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Re: [Gnumed-devel] encounter edit before final save

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] encounter edit before final save
Date: Mon, 11 Aug 2008 21:47:34 +0200

... had to run off to control an epileptic seizure ...


> Patient A comes in ... consultation, physical, past history, etc ... send
> him to X-ray
> Patient B , C, D
Well, there you have it: GNUmed considers the "close consult (for now)" to be 
equivalent to "activate
patient B" :-)   So, whenever you activate another patient the consult for the 
previous patient is
"temporarily closed". If there was any data entered (not just a review of the 
EMR) GNUmed will
allow you to edit the consultation details (RFE, AOE, start, end, type) before 
the new patient is

> Patient A returns in the same day ... as we OPEN him "message: this
> patient
> has been seen by a physician in this same date, do you want to open a
> Complementary consult?"

Precisely that is what happens ! :-))    You can even configure below which 
interval the old
encounter is *always* continued or above which interval a new encounter is 
*always* started.
Between the two intervals GNUmed will ask you whether to continue the old one 
(and show
you relevant data of the old one, too, of course).

> YES NO ... if NO the event will not be merged and
> a
> new episode will be made. If YES the event will be merged and a new
> episode
> will NOT be made,
There will NOT be a new *episode*. Episodes are a durations of activity of an 
They aggregate across encounters. They are only ever started and ended 
explicitely by
a clinician.

If patient comes in with a flu I start a new episode flu. If a couple weeks 
later I come across that
patient again and notice that beyond the two initial encounters the patient 
didn't come back
for the flu I will close the episode.

If the patient broke his ancle, had an episode and later comes back for ancle 
pain the first episode
may still be open because I never came across that patient again. If I then 
open a new episode
"post-trauma ancle pain" on the health issue "bimalleolar fracture left leg" 
there is an option which
tells GNUmed after which amount of time old open episodes can be auto-closed 
(eg. considered

> It gives a little more autonomy (for billing also, I guess) to the
> provider of care.
Ah, wait, do not confuse Episode of Care (that is, the patient was ill for some 
time) with
the arbitrary episode for billing which is something that is at the whim of 
politicians and
health insurers. Better to keep medicine apart from things not medicine.

> It also makes a step to what I feel is greately needed in GNUmed: a signal
> TO THE PROVIDER that he is about to close the consult to that patient.
Well, if there is never any danger (let alone possibility) to prematurely close
a consultation why would there be a need to warn on that ?  :-)

OTOH, we DO let the provider edit the consultation details of the old patient
when a new patient is called up.

> There should be no question on the providerĀ“s mind on WITCH patient he is
> working on.
There isn't. The active patient is always in the top panel. This got much better
with 0.3.

> So if your patient has to go home for those test he forgot,
> the
> provider has two choices: close and continue with other patients OR let
> him
> open and try at the admission desk to get that fax from the lab, but in
> that
> case NO OTHER patient can be worked on until he CLOSES the consult.
That's why we don't ever explicitely *close* an encounter other than
by *opening* a new one. This is entirely independant of how many
patients have been activated inbetween anywhere.

> It is basic chronology :when a timestamp of "end consult" was made on the
> bottom of the patientĀ“s file he no longer is in the care of a given
> provider, so if he bashes his head on the way home the timestamp will show
> it was AFTER the consult ended and not the POVIDER that bashed his head
> :)))))))
Exactly. That's why there's an "end" timestamp to the consultation. However,
simply setting the timestamp doesn't end the true consultation in real life.

I may have "closed" the encounter but the patient remembers something while
walking out and comes back - now what ?  Of course, I continue the old
encounter. The whole concept of "closed" is flawed. It rather is "current" vs. 
"not current".

Reality isn't defined by a flag. But it can be approximated by durations.

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