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

From: Karsten Hilbert
Subject: Re: fields in health issues (was Re: [Gnumed-devel] NEW TOPIC - FEATURES)
Date: Sun, 24 Aug 2008 12:20:02 +0200
User-agent: Mutt/1.5.18 (2008-05-17)

On Sat, Aug 23, 2008 at 08:31:33PM -0700, Jim Busser wrote:

> 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

Very sane advice.

> 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.  
Correct. But beware, the tree is not the problem list. There
is a TODO item to make the tree optionally behave like a
problem list but currently it displays all issues and
episodes. It informs of the entirety of the EMR.

> 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.
This is how it is intended to work :-)

> 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...
The association isn't strictly documenting causation, just
"relation" between things of lower and higher order.

> 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?

It can surely be re-opened. There can even be a second
episode of the same name. For attributed episodes only one
can be open while for unattributed even two of the same name
can be open -- I guess this should be fixed.

> 2. (alternative approach) make each one its own health issue.
>       issue "smoking"
>       issue "alcohol intake"
>       issue "exercise"
>       issue "diet"
> or
>       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.

Personally, I would create health issues "habits" and "fam
hx" and create appropriate episodes thereunder:

issue "habits"
 episode "smoking"
 episode "exercise"

issue "fam hx"
 episode "breast cancer"

Episodes already attributed to one of the issues "habits" or
"fam hx" can later be re-attributed to other issues as

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