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Re: [Gnumed-devel] need assessment from fellow clinicians

From: sjtan
Subject: Re: [Gnumed-devel] need assessment from fellow clinicians
Date: Thu, 01 Jul 2004 00:15:37 +1000
User-agent: Mozilla/5.0 (X11; U; Linux i686; en-US; rv:1.6) Gecko/20040113

From*: Richard Terry

S: patient requests BP review or BP review due
O: 120/70
A: (may contain commment if bad eg poor control)
P script atenolol 50 * 1/day

how about an editor that parses this?

: "patient requests" "BP review or BP review due" ->clin_history.discription , s/--> clin_history -> _enum_hx_type "requests" ,
                    -> _enum_hx_source "patient"

parse clin_history.description -> look for clin health issue terms -> ( clin health issue is linked to a ontology) 'BP' has a concept link to hypertension which is linked a patient clin_health_issue, therefore clin_history item is linked to the clin_health_issue "hypertension" o/ 120/70 -> clin_physical.description + link ( yet to be done) , (\d+)\/(\d+) is a regex mapping to [systolic_bp , diastolic_bp] and could be entered as quantified observations of category systolic bp, diastolic bps ( not yet in gnumed schema )

A/ ( comments on bad poor control ) -> entered in clin_notes, how to tag as free comment?

P/ script atenolol 50 * 1 / day -> parse this as script action , drug = atenolol, dose=50mg ( then check medication list for atenolol , and compare dose; note if increase or decrease , add as prescription qualifier dose adjustment - maintained, increase or decrease, link with free comment above ; check medication ontology for indications for dose increase, decrease, or maintenance e.g. systolic BP falls in equivalence class of "target BP range" -> indication link is maintain dose of hypertensive medications equivalence class. Therefore action is marked consistent with
guideline ontology.

The gui representation of all this processing can be a Tree control next to the text editor, and as parsing proceeds tentative items appear in the tree under the correct category. Each item has a checkbox for user validation; at the end, the user is asked to confirm any parsed tentative items, or to add new items to the tree ( this can be done by navigation). The tree represents recorded observations, communications, and can also have action items , such as issue scripts and order investigations. Confirmed items can be entered
in the medical record, and also start the printer rolling, send email etc.

Unconfirmed and denied items and actions can also be recorded.

Some problems with this approach is that there is insufficient computing power for real-time processing ; natural language might foil the configuration of the parser at a unacceptable rate , and therefore doesn't help
the cause of text only entry  transformation to structured entry.

Aside from seeking confirmation from the user of tentative items, a configuration dialog so that the user can configure/customise the parser terms/keywords/phrase patterns might make this more usable.

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