Re: [Gnumed-devel] emrjounalplugin.py comments further html work

[Karsten Hilbert]

On Tue, Sep 13, 2005 at 11:58:00AM -0700, Jim Busser wrote:

> We could have
> - diabetes mellitus (control)
> S - Having trouble adhering to diet. Checking ~ 2x daily, staggered 
> times, 9-13 mmol/L
> O - Last A1C 0.09% ( is it under O we would comment on test results, 
> or under A?)
> A - Agrees to incr meds while continuing effort at wt loss
> P - Incr metformin 500->850mg bid
>      (using whatever trigger text would activate the medication list)
> 
>  - diabetes mellitus (foot care)
> S - Noted slight drainage on socks past 3 days. No 
> pain/red/fever/trauma but new shoes 7d ago.
> O - (Details of exam)
> A - Whatever
> P - Whatever
> 
> likewise for dyslipidemia and hypertension
> 
> Richard may prefer to enter all this in a *single* SOAP note (maybe 
> I'm wrong).  But under what Karsten has been proposing, the "parts" 
> (dm control, foot care, lipids & hypertension) would each be 
> encountlets  (encounter-lets) within one encounter.
Precisely.

> So if the RFE originated from a patient saying "foot problem and 
> refill BP meds" is this a single row RFE that gets attached 
> unalterably to whichever issue the front desk or the doctor chooses? 
Not unalterably but, hey, I think you have a point here:

Should we not make RFE attach to the *encounter* instead of
it being a clin_narrative row (which would need to be
attached to one episode only) ? Surely the patient isn't
expected to deal with episodes and present suitable RFEs.
Still the RFE can be auto-copied for edition into Soap for
each episode that's appended to during the encounter.

> Is there a requirement that each encountlet have an RFE, or can we 
> have a single RFE for the encounter?
Likely the latter - what do other clinicians think ? Elizabeth ?

> In our display of what occurred in that encounter, if in the EMR tree 
> we clicked, inside an issue/episode, onto a single encounterlet, we 
> would presumably see only its parts (together perhaps with a shared 
> RFE if it's possible).
Yes, it is possible.

> However it is important that we be able to "see' the entirety of what 
> occurred in a visit. So we would need a means of being able to select 
> an encounter (meaning to include/display all encounterlets from that 
> encounter).
Sure. That view is still missing from 0.1. I hope to have it in 0.2.

> RFE
>  S1
>  O1
>  A1
>  P1
>  AOE1
Actually, IMHO:

RFE
 S1
 O1
 A1
 P1
AOE

where AOE == clin_encounter.description == clin_encounter.aoe
== consultation summary == edit(soAp1 + soAp2 + ... + soApX)

> If not, would the user have an option of using a single AOE to tie 
> together the parts into a synthesis e.g. new shoes / cellulitis / 
> hyperglycemia / high BP (role of NSAIDs?)
Yes, that would be Richard's consultation summary. We
already support it now.

> Can the AOE be attached to the encounter without having to be 
> attached to a specific health issue?
Yes.

> Encounter date/time
>    AOE xcvxcv nbncxb bxnbcnx
>    expansion triangle
> 
> under the expansion we would have the encounterlets that made up the 
> encounter, and each encounterlet would be denoted by its issue name & 
> assessment info (or AOE if this had been input down to the 
> encounterlet level?)
Yes, that's the second EMR tree view I hope to have in 0.2.

Karsten
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