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Re: [Gnumed-devel] Words of Wisdom on Past History Data

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] Words of Wisdom on Past History Data
Date: Wed, 17 Nov 2004 18:15:47 +0100
User-agent: Mutt/


I think it very worthwhile to have Dr.Ireland around as a "consulting
specialist" for GnuMed.

> 7 years down the track it never eventuated, however I did have progress notes 
> of sorts as shown in the accompanying PNG's. Every activity was recorded and 
> became a line of the progress notes, ie scripts, referrals, past history, 
> recalls, allergies, vaccinations etc.
I do think it is useful even now to have a "progress note"
line in the popup edit areas.

> I beleive this 'sequential' - 
> a la paper - type of progress notes are the most useful, because we can 
> peruse them on the screen, scroll back and forth, and print them out if 
> needed, or forward them electronically. 
We can certainly also have an export format that does not
order by issue/episode but rather chronologically only.

> Additional formats are of course needed e.g to type in a keyword, and bring 
> up 
> all consultations containing that,
This is pretty much why we put all the narrative into
clin_root_item - such that we may be able to search across
*all* narrative of a patient regardless of attribution.

> or to choose display by problem and show all those.
The EMR tree does that in a way. Surely not the best way,

> The main reason I am against the tree type of display is it is slow, 
> unweildy, 
> we do not think about consultations in terms of dates or trees (though we of 
> course view them in chronological order). Out of all the viewing methods, 
> scrolling down the sequential pages is the most useful.
It shouldn't be that big a job to write a chronological HTML
exporter. This seems a good way to get acquainted with the GnuMed

> In Addition, in most 
> of our clinical time we do not even refer to what has gone before, except by 
> memory.
Which IMO isn't good and should be changed ! I routinely do
read (well, scan) previous progress notes just before the
patient enters the exam room (at those clinics that use
EMRs if that's telling anything...).

> I guess in hospitals it is different when patients are being seen by 
> a number of different doctors.
Oh, you mean you don't look at previous notes because you
remember the patient ? I don't - but then I'm past 30 now...

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