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[Gnumed-devel] Re: Vaccination as a starting point

From: Karsten Hilbert
Subject: [Gnumed-devel] Re: Vaccination as a starting point
Date: Sun, 21 Jul 2002 16:30:26 +0200
User-agent: Mutt/

>> For each immun. a timestamp, the immun.type (reason:
>> prevention, travel, exposure, ...), the exact name of the
>> vaccine, the charge/lot/batch ID, the injection site/type
>> should be recorded.
> +should we have a line for 'reacton' in case patient has a problem with a 
> particular vaccine.
I would say, yes. Question is, where should this reside ? Does
it belong into "adverse reactions" in the allergies/reactions
window ? Does it make sense to put a line for that into the
Vaccination edit area - since most likely we will never yet
know if there's going to be an adverse reaction to a vaccine
we are giving right now.

> > Certain vaccination types should be able to trigger GNUmed
> > "request" events (check HepB titer 10 years post vacc., prompt
> > for boosters/repeat vacc. on multiple base immunisations, alert
> > for overdue vacc.s)
> Agree. In my program I linked age to the schedules and did a check when the 
I wonder if people caught the subtle hint towards a
generalized request-delivery framework inside GNUmed.

Scheduling an appointment will file a "request" for "seeing the
patient" at that date.

Recording a pregnancy files a request for recording an end of
pregnancy with outcome (of course, making it easy to link the
newborn's to its mother's record).

Ordering lab work files a request for completion of lab test
(if in-house) or reception of results (if offsite). Much the
same with X-ray, referrals to specialists and the like.

Recording a hypertension will file repeated requests for blood
pressure checkups.

Recording a diabetes mellitus files requests for regular
referrals to eye care.

Recording some fracture files a request for an appointment in,
say, 10 days depending on type of fracture.

Some request-fulfilled records will be kept (X-Ray for
documentation of due course), some will not (request for
scheduling an appointment where only the resulting appointment
will be kept of course). Some will vanish completely (scratch
pad note request to ask about how the gardening is going).

The possibilities are endless.

> patient was first loaded. The flashed up a sign if immunizations were 
> missing. Got a little messy because of
> a) Doctors putting vaccines in incorrect schedules
Garbage in, garbage out. Not much, really, we can do about
this. It should be easy to change previously incorrectly
recorded vacc. data.

> > Those mechanisms should be based on pluggable guidelines.
> This raises many issues. In australia we have immunization schedules (as I 
> presume all countries do). The schedules however are constantly being 
> modified e.g we had a situation not long back where kids born prior to 
> 01/05/2000 were on one schedule, and those after 01/05/2000 on another. This 
Sure, we just shouldn't try to _force_ people into certain
schedules. Just make it easy and convenient to comply with
them (and easy to switch them off).

> is not a problem if you present vaccines as either a schedule or a disease 
> target; eg in my edit area:
> Target
> Vaccine
> Date given
> Serial no
> Site
> (reaction)  - not there but perhaps we should
Looks good.

> The Target can be a disease, combinations of diseases or schedules

> One a schedule is chosen, all the vaccines in this schedule are automatically 
> presented, or or a disease is chosen, here meningococcal, ditto.
> Hitting enter on a vaccine them puts in a default date(today) which you can 
> change if entering past vaccine information, and the last vaccine_serial 
> number used for this brand of vaccine (which again you can edit).

> To put in the site, I just enter by hand, but one should have quick 
> abbreviations built into this line eg ld  would autoexpand to left deltoid 
> etc.
A phrase wheel helps, too.  :-)

> > It may be beneficial to be able to "link" vaccinations to
> > particular lab results.
> Agreed, but looking into the future here
Agreed, although it nearly naturally flows from the request-result

> > Recording a vaccination should create an event in the patient
> > state tracking time line (where major things like hospital
> > admissions, major diagnoses, off-work, pregnancies, etc. are
> > linked together to form a coherent picture).
> Yes, but again we need to walk before we run.

I'll start from your tables and post something for discussion
soon (hopefully).

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