[Gnumed-devel] Synopsis (AOE?) attaches to the prior encounter?

[Busser, Jim]

Hi all,

I have a patient in whom I had previously (on Nov 22) created an unattributed, 
open episode "angina" back 6 days ago, under encounter type "review chart"

        Episode »Angina« [#183]
        Created during encounter: 
        review chart (2012-11-22 18:22 - 18:22) [#718]
        Duration: 0:58 (11/2012 - …)
        Status: active

and when today, I got a call from the GP and I activated the patient, GNUmed 
1.2.5 autocreated a new encounter in which I entered a SOAP note and also, at 
the bottom of the Notes plugin, the

        Synopsis

as follows

        Angina resolved on atenolol 50/d but intolerant thereof (hr 40/min).

In case it matters, I believe that what I then did, without having intended to, 
was to "Save" just the notelet, immediately after which I clicked "Save all" 
thereby saving any additional encounter information.

I now have 4 questions.

1. Does my above input -- "Angina resolved…" -- populate two values:

- the AOE (as a property of the the Encounter) and
- the episode (as an Episode synopsis)

but not, in any circumstance, a "Health issue Synopsis" because even if I would 
have already promoted the item to a health issue, health issue (and past 
history) item synopses should have to cut across sometimes-multiple episodes 
and are separately managed and editable inside the EMR tree's second-to-higest 
node, contextual menu "Health Issue Actions"?

2. When inputting a "new problem" in the SOAP editor -- the synopsis seems 
suitably labelled "Episode synopsis". By contrast, in the case of my episode 
'Angina" I am not shown "Episode synopsis". I am instead shown "Synopsis 
(November 2012)". What is this intended to help me to grasp?

3. Why is it that despite that I inputted the synopsis "Angina resolved…" 
today, it shows up in the EMR browser under the encounter from 6 days ago)?

.------------------------------------------------------------------------------------------------------
|   Happened |       Doc |     | Narrative
|------------------------------------------------------------------------------------------------------
| 2012-11-22 |      JaBu |   … | Encounter: review chart 2012-11-22 18:22 - 
18:22 (2012-11-22 18:22)
|            |           |   A | Episode (open): Angina;
|            |           |     | Angina resolved on atenolol 50/d but 
intolerant thereof (hr 40/min).;
|            |           |     | (2012-11-28 11:18)
| 2012-11-28 |      JaBu |   … | Encounter: phone w/ provider 2012-11-28 10:40 
- 10:55
|            |           |     |  RFE: MIBI Dec 7, 2012 @ 0715 (2012-11-28 
11:34)
|            |           |   S | called by GP (patient in office), reported to 
her absence
|            |           |     | of angina since beginining atenolol 50mg/d 
~Nov 9th however has
|            |           |     | thereafter been tired and sleepy, and had 
increased leg edema, but no
|            |           |     | nocturnal dyspnea. Pre-existing, early evening 
upright dyspnea between
|            |           |     | about 7 and 9 pm has since also become more 
prominent. He only once
|            |           |     | tried 25mg daily but then reverted (2012-11-28 
11:18)
|            |           |   O | (per Dr A)  Looks ok, no crackles, but is 
bradycardic at 40/min.
|            |           |     | (2012-11-28 11:18)
|            |           |   A | Intolerant of atenolol 50mg/d (fatigue and 
brady 40/min).
|            |           |     | Edema NYD.
|            |           |     | Upright dyspnea NYD. (2012-11-28 11:18)
|            |           |   P | Dr A arranging CXR, CBC, lytes, urea, 
creatinine, BNP and pt will see me
|            |           |     | Mon Dec 3 @ 1pm. Has MRI Dec 7th @ 0715. 
(2012-11-28 11:18)
|       None |      JaBu |   O | Allergy state: unknown, unasked (2012-11-22 
18:22)
`------------------------------------------------------------------------------------------------------

4. Briefly, it seemed a similar problem affected the EMR tree because when I 
set focus on the Unattributed episode

        Angina

what I then saw at right, above the soaplets from my "Progress notes from most 
recent encounter", was the following

        Episode »Angina«   [#183]
          Created during encounter: review chart (2012-11-22 18:22 - 18:22)   
[#718]
          Duration: 1:28 (11/2012 - …)
          Status: active
 
           Angina resolved on atenolol 50/d but intolerant thereof (hr
          40/min).
 
         Last worked on: 2012-11-28 10:55
        
         1 encounter(s) (11/2012 - 11/2012):
          2012-11-28 10:40 - 10:55 (phone w/ provider): »MIBI Dec 7, 2012 @ 
0715« (RFE)
        
         Progress notes in most recent encounter: <snip>

but I now understand this is *not* "misplaced". That line of information 
("Angina resolved…") does not belong *under* the SOAP note (as it is not an AOE 
and anyways AOEs are not properties of episodes). Rather, that line is placed 
up top as meta-information (the synopsis) for the encounter.

So can GNUmed--next helpfully reformat this as

        Episode »Angina«   [#183]
          Created during encounter: review chart (2012-11-22 18:22 - 18:22)   
[#718]
          Duration: 1:28 (11/2012 - …)
          Status: active
          Synopsis: Angina resolved on atenolol 50/d but intolerant thereof (hr
          40/min).

-- Jim