Re: [Gnumed-devel] need assessment from fellow clinicians

[Jim Busser]

On Jul 2, 2004, at 4:30 AM, Karsten Hilbert wrote:
> > Makes sense to have the staff ask what it concerns (RFE)
> > Patient will either
> > - provide a specific answer, or
> > - indicate it's a "private matter", or
> eg. put in "undisclosed" - can be changed by the attending doc

Maybe best to leave "undisclosed" unchanged in the RFE, and instead 
input any detail in the encounter's Soap. I suppose it is up to the 
doctor to decide, but I was thinking ahead to a certain level of info 
that the Desk staff must have in order to be able to function 
effectively. For example:

- when a patient phones asking about an appointment, the Desk staff 
need to be able to "see" a list of all future appointments that have 
already been made, along with their RFEs. This serves two purposes, 
first to not make a second appointment needlessly, and second in case 
the existing appointment is for something that will fully consume the 
time that has been allotted for the appointment, making it identifiable 
whether to book extra time, and/or whether this "new" request will 
require a separate booking.

- -  the RFEs for future (and maybe even historical encounters? see 
below) probably need to be displayed to the staff; maybe if an RFE 
originally entered as "undisclosed" warrants privacy, the doctor could 
put the sensitive info into the Soap rather than editing the RFE --- so 
that the next RFE does not show as "followup - termination of 
pregnancy". Nicer yet, if the patient did inform the desk staff of a 
sensitive matter, the staff could capture the real reason yet at the 
same time code it "sensitive" to mask future desk staff accesses. Of 
course, the doctor should at any later time be able to code in in the 
same way. Alternatively, such masking could be achieved automatically 
via linkage to "highly sensitive" AOEs or aPs or diagnostic codes as 
previously suggested.

- - desk staff probably need to be able to view historical encounters' 
dates, times, types (visit, phone, corresp etc) and locations (office1, 
office2, housecall, hospital/facility). Maybe by default they should 
NOT be entitled to the AOE / aP name, or diagnosis?

The reason I am bringing up the above is not only for GUI purposes. It 
is also because at the same time as we are figuring out the 
interactions between RFE, Encounters' AOEs, aPs and diagnoses (and 
health issues), requirements by various user types to access "part(s)" 
could affect the data design therefore the back end.

ALSO - at present, I often phone doctors' offices to obtain information 
on their patients on the occasion of their being hospitalized under my 
care. Murphy's law often has the desk staff "in" but the doctor "out" 
at the time that I call. Maybe Carlo's exporter will be a help here 
because, even though the office staff MAY be able to examine the 
contents in the course of printing and faxing me the information, this 
is a step removed from what their normal widgets will have been 
providing on-screen.