[Gnumed-devel] Better-supporting staff and other non-patient persons

[James Busser]

I have no quarrel that the schema treats all persons (no matter their  
role) as needing to exist in the demographic schema.

I only have a problem that the schema requires staff (and by  
extension, any and every other kind of person) to be created first as  
a patient, and to then be "enlisted as staff".

:-)     :-)

Maybe in small towns where there is only one praxis, staff have no  
choice where to get their medical care. However, when there is a  
choice, even if your own care could be the best, staff will sometimes  
prefer to get their care somewhere else. We also recognize that we  
may wish to create (register) additional persons, who are not  
patients and who are not staff, in the database. I am thinking here  
consultant physicians or other clinicians whom we may wish to attach  
as involved in the care of particular patients.

It is totally unreasonable to have to extract actual birth dates from  
these external people as a condition of creating them. IMO it would  
make no sense for there to have to exist, within GNUmed, dozens to  
hundreds of individuals with a pseudo-date of birth of 1800.01.01.

Such people also immediately acquire an EMR with statistics of zero.  
I think it is important to not confuse the fact that someone is a  
person, with whether or not they ever got care, or whether or not it  
is even intended or appropriate that any clinical entries get  
created. This should be protected-against.

My proposed solution would be to include in the dem.identity table a  
boolean bit

	is_a_patient (to be interpreted as, or alternatively named,  
"ever_was_patient") DEFAULT true

This would then permit a validity check, so that if the individual is  
to be a patient and accordingly to have an EMR, the fields dob and  
gender must both be NOT NULL.

However, when a person who is to be created in GNUmed is *not* (for  
the time being) to be a patient, and is therefore not to have an emr  
enabled, then the values for dob and gender can (and must) be allowed  
to be NULL. Accordingly the constraints shold be modified so that NOT  
NULL is no longer a property of the individual fields, but is instead  
a property of a "check"

e.g. identity_ispatient_check	CHECK ((dob IS NOT NULL AND gender IS  
NOT NULL OR is_a_patient IS FALSE)

This would have several implications for non-patients
- it may help inform to not display, into the EMR tree and EMR  
journal, statistics which are zero
- it can help avoid the creation of an EMR and entries  for  
individuals for whom this would be totally inappropriate

Implementation proposal:
===================

The widget "Register new person" is presently able to be called by

        Patient > Enlist as staff
        search results
        Office > Manage master data > Staff > Add staff member
        ?? anything else ??

I suggest to vertically lengthen the widget to provide a row of extra  
space below "Comment" and when the widget is called by Office > ... >  
Add staff member, a checkbox appears in this new space that specifies  
one of

        Is also a patient
        Will also receive care here
        Enable EMR for this person

default "unchecked" and at the point where the widget Finish button  
is clicked, to accept to save even if date of birth and gender are  
empty (null) *provided* that the checkbox remained unchecked.

I would add a menu item

        Office > Manage master data > Staff > Enlist as patient

and give some thought to how it is envisioned that other non-patient  
persons would be managed. I would imagine that when looking up  
consultants they might be searched from within the usual name search  
box using their name or perhaps their specialty (cardiology) is this  
attribute of the person would be included in the search. However for  
the creation of such people and in order to manage sets of such  
people I imagine we would plan something in the Office > menu like  
Office > Manage master data > Other persons (perhaps immediately  
under Staff and above Document types).

Changing the status of a person who was not a patient, to become a  
patient, would require that any missing dob and gender be entered.  
However I cannot see that it is presently supported (in the GUI) to  
alter a person's date of birth or gender.

The clinical plug-ins (EMR tree, Progress notes, EMR journal,  
Documents, Attach documents, and Measurements) should refuse to be  
switched-tom the way they presently refuse when "no patient is  
selected". In other words, they should require more than having a  
*person* in focus, they should require to have *a person who  
is_a_patient* in focus.

I would relabel the "Patient details" widget to "Demographics" which  
will cover the general case whether or not the person is a patient.

Shall I make this a Launchpad Blueprint? ;-)