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[Gnumed-devel] Encounter, Encountlet, Episode, Health issue, Problem

From: James Busser
Subject: [Gnumed-devel] Encounter, Encountlet, Episode, Health issue, Problem
Date: Tue, 12 Aug 2008 12:09:28 -0700

For reconciliation if we are understanding these differently:

Encounter = interaction with the patient (record), involving the patient directly or indirectly. Examples: in-person visit; phone call; review of chart / results.

Encountlet ("...let" denoting "portion") = the { S | O | A | P } portion(s) of a multi-issue encounter that pertains to a particular problem or a particular health issue. In the case of a single-issue encounter, the encountlet *is* the encounter.

Episode = for any problem(s) or issue(s), a set of one or more encounters where the "last-in-set" denotes a definite or apparent or expected natural ending. Examples: death; resolution of symptoms / findings. Episodes remain "open", i.e. without a designated "end", until the clinician decides to mark them "closed", which may happen only when the patient returns for an unrelated reason and confirms whether the other has in the meantime subsided.

Health issue: one or more clinically-related episodes of care, aggregated under a clinically-suitable grouping name (diabetes, hypertension, chronic kidney disease, lupus). Note that among a patient's episodes, some will involve an as-yet undiagnosed set of complaints, which can often be self-limited and so not all episodes will get aggregated under a health issue.

Problem: open (active) episodes, and any health issues that, even if "inactive" (no open episodes), are of potential importance

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