Re: [Gnumed-devel] Changes to GuiMain - Suggestions

[richard terry]

Can I make a suggestion. Obviously everyone is going to have slightly 
different Ideas. Could those who have eg David's comments send me a sketch of 
the relative sizes of the screen you wish to be apportioned to whatever, and 
I will do some mucking around in VB to see how your ideas link to 
functionality and the incorporation of decision support.

I think it is vital that this prototyping be done so as to incorporate any 
new ideas with merit, or to show others how their idea can either already 
exist in the paradigm or be traded off against some other functionality.

a Simple box sketch would suffice, I've time this week and over the weekend 
to muck around with it.

David, I think we have the opportunity here to do more than just 'record data 
items' in a vertical column. The whole idea of the 'word wheel' as used in my 
program is to minimise typing and to provide contextural information when 
needed in an intelligent way.

I would assume that in the distant future consultations will be automatically 
videoed, translated on the fly, the computer will sort out what the doctor 
said, what the patient said, what was presenting symptoms, what was doctor 
assessment, and put them logically into notes. However this is a long way off.

In the meantime we can get much more out of progress notes than just list 
them in a column.

Consider that during a consultation I might write the following.

S: URTI symptoms
0 :ENT NAD, febrile, cough, chest - left basal crepitations, 
A: left basal pneumonia
P: Amoxycillin 500 tds, paracetamol etc
    FBC for wcc
    CXR
    review 10/7
(incidental items might have occurred as well:)
Scripts given for dichotride for stone
Reminded faecal occult bloods due 0 given form.

Now, your progress notes already have a fair bit of 'auto-generated' text,
namely the script data, the request forms for CXR, pathology forms for FBC, 
scripts for the medications including what they were for the doses, repeats 
etc, and info re the reminder. All this was generated just by your activity.

As for the SOAP notes, much of that can be auto-generated as well because the 
information is contextual eg the minute you start typting UR, up pops the 
word wheel options around symptomatology (cause the program knows that in the 
editing area you are typing on the symptoms prompt line), so often a minimal 
one key press allows you to select the symptoms. Once you hit the enter or 
tab key and end up on the Objective line, again, contextual information is 
presented in the word wheel using YOUR LANGUAGE, ie the computer has learnt 
from previous consultations how you describe patients symptoms with URTI's, 
so again a short pick list is easy to choose from, or you can add new terms 
if needed. In reality we use the same language over and over again. Hitting 
enter brings us the Assessment line, which operates similarly etc. The Plan 
line can be further refined so that typing Amo brings up the word wheel with 
amoxycillin (which the system recognises as an antibiotic hence includes the 
doses etc, so just the act of selecting amoxycillin 500 will autogenerate a 
script for the caps (as this is an adult, or syrup if it were a child at the 
approprate dose for age), so you may not even have to switch to the script 
module.

At the same time the system is monitoring what you are doing because once the 
symptom line got the URTI symptom the decision support guidlines start to 
swing into action using Ken's information set and underneath the editing area 
start to appear guidlines for managing and treating URTI's etc.

All this is acheivable using current technology and databases. Malcolm 
Ireland and I (malcolm is an academic GP/practicing GP/head of HUDPG IT 
department in NEwcastle/has IT degree from uni) sat and played with this 
stuff back in 1996/7 and even using vb3 it was easy to implement.

Note that you need about 60% of the width of the screen to acheive this. the 
remainder on the right being used for your lists of meds/path etc, the 
scratch pad, and reminders about overdues.

The reason you need this space is as follows:

-_________--------------------------------------------------------------------------------------------
| Subjective   | URTI;cough;runnynose;fever;
|Objective     | T38;unwell;left basal chest crepitations;increased RR;
|Assessment | basal pneumonia;left;urti;
|Plan            |  CXR;FBC;Amoxycillin 500tds;Paracetamol;Review 10/7
--------------------------------------------------------------------------------------------------------------
decisions support txt: current recommendations for the management of
                                  urti's are.. bla bla bla
                                :  where secondary infeciton is present first 
                            line agents are amoxycillin (covers xyz bacteria ...

                                 bla bla bla    (click here for more detail).
(note the font size/colour is different so it doesn't distract you)
----------------------------------------------------------------------------------------------------------------
(and underneath this there is still room for a list containing info you need 
to pay attention to but havn't yet eg)
- there  are 3 outstanding pathology reports for this patient
- letter from cardiologist Dr All Heart not yet read
- missing immunisations: fluvax, pneumovax
-----------------------------------------------------------------------------------------------------------------



Inputting data in this format is incredibly quick, and if saved in an 
appropriate fashion lets you pull back alot of detail for research. The 
computer can also monitor wether you take the time to access the decision 
support info, the same area under the editing area automatically can pop up 
disease/drug interactions at the same time (eg having noted you put the 
patient on drug X, it may recommend that because the patient is on drug Y 
that it's dosage is reduced, or that because the patient has renal failure, a 
drug dosage is reduced.

Note that  ALL OF THIS IS VISIBLE IMMEDIATELY TO YOU.  Once you confine 
yourself to either small vertical columns, or screen wide text boxes you 
really restrict your screen real estate.

Putting some notes in in this manner can allow you to input a whole lot of 
info automatically eg if the Objective line contains BP=120/70, this is 
automatically parsed and stored as systolic/diastolic if W=79.4 etc the 
weight is automatically stored.

Anyway, Have to see some patients as is nearly 9am.

Hope this helps

PLease send me you ideas re shapes/functionality so I can muck round with 
them.


On Tuesday 07 May 2002 12:50 am, you wrote:
> On Mon, 2002-05-06 at 22:19, dguest wrote:
> >   Ian Haywood wrote:
> > >I would like to propose some changes to the gmGuiMain module:
> > >
> > >- move to the 'split-screen' interface like Richard's interface.
> > >- replace the wxNotebook tabs with a row of small icons.
> > >- Convert the current windows in the notebook to plugins (find patient,
> > >cryptowidget, SQL query, Python interpreter, etc.) in a "plugins"
> > >subdirectory.
> > >
> > >Any objections/comments?
> >
> > Hi Ian
> >
> > I have been thinking about Richard's interface during the week and his
> > lecture made me focus on what was my main activity during the patient
> > encounter. For me, as a GP in private consulting rooms, it is clinical
> > data capture using a keyboard and manipulating the data while accessing
> > already collected information such as previous consultations,
> > investigations and other doctors' notes and correspondence.
> >
> > I prefer to record my data items one after the other in a left justified
> > vertical column. This means I need a tall but not very wide vertical
> > column to record and display the current encounter data. (Say 40% of the
> > screen width). For access to the other data I need a summary of all
> > previously recorded items (e.g. investigations, old notes,
> > correspondence) and a display window for the items that I select from
> > the summary.
> >
> > So, in essence this is a three window screen, with the middle and right
> > windows being accessed by hot keys and icons as per Richard's interface.
> > Hopefully there is still room to squeeze in his scratch pad and
> > Reminders windows. I also liked the way his patients' id window only
> > took up one line at the top of the screen.
> >
> > That's my $A0.02 worth anyway.
> >
> > David
> >
> >
> >
> >
> >
> > _______________________________________________
> > Gnumed-devel mailing list
> > address@hidden
> > http://mail.gnu.org/mailman/listinfo/gnumed-devel
>
> what about 2 monitors for hardcore electronic evangelists?
> just kidding.
>
>
>
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