[Gnumed-devel] idea (Part 2) for improved narrative representations in EMR Journal and EMR tree

[James Busser]

> From: "Rogerio Luz" <address@hidden>

> But I am not the best person to opinion because the journal view  
> for me is
> practically useless

If the Journal view is felt by people to be useless let us make it  
(more) useful. I actually just realized that when making a follow-on  
(addendum) note on any one particular issue/episode in a still-open  
encounter, the follow-on (addenda) notes could easily be positioned  
to hang off the end of the original associated note for that episode  
(see below entries time-stamped 1545h and 1625h).

Karsten had pointed out that when the encounter would cross midnight,  
this may or may not be evident from the time stamp and there is  
always the possibility of an encounter crossing two or more  
midnights. To address this use case, the date could be in most cases  
suppressed, and shown only when the modified_when date is different  
than the encounter start date, in the format

        ---------- <user abbreviation> (<hhmm>h yyyy-mm-dd)

Footnotes in the example below are expressed within [  ]

=================================
In office 2008-09-15 PST (open | closed: <datetime>) [ 1 ]

RFE: flu?; f/u depression
AOE: Strep throat; improving depression

---------- LMcC (0945h PST) [ 2 ]
S:   Flu? [ 3 ]
S:   Dry cough, temp 38, rhinorrhea 4 days. Achiness but
      no distinct myalgia. Went to clinic yest. No Rx.
O:   T 38 BP 130/80 HR 96 reg Nasal congestion, pharynx
      non-exudative, chest clear, minor cervical adenopathy
A:   URTI, viral, presumptive
P:   Fluids, rest, hs codeine 15-30 mg x 4.

---------- LMcC (1545h PST)
S: addendum
S: lab phoned: throat swab from clinic grew Strep spp
P: Contact patient

---------- LMcC (0005h PST 2008-09-16 )
S: patient callback
P: information relayed, recommendation made for abx
   Rx Pen V etc phoned to 24-hr Shopper's Drug Mart

---------- LMcC (0947h PST) [ 4 ]
S:   f/u depression
S:   Sleeping better, less tearful. No drug s/e
O:   Affect improved
A:   Responding to Rx
P:   Cont same dosage, r/a 4 weeks
=================================

Footnotes:

[ 1 ] this is the modified_when timestamp not clin_when
        It assumes we might agree on Journal as "real time" along
        the *documentation* perspective

[ 2 ] when the date is the same as the date on which the episode opened,
        only the time is shown. Does anyone prefer that the time zone
        is always shown even when it is only hhmm that is displayed?

[ 3 ] this is the "S"oap row "patient request"
        --> we need to engineer for it to be sorted at top among soap
                rows for the episode

[ 4 ] note was saved 2 minutes after the other problem "flu?"
        which was dealt with in the same visit / encounter

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Also, the EMR tree already serves as a "filter" to what is shown in  
the right pane of the EMR tree, but is there any reason why -- apart  
from building according to clin_when dates -- the EMR tree right-side  
cannot share the same format as shown in the EMR Journal?

If we would use the above example and for convenience assume the same  
clin_when dates were unaltered, then depending if you would click at  
the level of the Health issue, or one Episode or Encounter of  
interest within an issue, would control the extent of information  
displayed.

In other words, click in the EMR tree (left side) on

   Depression

and at right in the tree you would see only the notes attributed  
under depression:

=================================
In office 2008-09-15
---------- LMcC (0947h)
S:   f/u depression
S:   Sleeping better, less tearful. No drug s/e
O:   Affect improved
A:   Responding to Rx
P:   Cont same dosage, r/a 4 weeks
=================================

and if in the tree you then clicked

   Strep pharyngitis

then at right in the tree you would see only

=================================
In office 2008-09-15
---------- LMcC (0945h)
S:   Flu?
S:   Dry cough, temp 38, rhinorrhea 4 days. Achiness but
      no distinct myalgia. Went to clinic yest. No Rx.
O:   T 38 BP 130/80 HR 96 reg Nasal congestion, pharynx
      non-exudative, chest clear, minor cervical adenopathy
A:   URTI, viral, presumptive
P:   Fluids, rest, hs codeine 15-30 mg x 4.

---------- LMcC (1545h)
S: addendum
S: lab phoned: throat swab from clinic grew Strep spp
P: Contact patient

---------- LMcC (0005h 2008-09-16)
S: patient callback
P: information relayed, recommendation made for abx
   Rx Pen V etc phoned to 24-hr Shopper's Drug Mart
=================================