[Gnumed-devel] protecting against clinical failure to review, or to respond

[Jim Busser]

One of my concerns with my present (fragmented) record system and 
workflow / task management is trying to look out for things falling 
between the cracks.

Even when I know about something that needs to be looked after, I may 
have to postpone doing so or I may have begun but run into a delay on 
account of some dependency.

I am wondering about a few areas where his is already provided (in 
part) in gnumed and other areas where it could yet be structured.

For labs, we have the table test_result and the fields
- fk_reviewer (who has reviewed the item) and
- reviewed_by_clinician boolean (whether a clinician has seen this 
result yet. Depending on the use case, this be simply set by any read 
access by a clinican, or may follow specific business rules such as 
"set as SEEN when treating/  requesting doctor has reviewed the item"
- clinically_relevant

So far so good. If it is a bad day in the office, say with the treating 
doctor away, the covering doctor can have their work reduced by having 
to view only the results that have been flagged technically_abnormal 
(or, if there is unreliability of the test provider to flag these, 
extending the set of results to include any result that is above an 
upper range, or is below a lower range (say hemoglobin) or even any 
result that lacks both {val_normal_min, val_normal_max}

One thing missing is whether the results require action. There is a 
field clinically_relevant, but it best determines whether to include or 
suppress in reviews of test history. Special tests even when resulted 
normal, may be useful to mark "clinically_relevant" so as to keep them 
in view, to be able to later see that these tests have already been 
done.

If we add one field, something like "for_action" or "hold" or "track", 
it could help
- a covering doctor to flag it for action/attention by the treating 
doctor e.g. in cases where the business logic would otherwise have 
considered the result reviewed_by_clinician, and therefore dismissed 
it, OR
- the treating doctor wants to keep it flagged, because they have not 
yet had time to i) think enough on it, or ii) act on it, or iii) want 
the flag to remain as a reminder to re-measure it at some later time.

Some of the above could be achieved by the "cheat" of keeping (or 
re-setting to) FALSE reviewed_by_clinician, but the downside is that 
the covering doc will have to keep looking at it not only until the 
treating doctor's return but even beyond, at their next absence, and 
the treating doctor, once they acknowledge the review, would be left 
with no "action flag".

The GUI could provide the reviewer options to
- mark / unmark  ...  all / selected  ... [as] reviewed [as] 
flag_for_action