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


From: Karsten Hilbert
Subject: Re: [Gnumed-devel] EMR tree display of allergy
Date: Sun, 21 Sep 2008 01:25:27 +0200

> 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".
Exactly, and the state of allergicity (?) ist not a Health Issue but rather a 
Non-Issue.

> 1) absence of information in the Caveats (an empty box) is  
> ambiguous...
If there is no information there there is no known allergy. Other states are 
shown explicitely.

> 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 "?".
Please file as wishlist.

> 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.
The "summary" menu item should be more appropriately renamed "statistics" cause
that is what it shows. Of course, a clinical summary MUST contain allergy state.

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

- patient was asked but refused to disclose
- it explicitely models the case "I did my best, you cannot sue me"

> 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").
For such things there are other states.

> Therefore, I am wondering if the intended use  
> is meant to cover this situation,
No. Clarification was sought but denied.

> It may be a subtle distinction, but while "Undisclosed" *could* mean  
> that the patient elected not to answer i.e. was not co-operating...  
yes

> 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?
I did want to model "not co-operating".

> 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.
Exactly, such as to perhaps prompt again at prescription time.

Karsten
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