[Gnumed-devel] encounters... extend vs new, and how to decide? was: improved soap notes creator screenshot

[Karsten Hilbert]

On Sun, Nov 23, 2008 at 08:17:46PM -0800, Jim Busser wrote:

> The examples are easy to imagine in any multi-doctor praxis where more 
> than one doctor had to access (and make entries in) the record during the 
> window of an unexpired encounter. Invariably there will be portions of 
> the day when some but not all doctors (clinicians) are available to deal 
> with issues.

> Additionally, it is not all that unusual for the clinicians in a  
> multi-clinician praxis to have partial specialization where patients may 
> get care for a special thing from one doctor in the praxis while getting 
> the remainder of their care from their usual doctor. A variation on this 
> is in low population areas where a specialist may visit weekly or monthly 
I see.

> If a specific example is still desired, let us say that during the  
> morning, a patient ran out of a medication, and a pharmacy phoned the  
> praxis to obtain approval for renewal. Clinician 1 approved the renewal, 
> being the patient's usual doctor, or because the usual doctor was 
> unavailable that morning, and the patient needed the approval without 
> delay. We now have an encounter active...
> ... One or two hours later, the patient arrives to see clinician 2 for 
> any number of reasons such as a URTI or a pre-scheduled papanicolau smear 
> or any number of reasons which may be unrelated to the unexpired 
> encounter. Clinician 2 activates the record and is prompted whether or 
> not to begin a new encounter. Unless Clinician 2 would wait until the 
> patient is in the room and then ask *them* the reason GNUmed had been 
> open earlier that day
Why ? Clinician 2 will see the RFE/AOE, duration, and type
of encounter right in the dialog asking whether or not to
continue ? It's always been that way. It looks a bit like this:

------------------------------------------

This chart has been accessed only recently !

RFE: needs insulin refill
AOE: authorized Drugs'n'Goods, 11 Levenshtein Street

by phone (21.11.2008 8:45 - 8:57)

Do you want to continue that encounter or do
you want to start a new one ?

[Continue]                [New]

-----------------------------------------

Additionally, the clinician really *should* be able to know
of the (patient-expressed) RFE for the NEW show via a
waiting list note mechanism.

For those cases where the patient will not at all reveal
anything about the new encounter before actually seeing a
doctor (which may be very reasonable) the clinician will
have to ask for the new RFE anyway.

> When an office assistant would activate a patient with an open unexpired 
> encounter, is the office assistant given the option or requirement to 
> choose to extend the current encounter or to begin a new one?
Currently they would *have* to decide. It could be made
policy to have them always extend the previous encounter.
Their machines/logins could also be configured to have an
"inifinite" minimum duration of an encounter which would
then never ask but always extend or an "infinite" maximum
duration which would then always start a new encounter.

> When an importer script has added data (e.g. lab results) into the  
> backend... do we have different expiration threshold settings on a  
> per-encounter basis with the result that some types of encounters are  
> not left to the user to decide whether or not to extend?
not based on the type but we can configure that per user and
per workplace

Karsten
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