Re: [Gnumed-devel] Progress notes entry and patient interaction

[Karsten Hilbert]

On Thu, Jan 07, 2010 at 08:34:03PM -0800, Jim Busser wrote:

> David Guest made a very nice post back in 2002 (still on the archives and 
> referenced below)

(that's why it's good to have a few list archivers like
nabble et al subscribed)

> Its relevance to the current GNUmed is as follows. I
> myself am cognizant of the distraction between being
> attentive to a patient telling his or her story, at the same
> time as I feel pressured to "split" (both my thinking i.e.
> "brain-parsing", and my keyboarding) of bits as they arise,
> or even at intervals. At a stage when I do not yet know the
> fullness of the information that is to come, it feels way
> too early to pre-allocate the information.

Surely so. That's what I meant in the recent post about a
table or spreadsheet like notes editor:

- enter factoids as they are mentioned in a semi-lexically
  structured way (that is, identifiable factoids go on one
  line or under one text-only bullet point much like simple
  wiki markup) into a free-text widget

- in a second run (which may happen concurrently) use a
  dedicated tabular/cellular widget to "distribute" the
  collected factoids by drag/drop by mouse and/or keyboard
  among new and existing problems -- this may also be useful
  to (re)-arrange factoids when looking to support or
  disprove considered differential diagnoses

- in fact, even within one identified (as-yet not quite
  diagnosed) problem it may be helpful to be able to arrange
  factoids to support the considering of differential
  diagnoses, even with duplication of factoids

- think Dr.House' flipchart on steroids

- suggestions re how to layout-wise facilitate this are
  welcome !

> Accordingly I can
> imagine working in two modes at the same time:

People's use of the progress notes are at least two-fold:

The SOAP either serves as a structured summary of relevant
subjective, findings, assessments, and decisions or it tries
to capture "everything" being said/found/thought/done.

Typically it's a mixture of the above.

> And could lend itself to any amount of second-run
> splitting the doctor desires. The doctor might even wait
> until the next visit to do some of the splitting, to reduce
> the added overhead of splitting information into multiple
> problems, where multiple of these could prove self-limited.

Yes, see above.

This thread would seem to revolve around a 3rd generation
progress notes editor.

Karsten
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