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Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES

From: James Busser
Subject: Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES)
Date: Sat, 23 Aug 2008 20:31:33 -0700

following on from

If a user were to wish to create habits entries (likewise family history entries) for more than one habit or more than one family history concern, the options that seem currently available would be:

1. --- If the special "placeholder" health issue that is Unattributed will permit >1 episode to keep the status "open" (Karsten?) --- then each attribute of interest (smoker, problem drinker of alcohol, unhealthy diet, family history of each of breast cancer, colon cancer, premature cardiac disease) could be nicely listed within this branch of the EMR tree. In order to keep the components clustered together, users could prepend a space or a hyphen or other character, and could use an additional naming convention to include "habit:" or "fam hx:" within the episode name:

EMR of patient ...
        Unattributed episodes
                fam hx: breast ca
                fam hx: colon ca
                fam hx: premature coronary disease
                habit: problem drinking
                habit: smoking
                        encounter 1
                        encounter 2
                habit: unhealthy diet

A further advantage is among Unattributed episodes is that upon their closure (say, a patient has quit smoking for sufficiently long to be convincing) it would automatically disappear from the problem list. Until such a time, it would remain visible it the problem list except at times that the tree was fully closed. An additional advantage to managing such _potential_ issues is that they could be associated / attributed at a later time. For example if a patient should later prove to have developed breast cancer it could be chosen to attribute the family history under the health issue of breast cancer. I know... the issue of breast cancer did not cause the family history...

If a patient had quit smoking and the clinician closed the Unattributed episode "smoking", does the schema prevent the episode being re-opened if it should later prove that the patient is again smoking?

2. (alternative approach) make each one its own health issue.

        issue "smoking"
        issue "alcohol intake"
        issue "exercise"
        issue "diet"

        issue "habit: smoking"
        issue "habit: alcohol intake"
        issue "habit: exercise"
        issue "habit: diet"

        issue "fam hx: breast cancer"

I suppose the decision could be whether or not the smoking / alcohol / diet have contributed to clinical problems in which case the importance of attacking the risks becomes more, and maybe at that point they warrant to be issues of their own right.

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