Re: [Gnumed-devel] 0.3.2 feedback: EMR tree also Past History item behaviours

[Karsten Hilbert]

On Sun, Oct 19, 2008 at 04:53:51PM -0700, Jim Busser wrote:

> Yes, there must have been an episode of illness. But there may -- or may 
> not -- have been an episode of care around that illness.

To the point, as usual :-)

> I have been thinking further around retrospective documentation. Think of 
> a patient who comes into the praxis with a discharge summary from a 
> hospitalization during the 8 months that the patient lived and worked in 
> Italy. I might choose make an episode "hospitalization, Florence IT" 
> under the problem(s) which got care.

Under which I would file scans of the paper record w/o any
other notes for the time being.

> Each problem, where it would be 
> useful, could cause me to input 2-3 lines of information so that I can 
> better maintain a record of the patient's care (including care not 
> delivered by me).

I agree that when I expect that patient to be a now-regular
it can be useful to pre-seed the record with a few select
health issues pulled from the Italy record.

> Can we think through how any difference between clin_when and care_when 
> would be managed?

"old" health issue:

 - clin_when: dob + age_noted from record content
 - care_when: start/end of back-dated episodes taken from record
 - modified_when: now

old episode:

 - clin_when: defined by earliest/latest start/end of associated data/encounters
 - care_when: same as clin_when
 - modified_when: now

old encounter:

 - clin_when: same as care_when
 - care_when: defined by start/end
 - modified_when: now

old soap/whatever data:

 - clin_when: explicit where appropriate (vaccination, allergy, etc)
 - care_when: defined by containing encounter
 - modified_when: now

Might this belong into the wiki ?

Karsten
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