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Re: [Gnumed-devel] state of test results handling

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] state of test results handling
Date: Tue, 1 Apr 2008 10:28:20 +0200
User-agent: Mutt/1.5.17+20080114 (2008-01-14)

On Mon, Mar 31, 2008 at 06:41:21PM -0700, James Busser wrote:

> When presented with multiple lab results
> - they all need to be signed by some clinician (except as part of a bulk 
> bootstrap or import, I guess those might best be signed by gm-dbo?)
Or rather by a dedicated account.

> - they *may* (in some jurisdictions) need to be signed by the ordering 
> physician, even if already signed by someone else
No problem. Each physician can have their own review.

> - I think we want all clinicians to be able to sign results (for example 
> when covering in absence of a colleague)
No problem.

> - therefore we may wish to be able to display the "not check mark"  
> whenever
>       a result is not yet signed by anyone
>       *or*
>       a test_result has fk_intended_reviewer = <current user> but is not yet 
> signed by current user


> - a function or button to filter & sign "my unsigned results" might help 
> here...
In a later revision.

> but if the ordering clinician had already signed it, might the 
> clinician who is looking after the patient, if different, wish to make 
> their own newer entry to revise some values in technically abnormal and 
> clinically relevant? Would we therefore keep (and not overwrite) the 
> signature of the ordering physician, because they have completed their 
> requirement to sign the result.
We keep all signatures. Whoever wishes to sign can do so
regardless of who else signed already.

> We would (?) take the view that if a 
> different clinician wished to revise whatever is the current value
This only makes sense for "whatever is *their own* current value".

> for 
> technically_abnormal and clinically significant, they could do so, and 
> that would be captured and reviewable in the audit table if there were 
> later to be an issue?
Yes, if someone who signed a result later changes their
decision as to relevant and abnormal this will indeed
overwrite their review in the database. The change will be
captured in the audit system, yes, for tracking if need be.

> ... I am not sure how the above would interact with the patient vs  
> provider inbox, if there were results to be signed, which did get signed 
> by a doctor in absence of the ordering doctor, who would later need to 
> (re)-sign some of the same results,
Unless the covering doctor took over responsibility (made
herself fk_intended_reviewer) the results will still show up
as unsigned in the fk_intended_reviewers provider inbox.
When we start using patient inboxes it'll depend on what we
decide then regarding this issue.

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