An elegant EHRA is one of the holy grails. The
effort of the CHIME group in pursuing this goal is to be lauded. But the
GEHR design can be faulted on at least three aspects. The first weakness is its
catholic approach to any medical coding system. The integralness of medical
coding is in a sense destiny for the effectiveness of any medical record
system. To create an EHRA without a predefined medical coding base is like
defining a high level language and not committing oneself to either ASCII or
Unicode. The second weakness is the lack of precision of its medical record
infrastructure for decision support. The transaction in GEHR is too coarse
grain. This aspect will cause GEHR to founder as its lack of an underlying
scheme for doing machine decision support in the profound sense. An example of
a profound function is a subprogram to pick up a lapse of clinical management,
such as a failure to order certain tests in the face of persistent
symptomatology. The third factor that
will cause GEHR to founder is its complexity.
DocleScript is an
alternative to GEHR - it is designed in
the manner of JavaScript or Perl. It leverages on the strength of the all but
natural Docle language and medical coding system. Better still DocleScript is
defined in Extended Backus Naur notation on a single A4 page. DocleScript is
being used in some of the largest practices in Melbourne.