I am using a GNUmed placeholder to output the past 12 months (52 weeks) of progress notes on a patient thusly:
$<emr_journal::soap//{\footnotesize %(date)s } & {\tiny %(modified_by)s} & {\tiny %(soap_cat)s} & {\small %(narrative)s} \tabularnewline//very long line//52//tex::>$
In this example, I
- inputted an allergy
- created a problem (using "Simple notes" plugin), and
- created a progress note (in Notes plugin)
After which the output (see screenshot of table) was presumably determined by postgres-assigned date-time stamps:
a Putative subacute thyroiditis (in December 2012) resolved without evidence of anything more than mild goitre and small simple cysts not requiring intervention.
p Inform patient there had been a typo in the original US report where the right cyst had been reported in cm not mm.
a Health Issue (active, clinically relevant): Allergies/Intolerances;
a Episode (closed): Allergy detail: Penicillin;
s Sore throat improved post-clarithromycin for intercurrent "Strep throat"
o Asymmetric thyroid slightly larger on the right.
p Inform patient there had been a typo in the original US report where the right cyst had been reported in cm not mm.
a Health Issue (active, clinically relevant): Allergies/Intolerances;
a Episode (closed): Allergy detail: Penicillin;
s Sore throat improved post-clarithromycin for intercurrent "Strep throat"
o Asymmetric thyroid slightly larger on the right.
Feb 21 2013: TSH N, anti-TPO < 28 U/mL
Apr 18 2013 US dimensions were
right lobe: 1.7 * 1.5 * 6.7 = 17.1 cm^3
left lobe: 1.8 * 1.4 * 5.1 = 12.9 cm^3
simple cysts left lower pole (max 7mm) and right upper (max 5mm)
a Episode (open): Goitre, mild, with 2 small simple thyroid cysts;
o Allergy (allergy): blistering rash substance: Penicillin; allergene: Penicillin;
o Allergy state: does have allergies (last confirmed 2013-05-06 10:49)
a Episode (open): Goitre, mild, with 2 small simple thyroid cysts;
o Allergy (allergy): blistering rash substance: Penicillin; allergene: Penicillin;
o Allergy state: does have allergies (last confirmed 2013-05-06 10:49)
but the above sequence breaks the convention in which we are used to understanding (brain-parsing) clinical notes.
Better would be:
a Health Issue (active, clinically relevant): Allergies/Intolerances;
a Episode (closed): Allergy detail: Penicillin;
o Allergy (allergy): blistering rash substance: Penicillin; allergene: Penicillin;
o Allergy state: does have allergies (last confirmed 2013-05-06 10:49)
a Episode (closed): Allergy detail: Penicillin;
o Allergy (allergy): blistering rash substance: Penicillin; allergene: Penicillin;
o Allergy state: does have allergies (last confirmed 2013-05-06 10:49)
a Episode (open): Goitre, mild, with 2 small simple thyroid cysts;
s Sore throat improved post-clarithromycin for intercurrent "Strep throat"
o Asymmetric thyroid slightly larger on the right.
Feb 21 2013: TSH N, anti-TPO < 28 U/mL
Apr 18 2013 US dimensions were
right lobe: 1.7 * 1.5 * 6.7 = 17.1 cm^3
left lobe: 1.8 * 1.4 * 5.1 = 12.9 cm^3
simple cysts left lower pole (max 7mm) and right upper (max 5mm)
a Putative subacute thyroiditis (in December 2012) resolved without evidence of anything more than mild goitre and small simple cysts not requiring intervention.
p Inform patient there had been a typo in the original US report where the right cyst had been reported in cm not mm.
o Asymmetric thyroid slightly larger on the right.
Feb 21 2013: TSH N, anti-TPO < 28 U/mL
Apr 18 2013 US dimensions were
right lobe: 1.7 * 1.5 * 6.7 = 17.1 cm^3
left lobe: 1.8 * 1.4 * 5.1 = 12.9 cm^3
simple cysts left lower pole (max 7mm) and right upper (max 5mm)
a Putative subacute thyroiditis (in December 2012) resolved without evidence of anything more than mild goitre and small simple cysts not requiring intervention.
p Inform patient there had been a typo in the original US report where the right cyst had been reported in cm not mm.
However the challenges are several …
1) sort order within the current emr_journal appears to be purely datetime stamp, and I am not sure we can predict the sequence in which postgres will be writing various rows
2) maybe it is possible within emr_journal for all rows to sort by encounter and then, within encounter, by health issue (if applicable) then by episode
3) can we do anything to make
s
o
a
p
sort and be outputted in that order?
4) currently, we are assigning row type "a" to more than the traditional "assessment" … we currently also assign "a" to the namings of health issues and episodes.
What would be the involved if we should desire to assign such items instead to a different row type, like "A"?
-- Jim
