[Gnumed-devel] Family Hx, Allergies etc containable as Health Issues and feeding the caveats

[James Busser]

I am wondering to what extent it could be ideal to use GNUmed's  
health issue structure to manage what are considered "customary  
sections" of a patient's health history.

I could envision a health issue e.g. "Family Hx" which may be able to  
be created (if it did not already exist) as a debugged consequence of  
typing a keyword (e.g."fhx") and filling in the popup dialog.

A doctor could create one or multiple "episodes" nested under this  
item, one for each known or even suspected condition in the family.  
These items would most often remain inactive, but could be made newly  
active as the need arose. I could envision that when a patient  
presents with leg swelling that turns out to be a deep vein  
thrombosis (DVT aka "clot"), it may come up that the patient recalls  
something about their father having had a "clot".

Prior to the current clinical episode of leg swelling, it would have  
commonly gone unknown that his sister or father had had a "clot" and  
so this new episode "query clot in sister/father" could be created  
and nested under the Family Hx (in addition to the patient condition  
of DVT). The plan could include the need for the patient to obtain  
more information from his family and, in view of this being  
unresolved information, the episode could be made active. When the  
patient returns, he could reveal that his sister's clots had been a  
history of painful menstrual clots and that his father had had a  
heart infection passing a clot to his brain, permitting updating of  
this "episode" of family history and a redesignation as not active  
and not relevant. The family history would then disappear from the  
EMR tree and Progress note widget lists.

Conversely a determination of a family history of malignancy,  
especially premature or multiple malignancy, would cause such items  
to be marked "relevant" because to inform your patient's ongoing risk  
of personal cancer and help better decisions concerning screening and  
diagnosis. While always deserving to be relevant when reviewing this  
patient's overall problem list. the component items (episodes) might  
only be toggled "active" when useful to make them visible in the  
Progress notes widget, such as in preparation for a visit where the  
q3yearly colonoscopy is needing to be discussed and then made  
inactive when it yields a normal finding.

Even when a family condition is absent in a patient, that condition  
in the family member (think cancer, Huntington's, dementia) can be  
very important to your patient's health and/or their ability to keep  
to a care plan.

Social history could work in a similar fashion with respect to risk  
behaviours (smoking, ethanol, sex) and could include a subitem  
(episode) of relationship stress when applicable.

The beauty of what GNUmed already makes possible is that for any item  
in which *some other person* is discussed, for example in the family  
history, or in the social history where drug abuse or sexual or  
psychiatric issues (say, within the family or with partners)  
justifies the assessment or treatment of the patient, the SOAP editor  
makes it possible to preserve a record while segregating the directly  
or indirectly identifying information into threads that could be de- 
selected for export where a referral for consultation or a review of  
care did not require them.

Could allergies fit into such a model? Can a health issue, or one or  
more of that issue's episodes (relevant allergies, or a personality  
disorder or its periodically violent behaviour) programatically feed  
the caveats using a "caveats" indicator at the episode level?