Re: access to review audits (was Re: [Gnumed-devel] encounter edit before final save)

[Karsten Hilbert]

On Wed, Aug 13, 2008 at 12:15:16PM -0700, James Busser wrote:

> For lab and other tests, there can be a requirement for the doctor who 
> ordered a test to sign it. Thus if a test or a test revision was (in that 
> doctor's absence) signed-off by a colleague, some jurisdications may 
> require, and some groups may desire, that he first doctor who had ordered 
> the test (also / additionally) sign it off.

GNUmed currently also supports

a) unsetting the review status when a document part is changed
b) thereby re-notifying the responsible clinician via the inbox

c) notify the responsible clinician of a test results review change via the 
inbox

Jim, do you think we should invalidate a test results review
when said result is modified ? (this would, in turn, notify
the responsible clinician courtesy of the then-lacking review)

> people know that some things have been changed but to ignore the fact 
> that other things have been trivially changed.

This is part of the challenge of making narrative usefully
editable. I would desire to not require any additional
action/make auxiliary notes of the change when only a
trivial edit is undertaken while larger changes might
somehow be wanted to be signalled while yet larger changes
might somehow be prohibited or at least required to be
deliberately acknowledged to proceed.

Which has its own set of problems because the one-character
edit of "typical signs of appendicities +ve" to "typical
signs of appendicities -ve" makes all the difference in the
world.

> There does sit, on the modifier of clinical information, a  
> responsibility to make sure that any who would be affected are notified.

Yes, and that's part of due clinical diligence which isn't
taken away (if facilitated) by using any EMR.

>       Prog note of August 6 recorded patient referral to cardiologist when  
> actual discussion & pat expectation was referral to respirologist.  
> Cardiology referral cancelled. Respirologist referral booked. Pt  
> notified.
>
> Some might ask "why then also (bother to) alter the original note"?  
> Well, if you embed -- in the referral to the respirologist -- a progress 
> note which incorrectly recorded a plan to refer to a cardiologist, the 
> note would not make any sense.

But it may not make sense to "correct" rather than
"annotate" the original note. I usually change the original to

"referral to cardiologist (no, respirologist, Aug 8th, hil), appt booked"

or some such.

Karsten
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