I can’t answer for the v2 OBX segment uses specifically, but I think if we stray from the concept that the abstract notion of a ‘message’ is an ‘update indicating a change of state (very often of knowledge about the patient)’, then it has to be reasonable for each message to be memoryless. It would be up to a receiving EHR system to retain multiple instances of a test result over time – i.e. the EHR has to be the longitudinal memory device, and the messages the notification-of-change mechanism.

This clean model is no doubt blurred/confused by the legacy function (apparently) of some labs being expected to provide a history of values, not just the most recently ordered test result. In a hospital with standing orders on in-patients it clearly becomes a question of who is responsible for the longitudinal memory function: the lab, or some receiver system? Historically, the lab was/is computerised, and patient record still on paper or only recently becoming computerised – when an EMR is introduced, the owner of the memory function is unclear, and data clashes are inevitable.

In some cases, the only clarity on whose job it is to retain longitudinal results might be on a local basis, even department by department. But if IT provision overall is not even conscious of this issue, there is a real problem indeed. I believe if we deviate from 1 message = 1 update on the most recent order, we are in trouble.

Your amendments to CDA seem eminently sensible and would go some way to improving the CDA standard.
Of course, they would also need to be backed up by an effective conformance, compliance and accreditation regime, particularly for national programs like NEHTA’s current PCEHR implementation. I think that would take years to establish.

Unfortunately, down here in Australia, we currently have a government, and a complicit NEHTA, seemingly hell-bent on starting to populate repositories around the country from July 1 this year with all manner of clinical documents based on HL7 CDA in its current guise.

Your post alerted me to another potential problem with the current PCEHR design, which I don’t think has been taken into consideration, although the final design of the PCEHR has not been published. I think it is possible, even probable, that a clinician may be able to download a CDA document such as a hospital discharge summary, view the narrative, but not have access to one or more computable entries because they were never created in the first place. (This, after all, is a “feature” hailed by many advocates of CDA, since it lowers the bar to creating the document!) It is unlikely that the amount of “coded content” in any one document would be stored as metadata in the PCEHR indexing service, so it would be left to each and every document reading application to stumble on this for themselves. If this turns out to be the design for the PCEHR, it could lead to a pretty unhappy collection of clinicians in a year or two!

More seriously, Nick Cage is on my ‘automatic don’t watch this movie’ list as well… everything he is in is just appalling these days. I like some of the other criteria as well – the >1 monster one is one with promise. I recognise Van Helsing as a crap movie, but on the other hand, managed to watch it twice when totally bored on long-haul flights. But I think it does actually come close to the original rule of: you know its dead in the water by half-way. Also, there was a predator/alien movie. I did not see it, but I heard of the brain damage done to those who did…

Re: shots of cheap liquor afterward, I prefer to think of it as more of an anaestethic to alleviate injuries sustained… lastly I would not, under any circumstances watch any Transformers movie, and I know you wouldn’t either :->

That said, pretty good chance that any movie staring Nick Cage (excepting Raising Arizona) is worthy of consideration as un-watchable.

Other criteria would include any movie with an animal/child co-star that is written to be smarter than the rest of the cast (Ed, Howard the Duck, Spy Kids), caveman movies, any monster movie with > 1 monster in it (Van Helsing anyone) and movies based on a game/toy (Dungeons and Dragons, Street Fighter, Transformers–all of them) all should be good sources of criteria to define the genera where you walk out of the movie and start doing shots of cheap liquor just to punish yourself for seeing it in the first place.

I saw it at the Schonell. And aside from a couple moments of Nick Cage over-acting beyond all possible conception, and maybe a bit of Isabella Rosellini staggering about the place, I remember only an abiding pain, like unto a really bad toothache. I remember dialogue that was at once cliched and painful, and simultaneously absolutely irrelevant. I remember cinematography that existed purely to satisfy the director’s desire to employ a cinematographer.

And I remember the plot. Or rather, I don’t. I remember thinking that it was an appalling, contrived, meaningless piece of excrement. And I remember wishing like hell I could have that five hours of my life back… which is all the more impressive when you realise the film is only about two hours long.

Fuck. That. Shit.

Lynch has done some funky, fucked-up shit in his time, but he gets a pass for vision, and for kooky atmospherics. But “Wild At Heart”? Shit. I’d rather PAY to see Star Wars Episode 1 back to back with Avatar than subject myself to that again.