Nov
9
Written by:
admin
Sunday, November 09, 2008
What is a document?
A document is a piece of data that can be viewed from many different angles. An RTF document can be viewed:
- rendered, as Rich text.
- as plain text
- as a series of ones and zeros directly from the hard drive .
Most applications that we use today are document centric applications. Microsoft Word, Microsoft Excel. Here the document is the discrete information quantum that cannot be easily separated into separate parts or queried for information in a domain specific fashion.
The unstructured Rich text format cannot be easily queried programmatically for specific measurements, current symptoms, systems review, diagnosis, management etc. etc.
Therefore measurements, diagnoses, management etc are entered separately from the Rich text patient notes editor in our medical applications.
Individual panels and pop-up boxes facilitate entering most of the information within our medical applications with some of the information being transferred back into the Rich text notes.
We can end up with a complex disparity between patient notes and recorded measurements where the Rich text recording does not necessarily represent all the information entered into the medical application. It is too easy to overwrite/delete automatically entered information.
If we were able to unify the recording of notes and storage of measurements within the patient document we could envisage an application that could do away with separate panels and windows for recording measurements.
The document would need to be flexible yet provide structure, be easily stored/retrieved and, easily queried.
The application [user interface] which displays and allows editing of this document would need to allow sections to be edited individually within a document in a uniform and structured manner. It would still allow free-form and rich text to be entered and edited within the confines of the document structure.
XML documents are the obvious choice for providing the document structure.
We would then need an application to facilitate editing XML documents directly providing user interface sections representing the XML elements within the document.
For example, an end user enters blood pressure by navigation to the blood pressure measurement within the patient note. This appears as a simple rich text area, however when clicking within the blood pressure measurement area , a blood pressure measurement control will overlay the text and allow entering valid blood pressure measurements only. The blood pressure will be stored within the XML document is discrete integer measurements.
BP ___/___ [sitting]
The application would also need mechanisms to inject elements into the document at appropriate points as extra information is required to be entered through the user interface.
This represents a patient centric document where a document can be decomposed, queried, filtered, stored in whole or parts.
The patient centric document has other uses as well. Particularly to replace the notion of templates.
Patient information displayed by transformation of XML through the use of schemas and stylesheets and simple macro text injection is somewhat limited. For example, a template for a letter to be sent to patients will include the same information for all patients. If we wanted to send different letters to patients who were male, female, smokers, in a certain age range, having recent abnormal results etc. etc. we would need separate templates for each of these groups. We would then need to identify each of these groups and create a mail merge for each of these groups with the possibility that individual patients would be sent multiple letters. However through the use of filters applied to sections within the patient centric documents a single template could output different customized letters personalized to individual patients.
AK