[Gnumed-devel] Notes plugin - signaling and linkage among screen splits (plus a "todo" kluge)

[Jim Busser]

Just wondering what extent and capacity for signaling exists between  
the left and right halves, and the upper and lower portions, of the  
Notes plugin split screen.

I notice that when an active problem is single-clicked, no refresh  
occurs in the "Most Recent Related Notes". So, to raise the  
information, needs a double-click, which obliges raising an extra  
notelet editor, if one was not already raised for this problem.

I can see a use-case for the clinician to want to browse down the  
list of active problems' most recent notes. It can easily happen that  
even while a patient came for one purpose, and did not complain about  
the other problems, there is a need (forgotten by the clinician) to  
inform the patient about new information, or to update the assessment  
of the other problems. In the interval since the last thorough  
patient contact, there may have been a plan (not evident in the  
Purpose) to reassess a condition, and/or there may have arrived test  
results (or consultant reports) that need to be dealt with.

In order to brain-parse the record for such things, current options  
(and limitations) are to

1) stay within the Notes plugin, double-click each problem, view its  
most recent note, then Discard each raised notelet editor if it is  
not needed. This is busy-work, and may cost additional time at any  
lag in raising and discarding the notelet editors.

2) jump from the Notes plugin to the EMR tree, set it open to the  
episode level, and down-arrow through the episodes. While this would  
achieve the quick display of (and movement through) the most recent  
note-per-episode, drawbacks are:
- having to leave, and return to, the Notes plugin
- EMR tree may display many closed episodes, in addition to the  
current (open) one
- EMR tree includes relevant but inactive problems which may less  
deserve to be passed through

Is it too resource-intensive for a simple selection (single click) on  
any Active Problem to raise into the lower left this problem's most  
recent note text? If it is so (too intensive) then users also need to  
realize that a single-click will produce an apparent mismatch between  
what is selected at upper left, and what is displayed at lower left.

The left and right splits are not chained together. As a consequence,  
movement among notelet editors has no effect on what is shown at  
left. Perhaps this is OK, as long as the left side is internally  
(upper and lower) consistent, as the clinician may like to keep in  
view the most recent notes related to a *different* problem than the  
one on which they are working on in the right hand split.

Can we alter the left side "Most Recent Related Notes" descriptor to
        "Most recent notes on above problem" or
        "Active problem's most recent notes"

Can we also rectify some "case" mismatch that crept among the 4 split  
areas? For consistency, I might suggest

        Active Problems --> Active problems
        Tips and Hints --> Tips and hints

Clinicians may spend the most time in this plugin and whatever we  
make clear here may reward us by sparing some extent of new users'  
questions and confusion that I have seen in other EMRs... it is the  
basis for my apology to risk seeming fussy.

Do we anticipate that future Tips and hints will be chained to, and  
refreshed with any change in selection of, whichever notelet is in  
the foreground above?

==================
Footnote ideas:

1) presently, it would be possible for users to adapt the Waitlist,  
by creating a zone "todo" and – at patient contact – to filter the  
Waitlist to the current patient. This is probably a good practice  
anyway, even after we had a future way to "mark" tasks arising, since  
the patient may be in the waitlist for other things that the staff  
did not manage to achieve, and which may better be sorted out while  
the patient is here.

2) even more a kluge would be to create a per-patient Unattributed  
problem "todo" and into this pseudo-problem put what needs to be  
done... it could all be handled in a single episode that is always  
active and since it would appear at the top (even in the Notes  
editor) it is the only one that would have to be double-clicked to  
help the clinician relocate any tasks they had set for a future visit.