[Gnumed-devel] Re: Medication viewing

[Jim Busser]

I am very much liking what a medication list can offer us, depending  
on how we further think it through.

Let us imagine that we last saw a patient 6 months ago on April 15 for  
high blood pressure, and we started them on a 3 month supply of let us  
say ramipril, and the patient was *supposed* to come back 3 months ago  
in July, but was busy and did not manage to do so until now (say  
October 15)

... their medication list (until we would update it) would still show  
the ramipril as a "current medication" even though we may be able to  
know from the progress note or from a yet-to-be-created prescribing  
function that their supply would have run out in July

I now prescribe a new supply, and at the point where the patient again  
starts on the medication, the list will be correct. However (and this  
is important) I do not want it to appear that the patient has been  
taking this drug continuously since April. While it is true that the  
notes can contain a record of the explanation, there is 9to me) still  
value in being future-able to computationally show what the patient  
was taking at various points in time.

I would want to make the medication list show that the ramipril was  
stopped July 15 owing to a lapse ("ran out"). As soon as I make this  
change, the drug is no longer a current medication. However I will  
wish (before the end of the visit) to again *make* it a current  
medication.

For this reason, I do not want the original ramipril row to disappear  
as "deleted" from the Medication list. As soon as I would modify it,  
to make its status discontinued at at July 15 for reason "lapsed / ran  
out", a copy of the original would be preserved in the audit table

Among the records in the Medication List, the ramipril would  
presumably auto-sort lower down the list (into Group C as proposed in  
the last 24 hours) but it would be from the convenience of this  
location that I would want to re-activate it as newly current.

Is there disagreement here?

It would mean that within the Medication List, it would only be a  
subset of records that represent the current medications (substances).  
others would be recorded as having lapsed (without being restarted) or  
discontinued for lack of tolerability or effectiveness or  
affordability or desire or need. The difference could be managed in  
the filtering of the display and any ambiguity avoided by the use of  
last_used and status fields.