Robert,
Thank you for the insightful posting with regards to the Medical History Summary (MHS) and surgeries, treatments and hospitalizations.
This reminds me of the interesting - if not perhaps somewhat philosophical - topic of information capture vs. display. Without getting boringly technical, in HealthFrame we tried to come up with a reasonable information categorization and storage model without limiting our ability to report on the data in a way that is meaningful to the target audience.
The first part of this design basically deals with the meaning and categorization of the data (our "information model"). Here we hoped to come up with logical, non-overlapping buckets of information gathering, that users would consistently use to store their medical record information. Since medical information is so highly correlated, we created the concept of 'linking' to capture these ad hoc connections. Coming up with adequate semantic models for healthcare has been the target of tremendous research and effort including standardization efforts such as those of the National Library of Medicine's UMLS, which tries to mediate between disparate data models.
In "HealthFrame-ese", a treatment is an aggregating concept, capturing procedural care information that spans a specific time period and is possibly administered by a provider. A key point to note is that a treatment involves one or more procedures such as you point out, surgeries, but also includes therapies, recommended exercises, etc. A hospitalization is a type of visit, during which procedures associated with a particular treatment may occur. HealthFrame expects those types of relationships to be modeled using links.
Please take a look at the Susan Marie Taylor sample PHR. Note that she has an Obstetric Delivery (treatment) that takes place during a particular Hospitalization (visit). This information is linked and if you look at her MHS, there is no duplication of information.
The second part of the discussion is the reporting aspect of the information. It is useful to understand that we can (and often do) report/present medical history information in a way that is different from what is stored in HealthFrame. The most obvious examples of course are graphical reports. We couldn't agree with you more that the information needs to be presented in a way that is most beneficial to patients and the providers who are reviewing their medical records. With that in mind, maybe there is a specific report your providers use or that you think makes most sense... If so, please create a mock-up (perhaps in MS-Word) and share with the forum.
In closing, please note as an alternative model, the American Academy of Family Physicians (AAFP) report - included in HealthFrame - separates the concepts we've discussed as 'Procedures' (for Surgeries/Treatments) and 'Encounters' (for Hospitalizations).
Thanks,
Support Team