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[Gnumed-devel] progress note popups (was: question re prog note when ent

From: J Busser
Subject: [Gnumed-devel] progress note popups (was: question re prog note when entering phx)
Date: Fri, 22 Apr 2005 19:32:39 -0700

At 6:03 PM +0200 4/22/05, Karsten Hilbert wrote:
 So off I go typing "phx" into the progress note (in a Soap line).
Right after typing the "x" in "phx" up pops the past medical history

Is it already determined workable to have this design, in which
(I gather) the program would be able to continuously monitor
and "trap" any string that matches an item previously defined?

Would these previously-defined items "live" somewhere in the
backend and, if so, where?

Are they envisioned to be "localizable" and what is it about their
design that would have them active only within the progress notes
widget? Would it be something about the way that the client is written
and would it call to some special middleware? Does any of this need
to be defined and at what stage (post 0.1, 0.11 etc).

and I can seemlessly keep typing "s/p append" <TAB> "11
years" <TAB> "thanks $deity we don't need to worry about
appendicitis in this Crohn patient" thereby filling the fields
"condition", "age onset", "progress note". Hitting <ENTER>
will save them into the EMR as a past medical history item
(clin_health_issue), replace the "phx" in the original
progress note line with "s/p append at age 11 years",

The part about "replacing the... in the original progress line
with "..." - is it felt that the replacement is best planned to be
a literal string of text without any kind of pointer to the
[past hx item or script item or vaccination item etc] that is
being referred to?

Ian back in November
proposed that popup contents be held in RAM (until a record in the backend has been created to hold them). He also suggested that it makes little sense to commit the popups before committing the SOAP data. But would we not prefer to the committing of what is in the popup before leaving it to continue completion of the progress note? If that were the case, a backend record will have been created and the original soap row that is being returned-to could contain a reference to the issue or item (script, family hx, vaccination) that is being referred to. Dunno if we aim to have a markup language within the soap rows, so that what is *displayed* as "s/p append at age 11 years" in fact contains an un-displayed link to the record of interest. I realize that would greatly complicate the design so might only get added at a later stage *if ever*, and records created under an earlier version of gnumed would not enjoy the benefit of such a reference.

Still on this issue of whether or not to commit the contents of a popup before committing the soap note, is it alternately contended that, in the case of a prescription, you might "draft" a treatment for one health issue but then realize, as you look after a second health issue, that its management will impact the first and require a dose adjustment --- maybe even abandonment --- of the original drug? So maybe you would commit a *past history* item within a popup, but not a prescription, until *all* new drug orders (and drug dosage changes even when no new supply might be required) can be committed all at once?

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