Evaluation Procedures
What to do with Evaluation Procedures?
Comments
Jim Campbell ,
II am not sure I understand the need for a "performable" hierarchy. I was also unclear about the difference between the orderable and the resultable in your example. They look to have the same attributes and values.
Recall that an ontology is a computable conceptual view of the real world. Speaking as clinician and scientist, I don't think that 'Evaluation Procedures' are necessarily needed for interoperation of EHR results but it is not surprizing that they were the first elements to appear within these semantics in SNOMED CT because it was created by a bunch of lab directors! They viewed the reporting of these lab data as a procedure that results in some observation result that is then passed to the clinician. The clinician often doesn't care about the details of how the glucose level was determined and so their conceptualization includes other defining elements that the lab director ignores such as assuring that the blood draw was two hours after a meal.
I was making the observation that a conceptual definition of these Evaluation Procedures seems possible using a subset of attribute/values from the Observables concept model.
So, given the semantic space in SNOMED CT currently occupied by Evaluation procedures, we could say we don't care anymore and deactivate the concepts but the poor blokes who have been using these concepts within their extension namespace as defining values for the 'Interprets' attribute will suddenly find they have a lot of work to do to keep up with SNOMED CT evolution. I think they would have every right to be outraged.
Given I assert that the Observables concept model allows us to fully define PERFORMABLES=Evaluation Procedures within the proposal I forwarded, we can support everyone with their own corner of the sandbox: clinicians, lab directors, researchers and public health.
Jim Campbell
Daniel Karlsson wrote:
Jim and Jim,
I’m not that comfortable with creating two concepts with the same definition and just the addition of “orderable” as a primitive parent. Although it’s better than what we have today, I believe there will still be more than a slight chance that users will be confused about which kind to choose for storing and querying. There are still the pure orderables which cannot in any meaningful way be reported separately. I don’t think that pure observables (i.e. things that inherently can be observed but not ordered) exist.
The proposal to merge Observables and Evaluation procedures I’m all for, but for me it could go either way and it seems from the previous discussion that acceptance might be less of an issue moving O à E than vice versa, but I’m open for anything that would resolve the stand still.
Thanks,
Daniel
At Nebraska we have a contract with the FDA to evaluate some of their proposed tools for interoperability of laboratory data. In preparing our material for them, I authored the enclosed document (also attached to last minutes) which discussed end-to-end information modelling from the clinician order to the final result placed in the EHR. It employs some old ideas we have discussed at LOINC committee in the past but attempts to frame a proposed response to the discussion we had at our last F2F meeting on the question of Evaluation Procedures and semantic overlap with Observable entities.
In short, I suggest that we use a subset of the Observables concept model to fully define Evaluation Procedures and to move the body of concepts into Observable entites as a first level subhierarchy. I explain the rationale in the enclosed.
Jim