Re: [Gnumed-devel] clinicians: coding use case survey - please respond !

[Jim Busser]

On 2011-05-03, at 4:59 AM, Karsten Hilbert wrote:

> Patient has episode "URTI" coded to an appropriate ICD code.
> Doctor changes episode description to "hypertension".
> 
> I would expect the previously linked ICD codes of "URTI" to
> not any longer be linked to this episode:
> 
>       yes
>       no
>       comment

The app cannot know what it should do. Perhaps you are suggesting to "always 
break" the link with each edit.

Every revision of a description has the possibility (but not certainty) of 
breaking the coherence of the associated code.

I am not yet sure of the preferred behaviour. Ideally
1) for each code there should hopefully exist in GNUmed a "reference 
description" no matter that the clinician has substituted in the episode naming 
something more clinically-friendly or informative
2) when the description is being edited, I would suggest (at minimum) that the 
"reference description" has already been queried and be made available 
(visible) in the same editing window
3) the same editing window as permits the description to be altered should also 
permit the ICD etc to be altered and maybe write-enabled to be changed
4) ideally the ICD selector would default to show the adjacent (higher and 
lower) codes because this can inform whether the degree/extent (amplitude) of 
the change in the clinical description allows the ICD to be kept the same or 
whether the description has resulted in a "shift" -- or in a major / radical 
alteration -- of what the ICD should be
5) if the ICD is write-enabled and the user manually deletes the entry the 
question is whether, on saving, that emptied cell remains emptied or whether it 
is more efficient to set a default behaviour. The default behaviour could 
auto-prompt for tag (code) entry with each episode and health issue creation 
and prompt for a new value when a previous value is emptied. Either way the 
user may need be able to commit "no code" in the case of some individual 
entries.

> I would expect any known ICD codes for "hypertension" to
> automatically be linked to this episode:
> 
>       no
>       comment

No but the ICD should be easily searchable to assign the right code.

> 
> #--------------------------------------------------------
> Patient A has health issue "COPD". Patient B also has
> health issue "COPD".
> 
> I would expect to be able to link *different* ICD codes to
> each health issue *despite* that the two issues have the
> very same name:
> 
>       yes
>       comment

Because the codes could have varying levels of precision that may better apply 
despite that the description may not show the difference.
e.g. hypertension there are many different forms & the user might not bother to 
make the description granular.
This reminds me though… it may be helpful to allow the ICD reference 
description to default / overwrite an empty description or even a populated 
description

> I discover in patient A that there is a wrong/missing code
> for "COPD". I correct/add that code.
> 
> I would expect patient B to now *also* automatically have
> the added/corrected code for "COPD":
> 
>       no
>       comment

no, however it should ideally be possible to do a global search and replace but 
this is risky and if it is permitted at all would need the database 
administrator to do it together with at least 2 senior clinicians from the 
praxis

> 
> #--------------------------------------------------------
> In a list of terms with their codes I add/modify/remove a code
> to/from the term "Fracture of left tibia".
> 
> I would expect that now all patients with episode "Fracture
> of left tibia" have the updated list of codes for that term:
> 
>       yes
>       no
>       comment

no

When you say "term" do you mean

        the term that was bundled with the ICD by the ICD reference org
        the term that the praxis altered (but remains linked to the ICD) as db 
reference
        the free text description of episode / health issue (independent of ICD)

I will wait for this answer before continuing :-)

> 
> #--------------------------------------------------------
> In a list of terms with their codes I modify the term
> "Fracture of left tibia" to "Fracture of skull".
> 
> I would expect that now all patients with episode "Fracture
> of skull" have the list of codes which was formerly linked
> to "Fracture of left tibia":
> 
>       yes
>       no
>       comment
> 
> I would expect that all patient with episode "Fracture
> of left tibia" now do not have any codes anymore linked
> to that episode of theirs:
> 
>       yes
>       no
>       comment
> 
> #--------------------------------------------------------