[Gnumed-devel] Nailing down my discomfort with episode etc

[Richard Terry]

Ok, Karsten et al,

You know from my numerous correspondances on the progress notes stuff for a 
long time that it has not sat well with me, but I've never been able to 
articulate why. 

As I'm a visual person and not understood how the underlying data was 
organised, I think in some ways I've mis-judged it by looking at the current 
attempts to reproduce what has been put in (eg emr-journal/emr-dump), felt 
they looked hideous, and threw up my hands in judgemental horror.

Looking a bit deeper at this today, its obvious that the emr-journal is 
actually pretty good, and that it is only a matter of re-organising some of 
its display and converting it to html to make it easier to understand. The 
only current problem I can see with it is that it does not display separate 
episodes on the same day  - it meshes them all in together ie all lines of 
say three consultations on the one day are  grouped with all the Subjective 
lines/ the object lines/the assessment lines/the plan lines, stacked on top 
of one-another, rather than three separate SOAPs. Probably a mere detail of 
re-organisation I suspect in the display.

I still don't see the point of the EMR dump perhaps you can explain it to me, 
and the EMR tree doesn't work on my machine.

I've played with the progress notes module a bit and I think I can now 
understand why the data input side  doesn't make sense to me, and it is 
around my workflow and how I would normally record notes (and how Australian 
GP's organise their notes - not just me - because we swap medical records  
continuously and we all record things in a very similar manner.

At one extreme of a medical records system you would keep only free text and 
the system would be intelligent to either concurrently or later through 
queries, organise and present information to you in a slected manner. Eg in 
this system, finding all the text occurrences of 'headache' would bring up a 
html file listing all consultations containing that key board etc.

At the other extreme you try and enforce some sort of tagging on all 
consultations, which is what I think (correct me if I'm wrong) you have been 
doing with the gnumed clinical records backend.

There-in lies my difficulty. IE as many many consultations in practice are 
undifferentiated, and not linked, we  may or may not write a summary or 
episode name  for them, whereas the system as it stands is enforcing this  
for each face to face episode, and it is this I find unweildy as you unless I 
am mis-understanding it (if so correct me) you are enforcing the user to 
write a clinical note which may or may not reflect the content of the 
episode.

Does that make sense? 

I've some other comments to make on the data-entry wigit itself, but will post 
that in a different thread.

Richard