Previous papers have argued for the existence of three different models in many clinical information systems – for the medical record, for inference in guidelines, and for concepts and re-usable facts. This paper presents a principled approach to deciding which information belongs in each model based on the nature of the queries or inference to be performed: necessary or contingent, open or closed world, algorithmic vs heuristic. It then discusses an important class of systems – “ontologically indexed knowledge bases ” – and issues of metadata within this framework. Keywords: Computerized medical records, knowledge representation, terminology, decision support systems, standard
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