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Re: [Gnumed-devel] on meaningfully signing off reviewed items

From: J Busser
Subject: Re: [Gnumed-devel] on meaningfully signing off reviewed items
Date: Sun, 29 Jan 2006 09:42:51 -0800

self-replying on the issue of "on updates"

At 12:05 AM -0800 1/29/06, J Busser wrote:
So if a row becomes modified, it becomes subject to the audit trail which would make it clear that it had been altered, potentially by someone other than the person who signed it. So the only remaining problem is our contention that the doctor carries the responsibility to view and acknowledge the alteration. While the record would carry the modified_by value that pertains to the user who did it, any existing value for "signed by" would no longer have clinical meaning.

... what I mean is, the "signed by" would no longer accurately convey the clinical acknowledgement and acceptance of responsibility... it would be misleading

So we should specify "on update, signed_by is NULL"

... just realized the problem with this... it precludes ever signing a row unless, it was signed as part of the original record creation. And then if it were amended, you could never sign it under the above constraint. So is what we want, the following:

- do not *require* a row to be signed in the back end, for an unsigned row is part of the workflow we are needing to capture

- allow a row to be signed whether the row was being originally created, or updated

- if a row *was* signed, and was *afterward* updated, the update needs to contain a null signature in order to be able to flag it as having again to be reviewed & signed off. The fact that it gotten altered if by someone other than the original signer would show up in the audit log, but that is not enough for safe practice because we want to be able (in the workflow) to identify rows that *again* need review & signoff.

Any chance that the Postgres "on update" function can constrain based on the most recent (pre-update) value of the row? For example, "on update" requires signed_by to be null if the updating user is different than whoever signed it? Or do we allow a doctor other than the individual who signed it originally, to sign the newer version? We can constrain that only clinicians can sign, but maybe it needs to be in the GUI that in the event of a clinician updating a row previously signed by another clinician, the value in signed_by defaults to none and it is then up to the updating clinician to decide whether to sign it, or to leave it for the original clinician.

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