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

[Jim Busser]

On Jun 30, 2004, at 6:33 AM, Karsten Hilbert wrote:
> Once an episode has led to a medically well-founded diagnoses
> the most recent AOE is likely to contain the diagnosis text.
> So they will automatically appear as aPs, perhaps labelled
> permanently relevant.

Do we thus avoid having to code things specially to be "problems", i.e. by just having them declared programmatically as any AOE (in fact --> any clin_narrative row) that has had a diagnosis coded?

"Other" problems can include those carried into the practice or, as Elizabeth pointed out, later input retroactively, as Past History.

I am wondering how the data structure can best be helped to assemble these pieces into manageable views, which might be difficult if the data is distributed across multiple tables. Karsten had replied to Elizabeth on July 2

<x-tad-smaller>></x-tad-smaller><x-tad-smaller> Real world doesn't work like that, as the years go </x-tad-smaller><x-tad-smaller>
></x-tad-smaller><x-tad-smaller> by, you find out all sorts of things that weren't revealed before - we are in </x-tad-smaller><x-tad-smaller>
></x-tad-smaller><x-tad-smaller> a position of trust and as the trust grows, then old items of history get </x-tad-smaller><x-tad-smaller>
></x-tad-smaller><x-tad-smaller> revealed, and have to be added to the list.</x-tad-smaller><x-tad-smaller>
Sure, one may enter clin_narrative rows any time. If today I
learn of a 1993 miscarriage due to rubella I can enter a Soap
line "miscarr 93 - rubella" and a soAp line (is_aoe false)
with "post rubella". I could then link clin_diag* rows to that
if I feel the need to make that a hard diagnosis.

In fact, personally, I would probably not make that a diagnosis at
all but rather leave it as a history item (in a Soap line).

</x-tad-smaller>Does that mean that the mechanism of entry of all clinical data - past history, allergies, family history - will be through clinical narrative rows?

Does it also mean in the example that if no diagnosis is being coded, we need a way to make the Soap line "permanently relevant" so that the programmatic definition of a problem is expanded to include any clin_narrative (including AOE) rows marked Permanently relevant?