Re: Hospitalizations, Treatments & Surgeries v2.1.6

support@RecordsForLiving.com — Fri, 06 Jul 2007 19:25:49 GMT

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

Hospitalizations, Treatments & Surgeries v2.1.6

robert — Wed, 27 Jun 2007 22:50:13 GMT

Observe that when a surgery, for example, is recorded as a Visits > Visit Type > ‘Hospitalization’ and also recorded as a Treatment > Type, that the Hospitalization and Treatment records both appear on the Medical History Summary(MHS) providing, conceivably, the same information. Since surgeries are treatments, technically, and a hospital visit for a surgery should be recorded, that presents somewhat of a dilemma to avoid duplication on the MHS without having to customize. I’m uncertain how this record keeping issue can be resolved without program changes, but here are my thoughts. Possibly other forum members will join in with their thoughts and experiences.

While less ‘technically correct’ my first choice would be to use Visit Type ‘Hospitalization’ to record hospitalizations and surgeries. Hospitalization on the MHS displays the Date, Doctor and Reason(a text field that permits any information pertinent to the ‘treatment’). Treatments on the MHS, however, only displays the Date and the treatment name and leaves a lot of blank space.

This choice is less technically correct, since hospitalizations are considered ‘inpatient’ events, while the surgical example may well be an ‘outpatient’ event at the hospital, or at a clinic or office. What I believe is most important is for the MHS to provide the clearest, most appropriate summary information for use by doctors and patients alike. Keep in mind, questionnaire forms completed for doctors mainly ask for hospitalizations and surgeries in the same question. The word ‘Treatments’ to elicit surgeries, is just not used on those questionnaires. The interest is for hospital stay dates and surgery names and dates.

For the present HFE version, I am recording “operative interventions” (surgeries) in the Visits > Visit Type > ‘Hospitalization’ because that’s where most doctors/people look for such information and more data may be shown on the MHS. The Treatments category is, to me, more appropriate for recording the potentially longer term therapeutic and preventative procedures like Oxygen Therapy Care, Diabetic injections, physical therapy, etc. Surgeries, even though technically a ‘treatment’, are better associated with hospitalizations. Also, ‘hospitalizations’ should be more generalized to include outpatient surgical facilities in the HFE.

A suggestion for the MHS: consider a program change to remove the word "Hospitalization" under the Visit column(a duplication of the category Hospitalizations) and possibly change the column heading to 'Provider' instead of 'Visit'. I really like the MHS and will offer a few more suggestions in another post.

HealthFrame Discussion

Re: Hospitalizations, Treatments & Surgeries v2.1.6

Hospitalizations, Treatments & Surgeries v2.1.6