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Re: [Gnumed-devel] clin_health_issue - some thoughts
From: |
J Busser |
Subject: |
Re: [Gnumed-devel] clin_health_issue - some thoughts |
Date: |
Wed, 17 Nov 2004 01:07:50 -0800 |
At 6:40 PM +0100 11/14/04, Karsten Hilbert wrote:
I'll try to propose a structure this week
that implements the
defines_* fields in clin_narrative thereby consolidating
the
is_active/is_clinically_relevant business
if no one objects.
snip...
Further discussion welcome.
I think we want to understand how adequately would the
health_issue / episode / diagnosis schema meet our clinical
needs.
I have been thinking a lot about "episodes" because how
we frame them, and enclosing health_issues, is key to deciding what we
intend them to mean, and how they can be used.
At its narrowest, we may want an episode to be able to capture a
single symptom, or a patient concern (e.g. a risk factor perceived, or
truly present, or potentially present as with family history) or an
abnormality on examination, or on testing. One episode may capture the
entirely, or only a slice in time, of the eventual longtitudinal
thread of care encounterlets (my term, if people will suffer it, to
distinguish from overall encounters [visits] the snippets within each
encounter that pertain to a given thread).
Whether a user bothers to segment this longtitudinal thread into
discrete episodes is entirely optional and two clinicians might choose
different cutpoints. It is interesting to consider that after a
clinician flagged an episode to have become "inactive", a
patient could return to ask questions, or obtain clarification, that
does not really warrant a "new" episode, so can we permit a
new encounterlet to be attached back to the most recent, pertinent
episode even though it was already changed to inactive?
Perhaps the impetus to change an episode from is_active to
"not" is when it becomes superceded by a new episode, as
warranted by some new development (as suggested for example by Karsten
in a previous email e.g. at a point of "loss of BP
control"). In this case, the function of is_active becomes
instead is_open (or its opposite, is_closed) to denote that beyond a
certain point, no further encounterlets should be attached, because
they should instead be linked to the superceding, "open"
(not closed) episode.
In database terms, the is_active column just served to
communicate that that the (computer) episode status remained
"active", but this terminology competes with our clinical
mode ("active" health issues, disease). Patients who feel
better, and whose problems may in fact have become inactive, may
decline to come back until a need arises. When they next come back,
perhaps for some other issue, you may discern that earlier *clinical*
episode may not have been "active" at all. More correctly,
it is just that the (computer documentation) episode has remained
"open".
Is_open might serve a clearer purpose, as above. Now some may be
thinking "well, we still need is_active as the basis to filter
(in) episodes of interest" - but do we? That which is not
"clinically_relevant" will not be very important, but may
need to stay in view because there are still actions pending e.g. a
need to see the patient again in followup, a test request whose result
is not yet returned, a quick phone discussion you need to have with a
colleague / consultant. *** But *** I would say "why not
let the existence, or lack, of such things be the determinant of
whether an episode is 'active'".? After all, why would you want
to keep in view an episode that was "active" yet for which
there are no incomplete or unreviewed tasks, results, or
plans/arrangements for the patient to come back? If there remains a
benefit to keeping is_active, it might be nice if we could prevent or
dissuade a user from changing it to is_active while test requests
remain unresulted and unreviewed etc.
I am working on some use cases to better illustrate episodes and
what we may want them, and the health_issues and diagnoses, to be able
to accomodate.
- Re: [Gnumed-devel] clin_health_issue - some thoughts,
J Busser <=
- Re: [Gnumed-devel] clin_health_issue - some thoughts, Karsten Hilbert, 2004/11/17
- Re: [Gnumed-devel] clin_health_issue - some thoughts, J Busser, 2004/11/18
- Re: [Gnumed-devel] clin_health_issue - some thoughts, Ian Haywood, 2004/11/19
- Re: [Gnumed-devel] clin_health_issue - some thoughts, J Busser, 2004/11/19
- Re: [Gnumed-devel] clin_health_issue - some thoughts, Karsten Hilbert, 2004/11/28
- Re: [Gnumed-devel] clin_health_issue - some thoughts, J Busser, 2004/11/28
- Re: [Gnumed-devel] clin_health_issue - some thoughts, J Busser, 2004/11/28
- Re: [Gnumed-devel] clin_health_issue - some thoughts, Karsten Hilbert, 2004/11/29
- [Gnumed-devel] Aggregating health issues on screen., Richard Terry, 2004/11/28
- Re: [Gnumed-devel] Aggregating health issues on screen., Karsten Hilbert, 2004/11/29