Re: [Gnumed-devel] How to export an entire patient record

[Busser, Jim]

On 2011-11-09, at 11:27 AM, Karsten Hilbert wrote:

>> Just wondering whether the views provide a preferred
> 
> Yes.
> 
>> (and adequate)
> 
> That's the intent, at least.
> 
>> method to be able to access and to express the
>> data

Appended is a sample of what is outputted for Kirk from

        clin.v_emr_journal

We can see it combines information about the patient's health (entries like 
SOAP notes, updates to the medication and allergy record), and also what was 
done (for example, the review of lab results) but it is more or less a combined 
log of what was inputted as narrative, and a documentation of what was known  / 
done by the clinician.

Am I correct to suggest this journal is best suited to demonstrate, to the 
clinician who is retracing their own steps, or to another clinician who must 
review those steps, what was known and maybe being thought about?

And therefore, while an important component of a 'review of care that was 
given' (if that was the objective), the journal stands rather orthogonal to

        a useful inventory of the patient's health history and issues

Which is maybe better expressed as

        Demographics

        Problem list
                full
                includes past history items
                includes listing of closed and non-relevant unattributed 
episodes list

        Vaccination history
        Medication list
        Allergy information
        Hospital stays
        Procedures

        Family History
        Occupations

        Measurements information

and

        Documents

I am wondering whether everything (except the documents) would be able to pre 
provided in a single PDF.

I am wondering whether it would be easy or hard at this time to have postgres 
write the blobs contents into a temp directory which various .doc and .pdf and 
.jgp and .png (etc) files could then be

        bzip2

into a compressed archive that could be written onto the patient's USB stick or 
sent to the doctor who was going to be taking over care.


-- Jim

==============================
output from clin.v_emr_journal :

gnumed_v16=> select clin_when, narrative from clin.v_emr_journal where 
pk_patient = 12 order by clin_when ;
           clin_when           |                                                
         narrative                                                         
-------------------------------+---------------------------------------------------------------------------------------------------------------------------
 1999-01-29 12:11:11.111-08    | Health Issue (inactive, clinically not 
relevant): post appendectomy/peritonitis;
                               : noted at age: 24785 days;
                               : 
 2000-09-17 17:13:00-07        | Health Issue (active, clinically relevant): 
9/2000 extraterrestrial infection;
                               : 
 2000-09-17 17:13:00-07        | Episode (closed): postop infected laceration L 
forearm;
 2000-09-17 17:13:00-07        | Episode (open): abdominal lap;
 2000-09-17 17:13:00-07        | Encounter: seen in clinic 2000-09-17 17:13 - 
19:33
                               :  RFE: bleeding cut forearm L
                               :  AOE: ?contaminated laceration L forearm
 2000-09-17 18:17:00-07        | erythrocytes (RBC): 4.40 Tpt/l 
                               : Range:  -  / 4.1-5.1
                               : Review by LMcC @ 2011-04-23 14:57: 
                               : Responsible clinician: LMcC
 2000-09-17 18:17:00-07        | leukocytes (WBC): 9.5 Gpt/l ()
                               : Range:  -  / 4.4-11.3
                               : Review by LMcC @ 2011-04-23 14:57: 
                               : Responsible clinician: LMcC
 2000-09-17 18:17:00-07        | platelets (PLT): 282 Gpt/l 
                               : Range:  -  / 150-450
                               : Review by LMcC @ 2011-04-23 14:57: 
                               : Responsible clinician: LMcC
 2000-09-17 18:23:00-07        | C-reactive protein (CRP): 17.3 mg/l (++)
                               : Range: 0.07 - 8 / 0.07-8
                               : Review by LMcC @ 2011-08-04 12:22: abnormal, 
                               : Responsible clinician: LMcC
 2000-09-17 19:33:00-07        | 1) inflamm.screen/std ET serology
                               : 2) debridement/loose adapt.; 10ml xylocitin 
sc; 00-Reprolene
                               : 3) Pen 1.5 Mega 1-1-1
                               : 4) review +2/7; tomorrow if symptoms/blood 
screen +ve
 2000-09-17 19:33:00-07        | contam/infected knife cut left arm, 
?extraterr. vector, needs ABs/surg/blood
 2000-09-17 19:33:00-07        | ?contaminated laceration L forearm
 2000-09-17 19:47:00-07        | C-reactive protein (CRP): 14.5 mg/l (++)
                               : Range: 0.07 - 8 / 0.07-8
                               : Review by LMcC @ 2011-04-23 14:57: abnormal, 
relevant 
                               : Responsible clinician: LMcC
 2000-09-18 08:13:00-07        | Encounter: seen in clinic 2000-09-18 08:13 - 
08:47
                               :  RFE: knife cut follow-up, pain/swelling
                               :  AOE: postop infected laceration L forearm
 2000-09-18 08:47:00-07        | postop infected laceration L forearm
 2001-01-26 11:59:31.40124-08  | hospital stay: 2001-01-26 - 2001-02-03 
"Enterprise Healthcare Unit"
 2010-07-05 11:51:12.002227-07 | accid cut himself left forearm -2/24 w/ dirty
                               : blade rescuing self from being tentacled,
                               : extraterrest.envir.
 2010-07-05 11:51:12.002227-07 | Encounter: administrative encounter 2010-07-05 
11:51 - 11:51
 2010-07-05 11:51:12.002227-07 | left ulnar forearm; 6cm dirty laceration;
                               : skin/sc fat only; musc/tend not injured; no 
dist sens loss;
                               : pain/redness++; smelly secretion+; no pus
 2010-07-05 11:51:12.146045-07 | Document: patient photograph (2010-07-05 11:51)
                               :  Captain Kirk pictures
 2010-07-05 11:51:12.468998-07 | Allergy (allergy): developed urticaria/dyspnoe 
this morning, eg. 12h after first tablet
                               : substance: Penicillin V Stada; allergene: 
Penicillin; 
 2010-07-05 11:51:12.507171-07 | brother @ 37 years (2267, Stardate 3287): 
Denevan neural parasite infection
                               :  contributed to death @ 37 years
                               :  George Samuel Kirk, 1928-07-18
 2010-07-05 11:51:12.528882-07 | Document: consultant's report 
"vietnam-2003-3::1" (2010-07-05 11:51)
                               :  Vietnam 2003: The Peoples Republic
 2010-07-05 11:51:12.562361-07 | Document: consultant's report 
"vietnam-2003-3::2" (2010-07-05 11:51)
                               :  Vietnam 2003: Tagwerk
 2010-07-05 11:51:12.667288-07 | Encounter: administrative encounter 2010-07-05 
11:51 - 11:51
 2010-07-05 11:51:12.667288-07 | Episode (closed): back pain;
 2010-07-05 11:53:46.001729-07 | test_postappy_aaa
 2010-07-05 11:53:46.001729-07 | test_postappy_o
 2010-07-05 11:53:46.001729-07 | test_postappy_s
 2010-07-05 11:53:46.001729-07 | Episode (open): scar problems left arm;
 2010-07-05 11:53:46.001729-07 | test_postappy_p
 2010-07-05 11:53:46.001729-07 | Encounter: administrative encounter 2010-07-05 
11:53 - 11:53
 2010-07-06 11:51:57-07        | Episode (open): loss of control;
 2010-07-06 11:51:57-07        | Episode (open): abdominal pain;
 2010-07-06 11:51:57-07        | Encounter: seen in clinic 2010-07-06 11:51 - 
12:22
                               :  RFE: test_purpose
                               :  AOE: test_postappy_summ
 2010-07-06 11:51:57-07        | test_subjective
 2010-07-06 11:51:57-07        | test_objective
 2010-07-06 12:22:16-07        | test_plan
 2010-07-06 12:22:16-07        | test_assessment
 2010-07-07 00:16:55.413968-07 | Encounter: seen in clinic 2010-07-07 00:16 - 
00:22
 2010-07-07 00:16:55.413968-07 | Health Issue (active, clinically relevant): 
Diabetes;
                               : 
 2011-05-08 17:48:00.297369-07 | Encounter: seen in clinic 2011-05-08 17:48 - 
17:48
 2011-05-08 17:48:00.297369-07 | Episode (closed): administration;
 2011-05-08 17:48:00.332757-07 | medication list printed from template [Current 
medication list (GNUmed default) - 1.0]
 2011-06-17 09:10:58.393311-07 | Allergy (allergy): not tolerated: discontinued 
due to allergy or intolerance
                               : substance: MetoPharm comp.; allergene: HCT; 
generic: Metoprolol; HCT; ATC code: C03AA03; 
 2011-06-17 09:11:25.737297-07 | Allergy (allergy): 
                               : substance: Acyclovir; allergene: Acyclovir; 
 2011-06-25 14:06:39-07        | Episode (closed): Medication history;
 2011-06-25 14:06:39-07        | Encounter: review chart 2011-06-25 14:06 - 
14:06
                               :  AOE: Medication history;
 2011-06-26 09:01:00-07        | Document: Prescription "FreeDiams" (2011-06-26 
09:01)
 2011-06-29 18:15:20.752197-07 | Encounter: review chart 2011-06-29 18:15 - 
18:33
 2011-06-29 18:33:13.298482-07 | generic_document printed from template [EMR 
Journal (GNUmed default) - 1.0]
 2011-06-30 00:16:00.956806-07 | Document: Cumulative patient profile 
(2011-06-30 00:16)
 2011-07-14 23:25:46.380483-07 | Episode (closed): visual progress notes;
 2011-07-14 23:25:46.380483-07 | Episode (open): kirk's brain;
 2011-07-14 23:25:46.380483-07 | see kirk's brain
 2011-07-14 23:25:46.380483-07 | Encounter: review chart 2011-07-14 23:25 - 
23:25
 2011-07-14 23:25:46.392019-07 | generic_document printed from template [EMR 
Journal (GNUmed default) - 1.0]
 2011-07-14 23:25:46.392019-07 | Deletion of document:
                               :  2011-07-15 23:30 "visual progress note"
                               :  #1: ""
                               :  
/var/folders/rR/rRhuX5jzF8WCKfgoTie3Zk+++TQ/-Tmp-/gnumed/gm-jArJ5r/gm-I-Template-XQwgLW.png
                               : 
 2011-07-15 23:39:18-07        | Document: visual progress note (2011-07-15 
23:39)
 2011-07-15 23:43:55.07927-07  | Document: visual progress note (2011-07-15 
23:43)
 2011-07-30 07:32:58.039335-07 | Encounter: review chart 2011-07-30 07:32 - 
11:03
 2011-07-30 11:03:10.138358-07 | medication list printed from template [Current 
medication list (GNUmed default) - 1.0]
 2011-07-30 11:03:10.138358-07 | medication list printed from template [Current 
medication list (GNUmed default) - 1.0]
 2011-07-30 11:03:10.138358-07 | medication list printed from template [Current 
medication list (GNUmed default) - 1.0]
 2011-08-04 08:23:52.953183-07 | Episode (closed): un;
 2011-08-04 08:23:52.953183-07 | Encounter: review chart 2011-08-04 08:23 - 
08:25
 2011-08-04 12:23:09-07        | blood pressure (BP): 140/90 mmHg 
                               : Range:  -  / 
                               : Review by LMcC @ 2011-08-04 12:24: (comment 
via Actions button)
                               : Responsible clinician: LMcC
 2011-08-12 10:47:29.555156-07 | Encounter: review chart 2011-08-12 10:47 - 
14:16
 2011-08-13 12:36:37.904264-07 | generic_document printed from template [Test - 
1]
 2011-08-13 21:40:39.392883-07 | Document: Cumulative patient profile 
(2011-08-13 21:40)
 2011-08-13 22:04:52.611136-07 | Document: Cumulative patient profile 
(2011-08-13 22:04)
 2011-08-13 23:12:40.2236-07   | Encounter: review chart 2011-08-13 23:12 - 
23:12
 2011-08-13 23:12:40.235303-07 | generic_document printed from template 
[Referral letter (GNUmed default) [Dr.Rogerio Luz] - v15]
 2011-08-15 20:18:47.71003-07  | Encounter: review chart 2011-08-15 20:18 - 
20:55
 2011-08-15 20:18:47.71003-07  | Episode (closed): education sessions;
 2011-08-15 20:19:38.678963-07 | Document: Cumulative patient profile 
(2011-08-15 20:19)
 2011-08-15 20:55:47.896762-07 | generic_document printed from template 
[Referral letter (GNUmed default) [Dr.Rogerio Luz] - v15]
 2011-08-15 20:55:47.896762-07 | generic_document printed from template 
[Current medication list (GNUmed default) - 1.0]
 2011-08-15 20:55:47.896762-07 | generic_document printed from template 
[Consultation report (GNUmed default) - v15]
 2011-08-15 20:55:47.896762-07 | Continue dietary efforts. Increase exercise. 
Increase
                               : metformin to 500mg TID
 2011-08-15 20:55:47.896762-07 | generic_document printed from template [Test - 
1]
 2011-08-15 20:55:47.896762-07 | continue to monitor
                               : if episodes continue, refere to 
gastroenterology for possible endoscopy. Empiric H2 antagonist or PPI.
 2011-09-01 11:11:11.111111-07 | substance intake (approved of):
                               :  acetaminophen [N02BE01] 325.0mg tablet 1-2 
tabs up to 3 times daily, 2011-09-01
                               :  discontinued: 2011-09-29(stomach irritation)
                               :  aim_info_foo (advice_info_foo)
                               :  "Acetaminophen" [N02BE01] 
(FreeDiams::CA_HCDPD::DIN: 02237418)
 2011-10-05 11:59:57-07        | Encounter: seen in clinic 2011-10-05 11:59 - 
12:13
                               :  AOE: administration;
 2011-10-05 12:13:48-07        | generic_document printed from template [EMR 
summary - 1]
 2011-10-05 12:13:48-07        | generic_document printed from template 
[Letter, short: address and salutation, patient demog, more free text - 1]
 2011-10-05 20:33:08-07        | Encounter: seen in clinic 2011-10-05 20:33 - 
23:24
                               :  AOE: administration;
 2011-10-06 01:03:26-07        | Document: EMR printout (2011-10-06 01:03)
 2011-10-06 17:18:16.275626-07 | Encounter: seen in clinic 2011-10-06 17:18 - 
17:18
 2011-10-06 17:18:16.307262-07 | generic_document printed from template [EMR 
summary - 1]
 2011-10-10 12:24:37.825383-07 | Encounter: review chart 2011-10-10 12:24 - 
14:05
 2011-10-10 14:05:41.791667-07 | generic_document printed from template 
[Karsten statement 2 - 1]
 2011-10-10 14:05:41.791667-07 | generic_document printed from template 
[Letter, short: address and salutation, patient demog, more free text - 1]
 2011-10-10 14:07:10-07        | Document: EMR printout (2011-10-10 14:07)
 2011-10-11 12:09:52.646242-07 | Encounter: review chart 2011-10-11 12:09 - 
12:09
 2011-10-11 12:09:53.222252-07 | generic_document printed from template [Test - 
1]
 2011-10-14 23:50:19.458875-07 | Encounter: review chart 2011-10-14 23:50 - 
23:50
 2011-10-14 23:50:19.511786-07 | generic_document printed from template 
[Letter, short: address and salutation, patient demog, more free text - 1]
 2011-10-28 11:11:11.111111-07 | substance intake (approved of):
                               :  glyBURIDE [A10BB01] 2.5mg tablet 2 daily, 
2011-10-28
                               :  "Glyburide" [A10BB01] 
(FreeDiams::CA_HCDPD::DIN: 02350459)
 2011-10-29 11:41:33-07        | Encounter: seen in clinic 2011-10-29 11:41 - 
15:20
                               :  AOE: prevention; back pain; Medication 
history; loss of control;
 2011-10-29 11:41:33-07        | Episode (closed): prevention;
 2011-10-29 13:48:06.241112-07 | long-term substance intake (approved of):
                               :  acetylsalicylic acid [N02BA01] 81.0mg tablet 
(enteric-coated), 2011-10-29
                               :  "Asa 81 Mg" [N02BA01] 
(FreeDiams::CA_HCDPD::DIN: 02244993)
 2011-10-29 15:20:13-07        | Deletion of substance intake (approved of):
                               :  DONEPEZIL HYDROCHLORIDE [N06DA02] 5MG TABLET, 
2011-10-29
                               :  "ARICEPT (TABLET, 5MG)" 
(FreeDiams::CA_HCDPD::DIN: 02232043)
 2011-10-29 15:20:35.026063-07 | substance intake (approved of):
                               :  acetaminophen [N02BE01] 325.0mg tablet 2 tabs 
qid, 2011-10-29
                               :  "Acetaminophen Tab 325mg" [N02BE01] 
(FreeDiams::CA_HCDPD::DIN: 00589241)
 2011-10-29 18:14:34.862057-07 | Allergy state: does have allergies (last 
confirmed 2011-10-29 18:14)
 2011-10-29 20:51:51.50343-07  | Vaccination: Twinrix [1] (deltoid, L)
                               : Indications: hepatitis A / hepatitis B
 2011-10-29 23:05:49.207583-07 | Encounter: seen in clinic 2011-10-29 23:05 - 
23:31
 2011-10-29 23:31:27.894381-07 | generic_document printed from template 
[Letter, short: address and salutation, patient demog, more free text - 1]
 2011-10-29 23:32:35-07        | Document: EMR printout (2011-10-29 23:32)
 2011-10-31 22:17:09.061858-07 | Encounter: review chart 2011-10-31 22:17 - 
22:18
 2011-10-31 22:18:05.063067-07 | generic_document printed from template [test 
test - 1]
 2011-10-31 22:18:05.063067-07 | generic_document printed from template [test 
test - 1]
 2011-11-03 23:38:59.012688-07 | Encounter: video conference 2011-11-03 23:38 - 
23:38
 2011-11-05 06:40:39.405952-07 | Encounter: review chart 2011-11-05 06:40 - 
06:40
 2011-11-05 06:40:43-07        | Document: Correspondence (2011-11-05 06:40)
 2011-11-05 13:02:00.565586-07 | Encounter: review chart 2011-11-05 13:02 - 
13:02
 2011-11-08 13:15:51.012319-08 | Encounter: review chart 2011-11-08 13:15 - 
15:39
 2011-11-09 11:09:20.79629-08  | Encounter: review chart 2011-11-09 11:09 - 
11:17