[Gnumed-devel] Progress note workflow walkthrough and improvement (?)

[James Busser]

I am doing a mental walkthrough of how to use the chart. Use-cases  
include (but are not limited) to:

- review of the chart in order to assist external colleagues in their  
care of a shared patient (here, the EMR tree profile and the EMR  
journal informing the content of the last few encounters)

- managing your own care of your patients. Responsibility across  
multiple patients is maybe best managed by some combination of the  
Inbox and as-yet undeveloped "to do " functionality (maybe  
scratchpad). Activity within a single patient is maybe best done from  
Progress notes widget.

Within the visit widget, you want to orchestrate (manage) how much is  
wanted to be achieved. The Active Problems list is beautiful to help  
to manage this, but presently deficient (only) by failure to support  
any planned purpose for the new visit. This must somehow be "seeded".  
Use-cases include:
- the front line staff took requests from, and made the appointment  
for, the patient.
- the doctor has already developed a plan for the current visit

The "patient request" field of the widget could hold the patient  
"agenda" (purpose, "hope" even if unrealistic) for a visit. Even if  
this agenda ultimately pertains to multiple splittable issues, it is  
possible to begin with the whole agenda "floating" inside the Patient  
request of a "new episode".

This pooled content would only become manually parsed at the point  
that the doctor decides it is worth to move snippets into one of any  
health issues. As Richard previously offered, in some practices it is  
so busy that doctors will forego this approach *except* when it  
becomes advantageous (time-management-wise, perhaps in the case of  
complex patients) to do otherwise.

Here's an idea: I can confirm that the SOAP editor already supports  
double-click selection of a word and triple-click selection of a  
paragraph, and drag-and-dropping any selections between the sections  
within a single encountlet. However, the wider-ranging potential drag- 
and-drop targets of snippet selections (namely the Active Problems at  
left, and the already-loaded-in-SOAP-widget episodes) are invalid  
targets. Could they be made valid, so that if a selection were  
dropped on the "button" of an already-loaded-in-SOAP widget, the text  
would be appended to the end of the same-section (Soap row, sOap row,  
soAp row etc) of the target? Also, of the target were a health issue  
or episode that was not already loaded in the SOAP widget, the at- 
left item would become loaded and the intended transfer of the text  
could be completed? This would allow the doctor the benefits of
1) not having to click back and forth during the interview/exam in  
order to enter text into desired target areas
2) facilitating the benefits of efficiently moving the text nearer  
the end of the visit, when the clinical determination of goodness of  
fit into existing problems that may be active (or which need to be  
made active) is more possible.