[Gnumed-devel] design comment: prescription/drug ID

[Karsten Hilbert]

Some thoughts re what's in the wiki:

ATC has IMO never been a contender for *identifying* drugs.
Only for functionally useful classification thereof.

Brand names need to be stored with prescriptions. It doesn't
matter for how long they exist. They are what the patient has
been prescribed (if so). In many cases they'll also be what
the patient will receive.

A prescription is sort of a denormalized replica of parts of
drugref. But this is on purpose. And it is the same as in our
current records. It's not like I write down "take Rote Liste
64585 twice daily". I not down the brand name (or generic
name). Hence, prescriptions should store a) brand name (if
given), b) generic name, c) an identifier. Also note that the
backlog of prescriptions IS NOT IDENTICAL to the the
current-medication list. Prescriptions are prescriptions are
prescriptions. They are form instances. Current medication better
be handled separately, IMHO (with re-use to-fro, of course).

The clinical schema cannot depend on the drugref schema as
GnuMed clients should access drugref via xml rpc. The
prescribing widget might but needn't do so. It can handle
other sources fine given that the stored drug ID is
domain-qualified (eg, "drugref:9850175", "AMIS:<PZN> or some
such mechanism). However, if you really strictly refer to the
drug "demographics" data it might be possible to get away with
a unified DB.

As for functionality/re local legal rules I think we should
focus on supporting what the doctor actually wants to
*accomplish*. I want to prescribe a treatment, be that drug,
physical therapy, speech therapy, etc. Hence I want to select
"treatments" from a smart list of such. Eventually those will
be turned into appropriate "scripts", namely incantations of
how to actually legally prescribe the treatment. I do think it
worthwhile to clearly separate the What from the How. Collect
prescription intentions while the work flows on. Turn them into
actual scripts/what-not at some "commit" time. Then is the time
to handle such things as whom to attribute billing to (work
cover vs. insurance company), whom to ask for authorization,
what type of form to print which therapy instruction on (PT vs
speech vs OTC drugs vs non-OTC drugs vs narcotics vs
Hilfsmittel) etc etc. IMO it should be possible to have generic
therapy-intent collecting code and branching out to locale
specific code upon script instantiation/actuation. I know this
could lead to more work.

Karsten
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