Re: [Gnumed-devel] Overlapping encounters?

[Karsten Hilbert]

On Sun, Nov 20, 2011 at 09:26:22AM +0000, Jim Busser wrote:

> > Technically it is possible.
> > 
> > The question being why one would want that.
> 
> Because it can be too easy to misunderstand what actually happened with a 
> patient's care, when something appeared (on surface) to be a part of a visit, 
> but was not.

That's a good example. A few comments below.

> We understand the concept of encountlets being the components of encounter 
> but that is only meaningful when we are talking components of an interaction 
> with a *patient*. For example, within a physical visit (whether in praxis or 
> at a home visit or even by phone) more than one distinct clinical issue can 
> be managed and thus the origin and meaning of encountlet.
> 
> If GNUmed's encounters are to be technical segmentations of (invariantly) 
> consecutive interactions with the backend, we confuse things by labelling 
> each encounter with a "type" when the type is not an accurate depiction of 
> what is included.
> 
> Say that, while away from a computer (in the car) from 0820 to 0830, I handle 
> a clinical phone call that needed to be documented. Once I reach the praxis 
> and log on and create a new encounter of type
> 
>       phone w/patient
> 
> I will input start times and end times of 0820 and 0830 (despite that in 
> "real time" it is happening between 0902 and 0905h). This is clinically 
> natural and will cause GNUmed clinicians to believe entries are about what 
> was learned / communicated during interactions with the patient (or 
> interactions with other caregivers) and not about interactions with the 
> backend.
> 
> Just because a lab result was auto-imported at 0904 (or even later within the 
> configured auto-expire setting) does not mean it formed any part of the 
> interaction with the patient and a clearer example of puzzlement is when 
> there had been an in-praxis visit between 1300 and 1400 and an abnormal lab 
> from 1310 is auto-entered as being part of the in praxis encounter when not 
> only did the clinician not deal with it, the clinician may not even realize 
> it was available?

The .modified_by would tell that an importer created the lab
results and the .modified_when timestamps when things were
entered, regardless of which encounter it is recorded under.

Karsten
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