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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 10:04:27 -0800

Ian had previously pointed out the need for the original requestor of information to sign it off. Which meant that even if it was actioned in their absence (by a co-worker) it remains for the original requestor to sign.

Over in the lab schema / workflow we had contemplated reviewed_by_clinician though I can't recall if we stored *which* clinician - guess that could be inferred from the identity of the user who updated that value.

So the related thoughts are:

- anything that needs signing must be identifiable as whether signed by the *requesting* clinician

- it is also important to clinical care to identify that, in the possible temporary absence of the requesting clinician, the result has been acknowledged (signed) as reviewed by *some* clinician

- the concept of a requesting clinician will not apply to *all* items received into GNUmed as some of these items will arrive without having been requested a clinician inside the surgery/clinic group. Therefore, the field serving the reviewed_by_requesting_clinician function will have to be allowed to be null for some items. Either that, or whoever is signing will also sign in the role of requesting_clinican even though they did not request it. Unless it is intended to denote those items that were unsolicited, for example a requested_by field that is permitted to remain null. That way a record only needs to be signed by *a* clinician (provided that requested_by is null) whereas if it was possible to identify an incoming piece of information as requested_by, then reviewed_by_requesting_clinician will apply.

- if a doctor departs from a practice, it is possible they could keep their access in order to be able to sign stuff that comes back in after their last day of work. But at some point they will presumably stop logging in, or may have died. So here Ian, would some other doctor "take" responsibility for these and sign them "as" the requesting clinician?

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