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[Gnumed-devel] [Fwd: Re: [GPCG] Embedded Flags]

From: sjtan
Subject: [Gnumed-devel] [Fwd: Re: [GPCG] Embedded Flags]
Date: 11 Apr 2003 09:24:44 +1000

wrt to fast word search, how about pre-emptive indexing of clinical
notes :
(got this from a first year computer assignment)
1.tokenize the clinical text. Label each token with the indexing
information. ( line, which clinical note id).
2.remove all the tokens that appear in a stop list. A stop list is a
list of common non-important words like ( a, the, at, is)
3. add the clinical note id and lines of each token to a token link
Then finding 109 of 57,000 is as fast as doing a search on "implanon"
in the token link table. 

--- Begin Message --- Subject: Re: [GPCG] Embedded Flags Date: Thu, 10 Apr 2003 18:27:51 +1000
At 8:05 am +1000 9/4/03, Tony Eviston wrote:
Embedded Flags

One benefit of computerized records has been the ability to quickly insert
whole paragraphs of text into patients records with one or two shortcut
This has good and bad aspects - it does make possible perfect, uniform
documentation of tricky or medicolegally risky scenarios every time (even
if all of the points asserted in the text were not properly dealt with in
the consultation).
I think I read a paper by Ian Cheong on this subject somewhere?

The article was:
Cheong IR. The legal acceptability of an electronic medical record.
Australian Family Physician, 1997 January; 26(1):37-41.

The argument you refer to was to the effect that documentation that
has no relationship to reality is likely to be no better than no

I see lots of reports coming back from various specialists that bears
no relationship to what the patients perceive happened, eg:

REPORT: "Risks of the procedure were explained in full, including....
and the patient had opportunity to ask questions."

PATIENT: "He told me about the procedure just as the needle was going
into my hand to put me to sleep."

Further to that article, it would be better to:
A. give patients a written copy of the consultation which they could
verify and correct if needed
B. have the patient record in some way what they decided to choose and why
C. etc

One day, someone is going to lodge a complaint that what was recorded
had nothing to do with what happened, which will undermine the
perceived value of all this "auto-documentation".

Communication is much more important than documentation (even more so
if the documentation can be demonstrated to occur without reference
to the brain). Forget the name of the case (pap smear abnormality I
think) where the doctor lost despite copious contemporaneous
handwritten notes.


Another aspect which interests me is the ability to embed flags in progress
notes for later identification of groups of patients for GP research.
Of course database designers would frown on this as the least efficient way
of marking patients with certain characteristics, but from a clinician's
point of view it is beautiful in that we can simultaneously record relevant
notes and make the record findable through later database searching.
Searching through large amunts of text for distinct strings can be
surprisingly fast (eg a couple of seconds for me to find 109 out of 57,000
progress notes entries containing the string "Implanon".
Of course for this to be useful it is worthwhile for younger GPs to develop
a habit of embedding strings which mark those conditions / events /
procedures / consents etc in which they might later have a research


Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant
Elected Member, GPCG Management Committee (If you want GPCG to do
something, let me know.)
Internet: address@hidden
(for urgent matters, please send a copy to my practice email as well:

NOTE: Large attachments may bounce from If so, please send
to <address@hidden>.

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