[Gnumed-devel] Re: Altering the default encounter behaviour (type)

[Karsten Hilbert]

On Thu, Jul 02, 2009 at 01:08:27PM -0700, Jim Busser wrote:

> I noticed when I attached a document, it was assigned an encounter type 
> of "Document"

Only if an encounter contains documents *only* the type is
set to "chart review" and the AOE (if empty) set to "only
documents added".

> but when I edited the "problem" to which various  
> *measurements* had been associated, each of these resulted in an  
> individual encounter of type "in praxis".

No. They are all the same encounter. After all you those
results were entered during the same encounter, weren't
they?

> I think it better that any default that is intended for use with  
> clinical interaction with the patient
>
>       in praxis
>       in surgery
>       in office
>       in clinic
>       phone advice
>
> ... it does not matter what it is... be *not* the default for activities 
> when no progress note was created.

The default is whatever is configured the default. Are you
suggesting the default if no default is configured be "chart
review" ?

I suggest refraining from auto-altering the type except
under *very* controlled circumstances (like the above with
documents, or during encounter creation when nothing else
can have taken place yet).

> I did notice that one of my "sessions" with Kirk did result in "chart  
> review" although I am not sure about the behaviour that caused that. I do 
> think "chart review" is a suitable default for any user-based activity 
> and alterations to the chart that were not transacted through one of the 
> Notes editors and which did not already have a defined encounter type of 
> its own (in the way that attaching documents seems to have an encounter 
> type of its own).
It doesn't.

> Maybe "chart review" can be the "default default" encounter type for  
> encounters instantiated by patient activation through the GNUmed GUI and 
> if (during an encounter within the configured time limits) the user would 
> raise and *save* a progress note (complete with the *default* for 
> clinician encounters such as "in praxis" this type could be allowed to 
> overwrite the "default default" of chart review?
While that's technically possible it is likely to be the
wrong action in at least as many cases as it is the right
action. There is only really 2 sane places to manipulate the
encounter type:

- during creation, here a configurable default and a
  hardwired default can be applied

        We already do that. Is everyone OK to change the hard-
        wired default from in surgery to chart review ?

- during changing to another patient, eg. after possible
  user interaction with the encounter that's "left", here
  certain heuristics can be applied to auto-adjust the
  encounter type under *very* tightly controlled conditions

        I am happy to consider fully-complete arguments for
        such conditions.

Karsten
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