assessment about a set of raw information,
a problem to be further analyzed or maybe a proven diagnosis to be
- Support of collaborative work:
- Team work require the availability of a synthesis, all
partners of the care team could understand. From
of view of the continuity of care, this synthesis should be maintained
up to date, available for any new care provider at any time.
- Quality of care:
people to write explicitly what they think about the available facts,
is on itself a factor of quality. different actors could have a
different understanding about the same observed facts and are
responsible of their opinions.
- Beginners need to learn not
only a lot of theoretical knowledge, but also
a methodology to manage complex medical information in the scope of a
- Derived from Medical Data and adding the
- The recommended way to maintain a global synthesis is a
problem list, according to the principle of the "POMR", the Problem
Oriented Medical Record of Prof L WEED.
- One has
to look at one Health Issue at a time, i.e. at all issues which are not
"normal" and/or which require further attention.
must also be possible to record an assessment about the absence of a
problem, when it has been evaluated and found normal. This is
particular importance for the nursing and for health screening
plans (see below).
- For every health
- Attribute of an issue could be :
- "not yet understood problem": e.g. infectious
syndrome, back pain, ... when more investigations are
- "proved diagnosis", when the demand is
- "risk factors": e.g. allergy to
generic risk factors in a given population group, which are
motivation for vaccinations and health screening procedures.
- "past history": closed Health Issues, which
still have consequences, invalidity, or risk of recurrence.
- Version of the health issue, because health
usually an evolution through several versions, for example from reason
for encounter, preliminary syndrome, to a confirmed diagnose.
- Description of the the health issue:
of the problem, i.e. what is known up to now, e.g. infectious syndrome.
- Optional attributes as degree of certitude, degree of
- Optional classification(s), if
statistics are required.
- Links to
- Links to the
facts having motivated the assessment of the health issue, e.g. fever,
- Links to actions taken in
function of the problems, e.g. more tests, X rays, prescription, ...
- Links to additional comments and considered work
- Links to guidelines and recommendations, as far as
problem is well identified and as far as guidelines are available.
- A patient may have many health
issues at the same time, particularly the elderly patients.
- Although one of the issue could be at the foreground, a
doctor should always be aware of all issues.
care providers could make different assessments
about the same set of observed facts. The name of the author of the
always be visible. Several points of views can be useful to
record, coming from several doctors, from a nurse, from the patient
The reader of the information will have to make his mind, in function
of his own judgment and the degree of trust he has in the the authors
different points of view.
- A good dictionary of Health Issues does
not yet seem
available. To some extend the ICPC classification could be
Classification of Primary Care.
The alphabetic code identify the anatomic system and the
represent more or less a functional point of view, i.e. an issue.