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

[Karsten Hilbert]

On Wed, Sep 14, 2005 at 08:19:45AM +1000, Richard wrote:

> Regarding your comments on complexity I agree we have to
> look beyond the single encounter visit. 
Beyond the single *problem* visit, right ?

> As you mentioned, having to input SOAP notes as we do
> currently, we end up with
>
>  S ...
>  O ...
>  A ...
>  P ...
> 
>  S ...
>  O ...
>  A ...
>  P ...

That is what I would expect. It also fits my workflow quite
well. I capture what I am told, what I find, what I think
about it, what I do about it. I am going back and forth, of
course, but in general that's how I work.

Notice how this does not predefine how the data is
*displayed* later on !  The EMR is a tool to make things
*easier* for us. We can use one format to make input follow
our workflow but use *another* format to guide our reception
of information later on. The requirement for this ability is
that the input is in some sort of structure. That's
precisely the point. On paper I am forced to write down the
notes in a way that will facilitate easy reception. No
reformatting is possible unless I have the notes
transcribed! Such *is* the power of using a machine and
using structured data. That's exactly why we want to give
the machine some idea of what's what !

So, in the end, the statement "we end up with ..." is wrong
(thanks $DEITY). What we end up with is a bunch of unordered
lines of text thrown into an opaque bag called "table". It
is *our* responsibility to grab the proper lines from this
bag and display them any way we see fit. For that to be
possible we need to add metadata to the text when throwing
it into the bag: who, when, what type of text, which
encounter, which problem, etc.

> The essence of the encounter which we as a doctor
> immediately grasp is that of poor diabetic control
Hence we use "poor control" for the AOE of the encounter and
"foot problems" and "high sugars" for the progress note
assessment lines.

> Diabetes
> =====
>  - poor control:
>       Having trouble adhering to diet. Checking ~ 2x daily, staggered
>       times, 9-13 mmol/L
>       last A1C 0.09% ( is it under O we would comment on test results,
>       under A?)
>       Agrees to incr meds while continuing effort at wt loss
>       Incr metformin 500->850mg bid
> 
> - diabetes mellitus (foot care)
>       Noted slight drainage on socks past 3 days. No
>       pain/red/fever/trauma but new shoes 7d ago.
>       (Details of exam)
>       Assement Whatever
>       Plan Whatever'

And yes, one could reformat the above notes into that sort
of display - that's precisely what I asked for when I wanted
HTML snippets for how you guys want the notes to be
formatted. The above is simply:

$health_issue
=============
  - soAp
    Soap
        sOap
        soaP

  - soAp
    Soap
        sOap
        soaP

(Apart from the fact that we cannot currently have two open
episodes at once.)

> The more and more I play with this type of data entry in my consultations, , 
> the more I'm coming around to Malcom Irelands view (and I suspect Horsts and 
> David Guest's as well) that we need a large single textbox to collect all the 
> information we type in,
Sure, no problem. If you guys want a single text box you can
have it. Simply save all the text under, say, Soap (or
whatever category) and be done with it. Within that
narrative line the information can be structured any way. A
viewer can be made intelligent enough to not destroy the
pre-existing formatting and to ignore empty categories. That
way within the structure unstructured data is saved. The
additional structured data (scripts, vaccs, etc) can happily
coexist.

Karsten
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