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[Gnumed-devel] RE: [openhealth] Consolidation Proposal: ClearHealth, Fr

From: Shaw, Nikki
Subject: [Gnumed-devel] RE: [openhealth] Consolidation Proposal: ClearHealth, FreeMED and OpenEMR
Date: Tue, 14 Jun 2005 12:31:19 -0700

Good afternoon,

My comments aren't aimed at Karsten (GNUMed) specifically - just that he
provided such great leadins <s>
> > 5) how does your sessioning machinery guarantee that I 
> write data to 
> > the correct patient record when I have multiple patient 
> records open 
> > on the same workstation at the same time?
> I cannot imagine anyone releasing an EMR that does not
> *inherently* fulfill the requirement ? Anyways, our reference 
> client (written in Python) operates with (among others) one 
> basic assumption: There is only ever one patient active in 
> one instance of a client to which all data is attributed. 
> This is embodied not just in the client but rather - by way of OOness
> - inherent to the middleware. If you open several clients on 
> one machine you can work with several patients at the same 
> time, of course.

The problem is that many physicians do work with several patients at the
same time thus there is a need to have several patient charts open at
once. This is fine if you are using separate hardware in each physical
location. It is much harder to deal with if the physician is using
roaming technology such as a laptop or tablet. A method of making sure
that you are writing to the correct record would therefore be essential
in this environment. I have certainly seen systems that do not address
this workflow issue at all. Others do a better job, including colour
coding different patient charts that are open at the same time so that
you can see at a glance which patient chart you are looking at. Remember
that families often come in together so simply having name obvious on
each screen isn't always enough.
> > 7) is all clinical data coded?
> All clinical data is categorized into SOAP. All clinical 
> narrative *can* be coded if you so wish.

I'm not sure that people really understand what clinical coding means. I
should be able to write a paragraph and every part of that paragraph
should be able to be coded. For example, If I were to use the UK Read
Codes (now merged with SNOMED as SNOMED CT) the following is possible
(using Read 5 byte codes)

3/8/98  Home Visit. C/o chest pain, central tight, SOB at rest O/E BP
100/60 P98 AF, HS NAD basal creps. D MI admit CCU stat Aspirin 150mg
10/8/98 Discharged from hospital 8/8/98 Dyspepsia On ranitidine 150mg BD
Awaiting OPD for endoscopy/Hypylori tests
24/9/98 Endoscopy - Reflux, Hpylori neg Asymptomatic now BP 120/70 P82AF
for ECG smokes 15d leaflet given Rx Ranitidine 150mg
27/9/98 Nurse Clinic - ECG done
28/9/98 ECG - AF advised Aspirin 150mg daily

This could be coded as 

3/8/98  Home Visit 9N1C C/o chest pain 1822 central tight, SOB at rest
1734 O/E BP 100/60 246 & Reading P98 AF G5730, HS NAD 24B1 basal creps
23D D MI G30 admit CCU 8H2 stat Aspirin 150mg given bu25
10/8/98 9N11 (GP Surgery) Discharged from hospital 8/8/98 Dyspepsia
J16y4  On ranitidine 150mg BD Awaiting OPD for endoscopy/Hypylori tests
24/9/98 Endoscopy - Reflux J10y4, Hpylori neg 4JO1 Asymptomatic now BP
120/70 246 & Reading P82 AF G5730 for ECG 3211 smokes 15d 1374 leaflet
given 6791 Rx Ranitidine 150mg a628/a62v
27/9/98 Nurse Clinic 9N22 - ECG done 321
28/9/98 ECG 3272 - AF advised Aspirin 150mg daily 8CA3 8BC3

Obviously the codes would not appear on the note but be coded into the
data allowing for much more comprehensive searhinhg, reporting, review
and monitoring. (This example is taken from my book on going paperless
in prilary care).
> > If so which vocabularies or standards
> > are allowed/provided for?
> *Any* you care to use.

This seems an odd answer. Coding is a HUGE issue - one that takes a lot
of work to implement and make usable at the point of care. Can you
really implement Read 4 byte, Read 5 byte, ICD-10AM, ICD-9, ICPC, OIPC
etc etc?



Dr. N. T. Shaw
Secretary (Carolyn Smith) 604 875 2424 x6336; address@hidden
Communications Coordinator (Teena Legris) 604 875 2424 x5369;
Direct Line 604 875 2424 x6938; address@hidden

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