Re: [Gnumed-devel] Medication lists

[Busser, Jim]

On 2013-07-04, at 3:22 PM, Jim Busser <address@hidden> wrote:

> Even before we consider any extra functionality relating to the 
> *prescription* of medication, which we know is partly achievable through 
> forms. there remains unimplemented functionality relating to the patient's 
> medical record of care and treatment.
> 
> The main thing that I would like us to figure out earlier, rather than later, 
> is how to be able to keep in view a record of what a patient was *previously* 
> taking. Currently, we have a mixture with part of the information 
> disappearing into the audit tables and inaccessible except by going outside 
> of GNUmed using the gm-dbo credential.
> 
> Presently, it is possible to
> 
> (1) See what a patient is *currently* taking, and when they began to take it, 
> however
> 
> - the above risks to provide pseudo-accurate information because when the 
> medication was a result of previous (external) care or self-treatment, the 
> patient may recall only approximately when they started it whereas the column 
> in GNUmed "Started" holds only exact dates.
> - alternatively misleading is when the default "today" is allowed to be 
> saved, when entering a medication that a patient is on for some time 
> (currently, leaving the date blank creates an UE, see separate bug report)
> 
> … is it acceptable to make "Started" optional?
> 
> (2) See what a patient was *previously* taking by inputting a medication and 
> discontinuing it
> 
> (3) Not see what a patient was taking prior to a change in dosage …. 
> currently when a line item is edited in order to alter the regimen or 
> schedule, the previously lower or higher amount of medication taken becomes 
> lost in the audit table.
> 
> So both (1) and (3) could benefit from further thinking and maybe before too 
> long revision to the codebase.
> 
> -- Jim

Is there room to adjust the triggers from

        psql -d gnumed_v18 -U gm-dbo -c '\d clin.substance_intake'

which I think inhibit the following:

1) to record the fact that a patient is taking two instances of the same 
substance, which happens in a couple of cases

- the substance comes in a form that cannot be split (gel caps) and therefore 
to achieve a dose of 7.5 mg they cannot take one and a half x 5 mg, they must 
take 1 x 5 mg and 1 x 2.5 mg
- the substance comes in a combination form (ACE inhibitor with diuretic) but 
they require some additional amount of one of the components in the combination 
form (say, the ACE inhibitor) which could even be in the same strength as the 
ACE component of the combination form

--> it seems that triggers which prevent more than one instance of the same 
substance prevent to input what a patient is actually taking.
--> is there some way for a trigger to issue a message that can be communicated 
up through the middleware, instead of to disallow the 'save' of the information?

2) to keep in the substance table (inactive) the previous dosage of a medication

--> which, if the triggers were adjusted to permit (1), would automatically 
allow (2)

-- Jim