Re: [Gnumed-devel] clinician input wanted: how to implement "coding"

[Jim Busser]

Thread last active December 7, 2009

Thinking afresh... some principles might be

1) recognize and support the "rushed clinical encounter"
2) protect against easy to make and potentially serious errors
3) make it easy to later complete the "rushed clinical encounter"

if the above makes sense, then when entering a problem which happened to be one 
of

        essential hypertension
        hypertension, cause not yet elucidated
        history of hypertension

I am thinking that even if I knew that in ICD9 the code "401" refers to 
essential hypertension, maybe it is a bad idea to offer a codewheel as the 
primary basis for inputting diseases or conditions. Such a codewheel would 
require to query the backend and display choices among which one needs to be 
chosen. A stray keystroke could result in a seriously wrong entry that needs to 
then be immediately fixed at a rushed time.

It would actually be easy to enter

        ht

because it may be I do not yet have the time nor the information available to 
decide what kind of hypertension this is.

Sound (well thought out) long term patient care decisions are usually not best 
made rushed. Therefore it needs to be easy to see, at a later visit, which 
diseases and conditions (problems in the list) did not yet get coded and for 
this to be easily identifiably different from those already coded.

Ideas:
- prebuilt query to find patients somehow attached (related) to the current 
user who lack any codes
- within-patient
        - (1) visual indicator that is always in view or is that distracting
        - (2) "peek" view that exposes what is present and missing, which 
disappears on release of mouse or key?
        - (3) button that *alters* the view to present a different view that 
relists the problems as
                problem 1 as original text
                        1st of n codes attached, plus word equivalent
                        2nd of n codes attached...
                        ...
                problem 2
                        etc
        - (4) button or plugin providing a different view
                problem 1 as code, word equivalent
                problem 2 as code, word equivalent
                --> this would have to be understood to show only 1 of n per 
problem
- what would a preferred work area look like for the addition and editing of 
codes?
- from what (multiple) contexts should such a work area be made accessible?
- would it be possibly useful / important to make or allow the codes to appear 
with the problems in the list views and in the request for consultation letter?