[Gnumed-devel] Encounter workflows - staff and notes / narrative

[Busser, Jim]

Desk staff can already enjoy a default encounter of 'front desk' or 
'administrative' -- which is clinically useful to distinguish from the clinical 
types of encounters.

When a staff activates a patient whose last encounter is already beyond the 
maximum prompt age, a new encounter of whatever is the staff default would get 
created.

Desk staff who happen to activate a patient who is already in a 'clinical' 
encounter would presumably not change it back to a staff type. It could even be 
decided whether staff might not have privilege to alter encounter types, except 
it might be helpful for them to be able to change it from one staff / 
administrative type to another.

The recent discussion about clinical narrative

        SOAP

        vs

        Uncategorized (but still clinical)

        vs

        Null

reminded me that we can store in clin.clin_narrative some rows like

        e.g. medication list printed from template…
        e.g. Deletion of substance intake

So far, the 'NULL' soap_cat rows reference events in other tables.

Might it be desirable for staff to be able to input some soap_cat NULL (or 
soap_cat 'S') narrative into the narrative table? It is seeming to me that even 
though the desk staff are not clinicians, such information as

        'Mrs Smith is not coming today, she has the flu' or
        'Mrs Smith is not coming today, she has been admitted to XYZ hospital'

is actually meaningful and justifiable to be able to see / view in the context 
of the other narrative. This makes we wonder about the possibility of using the 
Inbox messages to communicate

1) information that does not relate to a specific patient

and

2) notification of an entry that was actually made in the notes (instead of 
making the entry as an inbox item) that a particular clinician may need to see

It raises the question of whether such entries by staff that appear in the 
notes could (just like labs and unsigned documents) auto-appear in the inbox 
for the staff to sign. Arguably, many of the communications that are received 
by staff, at the point where the staff would take the trouble to document them, 
have a potential impact on the patient's care and that it is intended that the 
clinicians should know about. The clinician can therefore be automatically the 
designated (in-praxis) primary without the reception who might be a new staff 
risking to make the error about who to notify. By extension, if the in-praxis 
primary should be away but another in-praxis colleague is covering for them, 
that colleague should be able to look over anything that may need reviewing. 
(This would depend on a not-yet-implemented filter or pop-up on the inbox, 
permitting to query and see the inbox listings for another colleague in the 
praxis.)

-- Jim