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Re: [Gnumed-devel] need-to-know change to backend

From: J Busser
Subject: Re: [Gnumed-devel] need-to-know change to backend
Date: Sun, 14 Nov 2004 08:56:27 -0800

As an attempt at re-expressing encounter and episode definitions, are the following more or less right? Any improvement warranted?

Encounters in GnuMed are intersections, or interactions, between:
- a patient, or patient information (such as the existing chart, or new test results, or enquiries about the patient's records or care) and
- a health professional possessing GnuMed privileges (though an encounter can be pre-entered on behalf of such a person by non-clinical staff)

Encounters are further characterized or defined by a datetime stamp, by the gnumed provider, by the type of encounter (chart review, phone call, visit) and, if a physical encounter, by the location or site. As a description of the encounter the schema presently suggests that applications should display "<date> (<provider>)" plus, if the description is "xxxDEFAULTxxx", some marker for "default". I would suggest the encounter_type also be displayed.

Encounters have a dual meaning i.e. meaning each portion of (e.g.) a visit, dealing with each of possibly several active problems, versus meaning these portions taken collectively. Both meanings have value and so rather than arbitrarily deciding that one is right and the other wrong, can we let the meaning be defined by the context of discussion (usually the portion, or "thread", when discussing episodes).

Episodes are user-defined collections of encounters, where each episode represents an aggregation, by problem (or by symptom cluster) within one or more encounter sessions, whether the problem (or symptom cluster) be
- of an uncertain nature (weight loss NYD), or
- pathophysiologically defined or diagnosed (constricting esophageal or colonic lesion; hyperthyroidism) but without a clear root cause (benign or malignant; Graves' disease vs toxic nodule vs other thyroid), or
- whether the problem episode *does* permit either declaring a new health issue, or attribution to an already- known health issue (in which case previous similar episodes may also be decided to be threaded/linked to that same health issue)

Each episode is described by the most recent encounter's clin_narrative as follows:
- by an Assessment of Encounter (AOE), if one exists
- by a "simple" (non-AOE) SOAP "Assessment" (soAp) row, if no AOE row exists
- by the reason For Encounter (RFE) if neither an AOE or soAp row exist

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