Re: [Gnumed-devel] EMR tree display of allergy

[James Busser]

On 19-Sep-08, at 2:42 AM, Karsten Hilbert wrote:

> > if in the course of a visit it is being
> > thought about to prescribe a medication or other drug (or give a
> > vaccination like influenza where there could exist egg allergy) the
> > clinician could always look at the upper left corner of the Active
> > Problems list to see
> or else they could look at the top right Cave field hovering the  
> mouse over which will
> reveal further detail to the allergies listed there, double- 
> clicking which will allow entering
> a newly elicited allergy


I might dispute the contention (per the email before) that the tree  
should show only "diseases" since the tree is, after all, supposed to  
list "Heath Issues".

I can accept not to list the absence of allergies in the list but  
would want us to better-address two deficiencies:

1) absence of information in the Caveats (an empty box) is  
ambiguous... can it be taken to mean the absence of allergies, or  
only the absence of allergy *information* ?? Perhaps no one had yet  
asked, or maybe they had asked but somehow failed to put it into  
GNUmed. Can I therefore suggest -- at minimum -- that while the  
allergy state is Unknown (which is the default at new patient  
creation) the Caveat field should display a "?".

2) absence from the EMR Summary of the known Allergy state. In my  
view when referring the patient and potentially providing a copy of  
the Summary, the presence of known allergy information will be  
included but the fact that to the best of our knowledge, the patient  
has no allergies is important to include in communications.

While I am at it, can I ask the intended use of the allergy state  
"Undisclosed"?

        http://lists.gnu.org/archive/html/gnumed-devel/2006-08/msg00006.html

While a patient's refusal to answer is possible, I suspect in the  
area of allergy it will more often denote an inability to remember,  
or a lack of knowledge. The patient may be unsure, and accompanying  
caregivers may likewise be unsure, or they may know the patient is  
allergic to something, while being unsure what it was ("an  
antibiotic, I think"). Therefore, I am wondering if the intended use  
is meant to cover this situation, as if to say that further  
clarification may be needed or perhaps even in-process.

It may be a subtle distinction, but while "Undisclosed" *could* mean  
that the patient elected not to answer i.e. was not co-operating...  
it could also mean that, not having been asked, neither did it occur  
to them to offer the information spontaneously. A more egregious  
assertion on our part would be if despite their actually having told  
us, we did not notice or remember having done so during our  
preoccupation with some other thought) :-)

So to me, in the situation where the question *had* been specifically  
asked, IMO "Unresolved" or "Pending" (if collateral were requested)  
would make clearer that the question was at least asked but that any  
lack of resolution was not necessarily from lack of co-operation. Is  
"Unresolved" acceptable?

While there is nothing stopping someone entering a text value in  
trigger and comment that would further detail the situation for any  
given patient, I am assuming there can still be programmatic value to  
recording Undisclosed (or Unresolved) as a "state", for example for  
programmatic purposes.