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

[Karsten Hilbert]

> On Thu, Sep 25, 2008 at 11:10:42PM -0700, Jim Busser wrote:
> 
> > If we now turn it around to suppose we had two patients, both of whom  
> > had been in the praxis x 5 years:
> > - both, at entry, had their allergy information asked: = no allergies
> > - both, over the next 5 years, receive various prescriptions
> > - allergy information for one was re-asked only last week, but since the 
> > information is unchanged, let us suppose that this re-asking was not 
> > captured in the EMR
> >
> > Now I see one of these patients (normally looked after by somebody else) 
> > and I must prescribe something. I can only know that the allergy question 
> > was asked as long as 5 years ago. Does that help me?
> >
> > If I now prescribe something, and there is an adverse reaction, and I am 
> > asked "did you ask if the patient had allergies?" and I say "well, the 
> > EMR said they had none" my answer would evade the question.  It is 
> > possible that I did not re-ask, or --- if I did re-ask --- I cannot prove 
> > that I re-asked.
> >
> > Ideally, I would be able to say that I *confirmed*, at the time that I 
> > made the prescription, any allergy information present or absent from 
> > clin.allergy.
> 
> You now can :-)
> 
> > I would expunge from clin.allergy_state a value for "has_allergy"  
> Technically there needs to be a value.
> 
> > because data here is properly derivative from (yet risks allowing a  
> > value discordant from) what is in the clin.allergy rows.
> The risk has always been mitigated with help of appropriate
> triggers and check constraints.
> 
> > Up until the time that clin.allergy_state was ever for the first time  
> > asked, this table would contain no row for the patient.
> correct
> 
> Karsten
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