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Re: [Gnumed-devel] clin_health_issue - some thoughts

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] clin_health_issue - some thoughts
Date: Mon, 29 Nov 2004 17:38:46 +0100
User-agent: Mutt/

* unlinked episode
> - at the point of being newly-created, an episode will have a first 
> encounter, and can default to take the name of the AOE (if there is 
> one) else the soAp row (if there is one) else the RFA
fine by me

> - if a software widget can easily/reliably determine so, then for as 
> long as an episode description matches what is predicted by default 
> (based on the above), the episode description be updatable by default 
> to carry the new value of AOE etc across new encounters within that 
> episode (whereas if the description no longer matches what would have 
> been predicted, it so clear that a user must have exercised a choice 
> to specify the episode description and it is left to the user to make 
> any further changes - no special field(s) required
fine by me

* linked episode
> - if we wish to create a "new episode of same" (as opposed to a first 
> episode of a brand new problem under the health issue) then **here** 
> we would likely
> - - set is_open to FALSE under the old episode

> - - put new encounter rows under this newer episode

> - - preserve the *identical* name for this episode description
yes, as the default

> - - modify the name of the episode only as part of a procedure to
>       rename in common all these "same problem" episodes
sounds like a reasonable plan

Since we wouldn't want to change the AOE of the old episode we
would simply create a new clin_narrative row attached to a)
the old episode but b) the new encounter (or alternatively the
youngest encounter for the old episode) and use that as the
name for the old episode.

> - - probably *not* retrospectively attach *new* encounter info to the 
> older episode
Agreed !

> what about 
> episodes unlinked to a health_issue?

> a) attach prior & new episodes of same to an existing clin_health_issue or
If the case warrants doing that, sure.

> b) create a new clin_health_issue "recurrent <episode name> NYD" to 
> which the existing and new episode would be attached or
Sure, one way to do it.

> c) leave episodes unattached to a health issue (as might be chosen 
> with "URTI" is "sick note"
Precisely. That's the whole business behind things. If
eventually someone's noted to have unusually high/complicated
recurrences of URTI a health issue may be thought of emerging.

> I suppose there is even another scenario in which, despite many 
> visits for their joints, a patient with Rheumatoid arthritis and many 
> episodes of "knee pain" might have another episode of knee pain, but 
> where the doctor is worried it may not be an RA flare (perhaps 
> worried about infection) and so wishes to "detach" this episode for 
> now,  it can always be re-attached later if it proves to be 
> non-infected and just RA
Sure, such distinction is entirely at the discreetion of the
treating clinician...

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