Re: [Gnumed-devel] clin_health_issue - some thoughts

[J Busser]

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.

Use case for episodes

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A nondiabetic student has a "spell" (note avoidance of gnumed "episode")  of possible hypoglycemia leading to a series of visits, tests etc which can be clustered within one gnumed episode. The spell may have presented with any among headaches, confusion, feeling faint, diaphoresis, shakiness. Let us say it was bad enough that it led to an ambulance being called with a capillary glucose level of 2.5. The AOE becomes "hypoglycemia NYD" and after evaluation it is determined that they were eating poorly prior to exams and had some alcohol so the AOE becomes "hypoglycemia, ?fasting ?EtOH".

I am not sure whether to code a diagnosis - I am reluctant to code an alcohol "disorder" and ICD9 otherwise offers me only 251 "disorders of pancreatic internal secretion" . The patient is cautioned. They have had no recurrence in the 14 days since the original spell including 2 followup visits. Maybe the gnumed episode (or at least the clinical problem) is inactive. Maybe only time will tell.

To bind these episodes as having some possible relationship to each other, I would have to establish / create a "clin_health_issue" which could inherit the most recent AOE. This AOE might, depending on that second spell, be another "hypoglycemia, ?fasting ?EtOH" but what if the second spell had no incriminating causes? The second spell might have become "hypoglycemia, r/o insulinoma" and might be reasonable to put as a new gnumed episode.

If the clin_health_issue takes its description (name) from the most recent episode's AOE, then the name given to the issue may have become too narrow - maybe the student, now embarassed, is hiding a drinking problem. Maybe clin_health_issue should just be "hypoglycemia". Maybe the clin_health_issue, when it spans a great many episodes, needs to be able to be given a name that communicates somethign about the episodes as a whole, not just the AOE of the very last episode.

If there are later further episodes, and we establish the presence of an insulinoma, it can be reflected in the AOE and this can "float" to become the description for the "clin_health_issue" and presumably in a tree listing we could see several episodes, each able to be displayed as named somewhat differently on account of preserving the names of their varied AOEs?

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A more complicated one is coming...