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

[Karsten Hilbert]

On Wed, Nov 28, 2012 at 08:32:58PM +0000, Jim Busser wrote:

> 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

No, not that I remember.

> - the episode (as an Episode synopsis)

Yes.

> but not, in any circumstance, a "Health issue Synopsis"

Correct. It would not auto-populate the 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"?

Exactly. I'm not sure whether - at the time of promotion -
an episode synopsis will be promoted to the new issue's
synopsis

... goes check ...

No it doesn't.  Should it ?  I guess it should not.



> 2. When inputting a "new problem" in the SOAP editor --
> the synopsis seems suitably labelled "Episode synopsis".

Initially, yes.

> 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?

This shows when the synopsis was last updated :-)

Much like last-affirmed of allergies.

> 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)?

That's the start timestamp (2012-11-22 18:22) of the
encounter within which the episode (containing the synopsis)
was created. It also shows that you last modified the
episode entry on 2012-11-28 11:18 (it doesn't show _what_
thereof you modified:

> .------------------------------------------------------------------------------------------------------
> |   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.

For the _episode_, but, yeah, that's right.

> 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).

Done as per screenshot.

Karsten
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