Proposed features/Healthcare 2.0
|Proposal status:||Inactive (inactive)|
|Tagging:||medical_system=*, type=health, health_*:*=*|
|Applies to:||, , ,|
|Definition:||This proposal is for health care/public health related objects.|
Why this proposal?
- What kind of doctor is amenity=doctors? Hopefully you will only need amenity=dentist in your life, where this is more clear. ;-)
- Which kind of medical system is used? The traditional medical systems are used in conjunction with the western medical system by tradition or to address its shortcomings.
- What about other public health related services such as home nursing?
- Maybe you want to do detailed mapping of support groups, counselling centres, health related amenities or services, without using tags of all the other in some kind always lacking proposals.
- You need something to represent the real relationships of an hospital and it's departments or a joint practice and the persons working in there.
- Health care commonly also includes prevention facilities such as counselling centres and community driven services such as support groups.
This was meant as an extension to the original healthcare proposal , but after some discussion it turns out, that it doesn't fit into Reclus's picture of the world, that there are more than the western medical system, which are at least in parts, valid medical treatments. OSM is for mapping what is there, not to tell you if it is good or right! He says that I should write my own proposal, so here it is. My other extensions intended for healthcare are also in here.
What healthcare=* is lacking
- No detailed mapping of support groups, counselling centres or even just health related amenities or services.
- No complex relationships between e.g. a hospital with it's departments and the rooms in the departments.
- No topological right ability to specify which the health persons working there, if micro mapping inside can not be done, e.g. in a health centre.
- No complex person roles. e.g. a physician can also be a therapist.
- It is badly constructed and restricted. E.g. there are specialities for physician's but not for therapists, other then psychotherapists.
- Supports only one (the western) medical system.
medical_system:*=yes/no describes the medical system used by this object. If it has an international known name, then it should be used, otherwise the name of the country or region of the world, where it originated from should be used. The word "traditional", which is mainly used when the medical system are exported to the outer world, should not be used in this place. The medical_system=* must be always a traditional medical system which is or was used many centuries as the main system to treat people in this region or country of the world.
Main group of the object
This proposal groups all medical objects into one of the following categories:
health_service:*=yes/no: This (additional) health care related service is not the main purpose of the object, it is only provided in addition to it's main purpose.
health_person:*=*: To describe a role of a person which works in a health care related object or who provides any health care related services. This tag can only be used in addition to an health_facility:type=* or health_service:*=yes/no object, and so must always be included in an extra type=health-relation to be non-ambiguous.
health_facility:*=*: This describes a medical facility. This means one or more localities such as buildings, groups of buildings or parts on an building.
health_amenity:*=*: This tag is for any health care related amenities and things which do fit in any other category. It is intended for any kind of technical and lifeless health care related objects.
The main idea of this tagging scheme is that you first specify the medical system in which an main object is located and after that health care object itself. This is why these keys are required to describe an new health care related object. After that you can add some of the additional subkeys, to describe the object further.
In a given medical system there can be a) a locality of a health facility, b) another kind of facility which provides some medical services or c) an health care related amenity which is some non-living, most technical installation, such as an aed. For a) such a health facility can contain another health facility, such as a hospital, which contains some departments or a health centre which contains some offices. For a) and b) there must be some (health care) persons working there, which provides the services, but they can also contain c) or may provide b) in addition. But in case of a health care related service, you may be more interesed in the kind of the, usually limited, service as in the kind of person it provides. But there is of course a difference, if the service is provided by a paramedic, which is only trained for help in emergencies or a physician.
Where to put the detailed type of a subgroup object?
This scheme has been adopted to be compatible with the Humanitarian Data Model which uses health_*:type=* as the default for the object type. So you should put the kind of an object into health_person:type=* (e.g. health_person:type=physician), health_facility:type=* (e.g. health_facility:type=hospital) and health_amenity:type=* (e.g. health_amenity:type=first_aid_kit). Note that there is one exception from that rule: health_service:*=yes/no.
Describing object subkeys
health_specialty:*=yes/no/partial/trained is used to specify the public health object in detail. health_specialty:*=partial means that their is only a limited subset of the specialty is practised by the object. The tag health_specialty:*=trained should be used, when the person has been trained in a specialty, but does not practise this specialty. This key have to be defined for the affecting medical system. The common British English term which is used also in research should be preferred as value for this tag. So for example in the western medical system "colorectal_surgery" and not the old term "proctology" should be preferred, but most times the Latin term, which is also mainly used in research, is the right one at least for the western medical system. This proposal was written in the western medical_system. If the specialities are not appropriate in your medical system, please extend them as needed. Many sub specialties fit into more then one specialty, the grouping in the tables below are mainly for helping humans to find the matching specialities.
office=*: A physician, therapist, healer and many other health persons can have their own office, where which they need provides his services. Mostly the office consists of a few rooms such as waiting room and examination room. the values of health_person:type=* are also defined for office=*. So e.g, use office=therapist for a therapist's office and office=nurse for a office of a nurse e.g. inside a hospital. The office of a nursing company or a nursing service should be tagges as office=nursing_service.
disease:*=yes/no: This tag specifies for which type of disease/disability any medical treatment/support/services are provided. The key should be the common used English scientific name of the disease in lower case with any white space and special char such as "/" converted to only one "_". For names with consist above three parts and which have an common used and easy to find abbreviation, this should be used. But make sure that it is non-ambiguous.
Also see the tables below for a more complete list.
Usage of the health-relation
You can also use a subset of the tags proposed in this proposal in a health-relation, but it should always be non-ambiguous clear, to which type of health object the tags in the relation apply and in what medical system the object is located. Tags in sub relations always apply to their parent object, if no new health object type (health_facility:type=*, health_service:*=yes/no health_person:type=* or health_amenity:type=*) is tagged inside the sub relation.
This key describes the medical system used by this object. If it has an international known name, then it should be used, otherwise the name of the country or region of the world, where it originated from should be used. The word "traditional", which is mainly used when the medical system are exported to the outer world, should not be used in this place. The medical_system must be always a traditional medical system which is or was used many centuries as the main system to treat people in this region or country of the world.
Usage conditions for medical_system:*=yes
- The person who use an affecting medical system, was educated in a country/region, where this medical system has a long term historic and traditional base.
- If the medical system is used in countries/regions where it is not originated from, e.g. imported from countries where it has a traditional base, then the knowledge base and quality of training of the persons who use it, must be comparable to the latest research in the originating countries. This usually means, that there is at least 20 years (one generation) of own ongoing medical research on a wider base and that there are at least some research facilities which give training in this medical system. The medical system is therefore in common use in this country and exists not only as a niche specialty.
If at least one of these conditions are not met, then the object falls under alternative medicine.
Explanation: It is common practice, that traditional medical systems are teached in crash courses in western countries, so the training is neither comparable in time nor in comprehensiveness and currentness. There exists also no up to date literature as there is no wider research base. This applies not to "exported" persons, who where trained in the originating countries, as the training was up to date on this time and they can get and read the original literature.
|medical_system:ayurveeda||yes/no||Traditional native medical system of the Indian subcontinent.|
|medical_system:chinese||Traditional Chinese medical system.|
|medical_system:kampo||Traditional Japanese medical system.|
|medical_system:mongolian||Traditional Mongolian medical system.|
|medical_system:tibetan||Traditional Tibetan medical system.|
|medical_system:sidda||Traditional south Indian Tamil medical system.|
|medical_system:unani||Traditional Greeko-Islamic medical system mainly used in South Asia.|
|medical_system:unknown||The used medical system of the object is not known.|
|medical_system:western||Medical system used globally, based on science.|
This describes a medical facility, which are usually one or more localities such as buildings, groups of buildings or parts of a building. See health_service:*=yes/no for additional medical services, which are not the main purpose of the facility. The main facility, on which health_service:*=yes/no is used, can be still be one from these list (or later: one defined by yourself) or any other. For an object with health_*:type=*, the health_service:*=yes/no tags must then be added to a type=health-relation.
|health_facility:type||office||An office of any health care related persons. See health_person:type=* for a list that can be used with office=*. An office consists of only a few working/examination rooms (1-2 are common) per health person. There is no common management staff for the facility with has usually no more then one building, so every health person acts for it's own. There is only outpatient treatment. See health_facility:type=health_centre, if the facility has more the one independent office.|
|hospital||A hospital is a health care facility, which treated cases are >= 50% inpatients. Usually this facility spans one to several buildings and there is extra staff for the patients which stay there over night and for the management of the facility on the whole. If not tagged otherwise, this facility will cover many specialities.|
|field_hospital||A field hospital. The difference to a hospital, as defined above, is that the "buildings" are only temporary there, such as tents.|
|clinic||A (poly)clinic is an integrated health facility which treats > 50% outpatients. The staff works together coordinated under a common leadership/management and so, other resources, such as equipment, are also shared. This facility usually spans at least one building on the whole. If not tagged otherwise, this facility will cover many specialities.|
|health_centre||A health centre is a facility where at least two independent health offices share the same building. This means, that there are usually at least two registration desk and/or waiting room like amenities, as a shared office is not independent on the whole.|
|counselling_centre||A health counselling centre. See counselling_type:*=yes/no for the type of couselling provided.|
|rehabilitation||A facility where disabled persons are restored for everyday life as far as possible. This tag should be used for all therapy facilities for (temporary) disabled people.|
|laboratory||A health care related. Usually such a facility can do a large number of analyses and tests which are, for the western medical system, most times related to clinical pathology, biochemistry or medical microbiology.|
|therapy||A therapy facility, which does not fit into an (therapists) office e.g. is more a common facility such as a spa. This includes also facilities for diseases/disabilities which are common old age problems or related to the way of life. The purpose of this facilitity is prevalent a therapeutic one. This means, in difference to a clinic, the physicians who may work there, are not primarily for making diagnosis, but to supervise the therapies. Please add treat:inpatient=yes/no/only.|
|department||A department of any health_facility:type=*, but not for single rooms.|
|dispensary||A dispensary. This can be any facility, where medicine is dispensed.|
|pharmacy||A pharmacy is a shop or shop like facility, which sells prescription-free medicine and/or dispenses medicine which needs prescription. This is an alternative to amenity=pharmacy, especially when relations are used. Please add dispensing=yes/no, if applicable.|
|first_aid||A first aid station/facility. These can be found e.g. on beaches. This is usally a small facility where you can get first aid from paramedics or volunteers. Please add emergency=yes, if applicable. See also emergency=ambulance_station.|
|nursing_home||A nursing home. In the western medical system, this can be combined with health_specialty:palliative_medicine=yes for a hospice. For retirement homes see social_facility=*.|
|support_group_home||A facility which provides meeting rooms for support groups.|
This tag is for any health care related amenities and things which do fit in any other category. It is intended for any kind of technical and lifeless health care related objects.
|health_amenity:type||first_aid_kit||A first aid kit.|
|baby_hatch||A baby hatch. Alternative to amenity=baby_hatch.|
|scales||For public scales. Not all are vending machines.|
|aed||A automated external defibrillator. Please also add emergency=yes. After medical=aed and emergency=aed this alternative is provided to join the health and the emergency aspect.|
health_person:type=* / office=*
To describe a role of a person which works in a health care related object or who provides any health care related services. This tag must always be used in addition to an health_facility:type=* or health_service:*=yes/no object. The values of health_person:type=* are also valid for the use with office=*. FIXME:It seems that there are still some isues with the person-service relationship, to be sure, use this keys on health facilities only.
- Simple tagging: Use office=* on the health care related object as a replacement for any relation with health_person:type=*. This has the disadvantage that you have to decide for one of the health persons from the list below (or you own value, if nothing fits).
- Advanced tagging: Add a type=health-relation with health_person:type=* to the health care related facility or service and omit the office=* tag. The specialties of the parent object are the union of all specialty, counselling and service tags of the type=health-relations on the object, where the specialty, counselling and service tags of the parent object overwrite these of the child relations or are added otherwise.
For the advanced tagging it is recommanded to tag at least the persons, whose specialties have the main influence of the kind of services provided by the health care related object. For the others such as e.g. assisant in Germany physician's offices, you can use staff_count:*=<number>.
|health_person:type||assistant||A person that helps e.g. a physician or therapist with the patients treatment and the administrative office work.|
|healer||A healer has at least got some limited (formal) medical training, but usually less than a physician.|
|midwife||This, most times female person, has been trained to help women with childbirth.|
|nurse||A nurse provides care for people as a service, usally in a health care related facility.|
|paramedic||A paramedic is a health care related person, who got at least enough training to do his work, which is to help in the case of emergencies.|
|physician||A person who has the full medical training e.g. a country provides for the specialty and medical system. This persoan first makes a diagnosis of disease and then usually becomes a therapist.|
|podologist||A person who does preventive pedicure, e.g. for people with diabetes mellitus, by profession. This is also known as medical foot care or podology in some countries.|
|psychologist||A psychologist is a scientist in the field of psychology, which is usually related to (statistical) testing, but can also include treatment techniques such as counselling. Some pschologists do pschotherapy in addition. Usually the psychotherapy training is separate, and can, at least in Germany, also be done e.g. by a physician.|
|therapist||This trained person provides treatment services, but does not make an initial diagnosis of the main cause, which causes the treatment, e.g. of a disease. But a therapist can make analyses which are related to the kind of therapy provided.|
|witchdoctor||A witchdoctor usually got no medical training, but offering medical procedures, which are most times based on some belief.|
|health_service:nursing||yes/no||The object provides general nursing services, mainly for people living in health facilities or social facilities. The service complements for things, this people can't do any longer themselves. This tag is for additional nursing. For a company, which does only diffent kinds of nursing use health_facility:type=office + office=nursing_service.|
|health_service:counselling||The object is not an dedicated counselling centre or other counselling facility, but also provides health related counselling. This tag should be used with counselling_type:*=yes.|
|health_service:examination||The object e.g. a social_facility=* or optician, provides some, most limited, medical examination services in any specialty.|
|health_service:child_care||The object, additional takes care of children. This is in general not a nursing service, such as health_service:nursing=yes.|
|health_service:prevention||The object provides any disease prevention service e.g. vaccination or condome distribution. This tag can be combined with disease:*=yes/no.|
|health_service:support||The object is mainly an other facility e.g. an office or therapy facility, but also provides a support group.|
|health_service:test||The object does any health care related (e.g. psychological or medical) testing. For medical testing, the number of tests is very limited, so it can't be called laboratory. This tag can also be combined with disease:*=yes/no and/or disease:*=yes/no if appropriate.|
- yes: The specialty is practised in/by the object.
- main: Same as yes, but the specialty is the main working field of the facility/person.
- additional: Same as yes, but the specialty is not the main working field of the facility/person.
- no: The specialty is not practised in/by the object.
- partial: A limited subset of the specialty is practised in/by the object. This tag will help to specify, that the provided services are under the common expected standard in an area such as a country.
- trained: The health person has got training in this specialty, but does not practice this specialty or provide any services in this specialty.
Use only the best matching (sub) specialties which fits for an object.
The kind of counselling which is provided by an object.
|counselling_type:child_guidance||child guidance counselling|
|counselling_type:rehabilitation||(medical) rehabilitation counselling|
|counselling_type:sexual_abuse||sexual abuse counselling|
|counselling_type:violence||(domestic / family) violence counselling|
This is an experimental extension, which is mainly there for completeness, as there is very few experience in Indoor mapping.
|group||working room for groups|
The service is provided only for a restricted person group (e.g. this depends on the developmental stage, gender or sexual orientation) and this group is not already defined by the kind of the object. The specified age ranges, are more for readers orientation, don't worry, if they do not exact match.
|provided_for:infant||yes/no||infants (<1 year old humans)|
|provided_for:toddler||toddlers (1 to 3 years old humans)|
|provided_for:child||children (4 to 11 years old humans)|
|provided_for:adolescent||adolescents (12 to 19 years old humans)|
|provided_for:adult||adults (20 years and above old humans)|
|provided_for:senior||senior and retired people (around 60 years and above old humans)|
|provided_for:boy||boys (shortcut for: < 20 years old males)|
|provided_for:girl||girls (shortcut for: < 20 years old females)|
|provided_for:man||men (shortcut for: >=20 years old males)|
|provided_for:woman||women (shortcut for: >=20 years old females)|
|provided_for:male||males ((same as provided_for:boy=* + provided_for:man=*), but can be combined with the developmental stages, even if not seen by me in the healthcare system until now)|
|provided_for:female||females ((same as provided_for:girl=* used together with provided_for:woman=*), but does not collide with the age dependent tags).|
|provided_for:transman||transgender, now a man|
|provided_for:transwoman||transgender, now a woman|
|capacity:bed||*||Total number of beds in a facility or building. More general alternative for building:beds=*. see also capacity=*.|
|treat:inpatient||yes/no/only||This objects treats (only) inpatients. This tag defaults to yes for all objects tagged as hospitals and to no for all other objects.|
|counselling||yes/no||This object is not health care related and provides counselling. Generic add-on tag for counselling_type:*=yes/no.|
|disease:*||For which type of disease/disability are the medical treatment/support/services provided? The key should be the common used English scientific name of the disease in lower case with any white space and special char such as "/" converted to one "_". For names with consist above three parts and which have an common used and easy to find abbreviation, this should be used. But make sure that it is non-ambiguous.|
|emergency||This object is used in case of an emergency. Already defined in emergency=*.|
|home_visit||This object provides home visits.|
|work_accident||If the object is in some kind involved in reviews or the treatment of work accidents.|
Newbie compatible tagging
On the area of the office:
Advanced tagging using relations
On the area of the office:
Relation 1 on the area of the office, to describe the person working there.
Relation 1 (the person is a physician):
Relation 2 (the person is also a therapist, so this additional role will be added as child of a person relation):
Physician's office for multiple, time dependent specialities
This is reported to be common in e.g. Brazil.
Direct on the node/area of the office or in a relation on the office:
As relations on the node/area or as child relations of the previously created master relation:
Different level of training in specialities
Physician's office for dermatology and venereology
This physician owning this office was mainly trained and practises in dermatology and venereology.
Physician's office for oral and maxillofacial surgery
This physician is a completely educated dentist, but now has specialised to do only oral and maxillofacial surgery.
Physician's office for dentistry and oral and maxillofacial surgery
If this above physician, would do also oral and maxillofacial surgery, besides common dentistry examinations, this should de tagged as:
Optician which provides optometry services
This is a real one.
Hospital with its departments
Newbie compatible tagging
On the area of the whole hospital (it should be a chinese hospital witch has two departments: internal medicine and tuina):
Advanced tagging using relations
Add the area of whole hospital area to relation 3, the 1st department to relation 4 and the 2nd to relation 5.
Now go on and add the rooms in every department to relation 4 and 5. ;-)
And here is a complex German university hospital example.
This is an example of a women domestic violence counselling centre.
Tags on the node/area:
On the area of the office:
If you want, you can extend the area with a relation for the person working there.
Example of a therapeutic clinic for neurologic diseases, especial for paraplegic patients.
Rehabilitation facility, providing also a support group
On the area:
Relation on the area of the facility:
Health centre - inside micro mapping can't be done
On the area:
Then add one relation to the area of the center for each independent office:
These are my comments and tagging recommendations for these new keys, you can use what you like. This proposal defines no replacements for any keys. The following table shows collisions with already used keys.
|Old tag||New tag||Comment|
|amenity=dentist||e.g. health_specialty:dentistry=yes||You should add the new tags to the old ones to better describe the object, as it can be e.g an office or clinic.|
|You should use the new tags in addition to the old ones to refine the tagging.|
|For simple tagging:no need to use these tags, but should be used for complex hospital tagging.|
|amenity=clinic||health_facility:type=clinic||Rarely used, maybe because the proposal was declared as dead. The new tag will provide an alternative, at least for complex objects.|
|amenity=baby_hatch||health_amenity:type=baby_hatch||The new tag is not necessary in most cases, but is there for completeness.|
|amenity=nursing_home||health_facility:type=nursing_home||This new tag is for nursing homes only, the old tag is also used for retirement homes.|
|amenity=pharmacy dispensing=yes /
|health_facility:type=pharmacy dispensing=yes or
|The new tag is only for completeness. Use what you want. health_facility:type=dispensary is used many times by HOT.|
|social_facility=healthcare||health_service:*=yes/no||You should not use the old redundant tag, and tag the provided health services in addition as needed.|
|medical_service:*=yes/no||health_service:*=yes/no||medical_service:*=yes/no is used in Kibera, to tag services in most times, but is also used for specialties, so I don't want to adopt it.|
|social_facility=ambulatory_care||health_facility:type=office||For offices of a, not only ambulant, nursing service company, health_facility:type=office with office=nursing_service should be used, For a streetworker office I think it will be better to use office=streetworker.|
|social_facility:for=*||provided_for:*=*||You should use the new tag, but only if it clearly refers to restricted person groups and not any functional aspects.|
Tagging scheme design
Theses scheme was first hierarchical, which was less extensible and inflexible,in that kind,that the tags can not be combined as you want. But the parser always knows what to look for. Now I have changed this to a binary *=yes/no-scheme mostly. The "name-spaces" (separated by ":") in the keys are restricted to two. As if you can't do an exact match on the key, you also must do an substring match on the tags.
The specialty tagging was now also unified for easy finding/parsing of the keys. To reduce the "I can't search easy for a specialty, if only the finer grained subspecialty of it is specified"-problem, which was the main reason for the old hierarchical tagging, the tables have been kept, but now to help the users to find the matching (sub)specialities. I used the full term if possible, so there are easier to remember and to google for, but you have to write a little bit more as when using healthcare=*.
Health care is always culturally based or biased and so included in the underlying medical system, so using medical_system:*=yes/no is recommended. Where the western medicine is based on anatomy, physiology and biochemistry, the chinese medicine uses Wu Xing and the yin-yang theory. the funny thing is when western physicians (e.g. there is further training for German physicians, to use acupuncture as special pain treatment) are using e.g. acupuncture backed by western medical theory. On the other hand there is also formal further training for physicians on homoeopathy in Germany, maybe just to make this pure water placebo treatment to look a little bit more "evidence-based", if it's done by a trained physician. ;-) This is also the problem with the so called alternative medicine: yes you may always find some reasons for group e.g. the naturopathy under alternative medicine, but this always depends on what you will look at. E.g. phytotherapy can be something between bach flower remedies and chinese phytotherapy. This is why I place all right done "traditional" medical systems in an extra group to help to resolve the problem a little bit. The NCCAM classification is more a try then a real classification, e.g. it places sub disciplines of the same medical system in different main groups. Most categories such as manual therapies, mind-body intervention and biological therapies (which I subdivided)) are OK, but then they e.g. put Qi Gong, which can be also considered a belief based therapy, as it has same Taoistic base, as the traditional chinese medicine (e.g. Qi flow on the meridians), together with some other energy based bullshit therapies. But the other therapies do not have any long term traditional base. But as Qi Gong has been used over many generations without being dropped or become a niche specialty, chances may be good that it at least helps in the most cases it is used for, even if there may be no hard evidence until now. This is why I treat is as an traditional first hand experience based therapy. Yes, nearly all of the therapies considered alternative have some religious aspects in some kind. But there is a difference between e.g. take high doses of vitamin x as nutrition supply and believe that it may help in some kind, to take homoeopathic "drugs", which contain that more water as more effective they should be. Even if there may be a chance to really have a single molecule of the drug in the bottle, there is not hard evidence that there is something which could, at least theoretical, cause a really change in some kind. The same applies to all energy therapies, which have no traditional base e.g. are at least 500 years old and have been transmitted over many generations, which improved these therapies.
Why should medical_system:*=yes specified? Yes, you may think, why should I specify the medical_system as in the western countries e.g. Europe and North America is nearly almost medical_system:western=yes today. At least it is much less redundant as e.g. the addr:country=* of the Karlsruhe scheme, which could be replaced by the boundary relation of the affected country. The problem is, that also in the western countries it may be possible that a person has got native training in a country which may use an other medical system, so the training, in this proposal, is considered as good as if the person where working in the origin country of it's medical training. As it is not possible to tell if the medical_system:*=yes/no tag where just forgotten or where dropped because the mapper thought that everything will default to e.g. medical_system:western=yes, I recommend to use this tag. A compromise could be to use the Defaults-relation, even if they would not really resolve the problem.
To support complex tree style health care facilities such as hospitals with it's departments and maybe the rooms there, a relation of type=health is defined and their use is highly recommended. The scheme to use in conjunction with relations are the same as for nodes, ways and areas.
Why yet another key for *=*?
Yes, I know about the problem, that some people then use tag A and the other ones use tag B. Maybe why two applications use/render one of them. But there are also other problems.
Over the time the exists many proposals e.g. for a physician's office, which do not integrate the existing medical objects into a common scheme. Some of these tags have been documented, the others are used without documentation, but they are distributed over x sources and proposals, so there are no improvement to the existing situation. Some people will argue, that we need "the proposal process", but it is as good as the abandoned Proposed_features/GP_Surgery for amenity=doctors. The intention of the proposal was a tag for a physician of the specialty general medicine, but as far as I know, this additional aspect have nowhere documented on the common used map feature pages. On the other hand you can find really good tags for things on e.g. taginfo, but as they are not documented anywhere or/and a lengthy proposal process is needed, someday a new proposal will appear to add it's own sight and tags.
An other aspect of the same problem is, that the first people see e.g. an automated external defibrillator as a medical device and the next proposal see it as an device used in case of an emergency. But why does e.g. the first healthcare proposal does not integrate it or a tagging recommendation like medical=aed + emergency=yes is added to the documentation pages, as it integrates both sights.
If then enough proposals for the same things have been created, then some people cry for keep tag X forever, as most applications are using it. They are at least partially right, as it should be kept as an additional tag for the scheme which tries to integrate the existing tags for a while. But the problem, that over the time medical objects have been spread over several keys/tags, are not solved and most people will not find all the documentation and existing undocumented usages. This is even hard to manage in applications, as if the application groups the different keys together for it's own e.g. by presets, then the flexibility of easy creating new tag combinations manually is sacrificed for false understood backward compatibility.
So a new tagging scheme must be as most specific as needed, but should also think about possibilities of tag overlappings. These overlapping tags should be then made more general. E.g. key:social_facility defines social_facility:for=*. But why is this not a generic key to specify for whom anything is? Why should be an affecting object for for more then one group of persons? So I have to redefine it as provided_for:*=yes/no. Social facility has also the problem of not clearly defines it's bounds, and so the author added some health care facilities also. As it should be for social facilities, why are there any medical facilities such as social_facility=healthcare or social_facility=ambulance_care, even after it was coordinated with Proposed_features/healthcare? The bounds of an proposal should be clearly defined and restricted to one topic.
I have not intended that this proposal will be used for non-health care related counselling centres, such as e.g. tax counselling. But I now made health_counselling_type:*=yes/no a generic tag counselling_type:*=yes/no.
There is also a downside of the use the most generic tags as possible, which are facility=*, amenity=*, service=* and person=*. Even if some of them had not been already defined and used, they are so generic, that some times later they will be used for everything. So why we would use a key for the tags, as it can always default to amenity=*. ;-)
This proposal tries to at least make all health care related objects easier to retrieve and to remember, as the tags most times will be entered by humans. But it is hard to do without redefining existing keys to much. E.g. this proposal should help to represent the topology of health object as the is in reality, and as good a self contained scheme is to remember, I have now changed health:office_of=* to the already existing office=*, as it will better fit into these key and the kind of office is not needed to represent the topology. Nor I invented health:medical_practice_of=*, because a physician's medical practice has to be a surgery (please don't confuse with the specialty) or medical practice in more common English, when office=* already exists. If someone want correct BE tags everywhere, then he should do the integration of all the existing health related schemes into a common one, which is consistent for the type of an object of the same category.
As conclusion, there should be some non-binding best current practice guidelines for tag design. As I also have to work out many things to create good tags for my own and I assume that there still will be things which can be optimized.
Please use the discussion page. Thanks.