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Re: [Gnumed-devel] Aggregating health issues on screen. - Contextual Inf

From: J Busser
Subject: Re: [Gnumed-devel] Aggregating health issues on screen. - Contextual Info
Date: Mon, 29 Nov 2004 22:42:41 -0800

Perhaps a clarification is needed for what is intended within any one encounter (e.g. "visit")

Do we envision ONE i.e. a *single* SOAP editing area whose content:

a) if it relates to only a single problem-episode, requires no division into encountlets *but* b) if, in the judgement of the doctor, the content is meaningfully / usefully separable into encountlets --- each such "bit" able to be "attached" to the pertinent problem --- this is *not mandatory* however *is recommended (the only sensible way)* for any doctor who desires to later assemble the pieces specific to such a "thread" to be able to do so

Alternatively some might think or favor that multiple SOAPlets be created concurrently, in some combination of full or collapsed views, with the doctor jumping back and forth among these SOAPlets as the patient jumps around, but I worry this forces premature choices of where the information "belongs". Moreover there could be 2 new problems happening but if the problems had not yet been created there is a risk of circularity to the process. Lastly if I am busy I might rather end the visit having captured my SOAP content but preferring a while later (maybe after a few phone calls and a few patients) to come back and further process what I was thinking. So I would rather have the option of collecting and caching content in a single area to be able to attach pieces to problems as time and reason permit.

So some more questions:
- suppose we have within a SOAP editing area several bullet points and/or a few paragraphs - suppose portions are highlighted, or demarcated (whatever is the method) thus denoting "encountlets" to be attached to each of multiple specified problems (episodes) -- what happens to any text that was *not* thus highlighted or demarcated, i.e. was the SOAP content being held only in memory, and after the encountlet(s) are parsed off and processed, any other text gets "dumped"? Or are we talking about *preserving* everything that was in the SOAP editing area, and simply supporting the additional functionality of *copying* bits into various problems
-- can the same bit of text be multipurposed into two separate problems?

At 11:34 PM +0100 11/29/04, Karsten Hilbert wrote:
If one so wishes one can display by encounter and
not worry about which part was connected to which problem but
rather just display all the linked problems as a list.

... It is not snipped out of context. Also this is entirely a
matter of display. What we are doing is *in*creasing the
contextual information by allowing to specify which parts of
the consultation relate to which problem. This neither says
how that data is later displayed. Also, it may not easily be
possible to cleanly discern which problem a specific data item
belongs to (in which case the user will just decide on
*something*) or the user may not even care (in which case she
will just "dump" all data onto a catch-all generic "problem").

 > Yet when faced witha  difficult case, where the symptoms have started to
 present on a few occasions over a period of time, and the patient history is
 often a little vague, or changing with every presentation,  When you look
 backwards through a set of patient notes - your eye takes in the context of
 the key words, and what information is associated with them. If you cut out
 this context, and link display to only part of an encounter, then you may
 miss the clues that will cause the 'penny to drop' and help you make the
Sure! If needed just look at the notes in a whole-consultation
mode. Where's the problem ? It's a frontend presentation

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