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Subject: My thoughts on Issues 5 and 9 that were assigned to me...
Frankly, I’m not entirely sure my thoughts here are going
to stay precisely on these two issues, but let me throw them out anyway… To set the set the stage …If we look at a simple
medical symptom scenario… A sick person calls a doctor and says, “I have a
really bad headache.” The doctor responds, “Take two aspirin and
call me in the morning.” Analyzing this from a SAF perspective, the portion of this
scenarios we don’t have covered is the “call me in the morning”
portion. We have discussed, of course, that the patient can always report
a new symptom (“The headache went away.” “The headache
stayed the same.” “The problem got better but I still need
help.” “The headache got worse.” “I died.”
Etc.), but since we don’t have ANY notion of a “case”
in the standard (or a linking to a prior symptom), it’s not clear to me
that a diagnostician can efficiently determine that a prescription actually
worked (which also means that it is difficult for it to decide which
symptoms are not longer applicable). A related issue is illustrated by the contrived medical
example… A person calls a doctor and says, “I got hit by an
ax this morning AND I have a really bad headache.” The doctor responds, “Remove the ax AND then
take two aspirin and call me in the morning.” At first glance, it appears that we have the first part of
this covered, since a symptom source can certainly report two different
symptoms, and, in theory, these can be correlated with a syndrome.
However, we don’t have any (formalized) way in the framework to let the reporter
STATE that it believes two symptoms are related, which is probably very
valuable information to a diagnosis. Likewise, we don’t have a way to associated two prescriptions.
Yes, we can create a compound prescription (“Remove ax and then take two
aspirin”) but this seems to me to create unnecessary complexity. Not to expand the scope any further, but we also don’t
have any clean way to have the doctor “gather more information”
about a condition: News Feed: Crazy Ax-man escapes from jail! Patient: I have a headache Doctor: Did you, by chance, get hit by an ax this
morning? Patient: Actually, I did. As much as I like the simplicity of our model (simple
reporting of single atomic symptoms, and simple issuing of atomic
prescriptions), I wonder whether we don’t need to have some kind of an explicit
feedback and linking mechanisms in the model. (linking) Patient: I am calling about the headache I reported
yesterday. I took the aspirin. My headache is now worse and blood
is now gushing out around the ax. (feedback) Doctor: Are you still having the headache you
reported yesterday. Patient: Nope. I took the two aspiring and my
headache went away. Now we might be getting in to “case management”
at this point (Frankly, I’m not sure I understand the domain of case
management), but maybe not. At a minimum, I think we may want to consider
how we would interface with a case management standard for a scenario like
this. However, we might be able to support all of these scenarios in
the absence of case management with something like the following: 1.
Some notion of a link, within a symptom, to a related
symptom. 2.
Perhaps this is the same as item 1, but some notion of
that this is a follow-up report to a previous symptom. 3.
Some “inquiry” interface back in to
the symptom source. Perhaps with 1 and 2 above this could be handled via
prescriptions. -Alvin |
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