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Re: [Gnumed-devel] About systems of codification
From: |
Karsten Hilbert |
Subject: |
Re: [Gnumed-devel] About systems of codification |
Date: |
Thu, 29 Sep 2011 10:32:10 +0200 |
User-agent: |
Mutt/1.5.21 (2010-09-15) |
On Wed, Sep 28, 2011 at 11:33:59PM -0700, Jim Busser wrote:
> The traditional and current approach (even in GNUmed) is
> *first* to input free text, and then (optionally) to code
> it. Once I would have SNOMED I would want the fields
> reversed and would want to flow (input) multiple past
> history items through a single widget like the one below
There have been studies on this with the result that:
- important information will be left out because it cannot
be captured or people are too lazy to search for the
"proper" code
- patients will receive invalid and/or wrong diagnosis in the EMR
- upcoding
- downcoding
- miscoding
- inappropriate batching of patients (people get diagnosed by
the coding system, not by the doctor)
A coding system can never replace free text in the EMR. It
can only serve precisely defined secondary purposes.
> I may be wrong, but predict Karsten will doubt the
> adequacy of SNOMED to replace free text.
It is not so much about SNOMED but about the *concept* of
"normalizing" medical narrative. It never works. SNOMED has
much developed since its inception.
> But maybe he will be open to the possibility that it could
> warrant to be the primary entry, with text as the optional
> supporting field?
No chance with SNOMED being a successful business model.
> A colleague who turns out to have worked a lot with SNOMED (and is in fact on
> a Canadian committee) told me today:
>
> "It was interesting that in the Infoway project that
> recommended SNOMED for clinical use that 20 or so clinicians
> seemed hostile towards SNOMED but as each subsequent meeting
> happened people were more and more in favour of SNOMED. In
> the end there was no question that SNOMED should be the
> terminology of choice for clinical purposes."
We are talking entire worlds of fantasy here:
- no one here uses SNOMED
- no one CAN use SNOMED as it stands
- no one here needs to use SNOMED
- we don't even have a way to support SNOMED (for what it
seems to be advertised to be: a foreign language)
- we are trying to release
Karsten
--
GPG key ID E4071346 @ gpg-keyserver.de
E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: [Gnumed-devel] About systems of codification, Jim Busser, 2011/09/28
- Re: [Gnumed-devel] About systems of codification, richard terry, 2011/09/28
- Re: [Gnumed-devel] About systems of codification, Liz, 2011/09/28
- Re: [Gnumed-devel] About systems of codification, Jim Busser, 2011/09/29
- Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/29
- Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/29
- Re: [Gnumed-devel] About systems of codification, Jim Busser, 2011/09/29
Re: [Gnumed-devel] About systems of codification,
Karsten Hilbert <=
Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/29
Re: [Gnumed-devel] About systems of codification, Adrian Midgley, 2011/09/29
Re: [Gnumed-devel] About systems of codification, Jim Busser, 2011/09/29
Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/29
Re: [Gnumed-devel] About systems of codification, Jim Busser, 2011/09/29
Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/28
Re: [Gnumed-devel] About systems of codification, Karsten Hilbert, 2011/09/28