Re: [Gnumed-devel] Prescription printing in arbitrary countries and services.

[Karsten Hilbert]

On Mon, May 30, 2005 at 12:00:13AM +0100, Adrian Midgley wrote:

> > prescription:
> > 
> >  - the database equivalent of the finished (paper) form a
> >    patient is given to carry to a pharmacy
> in the UK, up to 3 items can go on one form.
Same in Germany. What do you call that form ? We call it
"Rezept".

> If a patient is given 4 items, has he had one prescription (on two paper
> forms) or two prescriptions, one for 3 items and one for 1 item?
True to my above definition (and to common use here) he would
have had 2 prescriptions (2 Rezepte) with a total of 4 items
(drugs) prescribed. Arching back to Jim's treatment plan
comments there would be 1 treatment plan with 4 (drug) items
prescribed producing 2 prescription forms.

> I think there is a faultline in the definition, hence I talk about
> items.
I agree but we need a name for the grouping on the form, too.
Let's call it "prescription form".

> If a patient has 3 drugs (prescriptions/items, to me) for hypertension,
> and because of a newly painful knee gets another item - Paracetamol -
> for it, and all 4 are issued at the same time, does he have two
> prescriptions, one for HT and one for knee pain, albeit they may be
> arranged on the paper as 2 HT drugs and Paracetamol on page 1 and 2 HT
> drugs on page 2?
With my above definition he would in Germany and UK have 2
prescription forms no matter how the drugs are arranged. Either 2/2
or 3/1. Each item is tagged with the corresponding problem it
was prescribed for anyways independant of how the prescription
form was issued. Wait, I notice you are talking about pages.
In Germany prescription forms only ever have one page (may
have carbon copies, though). So in that case the patient would
have 2 prescription forms for a total of 4 prescribed items.

> > One reason for
> > keeping the actual text with the form instance is that users
> > may well edit the drug name right before printing 
> 
> Ouch.  This would be specifically forbidden in the UK, under
> requirements for accreditation (compliance testing).
So the requirements pretty much dictate use of a database.
Which is fine. I was also referring to free-text entries for
items that happen to be missing in the database. One day we
would write them in one way the next day we would use a
different spelling/abbreviation. I have seen that in practice
many times. Also, as Jim pointed out, legalese may require us
to be able to say: This is what was printed on the form.

> But if we can edit the items, I think we would like them to be presented
> to us next time.
There would be several sources of items going into the
prescribed-today queue:

- user submitted a free-text item
- user selected a drug from a drug database
- user selected an item from the current medication list
- user selected a reprint of a previous form instance

The last bullet may actually be a shortcut: The user wants to
repeat an entire previous description and simply selects it
for adjusted reprint.


> > In summary, prescriptions would be form instances. Form
> > instances are defined by a form template and associated form
> > data. 
> 
> I have not seen it that way, I think - rather I see each preparation
> prescribed as an entity, and putting them on a form just as something
> one might do in order to output a list of entities.
Sure, each prescribed item is an entity in itself. They will
eventually be grouped into a prescription form instance. The
form instance (eg template + data) is then kept (for mostly
medico-legal reasons).

> > Notice how we haven't taken into account any interaction with
> > a current medication list at all yet. Which can be developed
> > entirely separately and connected by a cleanly defined in/out
> > API.
> 
> Definitely something to do before printing (or despatch electronically)
> occurs, I'd think.  SO per item rather than per form.
Yes. Per item.

> >  ... Only at the end would I issue the "prescribe queued
> > items" command 
> Print/send/despatch/release/authorise rather than prescribe, I think.

You are right: "authorise queued items". Prescribing was done
when queuing the item.

Karsten
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