Date/time datum last confirmed.


when voluminous data sources like home-care monitoring
devices and ICU monitors are in the EHR environment, there is a
question of what part of the data to put in the EHR. Usually, the
clinical users of the EHR want only "important" data,
particularly abnormal values, changes etc. One way to accommodate
this kind of data would be to include a baseline sample, and then
add a date/time stamp for when that value was last verified. To
make this work properly, small fluctuations cannot cause new data
points - there has to be an operating range where the datum is
considered to be the same at each measurement.

A related scenario is when there is already an entry about a
patient, e.g. recording tobacco use or alcohol intake. The GP
might verify whether the current statements are still the case -
in this case there is a need to be able to just mark the existing
entry(s) as having been reconfirmed at the date when they are
verified. There are several ways this could be done. The most
obvious seems to be a new Entry with a link to the original entry
and an additional 'last_confirmed' date/time. However, the
consequences for sending data need to be considered (since this
will be one of the kinds of link types that always has to be
followed). The other possibility might be to create a new version
of the original Composition in which the same observation is just
repeated, but at the new date and time.

DK: This does concern me quite a bit. I can see the value in
workflow terms of having a clinical application deliver this
functionality, but I believe that each ENTRY in an EHR ought
to be self-consistent unless there are specific linkages between
components. I would personally favour duplicating data that has
been explicitly re-verified: if the fact is still true and the
composer has elected to wish to re-state that fact then it should
be re-committed as a fact. (Clearly everyday clinical practice
involves accepting many historic facts, with ad hoc re-verification
that is not explicitly re-recorded - we are not here seeking to
change clinical practice, only to confirm what should be persisted
as a consequence of clinical re-verification.)





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