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

[James Busser]

On 25-Sep-08, at 4:42 PM, Karsten Hilbert wrote:

> And I meant not to show the no allergies state there, not the  
> string "no allergies" ;-)

I am quite agreeable to not show, in the *tree*, the lack of allergy.

I only made that proposal be cause I (mis)understood there to be  
tight linkage between what gets shown in the right-side of the EMR  
tree as the statistics, and what may be easily transmissible if  
referring the patient to a consultant. Maybe without too much work,  
it can be possible to provide the consultant with something which  
overlaps, yet is a bit different from, the stuff that appears among  
the EMR statistics.

This reminds me that a local GP (talking about EMRs) said how even  
though he likes his EMR overall, it still bothers him after all these  
years that the orthopedic surgeon is provided a hard-coded summary  
and the GP has no easy ability to exclude the therapeutic abortion  
from age 17 and the maybe-not-rigorous diagnosis of depression or  
personality disorder entered a couple of years ago. Another GP added  
the concerns about the parent who insists on viewing the record of  
their child when it might contain items that ought not be disclosed  
to a parent (as sometimes happens during marital disputes and  
accusations, but which need not involve disputes or accusations).

What I was thinking we could model includes:

1) when generating an EMR summary export -- for shared care or  
consultation purposes -- any Issues marked "Confidential" would  
prompt the user whether to include none, all, or some of these issues  
in the report

2) for the situation where workers in the praxis (or patient proxies)  
should be allowed to see / review some issues (but not the  
confidential ones) the EMR contextual menu could be given additional  
options

        Show all issues
        Show only non-confidential
        Show only confidential

where "Show all issues" would be the default for some or all levels  
of clinicians, who could choose to alter the EMR display for special  
purposes such as reviewing with a proxy (parent) the non-confidential  
items

where "Show only non-confidential" could be the default for certain  
helper staff who might be given no other option

where "Show only confidential" makes it easier to check if there is  
something that *was* confidential but which the patient is at this  
stage more willing to have it easily able to be known to outside  
clinicians