Re: [Gnumed-devel] Re: Cannot change the dates of the encounters

[Karsten Hilbert]

On Sat, Sep 06, 2008 at 03:51:59PM -0700, Jim Busser wrote:

>> What exactly should we regard as the "literally" chronological journal 
>> ?
>>
>> Literally as in time-of-insertion or time-of-clinical-occurrence ?
>
> Time-of-insertion, *and* the time-of-clinical-occurrence are important. 
> Since the journal is the record, I was thinking in this context "literal" 
> would refer to the insertion.
>
> Time-of-clinical-occurrence is already the basis of the EMR tree, so I 
> was thinking we could / should use the EMR journal to display along time 
> of insertion.

I have written up the current understanding of times as used
in the GNUmed project here:

        http://wiki.gnumed.de/bin/view/Gnumed/GnumedTimeConcept

Thus, a third time becomes relevant to the question above:

        The time-of-care-process.

We need to decide among those three by which to order the
Journal. It seems there is equally good arguments for each ?

> If you look at the Journal the way that it works presently, GNUmed would 
> not (?) present to you that this was part of the discussion of the last 
> visit, coming about as a result of the praxis receiving a copy of the 
> report ordered 5 months ago by a walk-in clinic doctor elsewhere. 
> Assignment of a clinical_when of 5 months ago would move the information 
> potentially several screens up in the Journal.

That is why the Journal should be ordered by
time-of-care-process rather than either of the other two.
Time-of-insertion could move the information further down to
when the receptionist transcribed a voice-recorded note
while time-of-clinical-occurrence might move it up to, say,
5 months ago as you correctly note.

> Or maybe part of the last 
> visit would concern the discussion, but it would not show the (late) 
> entry of the radiology report, since that had been given a clin_when of 5 
> months ago and legitimate because after 5 months the condition of the 
> spine could have changed.
Correct. The clin_when of the xr report *content* would
legitimately be -5/12 while the modified_when of the entry
would be last night at 23:15 by the transcriptionist. But
the really relevant time would be the encounter start/end
during which the existance and content of the report was
relayed to us. I do think the time of technical insertion
may make sense to be displayed in parenthesis, though, as it
may help to explain a difference in knowledge between the
memory of the doctor who received the report first-hand in
the encounter and the follow-up doctor who looked after the
patient, say, 21:00 later that night while the earlier note
was only committed at 23:00 by the secretary ...

Do we agree here ?

Karsten
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