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Re: [Gnumed-devel] q about schema

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] q about schema
Date: Sat, 12 Aug 2006 12:12:27 +0200
User-agent: Mutt/1.5.12-2006-07-14

On Sat, Aug 12, 2006 at 09:49:41AM +0800, Syan Tan wrote:

> 1. where is nil known allergies stored ?
- either non-explicitely as in "no rows in clin.allergy"
- or clin.allergy_state

Not sure whether we should favour the one approach over the
other. I like the first approach as it does not lead us to
work with data which may be stale: Even if my system says
"no known allergies" when prescribing a new drug etc I still
need to ask the patient about allergies having become known
since I last asked.

The benefit of the second approach is that one could
explicitely model various state of non-knowledge. I would,
however, argue that better be left to OpenEHR and the time
when we start using it.

> 2. where to put warnings or alerts ?
- on the TODO for 0.3, as in general CAVE functionality,
  input solicited, the roadmap and TODO list have items
  waiting to be added on to
- learning from Richard may make sense here, too

> 3. how and where to put family history items?

This is a bit complex because one wants to be able to store
family history both for family members that *are* in the
database as patients as well as those that are not. Also,
one wants to be able to attach Auntie Tillies cardiac arrest
past history to both her daughter as well as her sister -
IOW reuse family history items. We use two tables to solve

1) clin.hx_family_item

   - stores the actual family history item
   - can either be foreign keyed to a patient in the database
   - or contain explicit name/dob of a family member
   - this is the family member to which the item applies
   - Aunt Tillie as in the above

2) clin.clin_hx_family

   - links hx_family_item rows to patient identities
   - this is the patient for which the family history was obtained
   - IOW daugher vs sister of Aunt Tillie
   - this table also holds how the family member is related to the patient
   - "daughter", "sister", respectively

BTW: Kirk has a (medically unsound) example: His brother
died of a Denevan neuro parasite.

> 4. smoking and alcohol , preferred way of storing ( ? temporary) 
- no well-defined tables yet
- approaches inlcude:
  - learn from Richard
  - use clin.clin_narrative rows
    - attach appropriate clin.clin_item_types
        - eg type = "habits", code = "hab" or similar
  - the latter is likely the easier short-term solution
    which still offers forward compatibility at whatever
        granularity one choses (various clin_item_types)
  - soap_cat would be "S"

> 5. occupation, where ?
- dem.occupation holds occupations in general
- dem.lnk_job2person, links, well, jobs to persons :-)

Feel free to ask for further clarification where needed,

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