Re: [Gnumed-devel] Re: [Gnumed-update] Initial checking for EMR struct elements editor. Based on original work and ideas by Syan and Karsten. It is an initial approach, feedback required

[Karsten Hilbert]

> The code looks good, but, once again, I'm left confused about the health 
> issue-episode conceptual distinction
The best way to look at this is to ignore health issues and
just look at episodes. The user opens episodes, starts
episodes, closes episodes, adds to episodes. Only sometimes
will she realize that all those episodes have a common cause,
namely the health issue which is then possible to encode by
creating a health issue and attaching the relevant episodes to
it. For understanding *ignore* health issues and think of
episodes to be named sequences of bad health.

> What does it mean to have any episode other than the latest one "open"?
It means there are two distinct entities worsening the health
of the patient. They may or may not be caused by the same
health issue. You can safely ignore this latter question for
the time being, though.

> If more than one is open, how to we decide to which one new SOAP notes are 
> added?
By using our brain. If we have trouble deciding the episodes
have not been clearly defined, eg merging/re-splitting should
be considered.

> This means the user has to select the health issue
> *and* an episode.
No. Just the episodes. Ignore the health issue until it just
jumps at you: "Gosh, all this stuff was caused by the
diabetes. I wish I knew earlier !"

> IMHO this is too complex, all the user should be doing is 
> selecting a health issue, and
> (possibly) whether this encounter is the start of a new episode.
This is too simplistic. The widgets, however, will hide the
complexity you are imagining, eg. in most cases the user will
only deal with episodes and not be bothered with health issues
in the first place.

> What does it mean when you change the name of an episode?
You rename it, eg attach another clin_narrative row.

> I understand 
> health issues can changes names, my understanding of an epsiode
> was that it was a *temporal*, not thematic, sequence of encounters under a 
> health issue (IOW, only and always the latest episode is open, and they 
> don't change names,
Well, I have never thought of them that way. Yes, they are
sequences of encounters. But they are only related to one given
problem the patient has. Whether or not some of the belong to
one or several health issues isn't of concern initially.

Of course, your definition is workable, too. There's no clear
definition in the literature to follow. It does make sense to
"name" the temporal sequence, though.

> This widget would be perfect if it was for health issues, not episodes. As 
> it stands, its making episodes exactly the same as health issues,
> just a level below.
And rightly so, as this is what I have in mind after studying
the literature. Ignore health issues until you very obviously
see their value.

Karsten
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