Re: [Gnumed-devel] Test results imports, and encounters

[Karsten Hilbert]

On Wed, Jun 24, 2009 at 10:05:45AM -0700, Jim Busser wrote:

> When a daemon / importer etc would, in one process, import many- 
> results-per-patient, how would this be recorded in the database in terms 
> of encounters and how would / should these be shown in the EMR tree?
Again, this question doesn't really exist. The encounter
just is. The Zen Of Encounter. Something is done to an EMR -
a better word for this encounter may be "session".

The type would probably be "administrational" I'd think
off-hand.

Should it be shown ? I think so.

> In asking the question, I am setting aside that the component tests may 
> individually relate to different health issues... I am only (at the 
> earlier stage of import) wondering:
>
> - even if a patient has an open encounter "in praxis", the import would 
> not be recorded as having been part of the same encounter, would it? 
Not if I wrote the importer.

> After all, the encounter may still be open at a time when the visit has 
> been concluded and the patient has departed and the doctor is no longer 
> interacting with a gnumed client
True enough.

> - would each import process create a single per-patient encounter which 
> may be of type "results <importer>" and could this encounter be  
> permitted to have a start datetime and an end datetime that falls inside 
> the time frame of an already-open encounter? The logic would just 
> recognize any existence of a still-open patient encounter and, in this 
> situation, would auto-close the newly-added results encounter? If there 
> was no already-open encounter, perhaps imports would still be 
> auto-closed? Maybe any clinician review (at a time when there was no open 
> encounter) could still be a new encounter of type "chart review" ?

All this isn't really answerable theoretically. It only
makes sense in the context of an actual use case.

- "auto-close" would mean "place chronologically older than"
- there is no explicit closure

> - how would such "results <importer>" be handled in the EMR tree? Would 
> there exist, under "Unattributed episodes", an episode "Results" with the 
> various closed encounters listed within?

There could and that would sound like a reasonable generic
approach to me. However, this is again only answerable for
specific cases - the context may allow for a better episode
selection.

> Over time, that would be a lot 
> of results, but maybe even for "active" patients there might be only one 
> record per week, 50 per year inside such a folder. The alternative would 
> be to allow test results import to be entered (stored) under a special 
> encounter type that simply adds more and more datetime stamped 
> administrative soap rows although maybe there is a downside to doing 
> this?

Sure, I wouldn't generate a new episode for each import.
Just use one "imported test results" or some such under
"unattributed".

Karsten
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