Re: [Gnumed-devel] Misconceptions about scratchpad, inbox,reminders.

[J Busser]

At 9:16 PM +0100 3/7/05, Karsten Hilbert wrote:
> Do you *really* want your general doctor inbox to hold all
> unreviewed lab items of all patients? Also, in your first design
> iteration the inbox was part of the clinical screen. It would
> then surely only contain items related to that patient and
> perhaps items that are for "you" but not specific to any
> patient, no ?

I was thinking that the importer could identify the ordering (or cc) 
doctor + patient combination for each test result, check whether the 
inbox for that doctor already has an inbox notification for that 
patient that has not been viewed and, if so, does not bother to 
create a new inbox record, because the doctor on checking their inbox 
can already be aware that there is something to check for that 
patient.

> The *patient* inbox I was thinking about would contain data
> pertinent to that patient, eg in the example of Mr Smith above
> it would contain the unreviewed (perhaps only abnormal) lab
> results in detail.

The inbox notification for that doctor / patient combination can have 
a flag for whether or not any of the results that have come in are 
abnormal. As soon as a result is imported that *is* abnormal, the 
flag could be updated.

If a practice of 3 doctors each sees 40 patients a day (I have no 
idea on the average for any GPs) let us just wildly assume this 
approximates the volume of patients for whom there is an information 
update. These notifications could be test results from tests that the 
group has ordered on previous days, could be cc results to do with 
care given elsewhere, could be correspondence like consultants' 
reports, could be messages from the pharmacy about medications a 
patient has run out of, could be new to-dos once we have put in place 
some kind of task tracker.

Let's say a doctor was out of the office for a day, they come back 
they have in their (individual) inbox

- 80 patients who have test results notification (these notify in 
fact of 800 tests but there is not a need to put all 800 in the 
inbox!) and it could be included in the inbox that of those 80 
patients, 50 have abnormal tests and if we supported the ability to 
store "critical" abnormal levels if that is what a lab provider can 
notify, we could know that 7 are critically abnormal. Optionally the 
importer, as it was updating the status flag of whether any of the 
tests were abnormal, could increment how many test there are to 
review, however would get out of sync of the doctor reviewed some but 
not all.

Maybe incoming correspondence would be counted among "results", they 
could be requests for information so should maybe be tallied 
separately. Also 20 patients for whom a pharmacy (or the patient) has 
called to indicate prescription expiration. And messages / to-dos 
depending on the relative role of email and if a task tracker has 
been implemented.

- when focusing on a single patient, it should be possible to see the 
same notifications pooled across doctors (and pooled across 
non-doctor office staff to whom tasks may have been delegated) but 
filtered on that patient. These items could be subgrouped by the type 
of item. It may be that 2 or all 3 doctors had been touched by 
results for that patient because one ordered tests, another was the 
usual doctor who received copies from tests done elsewhere, there is 
no need to be shows 2 occurrences of "there are test results to 
check" but I suppose the notification of one doctor may have been 
normal and another abnormal.