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Re: [Gnumed-devel] encounter edit before final save

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] encounter edit before final save
Date: Fri, 15 Aug 2008 16:52:58 +0200
User-agent: Mutt/1.5.18 (2008-05-17)

On Tue, Aug 12, 2008 at 01:23:39PM -0700, James Busser wrote:

> Even once an editing widget would be available, the first "writing"  
> would serve a dual function of "caching" as well as serving as the  
> "possible / assumed final". Only after a note would be edited would the 
> note become "relatively more final". Since any note will have the  
> capability to be corrected at a later date, we can never know that a  
> note will never change, however that is no matter. All that is important 
> to the person making the clinical decision is the state of the 
> information at the time that the decision is being made.
> What *appears* needed seems to be a workflow tool in which to  
> distinguish, and be able to make selectively available, those notes that 
> we knew were incomplete, from those notes that we believed complete.
> This is sounding a lot like "you have unsigned lab results"

Absolutely. To entirely cleanly model this one would need
the ability to "review" (sign) narrative just the same as
test results or documents.

However, there's workflow problems:

> - Clear     vs     Save     vs      Save and Sign
>       <the in-focus> issue SOAP note elements in this encounter, versus

Having Clear / Save only feels cumbersome in any case
because there's always the nagging feeling that "yeah, I'd
like to immediately sign *this* one progress note".

OTOH, having Clear / Save / Save and Sign lures users into
pressing Save and Sign most of the time -- which is quite understandable because

- it saves an extra step
- notes are later editable anyways

If notes weren't editable after signing anymore - typos and
such cannot be corrected anymore - same situation as right now.

If notes ARE editable after signing user will pseudo-sign
them most of the time which would then defy the purpose of

So, perhaps the conceptual idea should be to make signing an
*added* value rather than making a lack of signing a *deficit*
in the progress note.

Signing may then become an activity done deliberately on,
say, all progress notes on an episode that has been closed
for some time.

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