Re: [Gnumed-devel] on meaningfully signing off reviewed items

[J Busser]

self-replying on the issue of "on updates"

At 12:05 AM -0800 1/29/06, J Busser wrote:
> So if a row becomes modified, it becomes subject to the audit trail 
> which would make it clear that it had been altered, potentially by 
> someone other than the person who signed it. So the only remaining 
> problem is our contention that the doctor carries the responsibility 
> to view and acknowledge the alteration. While the record would carry 
> the modified_by value that pertains to the user who did it, any 
> existing value for "signed by" would no longer have clinical meaning.

... what I mean is, the "signed by" would no longer accurately convey 
the clinical acknowledgement and acceptance of responsibility... it 
would be misleading

> So we should specify "on update, signed_by is NULL"

... just realized the problem with this... it precludes ever signing 
a row unless, it was signed as part of the original record creation. 
And then if it were amended, you could never sign it under the above 
constraint.  So is what we want, the following:

- do not *require* a row to be signed in the back end, for an 
unsigned row is part of the workflow we are needing to capture

- allow a row to be signed whether the row was being originally 
created, or updated

- if a row *was* signed, and was *afterward* updated, the update 
needs to contain a null signature in order to be able to flag it as 
having again to be reviewed & signed off. The fact that it gotten 
altered if by someone other than the original signer would show up in 
the audit log, but that is not enough for safe practice because we 
want to be able (in the workflow) to identify rows that *again* need 
review & signoff.

Any chance that the Postgres "on update" function can constrain based 
on the most recent (pre-update) value of the row? For example, "on 
update" requires signed_by to be null if the updating user is 
different than whoever signed it? Or do we allow a doctor other than 
the individual who signed it originally, to sign the newer version? 
We can constrain that only clinicians can sign, but maybe it needs to 
be in the GUI that in the event of a clinician updating a row 
previously signed by another clinician, the value in signed_by 
defaults to none and it is then up to the updating clinician to 
decide whether to sign it, or to leave it for the original clinician.