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

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] Encounter, Encountlet, Episode, Health issue, Problem
Date: Wed, 13 Aug 2008 10:27:28 +0200
User-agent: Mutt/1.5.18 (2008-05-17)

On Tue, Aug 12, 2008 at 12:09:28PM -0700, James Busser wrote:

> For reconciliation if we are understanding these differently:

Please feel free to update:

as needed and perhaps enrich it with examples.

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

Agree. Often used almost-synonyms are "consultation" or
"visit" although those suggest the patient is somehow
directly involved.

> 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.

I suggest defining "problem" before defining "encountlet"
and then removing the term "issue" from the "encountlet"
definition in favour of "problem".

> 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.

Same here with problems vs issues. Other than that - fine.

Under some circumstances the client will auto-close old open

- issue has open episode
- hence the issue and the episode are clickable in soap module
- user double-clicks health issue
- user thus seems to not want to continue the episode
- user seems to want to start a new episode
- client checks age of existing open episode
- if it is older than a configurable age it is closed

Note that technically the check happens at the time of
*saving* the new episode rather than when initially opening
an editor for it because the user might decide to abort that
progress note, say, on behalf of eventually realizing that
there already is an open episode on that issue.

> 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

Agree. OK, I see the circularity here. So the Encountlet
definition might need to be moved way down here.

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