Re: [Gnumed-devel] Can we have a refresh of Attach documents (Episodes) when a problem was added to EMR

[Busser, Jim]

On 2011-12-07, at 7:18 PM, Jim Busser wrote:

> - relax the constraint, make them nullable in
> 
>       blobs.lnk_doc_med2episode

sorry, the above is incorrect, there is no point to a link record that does not 
link.

The constraint at issue is

        blobs.doc_med.fk_episode | integer | not null


Here now is another good reason to relax this constraint:

it currently prevents staff from attaching a document, because staff cannot 
successfully save the document without inputting a value for the clinical 
episode to which the document relates. This goes beyond what non-clinical staff 
have (a) the training to resolve and (b) the justification to be perusing 
documents at that level of detail and internalizing to such an extent the 
patients' clinical details.

Some time ago, on the list, there had been a response to the above like

        well, just associate the document with an administrative encounter in 
an unattributed, administrative episode of arbitrary name

but truly this is an empty exercise, and I would prefer as much as possible for 
GNUmed to avoid to require empty actions.

It would actually be much easier, at the time where the clinician would be 
(re)viewing the document earlier attached by the staff, to *see* that no 
episode had yet been assigned and to then have the *option* to decide whether 
or not to input a value.

This is all rather like the ability to input Uncategorized clinical narrative, 
it is just in the scenario of rows it was desired to distinguish 'clinical but 
unclassified' rows from

        soap_cat = null

where the null was being used to convey administrative entries.

In the case of documents, clinical relevance is assumed unless a praxis would 
bother to try to disambiguate things like billing and maybe medicolegal 
documents from clinical ones, which is achievable if the praxis would bother to 
maintain the

        [   ] clinically relevant

checkbox and is really not advanced by the use of unattributed, administrative 
episodes if their use would be forced.

-- Jim