Re: [Gnumed-devel] terminology question

[Karsten Hilbert]

> I was wondering how one would input the following condition into GNUmed.
Let's see.

> Patient suffers from AV-Block III° and receives a dual chamber pacemaker.
> Health issue/Grunderkrankung would be AV-Block III° I assume. Pacemaker 
> implant procedure would be what in that context ?

I would name the health issue:

"AV block III° s/p PM implant"

1) note that health issues can and will change specifity over time

This issue may evolve from (don't be too harsh on the medical side):

"constant unwellness"
 - first couple of times around, already perceived to amount to more than
   a simple episode

"block like arrhythmia"  (don't know the proper English term, in German it
                          would be "Höhergradige HRST/Blockbild)
 - GP did first ECG

"AV Block"
 - GP had time to take a closer look and then refers to cardiologist

"AV Block III°"
 - patient back from cardiologist

"AV Block III° s/p PM implant"
 - patient back from Sebastian ;-)

2) It is often helpful to think of health issues being "states of"
   or "facts about" the patient's health while episodes often lend
   themselves more to being ongoing activity within the state of
   health of the patient.

> If patient comes in for a pacemaker checkup and I want to write a soap
> note I would select av-block as health issue. What am I supposed to put > in 
> to reflect that the reason for encounter was a pacemaker checkup
>(not a problem in that case).

Well, you enter just that :-)

encounter.RFE == "scheduled PM check"
encounter.AOE == "needs replacement of built-in atomic reactor"

> What if the patient suffers from device associated infection.
-> Episode under the above issue.

Of course, you may later discover that, really, the patient suffered
said infection not so much because of the implant all by itself but
rather by the implant being an infectious opportunity for the underlying
immunodeficiency due to a long-time myoma having given rise to
a pancytopenia ...  At which point you might want to regroup that
episode under the health issue

"Myoma, relevant to blood screen"

:-)

> Is this a 
> seperate health issue or is the issue AV-Block III° and the active
> problem the device associated infection ?
The open episode, that is. Both the issue and this episode under it
will be "problems". The issue courtesy of a) having an open episode
and b) being marked relevant. The episode courtesy of being open.

> Any clues are appreciated
Basically, this structuring is up to you. It depends on what at a certain
point in time you deem useful to facilitate care. It takes a bit of
practice (and willingness to reflect about your work !) to get a feel
for it.

Karsten
-- 
Psssst! Schon vom neuen GMX MultiMessenger gehört? Der kann`s mit allen: 
http://www.gmx.net/de/go/multimessenger01