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

[Busser, Jim]

On 2011-12-08, at 12:01 AM, Karsten Hilbert wrote:

> On Thu, Dec 08, 2011 at 02:04:49AM +0000, Jim Busser wrote:
> 
>> Why can't documents be attached to health issues without having to be 
>> attached to an episode?
> 
> Clinically: because they always belong under a certain Episode of Care
> 
> Technically: because allowing both is a nightmare. We
> already have that nightmare with substance intakes (where I
> don't know how to avoid) which we need to be able to link to
> either a raw substance or a drug component.
> 
> (the equivalent would be to allow linking to either a drug
> brand or a raw substance)

No, I am not seeking any nightmare.

What I meant was that there was some merit to be able to link to a health issue 
without getting so granular as to have to (also) allow it to be linked to an 
episode but why must a document be required to link to anything at all?

We already acknowledged that a document can relate to two problems whose 
episodes do not even start and stop together, and when the encounter can 
provide a time frame and where it was *desired* to additionally link a document 
to a specific episode I would say "fine'.

But I CANNOT DISAGREE MORE with the assertion that they ALWAYS belong under a 
*certain* Episode of Care.

Why do they *have* to belong to an episode?

You receive a copy of a document for a problem for which the patient did not 
ever receive care for you. Maybe there was not even a problem identifiable. The 
patient for unclear reasons saw a cardiologist who assessed the patient and 
said they're normal. The patient brings it back with them from vacation.

So now it is not enough that the praxis is satisfied to attach this document as 
a type

        Consultation - Cardiology

with a comment

        unsolicited, reason NYD

but the praxis also has to invent a problem and a pseudo episode under which to 
associate this?

I totally understand why you want to avoid to nightmare linking, but that is 
not what I am asking, and I still cannot understand why you are insisting to 
require an associate to episode???????

Why not allow it to be null and then the sort order on episode will simply sort 
together the nulls?

What is the *clinical* problem with that? 

-- Jim