All,
Some interesting points raised so far. In terms or what we need to do moving forward though we probably need to try to summarise things. Here are some of the points i have picked up within this wiki and in the discussion prior to the wiki set up.
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The origin of this discussion stemmed from work to look at defining the requirements of a problem list for use within secondary care. From discussion so far I would agree that should be the focus @amscroggins made some good points about the potential for this to be a local list to start off with is a good idea.
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As highlighted @KarenDay highlighted problem lists do pose a wicked problem, they mean different things to different people and without curation you cannot rely on them being up to date. As @matthew.strother pointed currating these and keeping them accurate would take time and skill to do right especially if access to the list is just limited to a few curators
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As clinicians i believe that we should be able to apply our clinical reasoning to come up with a list that is relevant to the care we are providing. The significance of some issues may not be applicable to all and this is why I feel that the concept of the Ongoing Clinical Conditions under Active Management (OCCAM’s) List could be really useful here. If applied well it could solve the curation issue, and promote interdisciplinary practice. However it may need a filter on it, so you could see all or maybe just those items relevant to you. Looking at the screen shot in the recent article in ehealth news It looks like WDHB have developed a similar filter in their electronic clinical notes. But the source of the problem list in the screen shot in the article appears to remain the same. @lara are they the same list?
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@alastairk showed how awesome SNOMED CT can be and if we could have these lists done in a way where there was the potential to use NLP to markup your list items to snomed codes, rather than confining it to a refset or pick list that would be great
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@david.hay had mentioned that the iIPS may be a good starting point and I see that there are are alreadyFHIR resources for lists and this may be something for the MWS to utilise
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@jon_herries raises some good points about the potential of something similar to the “Medical warning System”. However a system like this is essential to ensure allergies are not missed and I am sure some DHB’s in the country do use this and do send allergy alert information when captured. But if
then addressing this should definitely be the first priority. I also agree with @michael.hosking that any work to refine MWS would need wider clinical consultation with users beyond this interest group.
Finally echoing @matthew.strother comment what do we do next?
- Are there any examples of electronic lists working well here in NZ that we can draw from
- Is there a time frame for when work on sorting out the MWS nationally will start happening, should we wait for this or carry on deliberations trying to find an interim solution
- Can we start crafting an agenda for workshops and refine things further so we can overcome intertia and get some runs on the board