From: Lloyd McKenzie [lmckenzi@ca.ibm.com]
Sent: Thursday, July 10, 2003 1:50 PM
To: Gunther Schadow
Subject: Re: RIM PROPOSAL: rename vocab code ActClass ALRT (Re: IM/CQ
vocabulary clean-up proposals for 7/11 RIM harmonization.


Hi Gunther,

I'd prefer the term "ProblemDetection" to "Caveat".  Caveat sounds like a warning, while the concept I'm looking for may sometimes stop a process from occurring (at least until the problem is managed.)

So lets try this instead:

RE NAME CODE ActClass ALRT (detected issue) (formalNaming change to detectedIssue)
    <definition>
An observation identifying a potential adverse outcome as a result of an Act or combination of Acts.

Examples:
Detection of a drug-drug interaction
Identification of a late-submission for an invoice
Requesting discharge for a patient who does not meet hospital-defined discharge criteria

Discussion:
This class is commonly used for identifying 'business rule' or 'process' problems that may result in a refusal to carry out a particular request. In some circumstances it may be possible to 'bypass' a problem by modifying the request to acknowledge the issue and/or by providing some form of mitigation.

Constraints: the Act or Acts that may cause the the adverse outcome are the target of a subject ActRelationship. The subbtypes of this concept indicate the type of problem being detected (e.g. drug-drug interaction) while the Observation.value is used to repesent a specific problem code (e.g. specific drug-drug interaction id).


Also note that we have an ActCode called ActAlertCode that should probably be renamed ActProblemDetectionCode  --> ActDetectedIssueCode  


Lloyd

Lloyd McKenzie, P.Eng.              I/T Architect, IBM Global Services
Internet: LMCKENZI@CA.IBM.COM
PhoneMail: (780)421-5620          Internal Mail: 04/QBG/1004 /EDM


Gunther Schadow <gunther@aurora.regenstrief.org>@lists.hl7.org on 2003-07-10 09:25:18 AM

Please respond to Gunther Schadow <gunther@aurora.regenstrief.org>

Sent by:    owner-mnm@lists.hl7.org


To:    Mark Shafarman <mark.shafarman@oracle.com>
cc:    hl7-cq lists <cq@lists.hl7.org>, "'HL7-MNM list'"
       <mnm@lists.hl7.org>, "Puyenbroek, Jennifer"
       <Jennifer.Puyenbroek@McKesson.com>, Lloyd
       McKenzie/CanWest/IBM@IBMCA, Mike Henderson
       <mike@easterninformatics.com>, Mark Tucker
       <mtucker@regenstrief.org>, Dale Nelson <dale@zed-logic.com>
Subject:    RIM PROPOSAL: rename vocab code ActClass ALRT (Re: IM/CQ
       vocabulary clean-up proposals for 7/11 RIM harmonization.


Lloyd and I weren't quite done to hash this out, but since it's coming up here I need to step in.

There is a problem with this ALRT ActCode in general.

It's said to be an observation, but it isn't clear how code and value are used. Also, the term "alert" is not exactly right for what THIS is supposed to be. For one, an alert in medicine is something where alarm bells are ringing. But here, that is not implied. I had an issue with this all the time if not a negative ballot comment. Lloyd had explained this to me in the past that he thought alarm bells are not implied here and that this is simply a statement of the fact that there is a problem, kind of like a diagnosis.

I think the term "ALRT" and "alert" are really chosen wrong. For one, this concept does NOT include medical alerts, such as we have on a vital signs monitor or ventilator. Here alerts are clearly acts of COMMUNICATION a potentially negative observation. So, the Alert in those cases are more like trigger events, control acts, that have an observation (e.g., the low blood pressure) as subject but not observations by themselves.

In order to let the concept go forward and not continue to overlap with such notions as diagnosis, conditions or alert communications, I strongly recommend to rename the term. In fact, the term AND the code needs to be changed. I would think the best way to do that is to retire the current code and create a new one.

RETIRE CODE ActClass ALRT (alert)

CREATE CODE ActClass CAVE (caveat)
    <definition>
An observation identifying a potential adverse outcome as a result of an Act or combination of Acts.

Examples: ...

Constraints: the Act or Acts that may cause the the adverse outcome are the target of a subject ActRelationship. The subbtypes of this concept indicate ... while the Observation.value is used to repesent ...
    </definition>

Note that this definition is not finished because there is critical information that I do not have and that is part of my negative toward this concept as an Observation.

Alternatively I can offer other terms, like  admonition or caution, anything but "alert". For your convenience I have attached Webster's definitions those varioud words.


Main Entry: 2alert
Function: noun
Date: 1796
1 : the state of readiness of those warned by an alert
2 : an alarm or other signal of danger
3 : the period during which an alert is in effect
- on the alert : on the lookout especially for danger or opportunity

Main Entry: 1warning
Pronunciation: 'wor-ni[ng]
Function: noun
Date: before 12th century
1 : the act of warning : the state of being warned <he had warning of his illness> 2 : something that warns or serves to warn; especially : a notice or bulletin that alerts the public that a tornado has been reported in the immediate vicinity or that the approach of a severe storm is imminent

Main Entry: caveat
Pronunciation: 'ka-vE-"t, -"at; 'k-vE-"t; 'kA-vE-"at
Function: noun
Etymology: Latin, let him beware, from cavEre -- more at HEAR
Date: 1533
1 a : a warning enjoining one from certain acts or practices b : an explanation to prevent misinterpretation 2 : a legal warning to a judicial officer to suspend a proceeding until the opposition has a hearing

Main Entry: admonition
Pronunciation: "ad-m&-'ni-sh&n
Function: noun
Etymology: Middle English amonicioun, from Middle French amonition, from Latin admonition-, admonitio, from admonEre
Date: 14th century
1 : gentle or friendly reproof
2 : counsel or warning against fault or oversight

Main Entry: 1caution
Pronunciation: 'ko-sh&n
Function: noun
Etymology: Latin caution-, cautio precaution, from cavEre to be on one's guard -- more at HEAR
Date: 1596
1 : WARNING, ADMONISHMENT
2 : PRECAUTION
3 : prudent forethought to minimize risk
4 : one that astonishes or commands attention <some shoes you see... these days are a caution -- Esquire>
- cautionary  /-sh&-"ner-E/ adjective


Mark Shafarman wrote:
> All:
>
> These are needed 'clean-up' proposals dealing with the IM domain for 
> the ballot currently being assembled.
>
> see the 3 brief attached word documents.
>
> kind regards,
>
> Mark
>
> ---
> To access the Mailing List archives, go to: 
> http://lists.hl7.org/lyris.pl?enter=mnm


--
Gunther Schadow, M.D., Ph.D.                    gschadow@regenstrief.org
Medical Information Scientist      Regenstrief Institute for Health Care
Adjunct Assistant Professor        Indiana University School of Medicine
tel:1(317)630-7960                         http://aurora.regenstrief.org



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