Re: [Gnumed-devel] next version progress note plugin

[Karsten Hilbert]

On Thu, Feb 08, 2007 at 09:53:20PM +1100, syan tan wrote:

> ideally, problem-based structuring would work, but in think it doesn't
> always in practice, and sometimes , if notes aren't too detailed, it's 
> better to do a quick review of the entire recent notes , using a scroll
> bar, not necessarily predicted to be related to the current problem,
> just at a particular time.
We already have that in the "EMR Journal" view but it will
become integrated with the next-gen progress notes editor as
described recently.

> One app has a list of chronologically ordered
> encounters, and clicking on the encounter gives all the notes on 
> all the problems /plans described for that encounter, in a third
> viewport
That will be another sort mode for the EMR Tree viewer once
I get around to enhancing that (or someone else). Now it is
by-problem while, eventually, it will be selectable either
by-problem or chronologically. The TODO

        http://wiki.gnumed.de/bin/view/Gnumed/GnumedTodo#EmrTreeBrowser

has the inside scoop.

> There is no mandatory labelling of the notes however in this app.
>       Another consideration, is that sometimes , notes might be
> given about multiple complaints, but covered as a single Hx Ex Dx Ix Mx 
> sectioned note, because it's easier to chronologically take down
> the history without classifying it , like a stenographer, 
> and then examination findings ( which are problem directed), but
> the formulation behind the directed examination only revealed
> in the Dx part,  which lists the problems formulated;
> in fact, the SOAP structure for multiple problems only comes
> in the Dx Ix Mx part as multiple iterations for each problem formulated,
> but Hx and Ex are just single. Just another slant about
> how notes seem to get naturally written.
Certainly, an all this applies to "random" encounters (which
are indeed not uncommon) as opposed to scheduled reviews. It
is a classical chicken-egg problem: In hindsight we want
Hx/Ex structured by problem as well, but can only really say
so after the fact.

Eventually one needs to come up with a way of entering Hx/Ex
in a non-problem-oriented just-type way and allow for *very*
easy separating out into SOap when Dx has been established.
Something to make moving about bits of history/findings
recorded earlier in the encounter easy enough for actually
doing it. Essentially "tagging" bits of Hx/Ex with problems.

Maybe one can borrow UI ideas from multi-file concurrent
editing conflict resolution software here.

That'd be some novel way to handle notes. I'd love to have
good ideas here.

Karsten
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