Re: [Gnumed-devel] another vista at abnormality/relevance flags

[Karsten Hilbert]

On Wed, Apr 09, 2008 at 04:37:40PM -0700, James Busser wrote:

> On 9-Apr-08, at 1:35 PM, Karsten Hilbert wrote:
>> 3) No, because neither am I responsible nor am I the first
>>    to see this result (and they did sign it). In which case
>>    I still *can* sign if I choose to.
>
> But there wouldn't be a point... wait... I think above you are using  
> responsible to denote the doctor who ordered the test.
No, I am referring to whoever is recorded as
intended_reviewer. Which most likely will still be the
ordering doctor, yes.

> I f I am neither 
> of the above but the patient sees me for a related or unrelated problem 
> (say in the absence of the usual GP) after the results had already been 
> signed, the question is whether I somehow want to make a record of having 
> seen the results.
Recording that I have seen them and incorporated them into
my clinical decision can be achieved by a free text SOAP
note if there's a real desire (say, "thanks to Dr.Busser
ordering ureic acid last week which was just above normal I
don't have to order it again today in this suspected bout of
gout"). Note that this is would not prompt me in any way to
re-sign the result particularly when I do not disagree with
your review status.

> However if there is no disagreement with what had been already entered 
> for whether they were abnormal or clinically significant, I don't see the 
> point of recording "I have seen those specific results and was aware of 
> and agreed with the recorded interpretation"
There is no point, indeed. And we don't talk about making a
point of it either.

> however are we then going to 
> document every read-activity like the review of documents by re-signing 
> already-signed documents?
Surely not as I explained earlier.

> To me, the answer would be no. At most you would enter into a ***  
> progress note *** something like
>
>       "documents <optionally identified> and results <optionally specific  
> ones> noted"
>
> if those would have been important to updating a clinical assessment.
Exactly.

This still begs the question whether there is any value in
enabling users to record differing judgements on test
results should they *wish* to. The argument that clinical
consensus should be sought and a single call of judgement
informed by possibly multiple opinions should be formed sure
sounds attractive. I wonder, though, whether there's any
multi-review use cases we don't think of.

Probably a good way forward would be to have a single
amalgamized review status per result and auto-forwarding a
note to the previous reviewer if any change to the review is
recorded thereby invoking consensus-seeking in cases of
disagreement.

Karsten
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